NHHC chapter 18 outline

1. Chapter 18 – Nutrition and Lower Gastrointestinal Disorders
Chapter Outline Instructor Resources
I. Common Intestinal Problems
A. Constipation - Defecation frequency of fewer than 3 bowel movements per week
1. More prevalent among women
2. Increases with age
3. Causes of Constipation - Correlates with:
a. Low-fiber diets
b. Low food intake
c. Inadequate fluid intake
d. Inactivity
e. Medical conditions
1. Diabetes mellitus
2. Hypothyroidism
3. Parkinson’s
4. Spinal cord lesions
5. MS
6. Pregnancy
f. Some medications & dietary supplements
4. Treatment of Constipation
a. Gradual increasein fiber to 25 g/day
1. Wheat bran
2. Fruits
3. Vegetables
4. Fiber supplements
b. Adequate fluid
c. Prunes/prunejuice
d. Daily exercise
5. Laxatives
6. Medical Interventions
a. Prokinetic agents
b. Physical therapy
c. Biofeedback
d. Surgery
B. Intestinal Gas (flatulence) - Causes:
1. High-fiber diets, bacterial fermentation
2. Incompletely digested or poorly absorbed carbohydrates
a. Fructose
b. Sugar alcohols (sorbitol, mannitol,maltitol)
c. Beans
d. Some grains & potatoes
3. Malabsorption disorders
4. Swallowed air
C. Diarrhea
1. Description

2. a. Frequent, watery stools
b. If severe, can cause dehydration & electrolyteimbalances
c. If chronic, may lead to weight loss and malnutrition
2. Causes of Diarrhea
a. GI disorders
b. Infections
c. Medications
d. Dietary substances
e. Inadequate fluid reabsorption,sometimes with increased intestinal secretions
f. Osmotic diarrhea
g. Secretory diarrhea
h. Motility disorders
i. Acute diarrhea
1. Infection
2. Certain medications
j. Chronic diarrhea - persists for 3 weeks or longer
1. Malabsorptive& endocrine disorders
2. Inflammatory diseases
3. Motility disorders
4. Infectious diseases
5. Radiation treatment
6. Others, especially tube feedings
3. Medical Treatment of Diarrhea: Correct underlyingmedical problem
4. Oral Rehydration Therapy - or IV solutions
5. Nutrition Therapy for Diarrhea
a. Low residue
b. Low fat
c. Lactose free
d. Avoid caffeine
II. Malabsorption
• Can be caused by pancreatic disorders,disorders that lead to bile deficiency, inflammatory
diseases, and medical treatments
• Resections
• Rarely involvesingle nutrient
A. Fat Malabsorption
1. Fat malabsorption is evidenced by steatorrhea: excessivefat in stool
2. Consequences of Fat Malabsorption
a. Loss of food energy
b. Loss of essential fatty acids
c. Loss of fat-solublevitamins
d. Decreased absorption of calcium, magnesium, & zinc
e. Bone loss
f. Increased risk of kidney stones
3. Nutrition Therapy for Fat Malabsorption
a. May need a fat-restricted diet
b. MCT oil

3. c. How to Follow a Fat-Restricted Diet
B. Bacterial Overgrowth
1. Description
a. Gastric acid protects stomach & intestinefrom bacterial overgrowth
b. Overgrowth disrupts fat digestion & absorption
c. May develop fat-solublevitamin & vitamin B12 deficiencies
d. Symptoms in severe cases:
1. Chronic diarrhea
2. Steatorrhea
3. Flatulence
4. Bloating
5. Weight loss
2. Causes of Bacterial Overgrowth
a. Impaired intestinal motility
b. Reduced gastric acid secretions
3. Treatment for Bacterial Overgrowth
a. Antibiotics & other medications
b. Surgery
c. Lactose-restricted diet
d. Diet with supplements
C. Lactose Intolerance
1. Loss or reduction of enzyme lactase,which digests lactosein milk products
2. Prevalent among certain ethnic groups
3. Symptoms:diarrhea & increased intestinal gas
4. Diet
a. Milk: usually 2 cups/day divided & consumed with food is tolerated
b. Chocolate milk
c. Aged cheese
d. Yogurt with livebacterial cultures
e. Lactose-free milk
f. Can take enzyme tablets before consumingdairy
III. Conditions Affecting the Pancreas
A. Pancreatitis
1. Acute Pancreatitis
a. Causes: gallstones,excessive alcohol, high triglycerides,toxins
b. Common symptoms
1. Severe abdominal pain
2. Nausea and vomiting
3. Abdominal distention
2. Nutrition Therapy for Acute Pancreatitis
a. Pain control,IV hydration,& withhold food & fluids for complete bowel rest
b. Small amounts of clear liquids
c. Low fat
d. Often high protein & high energy
3. Chronic Pancreatitis
a. Permanent and progressivedamage to tissue
b. 70-80% alcohol induced; cigarettesmoking often contributes

