nutrition for patients with upper gastrointestinal disorders chapter 17
TRANSCRIPT
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Nutrition for Patients with Upper Gastrointestinal
Disorders
Chapter 17
Nutrition for Patients with Upper Gastrointestinal
Disorders
Chapter 17
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Nutrition for Patients With Gastrointestinal DisordersNutrition for Patients With Gastrointestinal Disorders
• Nutrition therapy is used in the treatment of many digestive system disorders.
– Some diet therapy is only supportive.
– Some diet therapy is cornerstone of treatment.
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Disorders That Affect EatingDisorders That Affect Eating
• Anorexia
– Common symptom of many physical conditions
– Side effect of certain drugs
– Emotional issues
– Aim of nutrition therapy is to stimulate the appetite to maintain adequate nutritional intake.
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Interventions That May Help AnorexiaInterventions That May Help Anorexia
• Serve food attractively and season it according to individual taste.
• Schedule procedures and medications when they are least likely to interfere with meals, if possible.
• Control pain, nausea, or depression with medications as ordered.
• Provide small, frequent meals.
• Withhold beverages for 30 minutes before and after meals.
• Offer liquid supplements between meals.
• Limit fat intake if fat is contributing to early satiety.
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Disorders That Affect Eating—(cont.)Disorders That Affect Eating—(cont.)
• Nausea and vomiting
– May be related to
o A decrease in gastric acid secretion
o A decrease in digestive enzyme activity
o A decrease in gastrointestinal motility, gastric irritation, or acidosis
o Bacterial and viral infection, increased intracranial pressure, equilibrium imbalance
o Liver, pancreatic, and gallbladder disorders
o Pyloric or intestinal obstruction
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Disorders That Affect Eating—(cont.)Disorders That Affect Eating—(cont.)
• Nausea and vomiting—(cont.)
– Short-term concern of nausea and vomiting is fluid and electrolyte balance.
– With intractable or prolonged vomiting, dehydration and weight loss are concerns.
– Nutrition intervention for nausea is a commonsense approach.
o Food is withheld until nausea subsides.
o Clear liquids are offered and progressed to a regular diet as tolerated.
o Small meals of easily digested carbohydrates
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Disorders That Affect Eating—(cont.)Disorders That Affect Eating—(cont.)• Nausea and vomiting—(cont.)
– Interventions that might help:
o Encourage the patient to eat slowly and not to eat if he or she feels nauseated.
o Promote good oral hygiene with mouthwash and ice chips.
o Limit liquids with meals.
o Serve foods at room temperature or chilled.
o Avoid high-fat and spicy foods if they contribute to nausea.
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Disorders of the EsophagusDisorders of the Esophagus• Symptoms range from difficulty swallowing and the
sensation that something is stuck in the throat to heartburn and reflux.
• Dysphagia
– Impairments in swallowing can have a profound impact on intake and nutritional status.
– Mechanical causes include obstruction, inflammation, edema, and surgery of the throat.
– Neurologic causes include amyotrophic lateral sclerosis (ALS), myasthenia gravis, cerebrovascular accident, traumatic brain injury, cerebral palsy, Parkinson disease, and multiple sclerosis.
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Disorders of the Esophagus—(cont.)Disorders of the Esophagus—(cont.)• Dysphagia—(cont.)
– Nutrition therapy
o Goal is to modify the texture of foods and/or viscosity of liquids to enable the patient to achieve adequate nutrition and hydration while decreasing the risk of aspiration.
o Emotionally, dysphagia can affect quality of life.
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Disorders of the Esophagus—(cont.)Disorders of the Esophagus—(cont.)• Dysphagia—(cont.)
– Nutrition therapy—(cont.)
o Speech or language pathologist (SLP) performs a swallowing evaluation.
o Recommends feeding techniques based on the patient’s individual status
o Moist, semisolid foods are easiest to swallow.
o Commercial thickeners added to pureed foods can allow pureed foods to be molded into the appearance of “normal” food, which is more visually appealing than “baby food.”
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Disorders of the Esophagus—(cont.)Disorders of the Esophagus—(cont.)
• Dysphagia—(cont.)
– Nutrition therapy—(cont.)
o Thickened liquids are more cohesive than thin liquids and are easier to control.
Often poorly accepted
o Various feeding techniques may facilitate safe swallowing.
