Nutrition and diet in the management of GI disease in adults Flashcards
What are the two types of IBD
Crohn’s and Ulcerative colitis
What are the clinical features of Crohn’s
Abdo pain
Diarrhoea
Anorexia and weight loss
malaise and fever
What are the clinical features of Ulcerative colitis
Bloody diarrhoea
Colicky abdominal pain
Urgency
What is the main difference between ulcerative colitis and crohn’s
Crohn’s affects the whole of the GI system
Ulcerative colitis affects the large bowel only
What are the nutritional considerations in IBD
Nutrients in pathogenesis
Management of malnutrition
Nutrition as therapy
What is thought to lead to a micro flora change in the gut
Relation to refined western diet (sugar and fats)
What can contribute to Crohn’s disease greatly?
Smoking
What has a protective role for Crohn’s and UC
Fruit and fibre
What two nutrients in pathogenesis are associated with IBD
Lack of breast feeding
Hypersensitivity to cow’s milk
Why does the protein-energy malnutrition occur?
Malabsorption
Increased requirements
Poor dietary intake
What are IBD standards
Tailoring nutritional advice to the specific patient
Who is involved in the IBD team
Gastroenterologists Surgeons (not always) Clinical nurse specialists Dietitian Pharmacist Pathologist GI radiologist
What is involved in the Dietetic assessment
MUST assessment frequency of bowel movements Investigations (what is affected/ likelihood of surgery) medications (number of days) Detailed dietary history (observation)
What food should be avoided
High fibre foods Fatty foods Lactose Spices or other things that cause that specific patient problems Alcohol Vitamin / mineral supplements
What foods are encouraged
Calcium, vitamin D, other fat soluble vitamins, zinc, iron and vitamin B12
Serum vitamin B12 is best measure annually
IV iron replacement
What are the therapeutic options in the management of IBD
Nutritional therapy - exclusive enteral nutrition
Liquid feeding 6-8 weeks
Either oral or via NG tube may avoid adverse effect of steroids most often used in conjuction
What foods do we start to reintroduce
Low fibre, fat limited
Carbohydrates
What is the most useful way to improve nutritional status before pre-op
Parenteral Nutrition
What is IBS
Chronic functional disorder of the GI tract
At what age do symptoms tend to appear of IBS
usually 20-30 years
What are the symptoms of IBS
Abdominal pain, discomfort, bloating or distension, win d or flactulence, change in bowel habit
What are the causes of IBS
Related to increase in visceral sensitivity
Occasionally linked to previous GI illness
Stress
What do IBS patients need to be screened for
Caeliac’s disease
What are some of the first line dietary / lifestyle advice for IBS
Eat 3 regular meals a day Don't eat late at night Take time to eat meals and chew food well choose smaller meals Limit alcohol intake Ensure adequate fluid intake Limit caffeine intake Cut down on rich or fatty foods Take regular exercise Take time to relax Food and symptom diary
What are some of the stage 2/3 dietary advice
Adjustment of fibre intake Limit fruit juice / fizzy drink Polyols/ sugar alcohols Resistant starch Trial of probiotics Low lactose diet What free diet Elimination diet
What are probiotics thought to do?
Increase the transit time
What medications can be used for IBS
Anti spasmodics Amtimuscarniics Antimotility drugs Laxative Amatriptolene
What is a low fodmap diet?
Recent advance
for those who dont respond to 1st line dietary advice
to do with short chain carbs
used for 4-8 weeks
What is coeliac disease?
An auto-immune condition affecting 1% of the population
Female: Male ratio is 2:1
What is the treatment of coeliac disease
Removal of gluten from the diet
