G.I. Disorders Upper G.I.. Problems of the Mouth Difficulty chewing: Difficulty chewing: –AIDS...
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Transcript of G.I. Disorders Upper G.I.. Problems of the Mouth Difficulty chewing: Difficulty chewing: –AIDS...
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