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© 2007 Thomson - Wadsworth Chapter 18 Nutrition and Lower Gastrointestinal Disorders
© 2007 Thomson - Wadsworth Common Problems of the Lower Intestine Constipation Intestinal Gas Diarrhea Bacterial Overgrowth Steatorrhea
© 2007 Thomson - Wadsworth Constipation Difficult or infrequent stools More prevalent among women Increases with age Correlates with Low food intake Low-fiber diets Inactivity Medical conditions Hypothyroidism Diabetes mellitus Chronic renal failure Parkinson’s Spinal cord lesions MS Some medications & dietary supplements
© 2007 Thomson - Wadsworth Treatment Gradual increase in fiber Wheat bran Fruits (prunes) Vegetables Adequate fluid Daily exercise Laxatives Medical intervention
© 2007 Thomson - Wadsworth Intestinal Gas Causes High-fiber diets Carbohydrates Fructose Sugar alcohols (sorbitol, mannitol, maltitol) Beans Some grains & potatoes Other causes Malabsorption problems Swallowed air
© 2007 Thomson - Wadsworth
Diarrhea Frequent, watery stools If severe, can cause dehydration & electrolyte imbalances Types Osmotic diarrhea Motility disorders Secretory diarrhea Acute diarrhea Infection Certain medications Chronic diarrhea Altered GI motility Intestinal inflammation Malabsorptive & endocrine disorders Infectious diseases Radiation treatment Others
© 2007 Thomson - Wadsworth
Bacterial Overgrowth Gastric acid protects stomach & intestine from bacterial overgrowth Overgrowth Disrupts fat digestion & absorption May develop fat-soluble vitamin & vitamin B 12 deficiencies Symptoms Chronic diarrhea Abdominal discomfort Bloating Weakness Weight loss Causes Impaired intestinal motility Reduced gastric acid secretions
© 2007 Thomson - Wadsworth Steatorrhea Excessive fat in stool Causes Reduced availability of bile Reduced availability of pancreatic lipase Fat malabsorption May need a fat- restricted diet Consequences of fat malabsorption Loss of food energy Loss of essential fatty acids Loss of fat-soluble vitamins Decreased absorption of calcium, magnesium, & zinc Increased risk of kidney stones
© 2007 Thomson - Wadsworth Malabsorption Syndromes Lactose Intolerance Pancreatitis Cystic Fibrosis Celiac Disease Inflammatory Bowel Diseases Short-Bowel Syndrome
© 2007 Thomson - Wadsworth Lactose Intolerance Loss or reduction of enzyme lactase that digests lactose in milk products Prevalent among certain ethnic groups Symptoms: diarrhea & intestinal gas Diet Milk: usually 2 cups/day divided & consumed with food is tolerated Chocolate milk Aged cheese Yogurt with live bacterial cultures Lactose-free milk Can take enzyme tablets before consuming dairy
© 2007 Thomson - Wadsworth Pancreatitis Pancreatic tissue is destroyed by activated enzymes Severe abdominal pain Acute Causes: gallstones, excessive alcohol, high triglycerides, toxins Withhold food & fluids Chronic Permanent damage to tissue 70% alcohol induced Food avoidance & malabsorption lead to weight loss & malnutrition
© 2007 Thomson - Wadsworth Cystic Fibrosis Unusually viscous exocrine secretions Complications involve lungs, pancreas, sweat glands Respiratory infections Malabsorption of protein, fat, & fat-soluble vitamins Salt losses in sweat Nutrition therapy Children may need 120-150% of normal energy needs High-kcalorie, high-fat foods Frequent meals & snacks Pancreatic enzyme replacement Liberal use of table salt
© 2007 Thomson - Wadsworth Celiac Disease Abnormal immune response to a protein fraction Need a gluten-free diet for life Wheat Barley Rye Oats Rice is allowed Check food labels carefully Symptoms Diarrhea, steatorrhea, flatulence Consequences Severe damage to intestinal mucosa Malabsorption Children: stunted growth & underweight
© 2007 Thomson - Wadsworth Inflammatory Bowel Diseases Chronic inflammatory conditions Genetic & environmental factors contribute Exact triggers are unknown Crohn’s disease & ulcerative colitis
© 2007 Thomson - Wadsworth Crohn’s Disease Can occur in any region of the GI tract Ulcerations, fissures, & fistulas Thick scar tissue may cause obstructions Malnutrition from reduced intake, malabsorption, & surgical resections
