Presentation on theme: "Medical Nutrition Therapy for Lower Gastrointestinal Tract Disorders"— Presentation transcript:
1 Medical Nutrition Therapy for Lower Gastrointestinal Tract Disorders Chapter 30Medical Nutrition Therapy for Lower Gastrointestinal Tract Disorders
2 Common Intestinal Symptoms Intestinal gas and flatulenceConstipationDiarrheaSteatorrheaGastrointestinal strictures and obstruction
3 Diarrhea Need to solidify stools Pectin (apples, bananas) is helpful World Health Organization provides guidance on fluid and electrolyte replacements—set formula works bestGatorade also useful
4 Steatorrhea Dietary Modification Increase kcal to meet needs, especially protein and carbohydrateControl fat levelGive only level toleratedUse MCT oil to meet kcal needs with cautionVitamin and mineral supplementsUse fat-soluble vitamins; add extra Ca, Mg, Zn, Fe
5 Steatorrhea MCT Oil 8 to 10 carbons long Bile not needed for absorptionDelivered to liver via blood8.3 kcal/g1 T = 116 kcalExpensiveIncreases osmolality of tube feedings
6 Celiac Disease Gluten-Sensitive Enteropathy Adverse reaction to gluten—gliadin fractionIntestinal mucosa damaged—Malabsorption of nutrients—Iron deficiency—Osteomalacia—Growth failure—Projectile vomiting
7 Normal Human Duodenal Mucosa (A) and Peroral Small Bowel Biopsy Specimen (B) from a Patient with Gluten Enteropathy(From Floch MH. Nutrition and Diet Therapy in Gastrointestinal Disease. New York: Menum Medical Book Co., 1981.)
8 Celiac Disease−CauseAlgorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, Updated by Peter L. Beyer, 2002.
9 Celiac Disease−Pathophysiology (Adapted from Bray GA. Gray DS, Obesity, part 1: Pathogenisis. West J Med 149:429, 1988; and Lew EA, Garfinkle L; Variations in mortality by weight among 750,000 men and women. J Clin Epidemiol 32:563, 1979.)Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, Updated by Peter L. Beyer, 2002.
10 Celiac Disease−Medical and Nutritional Management Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, Updated by Peter L. Beyer, 2002.
11 Celiac Disease Gluten-Sensitive Enteropathy TreatmentRemove gluten from the diet:—Wheat—Rye—Buckwheat—Barley
12 Celiac Disease Gluten-Sensitive Enteropathy—cont’d Gluten/gliadin-containing foodsUsed to thicken many processed foodsSee Tables 30-3 and 30-4
13 Tropical Sprue Cause unknown; imitates celiac disease Results in atrophy and inflammation of villiSx: diarrhea, anorexia, abdominal distentionRx: tetracycline, folate 5 mg/d, B12 IM
14 Intestinal Brush Border Enzyme Deficiencies Lactose intoleranceCauses: genetic or secondary deficiency of milk sugar enzyme, lactase—Blacks, Asians, Native Americans—Aging: damage to GI tractDx: lactose tolerance test or breath hydrogen testRx: avoid large amounts of lactose(milk protein allergy requires milk-free diet); take lactase enzyme; processed dairy sometimes OK
15 Inflammatory Bowel Disease Crohn’s disease or ulcerative colitisBoth involve damage to the intestineCrohn’s: may damage either small or large intestineDisease progression variesUlcerative colitis: begins at rectum and progresses up the large intestine
16 Inflammatory Bowel Disease−Cause Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, Updated by Peter L. Beyer, 2002.
17 Inflammatory Bowel Disease− Pathophysiology Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, Updated by Peter L. Beyer, 2002.
18 Inflammatory Bowel Disease−Medical and Nutritional Management Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, Updated by Peter L. Beyer, 2002.
19 Inflammatory Bowel Diseases Rx:Diet depends on patient’s statusNutrition assessmentSelect route of feedingFiber is beneficial except during flareups.
