Transcript 4 short answer question-60 points multiple choice-lecture 7a

Note
Exam
180 minutes
120 multiple choice questions-120 points
-4 short answer question-60 points
multiple choice-lecture 7a-12c inclusive
short answer-whole Nutrition 2105 course
Note
CNS
Diet technician and dietitian positions
[email protected]
Lecture 9a 10 March 2014
Disorders of the Upper GI tract
Mouth
Chewing
Impaired due to:
-sedation and pain
Solution
-mechanical soft diet, food selection or
pureed foods
-what is the difference between these
three solutions?
Mouth
Impaired Chewing continued
Solution
-pureed foods
-can be boring
-bore factor may be overcome by
commercially available thickeners
-thickeners allow one to shape foods so
that look like the original food but
are much easier to chew
Mouth
Impaired Chewing continued
Solution
-pureed foods
-make more appealing by:
variety
colour
serve foods at right temperature
seasonings and spices
supplement with nutritious liquids like
milk, instant breakfasts, or liquid
formulas
Mouth ulcers
-caused by?
Solutions
-moist soft textured foods and
eliminate spicy, salty and acid foods
-example of each of these food
types
Inflammation of throat and lips
-solutions- nutritional approaches-see mouth
ulcers
Reduced flow of saliva: solutions
-moisten foods with sauces and gravies
-problem with this?
-avoid salty foods and snacks (examples) that
dry mouth
-give sugarless candy
Dysphagia
-difficulty swallowing
-due to aging, neurological disorders,
developmental disabilities and strokes
-muscles cannot not push food back to back of
throat or push foods down the esophagus into
stomach
Achalasia
-cardiac sphincter does not open up-it
fails to relax
-food backs up until sphincter opens or
there is regurgitation
Indications of dysphagia
-pain on swallowing, weight loss,
feeling food is sticking in mouth
-tendency to hold food in mouth
rather than swallowing
-choking or coughing during
meals
-frequent throat clearing, drooling or
change in voice quality
Dysphagia
Dietary interventions
-mono-texture meals
-mildly spiced and moderately sweet
foods served at room temperature
-avoid sticky foods and foods that
break into small pieces when eaten
-avoid true liquids – thickened
liquids are better (eg milkshakes
and puddings) as they slide down
more easily
Dysphagia
Solutions
-posture- sit up, feet flat on floor, head tilted
slightly forward to avoid choking
-tube feedings –intestinal tubes may be better
than stomach tubes to avoid aspiration
Esophageal reflux-solutions
-eat small meals and drink liquids one hour
before or after a meal
-limit foods that weaken cardiac
sphincter (fat,alcohol,caffeine)
-lose weight
-avoid cigarettes
-during reflux avoid acidic foods like citric
acid juices, tomatoes, spices, very hot or
very cold foods
Nausea and vomiting
Nausea-solutions
-avoid foods and aromas that make one nauseous
-do not overeat
-drink cold or carbonated liquids upon first
sensation of nausea
-eat carbohydrate-rich, low fat foods before getting
out of bed in morning
-if cyclical , one is avoid food at critical times
-ginger or peppermint teas provide relief for some
people
-relax after eating
Vomiting-solutions
-if vomiting resolves, consume clear
fluids to replace water and electrolytes
-otherwise use intravenous (iv) feedings
Gastritis-solutions
Except as tolerated avoid:
-alcohol and caffeine
-decaffeinated coffee
-pepper and spicy foods
-fatty and greasy foods
-any other offending agent
give B12 as required (injection or prescription
nasal spray) as clinically indicated
Ulcers-solutions
Post-onset
-eat slowly, chew well
-avoid overeating and any foods than
irritate the ulcer
e.g. -alcohol and caffeine
-chocolate
-pepper and spicy foods
Class activity
Design a diet for the pathology/problem of
your choice than meets the dietary
principles of adequacy, variety, moderation,
nutrient density, energy control, and balance
Lecture 9b 10 March 2014
Disorders of the Lower GI tract
Constipation-solutions
At least 25 grams of fibre
Lots of fluids
Eating prunes
Drinking prune juice
Foods containing fibre suitable to assist in the relief
of constipation
1 slice whole wheat bread
1 oz of ready to eat cereal
(100 % bran cereals contain 10 grams of fibre)
1 cup raw bean sprouts
½ cup cooked broccoli , brussel sprouts, carrots,
cauliflower
½ cup chopped raw carrots
1 medium apple, banana, kiwi, orange, pear
½ cup apple sauce, blackberries, blueberries,
strawberries
fruit juices contain very little fibre
Foods containing fibre suitable to assist in the relief
of constipation
½ cup baked beans, blackbeans, blackeyed peas,
kidney beans, navy beans (about 8 grams of fibre)
½ cooked garbanzo beans, lentils, lima beans, split
peas (about 5 grams of fibre)
Foods containing fibre suitable to assist in the relief
of constipation
most whole grain products contain about 1-2 grams
of fibre per serving
most vegetables contain 2 grams-3 grams of fibre
per serving
fresh, dried and frozen fruits contain about 2
grams per serving
many legumes contain about 8 grams of fibre per
serving
Relief of constipation via fibre consumption
fibre adds volume and weight to the stool which
normalises the transit of undigested materials
through the intestine and minimises the pressure
within the colon
Gas
Everybody responds differently to different
foods
Eliminate foods, one by one, to discover
offending foods
Diarrhoea-solutions
-replace lost fluids and electrolytes
-consume diluted fruit juices, sports drinks and
caffeine free-carbonated beverages for mild cases
-use oral rehydration formulas- (salts, sugar and
water)-mild to moderate cases
-severe cases combined with vomiting require
intravenous solutions
-if eating aggravates the situation then withhold
food and diarrhoea should resolve in a day or twopatient should drink only clear fluids in this case
Irritable bowel syndrome
Common motility disorder characterised by
abdominal pain associated with diarrhoea,
constipation i.e. alternating episodes of diarrhoea
and constipation or both diarrhoea and
constipation occurring at the same time
Cause unclear but stress and anxiety have been
suggested
Solutions-Avoid eating too much, too fast or
swallowing without chewing enough
Irritable bowel syndrome-solutions continued
Keep track of fluid and food intake and stool
consistency associated with that fluid and food
intake
Also keep track of other gastrointestinal tract
symptoms at particular times
people may benefit from reduced fat and liberal
fibre and fluid intake
However fibre intake has to be watched-why?
