Lower Gastrointestinal Tract (Lower GI Tract)

The lower digestive system includes the large intestine (ascending colon,
transverse colon, descending colon, and sigmoid colon) and the rectum.

Lower GI complaints include

Constipation

Diarrhea

Gas and bloating

Abdominal pain

Rectal pain or bleeding

Constipation
Constipation as a condition where at least two of the following
symptoms have occurred in the previous year for at least 12 non
consecutive weeks must include 2 or more of the following:

Straining during at least 25% of defectations

Lumpy or hard stools in at least 25% of defectations
Sensation of incomplete evacuation for at least 25% of
defecations
Loose stools are rarely present without the use of laxatives
There are sufficient criteria for irritable bowel syndrome

Causes:
Constipation can be a result of several different distant causes.
Slowed colonic transit can result in constipation.
Constipation can be a side effect of many different classes of
medication. These include very common prescription drugs
such as Calcium channel blockers. These include very common
prescription drugs such as amitriptyline, pain me medications
such as morphine, diuretics and antihistamines.
Some other medications that often cause constipation include
iron, calcium and other vitamin supplement and for some
individuals, even no steroidal anti-inflammatory drugs can
result in constipation.

Symptoms:
Decreased frequency of bowel movements. Bowel movements are
often hard and pellet-like.Abdominal pain, bloating and gas are
common accompanying symptoms
 Nutrition Therapy for Constipation:
Historically, nutritional treatment of constipation has concentrated on
the role of adequate fiber and fluid intake.

Nutrition Assessment for Constipation:

Relevant nutrition assessment data in cases of constipation
would include.
Fluid and beverage intake
Dietary fiber intake
Bioactive substance intake
Misuse of medication especially laxatives
Nutrition diagnoses commonly associated with constipation may
include:
Inadequate fluid intake
Inadequate fiber intake
Altered GI function
Not ready for diet / Lifestyle change
Undesirable food choices.

Nutrition Intervention
25-35 grams of dietary fibber are recommended for adults each
day. Based on caloric intake this would be approximately 10 to13
g of dietary fibre per 1000 kcal.
For children over the age of 2 years fibre intake is recommended
to be the amount equal to their age plus 5 grams/day
Ensuring adequate fibre and fluid intake has been the
foundation for nutrition therapy in constipation treatment.
Fibre result increase stool weight that assists in providing for
consistent bowel movements and a caloric transit time 2-4 days.
 High Fiber Nutrition Therapy:

Tips for Adding Fiber to your Eating Plan

Eat whole grain breads and cereals. Look for choices with
100% whole wheat, rye, oats or bran as the first or second
ingredient.
Have brown or wild rice instead of white rice or potatoes.
Enjoy a variety of grains. Good choices include barley, oats.
Bake with whole-wheat flour. You can use it to replace some
white or all purpose flour in recipes.
Enjoy baked beans more often add dried beans and peas or
soups.
Choose fresh fruits and vegetables instead of juices.
Eat fruits and vegetables with peels or skins on.
Drink plenty of fluids. Set a goals of at least 10-12 cups per day .
You may need even more with higher amounts of fibre. Fluid
helps your body process fibre without discomfort.
If you are taking calcium or iron supplement check with your
doctor or dietiton. You may be able to take smaller amounts
several times a day.

Intestinal gas and flatulence

The intestine normally contains gas that is rapidly transmitted through the
small intestine to the colon. The amount of gas that is normally present is
dependent on the effects of colonic bacteria on the undigested food that
reaches the colon and the speed with which the gas passes through
the intestines and is passed.

Commonly known as farting, passing wind, or having gas, flatulence is a

medical term for releasing gas from the digestive system through the anus.

What causes Intestinal gas and flatulence

Swallowing air
Reasons that you may swallow more air than normal include chewing gum, smoking,
sucking on objects such as pen tops, drinking carbonated drinks, and eating too
quickly

Dietary choices
beans
cabbage
broccoli
raisins
lentils
prunes
apples
foods high in fructose or sorbitol, such as fruit juices
Nutrition Therapy for Intestinal gas and
flatulence

Look at your diet.

