Module 9 - GI Issues in Athletes Flashcards
How many runners experience Gastrointestinal Distress?
- 30-90% of runners
What are the symptoms of Gastrointestinal Distress?
- Heartburn
- Nausea
- Vomiting
- Abdominal Cramping
- Bloody Diarrhoea
What is the GI tract divided into?
- Upper GI tract
- Lower GI tract
What is the beginning and end of the upper GI tract?
Begins
- Mouth
Ends
- Ileum
What is the beginning and end of the lower GI tract?
Begins
- Cecum
Ends
- Anus
How many parts make up the GI tract?
- 11
What part of the GI tract breaks down food and prepares it for ingestion?
- Mouth
- Salivary Glands
What does the Esophagus do?
- Transports food to stomach
How does food travel down the esophagus?
- Peristalsis
Describe the Stomach
- Hollow Organ
What does the Stomach do?
- Stores food while its being processed
- Food is broken down
What causes the food to be broken down in the stomach?
- A series of enzymatic and chemical reactions
What does the liver do in the GI tract?
- PRocesses nutrients absorbed from SI
- Produces Bile
- Major role in detoxification
What does bile do?
- Breaks down fat
What does the pancreas do in the GI tract?
- Secretes digestive enzymes into duodenum
- Secretes Insulin into blood stream
What do the enzymes excreted by the pancreas do?
- break down fat, carbohydrates, and protein
What does the gallbladder do in the GI tract?
- Stores and concentrates bile
- Releases it for fat digestion
Describe the structure of the Small intestine?
- Approx 7m long
- Composed of 3 parts
What 3 parts make of the small intestine? (in order)
- Duodenum
- Jejunum
- Ilium
What happens in the Small Intestine of the GI tract?
- Water, bile (liver), and enzymes (pancreas) are added to the food bolus
- nutrient absorption
Describe the Structure of the Large intestine?
- 5 Parts
- Approx 2m long
What are the 5 parts of the large intestine? (in order)
- Cecum
- Ascending Colon
- Transverse Colon
- Descending Colon
- Sigmoid Colon
What happens in the LArge Intestine of the GI tract?
- Waste Product remains
- Water is absorbed
What is mostly absorbed from waste when it reaches the large intestine?
- Most nutrients
What is the Appendix? What is its function?
- 4 inch pouch shape
- Function unclear
Describe the Rectum
- Approx. 20cm
What does the Rectum do?
- connects the colon and anus
- Holds waste until evacuation
Describe the Anus
- Final Part of GI Tract
- Approx 5cm
What does the Anus do?
- Release waste
How is waste held in the GI tract until excretion?
- A series of sphincters
- Pelvic floor muscles
What is it called when waste is held?
- Continence
What happens to the GI tract during exercise?
Blood is Directed to Working Muscles away from GI tract
- GI tract becomes ischaemic
- GI distress may also be induced
Why might GI distress occur from exercise?
- Aggressive diaphragm movement
- Abdominal contractions
- Intestinal Jarring
- Intestinal Bleeding
How does exercise affect the gut?
- Splanchnic Hypoperfusion
- Motility
- Possible Increased Intestinal Permeability and Exercise
What does Splanchnic Hypoperfusion of the Gut during exercise entail?
- Reduced blood flow to the gut: splanchnic vasoconstriction
- Steal of blood flow to exercising muscles
What happens to the motility of the gut due to exercise?
- Reduced esophageal motility and pyloric sphincter tone
- Reduced gastric emptying during severe exercise
What are the differing mechanical factors that impact the GI Tract?
- high-impact exercise
- Runners: pounding
- Cyclists: Positioning
What can the pounding of running do to the GI tract?
Cause Lower GI Tract Issues:
- Flatulence
- Diarrhoea
- Urgency
What can the positioning of cycling do to the GI tract?
Cause Upper GI issues
- Pressure on the abdomen
- Horizontal Esophagus
What are some nutritional causes for GI Issues?
- Fibre
- Fat
- Protein
- Carbohydrates, especially Fructose
- Beverages with high osmolalities (>500 mOsm/L)
- Delay Gastric Emptying
What are some nutritional solutions to GI issues?
- Mix of glucose/fructose better than single sugar alone
- Or Maltodextrin/Fructose
What is the recommendation for nutrition with GI Issues?
- Individual Variations
- Regular Fiber Intake
- Stay Hydrated
- Avoid Trigger Foods
What is the recommendation for managing individual variation for GI Issues and Nutrition?
- Athletes keep track of trigger food
- Dont introduce new food before a competition
- Time meals appropriately
- Inadequate pre-event feeding can also cause issues
Should you have fiber right before intense exercise?
- NO
When should you experiment with new food?
- before competition
What does NSAID stand for?