© 2007 Thomson - Wadsworth Healthy colon (left) vs. Crohn’s disease (right)
© 2007 Thomson - Wadsworth Ulcerative Colitis Only affects the rectum & colon Frequent urgent bowel movements Nutrient losses due to tissue damage, bleeding, & diarrhea Complications Weight loss Fever Weakness Anemia Dehydration Electrolyte imbalance Protein losses Colectomy prevents future occurrences
© 2007 Thomson - Wadsworth Healthy colon (left) vs. ulcerative colitis (right)
© 2007 Thomson - Wadsworth Treatment for Inflammatory Bowel Diseases Drugs Antidiarrheals Immunosuppressants Anti-inflammatory agents Nutrition therapy for Crohn’s Highly variable High-kcalorie, high- protein Liquid supplements Multivitamin Nutrition therapy for colitis May require few adjustments Restore fluids & electrolytes Low fiber or withhold food during severe illness
© 2007 Thomson - Wadsworth Short-Bowel Syndrome Can be the consequence of small intestine resections About 50% can be removed without serious nutritional consequences Intestine undergoes adaptation to improve absorptive capacity Diet Small, frequent meals Low fat, lactose restricted High carbohydrate Vitamin & mineral supplements At risk for kidney stones
© 2007 Thomson - Wadsworth
Disorders of the Large Intestine Irritable Bowel Syndrome Diverticular Disease of the Colon Ostomies Large intestine Moves undigested materials to the rectum Helps maintain fluid & electrolyte balance Bacteria ferment undigested materials
© 2007 Thomson - Wadsworth Irritable Bowel Syndrome Chronic & recurring intestinal symptoms Diarrhea & constipation Flatulence, bloating, & distention More common in women Excessive colonic response to meals, GI hormones, & stress Medicine Antidiarrheal agents Anticholinergics Antidepressants Laxatives Diet Increase fiber Limit caffeine, alcohol, fat, & milk products Small, frequent meals
© 2007 Thomson - Wadsworth Diverticular Disease Presence of pebble- sized outpockets in intestinal wall Prevalence increases with age High-fiber diet can be preventative May need to avoid nuts, popcorn, & food with seeds
© 2007 Thomson - Wadsworth Diverticulitis Inflammation or infection Most common complication of diverticulosis Symptoms Persistent abdominal pain Fever Alternating constipation & diarrhea Treatment Antibiotics, pain medication Clear liquid or bowel rest Surgery
© 2007 Thomson - Wadsworth Ostomies Surgical removal of some or all of large intestine Wastes exit through a stoma in abdominal wall Colostomy & ileostomy Temporary or permanent Chew food thoroughly to prevent obstructions Foods cause unpleasant odors Fish, eggs, dried beans & peas, onions, garlic, beer, others Foods that reduce odors Buttermilk, cranberry juice, parsley, yogurt
© 2007 Thomson - Wadsworth
Fiber-Modified Diets for Lower GI Tract Disorders
Normal Function of Lower GI
Diet, Disease, and Digestion
Medical Nutrition Therapy for Lower Gastrointestinal Tract Disorders
Irritable Bowel Syndrome §Abnormal stool pattern associated w/disturbances in GI motility that persist for > 3 months. §Symptoms: l l l §Causes:
© 2007 Thomson - Wadsworth Chapter 16 Nutrition in Metabolic & Respiratory Stress.
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Lower Gastrointestinal Tract KNH 411. © 2007 Thomson - Wadsworth.
Lower GI Tract - Part One NFSC Clinical Nutrition McCafferty.
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Gastrointestinal Disorders Chapter 6 Medical Considerations.
Crohn’s disease - A Review of Symptoms and Treatment
Nutrition & Diet Therapy (7 th Edition) Carbohydrate- & Fat-Modified Diets for Malabsorption Chapter 19.
Large Intestine Working knowledge of physiological changes during disease processes & the effects of these on nutrition care.
Problems of the Digestive System ulcer: a hole or sore inside the stomach or small intestine often caused by H-Pylori bacteria Our stomachs are covered.
Gluten Free Diet Accommodating the Gluten Free Diet in The PCH Setting.
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