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Lower GI Tract - Part One

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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  1. Lower GI Tract - Part One NFSC 370 - Clinical Nutrition McCafferty

  2. The Intestine • “The” organ of digestion and absorption • Physical barrier against organisms • Contains numerous immune cells

  3. 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

  4. Low-residue diet • Patients w/diarrhea, maldigestion, malabsorption • Minimizes foods that leave fecal residue • Minimizes foods that increase GI secretions

  5. 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:

  6. Diarrhea • Frequent evacuation of liquid stools • Intractable diarrhea: • Loss of fluid and electrolytes • Symptom of disease state

  7. Treatment • If osmotic diarrhea: • BRAT diet

  8. Steatorrhea • Fat malabsorptionfatty diarrhea • Fat losses of up to 60g/day • Fecal fat test • Loss of fat in stool 

  9. 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

  10. 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.

  11. Diseases of the Small Intestine

  12. Celiac Disease(Gluten-Sensitive Enteropathy) • Causes flattening of the intestinal villi and maldigestion/malabsorption.

  13. Requires strict adherence to the diet. • Substitutes: • Continuous adherence necessary, even if consuming gliadin does not precipitate symptoms.

  14. Lactose Intolerance • Causes • Treatment

  15. 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

  16. 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

  17. Fistulas may develop • Inflammatory tissue changes are chronic.

  18. 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.

  19. 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:

  20. Nutrition Therapy for Inflammatory Bowel Disease • Idea of “bowel rest” with TPN • may be necessary in severe cases/fistula/obstruction

  21. 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

  22. Drug Therapy • Corticosteroids are effective at inducing remission (prednisone) • Anti-inflammatory agents (aminosalicylates) • Antidiarrheal (loperamide - “Lomotil”) • Antibiotics (sulfasalazine) • Immunosuppressants (cyclosporine) • May require bowel resection

  23. Healed Crohn's

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