NHHC chapter 17 ppt

Nutrition for Health and Health Care, 5th Edition

DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and Upper

Gastrointestinal

Disorders

Chapter 17



Conditions Affecting the Mouth

and Esophagus

• Dry mouth (xerostomia)

– Caused by reduced salivary flow

• Side effect of many medications; associated with a

number of diseases and disease treatments

– Ways in which dry mouth impairs health

• Difficulty swallowing, mouth infections, dental

diseases, increased malnutrition risk, etc.

• How can dry mouth be managed? (Table 17-1)




and Esophagus (cont’d.)

• Processes involved in swallowing

– Oropharyngeal phase

• Mouth and tongue muscles propel the food bolus

through the pharynx and into the esophagus

• Food entry prevented: nasal cavity and trachea

– Esophageal phase

• Peristalsis forces the bolus through the esophagus

• Lower esophageal sphincter relaxes to allow bolus

passage into the stomach





• Categories of dysphagia

– Oropharyngeal dysphagia

• Inhibits the transfer of food from the mouth and

pharynx to the esophagus

• Typically a neuromuscular disorder

– Esophageal dysphagia

• Interferes with the passage of materials through

the esophageal lumen and into the stomach

• Obstruction in the esophagus or a motility disorder









• What are various complications that may

accompany dysphagia?

• Nutrition intervention for dysphagia

– Physically modified foods and beverages

– Dietary plan: requires frequent reassessment

– National Dysphagia Diet (Table 17-3)





• Dysphagia diets

– Food textures: altered to make easier to

swallow

• Solid foods: pureed, mashed, ground, or minced

• Liquid consistencies: thin, nectarlike, honeylike,

and spoon-thick

• “How To” Improve Acceptance of Mechanically

Altered Foods





• Alternative feeding strategies for

dysphagia

– Change head and neck position while eating

and drinking

– Strengthen the jaws, tongue, or larynx

– Learn new swallowing methods





• Gastroesophageal reflux disease (GERD)

– Frequent reflux (backward flow) of the

stomach’s acidic contents into the esophagus

– Heartburn or acid indigestion

• Causes of GERD

– Weak lower esophageal sphincter muscle

– Predisposing factors: high stomach pressures;

inadequate acid clearance (esophagus)





• Causes of GERD

– Higher rates associated with

• Obesity, pregnancy and hiatal hernia













• Consequences of GERD

– Reflux esophagitis, esophageal ulcers,

pulmonary disease, Barrett’s esophagus, etc.

• Treatment of GERD

– Alleviate symptoms and facilitate healing

– Use acid-suppressing drugs and make lifestyle

changes





• “How To” Manage Gastroesophageal

Reflux Disease

• Case Study – Woman with GERD



Conditions Affecting the Stomach

• Dyspepsia: symptoms of pain or

discomfort in the upper abdominal area

• Causes of dyspepsia

– Various medical problems:

• Foodborne illness, GERD, peptic ulcers, gastric

motility disorders, gallbladder disease, etc.

• Some chronic diseases, e.g., diabetes mellitus

– Other: medications, dietary supplements, etc.




(cont’d.)

• Potential food intolerances

– Minimize symptoms

• Consume small, frequent meals; avoid fatty or

highly spiced foods; and avoid the specific foods

believed to trigger symptoms

• Bloating and stomach gas

– Avoid air-swallowing practices

• Gum chewing, smoking, rapid eating, drinking

carbonated beverages, and using a straw




(cont’d.)

• Nausea and vomiting

– What health problems occur with prolonged

vomiting?

– Vomiting with abdominal pain: GI disorder or

obstruction

– Vomiting without abdominal pain:

medications, foodborne illness, pregnancy,

motion sickness, neurological disease, etc.




(cont’d.)

• Treatment of nausea and vomiting

– Find and correct the underlying cause

– Restore hydration

– Take medication with food

– May need medication to suppress nausea and

vomiting

– What may be necessary in cases of

intractable vomiting?




(cont’d.)

