Transcript Lower GI Tract

Irritable Bowel Syndrome
 Abnormal stool pattern associated w/disturbances in GI
motility that persist for > 3 months.
 Symptoms:
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 Causes:
Nutrition Therapy: depends on symptoms
 Commercial fiber supplements (psyllium)
 Use of wheat bran may be detrimental and
exacerbate non-complaining cases.
 Regular diet
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Diverticulosis
 Outpouchings (diverticula)
 Incidence  w/
 Often no symptoms until:
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 Symptoms:
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lower quadrant pain, abd distention, cramping
n/v
fever,
diarrhea or constipation
possibly obstruction.
 Rupture can 
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Nutrition Therapy
 Diverticulosis: high fiber to keep muscles toned
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 --itis: low residue
 Controversial:
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Avoidance of foods with seeds, such as okra and
strawberries.
Avoid seeds and nuts in general
Intestinal Surgery
Resection of the
Small Intestine
Short-Bowel Syndrome
 Severe malabsorption due to extensive
resection of the small intestine.
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IBD, CA, fistula, diverticulitis, obstruction, etc.
 40-50% of the s.i. can be resected without serious
nutritional consequences
 Even more can be tolerated, as long as
 Resection of ileum:
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Malabsorption of fat (and fat sol vits), protein, CHO, B12,
Ca++, Mg++, Zn++
Malabsorption of bile salts 
If any colon present, malabsorbed bile salts irritate
mucosa  fluid/lyte secretion (fluid/lyte absorption)
 When ileocecal valve is resected:
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Adaptation:
 Portion of S.I. remaining gets longer,
thicker, wider, and takes over absorptive
capacity of missing portion. **
 Takes up to 1-2 years.
 Doesn’t fully compensate if too much bowel
is resected.
 Intact colon:  CHO and prot
malabsorption following s.i. resection.
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Bacteria salvage some E by metabolizing into
SCFAs  absorbed and used for E.
Nutrition Therapy for SBS
 <40-50% resected p.o. intake ASAP
 B12
 >50% resected, TPN then EN as soon as
possible to stimulate adaptation.
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 While steatorrhea persists:
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 To improve adaptation:
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Blind Loop Syndrome (Bacterial Overgrowth)
 S.I. is protected from bacteria by gastric
acid and peristalsis
 Gastric surgery*
 Gastric or intestinal surgeries
 Also fistulas, obstructions, nerve
dysfunction such as in diabetes
 Bacteria dismantle bile salts 
 Bacteria compete w/body for
 Treatment:
 Diet:
Resection of the
Large Intestine
 Cancer, ulcerative colitis, Crohn’s disease, etc.
 Resection of colon less likely to 
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Colostomy
 Segment of the colon, rectum, or both is
removed
 Remaining portion is brought out through
intestinal wall (stoma) for defecation.
Ileostomy
 Colon and rectum are removed, and ileum is
used to form the stoma.
Ileal Pouch/Anal Anastomosis
 Colon and rectal tissue are removed and
ileum is connected to anus.
 Result:
 Often temporary ileostomy is created to
give intestine time to heal, then closed (2-3
months)
Implications of “Ostomies”
 Stools:
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Nutritional Care
 NPO post surgery  liq  low fiber, bland to
prevent obstructions and promote stoma healing.
 Add foods one at a time in small amounts to
check tolerance
 Encourage fluids
 Prevent obstructions:
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Foods that May Block a
Narrowed Stoma
 Cabbage
 Cucumbers
 Lettuce
 Celery
 Peas
 Dried fruits
 Mushrooms
 Coconut
 Pickles
 Green peppers
 Nuts
 Corn
 Pineapple
 Olives
Controlling Diarrhea
Foods that Thicken Stool:
 Applesauce
 Bananas
 Bread
 Cheeses
 Creamy peanut butter
 Starchy foods
Foods that Aggravate
Diarrhea:
 Apple, grape and prune juices
 Highly seasoned foods
 Caffeine
 (individual tolerances)
Controlling Odors
Odor-Producing Foods
 Asparagus
 Eggs
 Fish
 Garlic
 Onions
Odor-Reducers
 Buttermilk
 Yogurt
 Parsley
 Cranberry Juice
Reducing Gas
Things that Cause Excess Swallowed Air and
Then Gas
 Poorly fitting dentures, smoking pipes or
cigarettes, chewing gum or tobacco can cause
increased salivation and swallowing
 Eating fast and swallowing large chunks of food
or large amounts of beverages
 Using straws or drinking from a bottle or can
 Inactivity and lying down after eating
Foods that Tend to Form Gas
 Legumes
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Most beans, especially dried beans and peas,
baked beans, soy beans, lima beans
 Vegetables
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Cabbage, radishes, onions, broccoli, Brussels
sprouts, cauliflower, cucumbers, sauerkraut,
rutabaga, turnips, asparagus, onions
 Fruits
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Prunes, apples, raisins, bananas, excessive
amounts of fruit
 Cereals, breads
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Excessive wheat products, including breads and
cereals. Check labels for specific grains.
 Milk, milk products
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Excessive milk, ice cream, cheese
 Fatty foods
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Excessive pan-fried or deep-fried foods, fatty
meats; rich cream sauces and gravies; pastries
 Liquids
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Carbonated beverages
 Emotional Support:
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