Friday, May 9, 2008
Wednesday, April 30, 2008
Hunger
Ok, I decided to outline it anyway. Must be the obsessive/compulsive gene in me. Lol.
Hunger
Hunger in the United States
I Facts
A. Hunger and food insecurity are widespread in the US
B. People living in poverty are especially vulnerable
C. Government and community programs bring some relief
II Defining Hunger in the US
A. Food insufficiency: having too little food
B. Food poverty: hunger resulting from inadequate access to food
C. Food security: access to enough food to support an active and healthy lifestyle
D. Food insecurity: limited or uncertain access to sufficient quantity or quality of food to sustain a healthy and active life.
III Relieving Hunger in the US
A. Federal food assistance programs
1. WIC: (Women, Infants, and Children) is for low income pregnant women, breastfeeding women, and children. (Check vouchers specify healthy foods and exactly what is allowed to be purchased.)
2. School breakfast, lunch programs, and child-care food programs (some provide grants for food in the summer)
3. Meals on wheels and congregate meals (for the elderly, indigent, and handicapped) (Healthy low fat, low sodium foods)
4. Food stamp program (Does not specify healthy food, just food)
B. National Food Recovery Programs
1. Second harvest serves food pantries, emergency shelters, and soup kitchens. (Take blemished foods that aren’t aesthetically pleasing and passes them on.)
2. food banks
C. Community efforts depend on volunteers, concerned citizens, local agencies and churches
World Hunger
I Facts
A. Extreme hunger and poverty are common in developing countries.
B. Natural causes, politics, armed conflicts and government policies have a big impact.
1. During conflicts citizens cannot stay in one place long enough to plant and reap crops.
C. Technology offers some solutions.
D. Overpopulation must also be controlled.
II Food Shortages
A. Political turbulence and government policies during famine affect food problems.
1. Famine is usually man made.
B. Armed conflicts may interfere with humanitarian efforts to get food to people.
C. Natural disaster areas accept food assistance from other countries.
1. In the US we assume assistance is coming immediately, not so in other countries. Compare the slow Katrina response with the super slow tsunami response.
III Malnutrition
A. Affects 850 million people
B. Iron, iodine, and VitA are the nutrients most lacking.
1. Iron is the most common deficiency worldwide.
2. Some places have severe cretinism because of iodine deficiency
C. Protein-kcalorie malnutrition
D. Oral rehydration therapy (ORT) can reverse dehydration.
1. Used worldwide to treat dehydration in children
2. Similar to gatoraid/pedialyte.
3. Salt and water recipe. Sugar is included to help K+ cross cell barrier to hydrate cells.
E. A diminishing food supply is a problem as populations continue to grow.
IV Poverty and Overpopulation
A. Poverty and hunger with more people to feed interrelate to each other.
B. To break this cycle requires:
1. improving the economy
2. providing education
a. education in farming
b. education in food storage
c. education in skills
3. providing health care, and counseling about family planning
C. Population growth leads to hunger and poverty
1. human carrying capacity: the maximum number of people the earth can support
2. increasing rate in developing countries where hunger and poverty already exist
a. In some places children = wealth
b. Hard to change people’s ways of thinking in regard to large families.
D. Hunger and poverty lead to population growth
1. poverty leads to inadequate food and shelter, physical abuse, forced marriages, and prostitution
2. Lack access to reproductive care and family counseling
3. families depend on children to farm the land, carry water, and care for the elderly
4. with high death rates in children, parents may choose to have more children with hopes that some will survive to adulthood
E. Breaking the cycle
1. curbing population growth
2. improvements in living standards
a. health
b. education
3. sharing of resources among groups
a. bartering
4. education becomes a higher priority
a. education for daily survival needs.
