Lower GI Diseases Flashcards
describe 3 phases of dumping syndrome.
Early: 10-15min pm. High CHO foods. Too much blood to SI=high HR, faint, sweat
Intermediate: 20-60min pm. CHO ferment in colon=abd bloat/cramp, gassy, diarrhea
Late: 1-3 hr pm. Reactive hypoglycemia from too much insulin to respond to high CHO diet=sweat, shake, hunger.
MNT tips for Dumping Syndrome.
Liquids between meals Less simple CHO and more complex CHO 20% protein MCT with steatorrhea 5-6 small meals Slow, well chew meals Lay down after meals
What is at high risk with removal of ileum?
Fat malabsorption b/c it absorbs bike salts. Also B12 deficiency and fat sol vits.
What is at risk with removal of colon (mainly)?
Dehydration and low electrolytes/Vit K.
What is dumping syndrome and when is it common?
Too much food or liquid passes pyloric sphincter into the duodenum. Happens after gastric surgery.
Define Diarrhea.
It is a symptom.
SI or LI is irritated and fecal matter moves too rapidly thru intestine.
WHO= equal or more than 3 liquid stools per day
What are 2 types of diarrhea (based on the length of it)?
Acute:2-3 days (bad for infants and old)
Persistent:>14 days. Bad for dehydration, mucosa changes and malnutrition.
3 main types of diarrhea?
Secretory
Osmotic
Anti-biotic associated (AAD)
What is secretory diarrhea?
From eating bacteria or toxins(food poison or Cholera)
Fasting does NOT stop the diarrhea.
Dehydration and losing electrolytes.
What is osmotic diarrhea?
Eat too many osmotically active solutes (theophylline in TPN, grape jc, sports drinks)
Too much fluid rushes to GI.
Consumption is irritant so fasting relieves.
What are some med classes that could cause diarrhea?
H2 receptor agonists, PPI, antibiotics, NSAIDS, Na and beta blocker drugs, metformin, etc
What is AAD?
Microflora disturbed so C. Diff can colonize. NAP1 is most common strain. Spread with fecal-oral contact.
What is CDI? What is CDAD?
C diff infection and C diff associated diarrhea.
What meds used to treat CDAD?
metronidazole (Flagyl)
What puts you at risk for c. Diff?
Hospital stays, older than 65, really ill, NG usage. Need to wash hands and not overuse antibiotics.
What are main Tx for diarrhea?
Treat the cause first!
Use ORT to correct electrolytes/acid-base, anti-motility drugs, BRAT diet, pre/probiotic use, fecal transplant.
What are key components of ORT?
Glc, KCl, NaCl, Na3Citrate
What is the Brat diet and why is it used?
Banana, white rice, applesauce, toast.
Rice is binding. Refined easy on stomach.
What are probiotics? Prebiotics?
Live bacteria that are eaten and improve microbial colon balance.
Foods that are eaten and stimulate the growth of colon bacteria. (Fructans, resistant starch)
What are good sources of probiotics?
Yogurt, kefir, tempeh, miso, kimchi
What is constipation?
Symptom. Hard, infrequent stools. Feel incomplete BM and strain.
MNT for constipation.
Check for obstructions, motility probs and tumors first. High fiber diet Exercise -moderate Enough fluids (2-3L/day) Eat prunes, grapefruit, natural licorice
What is a ‘high fiber diet’?
6-10g above recs.
Women AI: 21-28g/d, men: 30-38g/d
5 high fiber foods we agree to know
Raspberries 1 cup, 8 grams WW spaghetti 1 cup, 6.3 grams Instant Oatmeal 1 cup, 4 grams Black Beans 1 cup, 15 grams Brussel sprouts 1 cup, 4.1 grams
Soluble fibers role and examples
Dissolves in water and speeds transit time
Beans, oat bran, fruits and veg
Examples of insoluble fiber.
No dissolving in water
Whole grains, vegetables, beans
What is high, good source, and added fiber mean?
5g+
2.5 to 4.9g +
At least 2.5g added to
Reference food
3 hidden constipation causes
Rice milk
Megadose of Vit C (UL is 2g and dose is 10-15g)
Calcium or Iron supp doses
100% WG stamp versus basic stamp.
Need 3 servings of 100% stamp or 6 servings of basic stamp.
What are some laxative examples?
Bulk- Metamucil
Stool softeners- Colace or Surfak
Stimulant- Dulcolax
Hydrating (saline)- milk of magnesia
What is Cholera?
Vibrio Cholera bacteria. Contaminates food and water.
