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What is the sm. intestine physio?
- villi/microvilli increase surface area, 600x abs (influence by malnutrition/dz)
- ileum seperate sm. bowel from large
- duodenum, jejunum, ileum
what happens in the sm. intestine (gateholder)?
- motility churns food
- makes: cholecystokinin, gastrin, secretin (release bile +pancreatic enzym) to stimulate pancreas + gallbladder
- 1.5 L water sol. secretions/ day made
- abs food via active transport (na/k) (glc, gal, aa)
- lipid turn into chylomicrons, then enter with passive abs>> to lymphatic systm (thyroid function)
What are important things about the large intestine?
- absorb H20, electrolytes, vitamins (no enzymes here)
- form/store poop
- intestine flora balance w/ fiber fermentation
- make vit K and biotin
what is the etiology of diarrhea?
- osmotic/acute (less than 2 weeks): high conc, then high water secretion
- secreatory(common)/ chronic (2 + weeks): hyper/undersecrete
- foul-smell/frothy, have blood (bright red = upper GI, dark red=lower), mucus (light), leukocytes (immune/white)
what is the Tx for diarrhea?
- correct dehydration, electro, acid/base balance
- pectin (fiber) sources
- low residue diet = low insoluble, high soluble
what is constipation and some important things about it?
- less than 3 bowel movements a week
- straining, hard stool, sense of fullness more than 25% of time
- had IBD manifestation
- pain medications relax muscle in colon so can poop
- motility/secretion dysfuncton?
what is the recommended fiber intake for constipation?
- 20-35 g soluble fiber
- age + 5g for over 2 yrs old
- always drink water
what is the etiology of malabsorption and the macromolecules absorption?
- impaired absorptive surface (crohn's, celiac's), protein cal malnutrition (PCM)
- lipids: have blockage/barrier so fat sol vitamin not abs, have to do fecal fat test
- pro: protein-loss enteropathy, might need 2-3 kg more if loss
- CHO: lactose (lg. intestine cant break down)
- all loose weight
What is celiac's disease (gluten sensitive enteropathy) and some important things about it?
- it is immune response to gliadin (infants, type I dm, auto imm. disorders)
- result in flattening of GI villi and malabs of all nutrients
- cureent use antibodies for gliadin
- need gluten free diet quick
- full recovery can take years =(
what are the clinical manifestations of celiacs?
- FTT (failure to thrive) in kids
- lactase deficient
- electrolyte disturbance
- osteomalacia (bone soften because no vit D)
- night blindness
- micro/macro anemias
what is the Tx for celiacs?
- avoid gluten food (because gliadin causes)!
- eiminate: buckwheat, rye, oats, wheat, barley
- be aware of hidden sources: medicine, malt, makeup, veggie gum, grain vinegar, startch, hydrolyzed things?
- get vitamin supplements
- once gluten is free from system there can be repairs
what is difficult about the symptoms of celiacs dz?
- there is no classic profile for it- no set symp or manifestation
- it is often mistaken for crohns dz, parasites, skin disorders, etc
- usually comes after trauma(physical or emotional)
what does genetics play a part in with celiacs?
it has a strong dispsition to genetics: pale, irritable(mood swings), fail to grow(cant gain lbs), flat butt ( low muscle), potbelly(has fat), stiny stool (malabs of stool)
what are general symptoms of celiacs?
diarrhea, low constipaton, gas, bloating, irritable, depressed, joint/bone pain, muscle cramp, skin rash, mouth sores, anemia, bone disorders, neuropathy (loss of touch, poor sight, veins damaged)
What testing can be done for celiac's and what is better testing method?
- ***biopsy: main test of stool (atrophy of villi checked)
- Antibody test/blood test:
- IgG (starting): immune disorders( usually false neg.
- IgA : food sensitivities (usually false positive)
what is important about villi?
- they are the mop/broom of the stomach linning
- they have digestive enzymes
- foods pass thru and dont get abs or digested
what are associated conditions with celiacs?
- Fe deficientcy anemia
- vit k deficient>> hemorrage
- CNS and PNS disorder because of no nutrients
- (always recommend vit D and ca)
- not work pancreas (type I dm)
- lactose intolerance
- neurological manifestations
What gets malnourished from celiacs?
- vitamins A,D,E,K
- vit. B12
- folate (not common)
- severe for kids may lead to FTT
what results from lack of Ca and vit D in celiacs?
- osteomalacia, rickets, kidney stones
- secondary lactose intolerance (vili can grow back)
What are additional medical consequences of celiacs?
- intestinal lymphoma
- bowel cancer
- peripheral neuropathy
what ingredients does one avoid with celiacs?
- grains, barley, wheat, rye, farina, triticale, graham, durum,semolina, kamut, bulgur, kasha, spelt, matzo meal, oats?
- WORB= controversial because does not contain, but made on same machines
what foods do celiac pateints aviod?
breads, cereals, crackers, pasta, cookies, cake, pie, gravy, sauces, medicine, snack food
what cosmetics should celiac patients avoid or be weary of?
- makeup or skin care products
- gluten free- toothpate, mouthwash, lip balms, lotions (for kids)
what foods are allowed for celiacs patients?
corn, potatoes, arrowroot, tapioca, rice, amarath, nut flours, quinoa
What should you do if u have celiacs?
- sit with and RD annually
- check ingredients and prep methods
- have vitamin/mineral supplements (vit D and Ca at least)
- be proactive
What is IBS ?
- irritable bowel syndrome (cluster of symptoms)
- alternating constipation and diarrhea (gas, bloating, abnormal bowel contractions)
How is IBS diagnosed and how much of the poop does it affect?
