G.I. Disorders

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Transcript G.I. Disorders

G.I. Disorders
Lower G.I. and
Irritable Bowel Syndrome
Approximately 5 million
people in the U.S. suffer
with the syndrome
 Also known as:
– Colitis
 Does not always include
– Spastic colon
 Does not always occur in the
– Not to be confused with
Ulcerative Colitis
Irritable Bowel Syndrome
Characterized by:
– Pain (duration > 3 months)
– 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
 Encourage regular bowel evacuation
 Stress and coping mechanisms
 Regular exercise
 Food diaries may help identify food
 Products that reduce intestinal gas (Bean-O)
Diverticular Disease
Diverticula – the
presence of
outpouchings in the
intestinal wall
– Diverticulum
Diverticulitis –
inflammation of
 Diverticulosis – the
presence of diverticula
Diverticular Disease
©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.
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
– Start with small amount and increase gradually
– Add whole grains, raw fruits and vegetables
 Increase
 Low
fluid intake
Medical Nutrition therapy
In both conditions, AVOID:
 Small seeds (strawberries,
 Nuts, chunky peanut butter
 Popcorn
 Corn
 Fibrous vegetables
Ulcerative Colitis
Inflammatory bowel
 Symptoms:
– Diarrhea (resulting in
– Rectal bleeding (resulting in
– Cramping, abdominal pain
– Anorexia, weight loss
Medical Nutrition therapy
 Dietary
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
– Mineral deficiencies
 Calcium, Magnesium, Zinc,
– 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
 Protein malnutrition (low serum protein levels)
 Anemia – iron, folate and Vit B12
 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
Inflammation of the
 Acute – due to organ
- Usually as a result of duct
- Enzymes become activated in
duct instead of duodenum
Alcohol abuse
 Gallstones (~45% of all
Acute Pancreatitis
Symptoms of Acute
 Sudden,
severe abdominal pain
– May be constant and disabling
 Nausea,
 Diarrhea
 Approximately
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
 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
 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
 Liberal salt use
 Encourage fluids
Medical Nutrition therapy
When body weight falls
below 85% std,
alternate feedings are
 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.
 Symptoms
- Dark urine
- Elevated liver enzymes
- Tender, enlarged liver
 Hepatitis is mainly
acute, but sometimes
– 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)
Definition: Chronic
liver failure where scar
tissue replace liver cells
and there is a
permanent loss of
 Causes: Alcohol
Biliary tract
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
– Impending coma (40 – 60 gm/day)
– Coma
 Vegetable protein and Branch Chain Amino Acid
Medical Nutrition
Drug Therapy
Sodium (2 grams)
– To limit growth of
intestinal bacteria
– To control ascites
Fluids (1.0 – 1.5
liters/ day)
– to decrease transit
– Restricted to control
 Diuretics
– To reduce fluid
 Vitamin and mineral
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
– Changes in fluid balance
Medical Nutrition therapy
– 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