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Lower Gastrointestinal Tract
KNH 411
© 2007 Thomson - Wadsworth
Pathophysiology: Lower GI Tract
 Malabsorption - maldigestion of fat, CHO, Protein
 Decreased villious height, enzyme production
 Disfunction of accessory organ (pancreas, etc)
 Decreased transit time (with surgery)
 Resection of area
Pathophysiology: Lower GI Tract
 Malabsorption - fat
 Steatorrhea
 Fat-soluble vitamins malabsorbed
 Potential for excess oxalate (kidney stones)
 Abdominal pain, cramping, diarrhea
 Dg; fecal fat test or D-xylose (type of sugar – tells how well
body is absorbing simple sugars) absorption test, or small
bowel x-ray
Pathophysiology: Lower GI Tract
 Malabsorption - Fat – Nutrition
 Restrict fat 25-50 g/day
 Use of MCT (medium chain triglycerides) supplements
 Pancreatic enzymes (before meals to aid with absorption)
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  excessive PRO loss
 Reduced serum protein
 Peripheral edema  cells cannot hold in water (fluid
overload)
Pathophysiology: Lower GI Tract
 Malabsorption - Nutrition Therapy
 Results in weight loss
 Loss of vitamins and minerals
 Treat underlying disease/ nutrient being malabsorbed
 Chronic Protein Energy malnutrition (PEM)
Pathophysiology: Lower GI Tract
 Celiac disease -damage to intestinal tract
 Genetic and autoimmune
 Occurs when alpha-gliadin from wheat, rye, malt, barley
(and oats – tolerable by some) are eaten
 Infiltration of WBC, production of IgA antibodies
Pathophysiology: Lower GI Tract
 Celiac disease - pathophysiology
 Damage to villi (reduced height/flattened)
Surface area is comprised
 Decreased enzyme function
 Maldigestion and malabsorption
 Occurs with other autoimmune disorders
Pathophysiology: Lower GI Tract
 Celiac disease - clinical manifestations
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Diarrhea, abdominal pain, cramping, bloating, gas
Bone and joint pain
Muscle cramping, fatigue
Skin rash
Higher risk for lymphoma and osteoporosis
Mouth ulcerations
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
(minimize diarrhea)
 No more than 45-50 grams of fat/day
 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
 Elimination “red flag” symptoms
Pathophysiology: Lower GI Tract
 IBS
 Most common GI complaint – pain with defecation
 More common in women
 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
 Wheat, high fiber, lactose
 Concurrent dg
 Fibermyalgia
 Chronic fatigue syndrome
 Food allergies
Pathophysiology: Lower GI Tract
 IBS - Treatment
 Guided by symptoms
 Antidiarrheal agents
 Tricyclic antidepressants, SSRIs (selective serotonin
reputake inhibitors – antidepressant)
 Bulking agents, laxatives (during constipation)
 Behavioral therapies
 Relieve stress
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
 Can lead to nutrient deficiency, underweight/malnourished
 Decrease anxiety, normalize dietary patterns
Pathophysiology: Lower GI Tract
 IBS - Nutrition Therapy
 Assess diet hx – what are triggering the concerns?
 Assess nutritional adequacy – 24 hour recall/assess macro
and micronutrient intake
 Focus on increasing fiber intake – 25 grams per day
 Adequate fluid – to help with motility (25 cc/kcal [250 cc
per cup])
 Pre- and probiotics – rebuild gut flora
 Avoid foods that produce gas – beans, cabbage, etc.
 Eliminate use of straws (swallowed air)
© 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
 During exacerbation – use enteral products (Ensure)
 Supplement – glutamine, arginine (decreasing
inflammation; need higher levels during crisis)
 Assess energy needs + stress factor
 May need to increase protein (1.5 to 1.7 g/kilo)
 Low-residue, lactose-free diet
 Small, frequent meals** (high calorie, high protein)
 As much nutrition as you can in small amounts throughout the
day
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 (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 – possibility that they will burts (GI
bleeding)
 Food stuff getting caught, resulting in infection
because of bacteria
 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
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-osis
Avoid nuts, seeds, hulls?
Fiber supplement
-itis
Bowel rest
Avoid nuts, seeds, fibrous vegetables
Low fiber because of inflammation (do not want to
exacerbate it)