Lower Gastrointestinal Tract
KNH 411
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
● Malabsorption - maldigestion of fat, CHO, Protein
● Decreased villious height, enzyme production
● Decreased transit time
Pathophysiology: Lower GI Tract
● Malabsorption - fat
● Steatorrhea
● Fat-soluble vitamins malabsorbed
● Potential for excess oxalate
● Abdominal pain, cramping, diarrhea
● Dg; fecal fat test or D-xylose absorption test, 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
● Most common
● Lactade
● 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
● Due to excess loss of protein in stool
● Peripheral edema
● Due to oncotic pressure
● Korshikor & marasmus
● Diseases left untreated
Pathophysiology: Lower GI Tract
● Malabsorption - Nutrition Therapy
● Results in weight loss
● Treat underlying disease/ nutrient being malabsorbed
Pathophysiology: Lower GI Tract
● Celiac disease
● Genetic and autoimmune
● Occurs when alpha-gliadin from wheat, rye, malt, barley
are eaten
● Infiltration of WBC, production of IgA antibodies
Pathophysiology: Lower GI Tract
● Celiac disease - pathophysiology
● Damage to villi
● Decreased enzyme function
● Maldigestion and malabsorption
● Occurs with other autoimmune disorders
Pathophysiology: Lower GI Tract
● Celiac disease - clinical manifestations
● 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
● Reversal of symptoms following gluten-free diet
● Refractory CD; d/t coexisting disease
Pathophysiology: Lower GI Tract
● Celiac Disease - Nutrition Intervention
● Low-residue, low-fat, lactose-free, gluten-free diet
● Identify hidden sources of gluten
● Specialty products
Pathophysiology: Lower GI Tract
● Irritable Bowel Syndrome (IBS)
● Pain relieved with defecation
● Onset associated with change in frequency of stool
● Onset associated with change in form of stool
● Eliminate “red flag” symptoms
● Anemia, weight loss, history of colon cancer
Pathophysiology: Lower GI Tract
● IBS
● Most common GI complaint
● Etiology unknown
● Increased serotonin, inflammatory response, abnormal
motility, pain
Pathophysiology: Lower GI Tract
● IBS - clinical manifestations
● Abdominal pain, alterations in bowel habits, gas,
flatulence
● Increased sensitivity to certain foods
● Concurrent dg
Pathophysiology: Lower GI Tract
● IBS - Treatment
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Guided by symptoms
Antidiarrheal agents
Tricyclic antidepressants, SSRIs
Bulking agents, laxatives
Behavioral therapies
● Hypnosis, guided imagery
Pathophysiology: Lower GI Tract
● IBS - Nutrition Therapy
● Can lead to nutrient deficiency, underweight,
malnourished, low gas producing foods
● Decrease anxiety, normalize dietary patterns
Pathophysiology: Lower GI Tract
● IBS - Nutrition Therapy
● Assess diet hx
● Look for offensive foods
● Assess nutritional adequacy
● Focus on increasing fiber intake
● At least 25g of fiber per day
● Slowly increase if their under
● Adequate fluid
● Pre- and probiotics
● Build up normal gut flora
● Avoid foods that produce gas
● Simple carbs, lactose, sorbitol, offer agents to help with gas
producing
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
● IBD - Nutrition Therapy
● Malnutrition
● Takes two to three days to make up what you’ve lost
● May need to increase kcal, protein, micronutrients
Pathophysiology: Lower GI Tract
● IBD - Nutrition Interventions
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During exacerbation
Supplement
Assess energy needs + stress factor
May need to increase protein
Low-residue, lactose-free diet
Small, frequent meals
Pathophysiology: Lower GI Tract
● IBD - Nutrition Interventions
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May use MCT oil
Restrict gas-producing foods
Increase fiber and lactose as tolerated
Advancement of oral diet
Multivitamin
Pathophysiology: Lower GI Tract
● IBD - Nutrition Interventions
● During remission/rehabilitation
● Maximize energy & protein
● Weight gain and physical activity
● Food sources of antioxidants, Omega-3s
● 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 during the inflammation stage
● Increases inflammatory response
● Other risks
Pathophysiology: Lower GI Tract
● Diverticulosis/diverticulitis – pathophysiology
● Fecal matter trapped
● Development of pouches
● Diverticulitis
● Food stuff to avoid
● Just a low fiber diet
● Bleeding abscess, obstruction, fistula, perforation
Pathophysiology: Lower GI Tract
● Diverticulosis/-itis – Treatment/ Nutrition Therapy
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Specific focus on fiber
Pro- and prebiotic supplementation
Acute
Antibiotics
● Only used in itis stage, have blood in stool, fever
Pathophysiology: Lower GI Tract
● Diverticulosis/-itis – Nutrition Therapy
● -osis
● Avoid nuts, seeds, hulls*
● Current research shows that this isn’t a problem
● Only if client feels its necessary
● Fiber supplement
● -itis
● Low fiber diet
● Bowel rest
● Avoid nuts, seeds, fibrous vegetables