Need antibiotics, ORT, fluids
What is malabsorption and some causes?
Inadequate absorption of nutrients from GI.
GI or gastric surgery, pancreatic or hectic probs (less bike so not fat abs), infection
What is the biggest clinical sign and others of malabsorption?
Steatorrhea
Gas, constipation, diarrhea, abd distension, FTT, wt loss, malaise, edema, hunger
What are monosaccharides?
Disaccharides?
Galactose, glucose, and fructose
Sucrose, lactose, maltose
What is the most common CHO malabsorption?
Lactose intolerance but fructose is growing.
Undigested lactose is fermented by colon 30min-2hr pm.
Osmotic diarrhea, bloat, cramp
Where are dietary CHO mostly broken down?
Jejunum
What is involved in CHO digestion and absorption?
Salivary and pancreatic amylase
Disaccharidases break di to mono in brush border
SGLT (active) moves Galac and Glu into epith
GLUT5 (passive facilitated) moves fructose
All exit epith by GLUT2 at bottom of cell. Enter blood stream with simple diffusion.
MNT for lactose intolerance.
Add milk back 1/2 cup at one time Drink it with other foods Pretreat with lactase Greek and active culture yogurt Other milks or Ca and D supps
What is a low lactose diet? What are some low lactose foods?
Less than 10g/day
Cottage cheese and cheese and butter. Ice cream and yogurt are medium.
What is the Dx test for lactose intolerance?
LTT- Lactose Tolerance Test
50g of lactose dose (milk has 11g per glass)
Measure the expired H2
What are foods with good sources of available calcium?
Sardines, canned salmon, tofu, dry beans, brassica family, almonds, blackstrap molasses.
(Spinach has binding oxalates)
What food chemical inhibits Ca absorption?
Oxalic acids in rhubarb, spinach, sweet potatoes. Physic acid (minimally)
Why is vitamin D status important?
It helps up regulate Ca receptors so Ca can be absorbed.
MNT for fructose malabsorption?
Limit fruit to 3 1/2 serve per day
Limit excess amounts (pop, syrups)
Limit wheat to 3-1oz serv per day
Limit onion, leek, garlic, asparagus, honey, agave
Fruits high in fructose?
Fruits low in fructose?
Apple, pear, plum, apricot, watermelon, peach, honeydew
Low: berries, citrus, banana, kiwi, pineapple
What is steatorrhea?
Symptom!
Unabsorbed fat in stool.
Around 60g left in stool (normal 2-6g)
What are some causes of steatorrhea?
Biliary probs: hepatic (less bile made), blockage (less secretion), or ileal resection (less reabsorbed).
Pancreatic: less lipases made
Mucosal damage
Less CM transport
What are risks to specific fat soluble deficiencies with steatorrhea?
A- night blind, skin, hyperkeratosis
D- low Ca status, soap formation in GI, osteomalacia
K- longer blood clotting
E- neuropathy, hemolytic anemia
MNT for steatorrhea?
Fat restricted diet of 50g per day (6oz meat and 3-5 fat eq) -OR-
25g per day (5oz meat and 1 fat eq per day)
What are MCT’s? What is a downfall?
6-12c long, 8.3 kcal/g, synthetic or found in coconut.
Doesn’t need Micelle or pancreatic lipase nor bile.
It doesn’t provide essential FA (18:2-6 or 18:2-3)
What are the differences between an ileostomy and Colostomy?
I- remove colon. Bring ileum out of ab wall for new opening
C- open colon and bring it out through abdominal wall.
What is IBD and what are the 2 types?
Inflammatory Bowel Disease
Crohn’s and ulcerative colitis.
What is the diet transition during an ostomy procedure?
NPO and oral feel POD-1
Clear liquid, full, low fiber and residue (4-6 feed/day), general diet at week 8
What are the main problems with ostomies?
Water and electrolyte: no colon to reabsorbed water. Hot weather and exercise!
Mech Blockage: high fiber foods might block stoma (corn, popcorn, nuts, coleslaw, bamboo, F/V)
Odor and Gas: avoid sulfur foods, beans, fizzy, choc, straws, gum)
High effluent volume: inconvenient
What foods should be avoided to decrease effluent volume?
Beans, broccoli, spinach, prune jc, licorice, red wine, beer, and spicy food.
What foods decrease effluent output volume?
Applesauce, bananas, boiled milk, rice, PB
Is there more effluent with a colostomy or ileostomy?
Ileostomy because there is no colon so a lot of water and bulk is not reabsorbed.