4. c. Severe and unrelentingabdominal pain
d. Food avoidance & malabsorption lead toweight loss & malnutrition
4. Nutrition Therapy for Chronic Pancreatitis
a. Objectives
1. Correct malnutrition
2. Reduce malabsorption
3. Prevent symptom recurrence
b. Dietary supplements
c. Small, low-fat meals
d. No alcohol
e. Pancreatic enzymereplacement
B. Cystic Fibrosis - most common life-threateninggenetic disorder
1. Introduction
a. Abnormal chloride and sodium levels in exocrine secretions
b. Unusually viscous exocrine secretions
2. Consequences of Cystic Fibrosis - Complications include:
a. Lung disease
b. Pancreatic disease
c. Other complications
3. Nutrition Therapy for Cystic Fibrosis
a. Children may have energy needs 120-200% of DRI values
b. High-kcalorie, high-fat foods
c. Frequent meals & snacks
d. Pancreatic enzymereplacement
e. Vitamin supplements
f. Liberal use of tablesalt
IV. Conditions Affecting the Small Intestine
A. Celiac Disease - Abnormal immuneresponse to gluten
1. Consequences of Celiac Disease
a. Severe damage to intestinal mucosa
b. Symptoms:Diarrhea, steatorrhea,flatulence
c. Malabsorption
d. Children: stunted growth & underweight
e. Adults: anemia, bone disorders,neurologic symptoms,& fertility problems
f. Dermatitis herpetiformis
2. Nutrition Therapy for Celiac Disease
a. Need a gluten-free diet for life
b. Sometimes need to avoid lactose
c. Dietary supplements
d. Wheat,barley,ryeeliminated; oats allowed if grown/processed separately
e. Check food labels carefully
B. Inflammatory Bowel Diseases
1. Description
a. Chronic inflammatory illnesses
b. Genetic & environmental factors contribute
c. Exact triggers are unknown
d. Crohn’s disease & ulcerativecolitis - periods of activedisease and remissions

5. 2. Complications of Crohn’s Disease
a. Can occur in any region of theGI tract
b. Ulcerations,fissures, & fistulas
c. Thick scar tissue may cause obstructions
d. 60-75% require surgical resection
e. Malnutrition from reduced intake, malabsorption,&surgical resections
3. Complications of UlcerativeColitis
a. Always affects the rectum & usually the colon
b. Frequent, urgent bowel movements of small volume that contain blood and mucus
c. Nutrient losses due to tissue damage, bleeding, & diarrhea
d. Weight loss
e. Fever
f. Weakness
g. Anemia
h. Dehydration
i. Electrolyte imbalance
j. Protein losses
k. Colectomy prevents future occurrences - performed in 25-40% of patients
4. Drug Treatment of Inflammatory Bowel Diseases
a. Antidiarrheals
b. Immunosuppressants
c. Anti-inflammatoryagents
d. Antibiotics
5. Nutrition Therapy for Crohn’s Disease
a. Highly variable
b. High-kcalorie, high-protein
c. Oral supplements
d. Vitamin and mineral supplements
e. Tube feedings
f. Small, frequent feedings
6. Nutrition therapy for UlcerativeColitis
a. May require few adjustments
b. Restore fluids & electrolytes;correct deficiencies
c. Low-fiber diet or withhold food during severe illness
C. Short Bowel Syndrome
1. Secondary to Crohn’s disease, cancers,& other intestinal disorders
2. Can be the consequence of small intestineresections
3. About 50% can be removed without serious nutritional consequences
4. Intestinal Adaptation - Intestine undergoes adaptation toimprove absorptivecapacity
5. Nutrition Therapy for Short Bowel Syndrome
a. Initially IV fluids and electrolytes
b. TPN - tapered with introduction of oral feedings
c. Variablediet
d. High kcalorie
e. Small, frequent meals
f. High fat, low carbohydrateor high complex carbohydrate,low fat with intact colon
g. Avoid concentrated sweets
h. Lactose restricted

