Transcript G.I. Disorders

G.I. Disorders
Lower G.I. and
accessory
organs
Irritable Bowel Syndrome
Approximately 5 million
people in the U.S. suffer
with the syndrome
 Also known as:

– Colitis
 Does not always include
inflammation
– Spastic colon
 Does not always occur in the
Colon
– Not to be confused with
Ulcerative Colitis
Irritable Bowel Syndrome

Characterized by:
– Pain (duration > 3 months)

Symptoms
– Diarrhea, constipation or alternating episodes
of both
– Flatulence, bloating,
– Indigestion, belching, heartburn, nausea
– Mucus in the stool
Irritable Bowel Syndrome

Medical Nutrition Therapy
– Elemental diet, for persons with acute IBS
– Low fat Diet, with liberal fruits and veggies
 Soluble fiber
– Avoid milk (lactose intolerance common)
– Liberal lactose free liquids
– Avoid spicy foods
– Avoid gas-forming foods
– Avoid caffeine, alcohol, sorbitol
Client Education
Vitamin B-complex supplement may be
necessary
 Encourage regular bowel evacuation
 Stress and coping mechanisms
 Regular exercise
 Food diaries may help identify food
sensitivities
 Products that reduce intestinal gas (Bean-O)

Diverticular Disease

Diverticula – the
presence of
outpouchings in the
intestinal wall
– Diverticulum
Diverticulitis –
inflammation of
diverticula
 Diverticulosis – the
presence of diverticula

Diverticular Disease
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Medical Nutrition therapy
 Diverticulitis (Inflamed state)
Bowel rest – NPO (nil per os)
 Clear liquids
 Progress to Soft, Low fat diet
 No excess spices or fiber
 Gradually progress to normal fiber intake
as inflammation decreases

Medical Nutrition therapy
 Diverticulosis
(Convalescent state)
 High fiber - >30grams per day
desirable
– Start with small amount and increase gradually
– Add whole grains, raw fruits and vegetables
 Increase
 Low
fat
fluid intake
Medical Nutrition therapy
In both conditions, AVOID:
 Small seeds (strawberries,
poppy)
 Nuts, chunky peanut butter
 Popcorn
 Corn
 Fibrous vegetables

Ulcerative Colitis
Inflammatory bowel
disease
 Symptoms:

– Diarrhea (resulting in
malabsorption)
– Rectal bleeding (resulting in
anemia)
– Cramping, abdominal pain
– Anorexia, weight loss
Medical Nutrition therapy
 Dietary
disease
interventions do not lessen
– Low fiber
– Lactose free
– Vitamin and mineral supplementation
Regional Enteritis (Crohn’s)
Inflammation and ulceration
of the G.I. tract.
 Nutrition consequences
– Protein malnutrition
 hypoalbuminemia
– Vitamin deficiencies
 Vitamin B12, Folate, C and fat
solubles
– Mineral deficiencies
 Calcium, Magnesium, Zinc,
Iron
– Anemia
Medical Nutrition therapy
High kcal,
 High protein, (1-1.5g/kg)
 Fat restricted (if steatorrhea is present)
 Low fiber
 Vitamin and mineral supplementation
 Avoid foods not well tolerated (i.e. lactose)
 Small, frequent meals recommended

Celiac Disease
Also known as Celiac Sprue
 Inflammatory condition of the G.I. tract that
affects the small intestines.
 Malabsorption due to a sensitivity to Gliadin
 Gliadin = part of the protein Gluten found in:
wheat, buckwheat, Rye, barley
Oats (can usually be taken in small amounts)

Celiac Disease
Consequences
 Protein malnutrition (low serum protein levels)
 Anemia – iron, folate and Vit B12
deficiency
 Steatorrhea, diarrhea (resulting in weight loss)
 Calcium deficiency (resulting in bone pain)
 Vitamin and mineral deficiencies (fat soluble
vitamins lost with steatorrhea)
Medical Nutrition therapy

Gliadin-free/ gluten restricted diet
– No wheat, buckwheat, rye,barley
– Small amount of oats (may be contaminated with
wheat during processing)
May have: corn, rice, tapioca, potato,
arrowroot, cassava (yuca) gluten-free flour
 Lactose restricted
 Vitamin and mineral supplementation

Accessory
Organs
Pancreatitis
Inflammation of the
Pancreas
 Acute – due to organ
autodigestion
- Usually as a result of duct
obstruction

- Enzymes become activated in
duct instead of duodenum
Alcohol abuse
 Gallstones (~45% of all
cases)

Acute Pancreatitis
Symptoms of Acute
Pancreatitis
 Sudden,
severe abdominal pain
– May be constant and disabling
 Nausea,
vomiting
 Diarrhea
 Approximately
pancreatitis
25% develop chronic
Medical Nutrition therapy
NPO with IV feedings ~ 48 hours
 Jejunostomy feedings if longer

Clear liquid progress to Low fat diet
 Provide pancreatic enzyme replacement
 Small frequent meals
 No alcohol, caffeine

