fundamentals of nutrition · •medical nutrition therapy –small, frequent meals of well-balanced...

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Chapter 20

Diet and Gastrointestinal Problems


Objectives

• Explain uses of diet therapy in gastrointestinal

disturbances

• Identify foods allowed and disallowed in

therapeutic diets discussed

• Adapt normal diets to meet requirements of

clients with conditions discussed


Gastrointestinal Tract

• Where digestion and absorption of food occurs

• Primary organs:

– Mouth, esophagus, stomach, small intestine, and large

intestine

• Accessory organs:

– Liver, gallbladder, and pancreas


Dyspepsia

• Also known as indigestion

• Discomfort in digestive tract of physical or

psychological origin

• Symptoms:

– Heartburn, bloating, pain and regurgitation

(continues)


Dyspepsia

• Treatment:

– Treat underlying organic cause

– Stress management if psychological


Esophagitis

• Irritation of mucosa of esophagus

• Causes heartburn, regurgitation, and dysphagia

• May be acute or chronic

• Causes:

– Hiatal hernia, reduced lower esophageal sphincter pressure,

abdominal pressure, recurrent vomiting, alcohol use,

overweight, and smoking


Hiatal Hernia

• Part of stomach protrudes through diaphragm

into thoracic cavity

– Prevents food from moving normally along digestive tract

• Heartburn and food regurgitation into mouth

can occur

(continues)


Hiatal Hernia

• Medical nutrition therapy

– Small, frequent meals of well-balanced diet

– Avoid irritants to esophagus

– Avoid foods that relax lower esophageal sphincter

– Weight loss recommended if necessary

– Avoid lying down two to three hours after eating


Peptic Ulcers

• Erosion of mucous membrane

• May be gastric or duodenal

• Predisposing factors:

– Genetics, high secretion of hydrochloric acid, stress,

excessive use of aspirin or ibuprofen, smoking, or

Helicobacter pylori bacteria

• Symptoms:

– Gastric pain and sometimes hemorrhage

(continues)


Peptic Ulcers

• Treatment:

– Drugs to control acid secretion and kill bacteria

– Stress management

– Sufficient low-fat protein

– Avoidance of caffeine, alcohol, aspirin, and smoking

– Well-balanced diet of three meals per day


Diverticulosis and Diverticulitis

• Diverticulosis

– Formation of little pockets in sides of large intestine where

food gets trapped

• Diverticulitis

– Inflammation in these pockets

• Cause:

– Insufficient dietary fiber

(continues)


Diverticulosis and Diverticulitis

• Treatment:

– For diverticulosis, high-fiber diet

– For diverticulitis, antibiotics and progressive diet to allow

bowel to rest


Stop and Share

• Consider the following scenario:

– A client with severe diarrhea has been placed on a low-

residue diet. What kinds of foods would you recommend?

(continues)


Stop and Share

• Milk and buttermilk

– Limit to 2 cups per day

• Cottage cheese and some mild cheeses

• Butter and margarine

• Eggs

– Except fried

(continues)


Stop and Share

• Tender chicken, fish, sweetbreads, ground

beef, and ground lamb

• Soup broth

• Cooked, mild-flavored vegetables without

coarse fibers

• Refined breads and cereals, white crackers,

macaroni, spaghetti, and noodles

(continues)


Stop and Share

• Custard, sherbet, or vanilla ice cream

• Coffee, tea, cocoa, or carbonated beverages

• Salt, sugar, or small amount of spices as

permitted


Inflammatory Bowel Disease

• Chronic condition causing inflammation in

gastrointestinal tract

• Ulcerative colitis

– Inflammation and ulceration of colon, rectum, or entire

large intestine

• Crohn’s disease

– Chronic progressive disorder

– Can affect both small and large intestines


Symptoms of Inflammatory Bowel

Disease• Bloody diarrhea

• Cramps

• Fatigue

• Nausea

• Anorexia

• Malnutrition

• Weight loss


Treatment of Inflammatory Bowel

Disease• Anti-inflammatory drugs

• Medical nutrition therapy

– Low-residue diet

– When tolerated, 100 g of protein, additional calories,

vitamins, and minerals

– Severe cases may require total parenteral nutrition (TPN)


Ileostomy or Colostomy

• Stoma or surgical opening from body surface

to intestine for purpose of defecation

• Ileostomy

– From ileum to abdomen surface

• Colostomy

– From colon to abdomen surface

• May be temporary or permanent

(continues)


Ileostomy or Colostomy

• Clients with ileostomies have greater than

normal need for salt and water because of

excess losses

• Vitamin C supplement recommended

• In some cases, B12 supplement required


Celiac Disease

• Also known as nontropical sprue or gluten

sensitivity

• Malabsorption of virtually all nutrients

• Symptoms:

– Diarrhea, weight loss, malnutrition, and foul-smelling,

light-colored, bulky stools

(continues)


Celiac Disease

• Cause unknown

– Considered to be hereditary

• Treatment:

– Gluten-controlled diet

• Protein found in barley, oats, rye, and wheat

• May use rice and corn

• Must read food labels


Cirrhosis

• General term for liver disease characterized by

cell loss


• Most often caused by alcohol abuse

• Other causes:

– Congenital defects, infections, or other toxic chemicals

(continues)


Cirrhosis

• Liver does regenerate

– But replacement during cirrhosis does not match loss

• Complications:

– Hypertension, anemia, hemorrhage in esophagus, ascites,

and death

(continues)


Cirrhosis

• Dietary treatment:

– 25 to 35 calories or more per kg per day

– 0.8 to 1.0 g of protein per kg per day

– May not tolerate fats or proteins well

– May need to increase CHO

– May supplement with vitamins and minerals

– May need to restrict fibers if bleeding

– No alcohol allowed


Hepatitis

• Acute or chronic inflammation of liver

• Causes:

– Viruses

– Toxic agents

• E.g., drugs, alcohol

(continues)


Hepatitis

• Hepatitis A virus (HAV) contracted through

contaminated drinking water, food, and

sewage via fecal-oral route

(continues)


Hepatitis

• Hepatitis B virus (HBV) and hepatitis C virus

(HCV) transmitted through blood, blood

products, semen, and saliva

– Can lead to chronic active hepatitis (CAH)

• Diagnosed by liver biopsy

• Chronic active hepatitis can lead to liver

failure and end-stage liver disease (ESLD)

(continues)


Hepatitis

• Symptoms:

– Nausea, headache, fever, fatigue, tender and enlarged liver,

anorexia, and jaundice

• Weight loss can be pronounced

• Treatment:

– Bed rest, fluids, and medical nutrition therapy


Medical Nutrition Therapy for

Hepatitis• 35 to 40 calories per kg of body weight per day

• Provide most calories by carbohydrates

• Have moderate fat intake

• If necrosis not severe, up to 70 to 80 g of

protein needed for cell regeneration

(continues)


Medical Nutrition Therapy for

Hepatitis• If necrosis severe, limit proteins to prevent

accumulation of ammonia in blood

• Clients may prefer frequent, small meals

– Rather than three large meals


Cholecystitis and Cholelithiasis

• Cholecystitis

– Inflammation of gallbladder

• Cholelithiasis

– Gallstones

(continues)



• Contributing factors:

– Being female, obesity, TPN, very low calorie diets for

rapid weight loss, estrogen use, and various diseases of

small intestine

• Both may inhibit flow of bile

• Symptoms:

– Pain, indigestion, and vomiting

(continues)



• Treatment:

– Medication to dissolve stones

– Diet therapy

• Abstinence during acute phase followed by clear liquid diet and,

gradually, regular fat-restricted diet

– Surgery may be indicated


Pancreatitis

• Inflammation of pancreas

• Causes:

– Infections, surgery, alcoholism, biliary tract disease, or

certain drugs


• Symptoms:

– Abdominal pain, nausea, steatorrhea, and weight loss

(continues)


Pancreatitis

• Diabetes mellitus may be complication

• Diet therapy:

– During acute phase, strict parenteral nutrition

– Later, liquid diet of carbohydrates to minimize stimulatory

effect on pancreatic secretions

– As recovery progresses, small, frequent feedings of

carbohydrates and protein with little fat or fiber

(continues)


Pancreatitis

• May give vitamin supplements

• Alcohol forbidden in all cases


Residue-Controlled Diets

• Residue made up of all undigested and

unabsorbed parts of food, connective tissue in

animal foods, dead cells, and intestinal bacteria

and their products

– Most composed of fiber

• Diets can be adjusted to increase or decrease

fiber and residue


High-Fiber Diet

• Often 30 g or more

• Helps prevent diverticulosis, constipation,

hemorrhoids, and colon cancer

• Sources:

– Coarse and whole-grain breads and cereals, bran, all fruits,

vegetables (especially raw), and legumes


Low-Residue Diet

• 5 to 10 g of fiber per day intended to reduce

normal work of intestines by reducing food

residue

• May be used in cases of severe diarrhea,

diverticulitis, ulcerative colitis, intestinal

blockage, and in preparation for and

immediately after intestinal surgery


Conclusion

• Wide variety of therapeutic diets used for

clients with gastrointestinal disturbances

– Peptic ulcers

• Medications, avoidance of alcohol, and caffeine

– Diverticulosis

• High-fiber diet

(continues)


Conclusion



– Diverticulitis

• Gradual progression from clear liquid to high-fiber diet

– Ulcerative colitis

• Low-residue diet combined with high protein and high calories

(continues)


Conclusion



– Cirrhosis

• Substantial, balanced diet, with occasional restrictions of fat,

protein, salt, or fluids

– Hepatitis

• Full, well-balanced diet

– Although protein may be restricted

(continues)


Conclusion



– Cholecystitis and cholelithiasis

• Fat-restricted diet and, in cases of overweight, addition of calorie-

restricted diet

– Pancreatitis

• TPN to individualized diet as tolerated

fundamentals of nutrition · •medical nutrition therapy –small, frequent meals of well-balanced...

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