b. only 1% of the world population are college educated
V Environmental Degradation and Hunger
A. Environmental limitations in food production
1. soil erosion
2. compaction
3. salinization (adding of salt) caused by:
a. over tillage
b. over irrigation
4. deforestation and desertification (not replacing nutrients in soil)
a. caused by overgrazing
b. desertification is caused by planting the same crops over and over
5. air pollution
a. from the burning of fossil fuels
6. ozone depletion
B. Other limitations in food production
1. irrigation
2. fertilizers (most fertilizer is used on golf courses, not crops)
3. improved genetic strains are reaching their limits
4. harvests are falling short of consumption needs
5. World agriculture produces enough food (grain) to provide each person with 2720 kcal per day.
a. in addition to meat, fruit, and dairy products
6. distribution is a problem
7. population is a problem
VI Solutions
A. Governments, businesses, and all individuals have opportunities to make environmentally conscious choices.
B. Proper choices may help to relieve hunger, improve quality of life, and generate jobs.
C. Sustainable development worldwide:
1. hunger relief
2. population stabilization
3. environmental preservation
4. sustainable resources must be considered
5. Permanently improve the lives of people by helping them to help themselves
VII Progress toward Sustainable Food Production
A. Large agriculture enterprises are among the world’s largest resource users and polluters.
B. Techniques are being studied to employ sustainable agriculture
C. These techniques emphasize careful use of natural processes, computer technology, GPS, and biotechnology
D. Consumers can help by buying locally and eating low in the food chain
1. 1 sack of grain produces1 lb bread
2. 1 ½ sacks of grain produces 1 fish
3. 2 = 1 chicken
4. 3 = 1 hog
5. 7 = 1 cow
VIII Costs of producing food unsustainably
A. resource waste and pollution
1. fishing
a. over fishing and depleted stock
b. fishing is energy intensive
i. using fuel for boats
ii. refrigeration
iii. processing, packing, and transport
c. bioaccumulation of toxins in fish
2. Energy overuse
a. massive fossil fuel usage
b. food industry consumes 20% of all the energy of the nation
IX Sustainable Methods
A. Rotate crops
1. preserve nitrogen in the soil
2. decreases desertification
B. Reduce fertilizer use
1. use animal manure when possible
C. Maintain animal health
1. more resistant to disease
2. less chemicals in manure
D. Plant resistant crops
1. require less pesticides
E. Use irrigation effectively
1. excess irrigation concentrate salts in the soil
F. Use tilling and other precision techniques to control weeds
1. eliminates the use of herbicides
Hunger
Hunger in the United States
I Facts
A. Hunger and food insecurity are widespread in the US
B. People living in poverty are especially vulnerable
C. Government and community programs bring some relief
II Defining Hunger in the US
A. Food insufficiency: having too little food
B. Food poverty: hunger resulting from inadequate access to food
C. Food security: access to enough food to support an active and healthy lifestyle
D. Food insecurity: limited or uncertain access to sufficient quantity or quality of food to sustain a healthy and active life.
III Relieving Hunger in the US
A. Federal food assistance programs
1. WIC: (Women, Infants, and Children) is for low income pregnant women, breastfeeding women, and children. (Check vouchers specify healthy foods and exactly what is allowed to be purchased.)
2. School breakfast, lunch programs, and child-care food programs (some provide grants for food in the summer)
3. Meals on wheels and congregate meals (for the elderly, indigent, and handicapped) (Healthy low fat, low sodium foods)
4. Food stamp program (Does not specify healthy food, just food)
B. National Food Recovery Programs
1. Second harvest serves food pantries, emergency shelters, and soup kitchens. (Take blemished foods that aren’t aesthetically pleasing and passes them on.)
2. food banks
C. Community efforts depend on volunteers, concerned citizens, local agencies and churches
World Hunger
I Facts
A. Extreme hunger and poverty are common in developing countries.
B. Natural causes, politics, armed conflicts and government policies have a big impact.
1. During conflicts citizens cannot stay in one place long enough to plant and reap crops.
C. Technology offers some solutions.
D. Overpopulation must also be controlled.
II Food Shortages
A. Political turbulence and government policies during famine affect food problems.
1. Famine is usually man made.
B. Armed conflicts may interfere with humanitarian efforts to get food to people.
C. Natural disaster areas accept food assistance from other countries.
1. In the US we assume assistance is coming immediately, not so in other countries. Compare the slow Katrina response with the super slow tsunami response.
III Malnutrition
A. Affects 850 million people
B. Iron, iodine, and VitA are the nutrients most lacking.
1. Iron is the most common deficiency worldwide.
2. Some places have severe cretinism because of iodine deficiency
C. Protein-kcalorie malnutrition
D. Oral rehydration therapy (ORT) can reverse dehydration.
1. Used worldwide to treat dehydration in children
2. Similar to gatoraid/pedialyte.
3. Salt and water recipe. Sugar is included to help K+ cross cell barrier to hydrate cells.
E. A diminishing food supply is a problem as populations continue to grow.
IV Poverty and Overpopulation
A. Poverty and hunger with more people to feed interrelate to each other.
B. To break this cycle requires:
1. improving the economy
2. providing education
a. education in farming
b. education in food storage
c. education in skills
3. providing health care, and counseling about family planning
C. Population growth leads to hunger and poverty
1. human carrying capacity: the maximum number of people the earth can support
2. increasing rate in developing countries where hunger and poverty already exist
a. In some places children = wealth
b. Hard to change people’s ways of thinking in regard to large families.
