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

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

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

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

Diagram of colon next

Colon

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

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

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

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

Constipation Nutr Care Fluids Fiber

Laxatives Gradual reduction of laxatives - can become dependent

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

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

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

Laxatives - Prunes Dihydroxyphenyl isatin –stimulates intestinal motility

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

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

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

Slide of what colon looks like in irritable bowel syndrome next

Colon in irritable bowel syndrome

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

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

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

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

IBS Nutritional Care Why the high fiber diet?

Diverticular Disease Diverticulosis –collection of herniations of the colonic wall

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

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

Next figure of diverticula

Diverticula

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

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

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

Diverticular Monitoring Blood pressure WBC (may increase)

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

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

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

Patient Education Fiber in foods Drink fluid Avoid constipation

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

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

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

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

Colon material consistency

Ileostomy

Colostomy

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

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

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

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

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

Digestion-Absorption- Metabolism