note exam 180 minutes 120 multiple choice questions-120 points -4 short answer question-60 points...
TRANSCRIPT
Note
Exam
180 minutes
120 multiple choice questions-120 points-4 short answer question-60 points
multiple choice-lecture 7a-12c inclusiveshort answer-whole Nutrition 2105 course
Lecture 9a 10 March 2014 Disorders of the Upper GI tract
Mouth Chewing
Impaired due to:-sedation and pain
Solution
-mechanical soft diet, food selection or pureed foods
-what is the difference between these three solutions?
Mouth Impaired Chewing continued
Solution-pureed foods -can be boring
-bore factor may be overcome by commercially available thickeners
-thickeners allow one to shape foods so that look like the original food but are much easier to chew
Mouth Impaired Chewing continued
Solution -pureed foods
-make more appealing by:varietycolourserve foods at right temperatureseasonings and spicessupplement with nutritious liquids
likemilk, instant breakfasts, or
liquid formulas
Mouth ulcers-caused by?
Solutions
-moist soft textured foods and eliminate spicy, salty and acid
foods
-example of each of these food types
Inflammation of throat and lips-solutions- nutritional approaches-see mouth
ulcers Reduced flow of saliva: solutions
-moisten foods with sauces and gravies-problem with this?
-avoid salty foods and snacks (examples) that dry mouth
-give sugarless candy
Dysphagia -difficulty swallowing
-due to aging, neurological disorders, developmental disabilities and strokes
-muscles cannot not push food back to back of throat or push foods down the esophagus into stomach
Achalasia
-cardiac sphincter does not open up-it fails to relax
-food backs up until sphincter opens or there is regurgitation
Indications of dysphagia
-pain on swallowing, weight loss, feeling food is sticking in mouth
-tendency to hold food in mouth rather than swallowing
-choking or coughing during meals
-frequent throat clearing, drooling or change in voice quality
Dysphagia Dietary interventions -mono-texture meals -mildly spiced and moderately sweet foods served at room temperature
-avoid sticky foods and foods that break into small pieces when eaten
-avoid true liquids – thickened liquids are better (eg milkshakes and puddings) as they slide downmore easily
Dysphagia
Solutions
-posture- sit up, feet flat on floor, head tilted slightly forward to avoid choking
-tube feedings –intestinal tubes may be better
than stomach tubes to avoid aspiration
Esophageal reflux-solutions -eat small meals and drink liquids one hour
before or after a meal
-limit foods that weaken cardiac sphincter (fat,alcohol,caffeine)
-lose weight
-avoid cigarettes
-during reflux avoid acidic foods like citric acid juices, tomatoes, spices, very hot or very cold foods
Nausea and vomiting
Nausea-solutions
-avoid foods and aromas that make one nauseous-do not overeat-drink cold or carbonated liquids upon first sensation of nausea-eat carbohydrate-rich, low fat foods before getting
out of bed in morning-if cyclical , one is avoid food at critical times-ginger or peppermint teas provide relief for some
people-relax after eating
Vomiting-solutions
-if vomiting resolves, consume clear fluids to replace water and electrolytes
-otherwise use intravenous (iv) feedings
Gastritis-solutions
Except as tolerated avoid: -alcohol and caffeine-decaffeinated coffee-pepper and spicy foods
-fatty and greasy foods-any other offending agent
give B12 as required (injection or prescription
nasal spray) as clinically indicated
Ulcers-solutions
Post-onset-eat slowly, chew well
-avoid overeating and any foods than irritate the ulcer
e.g. -alcohol and caffeine -chocolate -pepper and spicy foods
Class activity
Design a diet for the pathology/problem of your choice than meets the dietaryprinciples of adequacy, variety, moderation,nutrient density, energy control, and balance
Lecture 9b 10 March 2014
Disorders of the Lower GI tract
Constipation-solutions
At least 25 grams of fibreLots of fluidsEating prunesDrinking prune juice
Foods containing fibre suitable to assist in the relief of constipation
1 slice whole wheat bread1 oz of ready to eat cereal (100 % bran cereals contain 10 grams of fibre)1 cup raw bean sprouts½ cup cooked broccoli , brussel sprouts, carrots, cauliflower½ cup chopped raw carrots1 medium apple, banana, kiwi, orange, pear½ cup apple sauce, blackberries, blueberries, strawberriesfruit juices contain very little fibre
Foods containing fibre suitable to assist in the relief of constipation
½ cup baked beans, blackbeans, blackeyed peas, kidney beans, navy beans (about 8 grams of fibre)
½ cooked garbanzo beans, lentils, lima beans, split peas (about 5 grams of fibre)
Foods containing fibre suitable to assist in the relief of constipation
most whole grain products contain about 1-2 grams of fibre per serving
most vegetables contain 2 grams-3 grams of fibre per serving
fresh, dried and frozen fruits contain about 2 grams per serving
many legumes contain about 8 grams of fibre per serving
Relief of constipation via fibre consumption
fibre adds volume and weight to the stool which normalises the transit of undigested materials through the intestine and minimises the pressure within the colon
Gas
Everybody responds differently to different foods
Eliminate foods, one by one, to discover offending foods
Diarrhoea-solutions
-replace lost fluids and electrolytes
-consume diluted fruit juices, sports drinks and caffeine free-carbonated beverages for mild cases -use oral rehydration formulas- (salts, sugar and water)-mild to moderate cases
-severe cases combined with vomiting require intravenous solutions
-if eating aggravates the situation then withhold food and diarrhoea should resolve in a day or two-patient should drink only clear fluids in this case
Irritable bowel syndrome
Common motility disorder characterised by abdominal pain associated with diarrhoea, constipation i.e. alternating episodes of diarrhoea and constipation or both diarrhoea and constipation occurring at the same time Cause unclear but stress and anxiety have been suggested Solutions-Avoid eating too much, too fast or swallowing without chewing enough
Irritable bowel syndrome-solutions continued
Keep track of fluid and food intake and stool consistency associated with that fluid and food intake Also keep track of other gastrointestinal tract symptoms at particular times people may benefit from reduced fat and liberal fibre and fluid intake
However fibre intake has to be watched-why?
