Ch. 24 Lower GI Diseases Flashcards
What are the primary organs of the lower GI system?
Small and large intestine
Name the organs of the lower GI system [12].
- Stomach
- Pyloric Sphincter
- Small Intestine
- Ileocecal Valve
- Large Intestine
- Rectum
- Anus
- Liver
- Gallbladder
- Bile Duct
- Pancreas
- Pancreatic Duct
What is absorbed in the duodenum and jejunum?
simple CHO fat AA vitamins minerals water
What is absorbed in the ileum?
bile salts
vitamin B12
water
What is absorbed in the colon?
water
electrolytes
short-chain fatty acids
What are complications of removal/surgery of the duodenum/jejunum?
Minimal consequences of ileum remains intact
Calcium and iron malabsorption if duodenum resected
What are complications of removal/surgery of the ileum?
Fat malabsorption
Protein malabsorption
Malabsorption of fat-soluble vitamins and vitamin B12
Reduced calcium, magnesium, and zinc absorption
Fluid losses
Diarrhea/steatorrhea
What are complications of removal/surgery of the colon?
Fluid and electrolyte loss
Diarrhea
Losses are compound if ileum is also resected
What are causes of constipation?
Diet:
- -low fiber in diet
- -enough fiber but not enough fluid
Physical Inactivity
Diseases/Conditions:
- -neurological (Parkinson’s Disease, MS, Paralysis, etc.)
- -pregnancy
- -other illnesses (diabetes mellitus)
Medications:
–some pain medications
Emotional Stress
What are some dietary interventions for people who have constipation?
Fiber
- -gradual increase in fiber (i.e.: wheat bran, fruits and vegetables
- -How much fiber (AI)?
- ->males: 38g/d
- ->females: 35 g/d
Fluids:
- -adequate amount: 1c/kcal of food (have to watch fluid intake in elderly)
- -hot beverage (hot lemon water, etc.)
- -prune juice
Physical Activity
Prebiotics and Probiotics
What are Prebiotics?
Found in food, stimulate large intestines in beneficial way
What are Probiotics?
Contain microorganism and can be beneficial from that standpoint
–ex: yogurt
What is the BRAT diet? What is it used for?
Bananas
Rice
Applesauce
Toast
Used for diarrhea
What is the BRATTY diet?
Bananas Rice Applesauce Toast Tea Yogurt
Discuss the difference between acute, persistent, and chronic diarrhea.
Acute: less than 2 weeks
Persistent: 2-4 weeks
Chronic: greater than 4 weeks
Diarrhea is a common symptom of many GI diseases. Name some.
IBS (irritable bowel syndrome)
Celiac disease (gluten allergy)
Crohn’s disease
Ulcerative colitis
What are the 2 different types of diarrhea?
- Osmotic:
- -resolves when patient eats nothing by mouth (NPO) - Secretory:
- -does NOT resolve when patient eats NPO
What are some causes of diarrhea?
Physiological Emotional Treatments (radiation to abdominal area) Medications Food sensitivity or allergy (ex: gluten allergy) Clostridium difficile (C.diff)
What is Clostridium difficile (C.diff)?
Bacterium, passed on in feces and gets spread to food, surfaces, and objects
People with weakened immune systems are more susceptible
Watery diarrhea 2 times a day for 2 or more days
S and S: watery diarrhea, abdominal pain/cramping
Antibiotics can kill the good bacteria in the gut; C.diff takes over
Treatment: Flagyl
Dietary Treatment for Diarrhea: What foods should you avoid/limit?
- High fiber foods (initially) - not as many skins or peelings
- Gas producing foods - broccoli, cauliflower, onions
- Caffeine
- ETOH
- Milk products - if lactose intolerant
- High fructose - high concentrated sweets
- High fat - cream, half and half, gravy
- High sugar beverages
- Sugar ETOH (sorbitol, xylitol, mannitol)
- -this is found in a lot of sugar-free products; comes from plants
Dietary Treatment for Diarrhea: What foods should you use?