Chronic Pancreatitis
Fibrotic, necrotic disease
where cells suffer
permanent damage.
 Decreased enzyme
production
 Nausea, vomiting,
abdominal pain
 Most common cause is
alcohol abuse (~70%)
 Other causes: pancreatic
cancer, Cystic Fibrosis

Medical Nutrition therapy

High calorie, semi-elemental tube feeding
Low fat, high calorie, moderate protein
 Low fiber
 Six small meals
 No alcohol, caffeine or gastric stimulants
 Vitamin and mineral supplementation

Cystic Fibrosis
Consequences
 Pancreatic insufficiency (80-90%)
– May require enzyme replacement, insulin

Chronic lung disease
– Lung infections – major cause of death
Growth retardation (85%)
 Decreased bone density
 Abnormally high electrolytes in sweat

Medical Nutrition therapy

High kcal, high protein
– 20 – 50% above
normal needs

Pancreatic enzymes
– To control steatorrhea
Multivitamin
supplementation
 Liberal salt use
 Encourage fluids

Medical Nutrition therapy
When body weight falls
below 85% std,
alternate feedings are
indicated.
 Infant feeding:

– Enzyme replacement
with breast feeding
– Up to ¼ tsp salt daily
given to replace losses
Liver: Hepatitis
Definition: Inflammation of the Liver
 5 types
 Hepatitis A associated with food/water
contamination – highly contagious.

Hepatitis
 Symptoms
Jaundice
- Dark urine
- Elevated liver enzymes
- Tender, enlarged liver
 Hepatitis is mainly
acute, but sometimes
chronic
– May lead to cancer,
liver failure, hepatic
coma, death
-
Medical Nutrition Therapy
Regular diet
 High protein, high kcal (if malnourished)
 Small, frequent feedings

– Anorexia, nausea is common

Nutritional supplement (Ensure, Boost)
Cirrhosis
Definition: Chronic
liver failure where scar
tissue replace liver cells
and there is a
permanent loss of
function.
 Causes: Alcohol
abuse
Biliary tract
obstruction
Infection

Consequence of Cirrhosis
Portal hypertension
 Esophageal varices
 Ascites
 Elevated blood Ammonia levels

Hepatic Coma
Changes in judgment, mood, personality
 Sweet, musky or pungent (fecal) odor
 Flapping tremor of outstretched hand

Medical Nutrition Therapy

Energy: adequate carbohydrate and fat to
spare protein (35-45kcal/kg BW)

Protein (1.0 – 1.5 gm/kg BW)
– Enough to regenerate cells, but not increase
ammonia
– Impending coma (40 – 60 gm/day)
– Coma
 Vegetable protein and Branch Chain Amino Acid
Medical Nutrition
Therapy
Drug Therapy


Sodium (2 grams)
– To limit growth of
intestinal bacteria
– To control ascites

Fluids (1.0 – 1.5
liters/ day)
Antibiotics

Laxatives
– to decrease transit
time
– Restricted to control
 Diuretics
ascites
– To reduce fluid
 Vitamin and mineral
retention
Cholelithiasis
Gallstones: solid masses that form in the
gallbladder from bile
 Bile: fat emulsifier produced in the liver and
stored in the gallbladder
 Gallstones are:

– Cholesterol stones
– Pigment stones
Risk Factors
Body weight (obesity)
 Gender (female)
 Age (~40 yrs)
 Ethnicity
 Type II diabetes
 Short bowel syndrome, gastric bypass
 Certain medications

Medical Nutrition Therapy

Low fat
– Weight reduction if appropriate

High fiber
– Soluble fibers bind bile acids

Avoid gas formers
– Prevent distention

Water-based fat soluble vitamins
Renal Diseases:
Nephrotic Syndrome
Definition: Cluster of symptoms which
result in protein in the urine (albuminuria)
 Consequences:

– Protein calorie malnutrition
– Anemia
– Infection
– Atherosclerosis
 For unknown reasons, blood lipid levels rise
Medical Nutrition Therapy
Adequate non-protein calories
 Normal protein intake (0.8 – 1.0 gm/kg)
 Low saturated fat/ low cholesterol
 Sodium restriction (~2 grams)

Renal Failure
Definition: Loss of the
kidney’s ability to function
 May be acute or chronic
 Consequences:

– Uremia (azotemia)
– Electrolyte imbalance
(Hyperkalemia)
– Changes in fluid balance
Medical Nutrition therapy

Consider:
– Energy needs (non-protein kcalories)
– Protein restriction
 Depending on kidney function
– Electrolyte restriction`
 Sodium, potassium, phosphorus
– Fluid restriction
 Monitor intake and output
– Supplements
 Calcium, folate, Vitamin B6, Vitamin D
Renal Calculi (kidney stones)

Calcium stones (>75%)
– Causes: Hypercalciuria (idiopathic)
– Immobilization
– hyperoxaluria

Medical Nutrition Therapy
– Calcium management
– Increased fluids
– Limit oxalate intake
Renal Calculi (kidney stones)

Uric Acid Stones
– Common in gout

Medical Nutrition Therapy
– Low Purine diet
– Increase fluids

Cystine stones
– Genetically linked

Medical Nutrition Therapy
– Low Methionine diet
– Increased fluids