D. Hunger and poverty lead to population growth
1. poverty leads to inadequate food and shelter, physical abuse, forced marriages, and prostitution
2. Lack access to reproductive care and family counseling
3. families depend on children to farm the land, carry water, and care for the elderly
4. with high death rates in children, parents may choose to have more children with hopes that some will survive to adulthood
E. Breaking the cycle
1. curbing population growth
2. improvements in living standards
a. health
b. education
3. sharing of resources among groups
a. bartering
4. education becomes a higher priority
a. education for daily survival needs.
b. only 1% of the world population are college educated
V Environmental Degradation and Hunger
A. Environmental limitations in food production
1. soil erosion
2. compaction
3. salinization (adding of salt) caused by:
a. over tillage
b. over irrigation
4. deforestation and desertification (not replacing nutrients in soil)
a. caused by overgrazing
b. desertification is caused by planting the same crops over and over
5. air pollution
a. from the burning of fossil fuels
6. ozone depletion
B. Other limitations in food production
1. irrigation
2. fertilizers (most fertilizer is used on golf courses, not crops)
3. improved genetic strains are reaching their limits
4. harvests are falling short of consumption needs
5. World agriculture produces enough food (grain) to provide each person with 2720 kcal per day.
a. in addition to meat, fruit, and dairy products
6. distribution is a problem
7. population is a problem
VI Solutions
A. Governments, businesses, and all individuals have opportunities to make environmentally conscious choices.
B. Proper choices may help to relieve hunger, improve quality of life, and generate jobs.
C. Sustainable development worldwide:
1. hunger relief
2. population stabilization
3. environmental preservation
4. sustainable resources must be considered
5. Permanently improve the lives of people by helping them to help themselves
VII Progress toward Sustainable Food Production
A. Large agriculture enterprises are among the world’s largest resource users and polluters.
B. Techniques are being studied to employ sustainable agriculture
C. These techniques emphasize careful use of natural processes, computer technology, GPS, and biotechnology
D. Consumers can help by buying locally and eating low in the food chain
1. 1 sack of grain produces1 lb bread
2. 1 ½ sacks of grain produces 1 fish
3. 2 = 1 chicken
4. 3 = 1 hog
5. 7 = 1 cow
VIII Costs of producing food unsustainably
A. resource waste and pollution
1. fishing
a. over fishing and depleted stock
b. fishing is energy intensive
i. using fuel for boats
ii. refrigeration
iii. processing, packing, and transport
c. bioaccumulation of toxins in fish
2. Energy overuse
a. massive fossil fuel usage
b. food industry consumes 20% of all the energy of the nation
IX Sustainable Methods
A. Rotate crops
1. preserve nitrogen in the soil
2. decreases desertification
B. Reduce fertilizer use
1. use animal manure when possible
C. Maintain animal health
1. more resistant to disease
2. less chemicals in manure
D. Plant resistant crops
1. require less pesticides
E. Use irrigation effectively
1. excess irrigation concentrate salts in the soil
F. Use tilling and other precision techniques to control weeds
1. eliminates the use of herbicides
Friday, April 25, 2008
Last post
The only outline I have not done is the one on hunger. It is a pretty easy read, and I just don't feel the need to post it. Read it over, it is pretty self explanatory. I may take her class on World Hunger, I find it fascinating. Plus I want to travel and nurse in other countries that may need health care, the info could definately help.
Good luck on the last exam everybody!
Good luck on the last exam everybody!
Nutrition and Cancer
Nutrition and Cancer
I The immune system
A. lymphocytes
1. provide resistance to infection (b cells)
2. defends against viruses, bacteria and cancer cells (t cells)
II Nutrition and Cancer
A. Malnutrition compromises immunity.
B. Immunity and infectious disease increase nutrient needs and lower food intake
1. From a nutrition standpoint the pt needs more nutrients. They may die from malnutrition before they die from the disease.
