Lower Gastrointestinal Tract
KNH 411
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
 Malabsorption - maldigestion of fat, CHO, Protein
Celiac disease, diverticulitus, chrons disease can be
casued by
 Decreased villious height, enzyme production
 Unproper working of an accessory organ (Pancrease, liver)
cancer
 Decreased transit time
Pathophysiology: Lower GI Tract
 Malabsorption - fat
 Steatorrhea: loose lipid fatty stools
 Fat-soluble vitamins malabsorbed: ADEK
 Potential for excess oxalate: kidney stones
 Abdominal pain, cramping, diarrhea
 Dg; fecal fat test or
 D-xylose absorption test- to test how well the body is
absorbing simple sugars (depends on the length of the
compromised GI tract)
 or small bowel x-ray
Pathophysiology: Lower GI Tract
 Malabsorption - Fat – Nutrition
 Restrict fat 25-50 g/day
 Use of MCT supplements
 Pancreatic enzymes
Pathophysiology: Lower GI Tract
 Malabsorption - CHO
 Lactose malabsorption
 Increased gas, abdominal cramping, diarrhea
 Restrict milk and dairy products
 Products such as Lactaid can be rec.
Pathophysiology: Lower GI Tract
 Malabsorption - protein
 Protein-losing enteropathy
 Reduced serum protein
 Peripheral edema
 Cells can not hold in the water
 Fluid is overloaded because your system is not holding fluid
within the cells
Pathophysiology: Lower GI Tract
 Malabsorption - Nutrition Therapy
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Results in weight loss
Loss of vitamins and minerals
Difficencys
Chronic PEM (protein Energy Malnutrition)
 Treat underlying disease/ nutrient being malabsorbed
 What nutrient is being malabsorbed and what can you do to
treat that specifically
Pathophysiology: Lower GI Tract
 Celiac disease
 Damage to the intestinal mucosa
 Genetic and autoimmune disease
 Occurs when alpha-gliadin from wheat, rye, malt, barley
are eaten
 Looking at an inflammatory state that creates antibodies
 Some can handle small amounts of oats
 New onset patients you have to rebuild and you want to start
off really slow by being very easy on the gut- removing as many
irritants as possible
 Infiltration of WBC, production of IgA antibodies
Pathophysiology: Lower GI Tract
 Celiac disease - pathophysiology
 Damage to villi
 Reduced height as well as being flattened
 Decreased enzyme function
 Maldigestion and malabsorption
 Occurs with other autoimmune disorders
Pathophysiology: Lower GI Tract
 Celiac disease - clinical manifestations
 Peripheral neurothopy-sense of touch
 Bone and join
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Diarrhea, abdominal pain, cramping, bloating, gas
Muscle cramping, fatigue
Skin rash
Higher risk for lymphoma and osteoporosis
Pathophysiology: Lower GI Tract
 Celiac Disease - Diagnosis/Treatment/Prognosis
 Biopsy of small intestinal mucosa
 Or individuals will eliminate gluten and then follow through
with a gluten free plan
 Reversal of symptoms following gluten-free diet
 Refractory CD; d/t coexisting disease
Pathophysiology: Lower GI Tract
 Celiac Disease - Nutrition Intervention
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Low-residue: to minimize diarrhea
low-fat no more than 45-50 g per day
lactose-free
gluten-free diet
 Oats are controversial maximum amount is ½ cup a day
 Identify hidden sources of gluten
 Specialty products
Pathophysiology: Lower GI Tract
 Irritable Bowel Syndrome (IBS)
 Medical diagnosis : Abdominal pain that has to have at least
2 of the following
 Pain relieved with defecation
 Onset associated with change in frequency of stool
 Onset associated with change in form of stool
 Eliminate “red flag” symptoms: Difficulty eliminating
waste products
Pathophysiology: Lower GI Tract
 IBS
 Most common GI complaint
 Pain with defecation
 More common in women than men
 Etiology unknown
 Usually Increased serotonin, inflammatory response,
abnormal motility, pain in these individuals
 Stess, anxiety, emotional trauma are all more common in
these individuals
