Diarrhea is a very common daily based issue with lots of contributing factors. The need is to determine the underlying causes, otherwise the consequences may get worsen.

1. LOWER GIT ISSUES
DIARRHEA
Ms. RABIA SHABBIR
NUTRITIONAL PSYCHOLOGIST

2. Introduction
Pathophysiology
Prevention
Treatment
Nutritional Assessment
Medical Nutrition Therapy
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3. Diarrhea is defined as
an increase in frequency of bowel movements
and/or an increase in water content of stools that affects either
the consistency or the volume of fecal output.
Other definitions describe abnormality in stool production as
>200 g/day for adults and >20 g/kg for children
Passage of 3 or more loose or liquid stools/day (WHO)
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4. CONTD…
 Acute diarrhea is short-term (less than two weeks), whereas
diarrhea lasting longer than four weeks is considered chronic.
 Diarrhea presents as a change from the normal bowel function. This is
generally a watery stool that is increased in frequency.
 foul-smelling, frothy stools are associated with steatorrhea.
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5. PATHOPHYSIOLOGY
Diarrhea maybe related to any of the following conditions:
 Fungal infections
 Bacterial infections
 Viral agents
 Toxins
 Medications
 Excessive consumption of OCD’s
 Excessive sugar consumption
 Allergic reactions
 Inflammatory bowel diseases (Ulcerative collitis & Crohn’s disease)
 Inflammatory bowel syndrome (IBS)
 Short bowel syndrome (SBS) 5

6.  Celiac disease
 Lactose intolerance
 Vitamin B12 malabsorption
 Heavy metal poisoning
 Gastric resection
 Endocrine & metabolic syndromes
 Antibiotics
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7. TYPES OF DIARRHEA
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8. 1. EXUDATIVE DIARRHEA
 Always associated with mucosal damage
 Damaged mucosa causes outpouring of mucus, blood, plasma proteins,
electrolytes and water in gut
 Causes blood and pus in stools sometimes
 It is commonly associated with E.coli infections and IBDs
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9. 2. OSMOTIC DIARRHEA
 It occurs when osmotically active solutes are present in intestinal tract
 Excessive sugar consumption is an example
 Usually relieved by fasting
 Lactose intolerance, fructose intolerance, dumping syndrome are classical
examples of conditions associated with osmotic diarrhea
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10. 3. SECRETORY DIARRHEA
 Active secretion of water and electrolytes by intestinal epithelium
 It can be because of bacterial or viral infections, toxins, increased intestinal
hormonal secretions
 It also occurs due to inhibition of absorption
 Little or no structural damage to GIT
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11. 4. MALABSORPTIVE DIARRHEA
 When some disease impairs digestion or absorption of nutrients
 Fats start appearing in stools “STEATORRHEA”
 Not enough health absorptive area or inadequate production or interrupted
flow of bile and pancreatic enzymes
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12. 5. MEDICATION INDUCED DIARRHEA
 Hospitalized and long term care patients
ROLE OF ANTIBIOTICS
 Trillions of bacteria are present in gut
 These are responsible for fermenting the sloughed intestinal cells and
undigested food materials into short chain FAs and gases
 Broad term use of antibiotics causes a decrease in gut bacterial count
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13. Treatment of the underlying disorder is the most important
component of therapy.
If the diarrhea is infectious in nature, antibiotics will be the first
line of treatment.
Restoring normal fluid, electrolyte, and acid-base balance is crucial.
Intravenous therapy or the use of rehydration solutions.
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14. • Improving access to clean water and safe sanitation
• Promoting hygiene education
• Exclusive breast-feeding
• Improving weaning practices
• Immunizing all children, especially against measles
• Using latrines
• Keeping food and water clean
• Washing hands with soap (the baby’s as well) before touching food
• Sanitary disposal of stools 14