2. Example: during fever a pts burns more calories, but doesn’t feel like eating. Cancer is 1000x worse. Pt needs more calories to fight disease, but doesn’t feel like eating. They can’t keep up with their caloric needs.
C. Opportunistic infections develop when the immune system is suppressed.
1. Long term effects of malnutrition = compromised immunity
D. Physiological stress: organs shutting down b/c of whatever disease or problem it is fighting.
E. Consequences of cancer:
1. cancer cachexia (can happen b/c of therapy itself)
a. loss of appetite
b. weight loss
c. nausea
2. cancer therapy
a. radiation therapy: can cause decrease in food intake
b. chemotherapy: systemic (throughout body)
i. nausea
ii. vomiting
iii. taste blindness (all tastes like carboard)
iv. taste acuity (everything tastes overly sweet)
v. loss of appetite
c. surgery: normal healing process can cause lack of appetite
d. bone marrow transplant: immune comprimization
III HIV and AIDS
A. HIV: human immunodeficiency virus is the infection that attacks the immune system and disables the body defenses
B. AIDS: acquired immune deficiency syndrome is the infectious disease that destroys health and life
C. Contributors to Wasting and Weight Loss
1. poor appetite/insufficient nutrition intake
a. causes:
i. fatigue, lethargy and dementia
ii. depression
iii. swallowing problems
iv. poor dentition
v. oral infections (candida: thrush)
2. GI tract compications
a. nausea and vomiting
b. belching
c. reflux esophagitis
d. gastritis and heartburn
e. diarrhea and consitpation
f. hepatitis
3. psychological stress and pain (from the stigma)
4. respiratory infections
a. pneumonia
b. tuberculosis
5. cancer
a. Kaposi’s sarcoma
6. medical treatments and medication
D. Medical Nutrition Therapy
1. increased kcalories
2. increased protein and fluid
3. food and water safety (any bacteria can kill b/c no immune system to fight it off)
a. cook meats well and avoid raw seafood
b. reheat food until piping hot (>140 F)
c. wash hands for 20 seconds before and after food prep
An interesting note: Healthy looking people that have AIDS may come to the er to be treated for pneumonia. That is where they are usually first diagnosed, and then they die from the pneumonia pretty quickly. Sickly, skinny, wasted AIDS pts usually die from cancer (Kaposi’s sarcoma).
I The immune system
A. lymphocytes
1. provide resistance to infection (b cells)
2. defends against viruses, bacteria and cancer cells (t cells)
II Nutrition and Cancer
A. Malnutrition compromises immunity.
B. Immunity and infectious disease increase nutrient needs and lower food intake
1. From a nutrition standpoint the pt needs more nutrients. They may die from malnutrition before they die from the disease.
2. Example: during fever a pts burns more calories, but doesn’t feel like eating. Cancer is 1000x worse. Pt needs more calories to fight disease, but doesn’t feel like eating. They can’t keep up with their caloric needs.
C. Opportunistic infections develop when the immune system is suppressed.
1. Long term effects of malnutrition = compromised immunity
D. Physiological stress: organs shutting down b/c of whatever disease or problem it is fighting.
E. Consequences of cancer:
1. cancer cachexia (can happen b/c of therapy itself)
a. loss of appetite
b. weight loss
c. nausea
2. cancer therapy
a. radiation therapy: can cause decrease in food intake
b. chemotherapy: systemic (throughout body)
i. nausea
ii. vomiting
iii. taste blindness (all tastes like carboard)
iv. taste acuity (everything tastes overly sweet)
v. loss of appetite
c. surgery: normal healing process can cause lack of appetite
d. bone marrow transplant: immune comprimization
III HIV and AIDS
A. HIV: human immunodeficiency virus is the infection that attacks the immune system and disables the body defenses
B. AIDS: acquired immune deficiency syndrome is the infectious disease that destroys health and life
C. Contributors to Wasting and Weight Loss
1. poor appetite/insufficient nutrition intake
a. causes:
i. fatigue, lethargy and dementia
ii. depression
iii. swallowing problems
iv. poor dentition
v. oral infections (candida: thrush)
2. GI tract compications
a. nausea and vomiting
b. belching
c. reflux esophagitis
d. gastritis and heartburn
e. diarrhea and consitpation
f. hepatitis
3. psychological stress and pain (from the stigma)
4. respiratory infections
a. pneumonia
b. tuberculosis
5. cancer
a. Kaposi’s sarcoma
6. medical treatments and medication
D. Medical Nutrition Therapy
1. increased kcalories
2. increased protein and fluid
3. food and water safety (any bacteria can kill b/c no immune system to fight it off)
a. cook meats well and avoid raw seafood
b. reheat food until piping hot (>140 F)
c. wash hands for 20 seconds before and after food prep
An interesting note: Healthy looking people that have AIDS may come to the er to be treated for pneumonia. That is where they are usually first diagnosed, and then they die from the pneumonia pretty quickly. Sickly, skinny, wasted AIDS pts usually die from cancer (Kaposi’s sarcoma).