6. i. Vitamin & mineral supplements
V. Conditions Affecting the Large Intestine
A. Introduction
1. Moves undigested materials tothe rectum
2. Helps maintain fluid & electrolytebalance
3. Bacteria ferment undigested materials
B. IrritableBowel Syndrome
1. Description
a. Chronic & recurringintestinal symptoms
b. Diarrhea & constipation
c. Flatulence & discomfort
d. More common in women between the ages of 20 & 40 years old
e. Excessive colonic response to meals, GI hormones, & stress
2. Treatment of IrritableBowel Syndrome
a. Dietary adjustment
b. Stress management
c. Behavioral therapy
d. Drugs:
1. Laxatives
2. Antidiarrheal agents
3. Anticholinergics
4. Antispasmotics
5. Antidepressants
3. Nutrition Therapy for IrritableBowel Syndrome
a. Gradually increasefiber
b. Fatty foods, gas-producingfoods, milk products,wheat products,coffee, & alcohol may
worsen symptoms
c. Individual tolerances vary
C. Diverticular Disease of the Colon
1. Description
a. Presence of pebble-sized herniations in intestinal mucosa
b. Prevalence increases with age; occurs in 50-65% of 80 year olds
c. Low-fiber diets may increaserisk
2. Diverticulitis
a. Inflammation or infection
b. Most common complication of diverticulosis
c. Symptoms
1. Persistent abdominal pain
2. Tenderness in affected area
3. Fever
4. Alternatingconstipation &diarrhea
5. Anorexia, nausea and vomiting
3. Treatment for Diverticular Disease
a. Increased insoluble fiber for prevention
b. Some suggest avoiding nuts,popcorn, & food with seeds - no evidence supports this
c. Antibiotics,pain medication
d. Clear liquid or bowel rest

7. e. Surgery
D. Colostomies and Ileostomies
1. Ostomy = surgically created stoma in the abdominal wall
2. Description
a. Often surgical removal of some or all of large intestine
b. Temporary or permanent
c. Wastes exit through a stoma in abdominal wall
d. Colostomy & ileostomy
3. May be required with inflammatory bowel disease,diverticulitis,or colorectal cancers
4. Nutrition Carefor Patients with Ostomies
a. Individualized
b. Gradually advanced from clear liquids
c. Often low residue
d. Small, frequent meals
e. Appropriatefluids & electrolytes
5. Obstructions - Chew food thoroughly toprevent obstructions
6. Reducing Gas and Odors
a. Foods cause unpleasant odors: Asparagus,beer, cruciferous vegetables, dried beans &
peas, eggs, fish, onions, & garlic
b. Foods that reduce odors: Buttermilk, cranberryjuice,parsley,yogurt
7. Diarrhea
VI. Nutrition in Practice - Probiotics & Intestinal Health
A. Introduction
1. 400-500 species of bacteria residein the colon
2. Probiotics = live, non-pathogenic microorganisms;may beuseful for preventingor treating
various medical conditions
B. How do our intestinal bacteria influencehealth?
1. Degrade undigested, unabsorbed carbohydrates
2. Produce vitamins and short-chain fatty acids
3. Stimulateimmune defenses
4. May protect against pathogenic bacteria
5. Prebiotics
C. Why are certain types of bacteria considered “probiotic”?
1. Must be non-pathogenic
2. Must be resistant todestruction by digestion
3. Should be ableto alter the intestinal environment in a beneficial way
4. Consumed in large amounts
D. What types of medical problems arehelped by probiotics?
1. Gastric and intestinal disorders
2. Alter susceptibility tofood allergens and alleviatesome allergy symptoms
3. Improve availability and digestibilityofvarious nutrients
4. Should be considered adjunct therapy
E. What arethe main dietary sources of probiotics?
1. Fermented foods
2. Yogurt
3. Acidophilus milk
4. Ice cream

8. 5. Oatmeal gruel
6. Soft drinks
7. Supplements
F. Are there any potential problems associated with theuse of probiotics?
1. Infection in immune-compromised individuals
2. Lack of industrial standards