Inflammatory bowel diseases
Crohn’s disease and ulcerative colitis are two of the most prevalent
In children , Crohn’s gives protein energy malnutrition (PEM), vitamin and mineral deficiencies nutritional interventions -food during day and tube feedings at night -or tube feedings day and night in severe cases
All Crohn’s patients regardless of age should reduce lactose intake and avoid high fibre foods
Inflammatory bowel diseases-solutions
For ulcerative colitis no dietary interventions seem to lessen symptoms For all inflammatory bowel syndromes- fluid and electrolytes may have to be replaced by iv
Lactose intolerance-covered in first term
Malabsorption syndromes
Steatorrhea-malabsorption of fat and energy, essential fatty acids, fat soluble vitamins and some minerals
-also get binding of calcium to fatty acids
-this means that binding of calcium to oxalate in gut is lost-how does this relate to the last lecture?
Malabsorption syndromes-solutions
-treatment- high kcal and high protein diets are given-why?
-enzyme supplements given to aid digestion (pancreatic enzymes given)-medium chain fatty acids are given-
easier to digest-frequent small meals- why?-fat soluble vitamins given in water
soluble form-restrict oxalate in diet-why?
PancreatitisAcute-solutions
-fluids and electrolytes given iv
-suctioning of gastric secretions to help relieve pain and distension
-oral intake allowed after abdominal discomfort subsides and serum amylase returns to normal levels
-oral feeding starts off with liquid progressing to fat restricted diet to normal diet as tolerated
Chronic Pancreatitis
Absorption of fat can be permanently impaired
solution to this?
Cystic fibrosis-solutions
High kcal diet and high protein diet up to tolerance limits for protein and energy
As pancreas is damaged fat absorption is reduced but do not limit fats
Enzyme replacements for fat digestion
Multivitamin and fat soluble vitamins
supplements are routinely given
Cystic fibrosis –solutions continued
Liberal use of table salt to make up for losses in sweating
Oral diets in day and tube feedings at night for some people Breast milk, standard infant formulas and hydrolysed infant formulas work for infants provided that enzyme supplements are given
Bacterial overgrowth in stomach
Signs include chronic diarrhea, gas, malnutrition and weakness
Fat restricted diets to bring down bacterial growth
Oral mineral and vitamin supplements except B12 which cannot be absorbed
as the result of this overgrowth (injections of B12 or prescription B12
nasal sprays required)
Coeliac disease
Avoid gluten (wheat, rye and barley are out-even trace amounts)
Lactose intolerance may be permanent
Intestinal surgeries-solutions IV fluids to restore fluid and electrolyte imbalances after surgery then tube feedings and finally regular oral meals (low fibre, soft diets to prevent irritation and obstruction)
-low fibre, soft diets means avoiding dried fruits, raw apples and corn, stringy foods (celery, spinach for example), seeds, mushroom and nuts
Intestinal surgeries-nutritional interventions
B12 supplementation (injection or nasal
spray) if necessary
If diarrhea then give foods that thicken stool -apple sauce, bananas, cheese, creamy peanut butter and starchy foods such as white bread and potatoes
-avoid apple, grape and prune juice, highly seasoned foods, foods that cause gas and avoid alcohol and caffeine
Diverticulitis-solutions
Prevent by avoiding low fibre diets and constipation
-strain of pushing hard stools creates pockets in intestine
Liquid diets until symptoms subside
Class activity
Design a diet for the pathology/problem of your choice than meets the dietaryprinciples of adequacy, variety, moderation,nutrient density, energy control, and balance