GI Disorders
Upper GI
I Problems of the Mouth
A. Difficulty chewing:
1. AIDS
a. oral thrush
b. very painful
2. Parkinson’s Disease
a. Can affect mouth and throat muscles
b. Can take an hour to eat a normal meal which normally takes 10-15 minutes
3. Radiation Therapy
a. difficulty chewing
4. Missing (no) teeth
5. Ill fitting dentures
a. they may be loose after weight loss
6. Stroke
B. Dysphagia: difficulty swallowing
1. As a result of:
a. aging process
i. reflexes not as sharp
b. stroke
c. developmental disease
i. cerebral palsy
ii. severe Down’s syndrome (no swallowing reflex)
d. diseases of the nervous system (because reflexes are controlled by the nervous system)
2. Could lead to aspiration pneumonia
a. if too much food/liquid leaks down the throat the pt may not be able to cough it up
3. Signs of dysphagia:
a. repeated bouts of pneumonia (in elderly and disabled)
b. food “sticking” in the throat
c. pocketing food (keeping food in cheek, liquid will leak down into lungs)
d. wet, gurgled or hoarse sounding voice
e. coughing/choking during eating
4. Medical Nutrition Therapy (a speech and language pathologist/therapist will determine the degree of dysphagia. A nutritionist will suggest the diet therapy)
a. Adjust texture of food
i. mechanical soft (chopped or ground so they don’t need to chew as much)
ii. pureed
b. Adjust consistency of liquids
i. thin (normal)
ii. nectar consistency
iii. honey consistency
iv. spoon thick (yogurt) consistency
c. Food thickeners
i. made of starch
ii. do not provide taste/flavor
iii. potato flakes are a good thickener, but have taste
d. Patients are taught how to thicken foods and how to swallow.
C. Mouth Ulcers
1. Causes
a. poor dentition
b. radiation therapy
2. Medical Nutrition Therapy (the purpose is to get nutrition w/o aggravating the ulcers)
a. moist, soft textured foods (overcooked)
b. practice good oral hygeine
c. avoid salty foods and snacks
d. avoid “dry” foods
II Gastro-esophageal Reflux Disease (GERD or reflux esophagitis)
A. Occurs in the lower esophagus
B. The effect of acidic gastric reflux on the mucosa
1. stomach acid: 2.2 pH (very acidic)
C. Results from:
1. hiatal hernia:
a. outpouching occuring at junction of stomach and esophagus
b. stomach “burps” into hiatal hernia and acid burns the area
c. causes
i. overeating
ii. stress (psychological)
iii. pregnancy: as baby grows everything gets pushed up
2. increased abdominal pressure due to obesity or pregnancy
3. viral infection (not quite common)
4. Ingestion of an irritant, or recurrent vomiting
D. Medical Nutrition Therapy
1. small, frequent, low fat meals
2. do not lie down for 2 hours after eating
3. do not eat within 2-3 hours before bedtime
4. avoid stimulants
a. caffeine
b. alcohol
c. citrus
d. peppermint (people usually take this to calm an upset stomach, but it is a stimulant)
5. weight loss diet (if indicated)
6. wear loose, comfortable clothing
7. no smoking (stimulant)
III Gastritis
A. Inflammation of the gastric mucosa (stomach)
B. May be acute or chronic
1. acute (sudden and short term) caused by:
a. alcohol abuse
b. aspirin or other medication
c. food poisoning
d. radiation therapy
e. bacterial infection
2. chronic caused by:
a. gastric surgery
b. chronic stomach diseases
c. no known cause
C. Medical Nutrition Therapy
1. Acute
a. treat the cause
i. antibiotics for Helicobacter pylori
b. NPO for nausea/vomiting then progress diet
c. Avoid stimulants (see above)
2. Chronic (individual for each pt)
a. avoid foods that irritate gastric mucosa
b. vitamin B12 for pernicious anemia (b/c of extrinsic factor)
c. antacids, anti-ulcer medication and antibiotics as needed
IV Ulcers
A. Peptic Ulcers
1. In stomach or the duodenum, usually in the bend after stomach. Very rarely located by esophagus.
a. the duodenum is after the stomach, first part of small intestine.
