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 Disfunction of accessory organ (pancreas, etc) Decreased transit time (with surgery) Resection of area

7. Pathophysiology: Lower GI Tract Malabsorption - fat Steatorrhea Fat-soluble vitamins malabsorbed Potential for excess oxalate (kidney stones) Abdominal pain, cramping, diarrhea Dg; fecal fat test or D-xylose (type of sugar – tells how well body is absorbing simple sugars) absorption test, or small bowel x-ray

8. Pathophysiology: Lower GI Tract Malabsorption - Fat – Nutrition Restrict fat 25-50 g/day Use of MCT (medium chain triglycerides) supplements Pancreatic enzymes (before meals to aid with absorption)

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.

10. Pathophysiology: Lower GI Tract Malabsorption - protein Protein-losing enteropathy  excessive PRO loss Reduced serum protein Peripheral edema  cells cannot hold in water (fluid overload)

11. Pathophysiology: Lower GI Tract Malabsorption - Nutrition Therapy Results in weight loss Loss of vitamins and minerals Treat underlying disease/ nutrient being malabsorbed Chronic Protein Energy malnutrition (PEM)

12. Pathophysiology: Lower GI Tract Celiac disease -damage to intestinal tract Genetic and autoimmune Occurs when alpha-gliadin from wheat, rye, malt, barley (and oats – tolerable by some) are eaten Infiltration of WBC, production of IgA antibodies

13. Pathophysiology: Lower GI Tract Celiac disease - pathophysiology Damage to villi (reduced height/flattened) Surface area is comprised 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 Bone and joint pain Muscle cramping, fatigue Skin rash Higher risk for lymphoma and osteoporosis Mouth ulcerations

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 (minimize diarrhea) No more than 45-50 grams of fat/day 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 Elimination “red flag” symptoms

20. Pathophysiology: Lower GI Tract IBS Most common GI complaint – pain with defecation More common in women 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 Wheat, high fiber, lactose Concurrent dg Fibermyalgia Chronic fatigue syndrome Food allergies

22. Pathophysiology: Lower GI Tract IBS - Treatment Guided by symptoms Antidiarrheal agents Tricyclic antidepressants, SSRIs (selective serotonin reputake inhibitors – antidepressant) Bulking agents, laxatives (during constipation) Behavioral therapies Relieve stress

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

24. Pathophysiology: Lower GI Tract IBS - Nutrition Therapy Assess diet hx – what are triggering the concerns? Assess nutritional adequacy – 24 hour recall/assess macro and micronutrient intake Focus on increasing fiber intake – 25 grams per day Adequate fluid – to help with motility (25 cc/kcal [250 cc per cup]) Pre- and probiotics – rebuild gut flora Avoid foods that produce gas – beans, cabbage, etc. Eliminate use of straws (swallowed air)

27. © 2007 Thomson - Wadsworth

31. Pathophysiology: Lower GI Tract IBD - Nutrition Therapy Malnutrition May need to increase kcal, protein, micronutrients

32. Pathophysiology: Lower GI Tract IBD - Nutrition Interventions During exacerbation – use enteral products (Ensure) Supplement – glutamine, arginine (decreasing inflammation; need higher levels during crisis) Assess energy needs + stress factor May need to increase protein (1.5 to 1.7 g/kilo) Low-residue, lactose-free diet Small, frequent meals** (high calorie, high protein) As much nutrition as you can in small amounts throughout the day

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 (gut flora)

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 Increases inflammatory response Other risks

37. Pathophysiology: Lower GI Tract Diverticulosis/diverticulitis – pathophysiology Fecal matter trapped Development of pouches Diverticulitis – possibility that they will burts (GI bleeding) Food stuff getting caught, resulting in infection because of bacteria 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

39. Pathophysiology: Lower GI Tract Diverticulosis/-itis – Nutrition Therapy -osis Avoid nuts, seeds, hulls? Fiber supplement -itis Bowel rest Avoid nuts, seeds, fibrous vegetables Low fiber because of inflammation (do not want to exacerbate it)