Lower GI Tract - Part One
NFSC 370 - Clinical Nutrition
McCafferty
The Intestine “The” organ of digestion and
absorption Physical barrier against organisms Contains numerous immune cells
Principles of Nutritional CareReview:Fiber/Roughage
high-fiber diet: low-fiber diet:
Residue: fecal matter left after D&A of food and bacterial fermentation bacteria water fiber mucosal cells mucus unabsorbed starches, sugars, protein, and minerals
Low-residue diet Patients w/diarrhea, maldigestion, malabsorption Minimizes foods that leave fecal residue
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• Minimizes foods that increase GI secretions
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Constipation Fewer than 3 stools/week while on high residue diet More than 3 days without passage of stool Low stool volume/incomplete evacuation
Treatment:
Diarrhea
Frequent evacuation of liquid stools
Intractable diarrhea:
Loss of fluid and electrolytes
Symptom of disease state
Treatment
If osmotic diarrhea:
BRAT diet
Steatorrhea Fat malabsorptionfatty diarrhea Fat losses of up to 60g/day Fecal fat test Loss of fat in stool
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Treating Fat Malabsorption/Steatorrhea Fat-restricted diets:
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
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Water-Miscible Fat-Soluble Vitamins:
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Oxalate-Restricted diets:
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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.
Diseases of the Small Intestine
Celiac Disease(Gluten-Sensitive Enteropathy)
Causes flattening of the intestinal villi and
maldigestion/malabsorption.
Requires strict adherence to the diet. Substitutes:
Continuous adherence necessary, even if consuming gliadin does not precipitate symptoms.
Lactose Intolerance
Causes
Treatment
Inflammatory Bowel Diseases: Crohn’s Disease &Ulcerative Colitis
Both cause mucosal inflammation and lesions.
Etiology: linked to gene which causes faulty response to
microbes in the stomach recall: GI tract = major immune system organ may somehow trigger the immune system to
attack the intestinal lining
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
Fistulas may develop
Inflammatory tissue changes are chronic.
most common between ages of 20-40symptoms:
Bleeding can anemia, secretions can cause loss of
proteins (albumin). Growth failure in kids is common.Deficiencies cause decreased immune fx.
Ulcerative ColitisUsually confined to colon and rectumInflammatory 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:
Nutrition Therapy for Inflammatory Bowel Disease
Idea of “bowel rest” with TPN
may be necessary in severe cases/fistula/obstruction
Nutrition Therapy for Inflammatory Bowel Disease
Small, frequent meals Low-residue lactose if intolerantLow fat w/ MCT oil if fat malabsorption presentEnergy: Protein: MVI, Fe, Zn, vit. C, folate, B12, and fat-sol
vitamins
Drug TherapyCorticosteroids are effective at inducing
remission (prednisone)Anti-inflammatory agents
(aminosalicylates)
Antidiarrheal (loperamide - “Lomotil”)Antibiotics (sulfasalazine)Immunosuppressants (cyclosporine)May require bowel resection
Healed Crohn's