Clinical Nutrition- Final Exam- Nutrition for Upper and Lower GI Disorders

Avoid what for GERD

Avoid large height fat meals, eating 2-3 hrs before lying down, chocolate, mint, tomatoes, caffeine, alcohol, acidic, spicy foods

Consume what for GERD

Well balanced diet with adequate fiber, psyllium at each meal

Smaller, more frequent meals

Lifestyle recommendations for GERD

Lose weight, quit smoking, wear loose fitting cloth gin, elevate head 6-8 inches while sleeping, reduce stress

Normal stools

Type 3 and Type 4

Type 3= sausage shape with cracks in surface

Type 4= smooth, soft sausage or snake

Constipation level stools

Type 1 and Type 2

Type 1= separate hard bumps

Type 2= lumpy and sausage like

Diarrhea style stools

Type 5, 6 and 7

Type 5= soft blobs with clear cut edges

Type 6= mushy consistency with ragged edges

Ty[e 7= liquid consistency with no solid pieces

With diarrhea, the more liquid form

The more fatter malabsorption

Brown poop

Normal poop

Green poop

Green veggies, antibiotics, bacterial infections

Yellow poop

Excess fat, small intestine infection

Bright red poop

Hemorrhoids, bleeding lower digestive tract

Black or dark brown poop

Iron supplements, bismuth sybsalicyte, bleeding upper digestive tract

White or clay colored poop

Anti diarrheal medication, lack of bile

Reddish poop

Bleeding lower gut or rectum

What are the constipation subtypes

Normal transit constipation (AKA functional constipation)

Slow transit constipation

Anorectal dysfunction

Most common constipation

Normal transit constipation (aka functional constipation)

What is the only constipation that responds to dietary changes

Normal transit constipation (aka functional constipation)

How do you diagnose normal transit constipation (aka functional constipation)

Stool passes through colon at rate of 5 days, precedes of hard stools or perceive difficulty with defecation

What constipation responds to fiber

Normal transit constipation (aka functional constipation)

What constipation has bloating and abdominal pain, lack of sensation to defecate

Slow transit constipation

How do you fix slow transit constipation

Aggressive laxative therapy, or surgery may be needed

Constipation that is form weak pelvic floor muscles, and muscle training is needed to fix it

Anorectal dysfunction

Rome IV criteria for functional constipation

1. Must include 2 or more for at least 3 months for 25% of the poops

-straining

-lumpy or hard

-incomplete feeling

-feeling of anorectal obstruction

-manual maneuvers needed

-less than 3 defecations per week

2. Loose stools rarely present without laxatives

Normal amount of pooping done

3 times per week to 3 times per day

Nutritional therapy for constipation

Increase consumption of whole grain products to 6-11 servings

Increase veggies, legume, fruits, nuts and seeds to 5 per day

Consume high fibers cereals, granolas and legumes

Increase fluid intake to at least 2 L/day

Diarrhea is

Passage of 3 or more loose or liquid stools per day

Subtypes of diarrhea

Exudative

Osmotic

Secretory

Malabsorptive

Medication induced

Diarrhea that is for mucosal damage leading to excessive secretion of mucus and other flutes often found in IBD

Exudative

Diarrhea that osmotically active solutes in large intestine, diarrhea due to magnesium oxide intake

Osmotic

Diarrhea that is from excessive secretion of fluid and electrolytes due to bacteria, viruses, etc.

Secretory

Diarrhea that is from impairment of digestion and absorption

Malabsorptive

Nutritional therapy for diarrhea

Replenish fluids

-oral rehydration solution recipes

=2 cups of Gatorade plus 2 cups of water and 3/4 cup of salt

Or

1 quart water plus 3/4 tsp salt plus 6 tsp sugar

Limit what for diarrhea

Lactose, sugar alcohols, fructose and large amounts of sucrose

Modest intake of what for diarrhea

Soluble fibers like pectin- they can slow GI motility

What is the 3rd way to help diarrhea

Try probiotics

-when take probiotics its important to feed the bacteria with prebiotics with food that are high in them

Subtypes of celiac disease

Subclinical

Classical

Non classical (majority are this kind)

Celiac disease pathophysiology

It's an autoimmune disease

Genetic susceptibility then exposure to gluten then environmental trigger then autoimmune response

What are the genes that make someone susceptible to Celia disease

HLA DQ2 and DQ8

(Human leukocyte antigen)

What are the most common environmental triggers for celiac disease

Rotavirus and reovirus infections

What is a big thing that increases risk of celiacs disease

High amounts of gluten exposure before 3 months of life or after 6 months

What are some extraintenstinal symptoms of celiac disease

Malaise

Arthritis

Dermatitis herpetiformis

Infertility, miscarriage

Hepatitis

Ataxia

Psychiatric syndromes

What must you do during the diagnosis for celiac disease

Must eat gluten during the diagnosis

Most celiac disease diagnoses occur

During middle age

What is an automatic referee to a gastroenterologist for diagnosing celiac disease

When they dermatitis herpetaphormis

What antibodies are tested for to diagnose celiac diseases

TTGA IgA and IgA levels

How is celiac disease diagnosed

Four out of 5 rule, must have 4 out of the 5 of the following

1. Typical signs and symptoms (diarrhea, malabsorption)

2. Antibody positivity

3. HLA DQ2 and or HLA DQ 8

4. Intestinal damage

5. Clinical response to gluten free diet (GDF)

What are some hidden sources of gluten

OTC or prescription meds

Communion wafers

Toothpastes, mouthwash and cosmetics (especially shampoo and lipstick)

Children's modeling dough

What are safe gluten free options for grains and flours

Amaranth, arrow root, bean flours, corn, rice, soybean, potato, quinoa, flax, tapioca

What are safe gluten free opinions for desserts

Sorbet, popsicles

What are safe gluten free options for cheese, eggs, meat, fish poultry

Anything that is untreated

What foods are always safe for gluten free options

Beans, legumes, nuts, seeds, fruits and veggies

Gluten free diets are low in

Iron

Fiber

Folate

Niacin

Riboflavin

Gluten free diets are high in

Saturated fat

Starch

Sucrose

Sodium

-gluten is the "glue" so these are added to hold the food together

What are the most commonly brush border enzyme deficiencies

Lactose intolerance

Fructose malabsorption

What is the most comm form of carbohydrate malabsorption

Lactose intolerance

Lactose intolerance is what type of disorder

Functional/metabolic disorder

How are lactose intolerance and fructose malabsorption diagnosed

Hydrogen breath test

Hydrogen gas amount related to fermentation that occurs in the gut

What are the protein requirements for patients with IBD

1.3-1.5 g/kg

Which form of IBD is most likely to present with malnutrition

Crohns disease

What are the types of IBD

Crohn's disease

Ulcerative colitis (UC)

IBS subtypes

IBS with constipation (IBS-C)

IBS with diarrhea (IBS-D)

Mixed IBS (IBS-M)

How is IBS diagnosed

Recurrent abdominal pain or discomfort at least 1 day a week in the last 3 months associated with 2 or more of the following

1. Improved with defecation

2. Onset associated with a change in frequency of stool

3. Onset associated with a change in form (appearance) of stool

What else should you check in a patient with suspected IBS

Meds

rule of CD and IBD

Assessment of nutritional status and food intake

Supplants

Mind body therapies

Small intestine bacterial overgrowth often found in IBS

What are foods to limit on the FODMAP diet

Fermentable oligo, di and monosaccharides and polyols (sugar alcohols)

Limit fermentable foods (sugar, oligosaccharides and sugar alcohols)

What is the main diet used to figure out triggers for IBS

FODMAP elimination diet