2. Erosion of the top layer of cells from the lining of the esophagus (<1%), stomach (15%) or small intestine (85%)
3. Underlying layers of cells are exposed to gastric juices.
a. Gastric juices reach the nerves causing pain.
b. Very painful when the acid hits nerves. If the capillaries are exposed, bleeding occurs.
4. Causes
a. bacterial infection (H pylori: makes stomach acid less acidic)
b. anti-inflammatory drugs
i. ibuprofen
ii. naproxen
c. disorders that cause excessive gastric acid secretion
5. Medical Nutrition Therapy
a. antibiotic therapy and antacids
b. avoid foods that may cause gastric irritation
c. correct anemia (B12) if present
d. avoid aspirin (can erode lining)
e. no smoking (stimulant)
f. An ulcer will heal no matter what you eat as long as you avoid the stimulants. (after treating bacteria)
V Foods that May Cause Gastric Irritation
A. Alcohol
B. Caffeine
C. Peppermint
D. Cola beverages including: Mt Dew, Mellow Yellow
E. High energy drinks
F. Coffee, tea, decaf
G. Pepper and spicy foods
H. Any foods not tolerated
VI Gastric Surgery
A. Gastrectomy
1. removal of a portion or all of the stomach
a. because of disease
2. Side effects
a. Dumping syndrome
i. dizziness and weakness (due to rapid fall in circulating blood volume)
ii. rapid heart rate and sweating (due to hypoglycemia)
iii. diarrhea (hyper peristalsis due to large volume of hypertonic fluids)
iv. The stomach is a pouch that is made to hold food for a few hours while it mixes with acid. When food is dumped all at once, insulin is secreted in high amounts. Normally food would enter the small intestines as small bolus’. In gastrectomy food enters si all at once. Diarrhea b/c food is not digested or absorbed. Dumping occurs EVERYTIME the pt eats. The syndrome is so unpleasant that the pt may stop eating. If the pt has gastrectomy b/c of cancer the pt will have to deal with cancer and dumping syndrome.
3. Medical Nutrition Therapy
a. Goal
i. to provide energy (avoid weight loss)
ii. slow the passage of foods through the stomach
iii. minimize diarrhea
iv. avoid anemia: iron deficiency b/c not converted to a usable form. Malabsorption leads to folate and B12 anemia.
v. prevent bone disease: VitD and Calcium malabsorption lead to Osteomalacia.
b. Higher protein
c. Complex carbs (50-60%) Avoid mono and di-saccharides. They increase the amount of insulin being excreted b/c absorbed quickly.
i. simple sugars (0-15%)
d. moderate fat (30% of kcalories)
i. use medium chain triglycerides (MCT) Long chains take longer to digest. Use MCT so fat can be absorbed before diarrhea occurs. Fat soluble vitamins also have a chance to be absorbed.
e. Low (no) lactose: b/c you need the lactase in the stomach to break down lactose. If no/reduced stomach, can’t break it down. No supplements contain lactose because of this, just to avoid complications.
f. moderate sodium intake
g. vitamin and mineral supplementation
h. frequent small meals, fluids between meals (Dividing diet into small meals mimics the small bolus)
i. No more than 4oz of fluids with meals, remaining taken between
4. Client education
a. stress the importance of self-care
i. stress
ii. eating away from home
b. discuss
i. artificial sweeteners
ii. eating slowly in an upright position
iii. social significance of food and alcohol
iv. dumping syndrome and how to overcome reluctance and fear of pain with eating
VII Bariatric Surgery
A. Goal is weight loss
1. banded
2. stapled (gastric sleeve)
3. holds about 4oz after surgery
4. after years of overeating, can stretch back
B. Complications
1. ruptured staples
2. bowel obstruction from eating low residue diet
3. infections, nausea (from overeating), vomiting, dehydration
4. dumping syndrome
5. esophageal reflux
6. depression
C. Medical Nutrition Therapy
1. clear liquids: 4oz per hour
a. to clear residue
b. can’t have sugar because of dumping
i. diet jello
ii. crystal light
iii. water
iv. broth
2. progress to full liquids (after a week): low lactose
3. pureed, high protein
4. no sugar, very low carbs
5. common deficiencies
a. vitamins B12, D
i. if Vit D deficient, Ca+ deficiency is not far behind
b. iron
No comments:
Post a Comment