Kidneys, renal diseases
Accessory Organs
Renal Diseases (kidney)
I Nephrotic Syndrome
A. cluster of symptoms which result in protein in the urine (albuminuria)
B. Consequences:
1. protein calorie malnutrition
2. anemia
3. infection
4. atherosclerosis: for unknown reasons blood lipid levels rise (CHO) and atherosclerosis develops as a result.
C. Medical Nutrition Therapy
1. adequate non-protein calories: leaves protein to do its own work, and not provide energy. Let carbs and fats provide energy.
a. normal protein intake (0.8 – 1.0 gm/kg)
2. low saturated fat/low CHO b/c of atherosclerosis
3. sodium restriction (~2 grams)
II Renal Failure
A. loss of the kidney’s ability to function
1. may be acute or chronic
B. Consequences
1. uremia (azotmeia): accumulation of waste products in the blood
2. electrolyte imbalance (hyperkalemia) (K+ is potassium)
3. changes in fluid balance
C. Medical Nutrition Therapy
1. Consider:
a. energy needs (non-protein kcals, don’t want to lose muscle weight)
b. protein restriction: depending on kidney function
c. electrolyte restriction: sodium, potassium, phosphorus (phosphorus should just be monitored, not restricted, b/c we have meds to lower)
d. fluid restriction: monitor intake and output
e. supplements: Ca, folate, B6, D
III Renal Calculi: kidney stones
A. calcium stones (75%)
1. causes:
a. hypercalciuria (idiopathic, unknown reasons...some people just excrete alot of Ca+ in their urine)
b. immobilization: hard/full body casts. When bones aren’t moving Ca+ leaves bones and is excreted through urine.
c. hyperoxaluria: oxalate binds to Ca+ and makes it unavailable. Diets high in oxalates bind with Ca+ and form a stone. (Ca+ is a cation and must have something to bind with, it choose oxalate)
2. medical nutrition therapy
a. Ca+ management
b. increased fluids to dilute urine
c. limit oxalate intake
B. Uric acid (10%)
1. common in gout where uric acid is distributed to distal joints
2. medical nutrition therapy
a. low purine diet: certain types of proteins break down into purines. Purines = uric acid. Rich proteins are caviar, sardines, red meat, liver, anchovies
b. increase fluids
C. Cystine (2-3%)
1. genetically linked
2. medical nutrition therapy
a. low methioninie diet (essential amino acid used to produce non-essential cystine)
b. increased fluids
Renal Diseases (kidney)
I Nephrotic Syndrome
A. cluster of symptoms which result in protein in the urine (albuminuria)
B. Consequences:
1. protein calorie malnutrition
2. anemia
3. infection
4. atherosclerosis: for unknown reasons blood lipid levels rise (CHO) and atherosclerosis develops as a result.
C. Medical Nutrition Therapy
1. adequate non-protein calories: leaves protein to do its own work, and not provide energy. Let carbs and fats provide energy.
a. normal protein intake (0.8 – 1.0 gm/kg)
2. low saturated fat/low CHO b/c of atherosclerosis
3. sodium restriction (~2 grams)
II Renal Failure
A. loss of the kidney’s ability to function
1. may be acute or chronic
B. Consequences
1. uremia (azotmeia): accumulation of waste products in the blood
2. electrolyte imbalance (hyperkalemia) (K+ is potassium)
3. changes in fluid balance
C. Medical Nutrition Therapy
1. Consider:
a. energy needs (non-protein kcals, don’t want to lose muscle weight)
b. protein restriction: depending on kidney function
c. electrolyte restriction: sodium, potassium, phosphorus (phosphorus should just be monitored, not restricted, b/c we have meds to lower)
d. fluid restriction: monitor intake and output
e. supplements: Ca, folate, B6, D
III Renal Calculi: kidney stones
A. calcium stones (75%)
1. causes:
a. hypercalciuria (idiopathic, unknown reasons...some people just excrete alot of Ca+ in their urine)
b. immobilization: hard/full body casts. When bones aren’t moving Ca+ leaves bones and is excreted through urine.
