1. Lower GI Tract - Part One NFSC 370 - Clinical Nutrition McCafferty

2. The Intestine §“The” organ of digestion and absorption §Physical barrier against organisms §Contains numerous immune cells

3. Principles of Nutritional Care Review: §Fiber/Roughage l high-fiber diet: l low-fiber diet: §Residue: fecal matter left after D&A of food and bacterial fermentation l bacteria l water l fiber l mucosal cells l mucus l unabsorbed starches, sugars, protein, and minerals

4. §Low-residue diet l Patients w/diarrhea, maldigestion, malabsorption l Minimizes foods that leave fecal residue l Minimizes foods that increase GI secretions

5. §Constipation l Fewer than 3 stools/week while on high residue diet l More than 3 days without passage of stool l Low stool volume/incomplete evacuation Treatment: l l l l

6. §Diarrhea l Frequent evacuation of liquid stools l Intractable diarrhea: l Loss of fluid and electrolytes l Symptom of disease state

7. Treatment l l If osmotic diarrhea: l l BRAT diet

8. §Steatorrhea l Fat malabsorption  fatty diarrhea l Fat losses of up to 60g/day l Fecal fat test l Loss of fat in stool 

10. §Treating Fat Malabsorption/Steatorrhea l Fat-restricted diets: l MCTs: C6-C12 FAs Do not require pancreatic lipase or bile for D&A Don’t form micelles -- absorbed directly into portal vein rather than the lymphatic system

11. l Water-Miscible Fat-Soluble Vitamins: l Oxalate-Restricted diets: l Enzyme Replacement Therapy: When malabsorption is related to severe pancreatic insufficiency or when steatorrhea is severe. Made from extracts of pork or beef pancreatic enzymes.

12. Diseases of the Small Intestine

13. Celiac Disease (Gluten-Sensitive Enteropathy)   Causes flattening of the intestinal villi and maldigestion/malabsorption.  

14.  Requires strict adherence to the diet.  Substitutes:   Continuous adherence necessary, even if consuming gliadin does not precipitate symptoms.

15. Lactose Intolerance §Causes §Treatment

16. Inflammatory Bowel Diseases: Crohn’s Disease &Ulcerative Colitis §Both cause mucosal inflammation and lesions. §Etiology: l linked to gene which causes faulty response to microbes in the stomach l recall: GI tract = major immune system organ l may somehow trigger the immune system to attack the intestinal lining

17. Crohn’s Disease: §Inflammation and ulceration along the length of the GI tract, often with granulomas §Most often affects ileum and colon, but can occur anywhere along the GI tract. §Can affect liver kidneys, joints, eyes, and skin. §No medical cure §

18. §Fistulas may develop l §Inflammatory tissue changes are chronic. §

19. §most common between ages of 20-40 §symptoms: §Bleeding can  anemia, secretions can cause loss of proteins (albumin). §Growth failure in kids is common. §Deficiencies cause decreased immune fx. § §

20. Ulcerative Colitis §Usually confined to colon and rectum §Inflammatory tissue changes are acute and limited to mucosa and submucosal tissue layers of the intestine §age of onset: 15-30 and 50-60 yrs – more common later in life §Symptoms:

21. Nutrition Therapy for Inflammatory Bowel Disease § §Idea of “bowel rest” with TPN l l may be necessary in severe cases/fistula/obstruction

22. Nutrition Therapy for Inflammatory Bowel Disease §Small, frequent meals §Low-residue §  lactose if intolerant §Low fat w/ MCT oil if fat malabsorption present §Energy: §Protein: §MVI, Fe, Zn, vit. C, folate, B12, and fat-sol vitamins

23. Drug Therapy §Corticosteroids are effective at inducing remission (prednisone) §Anti-inflammatory agents (aminosalicylates) l §Antidiarrheal (loperamide - “Lomotil”) §Antibiotics (sulfasalazine) §Immunosuppressants (cyclosporine) §May require bowel resection

24. Healed Crohn's