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Lower GI Disordersl19 PDF
Lower GI Disordersl19 PDF
by
Ass. Prof. Nebal Abdel Rahman physician@
Clinical Nutrition Department@
Normal Function of Lower GI Tract
n Digestion
n Absorption
n Excretion
Normal Function of Lower GI Tract
n Digestion
– Begins in mouth & stomach
– Continues in duodenum & jejunum
– Secretions:
• Liver
• Pancreas
• Small intestine
Normal Function of Lower GI
n Absorption
– Most nutrients absorbed in jejunum
– Small amounts of nutrients absorbed in
ileum
– Bile salts & B12 absorbed in terminal ileum
– Residual water absorbed in colon
Sites of
Digestion and
Absorption
Sites of
Secretion,
Digestion and
Absorption
Principles of Nutritional Care
Dietary modifications
n To alleviate symptoms
n Correct nutritional deficiencies
n Address primary problem
n Must be individualized
Common Intestinal Problems
n Depends on cause
n Use high fiber or high residue diet as
appropriate
n If caused by medication, may be
refractory to diet treatment
Nutrition Intervention for
Constipation
n Eat adequate insoluble fiber (gradually increasing daily
total fiber to 25-38 g/day
n The major sources of insoluble fiber include cellulose,
psyllium, inulin, and oligosaccharides. These types of
fiber are primarily found in the skins of fruits,
vegetables, wheat and rice bran, and whole wheat.
n Increase fluid intake to a minimum of 64 oz each day.
n Participate in daily physical activity.
n Use bulk-forming agents such as Psyllium, Calcium
polycarbophil, or Methylcellulose.
n Avoid stool retention and initiate bowel retraining
program if required
ADA Nutrition Care Manual nutritioncaremanual.org
High-Fiber Diets
n Uses:
– When reduced fecal output is necessary
– When GI tract is restricted or obstructed
– When reduced fecal residue is desired
Restricted-Fiber Diets
n C-reactive protein
n Erythrocyte sedimentation rate (ESR)
n Lactoferrin
n White blood count and differential
n Stool assessment for presence of
leukocytes
Crohn’s Disease
n
IBD Nutritional Management (acute)
n Low-residue, low-fiber liquid diet
n “Bowel rest” with parenteral nutrition
n Enteral nutrition may have better success
at inducing remission
n Diet tailored to individual pt:
• Minimal residue for reducing diarrhea
• Limited fiber to prevent obstruction
• Small, frequent feedings
• Supplements
Nutritional Requirements Influenced
by
n Extent of stool output
n Current medication regimen
n Previous medical and surgical history
n Energy: Use indirect calorimetry to establish
requirements if possible. Infection and medical
intervention will influence metabolic needs.
Not all patients are hypermetabolic.
n Protein: Protein requirements may reach 150%
of baseline requirements.
n Specific Nutrient Supplementation: Omega-3-
fatty acids and glutamine should be considered.
Vitamin Needs in IBD
The patient may need higher levels of the following:
n Vitamin B-12
n Folate
n Thiamin
n Riboflavin
n Niacin
n Vitamin C
n Vitamin E
n Vitamin D
n Vitamin K
Food and Symptom Diary
FOOD AND SYMPTOM DIARY
n 20% of women
n ~10 – 15% of men
n 20 – 40% of visits to gastroenterologists
n One of the most common reason pts first
seek medical care
n Increased absenteeism, decreased
productivity
IBS: Etiology
n Increased visceral sensitivity and motility
in response to GI and environmental
stimuli
n React more to:
• Intestinal distention
• Dietary indiscretions الطائشة
• Psychosocial factors
• Life stressors
n Antispasmodics
n Anticholinergics
n Antidiarrheals
n Prokinetics
n Antidepressants
IBS: Nutritional Care
n Fluids
n Regular physical activity to reduce stress
Diverticulosis
n Sac-like
herniations or
outpouches of
the colon wall
n Caused by long-
term increased
colonic pressures
n Believed to result
from low fiber
diet, constipation
Diverticulitis
n Caused when bacteria or
other irritants are trapped
in diverticular pouches
n Inflammation
n Abscess formation
n Acute perforation
n Acute bleeding
n Obstruction
n Sepsis
Diverticulitis: MNT for acute disease
n Initiate soft diet with no excess spices or
fiber. Avoid nuts, seeds, popcorn, fibrous
vegetables
n Ensure adequate intake of protein and
iron
n Progress to normal fiber intake as
inflammation decreases
n Low fat diet may also be beneficial
Diverticulosis: MNT for chronic
disease
n Malabsorption of micronutrients,
macronutrients
n Fluid, electrolyte imbalances
n Wt loss
n Growth failure in children
n Gastric hypersecretion
n Kidney stones, gallstones
SBS: Predictors of Malabsorption,
Complications, Need for PN