1. Lower Gastrointestinal Tract KNH 411

3. © 2007 Thomson - Wadsworth

6. Pathophysiology: Lower GI Tract ●Malabsorption - maldigestion of fat, CHO, Protein ●Decreased villious height, enzyme production ●Decreased transit time

7. Pathophysiology: Lower GI Tract ●Malabsorption - fat ●Steatorrhea ●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

8. Pathophysiology: Lower GI Tract ●Malabsorption - Fat – Nutrition ●Restrict fat 25-50 g/day ●Use of MCT supplements ●Pancreatic enzymes

9. Pathophysiology: Lower GI Tract ●Malabsorption - CHO ●Lactose malabsorption ●Most common ●Lactade ●Increased gas, abdominal cramping, diarrhea ●Restrict milk and dairy products ●Products such as Lactaid can be rec.

10. Pathophysiology: Lower GI Tract ●Malabsorption - protein ●Protein-losing enteropathy ●Reduced serum protein ●Due to excess loss of protein in stool ●Peripheral edema ●Due to oncotic pressure ●Korshikor & marasmus ●Diseases left untreated

11. Pathophysiology: Lower GI Tract ●Malabsorption - Nutrition Therapy ●Results in weight loss ●Treat underlying disease/ nutrient being malabsorbed

12. 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

13. Pathophysiology: Lower GI Tract ●Celiac disease - pathophysiology ●Damage to villi ●Decreased enzyme function ●Maldigestion and malabsorption ●Occurs with other autoimmune disorders

15. Pathophysiology: Lower GI Tract ●Celiac disease - clinical manifestations ●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 ●Reversal of symptoms following gluten-free diet ●Refractory CD; d/t coexisting disease

17. Pathophysiology: Lower GI Tract ●Celiac Disease - Nutrition Intervention ●Low-residue, low-fat, lactose-free, gluten-free diet ●Identify hidden sources of gluten ●Specialty products

19. 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 ●Anemia, weight loss, history of colon cancer

20. Pathophysiology: Lower GI Tract ●IBS ●Most common GI complaint ●Etiology unknown ●Increased serotonin, inflammatory response, abnormal motility, pain

21. Pathophysiology: Lower GI Tract ●IBS - clinical manifestations ●Abdominal pain, alterations in bowel habits, gas, flatulence ●Increased sensitivity to certain foods ●Concurrent dg

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

23. Pathophysiology: Lower GI Tract ●IBS - Nutrition Therapy ●Can lead to nutrient deficiency, underweight, malnourished, low gas producing foods ●Decrease anxiety, normalize dietary patterns

24. Pathophysiology: Lower GI Tract ●IBS - Nutrition Therapy ●Assess diet hx ●Look for offensive foods ●Assess nutritional adequacy ●Focus on increasing fiber intake ●At least 25g of fiber per day ●Slowly increase if their under ●Adequate fluid ●Pre- and probiotics ●Build up normal gut flora ●Avoid foods that produce gas ●Simple carbs, lactose, sorbitol, offer agents to help with gas producing

27. © 2007 Thomson - Wadsworth

31. Pathophysiology: Lower GI Tract ●IBD - Nutrition Therapy ●Malnutrition ●Takes two to three days to make up what you’ve lost ●May need to increase kcal, protein, micronutrients

32. Pathophysiology: Lower GI Tract ●IBD - Nutrition Interventions ●During exacerbation ●Supplement ●Assess energy needs + stress factor ●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 ●Advancement of oral diet ●Multivitamin

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 ●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 during the inflammation stage ●Increases inflammatory response ●Other risks

37. Pathophysiology: Lower GI Tract ●Diverticulosis/diverticulitis – pathophysiology ●Fecal matter trapped ●Development of pouches ●Diverticulitis ●Food stuff to avoid ●Just a low fiber diet ●Bleeding abscess, obstruction, fistula, perforation

38. Pathophysiology: Lower GI Tract ●Diverticulosis/-itis – Treatment/ Nutrition Therapy ●Specific focus on fiber ●Pro- and prebiotic supplementation ●Acute ●Antibiotics ●Only used in itis stage, have blood in stool, fever

39. Pathophysiology: Lower GI Tract ●Diverticulosis/-itis – Nutrition Therapy ●-osis ●Avoid nuts, seeds, hulls* ●Current research shows that this isn’t a problem ●Only if client feels its necessary ●Fiber supplement ●-itis ●Low fiber diet ●Bowel rest ●Avoid nuts, seeds, fibrous vegetables