Transcript Upper GI
Chapter 17 Nutrition & Upper Gastrointestinal Disorders © 2007 Thomson - Wadsworth Dry Mouth: Xerostomia • Reduced salivary flow Side-effect of medications Poorly controlled diabetes Sjogren’s syndrome Radiation therapy Mouth breathing • Consequences Increased plaque Tooth & gum disease Mouth infections Interference with speech Bad breath Difficulty chewing & swallowing Diminished taste Ulcers from dentures Reduced food intake © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Dysphagia: Difficulty Swallowing • Oropharyngeal dysphagia Transfer of food from mouth to esophagus Problem of tongue, other oral tissues or swallowing reflex • Symptoms Inability to initiate swallowing Coughing during or after swallowing Nasal regurgitation Bad breath “Wet” voice • Stroke is a frequent cause © 2007 Thomson - Wadsworth Dysphagia: Difficulty Swallowing • Esophageal dysphagia • Causes Transfer of food through esophagus to stomach Complaints of “food sticking” after swallowing Obstruction in esophagus Motility disorder • Aspiration: a potential complication of oropharyngeal or esophageal dysphagia © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth National Dysphagia Diet • Level 1: Dysphagia pureed Moderate to severe dysphagia Poor oral or chewing ability • Level 2: Dysphagia mechanically altered Mild to moderate dysphagia • Level 3: Dysphagia advanced Mild dysphagia • Level 4: Liquid consistencies Thin Nectarlike Honeylike Spoon-thick © 2007 Thomson - Wadsworth Food Properties & Preparation • Offer Easy to manage textures & consistencies Soft, cohesive foods Moist rather than dry One texture at a time Thickeners Pureed, mashed, ground, or minced • Avoid Sticky or gummy foods Nuts & seeds More than one texture Thin liquids • Use a variety of colors & shapes © 2007 Thomson - Wadsworth Gastroesophageal Reflux Disease • GERD Reflux of acidic stomach contents into the esophagus Heartburn or acid indigestion Causes discomfort & may cause tissue damage • Conditions associated with GERD Pregnancy Asthma Hiatal hernia Obesity Large meals Some medications Nasogastric tubes • Treatment Proton-pump inhibitors Histamine-2-receptor blocking agents © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Conditions Affecting the Stomach • Dyspepsia • Nausea & Vomiting • Gastritis • Peptic Ulcer © 2007 Thomson - Wadsworth Dyspepsia • General discomfort in the upper abdominal area • Teaching Small meals with well-cooked foods Lightly seasoned Relaxed atmosphere • Causes Peptic ulcers GERD Motility disorders Malabsorption disorders Gallbladder disease Tumors in abdominal region Some medications & dietary supplements © 2007 Thomson - Wadsworth Nausea & Vomiting • Accompanies many • Dietary illnesses interventions Eating & drinking • Common side effect slowly of many medications Small meals • Correct underlying Clear, cold disorder beverages • May need to restore Dry salty foods hydration Foods cold or at room temperature © 2007 Thomson - Wadsworth Gastritis • Inflammation of the stomach mucosa • Causes Helicobacter pylori infection Irritating substances Damage to stomach lining (diseases/ treatments) • Acute erosive gastritis or chronic atrophic gastritis • Complications Low or absent hydrochloric acid Impaired absorption of nonheme iron & vitamin B12 • Dietary interventions Avoid alcohol, coffee, tea, cola, spicy foods, & fatty, greasy foods © 2007 Thomson - Wadsworth Peptic Ulcer • Gastric & duodenal • Causes Effects of hydrochloric acid & pepsin Helicobacter pylori infection Non-steroidal antiinflammatory drugs • Other risk factors Cigarette smoking Emotional stress Genetic factors © 2007 Thomson - Wadsworth Peptic Ulcers • Signs & symptoms Hunger pain Sensation of gnawing Burning in stomach • Complication GI bleeding • Weak & fatigued • Black, tarry stools • Coffee ground vomit • Drug therapy Antibiotics Discontinue aspirin & NSAIDS Antisecretory agents Bismuth preparations or sucralfate • Avoid irritating foods • Avoid large meals © 2007 Thomson - Wadsworth Gastric Surgery • Treatment for Severe obesity Peptic ulcer Stomach cancer © 2007 Thomson - Wadsworth Gastrectomy • Removal of diseased portions of the stomach • Other Vagotomy: suppresses acid secretion Pyloroplasty: widens pyloric sphincter from stomach to the duodenum • Postgastrectomy diet Several small meals & snacks Progress to 5-6 small meals/day Avoid sweets & sugars Fiber to delay stomach emptying Avoid irritating foods May need to avoid milk products (lactose intolerance) Liquids between meals © 2007 Thomson - Wadsworth Typical Gastric Surgery Resections © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Post-Surgical Problems • Dumping Syndrome Abnormally rapid gastric emptying Goals • Limit amount of food reaching the intestine • Slow rate of gastric emptying • Reduce foods that increase hypertonicity • Fat malabsorption Deficiencies of fatsoluble vitamins & some minerals • Bone disease Malabsorption of calcium & vitamin D • Anemia Impaired iron & vitamin B12 absorption due to decreased hydrochloric acid © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Bariatric Surgery • Creates a gastric pouch which restricts meal size to about a cup • Bypasses part of small intestine, decreasing absorption • Lose between 49-62% of excess weight • After weight loss, may need plastic surgery to remove excess skin • Progressive diet • Fluids consumed separately • Education on food portions To avoid dumping syndrome To maintain weight loss • Need dietary supplements © 2007 Thomson - Wadsworth © 2007 Thomson - 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