1. Lower Gastrointestinal Tract
KNH 411

3. Peptides: stimulates insulin
Motilin: between meals, triggering the hypothalamus
© 2007 Thomson - Wadsworth

4. As a dietitian you need to know what nutrients will be affected by certain areas of the GI not working.
Duodenum: fat soluble vitamins
Jejunum: vitamin B6
Vitamin C, K, B12- ileum
If the gut works use it: even if you have a small portion of the gut you don’t want to loose it! You don’t want it to atrophy
Premes: even with TPN feeding in babies, they would put one drop of mothers milk to keep the flora going in the gut and maintaining some function in the gut
*there are a lot of complications with feeding long term TPN especially at a young age

5. Looking at segmentation and sacs
Wherehouse or housing area for waste products for hours
Vitamin K is in the large intestine

6. Pathophysiology: Lower GI Tract
Malabsorption - maldigestion of fat, CHO, Protein
Celiac disease, diverticulitus, chrons disease can be casued by
Decreased villious height, enzyme production
Unproper working of an accessory organ (Pancrease, liver) cancer
Decreased transit time
Diarrhea
Constipaton
Decreased transit time with surgery

7. Pathophysiology: Lower GI Tract
Malabsorption - fat
Steatorrhea: loose lipid fatty stools
Fat-soluble vitamins malabsorbed: ADEK
Potential for excess oxalate: kidney stones
Abdominal pain, cramping, diarrhea
Dg; fecal fat test or
D-xylose absorption test- to test how well the body is absorbing simple sugars (depends on the length of the compromised GI tract)
or small bowel x-ray

8. Pathophysiology: Lower GI Tract
Malabsorption - Fat – Nutrition
Restrict fat g/day
Use of MCT supplements
Pancreatic enzymes
Basic prescriptions
limit intake of fat
Other ways with infants
medium chain fatty acids– often chemically made
you want to make it so that the body doesn’t have to activate enzymes (elemental product– gives the gut the rest that it needs but gives the body the nutrients it needs)
Chrons disease
may be taking pancreatic enzymes before there meals

9. Pathophysiology: Lower GI Tract
Malabsorption - CHO
Lactose malabsorption
Increased gas, abdominal cramping, diarrhea
Restrict milk and dairy products
Products such as Lactaid can be rec.
Diagnosed by a lactose tolerance test
Lactaid- is an aid that helps break down lactose into its smallest form

10. Pathophysiology: Lower GI Tract
Malabsorption - protein
Protein-losing enteropathy
Reduced serum protein
Peripheral edema
Cells can not hold in the water
Fluid is overloaded because your system is not holding fluid within the cells
Albuminin has a 21 day half life: easy to use as a serum marker
Pre albumin has a 2 day half life: a really good marker for short term protein status for the patient
Extreme signs: perip

11. Pathophysiology: Lower GI Tract
Malabsorption - Nutrition Therapy
Results in weight loss
Loss of vitamins and minerals
Difficencys
Chronic PEM (protein Energy Malnutrition)
Treat underlying disease/ nutrient being malabsorbed
What nutrient is being malabsorbed and what can you do to treat that specifically
Patients with carb malapsorptions
Once villi is trampled those with celiac disease may have problems with carb malabsorption
Chronic Diabetes
Gastroporesis
Blood glucose is uncontrolled, they are swimming in sugar water
Alcoholic
Serious nutrient loss
f blood glucose is unctrolled they are swimming in sugar water

12. Pathophysiology: Lower GI Tract
Celiac disease
Damage to the intestinal mucosa
Genetic and autoimmune disease
Occurs when alpha-gliadin from wheat, rye, malt, barley are eaten
Looking at an inflammatory state that creates antibodies
Some can handle small amounts of oats
New onset patients you have to rebuild and you want to start off really slow by being very easy on the gut- removing as many irritants as possible
Infiltration of WBC, production of IgA antibodies

13. Pathophysiology: Lower GI Tract
Celiac disease - pathophysiology
Damage to villi
Reduced height as well as being flattened
Decreased enzyme function
Maldigestion and malabsorption
Occurs with other autoimmune disorders
Type 1 diabetes seen in conjunction with celiac disease

15. Pathophysiology: Lower GI Tract
Celiac disease - clinical manifestations
Peripheral neurothopy-sense of touch
Bone and join
Diarrhea, abdominal pain, cramping, bloating, gas
Muscle cramping, fatigue
Skin rash
Higher risk for lymphoma and osteoporosis

16. Pathophysiology: Lower GI Tract
Celiac Disease - Diagnosis/Treatment/Prognosis
Biopsy of small intestinal mucosa
Or individuals will eliminate gluten and then follow through with a gluten free plan
Reversal of symptoms following gluten-free diet
Refractory CD; d/t coexisting disease

