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S and P- Nutrition > Nutrition and gastrointestinal disorders > Flashcards

Nutrition and gastrointestinal disorders Flashcards

1
Q

What is the role of the dietician?

A

Dieticians must be registered with HCPC
Translate nutrition science into understandable, practical information about food
Treat a range of medical conditions with dietary therapy, specially tailored to each individual

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2
Q

Order the parts of the intestines from longest to shortest?

A

Ileum
Jejunum
Colon
Duodenum

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3
Q

What is absorbed in the duodenum?

A

Iron, calcium, vit A and D and some carbohydrate

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4
Q

What is absorbed in the jejunum?

A

Vitamin B and C, fatty acids, some carbohydrate and protein

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5
Q

What is absorbed in the ileum?

A

Bile salts and vit B12

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6
Q

What is absorbed in the colon?

A

Water and sodium

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7
Q

What is ulcerative colitis like?

A

Diffuse mucosal inflammation limited to colon

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8
Q

What is crohn’s disease like?

A

Patchy, transmural inflammation which may affect any part of the gastrointestinal tract

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9
Q

What is crohn’s like on an endoscopy?

A

Cobblestone mucosa, inflammatory polyps and skip lesions

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10
Q

Which is more common out of UC and CD?

A

UC 243/100000

CD 145/100000

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11
Q

What are the signs and symptoms of IBD?

A 
Weight loss
Abdo pain
Bloody diarrhoea
Fatigue
Frequent need to use toilet
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12
Q

How do you diagnose Crohns?

A 
Clinical evaluation
Haematological investigations
Imaging
Endoscopy
Histological on biopsy
Negative stool examinations for infectious agents
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13
Q

What factors can affect nutritional status in IBD?

A 
B12 deficiency
Bile aicd malabsorption
Primary sclerosing cholangitis
Osteoporosis and osteomalacia
Anaemia 
Mood disorders in IBD
Malignancy
Surgical- enterocutaneous fistula or short bowel syndrome
Malnutrition
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14
Q

What is the treatment for IBD?

A 
Aminosalicylates- 5-ASA, sulfasalazine etc
Corticosteroids
Thiopurines
Methotrexate with steroids
Calcineurin inhibitors
Anti-TNF therapies
Surgery- try to avoid
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15
Q

What sort of diet can be used to manage Crohn’s?

A

Liquid diet
Low fibre/residue
Food reintroduction slowly
Prebiotics/probiotics

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16
Q

What sort of diet can be used to manage UC?

A

Dietary manipulation to minimise exacerbation of diarrhoea

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17
Q

When are liquid diets used?

A

If other medical therapies are contraindicated
Adjunctive treatment with corticosteroid and treatment
Nutrition support

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18
Q

What considerations are involved with liquid diet?

A 
Type of feed
Route (oral or tube)
Cmpliance
Refeeding syndrome
Monitoring/assessment- alcoholism or cancer treatment
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19
Q

What is refeeding syndrome?

A

Metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished

20
Q

What are the dietary modifications for Crohn’s?

A

Avoid fibrous parts of fruit and veg, wholegrains, nuts and seeds, gristle on meat, skin on meat or fish and edible fish bones
Consistency may need to be different

21
Q

What are probiotics used to treat?

A

Treatment and prevention of pouchitis VSL3 (inflammation of ileal pouch- artificial rectum surgically created out of ileal gut tissue in colectomy patients)
Some evidence for use in UC but not CD

22
Q

Problem with prebiotics?

A

Abdo pain, abdo bloating, diarrhoea and flatulence

23
Q

How well used are food intolerance tests for CD and UC?

A

Inappropriate
Result in food exclusions and nutritionally inadequate diets
Food intolerance in Crohn’s is unclear and no evidence

24
Q

What dietary therapy is there for diarrhoea?

A

Fluid- 10 cups per day, nutritious drinks and replace salt
Soluble fibre- jelly like fibre which helps stool absorb more water from stool
Avoid gas producing foods, high fibre or wholegrain cereals, alcohol, caffeine and personal triggers

25
Q

What are the nutritional consequences of IBD?

A

Inadequate intake due to anorexia, nausea, vomiting, diarrhoea or starvation for investigations
Increased loss due to malabsorption (micro and macronutrients) and blood loss
Increased requirements due to catabolic state- increased metabolic rate, increased energy expenditure, stress response and increased protein turnover

26
Q

What common nutrient deficiencies are there?

A 
Calcium
Vitamin D- common 
Other fat soluble vitamins
Zinc
Iron- common
Vit B12
Folate in ulcerative colitis
27
Q

When is nutrition support given?

