1. Large Intestine Working knowledge of physiological changes during disease processes & the effects of these on nutrition care.

2. Large Intestine Calculate & interpret nutrient composition of foods appropriate for diets used in MNT. Calculate & define diets for common conditions.

3. Large Intestine Parts of the colon –haustra - sacculations in wall of colon, due to the circular muscle fibers & tenia coli

4. Large Intestine Parts of the colon –tenia coli - three thickened bands of soft tissue 1/4” wide & 1/6 shorter than the colon, longitudinal fibers that go from appendix to rectum

5. Diagram of colon next

6. Colon

7. Constipation Infrequent and difficult passage of stool Fewer than 3 stools/week while eating high residue diet

8. What is the normal time it takes food to pass from the mouth to the anus?

9. Constipation Etiology Not defecating when the urge happens Failure to establish a regular time to defecate Lack of fiber in the diet

10. Constipation Etiology Insufficient fluid intake Loss of muscle tone in intestinal tract Side effects of medications Lack of exercise Pregnancy

11. Constipation Nutr Care Fluids Fiber

12. Laxatives Gradual reduction of laxatives - can become dependent

13. Laxatives - Stimulants Senna (natural) Bisacodyl –stimulates nerve endings to increase peristalsis Dulcolax - active ingredient is bisacodyl

14. Laxatives - Bulking Agents What do you think are the bulking agents?

15. Laxatives - Stool Softeners Colace –active agent is docusafe sodium –surface active agent

16. Laxatives - Prunes Dihydroxyphenyl isatin –stimulates intestinal motility

17. Irritable Bowel Syndrome Cause unknown Exaggerated gastrocolic reflex Abnormal colonic sensitivity to stretching Anxiety & stress

18. IBS Contributing causes –excessive use laxatives –excessive use caffeine –antibiotic therapy –irregular sleep, rest, fluid intake, bowel movements

19. IBS Abnormal stooling pattern associated with symptoms of intestinal dysfunction that persists May be some inflammation

20. Slide of what colon looks like in irritable bowel syndrome next

21. Colon in irritable bowel syndrome

22. IBS Symptoms Diarrhea & constipation Excessive flatulence Sensation of incomplete evacuation Rectal pain Mucus in stools

23. IBS Monitoring Body weight H & H Alb Na, K, Cl Ca, Mg

24. IBS Nutritional Care Get over fear of eating Gain or maintain wt Acute phase –elemental food products –advance DAT

25. IBS Nutritional Care Chronic phase –high fiber diet –avoid gas forming foods –DAT –exclusion of caffeine & chocolate

26. IBS Nutritional Care Why the high fiber diet?

27. Diverticular Disease Diverticulosis –collection of herniations of the colonic wall

28. Diverticular Disease Diverticulitis –accumulation of fecal matter in the diverticular pockets with infection & inflammation

29. Diverticular Disease Outpouchings results from segmentation due to high intracolonic pressures Low fiber diet Colon muscle weakens Common elderly

30. Next figure of diverticula

31. Diverticula

32. Symptoms Diverticulitis –pain –bleeding –low Hgb & Alb levels

33. Symptoms Diverticulosis –can be asymptomatic –pain –constipation with diarrhea

34. Diverticular Monitoring Body wt & change H & H Alb Transferrin, TIBC Stool number & frequency

35. Diverticular Monitoring Blood pressure WBC (may increase)

36. Nutritional Care Get over fear of eating Maintain or increase body wt Diet lessen pain

37. Nutritional Care Diverticulitis –bowel rest to prevent perforation –low fiber & residue –No nuts, seeds, fibrous veg –DAT

38. Nutritional Care Diverticulosis –increase stool caliber & vol –lessen intraluminal pressure –high fluid & fiber

39. Patient Education Fiber in foods Drink fluid Avoid constipation

40. Ileostomy & Colostomy Ulcerative colitis Crohn’s disease Colon cancer Intestinal trauma

41. Ileostomy Surgical formation of an opening of the ileum onto the surface of the abdomen

42. Colostomy Surgical formation of an artificial anus on the abdominal wall by incising the colon & bringing to the surface

43. Ileostomy & Colostomy Consistency of material in colon next Next slides of openings and where in the intestinal tract

44. Colon material consistency

45. Ileostomy

46. Colostomy

47. What would be the consistency of the material for each of these procedures?

48. Nutritional Care Avoid foods that cause odor –corn –dried beans –onions –cabbage –highly spiced foods

49. Nutritional Care Avoid foods that cause odor –fish –antibiotics –some vitamin & mineral supplements

50. Nutritional Care Avoid foods that produce flatulence Avoid very fibrous veg Chew food well More fluid More salt

51. Crohn’s Disease Case study #40 - 3, 4, 5 Diverticulosis Case study #17 - 2, 3, 4, 5, 6, 7, 8, 10, 11, 12 Select menu high in fiber from reg menu Write SOAP note

52. Digestion-Absorption- Metabolism