Note

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Note
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Lecture 9b 14 March 2011   Disorders of the
Lower GI tract
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Constipation   At least 25 grams of fibre Lots
of fluids Eating prunes Drinking prune juice
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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
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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)
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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  
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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
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Gas Everybody responds differently to different
foods Eliminate one by one to discover
offending foods
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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
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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
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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   Many people benefit from
reduced fat and liberal fibre and fluid
intake However fibre intake has to be watched
why?
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Inflammatory bowel diseases Crohns disease
and ulcerative colitis are two of the most
prevalent In children Crohns gives pem,
vitamin and mineral deficiencies Food during
day and tube feedings at night Or tube
feedings day and night in severe cases   All
Crohns regardless of age should reduce lactose
intake and avoid high fibre foods    
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 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  
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Lactose intolerance-covered in first term
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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?
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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
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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
fat restricted diet to normal diet as
tolerated    
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Chronic Pancreatitis Absorption of fat can be
permanently impaired solution to
this?
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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
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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
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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)
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Coeliac disease Avoid gluten (wheat, rye and
barley are out-even trace amounts)   Lactose
intolerance may be permanent
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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
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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
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Diverticulitis Prevent by avoiding low
fibre diets and constipation -strain
of pushing hard stools creates pockets in
intestine   Liquid diets
until symptoms subside
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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