Upload
simon-bryan
View
222
Download
2
Tags:
Embed Size (px)
Citation preview
Upper Gastrointestinal Tract
KNH 411
Upper GI – A&PStomach - Motility
Filling, storage, mixing, emptying50 mL empty – stretches to 1000 mLPyloric sphincter
© 2007 Thomson - Wadsworth
Pathophysiology - Oral CavityNutrition Therapy/Evaluation
Increase frequency of meals- tired quickly- 6 small feeding, high cal, high pro
Bland foods served at room temp.Liberal use of fluids- be careful with water, make sure
it is high energy density food Preference for cold and frozen foods- takes away some
of the smell if ill (chemo)Oral hygiene- embarrassed maybe Monitor using food diary, observation, or kcal count- a
lot of this done by computers but need to know how to do by hand
Monitor weight gain or maintenance
Pathophysiology - Esophagus
GERD - reflux of gastric contents into the esophagus Incompetence of LES
Increased secretion of gastrin, estrogen, progesterone Hiatal hernia Cigarette smoking- can losen Use of medications Foods high in fat, chocolate, spearmint, peppermint,
alcohol, caffeine (fried foods)
Pathophysiology - Esophagus
GERD - symptomsDysphagia- difficulty swallowingHeartburn- antiacids Increased salivationBelchingPain radiating to back, neck, or jawAspiration- refluxing of the contents of the stomachUlcerationBarrett’s esophagus- change in epithelial cells,
abnormal pH- squamous cell carcinoma- cancer a concern
Pathophysiology - Esophagus
GERD - TreatmentMedical management- antiacids, histamine blocker,
mucousal protectants Modify lifestyle factorsMedications – 5 classes (in book) to strengthen LES Surgery- most severe
Fundoplication- fundus, wrap it around the LES, tightens Stretta procedure- radiofrequency is energy is used,
increases the function
Pathophysiology - EsophagusGERD - Nutrition Therapy
Identify foods that worsen symptoms- previously mentioned
Assess food intake esp. those that reduce LES pressure, or increase gastric acidity
Assess smoking and physical activity- smoking cessation
Small, frequent meals- lessens the pressureWeight loss if warranted
Pathophysiology - EsophagusDysphagia – difficulty swallowing
Potential causes – GERD, StrokeDrooling, coughing, choking- could aspirate Weight loss, generalized malnutritionAspiration to aspiration pneumonia- inhalation into the
oral pharynx, constant oral problem Treatment requires health care teamdg by bedside swallowing, videofluoroscopy, barium
swallow
Pathophysiology - Esophagus
Dysphagia – Nutrition TherapyUse acceptable textures to develop adequate menuNational Dysphagia Diet 1,2,3 Use of thickening agents and specialized productsMonitor weight, hydration, and nutritional parameters
© 2007 Thomson - Wadsworth
Hiatal Hernia
Pathophysiology - Stomach
GastritisInflammation of the gastric mucosaPrimary cause: H. pylori bacteriaAlcohol, food poisoning, NSAIDsSymptoms: belching, anorexia, abdominal
pain, vomitingType A – automimmune- upper section of the
section- antibodies of the peritoneal cellsType B – H. pylori- atropy Increases with age, achlorhydria- lack of HClTreat with antibiotics and medications
Pathophysiology - StomachPeptic ulcer disease - ulcerations of the gastric
mucosa that penetrate submucosaGastric or duodenalH. pyloriNSAIDS, alcohol, smokingCertain foods, genetic link Increased risk of gastric cancer
Pathophysiology - StomachPeptic Ulcer Disease - Nutrition
Restrict only those foods known to increase acid secretion Black and red pepper, caffeine, coffee, alcohol,
individually non-tolerated foods
Consider timing and size of mealDo not lie down after mealsSmall, frequent meals
© 2007 Thomson - Wadsworth
Pathophysiology - StomachGastric Surgery - Nutrition Implications
Reduced capacityChanges in gastric emptying & transit timeComponents of digestion altered or lostDecreased oral intake, maldigestion, malabsorption
Alter their diet, chart about these
Pathophysiology - StomachGastric Surgery - Dumping Syndrome
Increased osmolar load enters small intestine too quickly from stomach
Release of hormones, enzymes, other secretions altered
Food “dumps” into small intestine
Pathophysiology - StomachGastric Surgery - Dumping Syndrome
Early dumping – 10-20 min.; diarrhea, dizziness, weakness, tachycardia
Intermediate - 20-30 min.; fermentation of bacteria produces gas, abdominal pain, etc.
Late dumping - 1-3 hrs.; hypoglycemia
Pathophysiology - StomachGastric Surgery - Dumping Syndrome
Other nutritional concerns: vitamin and mineral deficiencies, lack of intrinsic factor, iron deficiency, osteoporosis
Pathophysiology - Stomach
Dumping Syndrome - Nutrition“Anti-dumping” dietSlightly higher in protein & fatAvoid simple sugars & lactoseCalcium & vitamin DLiquid between mealsSmall, frequent mealsLie down after mealsAssess for weight loss, malabsorption, and
steatorrhea
© 2007 Thomson - Wadsworth