Transcript Document

Note
Lecture 9b 11 March 2013
Disorders of the Lower GI tract
Constipation
At least 25 grams of fibre
Lots of fluids
Eating prunes
Drinking prune juice
Foods containing fibre suitable to assist in the relief
of constipation
1 slice whole wheat bread
1 oz of ready to eat cereal
(100 % bran cereals contain 10 grams of fibre)
1 cup raw bean sprouts
½ cup cooked broccoli , brussel sprouts, carrots,
cauliflower
½ cup chopped raw carrots
1 medium apple, banana, kiwi, orange, pear
½ cup apple sauce, blackberries, blueberries,
strawberries
fruit juices contain very little fibre
Foods containing fibre suitable to assist in the relief
of constipation
½ cup baked beans, blackbeans, blackeyed peas,
kidney beans, navy beans (about 8 grams of fibre)
½ cooked garbanzo beans, lentils, lima beans, split
peas (about 5 grams of fibre)
Foods containing fibre suitable to assist in the relief
of constipation
most whole grain products contain about 1-2 grams
of fibre per serving
most vegetables contain 2 grams-3 grams of fibre
per serving
fresh, dried and frozen fruits contain about 2
grams per serving
many legumes contain about 8 grams of fibre per
serving
Foods containing fibre suitable to assist in the
relief of constipation
fibre adds volume and weight to the stool
which normalises the transit of
undigested materials through the intestine and
minimises the pressure with in the colon
Gas
Everybody responds differently to different
foods
Eliminate one by one to discover offending
foods
Diarrhoea
-replace lost fluids and electrolytes
-diluted fruit juices, sports drinks and caffeine freecarbonated beverages for mild cases
-oral rehydration formulas- (salts, sugar and
water)-mild to moderate cases
-severe cases combined with vomiting-iv solutions
-if eating aggravates the situation then withhold
food and should resolve in a day or two-patient
should drink only clear fluids in this case
Irritable bowel syndrome
Common motility disorder characterised by
abdominal pain associated with diarrhoea,
constipation i.e. alternating episodes of diarrhoea
and constipation or both diarrhoea and
constipation occurring at the same time
Cause unclear but stress and anxiety have been
suggested
Avoid eating too much too fast or swallowing
without chewing enough
Irritable bowel syndrome
Keep track of fluid and food intake and stool
consistency associated with that fluid and food
intake
Also keep track of other gastrointestinal tract
symptoms at particular times
people may benefit from reduced fat and liberal
fibre and fluid intake
However fibre intake has to be watched-why?
Inflammatory bowel diseases
Crohn’s disease and ulcerative colitis are two
of the most prevalent
In children Crohn’s gives pem, vitamin and
mineral deficiencies
Food during day and tube
feedings at night
Or tube feedings day and night in severe
cases
All Crohn’s regardless of age should reduce
lactose intake and avoid high fibre foods
Inflammatory bowel diseases
For ulcerative colitis no dietary interventions seem
to lessen symptoms
For all inflammatory bowel syndromes- fluid and
electrolytes may have to be replaced by iv
Lactose intolerance-covered in first term
Malabsorption syndromes
Steatorrhea-malabsorption of fat and energy,
essential fatty acids, fat soluble vitamins and
some minerals
-this may tax other nutrients, how?
-also get binding of calcium to fatty acids
-this means that binding of calcium to
oxalate in gut is lost
-how does this relate to the
last lecture?
Malabsorption syndromes
-treatment- high kcal and high protein diets are
given-why?
-enzyme supplements given to aid
digestion (pancreatic enzymes
given)
-medium chain fatty acids are giveneasier to digest
-frequent small meals- why?
-fat soluble vitamins given in water
soluble form
-restrict oxalate in diet
Pancreatitis
Acute-fluids and electrolytes given iv
-suctioning of gastric secretions to
help relieve pain and distension
-oral intake after abdominal discomfort
subsides and serum amylase
returns to normal levels (why?)
-oral feeding starts off with liquid
progressing to fat restricted diet to
normal diet as tolerated
Chronic Pancreatitis
Absorption of fat can be permanently
impaired
solution to this?
Cystic fibrosis
High kcal diet and high protein diet up
to tolerance limits for protein and energy
As pancreas is damaged fat absorption is
reduced but do not limit fats
Enzyme replacements for fat digestion
Multivitamin and fat soluble vitamins
supplements are routinely given
Cystic fibrosis continued
Liberal use of table salt to make up for losses in
sweating
Oral diets in day and tube feedings at night for
some people
Breast milk, standard infant formulas and
hydrolysed infant formulas work for infants
provided that enzyme supplements are given
Bacterial overgrowth
Signs include chronic diarrhea, gas,
malnutrition and weakness
Fat restricted diets to bring down
bacterial growth
Oral mineral and vitamin supplements
except B12 which cannot be absorbed
as the result of this overgrowth
(injections of B12 or
prescription B12 nasal sprays required)
Coeliac disease
Avoid gluten (wheat, rye and barley
are out-even trace amounts)
Lactose intolerance may be
permanent
Intestinal surgeries
IV fluids to restore fluid and electrolyte
imbalances after surgery then tube feedings and
finally regular oral meals (low fibre, soft diets to
prevent irritation and obstruction)
-low fibre, soft diets means avoiding dried fruits,
raw apples and corn, stringy foods (celery,
spinach for eg), seeds, mushroom and nuts
Intestinal surgeries
B12 supplementation (injection or nasal
spray) if necessary
If diarrhea then give foods that thicken stool
-apple sauce, bananas, cheese, creamy
peanut butter and starchy foods such
as white bread and potatoes
-avoid apple, grape and prune juice,
highly seasoned foods, foods that cause
gas and avoid alcohol and caffeine
Diverticulitis
Prevent by avoiding low fibre diets
and constipation
-strain of pushing hard stools
creates pockets in intestine
Liquid diets until symptoms subside
Class activity
Design a diet for the pathology/problem of
your choice than meets the dietary
principles of adequacy, variety, moderation,
nutrient density, energy control, and
balance