Non-steroidal anti-inflammatory drug
When do athletes use NSAIDs?
- Prior and during sport for pain relief
What are some examples of NSAIDs?
- Advil (ibuprofen)
- Aleve (naproxen sodium)
- Bayer (aspirin)
What are NSAIDs associated with in regards to the GI tract?
- Upper GI Issues: 3-5x risk
What is unique about advil’s effect on the GI tract?
- increase risk for intestine bleeding during exercise: especially when taken prophylactically
Where are GI Issues mostly seen with NSAIDs?
- Esophagus
- Stomach
- Duodenum
Where are GI Issues rarely seen with NSAIDs?
- Small Intestine
Where are GI Issues uncommonly seen with NSAIDs?
- Large Intestine
What can NSAIDs do to the esophagus?
- reflux
- Upper GI bleeding
What can NSAIDs do to the stomach and duodenum?
- Gastritis
- Upper GI bleeding
- Perforation
What, while rarely, do NSAIDs do to the small intestine?
- Increase permeability
What, while uncommon, can NSAIDs do to the large intestine?
- Increase Permeability
- Lower GI Bleeding
What are some Upper GI TRact Issues that NSAIDs can cause?
- Heartburn
- Reflux
- Nausea
- Vomiting
- Bloating
- Epigastric Pain
What is GERD?
- Gastroesophageal Reflux Disease
What is the likely causes of GERD?
Decrease
- esophageal peristaltic activity
- lower esophageal sphincter tone
Increase
- Transient lower sphincter relaxation
What are some non-exercise causes of GERD?
- Smoking
- Obesity
- Pregnancy
- Overeating
What are some trigger foods for GERD?
- High fat foods
- chocolate
- onions
- coffee
- tea
- alcohol
- tomatoes
- cheese
- juice
- ## carbonated bevies
What should an athlete do if they start experiencing GERD?
- start keeping a food log to track symptoms and identify trigger foods
Describe the relationship between GERD and athletes
- Exercise is a common cause
- May mimic symptoms of EILO
- the mechanism by which GERD occurs during exercise is not well understood
What symptoms of GERD should be addressed immediately?
- Chest pain: eliminate other causes
What are the symptoms of GERD?
- Heartburn
- Reflux
- Epigastric Pain
What is the treatment for GERD?
- Antacid Medication (Tums, Rolaids)
- Histamine Blocking Drugs
What is a suggested preventative method for GERD?
- No solid foods before training/competition
What are some Lower GI Tract Issues from Exercise?
- Cramping
- Urge to defecate
- Diarrhea
- Rectal Bleeding
- Flatulence
What is the ‘stitch’?
- Sharp pain in UL or UR quadrant during exercise
What are the mechanisms of the ‘Stitch’?
Unclear
- likely spasm of diaphragm or gas trapped in colon
What is a suggestion for preventing the ‘stitch’?
- Avoid solid food prior to exercise
What is runners diarrhoea also known as?
- Runner’s Trots
Describe Runner’s Trots
- Diarrhoea while running
- Frequency increases with intensity and duration of exercise
- More prevalent in competition than in practice
Why might runner’s trots be more frequent during the competition than training?
- Anxiety
What seems to be linked with runners’ diarrhea?
- Anxiety
- Caffein
- Artificial Sweeteners
What are the causes of runners diarrhoea?
Unclear
- ischemia
- Increased motility
What is the treatment for runners diarrhoea?
- Individualized
- Try to isolate the specific causes for the athlete
What is suggested to limit risk of runners diarrhea?
- Reduce fiber consumption 24hr prior competition
- Avoid trigger foods
- Anti-diarrheals may be used occasionally
What is suggested if there is persistent or long-term diarrhea?
- Investigate it further
What might runners find in their stool following endurance events?
- Blood in stool
Why might runners find blood in their stool following endurance events?
Unclear: Likely
- lack of blood flow
- Dehydration
- Mechanical jarring
What may recurrent bleeding do to an athlete?
- risk of iron-deficiency anaemia
What is the treatment for rectal bleeding following endurance events?
- Assure proper hydration
- Reduce mechanical jarring
- change technique/shoes/surface
What is unexplained GI bleeding a cause for?
- Medical Intervention
What is Irritable Bowel Syndrome (IBS)?
- Common non-malignant condition of the colon
What are the symptoms of IBS?
- Cramping
- Abdominal Pain
- Bloating
- Constipation
- Diarrhoea
What is FODMAPS?
Short Chain Carbohydrates
What does FODMAPS stand for?
- Fermentable Oligosaccharides
- Disaccharides
- Monosaccharides
- And Polyols
What is the pre-event protocol for avoiding GI Issues?
- Don’t experiment during an event
- Reduce: fiber, caffeine, and specific intolerance
- Train in similar environment (heat/cold)
What should you be cautious with during the event to avoid GI Issues?
