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