G.I. DisordersG.I. Disorders

Upper G.I.Upper G.I.

Problems of the MouthProblems of the Mouth

Difficulty chewing:Difficulty chewing:– AIDSAIDS– Parkinson’s DiseaseParkinson’s Disease– Radiation TherapyRadiation Therapy– Missing (no) teeth – Missing (no) teeth –

ill fitting denturesill fitting dentures– StrokeStroke

Problems of the Problems of the MouthMouth

Dysphagia - Dysphagia - difficulty Swallowingdifficulty Swallowing

As a result of:As a result of:– Aging processAging process– StrokeStroke– Developmental Developmental

diseasedisease– Diseases of the Diseases of the

nervous systemnervous system Could lead to Could lead to

Aspiration Aspiration PneumoniaPneumonia

©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.

Signs of DysphagiaSigns of Dysphagia

Repeated bouts of pneumoniaRepeated bouts of pneumonia Food “sticking” in the throatFood “sticking” in the throat Pocketing foodPocketing food Wet, gurgled or hoarse sounding Wet, gurgled or hoarse sounding

voicevoice Coughing/ choking during eatingCoughing/ choking during eating

Problems of the MouthProblems of the Mouth

Medical Nutrition TherapyMedical Nutrition Therapy– Adjust texture of foodAdjust texture of food

Mechanical softMechanical soft pureedpureed

– Adjust consistency of liquidsAdjust consistency of liquids Thin (normal)Thin (normal) Nectar consistencyNectar consistency Honey consistencyHoney consistency Spoon Thick (yogurt) consistencySpoon Thick (yogurt) consistency

Problems of the MouthProblems of the Mouth Mouth UlcersMouth Ulcers Medical Nutrition Medical Nutrition

TherapyTherapy– Moist, soft textured Moist, soft textured

foodsfoods– Practice good oral Practice good oral

hygienehygiene– Avoid salty foods and Avoid salty foods and

snackssnacks– Avoid “dry” foodsAvoid “dry” foods

Gastro-esophageal Reflux Gastro-esophageal Reflux DiseaseDisease

GERDGERD Reflux EsophagitisReflux Esophagitis

– Occurs in the lower esophagusOccurs in the lower esophagus– The effect of acidic gastric reflux on the The effect of acidic gastric reflux on the

esophageal mucosaesophageal mucosa– Results from:Results from:

Hiatal herniaHiatal hernia Increased abdominal pressure due to Increased abdominal pressure due to

obesity or pregnancyobesity or pregnancy Viral infectionViral infection Ingestion of an irritant, or recurrent vomitingIngestion of an irritant, or recurrent vomiting

Medical Nutrition Medical Nutrition TherapyTherapy

Small, frequent, low fat mealsSmall, frequent, low fat meals Do not lie down for 2 hours after Do not lie down for 2 hours after

eatingeating Do not eat within 2 – 3 hours before Do not eat within 2 – 3 hours before

bedtimebedtime Avoid stimulants (caffeine, alcohol, Avoid stimulants (caffeine, alcohol,

citrus, peppermint)citrus, peppermint) Weight loss diet (if indicated)Weight loss diet (if indicated) Wear loose, comfortable clothingWear loose, comfortable clothing No smokingNo smoking

GastritisGastritis Inflammation of the gastric mucosa Inflammation of the gastric mucosa

(stomach)(stomach) May be acute or chronicMay be acute or chronic

GastritisGastritis

AcuteAcute– Alcohol abuseAlcohol abuse– Aspirin or other Aspirin or other

medicationmedication– Food poisoningFood poisoning– Radiation Radiation

therapytherapy– Bacterial Bacterial

infectioninfection

ChronicChronic– Gastric surgeryGastric surgery– Chronic stomach Chronic stomach

diseasesdiseases– No known causeNo known cause

Medical Nutrition Medical Nutrition TherapyTherapy

AcuteAcute– Treat the causeTreat the cause

Antibiotics for Antibiotics for Helicobacter Helicobacter pyloripylori

– NPO for nausea/ NPO for nausea/ vomiting then vomiting then progress dietprogress diet

– Avoid stimulantsAvoid stimulants

ChronicChronic– Avoid foods that Avoid foods that

irritate gastric irritate gastric mucosamucosa

– Vitamin BVitamin B1212 for for pernicious anemiapernicious anemia

– Antacids, anti-Antacids, anti-ulcers and ulcers and antibiotics as antibiotics as neededneeded

ULCERSULCERS Peptic UlcersPeptic Ulcers

– Erosion of the top layer of cells Erosion of the top layer of cells from the lining of the esophagus from the lining of the esophagus (<1%), stomach (15%) or small (<1%), stomach (15%) or small intestine(85%)intestine(85%)