- Caffeine and other Stimulants
- Fiber
- Simple Sugars (fructose)
- Specific Intolerances: lactose, gluten
- Dehydration
- NSAIDs
What is Infectious Diarrhoea?
- Not the same as exercise-induced diarrhoea
What is Traveler’s Diarrhea caused by?
- Bacteria: e.g. salmonella, E. Coli
- Virus: Norovirus or Rotavirus
- Parasites: Giardia, Cyclospora
What is the most common cause of traveler’s diarrhoea?
- Bacteria
What is traveler’s diarrhea associated with?
- Frequent bowel movements
- Potential fever
- potentially bloody stool
What is the general treatment for traveler’s diarrhea?
- Hydration
- Track Weight
- Restricted Diet
- Clear Fluids
- Gradual Progression back to normal diet
What is the BRAT diet?
- Bananas
- Rice
- Apples/apple sauce
- Tea/toast
What is another treatment for traveler’s diarrhea?
- anti-diarrheal medication: imodium
What does Imodium do?
- Slows gut motility
- Reduces frequency of stool
What should you know about Imodium?
- NOT A CURE
- does not treat infection
- Used when limited access to a toilet
What is Protozoal Diarrhea?
Type of Traveler’s Diarrhea
What percentage of traveler’s diarrhea is due to protozoa/parasites?
- 5-10%
How is Protozoa Diarrhea acquired?
- Unclean drinking water
- Person-to-person contact
What are frequent symptoms of protozoa diarrhea?
- Diarrhea: initially watery
- Malaise: discomfort
- Foul-smelling and fatty stool
- Abdominal Cramps/bloating
- Flatulence
- Nausea
- Weight loss
- Vomiting
What are some examples of parasites that can cause protozoa diarrhea?
- Giardia
- Cyclospora
What is the treatment protocol for Protozoa Diarrhea?
- Supportive Care: Hydration and Rest
- Antiprotozoal Medication: prescription
What is the difference between bacterial and protozoa diarrhea?
Bacterial
- sudden
- uncomfortable diarrhoea
Protozoa
- Gradual
- Tolerable diarrhea
Where does much of the risk occur for bacterial traveler’s diarrhea?
- Restaurant
What is the suggestion for prevention of bacterial traveler’s diarrhea?
- Boil
- Peel
- Cook
What are some food recommendations to avoid traveler’s diarrhea?
- Avoid ice
- Alcohol does not sterilize water
- Carbonation is good when bottle opened
- Avoid Fruit salads, lettuce, chicken salads
- condiments usually bad
- steam table buffets bad
What are some water recommnedations to avoid traveler’s diarrhea?
- Boil 3 minutes, then let cool
- No ice
What can you add to water to kill bacteria?
- 5% sodium hypochlorite (bleach)
- Tincture of Idoine
How much sodium hypochlorite should you add to water to kill bacteria?
- 2 drops to a quart
How much tincture of iodine should you add to water to kill bacteria?
- 5 drops to a quart
How long does it take sodium hypochlorite or tincture of iodine to kill bacteria in water?
- about 30 minutes
What is the pharmaceutical treatment/prevention for traveler’s diarrhea?
- Antibacterial
- Dukoral Vaccine
What are antibacterials effective/not effective for treating?
Effective
- bacterial traveler’s diarrhea
Not Effective
- Viral Diarrhea
What is the Dukoral Vaccine Used for?
Prevention
- Cholera
- E. Coli
What is Viral Gastroenteritis?
“Stomach Flu” - not the same as influenza
- Spreads Rapidly
What are some types of Viral Gastroenteritis?
- Norwalk (norovirus)
- Rotavirus
What is the treatment for Viral Gastroenteritis?
- Oral Rehydration
- Symptomatic
How do you get Norovirus?
- Providing Care
- Changing Diapers
- Shaking Hands
- Touching Contaminated Surfaces
- All of above: then touch mouth
What are the symptoms of Viral Gastroenteritis?
Inflammation of Stomach/Intestines
- Stomach Pain
- Nausea
- Diarrhea
- Vomiting
What are some less common symptoms of Viral Gastroenteritis?
- Body Aches
- Headaches
- Fever
What is key for athletes with viral gastroenteritis?
- Early Diagnosis
- Rapid Isolation
What should you do when an athlete has viral gastroenteritis?
Isolate
- Hand-washing
- Barriers
- Disinfection with chlorine
Is there a vaccine for norovirus?
- NO
When should a physician be involved for an athlete with viral gastroenteritis?
- 24HRs: unable to keep liquid down
- Vomiting more than 2 days
- Blood in Vomit
- Severe Dehydration
- Blood in the Bowel
- Fever above (40C)
