Transcript Lower Gastrointestinal Tract - Jacqueline Farralls Portfolio

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 resecting of that area; surgery
Pathophysiology: Lower GI Tract
 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
Pathophysiology: Lower GI Tract
 Malabsorption - Fat – Nutrition
 Restrict fat 25-50 g/day
 Use of MCT supplements
 Pancreatic enzymes individuals who have chronnes will
be taking pancreatic enzymes before their meals
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
 Reduced serum protein lab value you would be looking at
 Peripheral edema system or cells can not hold in the
water
Pathophysiology: Lower GI Tract
 Malabsorption - Nutrition Therapy
 Results in weight loss
 Treat underlying disease/ nutrient being malabsorbed
Pathophysiology: Lower GI Tract
 Celiac disease
 Genetic and autoimmune
 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
Pathophysiology: Lower GI Tract
 Celiac disease - clinical manifestations
 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, low-fat, lactose-free, gluten-free diet
 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
 Eliminate “red flag” symptoms
Pathophysiology: Lower GI Tract
 IBS
 Most common GI complaint
 Etiology unknown
 Increased serotonin, inflammatory response, abnormal
motility, pain they do not know why this is
Pathophysiology: Lower GI Tract
 IBS - clinical manifestations
 Abdominal pain, alterations in bowel habits, gas,
flatulence
 Increased sensitivity to certain foods lactose, wheat and
other diet foods
 Concurrent dg
Pathophysiology: Lower GI Tract
 IBS - Treatment
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Guided by symptoms
Antidiarrheal agents
Tricyclic antidepressants, SSRIs
Bulking agents, laxatives
Behavioral therapies
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
 Can lead to nutrient deficiency, underweight
 Decrease anxiety, normalize dietary patterns
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
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Assess diet hx what is triggering the IBS concerns
Assess nutritional adequacy 24 hours recall
Focus on increasing fiber intake 25 grams per day
Adequate fluid help with GI motility
Pre- and probiotics
Avoid foods that produce gas and swallowed air, for
example the use of straws
© 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
 Supplement
 Assess energy needs + stress factor increase any 200-500
calories per day
 May need to increase protein 1.5-1.7 g per kilo
 Low-residue, lactose-free diet
 Small, frequent meals
Pathophysiology: Lower GI Tract
 IBD - Nutrition Interventions
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May use MCT oil
Restrict gas-producing foods
Increase fiber and lactose as tolerated if not in crisis
Advancement of oral diet individual basis
Multivitamin want them to have one. B12 iron zinc calcium
magnesium and copper are all the ones that are included in
your vitamin
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
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
 Food stuff
 Bleeding abscess, obstruction, fistula, perforation
Pathophysiology: Lower GI Tract
 Diverticulosis/-itis – Treatment/ Nutrition Therapy
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Specific focus on fiber
Pro- and prebiotic supplementation
Acute
Antibiotics
Pathophysiology: Lower GI Tract
 Diverticulosis/-itis – Nutrition Therapy
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-osis
Avoid nuts, seeds, hulls
Fiber supplement
-itis
Bowel rest
Avoid nuts, seeds, fibrous vegetables