MNT Exam 1- Lower GI, Celiacs

• villi/microvilli increase surface area, 600x abs (influence by malnutrition/dz)
• duodenum/jejunum
• ileum seperate sm. bowel from large
• duodenum, jejunum, ileum

• 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)

• absorb H20, electrolytes, vitamins (no enzymes here)
• form/store poop
• intestine flora balance w/ fiber fermentation
• make vit K and biotin

• 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)

• correct dehydration, electro, acid/base balance
• pectin (fiber) sources
• low residue diet = low insoluble, high soluble

• 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?

• 20-35 g soluble fiber
• age + 5g for over 2 yrs old
• always drink water

• 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

• 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 =(

• steatorhhea/diarrhea
• FTT (failure to thrive) in kids
• lactase deficient
• electrolyte disturbance
• osteomalacia (bone soften because no vit D)
• rickets
• night blindness
• micro/macro anemias

• 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

• 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)

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)

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)

• ***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)

• they are the mop/broom of the stomach linning
• they have digestive enzymes
• foods pass thru and dont get abs or digested

• Fe deficientcy anemia
• osteoporosis
• vit k deficient>> hemorrage
• CNS and PNS disorder because of no nutrients
• (always recommend vit D and ca)
• not work pancreas (type I dm)
• cancers
• lactose intolerance
• neurological manifestations

• vitamins A,D,E,K
• vit. B12
• folate (not common)
• Fe
• severe for kids may lead to FTT

• osteomalacia, rickets, kidney stones
• secondary lactose intolerance (vili can grow back)

• intestinal lymphoma
• bowel cancer
• seizures
• peripheral neuropathy

• 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

breads, cereals, crackers, pasta, cookies, cake, pie, gravy, sauces, medicine, snack food

• makeup or skin care products
• gluten free- toothpate, mouthwash, lip balms, lotions (for kids)

corn, potatoes, arrowroot, tapioca, rice, amarath, nut flours, quinoa

• sit with and RD annually
• check ingredients and prep methods
• have vitamin/mineral supplements (vit D and Ca at least)
• be proactive

• irritable bowel syndrome (cluster of symptoms)
• alternating constipation and diarrhea (gas, bloating, abnormal bowel contractions)

• 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,
• etc.)
• may be motility disorder, stress worsens
• similar to celiacs dz in symptoms

• SSRI's (antidepressants) decrease anxiety
• food diary
• probiotics
• 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)

• inflammatory bowel dz- with other autoimmune dz
• includes crohns and ulcerative colitis

• 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.

• it is chronic/ intermittent abdominal pain, nausea, vomiting, diarrhea
• it causes malabs from bacterial overgroth, inflamm, or bowel ressection

protein, folate Fe, kcal, Vit A,D,C,E, B12

• weight loss, fever, low albumin (increase enerrgy needs)
• unknown causes: genetic, infectous, immune

also diferent from others because can have active infection!

• 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

• with surgery, getting colon removed
• get fiber and fluid too

• 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

• corticosteriods, anti-inflammatory, immunosupre, antibio
• surgery: smll bowel resection, illeostomy, colonostomy

• low residue/fiber diet to reduce diarrhea
• supplements to replenish
• enteral nutrition (elemental)
• PN for severe cases (TPN good for fluid)

• energy not greatly increased
• protein increase up 50%, 1.3-1.5 g/kg
• supplement vitamin +min
• fat malabs (crohns)

• short bowel syndrome (75% gut removed)
• decreased GI surface and increase transient time
• the more colon removed to more the malabs

• depend on:
• extent/site of bowel loss
• present/absent ileocecal valve
• function of remain GI
• degree of bowel adaption

• abs of B12, bile salts, fat, fat sol vitamins
• availability of cations (mg, ca, zn)
• increase oxylate abs

• 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)

• typical from gun shoot wound
• cells migrate and go to colon

• 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.)

• acute inflammatory flare-up (occur in 10-25% patients)
• low-residue/insoluble fiber diet
• possible elemental or TPN for short time
• avoid seed/nuts

• over 25 g/day
• to prevent diverticulosis, and manage IBS

• less than 10 g/day
• use to reduce poop output (diarrhea, recovery from bowel surg.)
• can be used for people with maldigestion, absorption, diarrh.

• total amount of poop mass: water, bacteria, fiber, GI cells,
• mucous, sugars, pectin, minerals

refined bread, cereal, fruit/veggies (no skin, nuts, seeds) milk, meat, egg, fat,

• limit dairy to 2 c/day
• limit meat, seafood
• no whole fruit/veggie, nut, seeds, legumes, potatoe, peas
• refined bread +cereal

• surgical opening from distal ielum through abdominal wall
• that bypass colon, rectum, and anus

because massive lower GI surgery that render tissue unused

• 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

increase fluid, avoid high insoluble fiber (seeds), chew!

avoid: spinach, broccoli, beans, prune juice,raw fruit, spicy food, beer/wine

• eliminate gassy foods (cabbage)
• dont chew gum/ use a straw
• yogurt/probiotics may reduce smell

gradual progression to regular diet (6 wks)

• mgmt depend on location
• constipation, diarrhea, flatus, odor, may require diet change
• collection bag attached to stoma need changing (2 days)

less than 70% world pop. is lactase deficient