MALABSORPTION DISORDERS: DIARRHEA AND ULCERATIVE COLITIS
Malabsorption is a general term that describes incomplete absorption of one or more nutrients. Among the causes are increased motility of the gastrointestinal tract; inadequate supply or absence of pancreatic or intestinal enzymes or bile; defect in the structure of the villi so that the area of absorbing surface is reduced; and allergy. Symptoms that are usually present include anorexia, abdominal distention, diarrhea, muscle wasting and weight loss because of inability to absorb nutrients, and vitamin and mineral deficiencies.
Diarrhea
Diarrhea is the frequent passage of liquid or semisolid stools. In acute diarrhea fluids and electrolytes may be given intravenously to allow the gastrointestinal tract to rest. After the first 24 hours progression is made according to the patient’s tolerance to a very low-residue diet, soft diet, and regular diet.
Prolonged diarrhea leads to serious losses of fluids, electrolytes, proteins, fats, carbohydrates, and vitamins. These losses must be corrected by adequate fluid intake, mineral and vitamin supplements, and a high-calorie high-protein diet. In addition gluten restriction is required for gluten-induced enteropathy and lactose restriction or omission for lactase deficiency.
Ulcerative colitis
This is an inflammation of the colon, occurring more frequently in young adults. The causes are unknown. Many of the patients are nervous, worried, and emotionally unstable. Any upsets aggravate the condition. In severe colitis there is much loss of water, electrolytes, and protein in the numerous stools. Abdominal discomfort, weight loss, dehydration, anemia, and general weakness are outstanding.
Dietary management. Because tissue-wasting is great a diet that supplies 2500-3500 kcal and 100-150 gm protein is required. Supplements of iron and vitamins are usually indicated. Many of these patients have moderate to severe lactose intolerance and require calcium supplements as well. Initially a very low-residue diet is prescribed with progression to a soft fiber-restricted diet.
The nurse and the dietitian must convince the patient of their interest in his welfare by frequent visits, especially at mealtime. They must be prepared to listen to many complaints, to reassure the patient of the importance of diet in his recovery, and to assist in the selection of the diet from a list of appropriate foods.
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GENERAL HEALTH
