1. Lower Gastrointestinal Tract KNH 411

3. © 2007 Thomson - Wadsworth

6. Pathophysiology: Lower GI Tract Malabsorption - maldigestion of fat, CHO, Protein Decreased villious height, enzyme production Decreased transit time  resecting of that area; surgery

7. 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

8. Pathophysiology: Lower GI Tract Malabsorption - Fat – Nutrition Restrict fat 25-50 g/day Use of MCT supplements Pancreatic enzymes  individuals who have chronnes will be taking pancreatic enzymes before their meals

9. 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.

10. Pathophysiology: Lower GI Tract Malabsorption - protein Protein-losing enteropathy Reduced serum protein  lab value you would be looking at Peripheral edema  system or cells can not hold in the water

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

12. 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

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

15. 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

16. 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

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

19. 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

20. Pathophysiology: Lower GI Tract IBS Most common GI complaint Etiology unknown Increased serotonin, inflammatory response, abnormal motility, pain  they do not know why this is

21. Pathophysiology: Lower GI Tract IBS - clinical manifestations Abdominal pain, alterations in bowel habits, gas, flatulence Increased sensitivity to certain foods  lactose, wheat and other diet foods Concurrent dg

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

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

24. Pathophysiology: Lower GI Tract IBS - Nutrition Therapy Assess diet hx  what is triggering the IBS concerns Assess nutritional adequacy  24 hours recall Focus on increasing fiber intake  25 grams per day Adequate fluid  help with GI motility Pre- and probiotics Avoid foods that produce gas  and swallowed air, for example the use of straws

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

32. Pathophysiology: Lower GI Tract IBD - Nutrition Interventions During exacerbation Supplement Assess energy needs + stress factor  increase any 200-500 calories per day May need to increase protein  1.5-1.7 g per kilo Low-residue, lactose-free diet Small, frequent meals

33. Pathophysiology: Lower GI Tract IBD - Nutrition Interventions May use MCT oil Restrict gas-producing foods Increase fiber and lactose as tolerated  if not in crisis Advancement of oral diet  individual basis Multivitamin  want them to have one. B12 iron zinc calcium magnesium and copper are all the ones that are included in your vitamin

34. 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

35. 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

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

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

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