If it contains a large amount of carbohydrates that are difficult to digest,
try to replace them. Carbohydrates that are easier to digest, such as
potatoes, rice, and bananas, are good substitutes.

Keep a food diary.

This will help you can identify any triggers. After you identify some foods
that cause you excessive flatulence, you can learn to avoid them or to
eat less of them.

Eat less more.

Try to eat around five to six small meals a day instead of three larger
ones to help your digestive process.

Chew properly.
Avoid doing anything that may increase the amount of air that you
swallow. This includes making sure that you are chewing your food
properly, and avoiding chewing gum or smoking.

Exercise.
Some people find that exercising helps to promote digestion and can
prevent flatulence.

Try over-the-counter medications.

These include charcoal tablets that absorb gas through the digestive
system, antacids, and dietary supplements such as alpha-galactosidase
(Beano). It's important to note that these medications will only
temporarily provide relief.
 Diarrhea

Diarrhea is characterized by loose, watery stools or a frequent need to have

a bowel movement. It usually lasts a few days and often disappears without

any treatment. Diarrhea can be acute or chronic.

Acute diarrhea

Occur when the condition lasts for one to two days. You might experience

diarrhea as a result of a viral or bacterial infection

Chronic diarrhea

Refers to diarrhea that lasts for at least four weeks. Its usually the result of

an intestinal disease or disorder, such as celiac disease or Crohns disease.

What are the symptoms of diarrhea?

nausea
abdominal pain
cramping
bloating
dehydration
a fever
 bloody stools
a frequent urge to evacuate your bowels
a large volume of stools
Dehydration and diarrhea
The symptoms of dehydration include:

fatigue
dry mucous membranes
increased heart rate
a headache
lightheadedness
increased thirst
decreased urination
dry mouth

Diarrhea in babies and young children

Diarrhea is a serious condition in very young people. It can cause severe
dehydration in an infant in just one day.

decreased urination
dry mouth
a headache
fatigue
a lack of tears when crying
dry skin
sunken eyes
sunken fontanel
sleepiness
irritability
 Nutrition to prevent diarrhea?
Although diarrhea can occur for various reasons, there are actions that
you can take to prevent it:

You can avoid developing diarrhea from food poisoning by washing

the cooking and food preparation areas more frequently.
Serve food immediately after preparing it.
Refrigerate leftovers promptly.
Always thaw frozen food in a refrigerator.

Ulcerative colitis
What is ulcerative colitis?

Ulcerative colitis is a chronic inflammation of the large intestine (colon).

The colon is the part of the digestive system where water is removed from
undigested material, and the remaining waste material is stored. The
rectum is the end of the colon adjacent to the anus. In patients with
ulcerative colitis, ulcers and inflammation of the inner lining of the colon
lead to symptoms of abdominal, diarrhea, and rectal bleeding.

Types of ulcerative colitis (UC)

There are 4 types of ulcerative colitis (UC)
Ulcerative proctitis
Proctosigmoiditis
Left-sided colitis
Pan-ulcerative colitis

Ulcerative proctitis
A mild form of the disease and accounts for nearly 30% of all cases. Bowel
inflammation is limited to the rectum, and because the affected area is so
small, it is associated with fewer complications and offers a better outlook
than more widespread disease. Because of its limited extent (usually less
than the six inches of the rectum), ulcerative proctitis tends to be a milder
form of ulcerative colitis. Signs and symptoms include,

Rectal bleeding (for some patients this is the only symptom)

Rectal pain
Feeling of urgency or an inability to move the bowels even though
there is an urge to do so.
Ulcerative proctitis is usually the mildest form of ulcerative colitis.

Proctosigmoiditis
Proctosigmoiditis affects the rectum and the sigmoid colon (the lower
segment of colon located right above the rectum). Symptoms include
bloody diarrhea, cramps, and a constant feeling of the need to pass stool.
Moderate pain on the lower left side of the abdomen may occur in active
disease. Signs and symptoms include,

Bloody diarrhea
Abdominal cramps
Abdominal pain
Constant urge to go to the toilet.

