Lower Gastrointestinal Tract KNH 411

© 2007 Thomson - Wadsworth

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

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

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

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.

Pathophysiology: Lower GI Tract Malabsorption - protein Protein-losing enteropathy Reduced serum protein Peripheral edema

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

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

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

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

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

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

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

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

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

Pathophysiology: Lower GI Tract IBS - Treatment Guided by symptoms Antidiarrheal agents Tricyclic antidepressants, SSRIs Bulking agents, laxatives Behavioral therapies

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

Pathophysiology: Lower GI Tract IBS - Nutrition Therapy Assess diet hx Assess nutritional adequacy Focus on increasing fiber intake Adequate fluid Pre- and probiotics Avoid foods that produce gas

© 2007 Thomson - Wadsworth

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

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

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

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

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

Pathophysiology: Lower GI Tract Diverticulosis/diverticulitis – pathophysiology Fecal matter trapped Development of pouches Diverticulitis Food stuff Bleeding abscess, obstruction, fistula, perforation

Pathophysiology: Lower GI Tract Diverticulosis/-itis – Treatment/ Nutrition Therapy Specific focus on fiber Pro- and prebiotic supplementation Acute Antibiotics

Pathophysiology: Lower GI Tract Diverticulosis/-itis – Nutrition Therapy -osis Avoid nuts, seeds, hulls Fiber supplement -itis Bowel rest Avoid nuts, seeds, fibrous vegetables