c. hyperoxaluria: oxalate binds to Ca+ and makes it unavailable. Diets high in oxalates bind with Ca+ and form a stone. (Ca+ is a cation and must have something to bind with, it choose oxalate)
2. medical nutrition therapy
a. Ca+ management
b. increased fluids to dilute urine
c. limit oxalate intake
B. Uric acid (10%)
1. common in gout where uric acid is distributed to distal joints
2. medical nutrition therapy
a. low purine diet: certain types of proteins break down into purines. Purines = uric acid. Rich proteins are caviar, sardines, red meat, liver, anchovies
b. increase fluids
C. Cystine (2-3%)
1. genetically linked
2. medical nutrition therapy
a. low methioninie diet (essential amino acid used to produce non-essential cystine)
b. increased fluids
Pancreas
Accessory Organs
Pancreas
I Pancreatitis: Inflammation of the pancreas
A. acute: due to organ auto digestion (pancreas digesting itself)
1. usually as a result of duct obstruction
a. enzymes become activated in duct instead of duodenum
b. The gall bladder and the pancreas share the common duct. If a patient eats a mixed meal of fat, carbs, and protein and the duct is blocked by a gall stone; bile and pancreatic enzyme will remain in the duct at the same time. Usually it is one or the other. The enzyme (to break down protein) is activated when it recognizes the pancreas as a protein. It then starts to digest itself. (auto digestion) Very painful.
2. alcohol abuse
3. gallstones (~45% of all cases)
4. Symptoms of acute pancreatitis
a. sudden, severe abdominal pain
b. nausea, vomiting
c. diarrhea
d. approximately 25% develop chronic pancreatitis
e. sometimes jaundice
f. acute can turn chronic, especially if alcohol involved.
5. Medical nutrition therapy
a. NPO with IV feedings ~ 48 hours (complete bowel rest)
b. jejunostomy feedings if longer (to bypass digestion)
c. clear liquid progress to low fat diet
d. provide pancreatic enzyme replacement
e. small frequent meals
f. no alcohol, caffeine
B. chronic pancreatitis
1. fibrotic, necrotic disease where cells suffer permanent damage.
2. decreased enzyme production
3. nausea, vomiting, abdominal pain
a. symptoms not as severe as acute
4. most common cause is alcohol abuse (~70%)
5. Other causes: pancreatic cancer, cystic fibrosis (lung disease, but starts in the pancreas)
6. Medical Nutrition Therapy
a. If unable to eat, high calorie, semi-elemental (hydrolyzed/pre-digested) tube feeding.
b. If able to eat:
i. low fat, high calorie, moderate protein
ii. low fiber
iii. six small meals per day
iv. no alcohol, caffeine, or gastric stimulants
v. vitamin and mineral supplementation
c. co morbidity in case of alcoholics. Make sure to look at the whole person, not just the disease (pancreatitis).
II Cystic Fibrosis
A. Starts in the pancreas
B. Consequences
1. pancreatic insufficiency (80-90%)
a. may require:
i. enzyme replacement (for protein digestion)
ii. insulin (for carb metabolism)(have a diabetic life state)
2. chronic lung disease
a. lung infections – major cause of death
b. thick secretions may cause bacterial growth
3. growth retardation (85%)
4. decreased bone density
5. abnormally high electrolytes in sweat
6. may live to 30’s or 40’s, but used to be 20’s
C. Medical Nutrition Therapy
1. High kcal, high protein (they lose a lot in digestion)
a. 20-50% above normal needs
2. Pancreatic enzymes
a. to control steatorrhea
3. multivitamin supplementation (water based so not passed in fatty stool)
4. liberal salt use (b/c a lot lost in perspiration)
5. encourage fluids
6. When body weight falls below 85% of standard, alternate feedings are indicated. (usually tube feedings) (Nocturnal feedings all night, then eat normally during the day)
7. Infant feeding
a. enzyme replacement during breast feeding
b. up to ¼ tsp salt daily given to replace losses
Pancreas
I Pancreatitis: Inflammation of the pancreas
A. acute: due to organ auto digestion (pancreas digesting itself)
1. usually as a result of duct obstruction
a. enzymes become activated in duct instead of duodenum
b. The gall bladder and the pancreas share the common duct. If a patient eats a mixed meal of fat, carbs, and protein and the duct is blocked by a gall stone; bile and pancreatic enzyme will remain in the duct at the same time. Usually it is one or the other. The enzyme (to break down protein) is activated when it recognizes the pancreas as a protein. It then starts to digest itself. (auto digestion) Very painful.