Inflammatory bowel diseases
Crohn’s disease and ulcerative colitis are two of
the most prevalent
In children , Crohn’s gives protein energy
malnutrition (PEM), vitamin and mineral
deficiencies nutritional interventions
-food during day and tube feedings at night
-or tube feedings day and night in severe cases
All Crohn’s patients regardless of age should
reduce lactose intake and avoid high fibre foods
Inflammatory bowel diseases-solutions
For ulcerative colitis no dietary interventions seem
to lessen symptoms
For all inflammatory bowel syndromes- fluid and
electrolytes may have to be replaced by iv
Lactose intolerance-covered in first term
Malabsorption syndromes
Steatorrhea
-malabsorption of fat and energy, essential
fatty acids, fat soluble vitamins and some
minerals
-also get binding of calcium to fatty acids
-this means that binding of calcium to
oxalate in gut is lost-how does this relate
to the last lecture?
Malabsorption syndromes-solutions
-treatment- high kcal and high protein diets are
given-why?
-enzyme supplements given to aid
digestion (pancreatic enzymes
given)
-medium chain fatty acids are giveneasier to digest
-frequent small meals- why?
-fat soluble vitamins given in water
soluble form
-restrict oxalate in diet-why?
Pancreatitis
Acute-solutions
-fluids and electrolytes given iv
-suctioning of gastric secretions to
help relieve pain and distension
-oral intake allowed after abdominal
discomfort subsides and serum
amylase returns to normal levels
-oral feeding starts off with liquid
progressing to fat restricted diet to
normal diet as tolerated
Chronic Pancreatitis
Absorption of fat can be permanently
impaired
solution to this?
Cystic fibrosis-solutions
High kcal diet and high protein diet up
to tolerance limits for protein and energy
As pancreas is damaged fat absorption is
reduced but do not limit fats
Enzyme replacements for fat digestion
Multivitamin and fat soluble vitamins
supplements are routinely given
Cystic fibrosis –solutions continued
Liberal use of table salt to make up for losses in
sweating
Oral diets in day and tube feedings at night for
some people
Breast milk, standard infant formulas and
hydrolysed infant formulas work for infants
provided that enzyme supplements are given
Bacterial overgrowth in stomach
Signs include chronic diarrhea, gas,
malnutrition and weakness
Fat restricted diets to bring down
bacterial growth
Oral mineral and vitamin supplements
except B12 which cannot be absorbed
as the result of this overgrowth
(injections of B12 or prescription B12
nasal sprays required)
Coeliac disease
Avoid gluten (wheat, rye and barley
are out-even trace amounts)
Lactose intolerance may be
permanent
Intestinal surgeries-solutions
IV fluids to restore fluid and electrolyte
imbalances after surgery then tube feedings and
finally regular oral meals (low fibre, soft diets to
prevent irritation and obstruction)
-low fibre, soft diets means avoiding dried fruits,
raw apples and corn, stringy foods (celery,
spinach for example), seeds, mushroom and nuts
Intestinal surgeries-nutritional interventions
B12 supplementation (injection or nasal
spray) if necessary
If diarrhea then give foods that thicken stool
-apple sauce, bananas, cheese, creamy
peanut butter and starchy foods such
as white bread and potatoes
-avoid apple, grape and prune juice,
highly seasoned foods, foods that cause
gas and avoid alcohol and caffeine
Diverticulitis-solutions
Prevent by avoiding low fibre diets
and constipation
-strain of pushing hard stools
creates pockets in intestine
Liquid diets until symptoms subside
Class activity
Design a diet for the pathology/problem of
your choice than meets the dietary
principles of adequacy, variety, moderation,
nutrient density, energy control, and
balance