Lower Gastrointestinal Tract KNH 411

© 2007 Thomson - Wadsworth

Pathophysiology: Lower GI Tract Malabsorption - maldigestion of fat, CHO, Protein In diseases such as Chron’s and diverticulitis Decreased villious height, enzyme production Decreased transit time Decreased function of accessory organs

Pathophysiology: Lower GI Tract Malabsorption - fat Steatorrhea – fat travels undigested and unabsorbed 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 Kidney stones common concern

Pathophysiology: Lower GI Tract Malabsorption - Fat – Nutrition * Restrict fat g/day Use of MCT(medium chain triglycerides) supplements Pancreatic enzymes- aid fat absorption Don’t want body to have active enzymes (digest and absorb easily)

Pathophysiology: Lower GI Tract Malabsorption - CHO Lactose malabsorption Lactose tolerance test done Increased gas, abdominal cramping, diarrhea Restrict milk and dairy products Products such as Lactaid can be rec. Lactaid breaks down lactose to its simplest form

Pathophysiology: Lower GI Tract Malabsorption - protein Protein-losing enteropathy Reduced serum protein Peripheral edema – cells cannot pull in fluids

Pathophysiology: Lower GI Tract Malabsorption - Nutrition Therapy Results in weight loss Loss of vitamins, minerals, and energy Treat underlying disease/ nutrient being malabsorbed What nutrient isn’t being absorbed?

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 Type 1 diabetes

Pathophysiology: Lower GI Tract Celiac disease - clinical manifestations Sense of touch 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 No more than 45-50g of fat per day ½ cup oats max per day 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) Must have two of the following: Pain relieved with defecation Onset associated with change in frequency of stool Onset associated with change in form of stool As well as stomach pain Eliminate “red flag” symptoms

Pathophysiology: Lower GI Tract IBS Most common GI complaint Pain with defication Etiology unknown More common in women than men Increased serotonin, inflammatory response, abnormal motility, pain (not sure why)

Pathophysiology: Lower GI Tract IBS - clinical manifestations Abdominal pain, alterations in bowel habits, gas, flatulence Increased sensitivity to certain foods Concurrent dg Fibromyalgia, chronic fatigue syndrome, food allergies

Pathophysiology: Lower GI Tract IBS - Treatment Guided by symptoms Antidiarrheal agents Tricyclic antidepressants, SSRIs Bulking agents, laxatives Behavioral therapies Selective Serotonin Reuptake Inhibitors (SSRI) Relieve stress

Pathophysiology: Lower GI Tract IBS - Nutrition Therapy Can lead to nutrient deficiency, underweight Can be malnurished Decrease anxiety, normalize dietary patterns

Pathophysiology: Lower GI Tract IBS - Nutrition Therapy Assess diet hx 24 hour diet recall Assess nutritional adequacy Focus on increasing fiber intake Increase fiber once symptoms are controlled Adequate fluid Pre- and probiotics- rebuild gut flora Avoid foods that produce gas and swallowed air

© 2007 Thomson - Wadsworth

Pathophysiology: Lower GI Tract IBD - Nutrition Therapy Malnutrition May need to give nutrients through veins Iron, zinc, electrolytes, magnesium, sodium, potassium, chloride May need to increase kcal, protein, micronutrients

Pathophysiology: Lower GI Tract IBD - Nutrition Interventions “if the gut works, use it” During exacerbation Supplement Glutamine and algerine may need to be added Assess energy needs + stress factor ( ) May need to increase protein ( ) Low-residue, lactose-free diet *Small, frequent meals High calorie, high protein

Pathophysiology: Lower GI Tract IBD - Nutrition Interventions May use MCT oil Restrict gas-producing foods Increase fiber and lactose as tolerated Advancement of oral diet Multivitamin B12, iron, zinc, magnesium, copper

Pathophysiology: Lower GI Tract IBD - Nutrition Interventions Need to rebuild gut 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 Obese, sedentary lifestyle, steroids, alcohol, caffeine, smoking

Pathophysiology: Lower GI Tract Diverticulosis/diverticulitis – pathophysiology Fecal matter trapped Development of pouches Can burst, lead to infections Diverticulitis Food stuff Bleeding abscess, obstruction, fistula, perforation

Pathophysiology: Lower GI Tract Diverticulosis/-itis – Treatment/ Nutrition Therapy Specific focus on fiber Pro- and prebiotic supplementation Acute Antibiotics

Pathophysiology: Lower GI Tract Diverticulosis/-itis – Nutrition Therapy -osis – add 6-10g of fiber Avoid nuts, seeds, hulls Fiber supplement -itis –low fiber diet, consume clear liquids Bowel rest Avoid nuts, seeds, fibrous vegetables