Pathophysiology: Lower GI Tract
 IBS - clinical manifestations
 Abdominal pain, alterations in bowel habits, gas,
flatulence
 Increased sensitivity to certain foods
 Concurrent dg
 Fibromyalgia
 Chronic fatigue syndrome
 Food allergies
Pathophysiology: Lower GI Tract
 IBS - Treatment
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Guided by symptoms
Antidiarrheal agents
Tricyclic antidepressants, SSRIs
Bulking agents, laxatives
Behavioral therapies
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
 Can lead to nutrient deficiency, underweight, malnurited
 Decrease anxiety and depression
 Goal is to normalize dietary patterns
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
 Assess diet hx
 Assess nutritional adequacy: 24 hr recall assess what is
going on with macro nutrients and micro nutrients
 Focus on increasing fiber intake: increase to 25 g per day
 Adequate fluid: to try to help with GI motility 25 cc per
kcal
 Pre- and probiotics: trying to rebuild that gut flora and the
damage that has been done from that inflammation
 Avoid foods that produce gas and swallowed air
 Eliminate use of staws
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
 IBD - Nutrition Therapy
 Antibiotics
 Nutrition support
 TPN
 Malnutrition
 High cal high protein fiber regimen
 Iron, zn, mg,- can be lost with blood in stool electrolyes
(Na,K,Cl) fluid loss
 May need to increase kcal, protein, micronutrients
Pathophysiology: Lower GI Tract
 IBD - Nutrition Interventions
 During exacerbation
 Enteral nurtiition
 TPN
 Insure
 Glutamine
 Intromin
 Supplement
 Assess energy needs + stress factor
 1.5-1.7 g per kilo protein
 200-500 extra kcal per day
 May need to increase protein
 Low-residue, lactose-free diet
 Small, frequent meals
Pathophysiology: Lower GI Tract
 IBD - Nutrition Interventions
 May use MCT oil
 Restrict gas-producing foods
 Increase fiber and lactose as tolerated
 40 g per day
 Advancement of oral diet
 Individual basis
 Multivitamin
 Make sure they have one
 B12, iron, ca, zn, mg, cu
Pathophysiology: Lower GI Tract
 IBD - Nutrition Interventions
 During remission/rehabilitation
 Maximize energy & protein
 Weight gain and physical activity
 Food sources of antioxidants, Omega-3s
 Rebuild gut pro and prebiotics
 Pro- and prebiotics
Pathophysiology: Lower GI Tract
 Diverticulosis/diverticulitis – abnormal presence of
outpockets or pouches on surface of SI or
colon/inflammation of these
 Low fiber intake is of concern
 History of constpation
 When in inflammed state have a low fiber diet
 When not in an inflammed state high fiber diet
 Increases inflammatory response
 Other risks
 Obestiy, sedentary lifestyle, alcohol and caffeine intake and
cigarette smoking
Pathophysiology: Lower GI Tract
 Diverticulosis/diverticulitis – pathophysiology
Fecal matter trapped
Creates excess pressure on the fecal wall of the colon
Development of pouches
Diverticulitis: possibility that they could actually
burst
 Food stuff can get caught in there, bacteria can
result
 Bleeding abscess, obstruction,
 fistula
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 Bleeding area of that gut
 Perforation
 Surgical procedure
Pathophysiology: Lower GI Tract
 Diverticulosis/-itis – Treatment/ Nutrition Therapy
Specific focus on fiber
Pro- and prebiotic supplementation
Acute
Antibiotics
Ossis-trying to fix gut lining before it is in crisis
Itis-might need surgical intervention: associated with fever
and hospitalization
Trying to increase gut flora
During inflammation stage –bowel rest- clear liquids
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Pathophysiology: Lower GI Tract
 Diverticulosis/-itis – Nutrition Therapy
 -osis
 Avoid nuts, seeds, hulls? Because they are now thinking
that they might not get caught in the pouches
 Fiber supplement: increase from 35 g to 10 to 12 g more
 psyllium
 -itis
 Low fiber diet
 Bowel rest, may need to be on clear liquids
 Avoid nuts, seeds, fibrous vegetables