2. alcohol abuse
3. gallstones (~45% of all cases)
4. Symptoms of acute pancreatitis
a. sudden, severe abdominal pain
b. nausea, vomiting
c. diarrhea
d. approximately 25% develop chronic pancreatitis
e. sometimes jaundice
f. acute can turn chronic, especially if alcohol involved.
5. Medical nutrition therapy
a. NPO with IV feedings ~ 48 hours (complete bowel rest)
b. jejunostomy feedings if longer (to bypass digestion)
c. clear liquid progress to low fat diet
d. provide pancreatic enzyme replacement
e. small frequent meals
f. no alcohol, caffeine
B. chronic pancreatitis
1. fibrotic, necrotic disease where cells suffer permanent damage.
2. decreased enzyme production
3. nausea, vomiting, abdominal pain
a. symptoms not as severe as acute
4. most common cause is alcohol abuse (~70%)
5. Other causes: pancreatic cancer, cystic fibrosis (lung disease, but starts in the pancreas)
6. Medical Nutrition Therapy
a. If unable to eat, high calorie, semi-elemental (hydrolyzed/pre-digested) tube feeding.
b. If able to eat:
i. low fat, high calorie, moderate protein
ii. low fiber
iii. six small meals per day
iv. no alcohol, caffeine, or gastric stimulants
v. vitamin and mineral supplementation
c. co morbidity in case of alcoholics. Make sure to look at the whole person, not just the disease (pancreatitis).
II Cystic Fibrosis
A. Starts in the pancreas
B. Consequences
1. pancreatic insufficiency (80-90%)
a. may require:
i. enzyme replacement (for protein digestion)
ii. insulin (for carb metabolism)(have a diabetic life state)
2. chronic lung disease
a. lung infections – major cause of death
b. thick secretions may cause bacterial growth
3. growth retardation (85%)
4. decreased bone density
5. abnormally high electrolytes in sweat
6. may live to 30’s or 40’s, but used to be 20’s
C. Medical Nutrition Therapy
1. High kcal, high protein (they lose a lot in digestion)
a. 20-50% above normal needs
2. Pancreatic enzymes
a. to control steatorrhea
3. multivitamin supplementation (water based so not passed in fatty stool)
4. liberal salt use (b/c a lot lost in perspiration)
5. encourage fluids
6. When body weight falls below 85% of standard, alternate feedings are indicated. (usually tube feedings) (Nocturnal feedings all night, then eat normally during the day)
7. Infant feeding
a. enzyme replacement during breast feeding
b. up to ¼ tsp salt daily given to replace losses
Liver
Accessory Organs
Liver
I Hepatitis
A. Inflammation of the liver
B. 5 types, A being least severe
1. A is associated with food/water contamination and is highly contagious
C. Symptoms
1. jaundice: yellowness in palms, eyes, beds of nails
2. dark urine
3. elevated liver enzymes
4. tender, enlarged liver
D. Hepatitis is mainly acute, but sometimes chronic
1. Chronic may lead to cancer, liver failure, hepatic coma, and death
E. Medical Nutrition Therapy
1. regular diet
2. high protein, high kcal (if malnourished)
3. small frequent feedings
a. anorexia and nausea is common
b. anytime nausea is a symptom, we give small frequent meals
4. nutritional supplements
a. ensure
b. boost
II Cirrhosis
A. Chronic liver failure where scar tissues replace liver cells and there is a permanent loss of function. (cirrhosis = orange. Liver can regenerate itself, but not with cirrhosis)
B. Causes
1. alcohol abuse
2. billiary tract obstruction (billiary duct carries bile from the gall bladder to the liver)
3. infection
C. Consequences
1. portal hypertension (portal vein in liver)
2. esophageal varices (blisters inside esophagus)
3. ascites (excess fluid in abdomen)
4. elevated blood ammonia levels
5. hepatic coma
a. very little liver function taking place
6. changes in judgement, mood, personality, regression
7. sweet, musky or pungent fecal odor
8. flapping tremor of outstretched hand
D. Medical nutrition therapy
1. Energy: adequate carb and fat to spare protein (35-45 kcal/kg BW)
a. The function of protein is to build and repair tissue, and to provide energy.