What are the treatment options for ulcerative colitis?

If the GP confirms a diagnosis of ulcerative colitis the patient will be

referred to a gastroenterologist (a doctor who specializes in diseases,
conditions, and treatments of the digestive system). The specialist will
assess the severity of the condition and devise a treatment plant.
The following factors will contribute towards deciding how severe the
condition is:

How often the patient is passing stools

Whether the stools are bloody
The patient's body temperature
The patient's bladder control
The patient's general state of health.
Patients with severe symptoms will usually have to be hospitalized, while
those with mild to moderate symptoms are most likely to be treated on an
out-patient-basis.

Managing active ulcerative colitis (oral route)

Treatment will involve the use of three main types of medications:
Amino salicylates
This is the first treatment option for patients with mild to moderate
ulcerative colitis. Amino salicylates are usually effective in reducing
inflammation. They can be swallowed in tablet form, may be rubbed on to
the affected areas as a cream (topical medication), inserted into the rectum
(suppository medication), or added to a fluid and pumped into the colon
via the anus (enema medication). Patients with mild symptoms are usually
given oral tablets or topical amino salicylates. Those with more serious
forms of ulcerative colitis, where the entire colon is affected may require an
enema.
Side effects include:
Nausea
Skin rash
Headaches
Diarrhoea.
Immunosuppressant
Individuals who do not respond to treatment, or those whose steroid
prescription has been discontinued, may be prescribed
immunosuppressants. Immunosuppressants lower the patient's immune
system, which usually reduces inflammation in the colon/rectum.
Immunosuppressants usually taken a few months to become effective.
Immunosuppressants will affect the whole body's immune system, making
the patient more susceptible to infection. It is important to monitor the
patient closely for signs and symptoms of infection.
Immunosuppressants also raising the risk of developing anemia. Patients
will need to have regular blood tests.

Azathioprine is a commonly used immunosuppressant for patients with

ulcerative colitis.

Possible side effects include:

Nausea
Diarrhea
Liver damage
Anemia

Infliximab (Remicade)
This medication may be prescribed for patients with moderate-severe
symptoms who did not respond to other treatments or could not tolerate
them. Infliximab is said to work rapidly at bringing on remission, especially
if corticosteroids did not help. In some cases, it can even prevent the need
for surgery.
Infliximab neutralizes TNF (tumor necrosis factor), a protein produced by
the body's immune system that causes inflammation in the gut.
Managing severe active ulcerative colitis
The patient will need to be hospitalized because there is a risk of
malnutrition, dehydration and some life-threatening complications, such as
colon rupture. The patient will receive intravenous fluids, as well as the
necessary medications.

Maintaining remission
As soon as symptoms are in remission the patient will take regular doses of
amino salicylates to prevent recurrences.
If recurrences regularly occur, despite amino salicylates treatment,
Azathioprine the may be prescribed.
Patients with extensive ulcerative colitis may require long-term
maintenance therapy. This therapy may be altered if they go into remission
for two years without a recurrence.

Surgery
If treatments do not work the patient may have to consider surgery.
Colectomy
The colon or part of it is removed. The small intestine will have to be
rerouted from the colon so that waste products can pass out of the body.

Ileostomy
Requires an incision in the stomach - the small intestine is then pulled out
of the hole and connected to an external pouch. The pouch collects waste
material from the intestine. The ileo-anal pouch is constructed by the
surgeon internally, out of the small intestine and then connected to the
muscles surrounding the anus. The pouch is then emptied in a similar way
to when we go the use of an ileostomy has recently been replaced by an
ileo-anal pouch.

What is an ulcerative colitis diet?

A person with ulcerative colitis may find they need to modify their diet to
help manage their symptoms. There is not a single diet or meal plan that
fits everyone with ulcerative colitis, and diets are individualized for each
patient. Depending on symptoms different types of diets may be
recommended, such as:

A high-calorie diet: Many people with ulcerative colitis lose

weight and can develop signs of malnutrition. A high calorie diet
may prevent these problems.

