Lower Gastrointestinal Tract KNH 406

Lower Gastrointestinal Tract KNH 406

Lower GI Tract A&P Small Intestine Anatomy Duodenum, jejunum, ileum Maximum surface area for digestion and absorption Specialized enterocytes from stem cells of crypts

2007 Thomson - Wadsworth

2007 Thomson - Wadsworth

2007 Thomson - Wadsworth

2007 Thomson - Wadsworth

Lower GI Tract A&P Large Intestine Digestion & Absorption No enzymatic digestion occurs Reabsorption Formation and storage of feces

Lower GI Tract A&P Large Intestine Digestion & Absorption Maintaining balance of intestinal flora Vitamin K and biotin

Malabsorption - maldigestion of fat, CHO, Protein Decreased villious height, enzyme production Decreased transit time

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

Malabsorption - Fat Nutrition Restrict fat 25-50 g/day Use of MCT supplements Pancreatic enzymes

Malabsorption - CHO Lactose malabsorption Increased gas, abdominal cramping, diarrhea Restrict milk and dairy products Products such as Lactaid can be rec.

Malabsorption - protein Protein-losing enteropathy Reduced serum protein Peripheral edema

Malabsorption - Nutrition Therapy Results in weight loss Treat underlying disease/ nutrient being malabsorbed

Celiac disease Genetic and autoimmune Occurs when alpha-gliadin from wheat, rye, malt, barley are eaten Infiltration of WBC, production of IgA antibodies

Celiac disease - pathophysiology Damage to villi Decreased enzyme function Maldigestion and malabsorption Occurs with other autoimmune disorders

2007 Thomson - Wadsworth

Celiac disease - clinical manifestations Diarrhea, abdominal pain, cramping, bloating, gas Muscle cramping, fatigue Skin rash Higher risk for lymphoma and osteoporosis

Celiac Disease - Diagnosis/Treatment/Prognosis Biopsy of small intestinal mucosa Reversal of symptoms following gluten-free diet Refractory CD; d/t coexisting disease

Celiac Disease - Nutrition Intervention Low-residue, low-fat, lactose-free, gluten-free diet Identify hidden sources of gluten Specialty products

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

IBS Most common GI complaint Etiology unknown Increased serotonin, inflammatory response, abnormal motility, pain

IBS - clinical manifestations Abdominal pain, alterations in bowel habits, gas, flatulence Increased sensitivity to certain foods Concurrent dg

IBS - Treatment Guided by symptoms Antidiarrheal agents Tricyclic antidepressants, SSRIs Bulking agents, laxatives Behavioral therapies

IBS - Nutrition Therapy Can lead to nutrient deficiency, underweight Decrease anxiety, normalize dietary patterns

IBS - Nutrition Therapy Assess diet hx Assess nutritional adequacy Focus on increasing fiber intake Adequate fluid Pre- and probiotics Avoid foods that produce gas

2007 Thomson - Wadsworth

2007 Thomson - Wadsworth

2007 Thomson - Wadsworth

Inflammatory Bowel Disease (IBD) - autoimmune, chronic inflammatory condition of GI tract Ulcerative colitis (UC) Crohn s disease

2007 Thomson - Wadsworth

2007 Thomson - Wadsworth

2007 Thomson - Wadsworth

IBD - Treatment Antibiotics Immunosupressants Immunomodulators Biologic therapies Surgery

IBD - Nutrition Therapy Malnutrition May need to increase kcal, protein, micronutrients

IBD - Nutrition Interventions During exacerbation Supplement Assess energy needs + stress factor May need to increase protein If active state Low-residue, lactose-free diet Small, frequent meals

IBD - Nutrition Interventions May use MCT oil Restrict gas-producing foods Increase fiber and lactose as tolerated Advancement of oral diet Multivitamin

IBD - Nutrition Interventions During remission/rehabilitation Maximize energy & protein Weight gain and physical activity Food sources of antioxidants, Omega-3s Pro- and prebiotics

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

2007 Thomson - Wadsworth

Diverticulosis/diverticulitis pathophysiology Fecal matter trapped Development of pouches Diverticulitis Food stuff Bleeding abscess, obstruction, fistula, perforation

Diverticulosis/-itis clinical manifestations -osis -itis Diagnosed by radiology testing

Diverticulosis/-itis Treatment/ Nutrition Therapy Specific focus on fiber Pro- and prebiotic supplementation Acute Antibiotics

Diverticulosis/-itis Nutrition Therapy -osis Avoid nuts, seeds, hulls Fiber supplement -itis Bowel rest Avoid nuts, seeds, fibrous vegetables