20 Disorders of the Large Intestine 1. Irritable bowel syndrome—Common syndrome involving altered intestinal motility, increased sensitivity of the GI tract, and increased awareness and responsiveness of the viscera to internal and external stimuli—Alternating constipation and diarrhea, abdominal pain, and bloating
21 Disorders of the Large Intestine —cont’d 2. Diverticular disease—Herniations of the colon, chronic diverticulosis, acute diverticulitis—DiverticulosisHigh-fiber diet: fruits, vegetables, whole grains (2 tsp bran daily)—DiverticulitisLow-residue or elemental diet Possibly low-fat diet
22 Disorders of the Large Intestine —cont’d 3. Colon cancer and polyps—Colon cancer is the second most common cancer among US adults—Polyps are considered precursors of colon cancer.
23 Short Bowel SyndromeFollows removal of more than two thirds of small intestineCauses weight loss; diarrhea; decreased transit time; malabsorption; dehydration; loss of electrolytes; hypokalemia
24 Short Bowel Syndrome —cont’d Removal of ileocecal valve causes more complications.Fat malabsorption frequentSteatorrheaSaponify calcium, zinc, and magnesiumRemove ileum and lose B12 and bile salt absorption
25 Short Bowel Syndrome —cont’d Factors Affecting Severity of Malabsorption, Number of Complications, and Dependence on Parenteral NutritionLength of remaining small intestineLoss of ileum, especially distal one thirdLoss of ileocecal valveLoss of colonDisease in remaining segments(s) of gastrointestinal tractRadiation enteritisCoexisting malnutritionOlder age surgery
26 Short Bowel Syndrome Nutritional Care Step 1Parenteral only for most patientsStep 2Gradually introduce enteral nutrition.Glutamine is an important nutrient for the gut.Narcotic drugs for pain cause GI problems and should be evaluated.
27 Short Bowel SyndromeEventually the remaining bowel increases absorptive surface, and problems decrease.Nutrition support is designed to meet each patient’s needs.
28 Other Bowel Diseases Irritable bowel syndrome Alternating diarrhea and constipationRx:High-fiber diet: be careful with wheat branElimination of stimulantsEvaluate for food allergies or intolerances
29 Blind Loop SyndromeBacterial overgrowth from stasis in intestine, obstruction, radiation enteritis, fistula, or surgical repairTreatment (Rx):Appropriate meds for malabsorptionAntibiotics for bacterial overgrowth
30 Diet Modification of Fiber in Diets Restricted-fiber diet5 to 10 g/dayHigh-fiber diet25 to 35 g/dayMinimal-residue diet or elemental formulas
31 Causes of Constipation— Gastrointestinal Diseases of the upper gastrointestinal tract—Celiac disease—Duodenal ulcerDiseases of the large bowel resulting in:—Failure of propulsion along the colon (colonic inertia)—Failure of passage though anorectal structures (outlet obstruction)Irritable bowel syndromeAnal fissures or hemorrhoidsLaxative abuse—Gastric cancer—Cystic fibrosis
32 Causes of Constipation—Systemic Side effect of medicationMetabolic endocrine abnormalities, such as hypothyroidism, uremia, and hypercalcemiaLack of exerciseIgnoring the urge to defecateVascular disease of the large bowelSystemic neuromuscular disease leading to deficiency of voluntary musclesPoor diet, low in fiberPregnancy
33 Fistula Abnormal Opening Between Organs Causes: birth defects; trauma; inflammatory disease; malignant diseaseRx:For fluid lossFor electrolyte lossAggressive nutritional support
34 Ileostomy or Colostomy Surgical Opening of Intestine to Outside Causes: ulcerative colitis; Crohn’s disease; colon cancer; traumaRx:Nutrition needs vary with location and individualAvoid gas- or odor-forming foodsFluid and electrolyte needs
35 Hemorrhoidectomy Delay stool formation until healing can take place Rx:Minimal-residue diet or elemental dietAfter recoveryHigh-fiber diet to prevent
36 Summary Lower GI conditions—important for nutritional consequences Important to note where obstruction or surgery has taken place to determine impact on specific nutrientsMost dramatic: short bowel syndrome, which may require long-term TPN