NHHC chapter 18 ppt

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and LowerGastrointestinal Disorders

Chapter 18


Common Intestinal Problems

• Constipation– Fewer than three bowel movements per week– Hard stools and excessive straining– Incidence

• More prevalent in women; common during pregnancy; increases with aging

– Causes• Low-fiber diet, low food intake, inadequate fluid

intake, or low level of physical activity


Common Intestinal Problems (cont’d.)• Constipation

– Treatment• Fiber intake: gradual increase to 25 grams per day• Increase stool weight: wheat bran, fruits, and

vegetables• Fiber supplements• Laxatives and bulk-forming agents (Table 18-1)• Adequate fluids: 1.5 to 2 liters per day



– Laxatives• Action: increase stool weight, increase stool water

content, or stimulate peristaltic contractions– Enemas and suppositories

• Action: distend and stimulate the rectum or lubricate the stool



– What medical interventions may be taken for patients who do not respond to dietary or laxative treatments?

• Intestinal gas (flatulence)– Foods commonly associated with flatulence

• Apples, broccoli, cabbage, corn, dried beans and peas, fructose-sweetened products, pears, etc.


Common Intestinal Problems (cont’d.)• Diarrhea

– Passage of frequent, watery stools– Severe or persistent: dehydration and

electrolyte imbalances– Chronic cases: weight loss and malnutrition– Causes

• Various GI disorders, infections, medications, or dietary substances



– Osmotic diarrhea• Unabsorbed nutrients or other substances attract

water to the colon and increase fecal water content– Secretory diarrhea

• Fluid secreted by the intestines exceeds the amount that can be reabsorbed by intestinal cells

– Motility disorders: may result in diarrhea



– Acute cases• Start abruptly and may persist for several weeks• What are some typical causes of acute cases of

diarrhea?– Chronic cases

• Persist for about four weeks or longer• Result from malabsorption disorders, inflammatory

diseases, infectious diseases, etc.



– Medical treatment• Correct the underlying problem: antibiotics for

intestinal infections; eliminating responsible foods; prescribing a different medication; etc.

• Bulk-forming agents• Antidiarrheal drugs• Probiotics• Intractable diarrhea: parenteral nutrition



– Oral rehydration therapy• Replace lost fluid and electrolytes• Rehydration solutions: water, salts, glucose and

sucrose• Why are commercial sport drinks not ideal fluids

for rehydration?



– Nutrition therapy for diarrhea• Depends on medical diagnosis and severity• Initially recommended: low-fiber, low-fat, and

lactose-free diet• Fluid intakes: increased to replace fluid losses• Formula-fed infants: apple pectin or banana flakes

added to formulas




Malabsorption

• Causes– Pancreatic disorders leading to enzyme or

bicarbonate deficiencies– Disorders leading to bile deficiency– Inflammatory diseases or medical treatments

damaging intestinal tissue



Malabsorption (cont’d.)

• Fat malabsorption– Fat: nutrient most frequently malabsorbed

• Requires both digestive enzymes and bile for its digestion

– Steatorrhea: excessive fat in the stools• Evidence of fat malabsorption

– Consequences• Losses of food energy, essential fatty acids,

fat-soluble vitamins, and some minerals




• Nutrition therapy for fat malabsorption– Fat-restricted diet: but no more than

necessary– Medium-chain triglycerides (MCT): alternative

dietary fat source• Lacks essential fatty acids

– “How To” Follow a Fat-Restricted Diet





• Bacterial overgrowth– Excessive bacterial colonization of the

stomach and small intestine– May result in fat malabsorption

• Deficiencies of fat-soluble vitamins may develop

– Vitamin B12: increased deficiency risk– Causes

• Impaired intestinal motility, low gastric acidity, etc.



• Bacterial overgrowth– Treatment

• Antibiotics• Surgical correction: anatomical defects• Medications: stimulate peristalsis• Acid-suppressing medications: discontinue• Lactose-restricted diet• Dietary supplements: correct nutrient deficiencies



• Lactose intolerance– Seventy-five percent of people worldwide

• Some degree of lactose intolerance– Primary symptoms

• Diarrhea and increased intestinal gas– What dietary adjustments are recommended

for people with lactose intolerance?


Conditions Affecting the Pancreas

• Pancreatitis: inflammatory disease– Acute pancreatitis

• Digestive enzymes within pancreatic cells become prematurely activated: pancreatic tissue destruction and subsequent inflammation

• 70 to 80 percent of cases: caused by gallstones or alcohol abuse

• What are common symptoms of acute pancreatitis?


Conditions Affecting the Pancreas (cont’d.)• Acute pancreatitis

– Nutritional therapy• Initial treatment: pain control and intravenous

hydration; oral fluids and food withheld• Afterwards: low-fat liquid diet or small low-fat

meals


Conditions Affecting the Pancreas (cont’d.)• Chronic pancreatitis

– Progressive, permanent damage • Impaired secretion of digestive enzymes and

bicarbonate– 70 to 80 percent of cases

• Due to excessive alcohol consumption– Nutrition therapy

• Objectives: correct malnutrition, reduce malabsorption, and prevent symptom recurrence


Conditions Affecting the Pancreas (cont’d.)• Chronic pancreatitis

– Nutrition therapy• Dietary supplements: correct nutrient deficiencies• Consume small, low-fat meals• Avoid alcohol completely; quit smoking• Steatorrhea: treated with pancreatic enzyme

replacement– Be aware of diet-drug interactions (listed in

text)


Conditions Affecting the Pancreas (cont’d.)• Cystic fibrosis

– Genetic disorder• Alters the ion concentration and/or viscosity of

exocrine secretions– Common complications

• Lung disease: chronic coughing and progressive inflammation in bronchial tissues; labored breathing

