Nutrition and gastrointestinal disorders Flashcards
What is the role of the dietician?
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
Order the parts of the intestines from longest to shortest?
Ileum
Jejunum
Colon
Duodenum
What is absorbed in the duodenum?
Iron, calcium, vit A and D and some carbohydrate
What is absorbed in the jejunum?
Vitamin B and C, fatty acids, some carbohydrate and protein
What is absorbed in the ileum?
Bile salts and vit B12
What is absorbed in the colon?
Water and sodium
What is ulcerative colitis like?
Diffuse mucosal inflammation limited to colon
What is crohn’s disease like?
Patchy, transmural inflammation which may affect any part of the gastrointestinal tract
What is crohn’s like on an endoscopy?
Cobblestone mucosa, inflammatory polyps and skip lesions
Which is more common out of UC and CD?
UC 243/100000
CD 145/100000
What are the signs and symptoms of IBD?
Weight loss Abdo pain Bloody diarrhoea Fatigue Frequent need to use toilet
How do you diagnose Crohns?
Clinical evaluation Haematological investigations Imaging Endoscopy Histological on biopsy Negative stool examinations for infectious agents
What factors can affect nutritional status in IBD?
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
What is the treatment for IBD?
Aminosalicylates- 5-ASA, sulfasalazine etc Corticosteroids Thiopurines Methotrexate with steroids Calcineurin inhibitors Anti-TNF therapies Surgery- try to avoid
What sort of diet can be used to manage Crohn’s?
Liquid diet
Low fibre/residue
Food reintroduction slowly
Prebiotics/probiotics
What sort of diet can be used to manage UC?
Dietary manipulation to minimise exacerbation of diarrhoea
When are liquid diets used?
If other medical therapies are contraindicated
Adjunctive treatment with corticosteroid and treatment
Nutrition support
What considerations are involved with liquid diet?
Type of feed Route (oral or tube) Cmpliance Refeeding syndrome Monitoring/assessment- alcoholism or cancer treatment
What is refeeding syndrome?
Metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished
What are the dietary modifications for Crohn’s?
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
What are probiotics used to treat?
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
Problem with prebiotics?
Abdo pain, abdo bloating, diarrhoea and flatulence
How well used are food intolerance tests for CD and UC?
Inappropriate
Result in food exclusions and nutritionally inadequate diets
Food intolerance in Crohn’s is unclear and no evidence
What dietary therapy is there for diarrhoea?
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
What are the nutritional consequences of IBD?
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
What common nutrient deficiencies are there?
Calcium Vitamin D- common Other fat soluble vitamins Zinc Iron- common Vit B12 Folate in ulcerative colitis
When is nutrition support given?
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
What routes of nutritional support are there?
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
What is the lifetime risk of having surgery in CD and UC?
CD- 70-80%
UC- 20-30%
Depends on severity
What are the problems associated with short bowel?
Water, sodium and magnesium depletion Nutrient malabsorption Lactic acidosis Renal stones Gall stones Adaptation Social problems- diarrhoea
What is coeliac disease?
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
What are the signs and symptoms of coeliac disease?
Diarrhoea Abdo pain Bloating Nausea and vomiting Lethargy Low mood Poor appetite Anaemia
What is the diagnosis for coeliac disease?
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
What is the treatment of coeliac disease?
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
What factors affect compliance with coeliac disease treatment?
Lifestyle
Eating out
Cross contamination at home
Holidays
What are the associated risks of coeliac disease?
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)
What risks are associated with non-compliance and undiagnosed coeliac disease?
Osteoporosis Cancer (lymphoma) Depression Continued GI symptoms Micronutrient deficiencies- iron, B12 and folate Anaemia Infertility and negative outcomes
What is refractory coeliac disease?
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
What is IBS?
Common functional disorder of gut with no structural abnormality
Affects 1 in 5 in UK
What is suspected to cause IBS?
Biological factors: Visceral hypersensitivity Altered brain-gut interaction Altered motility Infections Environment Genes
Psychological factors: Childhood abuse Disordered sleep Stress Dysfunctional coping Psychiatric disorders
What are the signs and symptoms of IBS?
Abdo pain which may ease after opening bowels Diarrhoea and/or constipation Bloating and wind Passing mucus Incomplete evacuation Urgency to open bowels
How do you diagnose IBS?
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
How is IBS treated?
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
How does FODMAPS work?
Dietitian supervised diet- strict 6-8 week exclusion of all foods and 2-3 month reintroduction one by one
Give a summary of lecture
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
