Transcript Lower Gastrointestinal Tract

Lower Gastrointestinal Tract
KNH 411
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
 Malabsorption - maldigestion of fat, CHO, Protein
 Number one concern
 Decreased villious height, enzyme production
 Decreased transit time- recesting, surgury can alter or
stress the GI
 Might need time to recover- Chrons, CD, diverticulitis
 Disfunction of an accessory organ
Pathophysiology: Lower GI Tract
 Malabsorption - fat
 Steatorrhea- fat travels undigested and malabsorbed ,
ADEK a concern, worry about kidney stones
 Fat-soluble vitamins malabsorbed
 Potential for excess oxalate(kidney stones)
 Abdominal pain, cramping, diarrhea
 Dg; fecal fat test or D-xylose absorption test, or small
bowel x-ray
Pathophysiology: Lower GI Tract
 Malabsorption - Fat – Nutrition
 Restrict fat 25-50 g/day= #1
 Use of MCT supplements- medium chain triglycerides- must
be shorted chain, body cannot activate enzymes and cab
absorbed right into the system.
 Give gut a rest
 Pancreatic enzymes
 Chrones- take before their meals
Pathophysiology: Lower GI Tract
 Malabsorption - CHO
 Lactose malabsorption
 Increased gas, abdominal cramping, diarrhea
 Restrict milk and dairy products
 Diagnosed by lactose tolerance test- breath test
 Products such as Lactaid can be rec.
Pathophysiology: Lower GI Tract
 Malabsorption - protein
 Protein-losing enteropathy- excess of protein loss
 Reduced serum protein (shows in this lab value)
 Short term uses pre albumin
 Peripheral edema- Cells cannot hold water, fluid
overloaded
Pathophysiology: Lower GI Tract
 Malabsorption - Nutrition Therapy
 Results in weight loss, loss of vit/ min
 Chronic PEM (protein energy malnutrition)
 Treat underlying disease/ nutrient being malabsorbed
 Amino acid formula
 Simple carbs
 Short chain triglycerides
Pathophysiology: Lower GI Tract
 Celiac disease
 Genetic and autoimmune
 Occurs when wheat rye barely is eaten (oats can be
contaminated as well)
 Inflammatory state that creates antibodies
 Occurs when alpha-gliadin from wheat, rye, malt, barley
are eaten
 Infiltration of WBC, production of IgA antibodies
Pathophysiology: Lower GI Tract
 Celiac disease - pathophysiology
 Damage to villi
 Decreased enzyme function
 Maldigestion and malabsorption
 Occurs with other autoimmune disorders- type 1 diabetes,
r. arthritis, psorisis
Pathophysiology: Lower GI Tract
 Celiac disease - clinical manifestations
 Bone and joint pain, mouth sores
 Diarrhea, abdominal pain, cramping, bloating, gas
 Muscle cramping, fatigue
 Skin rash
 Higher risk for lymphoma and osteoporosis
Pathophysiology: Lower GI Tract
 Celiac Disease - Diagnosis/Treatment/Prognosis
 Biopsy of small intestinal mucosa
 Reversal of symptoms following gluten-free diet
 Refractory CD; d/t coexisting disease
Pathophysiology: Lower GI Tract
 Celiac Disease - Nutrition Intervention
 Low-residue (min diarrhea), low-fat 45-50g no more, lactosefree, gluten-free diet
 Identify hidden sources of gluten
 Specialty products
 Oats controversial- no more than 1/2 cup per day
 Much easier for individuals
 So many not CD are using this diet
 Of course you lose weight, its an elimination diet (eliminating
calories), physiological effect, lose a lot of B complex/ fiber
 Make sure to supplement with B complex vitamins and get
enough fiber
 Slight change in taste
Pathophysiology: Lower GI Tract
 Irritable Bowel Syndrome (IBS)
 Abdominal pain with two of the following, to truly have
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
 Difficulty eliminating waste products
Pathophysiology: Lower GI Tract
 IBS
 Most common GI complaint difficulty eliminating - more
common in women
 Etiology unknown
 Increased serotonin, inflammatory response, abnormal
motility, pain
 Stress trauma, emotional paindepression
