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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
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
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
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
Fiber-Modified Diets for Lower GI Tract Disorders
Normal Function of Lower GI
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 79 Laxatives.
Constipation Prepared by: Alison Deux, 4th year pharmacy student.
ASSISTING WITH BOWEL ELIMINATION MOUTH ESOPHAGUS LIVER STOMACH
Alterations of the GI Tract
© 2007 Thomson - Wadsworth Chapter 18 Nutrition and Lower Gastrointestinal Disorders.
1 Chapter 8 Drugs for Gastrointestinal Disorders.
Understanding Ostomies Get Out Your Unit 20.9 Worksheet out !!
Irritable Bowel Syndrome §Abnormal stool pattern associated w/disturbances in GI motility that persist for > 3 months. §Symptoms: l l l §Causes:
Two Key Functions: Digestion - breaking down food into smaller molecules (nutrients). Absorbing these nutrients into the bloodstream.
University of Georgia Cooperative Extension Service
Other Large Intestine Procedure
Lower Gastrointestinal Tract KNH 411. © 2007 Thomson - Wadsworth.
Irritable Bowel Syndrome Biol E-163 TA session 12/18/06.
BOWEL MANAGEMENT FOR SPINAL CORD INJURED PERSONS Presented by: Karen Flaherty, RN, ADN & Michael Caplinger, RN, BSN VABHS SCI Service West Roxbury Campus.
Constipation The University of Georgia Cooperative Extension Service.
Crohn’s Disease Allie Abraham.
BOWEL ELIMINATION Bowel elimination is a basic physical need. It is the excretion of wastes from the digestive system. As a health care worker, you will.
Crohn’s Disease Kyra Alexander. What is it? An inflammatory bowel disease that causes inflammation of the digestive tract. It is an unpredictable disease.
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