© 2007 thomson - wadsworth chapter 17 nutrition & upper gastrointestinal disorders
TRANSCRIPT
© 2007 Thomson - Wadsworth
Chapter 17
Nutrition & Upper Gastrointestinal Disorders
© 2007 Thomson - Wadsworth
Dry Mouth: Xerostomia
• Reduced salivary flow Side-effect of
medications Poorly controlled
diabetes Sjogren’s syndrome Radiation therapy Mouth breathing
• Consequences Increased plaque Tooth & gum disease Mouth infections Interference with speech Bad breath Difficulty chewing &
swallowing Diminished taste Ulcers from dentures Reduced food intake
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Dysphagia: Difficulty Swallowing
• Oropharyngeal dysphagiaTransfer of food
from mouth to esophagus
Problem of tongue, other oral tissues or swallowing reflex
• Symptoms Inability to initiate
swallowingCoughing during or
after swallowingNasal regurgitationBad breath“Wet” voice
• Stroke is a frequent cause
© 2007 Thomson - Wadsworth
Dysphagia: Difficulty Swallowing
• Esophageal dysphagiaTransfer of food
through esophagus to stomach
Complaints of “food sticking” after swallowing
• Causes Obstruction in
esophagus Motility disorder
• Aspiration: a potential complication of oropharyngeal or esophageal dysphagia
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
National Dysphagia Diet
• Level 1: Dysphagia pureedModerate to severe
dysphagiaPoor oral or chewing
ability
• Level 2: Dysphagia mechanically alteredMild to moderate
dysphagia
• Level 3: Dysphagia advancedMild dysphagia
• Level 4: Liquid consistenciesThinNectarlikeHoneylike Spoon-thick
© 2007 Thomson - Wadsworth
Food Properties & Preparation
• OfferEasy to manage
textures & consistencies
Soft, cohesive foodsMoist rather than dryOne texture at a
timeThickeners Pureed, mashed,
ground, or minced
• AvoidSticky or gummy
foodsNuts & seedsMore than one
textureThin liquids
• Use a variety of colors & shapes
© 2007 Thomson - Wadsworth
Gastroesophageal Reflux Disease
• GERD Reflux of acidic
stomach contents into the esophagus
Heartburn or acid indigestion
Causes discomfort & may cause tissue damage
• Conditions associated with GERD Pregnancy Asthma Hiatal hernia Obesity Large meals Some medications Nasogastric tubes
• Treatment Proton-pump inhibitors Histamine-2-receptor blocking
agents
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Conditions Affecting the Stomach
• Dyspepsia• Nausea & Vomiting• Gastritis• Peptic Ulcer
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Dyspepsia
• General discomfort in the upper abdominal area
• Teaching Small meals with
well-cooked foodsLightly seasonedRelaxed atmosphere
• CausesPeptic ulcersGERDMotility disordersMalabsorption disordersGallbladder diseaseTumors in abdominal
regionSome medications &
dietary supplements
© 2007 Thomson - Wadsworth
Nausea & Vomiting
• Accompanies many illnesses
• Common side effect of many medications
• Correct underlying disorder
• May need to restore hydration
• Dietary interventionsEating & drinking
slowlySmall mealsClear, cold
beveragesDry salty foodsFoods cold or at
room temperature
© 2007 Thomson - Wadsworth
Gastritis
• Inflammation of the stomach mucosa
• Causes Helicobacter pylori
infection Irritating substances Damage to stomach lining
(diseases/ treatments)
• Acute erosive gastritis or chronic atrophic gastritis
• Complications Low or absent
hydrochloric acid Impaired absorption of
nonheme iron & vitamin B12
• Dietary interventions Avoid alcohol, coffee,
tea, cola, spicy foods, & fatty, greasy foods
© 2007 Thomson - Wadsworth
Peptic Ulcer
• Gastric & duodenal • Causes
Effects of hydrochloric acid & pepsin
Helicobacter pylori infection Non-steroidal anti-
inflammatory drugs
• Other risk factors Cigarette smoking Emotional stress Genetic factors
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Peptic Ulcers
• Signs & symptomsHunger painSensation of gnawingBurning in stomach
• Complication GI bleeding
• Weak & fatigued• Black, tarry stools• Coffee ground vomit
• Drug therapyAntibiotics Discontinue aspirin &
NSAIDSAntisecretory agentsBismuth preparations
or sucralfate
• Avoid irritating foods • Avoid large meals
© 2007 Thomson - Wadsworth
Gastric Surgery
• Treatment forSevere obesityPeptic ulcerStomach cancer
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Gastrectomy
• Removal of diseased portions of the stomach
• Other Vagotomy:
suppresses acid secretion
Pyloroplasty: widens pyloric sphincter from stomach to the duodenum
• Postgastrectomy diet Several small meals & snacks Progress to 5-6 small
meals/day Avoid sweets & sugars Fiber to delay stomach
emptying Avoid irritating foods May need to avoid milk
products (lactose intolerance) Liquids between meals
© 2007 Thomson - Wadsworth
Typical Gastric Surgery Resections
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Post-Surgical Problems
• Dumping SyndromeAbnormally rapid
gastric emptyingGoals
• Limit amount of food reaching the intestine
• Slow rate of gastric emptying
• Reduce foods that increase hypertonicity
• Fat malabsorption Deficiencies of fat-
soluble vitamins & some minerals
• Bone disease Malabsorption of calcium
& vitamin D
• Anemia Impaired iron & vitamin
B12 absorption due to decreased hydrochloric acid
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Bariatric Surgery
• Creates a gastric pouch which restricts meal size to about a cup
• Bypasses part of small intestine, decreasing absorption
• Lose between 49-62% of excess weight
• After weight loss, may need plastic surgery to remove excess skin
• Progressive diet• Fluids consumed
separately• Education on food
portions To avoid dumping
syndrome To maintain weight
loss
• Need dietary supplements
© 2007 Thomson - Wadsworth