Adequate hydration - not caffeine products
Perhaps BRAT diet
Low fat
Low lactose
CHO malabsorption
ex: lactose intolerance
PRO malabsorption
ex: protein-losing enteropathy
- -increased fecal loss
Fat malabsorption
Steatorrhea = fat in stool
Diseases/Conditions:
–pancreatitis, cystic fibrosis (CF), short gut/short bowel
What are consequences of fat malabsorption?
Loss of:
- energy
- weight
- fatty acids (essential fatty acids - required that we get in our diet; may be losing out on those essential fatty acids)
- fat-soluble vitamins (A, D, E, K)
- minerals (calcium, magnesium, zinc)
- bone disease (b/c of calcium loss)
- increased risk of kidney stones
- -calcium binds w/ oxalates, oxalates get excreted
- -when stones occur, calcium binds with the non-absorbed fat, oxalates just floating around, can contribute to the formation of kidney stones
What are a few key points about dietary needs for a person suffering from fat malabsorption?
Fat restricted diet: ~25-50 g/d
Use of medium chain triglycerides (MCT)
- -don’t enter lymph; go directly into vascular system
- -products
Still need for essential fatty acids (FA) [long-chain triglycerices]
Fat soluble vitamins –> give them in water-soluble form
What are 3 gluten-restricted conditions?
- wheat sensitivity (may still be able to handle barley or rye)
- Non-Celiac Gluten Sensitivity (NCGS)
- -symptoms similar to those diagnosed with celiac disease (CD)
- -blood test: no CD antibodies
- -small intestine: not damaged/inflamed
- -NO TEST (per say) for NCGS - Celiac Disease (CD)
What is CD?
aka gluten-sensitive enteropathy, celiac sprue
Immune reaction to gluten consumption
Gluten = protein
Characterized by an abnormal immune response to a protein faction in WHEAT GLUTEN, and related to proteins found in RYE and BARLEY
Affects small intestine
Should people suffering with CD consume beer? Why or why not?
No; beer contains barley
What happens to the small intestine in CD?
The key to CD is what happens to the villi in the small intestine:
- -they get squashed or flattened
- -in normal small intestine, the villi are upright, non-flattened (“plush carpet”)
- -in CD small intestine, the villa are flattened, squashed (“tile floor”)
In CD, does the entire intestine have damaged villi? If not, where is the damaged villi usually located?
No
Damage usually occurs in the upper part of the small intestine, so there is still some capacity for absorption in the end of the small intestine
What are some signs and symptoms of CD?
GI Issues:
- -Diarrhea
- -Steatorrhea
- -Flatulence
- -Lactase deficiency
Other Issues:
- -Anemia
- -Weakness
- -Loss bone density
- -Skin rash (dermatitis)
- -Migraine-like headaches
- -Fatigue
Do all people experience symptoms with CD?
Symptoms vary from person to person, but a few people don’t experience any symptoms at all
Should you be tested for CD before trying a gluten-free diet?
YES
How do you test for CD?
Blood test to check for antibodies (indicates immune reaction to gluten)
–even if the person doesn’t experience symptoms, the test is sensitive enough to detect that they have CD
Gluten-Free Diet
Eliminate wheat, barley, rye
Eliminate triticale (cross between wheat and rye)
Use: rice, corn, soybean, potato, tapioca
Gluten-free products…need to read labels
Should you include or exclude lactose in a diet for a person who has CD?
Exclude lactose
Why do you have to watch for cross-contamination (concerning CD)?
Manufacturing (more challenging - lack control over it):
- -ex: oats. Oats are NOT on the eliminate list, but sometimes in the manufacturing process, they use the same machinery for oats as they do for wheat, barley, and rye
- ->also have to consider what else goes into the product containing oats (ex: oatmeal cookies…also contains wheat)
Home (preparation techniques)
What are the 2 inflammatory bowel diseases (IBD)?
Crohn’s Disease
Ulcerative Colitis
Crohn’s Disease
Crohn’s:
- -mainly affects ileum and/or large intestine
- -malnutrition from malabsorption, nutrient losses, decreased food intake, anemia, surgical resections
- -increased risk for cancer of small intestine, colon
Ulcerative Colitis
Ulcerative Colitis:
- -mainly affects colon and rectum
- -weight loss, fever, weakness, anemia, dehydration, fluid and electrolyte imbalances, diarrhea, abdominal pain, protein losses, possible colectomy
- -increased risk for colon cancer
What can you do in terms of nutrition therapy for IBD?
