Lower Gastrointestinal Tract KNH 411. © 2007 Thomson - Wadsworth

Lower Gastrointestinal Tract

KNH 411

© 2007 Thomson - Wadsworth

Pathophysiology: Lower GI Tract

●Malabsorption - maldigestion of fat, CHO, Protein

● Decreased villious height, enzyme production

● Decreased transit time


●Malabsorption - fat● Steatorrhea

● Fat-soluble vitamins malabsorbed

● Potential for excess oxalate

● Abdominal pain, cramping, diarrhea

● Dg; fecal fat test or D-xylose absorption test, or small bowel x-ray


●Malabsorption - Fat – Nutrition

● Restrict fat 25-50 g/day

● Use of MCT supplements

● Pancreatic enzymes


●Malabsorption - CHO● Lactose malabsorption

● Most common

● Lactade

● Increased gas, abdominal cramping, diarrhea

● Restrict milk and dairy products

● Products such as Lactaid can be rec.


●Malabsorption - protein● Protein-losing enteropathy

● Reduced serum protein● Due to excess loss of protein in stool

● Peripheral edema ● Due to oncotic pressure

● Korshikor & marasmus

● Diseases left untreated


●Malabsorption - Nutrition Therapy● Results in weight loss

● Treat underlying disease/ nutrient being malabsorbed


●Celiac disease

● Genetic and autoimmune

● Occurs when alpha-gliadin from wheat, rye, malt, barley are eaten

● Infiltration of WBC, production of IgA antibodies


●Celiac disease - pathophysiology● Damage to villi

● Decreased enzyme function

● Maldigestion and malabsorption

● Occurs with other autoimmune disorders


●Celiac disease - clinical manifestations

● Diarrhea, abdominal pain, cramping, bloating, gas

● Muscle cramping, fatigue

● Skin rash

● Higher risk for lymphoma and osteoporosis


●Celiac Disease - Diagnosis/Treatment/Prognosis● Biopsy of small intestinal mucosa

● Reversal of symptoms following gluten-free diet

● Refractory CD; d/t coexisting disease


●Celiac Disease - Nutrition Intervention● Low-residue, low-fat, lactose-free, gluten-free diet

● Identify hidden sources of gluten

● Specialty products


●Irritable Bowel Syndrome (IBS)

● Pain relieved with defecation● Onset associated with change in frequency of stool● Onset associated with change in form of stool

●Eliminate “red flag” symptoms● Anemia, weight loss, history of colon cancer


●IBS● Most common GI complaint

● Etiology unknown

● Increased serotonin, inflammatory response, abnormal motility, pain


●IBS - clinical manifestations● Abdominal pain, alterations in bowel habits, gas,

flatulence

● Increased sensitivity to certain foods

● Concurrent dg


●IBS - Treatment● Guided by symptoms● Antidiarrheal agents● Tricyclic antidepressants, SSRIs● Bulking agents, laxatives● Behavioral therapies

● Hypnosis, guided imagery


●IBS - Nutrition Therapy● Can lead to nutrient deficiency, underweight,

malnourished, low gas producing foods

● Decrease anxiety, normalize dietary patterns


●IBS - Nutrition Therapy● Assess diet hx

● Look for offensive foods

● Assess nutritional adequacy● Focus on increasing fiber intake

● At least 25g of fiber per day ● Slowly increase if their under

● Adequate fluid● Pre- and probiotics

● Build up normal gut flora

● Avoid foods that produce gas ● Simple carbs, lactose, sorbitol, offer agents to help with

gas producing




●IBD - Nutrition Therapy

● Malnutrition● Takes two to three days to make up what you’ve lost

● May need to increase kcal, protein, micronutrients


●IBD - Nutrition Interventions● During exacerbation ● Supplement ● Assess energy needs + stress factor● May need to increase protein● Low-residue, lactose-free diet● Small, frequent meals


●IBD - Nutrition Interventions● May use MCT oil ● Restrict gas-producing foods● Increase fiber and lactose as tolerated● Advancement of oral diet ● Multivitamin


●IBD - Nutrition Interventions● During remission/rehabilitation

● Maximize energy & protein

● Weight gain and physical activity

● Food sources of antioxidants, Omega-3s

● Pro- and prebiotics


●Diverticulosis/diverticulitis – abnormal presence of outpockets or pouches on surface of SI or colon/inflammation of these ● Low fiber intake during the inflammation stage

● Increases inflammatory response

● Other risks


●Diverticulosis/diverticulitis – pathophysiology● Fecal matter trapped

● Development of pouches

● Diverticulitis ● Food stuff to avoid

● Just a low fiber diet

● Bleeding abscess, obstruction, fistula, perforation


●Diverticulosis/-itis – Treatment/ Nutrition Therapy● Specific focus on fiber● Pro- and prebiotic supplementation● Acute ● Antibiotics

● Only used in itis stage, have blood in stool, fever


●Diverticulosis/-itis – Nutrition Therapy● -osis ● Avoid nuts, seeds, hulls*

● Current research shows that this isn’t a problem

● Only if client feels its necessary

● Fiber supplement● -itis

● Low fiber diet

● Bowel rest● Avoid nuts, seeds, fibrous vegetables

Documents

Lower Gastrointestinal Tract KNH 411. © 2007 Thomson - Wadsworth