Pathophysiology: Lower GI Tract
 IBS - clinical manifestations
 Abdominal pain, alterations in bowel habits, gas,
flatulence
 Increased sensitivity to certain foods
 Concurrent dg
 Lactose, wheat, high fiber foods, fibormyalgia, CFS, food
allergies
Pathophysiology: Lower GI Tract
 IBS - Treatment
 Guided by symptoms
 Antidiarrheal agents
 Tricyclic antidepressants, SSRIs (selective seretonin
reuptake inhibitors (another antidepressant)
 Bulking agents, laxatives
 Behavioral therapies- to relieve stress
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
 Can lead to nutrient deficiency, underweight, or
malnourished
 Due to constant pain/ depression
 Decrease anxiety, normalize dietary patterns (for dietitian
to do)
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
 Assess diet hx (trigger foods)
 Assess nutritional adequacy
 Focus on increasing fiber intake- to 25 grams per day after
crisis state
 Adequate fluid- 2,000 cc for a 2,000 calorie diet
 Pre- and probiotics- rebuild gut flora
 Avoid foods that produce gas!!
 AND SWALLowed air- straws
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
 IBD - Nutrition Therapy]
 Antibiotics
 May require nut support, TPN
 Malnutrition
 High cal, pro, fiber regimen
 Fe, Zn, Mg, electrolytes concern (Na, K, Cl replacement)
 May need to increase kcal, protein, micronutrients
Pathophysiology: Lower GI Tract
 IBD - Nutrition Interventions
 During exacerbation- if gut works use it, Ensure,
supplement to keep GI tract function
 Supplement
 Assess energy needs + stress factor- 200-500 extra calories
per day
 May need to increase protein 1.5- 1.7 g/kg bw
 Low-residue, lactose-free diet
 Small, frequent meals- that are high calorie, high protein
 Glutamine and AGRININE decrease inflammation
Pathophysiology: Lower GI Tract
 IBD - Nutrition Interventions
 May use MCT oil (for problems with steatorrhea)
 Restrict gas-producing foods
 Increase fiber and lactose as tolerated (out of crisis stage,
up to 40 grams per day)
 Advancement of oral diet- individual basis
 Multivitamin- make sure they have one, B12, Fe, Zn, Ca, Mg,
Cu- want to make sure these are included in the MV
specifically
Pathophysiology: Lower GI Tract
 IBD - Nutrition Interventions
 During remission/rehabilitation
 Maximize energy & protein
 Weight gain and physical activity
 Food sources of antioxidants, Omega-3s
 Pro- and prebiotics- help gut flora become stronger
Pathophysiology: Lower GI Tract
 Diverticulosis/diverticulitis – abnormal presence of
outpockets or pouches on surface of SI or
colon/inflammation of these pockets
 In SI and/ or colon
 Low fiber intake- when they have it/ crisis state
(minimize)
 History of constipation
 Increases inflammatory response
 Other risks





Obese
Steroids- for other disease states
Alcohol/ caffeine
Cigarette smoking
Sedentary
Pathophysiology: Lower GI Tract
 Diverticulosis- do instruction then/diverticulitis
pathophysiology
 Fecal matter trapped
 Development of pouches
 Diverticulitis- when matter is caught- bursts, GI
bleeding, fever, abdominal pain, increased WBC
count
 Food stuff- caught, infection
 Bleeding abscess, obstruction, fistula, perforation
 Worse case scenarios
Pathophysiology: Lower GI Tract
 Diverticulosis/-itis – Treatment/ Nutrition Therapy





Specific focus on fiber- increase when not in crisis
Pro- and prebiotic supplementation- help gut flora
Acute- it is, NBO, bowel rest
Antibiotics given to help inflammation
Surgical resection
Pathophysiology: Lower GI Tract
 Diverticulosis/-itis – Nutrition Therapy
 -osis
 Avoid nuts, seeds, hulls- could get caught (may not be of a
concern, new research?)
 Fiber supplement (35 + 6 TO 10 grams) need some type of
supplement
 -itis
 Bowel rest, clear liquids
 Avoid nuts, seeds, fibrous vegetables- want low fiber if they
are able to eat at all