EX2 DIARRHEA, CONSTIPATION, LACTOSE/FRUCTOSE INTOLERANCE

DIARRHEA

Define diarrhea

increase in frequency of bowel movements and/or an increase in water content of stools that affects consistency or volume of fecal output

why does diarrhea occur (basic)

caused by accelerated transit through small intestine

what does diarrhea result in (general)

electrolyte loss (Na,K)

what are the types of diarrhea (based on length)

• Acute (4 weeks)

• Persistent (2-4 weeks)

• Chronic (>4 weeks)

what are the 5 types of diahrrea?

• exudative 

• osmotic 

• secretory

• malabsorptive

• medication 

exudative diarrhea

associated with mucosal damage, outpouring of mucus, fluid, blood, proteins

Crohn’s disease, UC, radiation enteritis

osmotic diarrhea

 poorly absorbed, hyperosmolar compounds in lumen cause increased fluid to be drawn into lumen

lactose intolerance, fructose intolerance

secretory diarrhea

Caused by active intestinal secretion of electrolytes and water

bacterial endotoxins, viruses; fasting does not relieve it

malabsorptive diarrhea 

disease process causes malabsorption and increased appearance of nutrients in stool 

IBD, extensive bowel restriction, CD

medication-induced diarrhea

caused by medication to increase BMs or by antibiotics

which diarrhea could be stopped by stopping food intake

osmotic (caused by an excess of osmotically active substances in the gut, and fasting removes these substances, allowing water and electrolyte absorption to return to normal)

what medications can cause diarrhea? (5 categories)

-GI meds (H2 receptor antagonist, PPI’s)

-antibiotics

-anti-inflammatory (NSAIDS, ACE inhibitors, -beta blockers, cardiac meds)

-lipid-loweing meds

-laxatives

for diarrhea, doctors treat what 

the underlying problem 

what is a major complication/issue with diarrhea

dehydration

medical treatment of diarrhea

manage fluid and electrolyte replacement through oral rehydration solutions (ORT) integral (Pedialyte, Resol, Ricelyte, Rehydralyte)

traditional diet therapies for diarrhea (3)

• NPO

• clear liquids (may lead to osmotic diahrrea)

• BRAT (banana, rice, applesauce, toast)-not much evidence or for long-term

current nutrition therapy (3)

• diet therapy

• thicken consistency of stoll

• probiotics may be helpful 

the goal of diet changes are to

decrease GI motility

what diet changes can we make to decrease GI motility

• avoid gut stimulant (coffee, alcohol)

• avoid sugar alcohols

• avoid high sugar food and beverages

• avoid gas producing foods

what type of diet can be helpful

low residue/low fiber diet, low lactose, low-fat diet

how can we thicken stool consistency

banana flakes, pectin 

CONSTIPATION

What is constipation

inability or lack of easiness to pass stool (several criteria to be met and to characterize severity)

what must person have meet constipation criterias

• loose stool rarely w/out laxative use

• does not meet rome IV IBS criteria

what causes constipation (physiological)

• slowed colonic transition

• rectal outlet obstruction (fecal impaction or adhesion or tumor presence)

• secondary issue due to other med issues

slowed colonic transit may be due to (4)

• lack of adequate fluid intake

• lack of fiber

• lack of exercise or movement

• ignoring urge to defecate 

what medical conditions can cause constipation? (many)

• Chronic intestinal pseudo-obstruction

• Hypothyroidism

• Colonic inertia

• Gastroparesis

• Hirschprung’s disease

• ALS/MS/MD

• Scleroderma involving the gut

• CP

• Para or quadriplegia

what medications can cause constipation (4)

Opioids, calcium channel blockers, antidepressants, diuretics

diuretics cause fluid loss

what are the 3 main lifestyle therapies to relieve constipation

1. ensure adequate activity

2. ensure adequate fluid (at least 64oz)

3. ensure adequate fiber

fiber needs (general, woman, men)

-general: 14g/2000kcal

-men: 38g/d

-woman: 26g/d 

what can be used to meet fibers \?

• dietary fiber

• bulking agents (phyllium)

• stool softeners

• stimulant laxatives

• probiotics (may help enhance regularity)

when assessing patient with constipation, pay special attention to ?

• fluid intake

• review of medications

• recent changes in stool pattern

from medical notes/ charts

diagnosis for constipation (3)

• Altered GI function r/t

• Inadequate fiber intake r/t

• Inadequate fluid intake r/t

intervention for constipation (3)

• Education on fluid or fiber or activity

• Encouraging pre or pro biotic use

• Referral to MD for GI for bowel regimen

LACTOSE INTOLERANCE

what is lactose intolerance

syndrome of diarrhea, abd pain, flatulence or bloating after consumption of lactose

cause of lactose intolerance

lack of lactase production which results in lactose fermentation in the colon

MNT for lactose intolerance includes

• avoiding >12g of lactose/ day

• avoiding >7g of lactose/ meal

• include tolerable lactose products

  • include milk or dairy with meal (not alone)

  • build up tolerance slowly

• lactose free milk/ products

FRUCTOSE MALABSORPTION

how common is fructose malabsorption?

up to 50% of population may be susceptible to large doses (25-50 grams)

fructose in the diet sources

• Occurs as free fructose (honey, fruit)

• Disaccharide with glucose (sucrose, HFCS) (often better absorbed)

• FOS (wheat, vegetables, additives: chicory root)

who is more likely to have this issue

those with other GI disorders

what foods have higher fructose?

apples, pear, mangoes, dried fruits, fruit juices

why does fructose malabsorption occur?

excess fructose can’t be digested, causes osmotic diarrhea or bloating

MNT for fructose malabsorption

• limit foods of free fructose

• limit portion sizes of food with fructose

• eat fructose containing foods with meals and snacks (not alone)

• consume glucose+fructose (may help)

• keep a symptom diary