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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

Lower GI Tract - Part One

NFSC 370 - Clinical Nutrition

McCafferty

slide2
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
slide4
Low-residue diet
    • Patients w/diarrhea, maldigestion, malabsorption
    • Minimizes foods that leave fecal residue
    • Minimizes foods that increase GI secretions
slide5
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:

slide6
Diarrhea
    • Frequent evacuation of liquid stools
    • Intractable diarrhea:
    • Loss of fluid and electrolytes
    • Symptom of disease state
slide7
Treatment
  • If osmotic diarrhea:
  • BRAT diet
slide8
Steatorrhea
    • Fat malabsorptionfatty diarrhea
    • Fat losses of up to 60g/day
    • Fecal fat test
    • Loss of fat in stool 
slide10
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
slide11
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.
celiac disease gluten sensitive enteropathy
Celiac Disease(Gluten-Sensitive Enteropathy)
  • Causes flattening of the intestinal villi and maldigestion/malabsorption.
slide14
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
slide17
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
slide18
Fistulas may develop
  • Inflammatory tissue changes are chronic.
slide19
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.
slide20
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
slide23
Drug Therapy
  • Corticosteroids are effective at inducing remission (prednisone)
  • Anti-inflammatory agents (aminosalicylates)
  • Antidiarrheal (loperamide - “Lomotil”)
  • Antibiotics (sulfasalazine)
  • Immunosuppressants (cyclosporine)
  • May require bowel resection
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