A lactose-free diet: People with ulcerative colitis may also

have lactose intolerance.

A low-fat diet: Ulcerative colitis may interfere with fat absorption and
eating fatty foods may trigger symptoms.

A low-fiber diet (low-residue diet): This can help reduce the

frequency of bowel movements and abdominal cramps.

A low-salt diet: This diet is used when patients are on corticosteroid

therapy to help reduce water retention.

A gluten-free diet: People with ulcerative colitis may also be sensitive

to gluten.
 Crohn's disease

Crohn's disease is an inflammatory bowel disease (IBD). It causes

inflammation of the lining of your digestive tract, which can lead to
abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.

What Are the Symptoms of Crohn's Disease?

People with Crohn's disease can experience periods of severe symptoms

followed by periods of remission that can last for weeks or years.
The symptoms of Crohn's disease depend on where the disease occurs in
the bowel and its severity. In general, symptoms can include:

Chronic diarrhea, often bloody and containing mucus or pus

Weight loss

Fever

Abdominal pain and tenderness

Feeling of a mass or fullness in the abdomen

Rectal bleeding What Causes Crohn's Disease?

The cause of Crohn's disease is unknown. However, it is likely due to an

abnormal response of the immune system. Food or bacteria in
the intestines, or even the lining of the bowel may cause the uncontrolled
inflammation associated with Crohn's disease.

While Crohn's disease can affect people of all ages, it is primarily an illness
of the young. Most people are diagnosed before age 30, but the disease can
occur in people in their 60's, 70's, or even later in life.
How Is Crohn's Disease Diagnosed?

A specialist called a gastroenterologist may perform

a colonoscopy or sigmoidoscopy to obtain bowel tissue for analysis. An
upper endoscopy may also be done to look at the esophagus, stomach and
first part of the small intestine, the duodenum

Blood tests, including blood counts (often high white blood cell
counts -- a sign of inflammation -- and low red blood cells counts -- a
sign of anemia from blood loss -- are present).

Stool samples to rule out infections as the cause of diarrhea.

Special X-rays (such as a CT scan or MRI) of both the upper and lower
gastrointestinal tract may be ordered as well to confirm the location
of the inflammation.

How Is Crohn's Disease Treated?

Medication

Crohn's disease is treated primarily with medications, including:

Anti-inflammatory drugs, such as salicylates

Corticosteroids, a more powerful type of anti-inflammatory drug.

Immune system modifiers such as azathioprine (Imuran)
or methotrexate (Rheumatrex). It can take up to six months for these
drugs to work..

Antibiotics such as ciprofloxacin (Cipro), metronidazole (Flagyl), and

others. Flagyl can cause a metallic taste in the mouth, nausea, and
tingling or numbness of the hands and feet..
 Antidiarrheal drugs.

Biologic therapies, such as adalimumab (Humira),

Crohn's Disease Diet and Nutrition

Diet does not cause Crohn's disease. But pay attention to what you eat,
because it can help you control your symptoms. Cutting out some foods
may help, especially during a flare. Still, you want to make sure you eat a
variety of healthy foods.

Avoid Problem Foods

Common problem foods for people with Crohn's include:

High-fat, greasy, and fried foods. About one-third of people with Crohn's
find these hard to digest. These include:

Cream sauces

Butter

Margarine

Anything deep-fried

High-fiber foods. For example:

Corn

Popcorn
 Seeds

Nut

Crohn's and Diet Supplements:

B Vitamins. Crohn's can make you low in B12. And some Crohn's
drugs make it hard for your body to absorb folate, a type of B
vitamin.

Vitamin D . You may not get enough vitamin D, which helps you
absorb calcium and keep strong bones. One source is sunlight, so if
you don't get outside often or live in the far north part of the U.S.,
you're more likely to be missing it.

Iron. Inflamed tissue in your body can cause bleeding, which can
deplete iron.

