1. Irritable Bowel Syndrome §Abnormal stool pattern associated w/disturbances in GI motility that persist for > 3 months. §Symptoms: l l l §Causes:

2. Nutrition Therapy: depends on symptoms §Commercial fiber supplements (psyllium) §Use of wheat bran may be detrimental and exacerbate non-complaining cases. §Regular diet l l § § §

3. Diverticulosis §Outpouchings (diverticula) §Incidence  w/ §Often no symptoms until: § l

5. §Symptoms: l lower quadrant pain, abd distention, cramping l n/v l fever, l diarrhea or constipation l possibly obstruction. §Rupture can  §

6. Nutrition Therapy §Diverticulosis: high fiber to keep muscles toned l l §--itis: low residue §Controversial: l Avoidance of foods with seeds, such as okra and strawberries. l Avoid seeds and nuts in general

7. Intestinal Surgery

9. Resection of the Small Intestine Short-Bowel Syndrome § Severe malabsorption due to extensive resection of the small intestine. l IBD, CA, fistula, diverticulitis, obstruction, etc. l

10. §40-50% of the s.i. can be resected without serious nutritional consequences §Even more can be tolerated, as long as §Resection of ileum: l Malabsorption of fat (and fat sol vits), protein, CHO, B 12, Ca++, Mg++, Zn++ l Malabsorption of bile salts  l If any colon present, malabsorbed bile salts irritate mucosa  fluid/lyte secretion (  fluid/lyte absorption)

11. §When ileocecal valve is resected: l l l l

12. Adaptation: §Portion of S.I. remaining gets longer, thicker, wider, and takes over absorptive capacity of missing portion. ** §Takes up to 1-2 years. §Doesn’t fully compensate if too much bowel is resected.

13. §Intact colon:  CHO and prot malabsorption following s.i. resection. l Bacteria salvage some E by metabolizing into SCFAs  absorbed and used for E. Nutrition Therapy for SBS §<40-50% resected p.o. intake ASAP §B 12 §>50% resected, TPN then EN as soon as possible to stimulate adaptation.

14. § §While steatorrhea persists: § §To improve adaptation: l

15. Blind Loop Syndrome (Bacterial Overgrowth) §S.I. is protected from bacteria by gastric acid and peristalsis §Gastric surgery* §Gastric or intestinal surgeries

16. §Also fistulas, obstructions, nerve dysfunction such as in diabetes §Bacteria dismantle bile salts  §Bacteria compete w/body for §Treatment: §Diet:

17. Resection of the Large Intestine §Cancer, ulcerative colitis, Crohn’s disease, etc. §Resection of colon less likely to  §

18. Colostomy §Segment of the colon, rectum, or both is removed §Remaining portion is brought out through intestinal wall (stoma) for defecation.

20. Ileostomy §Colon and rectum are removed, and ileum is used to form the stoma.

22. Ileal Pouch/Anal Anastomosis §Colon and rectal tissue are removed and ileum is connected to anus. §Result: §Often temporary ileostomy is created to give intestine time to heal, then closed (2-3 months)

23. Implications of “Ostomies” §Stools: l l

24. Nutritional Care §NPO post surgery  liq  low fiber, bland to prevent obstructions and promote stoma healing. §Add foods one at a time in small amounts to check tolerance §Encourage fluids §Prevent obstructions: l l

25. Foods that May Block a Narrowed Stoma §Cabbage §Lettuce §Celery §Mushrooms §Coconut §Nuts §Corn §Olives §Cucumbers §Peas §Dried fruits §Pickles §Green peppers §Pineapple

26. Controlling Diarrhea Foods that Thicken Stool: §Applesauce §Bananas §Bread §Cheeses §Creamy peanut butter §Starchy foods Foods that Aggravate Diarrhea: §Apple, grape and prune juices §Highly seasoned foods §Caffeine §(individual tolerances)

27. Controlling Odors Odor-Producing Foods §Asparagus §Eggs §Fish §Garlic §Onions Odor-Reducers §Buttermilk §Yogurt §Parsley §Cranberry Juice

28. Reducing Gas Things that Cause Excess Swallowed Air and Then Gas §Poorly fitting dentures, smoking pipes or cigarettes, chewing gum or tobacco can cause increased salivation and swallowing §Eating fast and swallowing large chunks of food or large amounts of beverages §Using straws or drinking from a bottle or can §Inactivity and lying down after eating

29. Foods that Tend to Form Gas §Legumes l Most beans, especially dried beans and peas, baked beans, soy beans, lima beans §Vegetables l Cabbage, radishes, onions, broccoli, Brussels sprouts, cauliflower, cucumbers, sauerkraut, rutabaga, turnips, asparagus, onions §Fruits l Prunes, apples, raisins, bananas, excessive amounts of fruit

30. §Cereals, breads l Excessive wheat products, including breads and cereals. Check labels for specific grains. §Milk, milk products l Excessive milk, ice cream, cheese §Fatty foods l Excessive pan-fried or deep-fried foods, fatty meats; rich cream sauces and gravies; pastries §Liquids l Carbonated beverages

31. §Emotional Support: l l