- affects 20% of pop
- Dx: 12 wks with abdominal pain in 1 year and 1 of 3:
- pain relief with pooping, change in poop frequently
- (high or low), change on form of poop (dry, wet, lose,
- may be motility disorder, stress worsens
- similar to celiacs dz in symptoms
what is the Tx for IBS?
- SSRI's (antidepressants) decrease anxiety
- food diary
- increase fiber : FOMAP (ferm. oligo,disac, mono, poly olig = decrease symptoms in 2 wks)
- increase sol, decrease insol.
- try stress mgmt 1st (related to IBS flares)
what is IBD?
- inflammatory bowel dz- with other autoimmune dz
- includes crohns and ulcerative colitis
What are causes, Tx, and other important things about IBD?
- effects both sexes (15-30 yrs)
- causes: unknown- genetic or autoimmune
- at risk for malnutrition (crohns)
- increase risk for malignant dz's
- Tx: surger, antibioti, immunosuppress.
What is crohns dz?
- it is chronic/ intermittent abdominal pain, nausea, vomiting, diarrhea
- it causes malabs from bacterial overgroth, inflamm, or bowel ressection
what are the deficiencies of crohns?
protein, folate Fe, kcal, Vit A,D,C,E, B12
What are symptoms and causes of crohns dz?
- weight loss, fever, low albumin (increase enerrgy needs)
- unknown causes: genetic, infectous, immune
also diferent from others because can have active infection!
what is UC and in causes +symptoms?
- it is ulcerative colitis ( in the colon)
- it usually comes and goes (remmision/exascerbations)
symp: bloody diarrhea/stomach pain, increase bowel movmt, decrease appetitie, rectal mucus with ulcer, fever, dehydration, anemia, protein loss, low albumin
how would you treat UC?
- with surgery, getting colon removed
- get fiber and fluid too
what are the differences between crohns and UC?
- Crohns: any part of GI (mouth to anus)
- segmented involvment
- all mucosa layers
- surgery not cured
- resections result in malabs
- UC: only in colon
- continuos dz
- rectal bleed/blood diarrhea
- colon need removal
what is medical mgmt of IBD?
- corticosteriods, anti-inflammatory, immunosupre, antibio
- surgery: smll bowel resection, illeostomy, colonostomy
what is nutritional mgmt of IBD?
- low residue/fiber diet to reduce diarrhea
- supplements to replenish
- enteral nutrition (elemental)
- PN for severe cases (TPN good for fluid)
what micro/macro nutrients are needed for IBD?
- energy not greatly increased
- protein increase up 50%, 1.3-1.5 g/kg
- supplement vitamin +min
- fat malabs (crohns)
What is SBS?
- short bowel syndrome (75% gut removed)
- decreased GI surface and increase transient time
- the more colon removed to more the malabs
what doe the consequences of SBS?
- depend on:
- extent/site of bowel loss
- present/absent ileocecal valve
- function of remain GI
- degree of bowel adaption
what do illeal resections decrease?
- abs of B12, bile salts, fat, fat sol vitamins
- availability of cations (mg, ca, zn)
- increase oxylate abs
what is the Tx for SBS?
- IV with electrolyte +fluid
- TPN in early phase
- slow intro to enteral feed
- aa/'s glutamine + arginine help heal gut
- transition to oral diet (sm/frequent meal, low fiber/lactose, fat vitamin +min supple)
what is specific for SBS?
- typical from gun shoot wound
- cells migrate and go to colon
what is diverticulosis?
- hemiations in colonic wall (pouches) due to chronice increased colon pressure
- associated with constipation
- contain polops (bacterial ball)
- have high fiber diet to soften stool(white bread, rice etc.)
What is diverticulitis?
- acute inflammatory flare-up (occur in 10-25% patients)
- low-residue/insoluble fiber diet
- possible elemental or TPN for short time
- avoid seed/nuts
what are high fiber food choices?
- over 25 g/day
- to prevent diverticulosis, and manage IBS
what are the low fiber/residue diets?
- less than 10 g/day
- use to reduce poop output (diarrhea, recovery from bowel surg.)
- can be used for people with maldigestion, absorption, diarrh.
what is residue?
- total amount of poop mass: water, bacteria, fiber, GI cells,
- mucous, sugars, pectin, minerals
what are the food choices for minimal fiber?
refined bread, cereal, fruit/veggies (no skin, nuts, seeds) milk, meat, egg, fat,
what are food choices for low residue diets?
- limit dairy to 2 c/day
- limit meat, seafood
- no whole fruit/veggie, nut, seeds, legumes, potatoe, peas
- refined bread +cereal
What is an illeostomy?
- surgical opening from distal ielum through abdominal wall
- that bypass colon, rectum, and anus
why would someone have an ileostomy?
because massive lower GI surgery that render tissue unused
what should a patient be weary of and consume if they have a ileostomy?
- that adjustments should be made to prevent obstruction, watery dischareg, smell, gas
- make sure to chew all food well so dont get stuck
- start on clear liquid and then eat reg. food
how would a patient prevent obstruction of ileotomy?
increase fluid, avoid high insoluble fiber (seeds), chew!
how would a patient prevent watery discharge?
avoid: spinach, broccoli, beans, prune juice,raw fruit, spicy food, beer/wine
how would a patient avoid flatulance with pain and odor?
- eliminate gassy foods (cabbage)
- dont chew gum/ use a straw
- yogurt/probiotics may reduce smell
what is the nutritional mgmt of an ileostomy?
gradual progression to regular diet (6 wks)
what are some improtant factora about colostomy?
- mgmt depend on location
- constipation, diarrhea, flatus, odor, may require diet change
- collection bag attached to stoma need changing (2 days)
how many people are lactose intolerant?
less than 70% world pop. is lactase deficient