Lower gi tract part one
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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 Care. Review: Fiber/Roughage high-fiber diet: low-fiber diet:

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Lower GI Tract - Part One

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Lower gi tract part one

Lower GI Tract - Part One

NFSC 370 - Clinical Nutrition

McCafferty


Lower gi tract part one

The Intestine

  • “The” organ of digestion and absorption

  • Physical barrier against organisms

  • Contains numerous immune cells


Principles of nutritional care

Principles of Nutritional Care

Review:

  • 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


Lower gi tract part one

  • Low-residue diet

    • Patients w/diarrhea, maldigestion, malabsorption

    • Minimizes foods that leave fecal residue

    • Minimizes foods that increase GI secretions


Lower gi tract part one

  • 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:


Lower gi tract part one

  • Diarrhea

    • Frequent evacuation of liquid stools

    • Intractable diarrhea:

    • Loss of fluid and electrolytes

    • Symptom of disease state


Lower gi tract part one

Treatment

  • If osmotic diarrhea:

  • BRAT diet


Lower gi tract part one

  • Steatorrhea

    • Fat malabsorptionfatty diarrhea

    • Fat losses of up to 60g/day

    • Fecal fat test

    • Loss of fat in stool 


Lower gi tract part one

  • 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


Lower gi tract part one

  • Water-Miscible Fat-Soluble Vitamins:

  • Oxalate-Restricted diets:

  • 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

Diseases of the Small Intestine


Celiac disease gluten sensitive enteropathy

Celiac Disease(Gluten-Sensitive Enteropathy)

  • Causes flattening of the intestinal villi and maldigestion/malabsorption.


Lower gi tract part one

  • Requires strict adherence to the diet.

    • Substitutes:

    • Continuous adherence necessary, even if consuming gliadin does not precipitate symptoms.


Lactose intolerance

Lactose Intolerance

  • Causes

  • Treatment


Inflammatory bowel diseases crohn s disease ulcerative colitis

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


Lower gi tract part one

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


Lower gi tract part one

  • Fistulas may develop

  • Inflammatory tissue changes are chronic.


Lower gi tract part one

  • most common between ages of 20-40

  • symptoms:

  • Bleeding can  anemia, secretions can cause loss of proteins (albumin).

  • Growth failure in kids is common.

  • Deficiencies cause decreased immune fx.


Lower gi tract part one

Ulcerative Colitis

  • Usually confined to colon and rectum

  • Inflammatory 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

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 disease1

Nutrition Therapy for Inflammatory Bowel Disease

  • Small, frequent meals

  • Low-residue

  •  lactose if intolerant

  • Low fat w/ MCT oil if fat malabsorption present

  • Energy:

  • Protein:

  • MVI, Fe, Zn, vit. C, folate, B12, and fat-sol vitamins


Lower gi tract part one

Drug Therapy

  • Corticosteroids are effective at inducing remission (prednisone)

  • Anti-inflammatory agents (aminosalicylates)

  • Antidiarrheal (loperamide - “Lomotil”)

  • Antibiotics (sulfasalazine)

  • Immunosuppressants (cyclosporine)

  • May require bowel resection


Lower gi tract part one

Healed Crohn's


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