© 2007 thomson - wadsworth chapter 18 nutrition and lower gastrointestinal disorders
TRANSCRIPT
© 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 intakeLow-fiber diets Inactivity
• Medical conditionsHypothyroidismDiabetes mellitusChronic renal failureParkinson’sSpinal cord lesionsMS
• Some medications & dietary supplements
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Treatment
• Gradual increase in fiberWheat branFruits (prunes)Vegetables
• Adequate fluid• Daily exercise• Laxatives• Medical intervention
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Intestinal Gas
• CausesHigh-fiber dietsCarbohydrates
• Fructose • Sugar alcohols
(sorbitol, mannitol, maltitol)
• Beans• Some grains &
potatoes
• Other causesMalabsorption
problemsSwallowed air
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© 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
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© 2007 Thomson - Wadsworth
Bacterial Overgrowth
• Gastric acid protects stomach & intestine from bacterial overgrowth
• Overgrowth Disrupts fat digestion &
absorptionMay develop fat-soluble
vitamin & vitamin B12
deficiencies
• SymptomsChronic diarrheaAbdominal discomfortBloatingWeaknessWeight loss
• Causes Impaired intestinal
motilityReduced gastric acid
secretions
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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
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Malabsorption Syndromes
• Lactose Intolerance• Pancreatitis• Cystic Fibrosis• Celiac Disease• Inflammatory Bowel
Diseases• Short-Bowel Syndrome
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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
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Pancreatitis
• Pancreatic tissue is destroyed by activated enzymes
• Severe abdominal pain• Acute
Causes: gallstones, excessive alcohol, high triglycerides, toxins
Withhold food & fluids
• ChronicPermanent damage
to tissue70% alcohol inducedFood avoidance &
malabsorption lead to weight loss & malnutrition
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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
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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
• SymptomsDiarrhea, steatorrhea,
flatulence
• ConsequencesSevere damage to
intestinal mucosaMalabsorption Children: stunted
growth & underweight
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Inflammatory Bowel Diseases
• Chronic inflammatory conditions• Genetic & environmental factors
contribute• Exact triggers are unknown• Crohn’s disease & ulcerative colitis
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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
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Healthy colon (left) vs. Crohn’s disease (right)
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Ulcerative Colitis
• Only affects the rectum & colon
• Frequent urgent bowel movements
• Nutrient losses due to tissue damage, bleeding, & diarrhea
• ComplicationsWeight lossFeverWeaknessAnemiaDehydrationElectrolyte imbalanceProtein losses
• Colectomy prevents future occurrences
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Healthy colon (left) vs. ulcerative colitis (right)
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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 colitisMay require few
adjustmentsRestore fluids &
electrolytesLow fiber or
withhold food during severe illness
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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
© 2007 Thomson - Wadsworth
Disorders of the Large Intestine
• Irritable Bowel Syndrome
• Diverticular Disease of the Colon
• Ostomies
• Large intestineMoves undigested
materials to the rectum
Helps maintain fluid & electrolyte balance
Bacteria ferment undigested materials
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Irritable Bowel Syndrome
• Chronic & recurring intestinal symptoms Diarrhea & constipation Flatulence, bloating, &
distention
• More common in women
• Excessive colonic response to meals, GI hormones, & stress
• MedicineAntidiarrheal agentsAnticholinergicsAntidepressantsLaxatives
• Diet Increase fiberLimit caffeine, alcohol,
fat, & milk productsSmall, frequent meals
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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
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Diverticulitis
• Inflammation or infection• Most common complication of
diverticulosis• Symptoms
Persistent abdominal painFeverAlternating constipation & diarrhea
• TreatmentAntibiotics, pain medicationClear liquid or bowel restSurgery
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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 odorsFish, eggs, dried beans &
peas, onions, garlic, beer, others
• Foods that reduce odorsButtermilk, cranberry
juice, parsley, yogurt
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