Large Intestine

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Large Intestine

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

2
Large Intestine

• Calculate interpret nutrient composition of
  foods appropriate for diets used in MNT.
• Calculate define diets for common conditions.

3
Large Intestine

• Parts of the colon
• haustra - sacculations in wall of colon, due to
  the circular muscle fibers tenia coli

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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

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• Diagram of colon next

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Colon
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Constipation

• Infrequent and difficult passage of stool
• Fewer than 3 stools/week while eating high
  residue diet

8

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

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Constipation Etiology

• Not defecating when the urge happens
• Failure to establish a regular time to defecate
• Lack of fiber in the diet

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Constipation Etiology

• Insufficient fluid intake
• Loss of muscle tone in intestinal tract
• Side effects of medications
• Lack of exercise
• Pregnancy

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Constipation Nutr Care

• Fluids
• Fiber

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Laxatives

• Gradual reduction of laxatives - can become
  dependent

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Laxatives - Stimulants

• Senna (natural)
• Bisacodyl
• stimulates nerve endings to increase peristalsis
• Dulcolax - active ingredient is bisacodyl

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Laxatives - Bulking Agents

• What do you think are the bulking agents?

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Laxatives - Stool Softeners

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

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Laxatives - Prunes

• Dihydroxyphenyl isatin
• stimulates intestinal motility

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Irritable Bowel Syndrome

• Cause unknown
• Exaggerated gastrocolic reflex
• Abnormal colonic sensitivity to stretching
• Anxiety stress

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IBS

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

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IBS

• Abnormal stooling pattern associated with
  symptoms of intestinal dysfunction that persists
• May be some inflammation

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

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Colon in irritable bowel syndrome
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IBS Symptoms

• Diarrhea constipation
• Excessive flatulence
• Sensation of incomplete evacuation
• Rectal pain
• Mucus in stools

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IBS Monitoring

• Body weight
• H H
• Alb
• Na, K, Cl
• Ca, Mg

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IBS Nutritional Care

• Get over fear of eating
• Gain or maintain wt
• Acute phase
• elemental food products
• advance DAT

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IBS Nutritional Care

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

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IBS Nutritional Care

• Why the high fiber diet?

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Diverticular Disease

• Diverticulosis
• collection of herniations of the colonic wall

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Diverticular Disease

• Diverticulitis
• accumulation of fecal matter in the diverticular
  pockets with infection inflammation

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Diverticular Disease

• Outpouchings results from segmentation due to
  high intracolonic pressures
• Low fiber diet
• Colon muscle weakens
• Common elderly

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• Next figure of diverticula

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Diverticula
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Symptoms

• Diverticulitis
• pain
• bleeding
• low Hgb Alb levels

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Symptoms

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

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Diverticular Monitoring

• Body wt change
• H H
• Alb
• Transferrin, TIBC
• Stool number frequency

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Diverticular Monitoring

• Blood pressure
• WBC (may increase)

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Nutritional Care

• Get over fear of eating
• Maintain or increase body wt
• Diet lessen pain

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Nutritional Care

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

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Nutritional Care

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

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Patient Education

• Fiber in foods
• Drink fluid
• Avoid constipation

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Ileostomy Colostomy

• Ulcerative colitis
• Crohns disease
• Colon cancer
• Intestinal trauma

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Ileostomy

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

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Colostomy

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

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Ileostomy Colostomy

• Consistency of material in colon next
• Next slides of openings and where in the
  intestinal tract

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

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Nutritional Care

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

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Nutritional Care

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

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Nutritional Care

• Avoid foods that produce flatulence
• Avoid very fibrous veg
• Chew food well
• More fluid
• More salt

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• Crohns 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

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Digestion-Absorption-Metabolism