© 2007 Thomson - Wadsworth Chapter 18 Nutrition and Lower Gastrointestinal Disorders.

© 2007 Thomson - Wadsworth

Chapter 18

Nutrition and Lower Gastrointestinal Disorders


Common Problems of the Lower Intestine

• Constipation• Intestinal Gas• Diarrhea• Bacterial Overgrowth• Steatorrhea


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


Treatment

• Gradual increase in fiberWheat branFruits (prunes)Vegetables

• Adequate fluid• Daily exercise• Laxatives• Medical intervention


Intestinal Gas

• CausesHigh-fiber dietsCarbohydrates

• Fructose • Sugar alcohols

(sorbitol, mannitol, maltitol)

• Beans• Some grains &

potatoes

• Other causesMalabsorption

problemsSwallowed air


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


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


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


Malabsorption Syndromes

• Lactose Intolerance• Pancreatitis• Cystic Fibrosis• Celiac Disease• Inflammatory Bowel

Diseases• Short-Bowel Syndrome


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


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


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


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


Inflammatory Bowel Diseases

• Chronic inflammatory conditions• Genetic & environmental factors

contribute• Exact triggers are unknown• Crohn’s disease & ulcerative colitis


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


Healthy colon (left) vs. Crohn’s disease (right)


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


Healthy colon (left) vs. ulcerative colitis (right)


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


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


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


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


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


Diverticulitis

• Inflammation or infection• Most common complication of

diverticulosis• Symptoms

Persistent abdominal painFeverAlternating constipation & diarrhea

• TreatmentAntibiotics, pain medicationClear liquid or bowel restSurgery


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

© 2007 Thomson - Wadsworth Chapter 18 Nutrition and Lower Gastrointestinal Disorders.

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Transcript of © 2007 Thomson - Wadsworth Chapter 18 Nutrition and Lower Gastrointestinal Disorders.