Transcript Lower GI
Chapter 18 Nutrition and Lower Gastrointestinal Disorders © 2007 Thomson - Wadsworth Common Problems of the Lower Intestine • Constipation • Intestinal Gas • Diarrhea • Bacterial Overgrowth • Steatorrhea © 2007 Thomson - Wadsworth Constipation • Difficult or infrequent stools • More prevalent among women • Increases with age • Correlates with • Medical conditions Low food intake Low-fiber diets Inactivity • Some medications & dietary supplements Hypothyroidism Diabetes mellitus Chronic renal failure Parkinson’s Spinal cord lesions MS © 2007 Thomson - Wadsworth Treatment • Gradual increase in fiber Wheat bran Fruits (prunes) Vegetables • • • • Adequate fluid Daily exercise Laxatives Medical intervention © 2007 Thomson - Wadsworth Intestinal Gas • Causes • Other causes High-fiber diets Carbohydrates • Fructose • Sugar alcohols (sorbitol, mannitol, maltitol) • Beans • Some grains & potatoes Malabsorption problems Swallowed air © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Diarrhea • Frequent, watery • Acute diarrhea stools Infection Certain medications • If severe, can cause dehydration & • Chronic diarrhea electrolyte imbalances Altered GI motility Intestinal inflammation • Types Osmotic diarrhea Motility disorders Secretory diarrhea Malabsorptive & endocrine disorders Infectious diseases Radiation treatment Others © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Bacterial Overgrowth • Gastric acid protects stomach & intestine from bacterial overgrowth • Overgrowth • Symptoms Chronic diarrhea Abdominal discomfort Bloating Weakness Weight loss Disrupts fat digestion & • Causes absorption Impaired intestinal May develop fat-soluble motility vitamin & vitamin B12 Reduced gastric acid deficiencies secretions © 2007 Thomson - Wadsworth Steatorrhea • Excessive fat in stool • Causes Reduced availability of bile Reduced availability of pancreatic lipase Fat malabsorption • May need a fatrestricted diet • Consequences of fat malabsorption Loss of food energy Loss of essential fatty acids Loss of fat-soluble vitamins Decreased absorption of calcium, magnesium, & zinc • Increased risk of kidney stones © 2007 Thomson - Wadsworth Malabsorption Syndromes • Lactose Intolerance • Pancreatitis • Cystic Fibrosis • Celiac Disease • Inflammatory Bowel Diseases • Short-Bowel Syndrome © 2007 Thomson - Wadsworth Lactose Intolerance • Loss or reduction of enzyme lactase that digests lactose in milk products • Prevalent among certain ethnic groups • Symptoms: diarrhea & intestinal gas • Diet Milk: usually 2 cups/day divided & consumed with food is tolerated Chocolate milk Aged cheese Yogurt with live bacterial cultures Lactose-free milk • Can take enzyme tablets before consuming dairy © 2007 Thomson - Wadsworth Pancreatitis • Pancreatic tissue is • Chronic destroyed by activated Permanent damage to tissue enzymes 70% alcohol induced • Severe abdominal pain Food avoidance & • Acute Causes: gallstones, excessive alcohol, high triglycerides, toxins Withhold food & fluids © 2007 Thomson - Wadsworth malabsorption lead to weight loss & malnutrition Cystic Fibrosis • Unusually viscous exocrine secretions • Complications involve lungs, pancreas, sweat glands Respiratory infections Malabsorption of protein, fat, & fat-soluble vitamins Salt losses in sweat • Nutrition therapy Children may need 120-150% of normal energy needs High-kcalorie, high-fat foods Frequent meals & snacks Pancreatic enzyme replacement Liberal use of table salt © 2007 Thomson - Wadsworth Celiac Disease • Abnormal immune response to a protein fraction • Need a gluten-free diet for life Wheat Barley Rye Oats Rice is allowed • Check food labels carefully • Symptoms Diarrhea, steatorrhea, flatulence • Consequences Severe damage to intestinal mucosa Malabsorption Children: stunted growth & underweight © 2007 Thomson - Wadsworth Inflammatory Bowel Diseases • Chronic inflammatory conditions • Genetic & environmental factors contribute • Exact triggers are unknown • Crohn’s disease & ulcerative colitis © 2007 Thomson - Wadsworth Crohn’s Disease • Can occur in any region of the GI tract • Ulcerations, fissures, & fistulas • Thick scar tissue may cause obstructions • Malnutrition from reduced intake, malabsorption, & surgical resections © 2007 Thomson - Wadsworth Healthy colon (left) vs. Crohn’s disease (right) © 2007 Thomson - Wadsworth Ulcerative Colitis • Only affects the rectum & colon • Frequent urgent bowel movements • Nutrient losses due to tissue damage, bleeding, & diarrhea • Complications Weight loss Fever Weakness Anemia Dehydration Electrolyte imbalance Protein losses • Colectomy prevents future occurrences © 2007 Thomson - Wadsworth Healthy colon (left) vs. ulcerative colitis (right) © 2007 Thomson - Wadsworth Treatment for Inflammatory Bowel Diseases • Drugs Antidiarrheals Immunosuppressants Anti-inflammatory agents • Nutrition therapy for Crohn’s Highly variable High-kcalorie, highprotein Liquid supplements Multivitamin • Nutrition therapy for colitis May require few adjustments Restore fluids & electrolytes Low fiber or withhold food during severe illness © 2007 Thomson - Wadsworth Short-Bowel Syndrome • Can be the consequence of small intestine resections • Diet About 50% can be removed without serious nutritional consequences Intestine undergoes adaptation to improve absorptive capacity Small, frequent meals Low fat, lactose restricted High carbohydrate Vitamin & mineral supplements • At risk for kidney stones © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Disorders of the Large Intestine • Irritable Bowel Syndrome • Diverticular Disease of the Colon • Ostomies • Large intestine Moves undigested materials to the rectum Helps maintain fluid & electrolyte balance Bacteria ferment undigested materials © 2007 Thomson - Wadsworth Irritable Bowel Syndrome • Chronic & recurring intestinal symptoms Diarrhea & constipation Flatulence, bloating, & distention • More common in women • Excessive colonic response to meals, GI hormones, & stress • Medicine Antidiarrheal agents Anticholinergics Antidepressants Laxatives • Diet Increase fiber Limit caffeine, alcohol, fat, & milk products Small, frequent meals © 2007 Thomson - Wadsworth Diverticular Disease • Presence of pebblesized outpockets in intestinal wall • Prevalence increases with age • High-fiber diet can be preventative • May need to avoid nuts, popcorn, & food with seeds © 2007 Thomson - Wadsworth Diverticulitis • Inflammation or infection • Most common complication of diverticulosis • Symptoms Persistent abdominal pain Fever Alternating constipation & diarrhea • Treatment Antibiotics, pain medication Clear liquid or bowel rest Surgery © 2007 Thomson - Wadsworth Ostomies • Surgical removal • Chew food thoroughly of some or all of to prevent obstructions large intestine • Foods cause unpleasant • Wastes exit odors through a stoma Fish, eggs, dried beans & in abdominal wall peas, onions, garlic, • Colostomy & beer, others ileostomy • Foods that reduce odors • Temporary or Buttermilk, cranberry permanent juice, parsley, yogurt © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth