Transcript Fundamentals of Nutrition - Delmar

Chapter 20
Diet and Gastrointestinal Problems
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Objectives
• Explain uses of diet therapy in gastrointestinal
disturbances
• Identify foods allowed and disallowed in
therapeutic diets discussed
• Adapt normal diets to meet requirements of
clients with conditions discussed
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Gastrointestinal Tract
• Where digestion and absorption of food occurs
• Primary organs:
– Mouth, esophagus, stomach, small intestine, and large
intestine
• Accessory organs:
– Liver, gallbladder, and pancreas
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Dyspepsia
• Also known as indigestion
• Discomfort in digestive tract of physical or
psychological origin
• Symptoms:
– Heartburn, bloating, pain and regurgitation
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Dyspepsia
• Treatment:
– Treat underlying organic cause
– Stress management if psychological
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Esophagitis
•
•
•
•
Irritation of mucosa of esophagus
Causes heartburn, regurgitation, and dysphagia
May be acute or chronic
Causes:
– Hiatal hernia, reduced lower esophageal sphincter pressure,
abdominal pressure, recurrent vomiting, alcohol use,
overweight, and smoking
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hiatal Hernia
• Part of stomach protrudes through diaphragm
into thoracic cavity
– Prevents food from moving normally along digestive tract
• Heartburn and food regurgitation into mouth
can occur
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hiatal Hernia
• Medical nutrition therapy
–
–
–
–
–
Small, frequent meals of well-balanced diet
Avoid irritants to esophagus
Avoid foods that relax lower esophageal sphincter
Weight loss recommended if necessary
Avoid lying down two to three hours after eating
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Peptic Ulcers
• Erosion of mucous membrane
• May be gastric or duodenal
• Predisposing factors:
– Genetics, high secretion of hydrochloric acid, stress,
excessive use of aspirin or ibuprofen, smoking, or
Helicobacter pylori bacteria
• Symptoms:
– Gastric pain and sometimes hemorrhage
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Peptic Ulcers
• Treatment:
–
–
–
–
–
Drugs to control acid secretion and kill bacteria
Stress management
Sufficient low-fat protein
Avoidance of caffeine, alcohol, aspirin, and smoking
Well-balanced diet of three meals per day
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Diverticulosis and Diverticulitis
• Diverticulosis
– Formation of little pockets in sides of large intestine where
food gets trapped
• Diverticulitis
– Inflammation in these pockets
• Cause:
– Insufficient dietary fiber
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Diverticulosis and Diverticulitis
• Treatment:
– For diverticulosis, high-fiber diet
– For diverticulitis, antibiotics and progressive diet to allow
bowel to rest
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Stop and Share
• Consider the following scenario:
– A client with severe diarrhea has been placed on a lowresidue diet. What kinds of foods would you recommend?
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Stop and Share
• Milk and buttermilk
– Limit to 2 cups per day
• Cottage cheese and some mild cheeses
• Butter and margarine
• Eggs
– Except fried
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Stop and Share
• Tender chicken, fish, sweetbreads, ground
beef, and ground lamb
• Soup broth
• Cooked, mild-flavored vegetables without
coarse fibers
• Refined breads and cereals, white crackers,
macaroni, spaghetti, and noodles
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Stop and Share
• Custard, sherbet, or vanilla ice cream
• Coffee, tea, cocoa, or carbonated beverages
• Salt, sugar, or small amount of spices as
permitted
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Inflammatory Bowel Disease
• Chronic condition causing inflammation in
gastrointestinal tract
• Ulcerative colitis
– Inflammation and ulceration of colon, rectum, or entire
large intestine
• Crohn’s disease
– Chronic progressive disorder
– Can affect both small and large intestines
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Symptoms of Inflammatory Bowel
Disease
•
•
•
•
•
•
•
Bloody diarrhea
Cramps
Fatigue
Nausea
Anorexia
Malnutrition
Weight loss
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Treatment of Inflammatory Bowel
Disease
• Anti-inflammatory drugs
• Medical nutrition therapy
– Low-residue diet
– When tolerated, 100 g of protein, additional calories,
vitamins, and minerals
– Severe cases may require total parenteral nutrition (TPN)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Ileostomy or Colostomy
• Stoma or surgical opening from body surface
to intestine for purpose of defecation
• Ileostomy
– From ileum to abdomen surface
• Colostomy
– From colon to abdomen surface
• May be temporary or permanent
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Ileostomy or Colostomy
• Clients with ileostomies have greater than
normal need for salt and water because of
excess losses
• Vitamin C supplement recommended
• In some cases, B12 supplement required
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Celiac Disease
• Also known as nontropical sprue or gluten
sensitivity
• Malabsorption of virtually all nutrients
• Symptoms:
– Diarrhea, weight loss, malnutrition, and foul-smelling,
light-colored, bulky stools
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Celiac Disease
• Cause unknown
– Considered to be hereditary
• Treatment:
– Gluten-controlled diet
• Protein found in barley, oats, rye, and wheat
• May use rice and corn
• Must read food labels
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cirrhosis
• General term for liver disease characterized by
cell loss
• May be acute or chronic
• Most often caused by alcohol abuse
• Other causes:
– Congenital defects, infections, or other toxic chemicals
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cirrhosis
• Liver does regenerate
– But replacement during cirrhosis does not match loss
• Complications:
– Hypertension, anemia, hemorrhage in esophagus, ascites,
and death
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cirrhosis
• Dietary treatment:
–
–
–
–
–
–
–
25 to 35 calories or more per kg per day
0.8 to 1.0 g of protein per kg per day
May not tolerate fats or proteins well
May need to increase CHO
May supplement with vitamins and minerals
May need to restrict fibers if bleeding
No alcohol allowed
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hepatitis
• Acute or chronic inflammation of liver
• Causes:
– Viruses
– Toxic agents
• E.g., drugs, alcohol
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hepatitis
• Hepatitis A virus (HAV) contracted through
contaminated drinking water, food, and
sewage via fecal-oral route
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hepatitis
• Hepatitis B virus (HBV) and hepatitis C virus
(HCV) transmitted through blood, blood
products, semen, and saliva
– Can lead to chronic active hepatitis (CAH)
• Diagnosed by liver biopsy
• Chronic active hepatitis can lead to liver
failure and end-stage liver disease (ESLD)
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hepatitis
• Symptoms:
– Nausea, headache, fever, fatigue, tender and enlarged liver,
anorexia, and jaundice
• Weight loss can be pronounced
• Treatment:
– Bed rest, fluids, and medical nutrition therapy
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medical Nutrition Therapy for
Hepatitis
•
•
•
•
35 to 40 calories per kg of body weight per day
Provide most calories by carbohydrates
Have moderate fat intake
If necrosis not severe, up to 70 to 80 g of
protein needed for cell regeneration
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medical Nutrition Therapy for
Hepatitis
• If necrosis severe, limit proteins to prevent
accumulation of ammonia in blood
• Clients may prefer frequent, small meals
– Rather than three large meals
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cholecystitis and Cholelithiasis
• Cholecystitis
– Inflammation of gallbladder
• Cholelithiasis
– Gallstones
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cholecystitis and Cholelithiasis
• Contributing factors:
– Being female, obesity, TPN, very low calorie diets for
rapid weight loss, estrogen use, and various diseases of
small intestine
• Both may inhibit flow of bile
• Symptoms:
– Pain, indigestion, and vomiting
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cholecystitis and Cholelithiasis
• Treatment:
– Medication to dissolve stones
– Diet therapy
• Abstinence during acute phase followed by clear liquid diet and,
gradually, regular fat-restricted diet
– Surgery may be indicated
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Pancreatitis
• Inflammation of pancreas
• Causes:
– Infections, surgery, alcoholism, biliary tract disease, or
certain drugs
• May be acute or chronic
• Symptoms:
– Abdominal pain, nausea, steatorrhea, and weight loss
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Pancreatitis
• Diabetes mellitus may be complication
• Diet therapy:
– During acute phase, strict parenteral nutrition
– Later, liquid diet of carbohydrates to minimize stimulatory
effect on pancreatic secretions
– As recovery progresses, small, frequent feedings of
carbohydrates and protein with little fat or fiber
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Pancreatitis
• May give vitamin supplements
• Alcohol forbidden in all cases
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Residue-Controlled Diets
• Residue made up of all undigested and
unabsorbed parts of food, connective tissue in
animal foods, dead cells, and intestinal bacteria
and their products
– Most composed of fiber
• Diets can be adjusted to increase or decrease
fiber and residue
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
High-Fiber Diet
• Often 30 g or more
• Helps prevent diverticulosis, constipation,
hemorrhoids, and colon cancer
• Sources:
– Coarse and whole-grain breads and cereals, bran, all fruits,
vegetables (especially raw), and legumes
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Low-Residue Diet
• 5 to 10 g of fiber per day intended to reduce
normal work of intestines by reducing food
residue
• May be used in cases of severe diarrhea,
diverticulitis, ulcerative colitis, intestinal
blockage, and in preparation for and
immediately after intestinal surgery
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Conclusion
• Wide variety of therapeutic diets used for
clients with gastrointestinal disturbances
– Peptic ulcers
• Medications, avoidance of alcohol, and caffeine
– Diverticulosis
• High-fiber diet
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Conclusion
• Wide variety of therapeutic diets used for
clients with gastrointestinal disturbances
– Diverticulitis
• Gradual progression from clear liquid to high-fiber diet
– Ulcerative colitis
• Low-residue diet combined with high protein and high calories
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Conclusion
• Wide variety of therapeutic diets used for
clients with gastrointestinal disturbances
– Cirrhosis
• Substantial, balanced diet, with occasional restrictions of fat,
protein, salt, or fluids
– Hepatitis
• Full, well-balanced diet
– Although protein may be restricted
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Conclusion
• Wide variety of therapeutic diets used for
clients with gastrointestinal disturbances
– Cholecystitis and cholelithiasis
• Fat-restricted diet and, in cases of overweight, addition of calorierestricted diet
– Pancreatitis
• TPN to individualized diet as tolerated
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.