1. A Practical Application for Students With GI Upset
GI Issues
A Practical Application for Students With GI Upset
Andrea Kendrick, RD, LDN
Tennessee Academy of Nutrition and Dietetics Reimbursement Rep
Knoxville Academy of Nutrition and Dietetics Media Spokesperson & Social Media Chair

2. Scenario 16 year old Female, HL
Comes to your office with abdominal pain and “needing to go to the bathroom”
This is the 2nd time this week. She has been in 3 times last week.
Coffee and protein bar for breakfast
No medical hx of GI disorders reported
This visit she shares she recently broke up with her boy friend
You currently do not think much of it

3. Issues of the GI Tract

4. Causes of Diarrhea Virus Bacteria Intolerance
EX: foodborne illness
Intolerance
EX: gluten or lactose
Inflammatory Bowel Disease
Ulcerative colitis
Crohn’s
Celiac disease
What about IBS?

5. Inflammatory Bowel Disease
Ulcerative Colitis
Continuous inflammation of the colon (type of IBD)
Crohn’s Disease
Healthy intestine mixed in between inflamed areas (type of IBD)
Mostly occurs in the small intestine
Inflammation can occur anywhere from mouth to anus
Both can occur at any time
Usually bw ages 15 – 30 years
Cause is unclear but may involve: genetics, environment, and an overactive immune system

6. Celiac Disease Autoimmune disorder affecting 1 in 100 people worldwide
2.5 million Americans are undiagnosed and at risk for long term health complications
Celiac disease is hereditary
Long term health effects: iron deficiency anemia, early onset of osteoporosis/osteopenia, infertility/miscarriage, lactose intolerance, vitamin & mineral deficiencies, pancreatic insufficiency, intestinal lymphomas, gall bladder malfunction, neurological manifestations like seizures, migraine, neuropathy

7. Irritable Bowel Syndrome (IBS)
Chronic disorder affecting between 5% –20% of kids and ~ 20% of adults
14% high school students
6% middle school students complain of IBS-like symptoms.
Girls and boys are equally affected
No known gene that causes IBS, but seems to occur in families
Not a progressed disease – symptoms can be managed
Symptoms are present but usual not evidence of tissue damage

8. Symptoms Include Bloating- IBS, CD, UC, Cr Cramping – IBS, UC, Cr
Chronic or intermittent diarrhea – IBS, CD, UC, Cr
Chronic or intermittent constipation – IBS, CD
Urgency with defecation
Incomplete sensation of defecation
Passage of mucus in the stool
CD also associated with vomiting, pale, foul-smelling or fatty stool, weight loss, fatigue, irritability or behavioral issues, dental enamel defects of permanent teeth, delayed growth and puberty, short stature, failure to thrive, ADHD
UC – blood or pus in the stool, fever, weight loss, fatigue, reduced appetite, anemia if moderate to severe
Crohn’s – rectal bleeding, unexplained weight loss, fever, fatigue, reduced appetite

9. Children with IBS May Experience:
Problems with how food moves through the digestive system
Hypersensitivity of the inside of the bowel to stretching and motion
Stress
Overgrowth of bacteria in the bowel

10. HL is back in your office again for the third week in a row
Visiting 3 – 4 days per week
You decide to press in a little more and ask if she has been to the doctor
She has not she figured it was just stress but you encourage her to go to her doctor
Next week she shares she has been to her doctor and a gastroenterologist and has a series of tests scheduled to determine what the source of her GI issues

11. Diagnosis of IBS – Process of Elimination
Blood test – check for anemia or infection
Urine analysis & culture
Stool sample – rule out bacteria and parasites
Stool sample for occult – to test for inflammatory source in the GI tract
Lactose breath H test – rule out lactose intolerance
Abdominal X-ray, US, Endoscopy, Colonoscopy – imaging and biopsy to rule out

12. HL is diagnosed with IBS she is working with her GI doctor and a registered dietitian

13. Treatment
No cure for IBS, but can be treated with a combination therapy:
Changes in eating, diet, and nutrition
Medications
Fiber supplements, laxatives, antidiarrheals, antispasmodics, antidepressants
Probiotics
Therapies for mental health problem

14. Nutrition Plan Large meals can cause cramping and diarrhea
Smaller meals more often may help IBS symptom
Low fat and high carbohydrate diets help
Certain foods & drinks may cause IBS symptoms such as:
foods high in fat
milk products
drinks with caffeine
drinks with large amounts of artificial sweeteners or sugar alcohols
foods that may cause gas, such as beans and cabbage

15. Low FODMAP Diet Fermentable Oglio- Di- Mono-saccharides And Polyols
Quite restrictive
Not appropriate for all cases but it is quite effective
Fructans (a type of fiber found in wheat, onions, garlic and chicory root
Oligosaccharides (a type of fiber found in beans, hummus and soy milk)
Lactose (also known as milk sugar; found in milk, yogurt and ice cream)
Fructose (also known as fruit sugar; found in fruit, high-fructose corn syrup, honey and agave syrup)
Sorbitol, mannitol, and other “-ol” sweeteners (also known as sugar alcohols; found in certain fruits and vegetables as well as some types of sugar-free gums and candies)

17. School Nurse Checklist
Let the teachers know
Frequent bathroom visits
Maybe create a sign with teacher to indicate need to use the restroom
Talk to school counselor
Discuss any stressors
School Nurse
Possibly allow student to use the private restroom
Map out bathrooms
Encourage student to know where the closed restroom is located for each class
Possible 504 plan

18. Resources

19. Connect with me
Andrea Kendrick, RD, LDN Westwood Rd #109 | Knoxville, TN Instagram: andrea.kendrick.rd Pinterest: AKendrickRD