Treat the symptom or complication
Depends on the part of the GI involved (nutrition care is very, very individualized)
Intervention varies depending on status
May require TPN, TF –> may use elemental formulas where macronutrients are broken down
Adequate fluids and electrolytes
What is Irritable Bowel Syndrome (IBS)?
Motility disorder of the small and large intestine
How do you determine if a person has IBS? Are there any physical signs of IBS?
Tests done to rule out Crohn’s, cancer, and ulcerative colitis (if none of those, it’s probably IBS)
There are NO physical signs of IBS
IBS is characterized by alterations in what?
Stool frequency
Stool consistency
What are some possible triggers of IBS?
Food
Stress or Anxiety
Hormones
Other Illnesses
Is treatment individualized for patients who have IBS?
Yes
What are FODMAPs?
Type of CHO
What does FODMAP stand for?
Fermentable Oligo-Di-Monosaccharides and Polyols
What are FODMAPs in?
Fructose (fruits, honey, high fructose corn syrup, etc.)
Lactose (dairy)
Fructans (wheat, garlic, onion, insulin, etc.)
Galactans (legumes such as beans, lentils, soybeans, etc.)
Polyols (sweeteners containing isomalt, mannitol, sorbitol, xylitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums, etc.)
–NOT ASPARTAME
Where did the FODMAP diet come from? About how long go?
Australia
About 6 years ago
Discuss the FODMAP diet.
CHO and sugars that are found in foods
Often used in those with IBS
Can also be used in individuals who have gluten sensitivity (non-celiac)
Add high FODMAPs into your diet in small amounts to figure out your triggers
Diverticular Disease of the Colon: Impacted Areas
Can impact esophagus, small and large intestine
–most commonly impacts large intestine
Diverticular Disease of the Colon: Diverticula and formation of Diverticula
Diverticula are pouches
Naturally weak areas in colon and increased pressure in colon can create pouches called diverticula
- -pouches can become inflamed and are very, very painful
- -pouches are the bulging parts in the large intestine
Very individual in terms of what effects each person
Diverticular Disease of the Colon: General Definition
Development of pebble-seized herniations in the intestinal wall
Diverticular Disease of the Colon: Where does it most often occur?
Most often occurs in sigmoid colon
Diverticular Disease of the Colon: Prevalence
Prevalence increases with age:
- -more common in individuals over 40
- -person usually lives with diverticular disease, but it can become so severe that surgery is necessary (PAINFUL)
Diverticulosis
[Def] Condition of having diverticula
High fiber diet with fluids
–helps to soften the stool and helps to decrease the transit time through the colon which leads to a decrease in pressure in the colon
Exercise helps to improve the transit time through the colon as well
Respond to bowel urges: doesn’t hold in (too much pressure)
Diverticulitis
Inflamed diverticula
Individuals may still consume fiber but they’re usually treated with antibiotics. Fecal matter can get trapped in pouches, concern about infection.
In terms of diet, it really depends on the person (quite individualized).
Your patient has an ileostomy. Which organ has been bypassed or removed?
Large intestine
What are Ostomies?
Surgical Procedure
Create stoma (opening) in final portion of remaining intestine
Bag attached to stoma to collect waste material
Ostomy may be temporary or permanent
Ileostomy
Removal or bypass ALL of colon
Ileo signifies where the stoma is attached. The entire colon is removed or bypassed, and the stoma is formed from the ileum.
Colostomy
Remove or bypass PART of the colon. The stoma is formed from the remaining section of the functional colon.
Discuss ostomy diets.
Post Surgery: clear liquid diet (CL) advanced to regular
There are food lists that go along with ostomy diets
Reintroduce foods gradually:
- -initially individual may be on a low fiber diet (time needed for healing, concerns about blockage)
- -watch foods that cause obstructions (ex. nuts, stringy vegetables)
- -watch gas-producing or strong odor foods
- ->gas ex: brussels sprout, broccoli
- -> odor ex: asparagus
- ->buttermilk is often used to offset/decrease odor
- -encourage fluids
What is often used to offset/decrease odor in ostomy diets?
Buttermilk