Potassium . Diarrhea and some corticosteroid drugs can lower your

stores of this mineral.

Magnesium : Chronic diarrhea, having Crohn's in your small

intestine, or having much of your intestine removed can make it hard
to get enough magnesium.

Calcium . You may be short on this if you can't eat dairy foods or
your body doesn't absorb them well. Long-term use of
corticosteroids can also cause bone loss.

Steatorrhea
Not a really a condition but a symptom in which fecal matter is frothy, foul-
smelling and floats because of a high fat content. It is common
in malabsorption syndromes.
Symptoms of Steatorrhea
Steatorrhea itself is a symptom of the underlying disease. There are several
disease and conditions that can cause Steatorrhea. Many other symptoms
can accompany Steatorrhea together with the other symptoms of that
particular disease.

Colicky abdominal pain.

Foul smelling stool.

Stool too sticky and difficult to flush from toilet pan.

Presence of diarrhea.

Distension of abdomen.

Flatulence and rumbling noise produced by gases in the intestine.

Pale and bulky stool.

Nausea.

What Are The Causes Of Steatorrhea?

The main reason of Steatorrhea is due to impaired supply of digestive

enzymes from the pancreas and intestine or bile salts as in case of liver
disease, especially biliary tract obstruction.

Infection due to bacteria, virus or parasites in the gastrointestinal

tract.

Celiac disease ( gluten allergy).

Tropical sprue.

Inflammation of the intestine due to giardiasis or tuberculosis.

 Food allergy.

Inadequate mixing of enzyme after gastrectomy or other intestinal

operation.

Liver and biliary tract causes of Steatorrhea: bile is needed for

digestion of fat and absorption.

Absence of bile duct since birth.

Stricture in the Bile duct.

Gallstone that blocks the flow of bile.

Cancer of liver or gallbladder.

Pancreatic causes of Steatorrhea

Deficiency of pancreatic enzyme since birth.

Cystic fibrosis.

Chronic pancreatitis.

Cancer of pancreas.

Pancreatic resection (Removal of pancreas).

Alcohol related pancreatitis.

Diagnosis of Steatorrhea

When diagnosing this condition, it generally takes a maximum of 72 hours

analyzing the stool. Its because the patient will be required to submit his or
her stool of 100g per day for three consecutive days. If bad fat is higher than
14g each day, it will probably suggest that you are suffering from
Steatorrhea because of malabsorption and malabsorption Three days of a
collection will mean that the total mass will surpass 35g that will then
require prompt treatment.

Treatment of Steatorrhea
1. Limiting intake of fat

The first and always the primary treatment of Steatorrhea is to reduce the
number of fats in the diet. Since the stool has excess fat, your doctor will
probably recommend a diet that includes little fats.

2. Reduction of alcohol intake

Where an alcohol condition is the cause of Steatorrhea, a patient should

prepare a plan to drastically reduce alcohol intake. Where possible, they
can also totally stop drinking alcohol.

3. Pancreatic enzymes

Sometimes, reducing the amount of fats in the diet yields a little result in
the body. Taking supplementary pancreatic enzymes together with your
meals will then be applicable. Its vital to note that they should only be
taken with meals and not before or after the meals.

4. Use of antibiotics

When Steatorrhea is as a result of bacterial overgrowth in the intestines, the

only way to counter the problem is by taking antibiotics.

5. Medium-Chain Triglycerides

When supplementary pancreatic enzymes fail to work, medium chain

triglycerides are added into the diet as supplements. Although such cases
are rare, they are excellent alternatives because they do not require any
enzymes to be absorbed into the bloodstream.

6. Supplements of fat-soluble vitamins

When Steatorrhea has been discovered with the patient suffering from
chronic pancreatitis, vitamins A, D, E, and K will be increased in the diet.

7. Folic acid therapy

If patients suffer from Sprue, they respond well to folic acid therapy. They
can eat foods that are rich in folic acid such as kale, asparagus, spinach and
Broccoli.