– Underlying layers of cells are Underlying layers of cells are exposed to gastric juicesexposed to gastric juices

– Gastric juices reach the nerves,Gastric juices reach the nerves,

causing paincausing pain

Peptic UlcersPeptic Ulcers CausesCauses

– Bacterial infection (H Bacterial infection (H Pylori)Pylori)

– Anti-inflammatory Anti-inflammatory drugs (ibuprofen, drugs (ibuprofen, naproxen)naproxen)

– Disorders that cause Disorders that cause excessive gastric excessive gastric acid secretionacid secretion

Medical Nutrition Medical Nutrition TherapyTherapy

Antibiotic therapy and antacidsAntibiotic therapy and antacids Avoid foods that may cause gastric Avoid foods that may cause gastric

irritationirritation Correct anemia (BCorrect anemia (B1212) if present) if present Avoid aspirinAvoid aspirin No smokingNo smoking

Foods that may cause Foods that may cause Gastric IrritationGastric Irritation

AlcoholAlcohol CaffeineCaffeine Peppermint Peppermint Cola beverages Cola beverages High energy drinksHigh energy drinks Coffee, tea, decafCoffee, tea, decaf Pepper and spicy Pepper and spicy

foodsfoods Any foods not Any foods not

tolerated.tolerated.

Gastric Gastric SurgerySurgery GastrectomyGastrectomy

– Removal of a portion or all Removal of a portion or all of the stomachof the stomach

Side effectsSide effects– Dumping SyndromeDumping Syndrome

Dizziness and weakness (due Dizziness and weakness (due to rapid fall in circulating to rapid fall in circulating blood volume)blood volume)

Rapid heart rate and Rapid heart rate and sweating (due to sweating (due to hypoglycemia)hypoglycemia)

Diarrhea (hyper peristalsis Diarrhea (hyper peristalsis due to large volume of due to large volume of hypertonic fluids)hypertonic fluids)

Medical Nutrition Medical Nutrition TherapyTherapy

GoalGoal– To provide energy (avoid weight loss)To provide energy (avoid weight loss)– Slow the passage of foods through the Slow the passage of foods through the

stomachstomach– Minimize diarrheaMinimize diarrhea– Avoid anemiaAvoid anemia

Iron deficiency – not converted to a usable formIron deficiency – not converted to a usable form Malabsorption lead to Folate and Vit BMalabsorption lead to Folate and Vit B1212 anemia anemia

– Prevent bone diseasePrevent bone disease Vit D and Calcium malabsorption lead to Vit D and Calcium malabsorption lead to

OsteomalaciaOsteomalacia

Medical Nutrition TherapyMedical Nutrition Therapy High ProteinHigh Protein Complex carbohydratesComplex carbohydrates (50 – 60%) (50 – 60%)

– Simple sugars 0-15%)Simple sugars 0-15%) Moderate fatModerate fat (30% of kcalories) (30% of kcalories)

– Use medium chain triglycerides (MCT)Use medium chain triglycerides (MCT) Low Low (no) (no) LactoseLactose Moderate sodium intakeModerate sodium intake; ; Vitamin and mineral Vitamin and mineral

supplementationsupplementation Frequent small meals, fluids between Frequent small meals, fluids between

mealsmeals

Client EducationClient Education Stress importance of self-careStress importance of self-care

– Stress, eating away from home Stress, eating away from home

Discuss Discuss Artificial sweetenersArtificial sweeteners

Eating slowly in an upright positionEating slowly in an upright position

Social significance of food and alcoholSocial significance of food and alcohol

Dumping syndrome and how to Dumping syndrome and how to overcome reluctance and fear of pain overcome reluctance and fear of pain with eatingwith eating

Bariatric SurgeryBariatric Surgery Goal is weight lossGoal is weight loss ComplicationsComplications

– Ruptured staplesRuptured staples– Bowel obstructionBowel obstruction– Infections, nausea, Infections, nausea,

vomiting, vomiting, dehydrationdehydration

– Dumping syndromeDumping syndrome– Esophageal refluxEsophageal reflux– depressiondepression

Bariatric SurgeryBariatric Surgery

Medical Nutrition TherapyMedical Nutrition Therapy Clear liquids ~ 4 oz per hour (sugar free)Clear liquids ~ 4 oz per hour (sugar free) Progress to full liquids – low lactoseProgress to full liquids – low lactose Pureed, high proteinPureed, high protein No Sugar, very low carbohydratesNo Sugar, very low carbohydrates Common deficienciesCommon deficiencies

– Vitamins BVitamins B1212, D, D– IronIron