Transcript Fundamentals of Nutrition

Section 3
Medical Nutrition Therapy
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Chapter 20
Diet and Gastrointestinal Problems
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Objectives
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Explain the uses of diet therapy in the
gastrointestinal disturbances discussed
here
Identify the foods allowed and
disallowed in the therapeutic diets
discussed
Adapt normal diets to meet the
requirements of clients with these
conditions
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GI Tract
Digestion and absorption of food occurs in
the gastrointestinal tract.
Primary organs include mouth, esophagus,
stomach, small and large intestine.
Liver, gallbladder, and pancreas are
accessory organs.
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Dyspepsia
Indigestion, discomfort in the digestive
tract, can be physical or psychological in
origin.
“Heartburn”, bloating, pain, regurgitation.
Psychological stress treatment includes:
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Finding relief from underlying stress
Allowing sufficient time to relax and
enjoy meals
learning to improve eating habits
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Esophagitis
Irritating effect of acidic gastric reflux on
mucosa of esophagus.
Heartburn, regurgitation, and dysphagia.
Chronic, or reflux esophagitis is caused by
recurrent gastroesophageal reflux (GER)
Causes include hiatal hernia, reduced
lower esophogeal sphincter pressure,
abdominal pressure, or recurrent vomiting.
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Hiatal Hernia
A part of the stomach protrudes through
the diaphragm into the thoracic cavity.
The hernia prevents the food from moving
normally along the digestive tract.
Food moves back into the esophagus,
creating a burning sensation (heartburn),
and sometimes food will be regurgitated
into the mouth.
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Hiatal Hernia
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Nutrition Therapy for Hiatal
Hernia
Small, frequent meals; well-balanced diet.
Avoid irritants such as carbonated
beverages, citrus fruits and juices, tomato
products, spicy foods, coffee, pepper, and
some herbs.
Avoid foods that relax sphincter such as
alcohol, garlic, onion, oil or peppermint
and spearmint, chocolate, cream sauces,
gravies, margarine, butter, and oil.
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Nutrition Therapy for Hiatal
Hernia
If client is obese, weight loss may be
recommended.
Avoid lying down 2 to 3 hours after eating.
When lying down, sleep with head and
upper torso elevated.
Surgery may become necessary.
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Peptic Ulcers
Erosion of the mucous membrane.
May occur in the stomach (gastric ulcer) or
the duodenum (duodenal ulcer); cause
unclear.
Factors that predispose: genetics, high
secretion of hydrochloric acid, stress,
excessive use of aspirin or ibuprofen,
smoking, Helicobacter Pylori bacteria.
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Peptic Ulcers
Symptoms include gastric pain (burning
relieved with food or antacids),
hemorrhage (usually requires surgery).
Treatment: drugs such as antibiotics and
cimetidine to kill bacteria and inhibit acid
secretion respectively. Antacids neutralize
excess acid.
Rest and counseling.
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Peptic Ulcers
Sufficient low-fat protein should be
provided.
No less than 0.8g of protein per kilogram
of body weight recommended.
Avoid caffeine containing beverages,
alcohol, aspirin, smoking.
Well-balanced diet of three meals a day.
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Ulcers
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Diverticulosis/Diverticulitis
Diverticulosis is an intestinal disorder
characterized by little pockets in sides of
the large intestine where food gets trapped.
Diverticulitis can result from bacteria
breeding in these pockets.
Cause is diet lacking sufficient fiber.
Diet treatment includes clear liquid diet,
then low-residue progressing to high fiber
over several weeks.
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Diverticulosis
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Residue-controlled Diets
Residue is the solid part of feces. Residue
is made up of all the undigested and
unabsorbed parts of food (including fiber),
connective tissue in animal foods, dead
cells, and intestinal bacteria and their
products. Most of this residue is
composed of fiber. Diets can be adjusted
to increase or decrease fiber and residue.
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The High-fiber Diet
30g or more of dietary fiber is believed to
help prevent diverticulosis, constipation,
hemorrhoids, and colon cancer.
