Gastrointestinal disease 2 Flashcards
What is Diverticular Disease?
A protrusion through the muscular wall of the colon to form a small sac/ pouch
Caused by a weak area of bowel wall
Often asymptomatic, diverticulitis occurs when sacs are infected and inflamed
Approximately half of people over 50 will have some of these sac pouches, and over 85 will occur in 80%
Symptoms:
- abdominal pain
- bloating
- diarrhoea
- constipation
- mucus in stools
- temperature
Causes:
- Some medication
- IBS –> constipation causing pressure
- Low fibre diet –> leads to constipation
- Inadequate fluid intake
What is the treatment of diverticular disease?
CT scan or colonoscopy to diagnose
High fibre diet with adequate fluid to prevent diverticular disease
May need a fluid only or low fibre diet to rest the bowel until symptoms improve and then gradually increase back to normal fibre intake
What is Crohn’s Disease?
A type of inflammatory bowel disease that affects any part of the GI tract from mouth to anus, but frequently the terminal ileum.
Cause unclear –> environmental, genetic?
Increased risk with smoking
Characterised by distinct patches of inflammation with granulomas, deep fissures and ulceration.
Strictures of bowel wall may occur and perforation leading to infection or fistula –> abnormal channel connecting one organ to another
A condition that can relapse and go into remission
What are the symptoms of Crohn’s Disease?
How is it diagnosed?
Symptoms:
- Abdominal pain
- Diarrhoea, sometimes with blood and mucus
- Weight loss –> reduced intake due to post prandial pain, food phobia
- Tiredness
- Anaemia –> malabsorption of iron, B12, folate, could be reduced intake
- Ulcers
Diagnosis:
- Blood tests –> ESR, CRP (acute phase protein produced in the liver) - inflammatory markers
- Barium studies –> x-ray areas of inflammation
- Endoscopy
- Histology
Disease severity scores used in hospitals –> Harvey and Bradshaw index
- wellbeing score
- pain score
- stool score
- complications present
What is the medical management of Crohn’s Disease?
- Anti-inflammatory drugs such as oral corticosteroids e.g. Prednisolone
- Antibiotics such as metronidazole, to control bacterial overgrowth
- Immunosuppressants
- Surgery may be required
- Diet can be an effective treatment for Crohn’s
What is the dietary management of Crohn’s disease?
- Correction of nutritional deficiencies
- Dehydration correction caused by diarrhoea
- High energy nutritional supplement especially in children where growth is a concern
- Low residue diet for symptom management –> low in fibre, gentle and easily digested food, soft foods
- Consider ‘triggers’/ intolerances –> alcohol, caffeine
- Lactose intolerance may develop
- Food fortification +/- oral nutritional support –> can be found to be easy to digest
- With poor appetite, small frequent meals
- Assess food phobias
How can diet be used a primary treatment of Crohn’s disease?
Enteral feeding (elemental/ peptide) followed by exclusion/ elimination diet can achieve remission.
LOFFLEX diet –> Low fat fibre limited exclusion diet
What is Ulcerative Colitis?
A type of inflammatory bowel disease affecting the mucosa of large bowel, causing bloody diarrhoea.
Severity depends on frequency of bowel motions and presence of symptoms such as fever, anaemia or toxic megacolon
Complications include perforation of the colon, cancer and systemic problems such as arthritis, liver and biliary problems.
What is the medical management of UC?
Medical treatment with corticosteroids or an immunosuppressant –> e.g. Azothioprine
Surgery indicated in severe cases
- total colectomy with ileostomy or ileorectal pouch construction
What is the dietary treatment/ management of UC?
- Correction of dehydration –> fluid and electrolytes
- Some people may not tolerate foods with skins, pip or husks
- Consider low fibre diet for symptom management
- Fibre to tolerance in remission to prevent constipation
- Food fortification +/- oral nutritional support
- Vitamin and mineral loses, especially iron need replacing if the person is deficient
- If appetite is poor, small frequent meals
What are some common nutritional deficiencies in patients with IBD?
Causes?
Dietary energy
- Poor appetite as a result of symptoms or drug side effects
- Malabsorption
- Catabolic effects of chronic inflammation
Protein
- Increased nitrogen loses
- High requirements for tissue repair
Vitamin D and K
- Bile salt deficiency
Iron
- Poor intake
- Poor absorption
- Chronic blood loss (UC more common)
Folate
- Impaired absorption
- Use of Sulphasalazine
Vitamin C
- Low consumption of fruit and vegetables
Vitamin B12
- Ileal resection
- Small bowel overgrowth
Calcium
- Corticosteroid use
- Malabsorption and chronic diarrhoea
- Avoidance of dairy foods
Magnesium and zinc
- Malabsorption and chronic diarrhoea
- Short bowel syndrome
Sodium and potassium
- Avoidance of dairy foods
- Persistant diarrhoea and vomiting
What is the surgical interventions in the small bowel?
Minor resections –> gut adaption
Major resections –> short bowel syndrome (small bowel <200cm)
Discuss colorectal cancer
Associated with low fibre diet, high intake of red meat and smoking
Strong genetic predisposition
Presents with change in bowel habits, rectal bleeding, abdominal pain and weight loss
Treated with surgery and chemotherapy
Survival rate is relatively poor
What is the surgical intervention of resection of the large intestine?
Pouch can be created by joining segment of ileum to anus
Ileostomy or colostomy
What is the dietary management of ileostomy or pouch?
- Regular meal pattern, small frequent meals
- Fluid replacement
- Varied diet as tolerated
- Don’t rush meals
- Avoid eating late at night
- Only avoid foods known to cause wind, odours or poor stool consistency