b. Sparing protein: If the pt doesn’t have enough liver function to metabolize protein, a small amount is given to keep the liver from having to work too hard. If the pt does not receive enough protein he will burn it from the muscles, which is not good either. It is just as bad to have too much protein as not enough protein. Protein metabolism needs liver function. Provide just enough protein to do protein’s work, but not as a form of energy. Have an adequate amount of fat and carbs for energy. (non-protein calories)
2. protein (1.0 – 1.5 gm/kg BW)
a. enough to regenerate the cells, but not increase ammonia
b. impending coma (40 – 60 gm/day) ONLY
c. coma
i. vegetable protein
ii. branch chain amino acids (b/c metabolized in muscle)
iii. no animal protein at all
3. Hepatic formula diet
4. sodium (2 grams)
a. to control ascites
5. fluids (1.0 – 1.5 liters/day)
a. restricted to control ascites
6. vitamins and mineral supplementation
E. Drug therapy
1. antibiotics: to limit growth of intestinal bacteria (bacteria produces ammonia that will be absorbed)
2. laxatives: to decrease transit time
3. diuretics: to reduce fluid retention
Liver
I Hepatitis
A. Inflammation of the liver
B. 5 types, A being least severe
1. A is associated with food/water contamination and is highly contagious
C. Symptoms
1. jaundice: yellowness in palms, eyes, beds of nails
2. dark urine
3. elevated liver enzymes
4. tender, enlarged liver
D. Hepatitis is mainly acute, but sometimes chronic
1. Chronic may lead to cancer, liver failure, hepatic coma, and death
E. Medical Nutrition Therapy
1. regular diet
2. high protein, high kcal (if malnourished)
3. small frequent feedings
a. anorexia and nausea is common
b. anytime nausea is a symptom, we give small frequent meals
4. nutritional supplements
a. ensure
b. boost
II Cirrhosis
A. Chronic liver failure where scar tissues replace liver cells and there is a permanent loss of function. (cirrhosis = orange. Liver can regenerate itself, but not with cirrhosis)
B. Causes
1. alcohol abuse
2. billiary tract obstruction (billiary duct carries bile from the gall bladder to the liver)
3. infection
C. Consequences
1. portal hypertension (portal vein in liver)
2. esophageal varices (blisters inside esophagus)
3. ascites (excess fluid in abdomen)
4. elevated blood ammonia levels
5. hepatic coma
a. very little liver function taking place
6. changes in judgement, mood, personality, regression
7. sweet, musky or pungent fecal odor
8. flapping tremor of outstretched hand
D. Medical nutrition therapy
1. Energy: adequate carb and fat to spare protein (35-45 kcal/kg BW)
a. The function of protein is to build and repair tissue, and to provide energy.
b. Sparing protein: If the pt doesn’t have enough liver function to metabolize protein, a small amount is given to keep the liver from having to work too hard. If the pt does not receive enough protein he will burn it from the muscles, which is not good either. It is just as bad to have too much protein as not enough protein. Protein metabolism needs liver function. Provide just enough protein to do protein’s work, but not as a form of energy. Have an adequate amount of fat and carbs for energy. (non-protein calories)
2. protein (1.0 – 1.5 gm/kg BW)
a. enough to regenerate the cells, but not increase ammonia
b. impending coma (40 – 60 gm/day) ONLY
c. coma
i. vegetable protein
ii. branch chain amino acids (b/c metabolized in muscle)
iii. no animal protein at all
3. Hepatic formula diet
4. sodium (2 grams)
a. to control ascites
5. fluids (1.0 – 1.5 liters/day)
a. restricted to control ascites
6. vitamins and mineral supplementation
E. Drug therapy
1. antibiotics: to limit growth of intestinal bacteria (bacteria produces ammonia that will be absorbed)
2. laxatives: to decrease transit time
3. diuretics: to reduce fluid retention
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