Large Intestine

• Working knowledge of physiological changes during disease processes & the effects of these on nutrition care.

Large Intestine

• Calculate & interpret nutrient composition of foods appropriate for diets used in MNT.

• Calculate & define diets for common conditions.

Large Intestine

• Parts of the colon– haustra - sacculations in wall of colon,

due to the circular muscle fibers & tenia coli

Large Intestine

• Parts of the colon– tenia coli - three thickened bands of soft

tissue 1/4” wide & 1/6 shorter than the colon, longitudinal fibers that go from appendix to rectum

• Diagram of colon next

Colon

Constipation

• Infrequent and difficult passage of stool

• Fewer than 3 stools/week while eating high residue diet

• What is the normal time it takes food to pass from the mouth to the anus?

Constipation Etiology

• Not defecating when the urge happens

• Failure to establish a regular time to defecate

• Lack of fiber in the diet

Constipation Etiology

• Insufficient fluid intake

• Loss of muscle tone in intestinal tract

• Side effects of medications

• Lack of exercise

• Pregnancy

Constipation Nutr Care

• Fluids

• Fiber

Laxatives

• Gradual reduction of laxatives - can become dependent

Laxatives - Stimulants

• Senna (natural)

• Bisacodyl – stimulates nerve endings to increase

peristalsis

• Dulcolax - active ingredient is bisacodyl

Laxatives - Bulking Agents

• What do you think are the bulking agents?

Laxatives - Stool Softeners

• Colace– active agent is docusafe sodium– surface active agent

Laxatives - Prunes

• Dihydroxyphenyl isatin– stimulates intestinal motility

Irritable Bowel Syndrome

• Cause unknown

• Exaggerated gastrocolic reflex

• Abnormal colonic sensitivity to stretching

• Anxiety & stress

IBS

• Contributing causes– excessive use laxatives– excessive use caffeine– antibiotic therapy– irregular sleep, rest, fluid intake, bowel

movements

IBS

• Abnormal stooling pattern associated with symptoms of intestinal dysfunction that persists

• May be some inflammation

• Slide of what colon looks like in irritable bowel syndrome next

Colon in irritable bowel syndrome

IBS Symptoms

• Diarrhea & constipation

• Excessive flatulence

• Sensation of incomplete evacuation

• Rectal pain

• Mucus in stools

IBS Monitoring

• Body weight

• H & H

• Alb

• Na, K, Cl

• Ca, Mg

IBS Nutritional Care

• Get over fear of eating

• Gain or maintain wt

• Acute phase– elemental food products– advance DAT

IBS Nutritional Care

• Chronic phase– high fiber diet– avoid gas forming foods– DAT– exclusion of caffeine & chocolate

IBS Nutritional Care

• Why the high fiber diet?

Diverticular Disease

• Diverticulosis– collection of herniations of the colonic

wall

Diverticular Disease

• Diverticulitis– accumulation of fecal matter in the

diverticular pockets with infection & inflammation

Diverticular Disease

• Outpouchings results from segmentation due to high intracolonic pressures

• Low fiber diet

• Colon muscle weakens

• Common elderly

• Next figure of diverticula

Diverticula

Symptoms

• Diverticulitis– pain– bleeding– low Hgb & Alb levels

Symptoms

• Diverticulosis– can be asymptomatic– pain– constipation with diarrhea

Diverticular Monitoring

• Body wt & change

• H & H

• Alb

• Transferrin, TIBC

• Stool number & frequency

Diverticular Monitoring

• Blood pressure

• WBC (may increase)

Nutritional Care

• Get over fear of eating

• Maintain or increase body wt

• Diet lessen pain

Nutritional Care

• Diverticulitis– bowel rest to prevent perforation– low fiber & residue– No nuts, seeds, fibrous veg– DAT

Nutritional Care

• Diverticulosis– increase stool caliber & vol– lessen intraluminal pressure– high fluid & fiber

Patient Education

• Fiber in foods

• Drink fluid

• Avoid constipation

Ileostomy & Colostomy

• Ulcerative colitis

• Crohn’s disease

• Colon cancer

• Intestinal trauma

Ileostomy

• Surgical formation of an opening of the ileum onto the surface of the abdomen

Colostomy

• Surgical formation of an artificial anus on the abdominal wall by incising the colon & bringing to the surface

Ileostomy & Colostomy

• Consistency of material in colon next

• Next slides of openings and where in the intestinal tract

Colonmaterialconsistency

Ileostomy

Colostomy

• What would be the consistency of the material for each of these procedures?

Nutritional Care

• Avoid foods that cause odor– corn– dried beans– onions– cabbage– highly spiced foods

Nutritional Care

• Avoid foods that cause odor– fish– antibiotics– some vitamin & mineral supplements

Nutritional Care

• Avoid foods that produce flatulence

• Avoid very fibrous veg

• Chew food well

• More fluid

• More salt

• Crohn’s Disease Case study #40 - 3, 4, 5

• Diverticulosis Case study #17 - 2, 3, 4, 5, 6, 7, 8, 10, 11, 12

• Select menu high in fiber from reg menu

• Write SOAP note

Digestion-Absorption-Metabolism