DISEASES OF THE GALL BLADDER

Bile produced in the liver is concentrated and stored in the gall bladder. Stones or inflammation of gall bladder obstructs the flow of bile. Fat digestion is impaired for want of bile and there is pain in the abdomen, nausea and vomiting.

DIET THERAPY:-

• Obese persons are found more likely to suffer from gall bladder disease is. Hence losing excess weight and maintaining normal weight is suggested for those who are susceptible to this condition.
• To ensure the contraction of the gall bladder and hence the pain, fat intake needs to be reduced.
• During acute attack, no food is given to rest the system. Gradually the patient is given clear fluids followed by soft fiber-restricted low fat (20-30g) diet.
• Secondary bile acids may be given to dissolve small stones present. Ultra sound shock waves are used to shatter the stones.

HEPATIC FAILURE

Hepatic failure is also known as enlarged liver disease. Liver function is severely reduced due to reduction in the number of functional liver cells. This affects a number of reaction such as:

• Conversion of ammonia to urea is disturbed, accumulated ammonia is toxic to the central nervous system.
• The breakdown of aromatic amino acids is reduced (phenylalnine, tyrosine and tryptophan) and these accumulate in the blood.
• Branched chain amino acids (leucine, isoleucine and valine) are broken  in peripheral muscle for energy and their blood level decreases.

DIET:-

The main principle is to reduce protein intke to minimize ammonia production. 

This can be done as follows:

• Protein free to low protein diet - 20 to 30g is given for a few days. As improvement occurs, protein intake is increased by 5 to 10g every few days, until the intake reaches 40 to 50 per day. The protein profile can be improved by ensuring intake of branched chain amino acids, orally, enterally or parenterally.
• To prevent tissue breakdown, 1500 - 2000kcal are provided in the form of carbohydrates and fat.
• Patients, who are unable to take nourishment orally, tube feeding or parenteral  nutrition is given.

HEPATITIS

In this disease, liver is inflammed and degeneration may have occurred. There are four types of hepatitis - A, B, C and D. In all these, the symptoms are similar. The symptoms are loss of appetite, nausea, abdominal pain, vomiting, diarrhea, fever and loss of weight. Jaundice follows, if these symptoms are not treated promptly by diet modification.

DIET:

In hepatitis, the main therapy consists of nutritionally adequate diet and bed rest. The aim is to ensure recovery of damaged tissues and to prevent further damage.

In the early stages parenteral fluids or tube feeding may be necessary, if nausea and vomiting is severe.

Apetite is normally poor. So it is crucial that meals are attractive, small and frequent - 5 to 6 meals at regular intervals are suggested. 

It is advisable to follow the tips given below:-

• Give a full liquid diet in six small feeds, as soon as the patient is able to eat.
• Follow it by a soft fiber-restricted diet and then a normal diet.
• A high calorie, high protein diet is given, if there is extensive weight loss.
• A low fat is given in the beginning and gradually move is made towards normal fat intake as the biliary tract obstruction is cured.
• Adequate calorie supply and glycogen synthesis are ensured by giving a high carbohydrate diet.
• Vegetables with strong flavors, spicy foods, as also rich desserts are avoided as these may affect food tolerance adversely. 

JAUNDICE

Jaundice is characterized by yellow color of skin and tissues. In jaundice, the blood levels of bile pigments are high. This is a frequent sign of liver and biliary tract diseases.

THERAPY:

The primary aim is to protect the liver from further stress and help it to function as normally as feasible. Therefore, a nutritionally adequate diet is basic to avoid permanent damage.

DIET:

The modification of diet is based on:-

• Generous intake of good quality protein to regenerate tissues and prevent fatty infiltration
• High carbohydrate intake to spare protein and synthesis of glycogen
• A moderate fat restriction
• Providing vitamin supplements
• Ensuring sodium restriction, if there is edema

LOW RESIDUE DIET

Oral rehydration therapy is followed by a low residue diet in cases of severe diarrhea. The low residue diet of less than 10g of fiber a day reduces the normal work of the intestines by restricting the amount of dietary fiber and reducing food residue. Food residue is the bulk in colon that includes undigested food, intestinal secretions, bacteria and cells shed from the intestinal lining. 

The foods allowed and foods avoided in low residue soft diet mainly consists of liquids such as buttermilk, dhal, soup, broth, vegetable and fruit juices, coconut water.

Some soft foods such as soft cooked dhal, cooked eggs, pureed mild-flavored vegetables, apple sauce, fruit pulp, refined breads, soft cooked rice, custards, kheer can be gradually be added to improve the nutrient content, as the condition of the patient improves and appetite slowly recovers.

The patient needs to progress from liquid diet, soft diet to normal diet gradually. Contamination of food much be prevented to avoid recurrence of diarrhea.

DIARRHEA

Diarrhea is one of the most common gastrointestinal ailments. It is still the second most common cause of death in childhood, killing over 1.5 million children in India alone.

The occurrence of diarrhea indicates that there is contamination of food and water with virus and bacteria from human faeces. In diarrhea, the stools are liquid or semisolid and large volumes of these are passed frequently. There is also vomiting, cramps and abdominal pain. The food passes through the gastrointestinal tract so rapidly that its digestion and absorption is reduced. The fecal matter moves through the colon so fast that water and electrolytes are not reabsorbed.

Frequent and/or prolonged attacks result in loss of fluids, electrolytes, minerals, vitamins, proteins, fats, carbohydrates and as a result there is loss of body weight. This leads to dehydration.

THERAPY:

• The first step is to identify the cause and remove it. 
• If diarrhea is severe and dehydration has set in (eyes sunken, skin loose and inelastic, passing reduced amounts of dark urine), fluids and electrolytes may be first given intravenously to let the gastrointestinal tract to rest.
• This is followed by feeding fluids, with gradual move to oral rehydration therapy and later to a very low residue diet.

FEVER

      Fever often accompanies infection. The patient may have chills due to fever and may complain of feeling cold. But all fevers are not a result of infection. All elevations in body temperature are not fever. For example, there is elevation of body temperature in heat stroke, as the body is unable to eliminate heat.

    Infection affects protein catabolism (breakdown), often decreases food intake and increases nutrient loss through vomiting and/or diarrhea. Enteric (intestinal) infections, as in typhoid, interfere with absorption and reduce nutrient utilization. Fever, which often accompanies infection, increases energy needs of the body (about 70% per degree Fahrenheit) above normal temperature.

          Fever may be acute and of short duration as in colds, intermittent as in malaria or chronic as in tuberculosis.

DIET:

• The dietary treatment varies with the kind of fever and its duration. 
• When fever is acute and of short duration, the most important aspect is to feed sufficient fluids and electrolytes to make up for the losses from the body. 
• As appetite is usually poor, frequent small feeds of liquid and soft foods need to be given to ensure adequate intake.
• As the condition improves, the size of the feed is increased to meet nutritional needs.
• The critical problem is protein breakdown, which occurs in infection.
• A high protein, high calorie diet is prescribed.
• Liquid and soft foods need to be fed often to ensure sufficient food intake as appetite is poor.