A

During active disease- in catabolic state so needs to maintain current nutritional state and prevent further deterioration
During remission- improve/maintain nutritional state and maintain healthy BMI

28
Q

What routes of nutritional support are there?

A

Oral where possible
Enteral tube feed (nasogastric tube, gastrotomy, nasoduodenal tube, nasojejunal tube, jejunostomy tube)
Parenteral nutrition (post surgery, enterocutaneous fistula, high output fistula, anastomotic breakdown after GI surgery and short bowel syndrome

29
Q

What is the lifetime risk of having surgery in CD and UC?

A

CD- 70-80%
UC- 20-30%
Depends on severity

30
Q

What are the problems associated with short bowel?

A 
Water, sodium and magnesium depletion
Nutrient malabsorption
Lactic acidosis
Renal stones
Gall stones
Adaptation
Social problems- diarrhoea
31
Q

What is coeliac disease?

A

An inflammatory, auto-immune condition of small intestinal mucosa that is induced by the ingestion of gluten and which improves when gluten is removed from diet

32
Q

What are the signs and symptoms of coeliac disease?

A 
Diarrhoea
Abdo pain
Bloating
Nausea and vomiting
Lethargy
Low mood
Poor appetite
Anaemia
33
Q

What is the diagnosis for coeliac disease?

A

Blood test for endomysial antibodies (EMA) and tissue transglutaminase antibodies (TGA)
Possible to have a negative blood test yet have coeliac diseaseEndoscopy with duodenal biopsy is taken to confirm diagnosis

34
Q

What is the treatment of coeliac disease?

A

Gluten free diet- avoid wheat, barley, rue
Avoid wheat starch, flour, rusk, brain, barley, malt/flour, oat bran and rye flour and wheat coated medications
Gluten free food can be prescribed

35
Q

What factors affect compliance with coeliac disease treatment?

A

Lifestyle
Eating out
Cross contamination at home
Holidays

36
Q

What are the associated risks of coeliac disease?

A

Dermatitis herpretiformis- skin condition of coeliac disease - rare
Autoimmune conditions- increased risk of developing diabetes and thyroid disease
Lactose intolerance- caused by gut damage (temporary)

37
Q

What risks are associated with non-compliance and undiagnosed coeliac disease?

A 
Osteoporosis
Cancer (lymphoma)
Depression
Continued GI symptoms
Micronutrient deficiencies- iron, B12 and folate
Anaemia 
Infertility and negative outcomes
38
Q

What is refractory coeliac disease?

A

Rare but persistent malabsorptive symptoms and villous atrophy on strict gluten free diet with negative serology for anti-tTG or EMA
Focus is on correcting nutritional status, strict gluten free diet, immune suppression via steroids and monitoring for early detection of lymphoma

39
Q

What is IBS?

A

Common functional disorder of gut with no structural abnormality
Affects 1 in 5 in UK

40
Q

What is suspected to cause IBS?

A 
Biological factors:
Visceral hypersensitivity
Altered brain-gut interaction
Altered motility
Infections
Environment
Genes
Psychological factors:
Childhood abuse
Disordered sleep
Stress
Dysfunctional coping
Psychiatric disorders
41
Q

What are the signs and symptoms of IBS?

A 
Abdo pain which may ease after opening bowels
Diarrhoea and/or constipation
Bloating and wind
Passing mucus
Incomplete evacuation
Urgency to open bowels
42
Q

How do you diagnose IBS?

A

12 weeks or more in past 12 months of abdominal discomfort or pain that has 2 out of 3 features:
Relieved with defecation
Associated with a change in frequency of stool
Associated with a change in consistency of stool

43
Q

How is IBS treated?

A

Education
Reassurance
Diet-
Healthy eating
Low fibre/high fibre dependent on symptoms
Probiotics
FODMAPS- dietician supervised diet
Medication- Antispamodics, antidiarrhoeals/laxatives
Psychological treatment- counselling, cognitive based therapy

44
Q

How does FODMAPS work?

A

Dietitian supervised diet- strict 6-8 week exclusion of all foods and 2-3 month reintroduction one by one

45
Q

Give a summary of lecture

A

IBD and short bowel- severe malnutrition, should be monitored carefully and proactive nutrition support required
Coeliac disease- gluten free diet- Non-compliance= severe health risk
IBS- diet, lifestyle, psychosocial considerations
FODMAPS
Identify risks and refer

S and P- Nutrition (15 decks)

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