Prevention of Steatorrhea

It has been proved that excessive intake of alcohol also causes

Steatorrhea. Since alcohol causes liver cirrhosis, the liver will be
hampered from producing the essential enzymes necessary for digestion
of fats in the body. Reduction and even complete cutback of alcohol will
lessen the chances of suffering from this condition

Dietary Treatment for Steatorrhea

Depending on diagnosis it is possible to institute specific dietary

treatment such as elimination of gluten or limiting the intake of fat
in the diet.

If the underlying cause is due to chronic alcohol condition, the

patient suffering from Steatorrhea should drastically reduce intake
of alcohol.

Pancreatic enzyme supplementation may be given in case of

pancreatic disease.
 Patient suffering from Sprue may respond to folic acid therapy.
Foods rich in folic acid are dark leafy vegetables such as spinach,
asparagus, kale, Broccoli, all types of fruits, beans and legumes etc.

Bowel Obstruction
What Is It?

In a bowel obstruction (intestinal obstruction), a blockage prevents the

contents of the intestines from passing normally through the digestive tract.
The problem causing the blockage can be inside or outside the intestine.
Inside the intestine, a tumor or swelling can fill and block the inside
passageway of the intestine bowel obstruction can occur in the small bowel
(small intestine) or large bowel (large intestine or colon).

Signs and symptoms of intestinal obstruction include:

Crampy abdominal pain that comes and goes

Loss of appetite

Constipation

Vomiting

Inability to have a bowel movement or pass gas

Swelling of the abdomen

Common causes of bowel obstruction

The most common causes of intestinal obstruction in adults are:

 Intestinal adhesions bands of fibrous tissue in the abdominal
cavity that can form after abdominal or pelvic surgery

Colon cancer

Hernias portions of intestine that protrude into another part of

your body

Inflammatory bowel diseases, such as Crohn's disease

Diagnosis

To diagnose a bowel obstruction, your doctor will need to feel and listen to
your abdomen and feel inside your rectum. A blockage in the intestine is
confirmed by X-rays of your abdomen, which show gas and liquid bowel
contents above the area of the blockage, but no gas below the blockage.
Blood tests must be done to check for dehydration or loss of electrolytes
(such as sodium and potassium) if your symptoms have included vomiting.

Diverticulitis a condition in which small, bulging pouches

(diverticulitis) in the digestive tract become inflamed or infected

Twisting of the colon (volvulus)

Impacted feces
Risk factors

Diseases and conditions that can increase your risk of intestinal obstruction
include:

Abdominal or pelvic surgery, which often causes adhesions a

common intestinal obstruction

Crohn's disease, which can cause the intestine's walls to thicken,

narrowing the passageway
 Cancer in your abdomen, especially if you've had surgery to remove
an abdominal tumor or radiation therapy

Diet after Small Bowel Obstruction

Clear Liquid

A clear liquid diet, starting with sips and advancing to half-cup to one-cup

portions, is first. With oral intake, you are monitored for any symptoms of

diet intolerance such as vomiting, nausea or abdominal pain. Foods

allowed on the clear liquid diet are broths, gelatin, ice pops, juice and

carbonated beverages that are clear in color. This diet should only be

followed short term as it does not provide sufficient calories and protein.

Full Liquid

The full liquid diet includes yogurt. The full liquid diet includes all of the

foods allowed on the clear liquid diet in addition to milk, smooth yogurt,

pudding, creamed soups without chunks, and hot cereals with refined

grains. You can add milkshakes, tomato soup or strained cream of chicken

soup, smoothies and oatmeal to your diet. Since this diet is also limited in

calories and protein, high protein supplements may be recommended to

support healing.

Low Fiber or Low Residue Diet

White toast and an egg is an acceptable breakfast on a low residue diet.

Healthy Diet

Gradually incorporate foods that contain fiber. Daily fiber goals for

individuals ages 50 and younger are 25 grams for women and 38 grams for

men. With the addition of higher fiber foods, focus on drinking plenty of

fluids, especially water..