Download Chpt 17 - Upper GI disorders

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
dysphagia
 Transfer of food
from mouth to
esophagus
 Problem of
tongue, other oral
tissues or
swallowing reflex
• Symptoms
 Inability to initiate
swallowing
 Coughing during or
after swallowing
 Nasal regurgitation
 Bad breath
 “Wet” voice
• Stroke is a frequent
cause
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Dysphagia:
Difficulty Swallowing
• Esophageal
dysphagia
• Causes
 Transfer of food
through esophagus
to stomach
 Complaints of “food
sticking” after
swallowing
 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
pureed
 Moderate to severe
dysphagia
 Poor oral or chewing
ability
• Level 2: Dysphagia
mechanically altered
 Mild to moderate
dysphagia
• Level 3: Dysphagia
advanced
 Mild dysphagia
• Level 4: Liquid
consistencies
 Thin
 Nectarlike
 Honeylike
 Spoon-thick
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Food Properties
& Preparation
• Offer
 Easy to manage
textures &
consistencies
 Soft, cohesive foods
 Moist rather than dry
 One texture at a
time
 Thickeners
 Pureed, mashed,
ground, or minced
• Avoid
 Sticky or gummy
foods
 Nuts & seeds
 More than one
texture
 Thin liquids
• Use a variety of
colors & shapes
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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 foods
 Lightly seasoned
 Relaxed atmosphere
• Causes
 Peptic ulcers
 GERD
 Motility disorders
 Malabsorption disorders
 Gallbladder disease
 Tumors in abdominal
region
 Some medications &
dietary supplements
© 2007 Thomson - Wadsworth
Nausea & Vomiting
• Accompanies many
• Dietary
illnesses
interventions
 Eating & drinking
• Common side effect
slowly
of many medications
 Small meals
• Correct underlying
 Clear, cold
disorder
beverages
• May need to restore
 Dry salty foods
hydration
 Foods cold or at
room temperature
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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 antiinflammatory drugs
• Other risk factors
 Cigarette smoking
 Emotional stress
 Genetic factors
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Peptic Ulcers
• Signs & symptoms
 Hunger pain
 Sensation of gnawing
 Burning in stomach
• Complication
 GI bleeding
• Weak & fatigued
• Black, tarry stools
• Coffee ground vomit
• Drug therapy
 Antibiotics
 Discontinue aspirin &
NSAIDS
 Antisecretory agents
 Bismuth preparations
or sucralfate
• Avoid irritating foods
• Avoid large meals
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Gastric Surgery
• Treatment for
Severe obesity
Peptic ulcer
Stomach 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 Syndrome
 Abnormally rapid
gastric emptying
 Goals
• Limit amount of food
reaching the intestine
• Slow rate of gastric
emptying
• Reduce foods that
increase hypertonicity
• Fat malabsorption
 Deficiencies of fatsoluble 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
© 2007 Thomson - Wadsworth