17. Pathophysiology: Lower GI Tract
Celiac Disease - Nutrition Intervention
Low-residue: to minimize diarrhea
low-fat no more than g per day
lactose-free
gluten-free diet
Oats are controversial maximum amount is ½ cup a day
Identify hidden sources of gluten
Specialty products

19. Pathophysiology: Lower GI Tract
Irritable Bowel Syndrome (IBS)
Medical diagnosis : Abdominal pain that has to have at least 2 of the following
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 eliminating waste products

20. Pathophysiology: Lower GI Tract
IBS
Most common GI complaint
Pain with defecation
More common in women than men
Etiology unknown
Usually Increased serotonin, inflammatory response, abnormal motility, pain in these individuals
Stess, anxiety, emotional trauma are all more common in these individuals

21. 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

22. Pathophysiology: Lower GI Tract
IBS - Treatment
Guided by symptoms
Antidiarrheal agents
Tricyclic antidepressants, SSRIs
Bulking agents, laxatives
Behavioral therapies

23. Pathophysiology: Lower GI Tract
IBS - Nutrition Therapy
Can lead to nutrient deficiency, underweight, malnurited
Decrease anxiety and depression
Goal is to normalize dietary patterns

24. Pathophysiology: Lower GI Tract
IBS - Nutrition Therapy
Assess diet hx
Assess nutritional adequacy: 24 hr recall assess what is going on with macro nutrients and micro nutrients
Focus on increasing fiber intake: increase to 25 g per day
Adequate fluid: to try to help with GI motility 25 cc per kcal
Pre- and probiotics: trying to rebuild that gut flora and the damage that has been done from that inflammation
Avoid foods that produce gas and swallowed air
Eliminate use of staws

27. Smaller for frequent feedings
Avoiding fried foods
Adress drug
© 2007 Thomson - Wadsworth

29. Hematochezia: blood in stool
Temp: 99.5 F
Racing pulse with severity
Trying to measure or quantify inflammation
© 2007 Thomson - Wadsworth

31. Pathophysiology: Lower GI Tract
IBD - Nutrition Therapy
Antibiotics
Nutrition support
TPN
Malnutrition
High cal high protein fiber regimen
Iron, zn, mg,- can be lost with blood in stool electrolyes (Na,K,Cl) fluid loss
May need to increase kcal, protein, micronutrients

32. Pathophysiology: Lower GI Tract
IBD - Nutrition Interventions
During exacerbation
Enteral nurtiition
TPN
Insure
Glutamine
Intromin
Supplement
Assess energy needs + stress factor
g per kilo protein
extra kcal per day
May need to increase protein
Low-residue, lactose-free diet
Small, frequent meals

33. Pathophysiology: Lower GI Tract
IBD - Nutrition Interventions
May use MCT oil
Restrict gas-producing foods
Increase fiber and lactose as tolerated
40 g per day
Advancement of oral diet
Individual basis
Multivitamin
Make sure they have one
B12, iron, ca, zn, mg, cu

34. Pathophysiology: Lower GI Tract
IBD - Nutrition Interventions
During remission/rehabilitation
Maximize energy & protein
Weight gain and physical activity
Food sources of antioxidants, Omega-3s
Rebuild gut pro and prebiotics
Pro- and prebiotics

35. Pathophysiology: Lower GI Tract
Diverticulosis/diverticulitis – abnormal presence of outpockets or pouches on surface of SI or colon/inflammation of these
Low fiber intake is of concern
History of constpation
When in inflammed state have a low fiber diet
When not in an inflammed state high fiber diet
Increases inflammatory response
Other risks
Obestiy, sedentary lifestyle, alcohol and caffeine intake and cigarette smoking

37. Pathophysiology: Lower GI Tract
Diverticulosis/diverticulitis – pathophysiology
Fecal matter trapped
Creates excess pressure on the fecal wall of the colon
Development of pouches
Diverticulitis: possibility that they could actually burst
Food stuff can get caught in there, bacteria can result
Bleeding abscess, obstruction,
fistula
Bleeding area of that gut
Perforation
Surgical procedure

38. Pathophysiology: Lower GI Tract
Diverticulosis/-itis – Treatment/ Nutrition Therapy
Specific focus on fiber
Pro- and prebiotic supplementation
Acute
Antibiotics
Ossis-trying to fix gut lining before it is in crisis
Itis-might need surgical intervention: associated with fever and hospitalization
Trying to increase gut flora
During inflammation stage –bowel rest- clear liquids

39. Pathophysiology: Lower GI Tract
Diverticulosis/-itis – Nutrition Therapy
-osis
Avoid nuts, seeds, hulls? Because they are now thinking that they might not get caught in the pouches
Fiber supplement: increase from 35 g to 10 to 12 g more
psyllium
-itis
Low fiber diet
Bowel rest, may need to be on clear liquids
Avoid nuts, seeds, fibrous vegetables