1. © 2007 Thomson - Wadsworth Chapter 18 Nutrition and Lower Gastrointestinal Disorders

2. © 2007 Thomson - Wadsworth Common Problems of the Lower Intestine Constipation Intestinal Gas Diarrhea Bacterial Overgrowth Steatorrhea

3. © 2007 Thomson - Wadsworth Constipation Difficult or infrequent stools More prevalent among women Increases with age Correlates with Low food intake Low-fiber diets Inactivity Medical conditions Hypothyroidism Diabetes mellitus Chronic renal failure Parkinson’s Spinal cord lesions MS Some medications & dietary supplements

4. © 2007 Thomson - Wadsworth Treatment Gradual increase in fiber Wheat bran Fruits (prunes) Vegetables Adequate fluid Daily exercise Laxatives Medical intervention

5. © 2007 Thomson - Wadsworth Intestinal Gas Causes High-fiber diets Carbohydrates Fructose Sugar alcohols (sorbitol, mannitol, maltitol) Beans Some grains & potatoes Other causes Malabsorption problems Swallowed air

6. © 2007 Thomson - Wadsworth

7. Diarrhea Frequent, watery stools If severe, can cause dehydration & electrolyte imbalances Types Osmotic diarrhea Motility disorders Secretory diarrhea Acute diarrhea Infection Certain medications Chronic diarrhea Altered GI motility Intestinal inflammation Malabsorptive & endocrine disorders Infectious diseases Radiation treatment Others

8. © 2007 Thomson - Wadsworth

9. Bacterial Overgrowth Gastric acid protects stomach & intestine from bacterial overgrowth Overgrowth Disrupts fat digestion & absorption May develop fat-soluble vitamin & vitamin B 12 deficiencies Symptoms Chronic diarrhea Abdominal discomfort Bloating Weakness Weight loss Causes Impaired intestinal motility Reduced gastric acid secretions

10. © 2007 Thomson - Wadsworth Steatorrhea Excessive fat in stool Causes Reduced availability of bile Reduced availability of pancreatic lipase Fat malabsorption May need a fat- restricted diet Consequences of fat malabsorption Loss of food energy Loss of essential fatty acids Loss of fat-soluble vitamins Decreased absorption of calcium, magnesium, & zinc Increased risk of kidney stones

11. © 2007 Thomson - Wadsworth Malabsorption Syndromes Lactose Intolerance Pancreatitis Cystic Fibrosis Celiac Disease Inflammatory Bowel Diseases Short-Bowel Syndrome

12. © 2007 Thomson - Wadsworth Lactose Intolerance Loss or reduction of enzyme lactase that digests lactose in milk products Prevalent among certain ethnic groups Symptoms: diarrhea & intestinal gas Diet Milk: usually 2 cups/day divided & consumed with food is tolerated Chocolate milk Aged cheese Yogurt with live bacterial cultures Lactose-free milk Can take enzyme tablets before consuming dairy

13. © 2007 Thomson - Wadsworth Pancreatitis Pancreatic tissue is destroyed by activated enzymes Severe abdominal pain Acute Causes: gallstones, excessive alcohol, high triglycerides, toxins Withhold food & fluids Chronic Permanent damage to tissue 70% alcohol induced Food avoidance & malabsorption lead to weight loss & malnutrition

14. © 2007 Thomson - Wadsworth Cystic Fibrosis Unusually viscous exocrine secretions Complications involve lungs, pancreas, sweat glands Respiratory infections Malabsorption of protein, fat, & fat-soluble vitamins Salt losses in sweat Nutrition therapy Children may need 120-150% of normal energy needs High-kcalorie, high-fat foods Frequent meals & snacks Pancreatic enzyme replacement Liberal use of table salt

15. © 2007 Thomson - Wadsworth Celiac Disease Abnormal immune response to a protein fraction Need a gluten-free diet for life Wheat Barley Rye Oats Rice is allowed Check food labels carefully Symptoms Diarrhea, steatorrhea, flatulence Consequences Severe damage to intestinal mucosa Malabsorption Children: stunted growth & underweight

16. © 2007 Thomson - Wadsworth Inflammatory Bowel Diseases Chronic inflammatory conditions Genetic & environmental factors contribute Exact triggers are unknown Crohn’s disease & ulcerative colitis

17. © 2007 Thomson - Wadsworth Crohn’s Disease Can occur in any region of the GI tract Ulcerations, fissures, & fistulas Thick scar tissue may cause obstructions Malnutrition from reduced intake, malabsorption, & surgical resections

18. © 2007 Thomson - Wadsworth Healthy colon (left) vs. Crohn’s disease (right)

19. © 2007 Thomson - Wadsworth Ulcerative Colitis Only affects the rectum & colon Frequent urgent bowel movements Nutrient losses due to tissue damage, bleeding, & diarrhea Complications Weight loss Fever Weakness Anemia Dehydration Electrolyte imbalance Protein losses Colectomy prevents future occurrences

20. © 2007 Thomson - Wadsworth Healthy colon (left) vs. ulcerative colitis (right)

21. © 2007 Thomson - Wadsworth Treatment for Inflammatory Bowel Diseases Drugs Antidiarrheals Immunosuppressants Anti-inflammatory agents Nutrition therapy for Crohn’s Highly variable High-kcalorie, high- protein Liquid supplements Multivitamin Nutrition therapy for colitis May require few adjustments Restore fluids & electrolytes Low fiber or withhold food during severe illness

22. © 2007 Thomson - Wadsworth Short-Bowel Syndrome Can be the consequence of small intestine resections About 50% can be removed without serious nutritional consequences Intestine undergoes adaptation to improve absorptive capacity Diet Small, frequent meals Low fat, lactose restricted High carbohydrate Vitamin & mineral supplements At risk for kidney stones

23. © 2007 Thomson - Wadsworth

24. Disorders of the Large Intestine Irritable Bowel Syndrome Diverticular Disease of the Colon Ostomies Large intestine Moves undigested materials to the rectum Helps maintain fluid & electrolyte balance Bacteria ferment undigested materials

25. © 2007 Thomson - Wadsworth Irritable Bowel Syndrome Chronic & recurring intestinal symptoms Diarrhea & constipation Flatulence, bloating, & distention More common in women Excessive colonic response to meals, GI hormones, & stress Medicine Antidiarrheal agents Anticholinergics Antidepressants Laxatives Diet Increase fiber Limit caffeine, alcohol, fat, & milk products Small, frequent meals

26. © 2007 Thomson - Wadsworth Diverticular Disease Presence of pebble- sized outpockets in intestinal wall Prevalence increases with age High-fiber diet can be preventative May need to avoid nuts, popcorn, & food with seeds

27. © 2007 Thomson - Wadsworth Diverticulitis Inflammation or infection Most common complication of diverticulosis Symptoms Persistent abdominal pain Fever Alternating constipation & diarrhea Treatment Antibiotics, pain medication Clear liquid or bowel rest Surgery

28. © 2007 Thomson - Wadsworth Ostomies Surgical removal of some or all of large intestine Wastes exit through a stoma in abdominal wall Colostomy & ileostomy Temporary or permanent Chew food thoroughly to prevent obstructions Foods cause unpleasant odors Fish, eggs, dried beans & peas, onions, garlic, beer, others Foods that reduce odors Buttermilk, cranberry juice, parsley, yogurt

29. © 2007 Thomson - Wadsworth