GI 3 Flashcards
Common prebiotics
Oligofructose Inulin Galacto-oligosaccharides Lactulose Breast milk oligosaccharides
recommendations for high output ostomy
High Output: more than 1 litre (4 cups) per day
Add 1-2 extra litres (4-8 cups) of fluid each day. Good choices are: water, milk or milk alternatives, diluted 100% fruit juices, herbal or weak tea
Add 5 mL (1 tsp) of salt throughout the day. You can do this by sprinkling salt on your food and choosing saltier items such as canned soups or crackers.
Include potassium rich foods such as bananas, diluted orange juice, potatoes, tomato juice, milk and milk alternatives.
Do not restrict your fluids to control a high ostomy output. This could lead to dehydration or worsen existing dehydration.S
peak to your doctor or dietitian if you continue to have a high stool output. They may recommend an oral rehydration drink or have other dietary suggestions
what does gut microbiota play a role in?
• energy balance
• resistance to pathogen colonization
• maturation of intestinal and immune
systems
What can gut microbiota be altered by?
- medications
- physiological and psychological stress
- diet
- exercise
prebiotic vs probiotic
Probiotic- bacteria
• Living strains of bacteria that add to
the population of good bacteria in your digestive system when administered in adequate amounts.
Prebiotic- fiber
• Fibres that feed the good bacteria.
This stimulates growth among the preexisting good bacteria
benefit and mechanism of prebiotics
prebiotics get fermented by bacteria to SFA that serve as fuel for the gut and can help maintain the tight junctions this can help down-regulate the inflammation process
impact of gut microbial dysbiosis
gut microbial dysbiosis occurs when harmful bacteria dominates over beneficial bacteria
results in
- increased gut permebaility
- endotoxemia; septicemia
- diarrhea, IBS, IBD, diabetes, obesity, liver disease, CVD
is yoghurt a prebiotic?
no
Types of bleeding in stool
- Frank blood: bright red and on the surface of stool - represents anus or rectum bleeding; blood coming from anus or rectum e.g. in haemorrhoids
- Occult: detected by testing and results from bleeding in lower GI
- Melena: dark stool and results from upper GI bleeding
NELMS definition of diarrhea
increase in frequency of bowel movements and/or increase in water content of stools
• Affects consistency or volume
• >200 g/day adults, >20 g/kg
for children
Acute vs chronic diarrhea
Acute:
- <2 weeks
- increase in frequency of bowel movements and/or increase in water content of stools
Chronic:
- > 4 weeks
- no pain
- loose or watery stools
- loose stools occur 25% of the time
- criteria fulfilled for the last 3 months, with symptoms onset at least 6mo prior to diagnosis
- patients meeting the criteria for IBS should be excluded
osmotic vs secretory diarrhea
Osmotic
- increased water efflux due to an increase in osmolality
- Increased osmolality in intense, body responds by pulling water into lumen
- Caused by: maldigestion (e.g., lactose), excessive sorbitol (e.g., sugar free candies) or fructose (e.g., ++juice), laxative use
- Resolves when NPO/ eliminate offending food
Secretory- underlying disease causes excess secretions (not hyperosmolarity)
• Does not resolve when NPO
• Bacterial, protozoa, viruses
• Traveler’s diarrhea
• Medications
• Antibiotic-related
- Increase GI motility or alter flora of colon E.g., Clostridium difficile (C.diff) major cause of antibiotic-related diarrhea
• Symptom of a GI disease: Crohn’s, UC, celiac, tumor
• AIDS enteropathy, thyroid dysfunction
Concerns with diarrhea
Concerns: dehydration, electrolyte imbalance, acid-base imbalance, malabsorption, malnutrition, weight loss
Jim notices that he gets diarrhea every time he drinks milk. What type of diarrhea is this?
A. Osmotic B. Secretory
A
Diarrhea- Medical Diagnosis components
- Diagnose underlying etiology
- Recurrence of episodes related to time of day and food intake E.g.,lactose intolerance
- Rule out inflammatory process: IBD, Celiac • Stool cultures – parasites, WBCs
- Procedures such as endoscopy
Diarrhea- Treatment goals
Restore fluid, electrolyte, and acid-base balance; decrease GI motility; thicken consistency of stool; repopulate GI with normal flora; introduce foods that do not aggravate symptoms
Diarrhea treatment components
• Treat underlying disease
• Antibiotics if infectious
• Restore fluid, electrolyte, acid-
base balance; IV therapy, rehydration solutions
• Medications to treat symptoms (e.g., Imodium)- slows down transit time
• Suggest prevention strategies E.g., hygiene education, clean water, wash fruit and veg
which acid-base disturbance is associated with diarrhea?
a. Respiratory alkalosis
b. Respiratory acidosis
c. Metabolic alkalosis
d. Metabolic acidosis
d. Metabolic acidosis
someone with diarrhea might become acidotic as they are loosing bicarb-> acidosis
Diarrhea- Nutrition diagnosis
E.g.,“inadequate fluid/ energy intake” or “altered GI function”
Diarrhea- nutrition intervention
• NPO or clear liquids (e.g., juice) – OLD recommendation juice usually makes diarrhea worse (sugar is hyperosmolar)
• Oral rehydration solutions should be taken instead, if patient can take PO e.g.Pedialyte, Rehydrlyte, Gastrolyteetc.
• Decrease motility: limit/avoid simple CHO, sugar alcohols, caffeine, alcohol
• Avoid gas-producing foods (e.g., cruciferous veg, legumes)
• Encourage low-residue foods
-> no bulk and easily digested
• BRAT (banana, rice applesauce, toast) can be used for short period-> source of soluble fiber (helps with viscosity), usually well tolerated
• Use of soluble fibre
• Pectin, banana flakes, applesauce, rice
• Pro and prebiotics – know what to look for! One size does not fit all.
Components of low residue diet
Low residue diet = minimize foods that contribute bulk to stool • Low insoluble fibre • Moderate fat - Diary - Meats - Limit fats to 8 tsp/d
low residue diet reccs
Milk and Milk products: recommended and not recommended
notes
recommended: Buttermilk, Skim milk, Soy milk, Low-fat and aged cheese
not recommended: Whole milk, cream, yogurt with berries + dried fruits +nuts
notes: If lactose intolerant, try lactose free products
proteins in low residue diet
recommended:
not recommended:
notes:
recommended: Tender, well cooked meat, pork, poultry, fish, eggs or soy without added fats
not recommended: Fried, salami, bologna, sausage, bacon, hot dogs, fatty meats
