Transcript Lower Gastrointestinal Tract

Lower Gastrointestinal Tract
KNH 411
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
 Malabsorption - maldigestion of fat, CHO, Protein
 Diarrhea may result
Concerned with: Celiac’s, Crohn’s, Diverticulitous
May concern accessory organs due to cancer
 Decreased villious height, enzyme production
 Decreased transit time—surgery or resecting of a certain
area may stress/compromise a part of the the GI
Pathophysiology: Lower GI Tract
 Malabsorption - fat
 Steatorrhea (excretion of abnormal quantities of fat)
 Fat-soluble vitamins malabsorbed—A,D,E,K (=diarrhea)
 Potential for excess oxalate (“kidney stones”)
 Signs/Conerns: Abdominal pain, cramping, diarrhea
 Diagnoses from: fecal fat test or D-xylose (type of sugar in
the blood/urine & tells how well body is absorbing simple
sugars) absorption test, or small bowel x-ray
Pathophysiology: Lower GI Tract
 Malabsorption - Fat – Nutrition
 1. Restrict fat 25-50 g/day (would have to write up
menu/plan)
 2. 2. Use of MCT supplements (short chain triglycerides
used; chemically made—helps absorb fat directly in the
system (enzymes won’t need to be utilized so gut doesn’t
have to work as hard yet body gets the nutrients it needs
 Elemental product
 3. Pancreatic enzymes
Pathophysiology: Lower GI Tract
 Malabsorption - CHO
 Lactose malabsorption
 Increased gas, abdominal cramping, diarrhea—similar to
signs with fat
 Restrict milk and dairy products
 Diagnosed by a lactose tolerance test
 Products such as Lactaid can be rec.
Pathophysiology: Lower GI Tract
 Malabsorption - protein
 Protein-losing enteropathy (excess protein loss)
 Reduced serum protein
 Use albumin for long term stays
 Use pre-albumin for short term (2 day turnover)
 Both aids in protein status
 Peripheral edema
 System/cells can’t hold in the water (bleeding it out) and
you’re fluid overloaded since fluids aren’t being held in their
cells
Pathophysiology: Lower GI Tract
 Malabsorption - Nutrition Therapy
 Results in weight loss
 Loss of vit/ minerals
 Protein Energy Malnutrition (PEM_
 Treat underlying disease/ nutrient being malabsorbed
 Fat: you could used a shorter chain triglycerides
 Protein: use elemental formula that has protein broken down into
simplest form
 Carbs: elemental formula with simple sugars
Pathophysiology: Lower GI Tract
 Celiac disease
 Inflammatory state that create antibodies
 Inflammation of the abdomen due to inability to break
down gluten
 Genetic and autoimmune that occurs when alphaglaten
from wheat, rye, malt, oats, or barley is eaten
 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
 Surface area compromised
 Decreased enzyme function
 Maldigestion and malabsorption
 Occurs with other autoimmune disorders
 Type 1 diabetes
 Rheumatoid arthritis
Pathophysiology: Lower GI Tract
 Celiac disease - clinical manifestations
 Sense of touch affected (something neuropathy)
 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 (clinical disease); d/t coexisting disease
Pathophysiology: Lower GI Tract
 Celiac Disease - Nutrition Intervention
 Low-residue (to minimize diarrhea), low-fat (45-50 g/day),
lactose-free, gluten-free diet (for life)
 Oats are controversial (max: ½ c./day) because of cross
contamination
 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: difficulty with
elimination
Pathophysiology: Lower GI Tract
 IBS (irritable bowel syndrome)
 Most common GI complaint: pain with defication
 More common in women than men
 Etiology unknown in most cases
 Increased serotonin, inflammatory response, abnormal GI
motility, pain
 Stressed, anxiety , depression, emotional trauma can trigger
IBS (if predisposed)
Pathophysiology: Lower GI Tract
 IBS - clinical manifestations
 Abdominal pain, alterations in bowel habits, gas,
flatulence
 Increased sensitivity to certain foods (lactose, wheat, high
fiber foods specifically)
 Concurrent dg: fibro mialga, chronic fatigue syndrome,
food allergies
Pathophysiology: Lower GI Tract
 IBS - Treatment
 Guided by symptoms
 Antidiarrheal agents
 Tricyclic antidepressants, SSRIs (selected serotonin
reuptake inhibitors—another depressant)
 Bulking agents, laxatives
 Behavioral therapies (to help relieve the stress)
 Antidepressents
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
 Can lead to nutrient deficiency, underweight or
malnourished due to constant pain or depression
 Decrease anxiety which leads to normalize dietary
patterns: depressed or GI discomfort state
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
 Assess diet hx (what foods trigger?)
