Lower Gastrointestinal Tract
KNH 411
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
 Malabsorption - maldigestion of fat, CHO, Protein
 Decreased villious height, enzyme production (lowered)
 Decreased transit time
Pathophysiology: Lower GI Tract
 Malabsorption - fat
 Steatorrhea-loss of fat quickly, fatty diarrhea
 Fat-soluble vitamins malabsorbed--loss of A, E, D, K
 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
 1st line of defense:
 Restrict fat 25-50 g/day
 Use of MCT supplements
 Pancreatic enzymes—aid in the absorption and digestion
of fats when there’s a dysfunction of the pancreas
Pathophysiology: Lower GI Tract
 Malabsorption - CHO
 Lactose malabsorption—supplement lactate, work with
tolerance and side effects—if they start restricting calciumlook at relevant levels
 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 –can cause a shift in fluid status
 Reduced serum protein
 Peripheral edema –build up of fluid in the gut, increased
fluid leaking out
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
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
 Lactose, wheat, high fiber diet
 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
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
 Can lead to nutrient deficiency, underweight
 Decrease anxiety, normalize dietary patterns
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
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Assess diet hx
Assess nutritional adequacy
Focus on increasing fiber intake
Adequate fluid
Pre- and probiotics
Avoid foods that produce gas
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
 IBD - Nutrition Therapy
 Malnutrition
 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 to give area time to heal
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 (anti-inflammatory)
 Pro- and prebiotics (maximize the gut flora)
Pathophysiology: Lower GI Tract
 Diverticulosis/diverticulitis – abnormal presence of
outpockets or pouches on surface of SI or
colon/inflammation of these
 Low fiber intake
 Increases inflammatory response
 Other risks
Pathophysiology: Lower GI Tract
 Diverticulosis/diverticulitis – pathophysiology
 Fecal matter trapped
 Development of pouches
 Diverticulitis
 Food stuff
 Want to avoid: 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
Pathophysiology: Lower GI Tract
 Diverticulosis/-itis – Nutrition Therapy
-osis
Avoid nuts, seeds, hulls**
 If the client says it is a concern
Fiber supplement
 To get to 35 g
-itis
Low fiber diet
Bowel rest
 Possibly just clear liquid—then to full liquids—then soft diet
Avoid nuts, seeds, fibrous vegetables