uploads/1/5/4/6/15466770 - Professional Portfolio Jessica Leis
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Transcript uploads/1/5/4/6/15466770 - Professional Portfolio Jessica Leis
Lower Gastrointestinal Tract
KNH 411
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
Malabsorption - maldigestion of fat, CHO, Protein
Decreased villious height, enzyme production
Disfunction of accessory organ (pancreas, etc)
Decreased transit time (with surgery)
Resection of area
Pathophysiology: Lower GI Tract
Malabsorption - fat
Steatorrhea
Fat-soluble vitamins malabsorbed
Potential for excess oxalate (kidney stones)
Abdominal pain, cramping, diarrhea
Dg; fecal fat test or D-xylose (type of sugar – tells how well
body is absorbing simple sugars) absorption test, or small
bowel x-ray
Pathophysiology: Lower GI Tract
Malabsorption - Fat – Nutrition
Restrict fat 25-50 g/day
Use of MCT (medium chain triglycerides) supplements
Pancreatic enzymes (before meals to aid with absorption)
Pathophysiology: Lower GI Tract
Malabsorption - CHO
Lactose malabsorption
Increased gas, abdominal cramping, diarrhea
Restrict milk and dairy products
Products such as Lactaid can be rec.
Pathophysiology: Lower GI Tract
Malabsorption - protein
Protein-losing enteropathy excessive PRO loss
Reduced serum protein
Peripheral edema cells cannot hold in water (fluid
overload)
Pathophysiology: Lower GI Tract
Malabsorption - Nutrition Therapy
Results in weight loss
Loss of vitamins and minerals
Treat underlying disease/ nutrient being malabsorbed
Chronic Protein Energy malnutrition (PEM)
Pathophysiology: Lower GI Tract
Celiac disease -damage to intestinal tract
Genetic and autoimmune
Occurs when alpha-gliadin from wheat, rye, malt, barley
(and oats – tolerable by some) are eaten
Infiltration of WBC, production of IgA antibodies
Pathophysiology: Lower GI Tract
Celiac disease - pathophysiology
Damage to villi (reduced height/flattened)
Surface area is comprised
Decreased enzyme function
Maldigestion and malabsorption
Occurs with other autoimmune disorders
Pathophysiology: Lower GI Tract
Celiac disease - clinical manifestations
Diarrhea, abdominal pain, cramping, bloating, gas
Bone and joint pain
Muscle cramping, fatigue
Skin rash
Higher risk for lymphoma and osteoporosis
Mouth ulcerations
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, low-fat, lactose-free, gluten-free diet
(minimize diarrhea)
No more than 45-50 grams of fat/day
Identify hidden sources of gluten
Specialty products
Pathophysiology: Lower GI Tract
Irritable Bowel Syndrome (IBS)
Pain relieved with defecation
Onset associated with change in frequency of stool
Onset associated with change in form of stool
Elimination “red flag” symptoms
Pathophysiology: Lower GI Tract
IBS
Most common GI complaint – pain with defecation
More common in women
Etiology unknown
Increased serotonin, inflammatory response, abnormal
motility, pain
Pathophysiology: Lower GI Tract
IBS - clinical manifestations
Abdominal pain, alterations in bowel habits, gas,
flatulence
Increased sensitivity to certain foods
Wheat, high fiber, lactose
Concurrent dg
Fibermyalgia
Chronic fatigue syndrome
Food allergies
Pathophysiology: Lower GI Tract
IBS - Treatment
Guided by symptoms
Antidiarrheal agents
Tricyclic antidepressants, SSRIs (selective serotonin
reputake inhibitors – antidepressant)
Bulking agents, laxatives (during constipation)
Behavioral therapies
Relieve stress
Pathophysiology: Lower GI Tract
IBS - Nutrition Therapy
Can lead to nutrient deficiency, underweight/malnourished
Decrease anxiety, normalize dietary patterns
Pathophysiology: Lower GI Tract
IBS - Nutrition Therapy
Assess diet hx – what are triggering the concerns?
Assess nutritional adequacy – 24 hour recall/assess macro
and micronutrient intake
Focus on increasing fiber intake – 25 grams per day
Adequate fluid – to help with motility (25 cc/kcal [250 cc
per cup])
Pre- and probiotics – rebuild gut flora
Avoid foods that produce gas – beans, cabbage, etc.
Eliminate use of straws (swallowed air)
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
IBD - Nutrition Therapy
Malnutrition
May need to increase kcal, protein, micronutrients
Pathophysiology: Lower GI Tract
IBD - Nutrition Interventions
During exacerbation – use enteral products (Ensure)
Supplement – glutamine, arginine (decreasing
inflammation; need higher levels during crisis)
Assess energy needs + stress factor
May need to increase protein (1.5 to 1.7 g/kilo)
Low-residue, lactose-free diet
Small, frequent meals** (high calorie, high protein)
As much nutrition as you can in small amounts throughout the
day
Pathophysiology: Lower GI Tract
IBD - Nutrition Interventions
May use MCT oil
Restrict gas-producing foods
Increase fiber and lactose as tolerated
Advancement of oral diet
Multivitamin
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 (gut flora)
Pathophysiology: Lower GI Tract
Diverticulosis/diverticulitis – abnormal presence of
outpockets or pouches on surface of SI or
colon/inflammation of these
Low fiber intake
Increases inflammatory response
Other risks
Pathophysiology: Lower GI Tract
Diverticulosis/diverticulitis – pathophysiology
Fecal matter trapped
Development of pouches
Diverticulitis – possibility that they will burts (GI
bleeding)
Food stuff getting caught, resulting in infection
because of bacteria
Bleeding abscess, obstruction, fistula, perforation
Pathophysiology: Lower GI Tract
Diverticulosis/-itis – Treatment/ Nutrition Therapy
Specific focus on fiber
Pro- and prebiotic supplementation
Acute
Antibiotics
Pathophysiology: Lower GI Tract
Diverticulosis/-itis – Nutrition Therapy
-osis
Avoid nuts, seeds, hulls?
Fiber supplement
-itis
Bowel rest
Avoid nuts, seeds, fibrous vegetables
Low fiber because of inflammation (do not want to
exacerbate it)