 Assess nutritional adequacy (24-hr. recall, access
macro./micro nutrients)
 Focus on increasing fiber intake (25 g/day)
 Adequate fluid (to help with GI motility; 2,000 cc’s/kcal)
 Pre- and probiotics (trying to rebuild the gut flora)
 Avoid foods that produce gas & straws (swallowed air)
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
 IBD - Nutrition Therapy
 Malnutrition: those who can eat: high calorie, protein,
fiber regiment
 Look at micronutrients Iron, Zinc, Magnesium,
Electrolytes—Na, K, Cl—replaced because of fluid loss
 May need to increase kcal, protein, micronutrients
Pathophysiology: Lower GI Tract
 IBD - Nutrition Interventions
 During exacerbation
 Supplement (use enteral products such as Ensure to keep
GI functioning)
 Supplement (glutamine, argenine help glutamine, argenine
help decrease inflammation
 Assess energy needs + stress factor (200-500 extra
calories/day)
 May need to increase protein (1.5-1.7 g/kilo)
 Low-residue, lactose-free diet
 Small, frequent meals that are high calorie, high protein
(key!)
Pathophysiology: Lower GI Tract
 IBD - Nutrition Interventions
 May use MCT oil (if problems with steatorrhea)
 Restrict gas-producing foods
 Increase fiber and lactose as tolerated once they’ve
stabilized and out of crises stage –individual bases
 Advancement of oral diet –individual basis
 Multivitamin (make sure patient has these; B12, Iron, zinc,
calcium, magnesium, copper need to be present,
specifically)
Pathophysiology: Lower GI Tract
 IBD - Nutrition Interventions
 During remission/rehabilitation
 Maximize energy & protein
 Weight gain and physical activity
 Food sources of antioxidants, Omega-3s specifically
 Pro- and prebiotics (to keep flora)
Pathophysiology: Lower GI Tract
 Diverticulosis—when inflammed/diverticulitis –
abnormal presence of outpockets or pouches on surface
of SI or colon/inflammation of these
 Low fiber intake (concern during crises); history of
constipation
 Increases inflammatory response
 Other risks: obesity, sedentary lifestyle, on steroids for
other health concerns, high alcohol/caffeine intake,
history of smoking
Pathophysiology: Lower GI Tract
 Diverticulosis/diverticulitis – pathophysiology
 Fecal matter trapped creates excessive pressure
against wall of colon and how pouches are developed
 Development of pouches
 Diverticulitis—inflammation of those pouches and
concern is they could burst
 Food stuff
 Bleeding abscess, obstruction, fistula (bleeding area
of the gut & need resection, perforation
Pathophysiology: Lower GI Tract
 Diverticulosis/-itis – Treatment/ Nutrition Therapy
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Specific focus on fiber
Pro- and prebiotic supplementation (to increase gut flora)
Acute
Antibiotics
Pathophysiology: Lower GI Tract
 Diverticulosis/-itis – Nutrition Therapy
 -osis
 Avoid nuts, seeds, hulls (? May not get trapped in the pouch
so may not be of concern)
 Fiber supplement ( in order to reach 40 g per day)
 -itis
 Low fiber diet (area is inflamed and you don’t want to
exacerbate it)
 Bowel rest (may be on clear liquids)
 Avoid nuts, seeds, fibrous vegetables (because of fiber
content not their shape)