A high-fiber diet is often 25 to 35g.
Coarse and whole grain breads and cereals,
bran, all fruits, vegetables (especially raw),
and legumes.
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Low-residue Diet
5 to 10g of fiber a day is intended to
reduce the normal work of the intestines
by restricting the amount of dietary fiber
and reducing food residue.
Low-fiber or residue-restricted diets may
be used in cases of severe diarrhea,
diverticulitis, ulcerative colitis, and
intestinal blockage and in preparation for
and immediately after intestinal surgery.
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Stop and Share
A client with severe diarrhea has been
placed on a low-residue diet.
What kinds of foods would you
recommend for the client?
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Stop and Share
Milk, buttermilk (limit to 2 cups/day)
Cottage cheese and some mild cheeses
Butter and margarine
Eggs, except fried
Tender chicken, fish, sweetbreads, ground
beef, and ground lamb
Soup broth
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Stop and Share
Cooked, mild-flavored vegetables without
coarse fibers
Refined breads and cereals, white crackers,
macaroni, spaghetti, and noodles.
Custard, sherbet, vanilla ice cream.
Coffee, tea, cocoa, carbonated beverage.
Salt, sugar, small amount of spices as
permitted.
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Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is a
chronic condition causing inflammation in
the GI tract.
Two examples include ulcerative colitis
and Crohn’s disease.
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Ulcerative Colitis
Causes inflammation and ulceration
of the colon, the rectum or,
sometimes, the entire large intestine.
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Crohn’s Disease
Chronic progressive disorder that can
affect both the small and large
intestines.
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Symptoms of Inflammatory
Bowel Disease
Bloody diarrhea
Cramps
Fatigue
Nausea
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Anorexia
Malnutrition
Weight loss
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Treatment of Inflammatory
Bowel Disease
Anti-inflammatory drugs
Medical nutrition therapy
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Low-residue diet
100g of protein, additional kcal, vitamins,
and minerals
Severe cases may require total parenteral
nutrition (TPN)
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Ileostomy or Colostomy
Clients with inflammatory bowel disease
may require a surgical opening, a stoma,
from the body surface to the intestine for
the purpose of defecation.
Ileostomy: from ileum to abdomen
surface.
Colostomy: from colon to abdomen
surface.
May be temporary or permanent.
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Ileostomy or Colostomy
Clients with ileostomies have a greater
than normal need for salt and water
because of excess losses.
A vitamin C supplement is recommended,
and, in some cases, a B12 supplement may
be needed.
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Celiac Disease
Nontopical sprue or gluten sensitivity
Characterized by malabsorption of
virtually all nutrients.
Thought to be hereditary.
Symptoms include diarrhea, weight loss,
and malnutrition. Stools are foul-smelling,
light-colored, and bulky.
Cause unknown.
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Celiac Disease
Elimination of gluten from diet gives
relief.
A gluten-controlled diet is used to treat
celiac disease.
Gluten is a protein found in barley, oats,
rye, and wheat.
Difficult to avoid these products.
Rice and corn may be used.
Read labels.
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Cirrhosis
Liver disease may be acute or chronic.
Cirrhosis is a general term referring to all
types of liver disease characterized by cell
loss.
Alcohol abuse is the most common cause
of cirrhosis.
Other causes include congenital defects,
infections, or other toxic chemicals.
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Cirrhosis
Liver does regenerate, however, the
replacement during cirrhosis does not
match the loss.
Complications include hypertension,
anemia, hemorrhage in the esophagus.
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Cirrhosis
Dietary treatment of cirrhosis provides at
least 25 to 35 kcal or more, and 0.8 to 1.0g
of protein per kilogram of weight each day.
Supplements of vitamins and minerals are
usually needed.
In advanced cirrhosis, 50 to 60% of the
kcal should be from carbohydrates.
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Cirrhosis
Sometimes cirrhosis causes ascites.
Sodium and fluids may be restricted.
If there is bleeding in the esophagus, fiber
can be restricted to prevent irritation of the
tissue.
