1. Note

2. Lecture 9b 11 March 2013 Disorders of the Lower GI tract

3. Constipation At least 25 grams of fibre Lots of fluids Eating prunes Drinking prune juice

4. 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

5. 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)

6. 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

7. 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

8. Gas Everybody responds differently to different foods Eliminate one by one to discover offending foods

9. Diarrhoea -replace lost fluids and electrolytes -diluted fruit juices, sports drinks and caffeine free- carbonated 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

10. 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

11. 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?

12. 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

13. 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

14. Lactose intolerance-covered in first term

15. 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?

16. 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 given- easier to digest -frequent small meals- why? -fat soluble vitamins given in water soluble form -restrict oxalate in diet

17. 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

18. Chronic Pancreatitis Absorption of fat can be permanently impaired solution to this?

19. 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

20. 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

21. Bacterial overgrowth Signs include chronic diarrhea, gas, malnutrition and weakness Fat restricted diets to bring down bacterial growth Oral mineral and vitamin supplements except B 12 which cannot be absorbed as the result of this overgrowth (injections of B 12 or prescription B 12 nasal sprays required)

22. Coeliac disease Avoid gluten (wheat, rye and barley are out-even trace amounts) Lactose intolerance may be permanent

23. 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

24. Intestinal surgeries B 12 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

25. Diverticulitis Prevent by avoiding low fibre diets and constipation -strain of pushing hard stools creates pockets in intestine Liquid diets until symptoms subside

26. 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