Review Chapter 18

1
Review Chapter 18

• Review of Test Scores
• Clarification of Syllabus
• Review
• Clear Liquid Supplements
• The Diet Manual
• Fear Factor
• Drinking Thickened Liquids for Bonus Points!

2
Ch. 19 Fiber-Modified Diets for Lower GI Tract
Disorders

• Case Study - When not to order a patient a salad
  . . .
• Class discussion What should have been ordered?

3
Fiber-Modified Diets

• High-Fiber Diets
• Constipation, irritable bowel diverticulosis
• Weight loss, blood glucose lipids
• Soluble fiber vs insoluble fiber diarrhea
• Differentiate between residue fiber
• Residue total amount of material in colon
  fiber, undigested food, intestinal secretions,
  cells, materials from milk and meat connective
  tissue

4
Indications for Fiber-Modified Diets
5
Fiber and Residue Modifications

• Fiber Non-digestible materials including
  cellulose, pectin, gums, etc.
• Soluble vs insoluble
• High-fiber Diets
• 20-35 grams of fiber daily
• Whole grains, fruits, vegetables legumes
• Increase need for fluids
• Increase slowly
• Mix with other foods

6
Intestinal Gas

• Causes
• Bacteria metabolizes dietary fibers
• Malabsorption
• High fats, fructose, sorbitol
• Lactose intolerant
• Experimentation with high fiber foods
• Patient education material

7
Fiber and Residue Modifications

• Low-Fiber and Low-Residue Diets
• Lowers fecal volume
• Low-fiber restricts high-fiber foods and and
  tough meats
• Low-residue restricts all high-fiber foods and
  are usually short-term
• Used to prevent obstructions in intestinal tract
  caused by inflammation, scarring or slowed
  motility

8
Motility Disorders

• Motility Disorders
• Examples delayed gastric emptying
  constipation, diarrhea, irritable bowel syndrome
• Delayed Gastric Emptying and Tx
• Typical causes include diabetes and following
  surgery
• Premature satietyfullness, nausea, vomiting,
  bloating, weight loss
• Tx low fiber, low fat will increase digestion
  rate frequent small meals liquid formulas PO
  severe--tube feedings or IV

9
Constipation

• Constipation and Tx
• Symptom of another condition
• Causes fluid imbalances, diseases or GI tract,
  laxative abuse, stress, medications
• Tx high fiber diet, increased fluids, natural
  laxatives, bulk forming laxatives, regular
  physical exercise
• Institutions need accurate output weight
  monitoring!

10
Diarrhea

• Diarrhea and Dehydration Tx
• Diarrhea increased frequency or volume of
  stools
• Causesviral, bacterial or protozoal infections,
  meds, dietary supplements olestra
• Infants, children, elderly high risk
• Severity and persistence result in dehydration
• Chronic conditions irritable bowel syndromes,
  malabsorption, food intolerances, HIV
• Tx Replace fluids electrolytes through IV,
  diluted fruit juices, sports drinks,
  caffeine-free carbonated drinks

11
IBS vs. IBD

• Irritable Bowel Syndrome and Tx
• Alternating diarrhea constipation bloating and
  flatulence nausea
• Causes stress and food intolerances abnormal GI
  motility
• IBS more prevalent than IBD more in women
• Tx high fiber high fluid intake fat high
  seasonings restricted

12
Intestinal Obstructions

• What is a Bezoar?!
• Intestinal Obstructions and Tx
• Ileus Blockages caused by scar tissue, tumors,
  slowed intestinal movement
• Adynamic vs. mechanical
• Risks Perforation and sepsis
• Sx include pain, abdominal distention, nausea,
  vomiting, constipation
• Low fiber, small meals
• Surgery NPO if total
• Partial requires suctioning and/or antibiotics

13
IBD - Inflammatory Bowel Disease

• Crohns Disease and Ulcerative Colitis
• Genetic mutation or immune system problem
• Crohns in small or large intestine Ulcerative
  Colitislarge intestine only
• Diarrhea, losses of fluids and electrolytes
• Weight lossanemia
• Scar tissue Fistulas can cause obstructions
• Malabsorption, weight loss, malnutrition can
  result-esp. Crohns
• Surgery to eliminate obstructions

14
IBD - Inflammatory Bowel Disease

• Medical Nutrition Therapy
• Remissionhigh fiber diet
• High-kcalorie, high protein diet
• Liquid formulas tube feedings at night
• Eliminate foods that cause symptomshigh fiber,
  high fat, high lactose foods
• Complete bowel rest when severe pain and
  diarrheafeeding tubes IV
• Vitamin and mineral supplements

15
Diverticulosis vs. Diverticulitis

• Diverticulosis defined
• Usually symptom freeminimize risk with a high
  fiber, low-fat diet
• Diverticulitis Fecal material trapped in
  diverticula causing inflammation and infection
  abdominal pain and distention diarrhea and/or
  constipation
• Fiber restrictions and/or low residue diet -avoid
  flakes, seeds nuts when acute

16
Resectioning of Large Intestine

• Obstructions, lesions and tumors may require
  removal of part of large int.
• Colostomysegment of colon removed
• Ileostomyentire colon and rectum removed
  resulting in watery stools
• Nutritional support low-fiber, bland diets
  following surgery adding foods back per tolerance
• Prevent obstructions avoid stringy foods, touch
  skins, raw apples and corn, fibrous meats,
  popcorn, nuts, etc.

17
MNT for Ostomy Patients

• Encourage fluids dont contribute to watery
  stools prevent dehydration and constipation
  reduce gas and odor formers
• Control diarrhea
• Utilize soluble fiber to thicken stoolsbananas,
  applesauce, starchy foods
• Avoid natural laxatives, highly seasoned foods,
  caffeine and alcohol
• Reducing gas and odors
• Legumes, beer, carbonated beverages, eggs,
  garlic, onions, etc.
• Utilize buttermilk, parsley and yogurt to reduce
  odors
• Ostomy diet handout

18
Test Questions

• Treatments for constipation include
• A. Limited fluids
• B. Low-fiber foods
• C. Rest after meals
• D. High-fiber foods

19
Test Questions

• Following a colostomy or ileostomy a low-fiber
  diet is recommended until the surgery heals
• A. True
• B. False

20
Test Questions

• The primary nutrition-related concern for the
  client in the immediate post-operative period is
• A. Prevention of constipation
• B. Prevention of diarrhea
• C. Maintenance of fluid electrolyte balance
• D. Maintenance of a low calorie diet