• Pancreatic disease: obstructed pancreatic ducts


Conditions Affecting the Pancreas (cont’d.)• Cystic fibrosis

– Common complications• Other complications: excessive salt loss (sweat);

intestinal obstruction; gallbladder and liver diseases; and abnormalities in genital tissues

– Nutrition therapy• High-kcal and high-fat foods; frequent meals and

snacks; milk shakes or oral dietary supplements• Pancreatic enzyme therapy


Conditions Affecting the SmallIntestine• Celiac disease

– Immune disorder: abnormal response to wheat gluten and related proteins

– Causes severe damage to the intestinal mucosa

• Subsequent malabsorption– Symptoms

• GI disturbances: diarrhea, steatorrhea, and flatulence


Conditions Affecting the SmallIntestine (cont’d.)

• Celiac disease– Nutrition therapy

• Gluten-free diet: life-long adherence (Table 18-6) • Avoid lactose until recovered: if lactase deficiency

suspected• Dietary supplements




Conditions Affecting the SmallIntestine (cont’d.)• Inflammatory bowel diseases

– Chronic inflammatory illnesses• Abnormal immune responses to microbes that

inhabit the GI tract– Major forms

• Crohn’s disease• Ulcerative colitis



Conditions Affecting the SmallIntestine (cont’d.)• Complications of Crohn’s disease

– Seventy-five percent require surgery• Within 20 years of diagnosis

– Increased risk of cancer– Malnutrition resulting from

• Poor food intake, malabsorption, nutrient losses, and increased needs

– Other: B12 deficiency, anemia, and anorexia


Conditions Affecting the SmallIntestine (cont’d.)• Complications of ulcerative colitis

– Varying symptoms among patients• Diarrhea, constipation, rectal bleeding, and

abdominal pain– Mild cases

• Weight loss, fever, and weakness– Severe cases

• Anemia, dehydration, and electrolyte imbalances– Cancer risk: substantially increased


Conditions Affecting the SmallIntestine (cont’d.)• Drug treatment for inflammatory bowel

diseases– Purpose: control symptoms, reduce

inflammation, and minimize complications• Nutrition therapy for Crohn’s disease

– Aggressive dietary management• Specific measures: depend on functional status of

the GI tract; symptoms and complications that develop




Conditions Affecting the SmallIntestine (cont’d.)• Nutrition therapy for ulcerative colitis

– In most cases: few adjustments to diet– Manage symptoms as needed

• Restore fluid and electrolyte balances• Correct deficiencies

– Severely impaired colon function• Intravenous fluids and electrolytes


Conditions Affecting the SmallIntestine (cont’d.)• Short bowel syndrome

– Malabsorption syndrome following resection of a major portion of small intestine

• What changes occur during intestinal adaptation?– Nutrition therapy

• Initially following resection: fluids and electrolytes must be supplied intravenously

• First few weeks: rehydration therapy


Conditions Affecting the SmallIntestine (cont’d.)• Short bowel syndrome

– Nutrition therapy• Gradual transition: parenteral nutrition to tube

feedings and/or oral feedings• What factors determine the exact diet prescribed

for short bowel syndrome?– Case Study – Patient with Short Bowel

Syndrome



Conditions Affecting the Large Intestine• Irritable bowel syndrome

– Chronic and recurring intestinal symptoms• Unknown cause

– Symptoms• Abdominal pain, flatulence, diarrhea, and

constipation– Treatment

• Dietary adjustments, stress management, and behavioral therapies


Conditions Affecting the Large Intestine (cont’d.)• Nutrition therapy for irritable bowel

syndrome– Responses among patients vary considerably

• Increase fiber intake: relieve constipation; may worsen flatulence

• Small, frequent meals• Avoid foods that aggravate symptoms: fried or fatty

foods, gas-producing foods, milk products, etc.


Conditions Affecting the Large Intestine (cont’d.)• Case Study – Patient with Irritable Bowel

Syndrome• Diverticular disease of the colon

– Diverticulosis• Presence of small herniations (diverticula) in the

intestinal wall– Diverticulitis

• Inflammation or infection involving diverticula


Conditions Affecting the Large Intestine (cont’d.)• Diverticulitis

– Symptoms• Persistent abdominal pain, tenderness in the

affected area, fever, constipation, and diarrhea

• Treatment for diverticular disease– Increase fiber intake– May need antibiotics and pain-control drugs– Surgical interventions for complications


Conditions Affecting the Large Intestine (cont’d.)• Ostomy

– Surgically created opening (stoma) in the abdominal wall

• For dietary waste elimination

• Colostomy– Stoma formed from a section of the colon

• Ileostomy– Stoma formed from a section of the ileum



Conditions Affecting the Large Intestine (cont’d.)• Nutrition care for patients with ostomies

– Individualized dietary adjustments• Depends on length of colon removed and portion

of ileum that remains– Recommendations with ileostomies

• Chew foods thoroughly; avoid foods high in insoluble fibers; drink beverages with added electrolytes


Conditions Affecting the Large Intestine (cont’d.)• Nutrition care for patients with ostomies

– Recommendations with colostomies• Most patients return to a regular diet

• Obstructions– Primary concern of ileostomy patients– What are examples of foods that may cause

difficulty?


Conditions Affecting the Large Intestine (cont’d.)• Ostomies

– Reducing gas and odors • Foods that may help to reduce odors: cranberry

juice, parsley, and yogurt– Diarrhea

• Some foods may worsen diarrhea (Table 18-3)• Products that may thicken stool: applesauce,

banana, cheese, pasta, pectin, potatoes, etc.

Education

NHHC chapter 18 ppt