15. When completing the nutrition assessment for a patient with
diarrhea, it is especially important to review the following types of
assessment data:
◦ Fluid and beverage intake
◦ Energy and mineral intake
◦ Medication and herbal supplement use
◦ Weight change
◦ Biochemical data (reflective of hydration status-mineral content, urine
output and color)
◦ Nutrition-focused physical findings (especially those related to the
digestive system and skin)
◦ Past surgical history
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17. Current practice recognizes the importance of stimulating the
gastrointestinal tract by feeding the patient. This speeds recovery of
damaged cells.
In addition, clear liquids are typically high in simple carbohydrates, which
increase osmolality of the gastrointestinal tract must be avoided. This
actually can make diarrhea worse.
Oral rehydration solutions are designed to both restore fluid and electrolyte
balance and enhance absorption in the intestinal tract.
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18. Nutrition therapy to decrease motility should focus on
avoiding high- sugar beverages and foods high in simple
carbohydrates (lactose, sucrose or fructose); sugar alcohols
(sorbitol, xylitol, mannitol); caffeine; and alcoholic beverages.
Gas-producing foods should be avoided.
Adding sources of soluble fiber and resistant starch has been the
most typical route to thicken the consistency of the stool.
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19.  If the infant has begun solid foods, use of strained bananas,
apple sauce, and rice cereal are the best initial food choices.
 BRAT (bananas, rice, applesauce, and toast [bran]) eating pattern has
been used to guide the initial food choices for acute diarrhea, but it
does not provide a sufficient variety of nutrients for long periods of
use.
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20. ANOTHER STEP IN TREATING DIARRHEA IS THE USE OF
PROBIOTICS AND PREBIOTICS.
PROBIOTICS FOODS:
◦ Live culture yogurt
Prebiotics foods:
Any form of carbohydrates (preferably banana)
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21. ORS: COMPOSITION
Glucose 20 g/100ml
Sodium 90mEQ/L
Potassium 20mEQ/L
Chloride 80mEQ/L
Bicarbonate 30mEQ/L
Osmolatrity 330mOsm/L
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22. Medical Nutrition Therapyfor Diarrhea
FoodGroup RecommendedFoods FoodsNot Recommended
Milk andMilk Products • Buttermilk
• Evaporated, skim,andlow-fat milk
• Yogurtwith live activecultures
• Cheese
• Sherbet
• Wholemilk
•Half-and-half
• Cream
•Regular(whole milk) ice
cream
• Yogurtwith berries, dried
fruit, ornuts
Meat andOtherProtein
Foods
•Tender,well-cookedmeat, poultry,
fish,eggs,or foodsmadewithout
addedfat
•Friedmeat,poultry,
or fish
• Sausage
• Hot dogs
• Fattymeats
• Nuts
• Chunkynut butters
Grains • White flour
• Bread,bagels,rolls,crackers,and
pastamadefrom
white or refinedflour
•Coldor hot cerealsmadefrom white
or refined flour
•Whole-wheat or
whole-grainbreads,
rolls,crackers,or
pasta
• Brownor wild rice
•Barley,oats,and
other wholegrains
•Cerealsmadefrom whole
grainor bran
• Breadsor cerealsmade with
seedsor nuts
• Popcorn
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23. Medical Nutrition Therapyfor Diarrhea
FoodGroup RecommendedFoods FoodsNot Recommended
Vegetables •Most well-cookedvegetables
without seedsor skins
• Potatoeswithout skin
• Lettuce
• Strainedvegetable juice
•Rawvegetables
(exceptfor lettuce)
• Friedvegetables
• Beets
• Broccoli
• Brusselssprouts
• Cabbage
• Cauliflower
• Turnipgreens
• Corn
• Potatoskins
Fruits • Fruit juicewithout pulp,except
prunejuice
• Ripebananas
• Melons
•Allraw fruits
exceptbananaand
melons
•Driedfruits,
includingprunes
andraisins
• Fruit juicewithpulp
• Anyfruits sweetened
withsorbitol
• Prune juice
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24. Medical Nutrition Therapyfor Diarrhea
FoodGroup Recommended Foods FoodsNot Recommended
Beverages • Decaffeinated coffee
• Caffeine-free teas
•Softdrinkswithout
caffeine
• Rehydration beverages
•Beverages
containing
caffeine,
includingregular
coffee, regular
tea, colas,and
energydrinks
•Avoidbeverages
sweetenedwith
sorbitol
• Alcoholicbeverages
Fats •Limitfats to lessthan 8 teaspoonsper
day
Other foodsto avoid •Sugaralcoholssuchasxylitol and
sorbitol;honey
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25. NUTRITION THERAPY AND PATHOPHYSIOLOGY
Marcia Nelms
Katheryn Sucher
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