Transcript Normally

Large Intestine
• Working knowledge of physiological
changes during disease processes &
the effects of these on nutrition care.
Large Intestine
• Calculate & interpret nutrient
composition of foods appropriate for
diets used in MNT.
• Calculate & define diets for common
conditions.
Large Intestine
• Parts of the colon
– haustra - sacculations in wall of colon,
due to the circular muscle fibers & tenia
coli
Large Intestine
• Parts of the colon
– tenia coli - three thickened bands of soft
tissue 1/4” wide & 1/6 shorter than the
colon, longitudinal fibers that go from
appendix to rectum
• Diagram of colon next
Colon
Constipation
• Infrequent and difficult passage of
stool
• Fewer than 3 stools/week while
eating high residue diet
• What is the normal time it takes food
to pass from the mouth to the anus?
Constipation Etiology
• Not defecating when the urge
happens
• Failure to establish a regular time to
defecate
• Lack of fiber in the diet
Constipation Etiology
• Insufficient fluid intake
• Loss of muscle tone in intestinal
tract
• Side effects of medications
• Lack of exercise
• Pregnancy
Constipation Nutr Care
• Fluids
• Fiber
Laxatives
• Gradual reduction of laxatives - can
become dependent
Laxatives - Stimulants
• Senna (natural)
• Bisacodyl
– stimulates nerve endings to increase
peristalsis
• Dulcolax - active ingredient is
bisacodyl
Laxatives - Bulking Agents
• What do you think are the bulking
agents?
Laxatives - Stool Softeners
• Colace
– active agent is docusafe sodium
– surface active agent
Laxatives - Prunes
• Dihydroxyphenyl isatin
– stimulates intestinal motility
Irritable Bowel Syndrome
• Cause unknown
• Exaggerated gastrocolic reflex
• Abnormal colonic sensitivity to
stretching
• Anxiety & stress
IBS
• Contributing causes
– excessive use laxatives
– excessive use caffeine
– antibiotic therapy
– irregular sleep, rest, fluid intake, bowel
movements
IBS
• Abnormal stooling pattern
associated with symptoms of
intestinal dysfunction that persists
• May be some inflammation
• Slide of what colon looks like in
irritable bowel syndrome next
Colon in irritable bowel syndrome
IBS Symptoms
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Diarrhea & constipation
Excessive flatulence
Sensation of incomplete evacuation
Rectal pain
Mucus in stools
IBS Monitoring
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Body weight
H&H
Alb
Na, K, Cl
Ca, Mg
IBS Nutritional Care
• Get over fear of eating
• Gain or maintain wt
• Acute phase
– elemental food products
– advance DAT
IBS Nutritional Care
• Chronic phase
– high fiber diet
– avoid gas forming foods
– DAT
– exclusion of caffeine & chocolate
IBS Nutritional Care
• Why the high fiber diet?
Diverticular Disease
• Diverticulosis
– collection of herniations of the colonic
wall
Diverticular Disease
• Diverticulitis
– accumulation of fecal matter in the
diverticular pockets with infection &
inflammation
Diverticular Disease
• Outpouchings results from
segmentation due to high
intracolonic pressures
• Low fiber diet
• Colon muscle weakens
• Common elderly
• Next figure of diverticula
Diverticula
Symptoms
• Diverticulitis
– pain
– bleeding
– low Hgb & Alb levels
Symptoms
• Diverticulosis
– can be asymptomatic
– pain
– constipation with diarrhea
Diverticular Monitoring
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Body wt & change
H&H
Alb
Transferrin, TIBC
Stool number & frequency
Diverticular Monitoring
• Blood pressure
• WBC (may increase)
Nutritional Care
• Get over fear of eating
• Maintain or increase body wt
• Diet lessen pain
Nutritional Care
• Diverticulitis
– bowel rest to prevent perforation
– low fiber & residue
– No nuts, seeds, fibrous veg
– DAT
Nutritional Care
• Diverticulosis
– increase stool caliber & vol
– lessen intraluminal pressure
– high fluid & fiber
Patient Education
• Fiber in foods
• Drink fluid
• Avoid constipation
Ileostomy & Colostomy
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Ulcerative colitis
Crohn’s disease
Colon cancer
Intestinal trauma
Ileostomy
• Surgical formation of an opening of
the ileum onto the surface of the
abdomen
Colostomy
• Surgical formation of an artificial
anus on the abdominal wall by
incising the colon & bringing to the
surface
Ileostomy & Colostomy
• Consistency of material in colon next
• Next slides of openings and where in
the intestinal tract
Colon
material
consistency
Ileostomy
Colostomy
• What would be the consistency of
the material for each of these
procedures?
Nutritional Care
• Avoid foods that cause odor
– corn
– dried beans
– onions
– cabbage
– highly spiced foods
Nutritional Care
• Avoid foods that cause odor
– fish
– antibiotics
– some vitamin & mineral supplements
Nutritional Care
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Avoid foods that produce flatulence
Avoid very fibrous veg
Chew food well
More fluid
More salt
• Crohn’s Disease Case study #40 - 3,
4, 5
• Diverticulosis Case study #17 - 2, 3,
4, 5, 6, 7, 8, 10, 11, 12
• Select menu high in fiber from reg
menu
• Write SOAP note
Digestion-AbsorptionMetabolism