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Gastroesophageal Reflux DiseaseGastroesophageal Reflux Disease
• Gastroesophageal reflux disease (GERD)
– Caused by an abnormal reflux of gastric contents into the esophagus related to an abnormal relaxation of the lower esophageal sphincter
– Other contributing factors
o Increased intra-abdominal pressure
o Decreased esophageal motility
– Indigestion, “heartburn,” and regurgitation are common.
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Gastroesophageal Reflux Disease—(cont.)Gastroesophageal Reflux Disease—(cont.)
• Gastroesophageal reflux disease (GERD)—(cont.)
– Pain frequently worsens when the person lies down, bends over after eating, or wears tight-fitting clothing.
– Chronic untreated GERD may cause reflux esophagitis, dysphagia, adenocarcinoma, esophageal ulcers, and bleeding.
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Gastroesophageal Reflux Disease—(cont.)Gastroesophageal Reflux Disease—(cont.)• Nutrition therapy
– A three-pronged approach is used to treat GERD.
o Lifestyle modification, including nutrition therapy
o Drug therapy
o Surgical intervention, if necessary
– Lifestyle and diet modifications focus on reducing or eliminating behaviors believed to contribute to GERD.
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Gastroesophageal Reflux Disease—(cont.)Gastroesophageal Reflux Disease—(cont.)
• Nutrition therapy—(cont.)
– Elevate the head of the bed 6 to 8 inches and avoid lying down for 3 hours after meals to limit esophageal acid exposure.
– Avoid alcohol.
– Avoid spicy food.
– Limit fat intake.
– Limit caffeine, chocolate, and peppermint.
– Take antireflux medications.
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Disorders of the StomachDisorders of the Stomach
• Peptic ulcer disease
– H. pylori infection
– Second leading cause of peptic ulcers is the use of nonsteroidal anti-inflammatory drugs.
– Pain from duodenal ulcers may be relieved by food.
– Pain from gastric ulcers may be aggravated by eating.
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Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)
• Peptic ulcer disease—(cont.)
– After nausea and vomiting subside, low-fat carbohydrate foods, such as crackers, toast, oatmeal, and bland fruit, usually are well tolerated.
– Patients should avoid liquids with meals because liquids can promote the feeling of fullness.
– Pain, food intolerances, or loss of appetite may impair intake and lead to weight loss.
– Iron-deficiency anemia can develop from blood loss.
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Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)• Peptic ulcer disease—(cont.)
– No evidence that diet causes peptic ulcer disease or speeds ulcer healing.
– Some evidence suggests that a high-fiber diet, especially soluble fiber, may reduce the risk of duodenal ulcer.
– Nutrition intervention may play a supportive role in treatment by helping to control symptoms.
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Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)
• Peptic ulcer disease—(cont.)
– Strategies that may help
o Avoid foods that stimulate gastric acid secretion—namely, coffee (decaffeinated and regular), alcohol, and pepper.
o Avoid eating 2 hours before bed.
o Avoid individual intolerances.
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Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)
• Dumping syndrome
– Common complication of gastrectomy and gastric bypass is dumping syndrome.
– Group of symptoms caused by rapid emptying of stomach contents into the intestine
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Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)• Dumping syndrome—(cont.)
– Early
o Large volume of hypertonic fluid into the jejunum and an increase in peristalsis leads to nausea, vomiting, diarrhea, and abdominal pain.
o Weakness, dizziness, and a rapid heartbeat occur as the volume of circulating blood decreases.
o These symptoms occur within 10 to 20 minutes after eating.
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Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)
• Dumping syndrome—(cont.)
– Intermediate
o Occurs 20 to 30 minutes after eating
o Digested food is fermented in the colon, producing gas, abdominal pain, cramping, and diarrhea.
– Late
o Occurs 1 to 3 hours after eating
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Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)
• Dumping syndrome—(cont.)
– Late—(cont.)
o Rapid absorption of carbohydrate causes a quick spike in blood glucose levels.
o Body compensates by oversecreting insulin.
o Blood glucose levels drop rapidly.
o Symptoms of hypoglycemia develop, such as shakiness, sweating, confusion, and weakness.
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Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)
• Dumping syndrome—(cont.)
– Increased risk of maldigestion, malabsorption, and decreased oral intake
– Excretion of calories and nutrients produces weight loss and increases the risk of malnutrition.
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Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)
• Dumping syndrome—(cont.)
– Nutrition therapy
o Eat small, frequent meals.
o Eat protein and fat at each meal.
o Avoid concentrated sugars.
o Restrict lactose.
o Consume liquids 1 hour before or after eating instead of with meals.