Transcript Upper GI - CSU, Chico

Upper GI
NFSC 370 - Clinical Nutrition
McCafferty
Anatomy: Review
• Mouth
– Salivary glands
– Food chewed and mixed w/saliva. Bolus is moved
toward pharynx and swallowing is stimulated
• Esophagus: Extends from pharynx to stomach
– Protected by mucus
– Empty and collapsed at rest
– Esophagus is maintained empty by 2 sphincters
• UES - Upper Esophageal Sphincter – first 2-3 cm of
the esophagus. Thickening of circular muscle layer
which allows food to move from the mouth to the
esophagus
• LES - Lower Esophageal Sphincter – (AKA Cardiac
sphincter) Between esophagus and stomach.
No structural difference (no thickening) but high
intraluminal pressure that keeps it closed until food
needs to be dumped into the stomach. This prevents
gastric reflux.
• Stomach
– Upper portion (fundus/orad region) Storage occurs
here. Little muscle tone so it can bulge outward:
“active relaxation.” Little contractile activity.
– Lower portion (body, antrum) Mixing moves contents
toward antrum. With each wave, a few ml of chyme
move into duodenum, but most is pushed back for
more mixing w/gastric secretion (retropulsion).
– As the stomach empties, contractions begin further up
the body to bring down stomach contents.
– Pyloric Sphincter connects stomach to duodenum
• Small Intestine (duodenum, jejunum, ileum)
bulk of nutrient absorption
– structural folds in lining (less in ileum), including
villi and microvilli (brush border)
– ileocecal sphincter (ileocecal valve) connects s.i. to
large intestine.
• Large Intestine (colon) bulk of fluid and
electrolyte absorption
• Rectum/Anus – holding/excretion of fecal
matter.
LES
Pyloric sphincter
Disorders of the Mouth and
Esophagus
• Difficulties Chewing (masticating) can lead to wt.
loss and compromised nutritional status.
• Depending on the problem (individualized!) soft
or pureed foods may be used. (remember this is
just a regular diet that’s mechanically modified).
– keep as wide a variety of foods as possible, and use
appropriate temperatures/variety of colors
Conditions that may interfere w/chewing
and swallowing:
1. Mouth ulcers (2’ viruses, drugs, radiation therapy)
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2. Inadequate Saliva Production
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– Encourage good oral hygiene Encourage sucking on
sugarless candy/chewing sugarless gum
Difficulties Swallowing –
DYSPHAGIA
• Causes:
• Diagnosis: ____________________________,
x-ray, measurement of UES pressure,
fluoroscopy.
• Dangerous and often undiagnosed:
– “food gets stuck in my throat”
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Watch for:
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 aspiration
 food caught in trachea/lungs 
 “Silent” aspiration:
Nutrition Therapy
• Individualized according to pt.’s particular
swallowing problem
• Mechanical soft “solids” and smooth or
thickened liquids are easiest to handle
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• Tube feedings may be necessary
– TF into stomach still risks aspiration pneumonia
– Safer:
Nutrition Therapy
• Monitor patient for
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Disorders of the Esophagus and
Stomach
Indigestion and Reflux Esophagitis (GERD)
• Indigestion (dyspepsia) = vague term for
epigastric pain, fullness, early satiety,
belching, hiccups, heartburn and regurgitation
of stomach acid into the esophagus.
• Recurrent acid reflux irritation of
esophageal mucosa 
• Severe inflammation may cause:
• Causes
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Nutrition Therapy
• Alleviate reflux and irritation by
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• “CAPA-free diet” (peptic ulcer diet)
• Foods that decrease LES pressure or increase
acid secretion:
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• Small meals w/ fluids between meals
• Eat slowly, relax, chew food thoroughly
• Elevate head of bed and/or refrain from
lying down after eating.
• Avoid tight clothing that increases
abdominal pressure.
Drug Therapy
• Antacids
• Antiulcer agents
• Cholinergics
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Hiatal Hernia –
Protrusion of stomach
into the chest cavity
through the
esophageal hiatus of
the diaphragm
Normally, the LES sits
right in the hiatus of
the diaphragm and is
reinforced by it.
Cause: hiatus weakens
allowing a portion of the
stomach to protrude above
the diaphragm.
Most common: “sliding”
hiatal hernia.
Pressure generated by the
hernia is sufficient to force
acidic stomach contents
into the esophagus.
Nutrition Therapy
Same as for reflux
esophagitis.
Gastritis
Inflammation of the stomach mucosa
– pain, n/v.
• Acute Gastritis:
– asprin/alcohol use, food allergies, food
poisoning, radiation therapy, metabolic stress,
bacterial infection
– n/v:
• Chronic Gastritis (atrophic gastritis):
– May be associated w/ chronic disease or
no known etiology.
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Peptic Ulcer Disease (PUD)
Erosion of cells of the top layer of mucosa
(gastric, duodenal, esophageal).
– Underlying layers exposed to stomach
acid/peptidases.
– If 
– If 
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• Causes:
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– Disorders that cause excessive gastric acid
production (less common)
– Zollinger-Ellison syndrome: tumor in pancreas
secretes excessive amts. of gastrin, causing
hypersecretion of gastric acid,  ulcers
• Nutrition Therapy
– Minimizing pain/irritation, promoting
healing.
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• Drugs
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• decrease gastric secretions or otherwise
protect mucosa from further erosion.
Gastric Surgery
• Gastrectomy
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• Pyloroplasty
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• Gastric partitioning
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• Gastric Bypass
• Nutritional consequences
– If duodenum is bypassed:
•  absorption of:
• Patients are required to take nutritional
supplements that usually prevent these
deficiencies.
– Dumping Syndrome:
Mr. C had extensive gastric resection 1 wk ago, and
has just begun to eat solids. About 15 minutes after
eating he begins to feel weak and dizzy. He looks
pale, his heart beats rapidly, and he breaks out into a
sweat. Shortly thereafter, he develops diarrhea. What
has happened?
• Pylorus removed
• Partially digested food is “dumped” into the
jejunum
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• Fluid from body (capillaries) enters jejunum
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• Result:
The pt. may experience the same symptoms again a
few hours later… why?
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• Most people who experience dumping gradually
adapt to a fairly regular diet.
Nutrition Therapy: The Post-Gastrectomy Diet
– NPO post-surgically for several days.
• Advanced to liquids, then solids.
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– High protein, moderate fat
– ADAT (close monitoring of tolerances)
– Monitor fluid and lytes/hydration
– Gastric bypass patients:
• 1 week
• 2 weeks
• 2 weeks
• 2 weeks
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Nutrition-related Gastrectomy Complications
• Weight loss, malabsorption, nutrient
deficiencies.
– Limited intake 2 early satiety, post-surgical pain, &
dumping
– Reflux esophagitis
– Prot and fat malabsorption
• Normally, food entering the duodenum triggers
the release of hormones such as CCKsecretion
of digestive enzymes & bile.
• Duodenum bypassed: fat D&A interrupted.
• Accelerated transit of food  absorption
– Anemia – Fe-deficiency common after gastric
surgery. (may take time to show up)
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– B12 def from  IF prod?
– Bone disease –