Smaller feedings will be better accepted
than larger ones.
No alcohol is allowed.
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Hepatitis
Inflammation of the liver.
Caused by viruses or toxic agents such as
drugs and alcohol.
Hepatitis A virus (HAV) contracted
through contaminated drinking water,
food, and sewage via a fecal-oral route.
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Hepatitis
Hepatitis B virus (HBV) and hepatitis C
virus (HCV) are transmitted through
blood, blood products, semen, and saliva.
Hepatitis B and C can lead to chronic
active hepatitis (CAH), which is diagnosed
by liver biopsy.
Chronic active hepatitis can lead to liver
failure and end stage liver disease (ESLD).
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Hepatitis
Symptoms may include nausea, headache,
fever, fatigue, tender and enlarged liver,
anorexia, and jaundice (yellow cast of the
skin and eyes). Weight loss can be
pronounced.
Treatment involves bed rest, plenty of
fluids, diet therapy.
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Diet Therapy for Hepatitis
Diet should provide 35 to 40 kcal per
kilogram of body weight.
Most kcal should be provided by
carbohydrates; moderate amounts of fat;
and if the necrosis has not been severe, up
to 70 to 80grams of protein for cell
regeneration.
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Diet Therapy for Hepatitis
If the necrosis has been severe and the
proteins cannot be properly metabolized,
they must be limited to prevent the
accumulation of ammonia in the blood.
Clients may prefer frequent, small meals
rather than three large ones.
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Cholecystitis and Cholelithiasis
Being female, obesity, total parenteral
nutrition (TPN), very-low-calorie diets for
rapid weight loss, the use of estrogen, and
various diseases of the small intestine are
frequently associated.
Cholecystitis: Inflammation of gallbladder
Cholelithiasis: Gallstones
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Cholecystitis and Cholelithiasis
Inhibit the flow of bile and cause pain.
Symptoms include pain, which can be
severe, indigestion, and vomiting
(particularly after the ingestion of fatty
foods).
Treatment may include medication to
dissolve the stones and diet therapy.
Surgery may be indicated.
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Cholecystitis and Cholelithiasis
Diet therapy includes abstinence during
acute phase.
Followed by clear liquid diet and,
gradually, a regular but fat-restricted diet.
Fats allowed range from 40 to 45 grams a
day.
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Pancreatitis
Inflammation of the pancreas.
May be caused by infections, surgery,
alcoholism, biliary tract (includes bile
ducts and gallbladder) disease, or certain
drugs.
May be acute or chronic.
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Pancreatitis
Symptoms include abdominal pain, nausea
and steatorrhea (abnormal amounts of fat
in the feces).
Malabsorption (particularly of fat-soluble
vitamins) and weight loss.
If islets of Langerhans are destroyed,
diabetes mellitus may result.
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Pancreatitis
During acute pancreatitis, the client is
nourished strictly parenterally.
Later, when the client can tolerate oral
feedings, a liquid diet consisting mainly of
carbohydrates is given because, of these 3
nutrients, carbohydrates have the least
stimulatory effect on pancreatic secretions.
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Pancreatitis
As recovery progresses, small, frequent
feedings of carbohydrates and protein with
little fat or fiber are given.
Vitamin supplements may be given.
Alcohol is forbidden in all cases.
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Conclusion
A wide variety of therapeutic diets are
used for clients with GI disturbances.
Peptic ulcers: drugs, avoidance of alcohol
and caffeine.
Diverticulosis: high-fiber diet.
Diverticulitis: gradual progression from
clear liquid to high-fiber diet.
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Conclusion
Ulcerative colitis: low-residue diet
combined with high protein and high kcal.
Cirrhosis: substantial, balanced diet, with
occasional restrictions of fat, protein, salt,
or fluids.
Hepatitis: full, well-balanced diet,
although protein may be restricted.
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Conclusion
Cholescystitis and cholelithiasis: fatrestricted diet and, in cases of overweight,
a kcal-restricted diet as well.
Pancreatitis: TPN to individualized diet as
tolerated.
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