Outline

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Outline GI Lecture 1
I. Reminder for Recitation Bring Appropriate
Text(s) Calculator II. Relationship
between illness and nutrition III. Review of
upper GI physiology IV. Definition Dietary Trt
for Common GI Problems V. Disorders of Mouth,
Esophagus, and Stomach
http//www.msu.edu/course/hnf/470/
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Common Digestive Problems
Choking Vomiting Heartburn
Ulcers Diarrhea Belching
and Gas Constipation
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Choking Food lodges in airway breathing cut
off. Common causes tough meats, hot dogs,
nuts, grapes, carrots, hard candy,
etc. Help Ask if victim can say anything.
If not, use Heimlich maneuver. Vomiting Loss
of stomach contents by reverse peristalsis. Mas
sive fluid loss causes electrolyte
imbalances, N/V, possible cardiac
complications. Restore fluids po or via IV
saline/dextrose solution.
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Chewing and Swallowing Disorders
Cause? Numerous (see Table 21-1) Include
dental, medical and surgical conditions.
Eating may be difficult and painful, resulting
in kcal and protein deficits
deteriorating nutritional status
Dx and Trt may be prescribed (MD/DO) OR
Dietitians nutritional assessment may be first
to identify.
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In All Cases Individualize the Diet!
Whether caused by surgery, mouth ulcers, or low
saliva flow Use of mechanical soft diets
(excludes foods difficult to chew or swallow) or
pureed diets--LONG TERM-- is associated with
increased nutritional risk. The
Challenges! Minimize nutrient deficiencies C
hoose foods to enhance appetite Prevent
boredom!
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Contraindicated Foods
Mouth Ulcers Spicy, acidic or salty
foods Foods with nuts or seeds Excessively
hot temperatures Reduced Saliva Flow Savory
(salty) snacks that draw moisture from the
mouth. Dental hygiene important! Drugs
Enhance saliva production Lozenges
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What is Dyphagia? Who is at risk?
Disordered or Difficult Swallowing AGING S
troke patients Neurological Disorders Developm
ental Disabilities (DD) Many causes Often
goes undiagnosed Typical Problem Repeated
Aspiration of Food into the Lungs
Aspiration Pneumonia
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Dietary Interventions for Dysphagia
Standard Use of mechanical soft diet Good
choices smooth solid foods yogurt
puddings custards Baby foods Use
commercial thickeners Tube Feedings? Jejunostomy
tube safest. Delivery to stomach OK but
risk of aspiration is HIGH.
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Heartburn/ Indigestion
Burning in esophagus cause epigastric
pain. Stomach contents reflux into
esophagus. Overeating/drinking, smoking,
certain medications, Too tight clothing. Remedies
Eat small meals Drink 1 hr before or after
meals Dont lie down after meals Elevate head
of bed 4 to 6 Refrain from cigarette smoking
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Acid Reflux Disorders
Reflux Hiatal Esophagitis hernia
Inflammation, scarring due to acid flux into
esophagus
Protrusion of The stomach thru The Cardiac
Sphincter
Reduce gastric acidity Eliminate foods etc.
that Weaken cardiac sphincter- Alcohol
chocolate garlic Onions Ca Blockers High
fat Anticholinergics foods
Enteral feeding tubes, Aging, Certain drugs
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Ulcers
Helicobacter pylori infection
Causes
Anti-inflammatory medications Excessive
gastric acid secretion syndromes
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Diet Therapy for Ulcers?
Not a major treatment strategy. Current
practice Treat source of infection. Eliminate
problem foods. Avoid caffeine- and alcohol-
containing beverages ( gastric acid
secretions aggravate existing ulcers)
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Gastritis
Alcohol Radiation Abuse
Therapy Metabolic Stress
Food Bacterial Infection
Poisoning
Acute
Transition
Trt Withhold food 1-2 days Liquid diet
Bland Diet Colas,
Cocoa Bland diet? Avoid irritating foods
Caffeine Coffee, Tea Alcohol
Decaf coffee or tea Pepper/ spicy foods
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Gastric Bacterial Surgery
Infection Liver Disease
Idiopathic
Gastritis
Chronic
Appropriate Medical Trt Bland Diet
Long-term effects of gastritis Vitamin B12
deficiency (2 to Intrinsic
Factor) Perforation Ulcers Malnutrition
Esophagitis
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Nutritional Complications of GI Surgeries
What puts them at nutritional risk? Early
satiety Postsurgical or epigastric pain
Fear of dumping sx
Weight Loss, Serum Proteins
(Total Gastrectomies, Jejunostomies Protein AND
Fat Malabsorption)
Significant Resection of Gastric Mucosa Loss of
IF production
Risk of B12 deficiency
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Nutritional Complications of GI Surgeries
Malabsorption of Folate Macrocytic
Anemia Iron Microcytic Anemia
Fat Malabsorption Osteomalacia
Vitamin D absorption (soft bone disease)
(2 Ca absorption)
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Postgastrectomy Diet
Transition from liquids to solids
gradually Limit simple sugars Frequent small
meals Liquids in small amts 45 min lt gt eating.
Prevent Dumping Syndrome!!
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Diarrhea
Loose, watery stools caused by fluid moving too
quickly into GI tract for absorption to
occur. Replace fluids po or IV
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Constipation
Defecation with discomfort, pain, or
difficulty. Causes Lack of physical
activity Low levels of dietary
fiber Inadequate water intake With physician
laxatives enemas mineral oil
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