• Gastritis: inflammation of the stomach

mucosa

– Acute cases

• Caused by irritating substances or treatments:

damage the gastric mucosa

– Chronic cases

• Caused by long-term infections: Helicobacter pylori

• Autoimmune disease








(cont’d.)

• Complications of gastritis

– Disrupted gastric secretory functions

• Hypochlorhydria or achlorhydria: absorption of

nonheme iron and vitamin B12 can be impaired

• Intrinsic factor: macrocytic anemia of vitamin B12

deficiency

• Dietary interventions for gastritis

– Avoid irritating foods and beverages

– Iron and vitamin B12 supplements




(cont’d.)

• Peptic ulcer disease

– Peptic ulcer: open sore in the GI mucosa

– H. pylori infection

• 30 to 60 percent of patients with gastric ulcers

• 70 to 90 percent with duodenal ulcers

– NSAIDs: damage the GI lining

– Other factors: smoking and psychological

stress




(cont’d.)


– Effects of psychological stress

• May play a contributory role in ulcer development;

precise effects are not fully understood

– Symptoms of peptic ulcers

• Vary: asymptomatic or mild discomfort; hunger

pain or burning pain in the stomach

• Tend to go into remission and recur every few

weeks or months




(cont’d.)


– Complications of peptic ulcers

• Gastrointestinal bleeding, stomach or duodenum

perforations, ulcer penetration into an adjacent

organ, and gastric outlet obstruction

– Drug therapy for peptic ulcers

• What are the goals of ulcer treatment?




(cont’d.)


– Drug therapy for peptic ulcers

• Discontinue aspirin and other NSAIDs

• Antibiotics for H. pylori

• Antisecretory drugs

• Diet-drug Interactions feature

– Nutrition care for peptic ulcers

• What are the goals of nutrition care for peptic

ulcers?



Gastric Surgery

• Gastrectomy

– Partial gastrectomy

• Only part of the stomach is removed

• Remaining portion: connected to the duodenum or

jejunum

– Total gastrectomy

• Entire stomach removed

• Esophagus connected directly to the small

intestine





Gastric Surgery (cont’d.)

• Gastrectomy

– Nutrition care after gastrectomy (Table 17-6)

• What are the primary goals of nutrition care after a

gastrectomy?

• Feeding progression: oral intake suspended until

healing occurs; intravenous feeding; first fluids

orally: small sips of water; liquid meals (with no

sugar); soft foods by fourth or fifth day post surgery




• Gastrectomy

– Dumping syndrome: rapid gastric emptying

• Flow from stomach to duodenum: normally

controlled by pyloric sphincter

• Some types of gastric surgery: hypertonic gastric

contents are no longer regulated

• “How To” Alter the Diet to Reduce Symptoms of

Dumping Syndrome

• Case Study – Nutrition Care after Gastric Surgery






• Gastrectomy

– Nutrition problems following a gastrectomy

• Food avoidance; substantial weight loss; and

eventually, malnutrition

• Fat malabsorption

• Bone disease: osteoporosis and osteomalacia

• Anemia




• Bariatric surgery: most effective and

durable treatment for morbid obesity

– Candidates

• BMI: greater than 40

• BMI: between 35 and 40; accompanied by severe

weight-related problems

• Patient should have attempted a variety of

nonsurgical weight-loss measures




• Most popular bariatric surgical procedures

– Gastric bypass: small gastric pouch

constructed; connected directly to the

jejunum

– Gastric pouch: created with an inflatable band

near the top of the stomach

– Comparisons

• Gastric bypass: permanent; more effective

• Gastric pouch: fully reversible






• Nutrition care after bariatric surgery

– Main objectives

• Maximize and maintain weight loss

• Ensure appropriate nutrient intakes

• Maintain hydration

• Avoid complications

– “How To” Alter Dietary Habits to Achieve and

Maintain Weight Loss after Bariatric Surgery




• Postsurgical concerns in gastric bypass

surgery

– Common complaints

• Nausea, vomiting, and constipation

– Long-term complications

• Fat malabsorption, bone disease, and anemia

– Rapid weight loss

• Increases risk of gallbladder disease

Education

NHHC chapter 17 ppt