Dental problems are more common in the elderly and those of lower socioeconomic background.
Use Table 18-1 for information on liquid feedings.
Problems with the oral tissues can be quite painful and can cause significant malnutrition if left untreated.To counteract decreased saliva production, eat more foods that have a higher liquid content. Artificial saliva also can be used.
A, Gingivitis. B, Stomatitis. C, Glossitis. D, Cheilosis.
A common symptom of dysphagia is recurrent pneumonia from aspiration.Affects 40% to 60% of nursing home residents.Seen in patients with head trauma, brain tumors, or strokes.Also common in late-stage Alzheimer’s disease and Parkinson’s disease.
Careful monitoring of patients—especially those in a nursing home setting—can help identify dysphagia early.Usually diagnosed by modified barium swallow study, a radiologic examination that evaluates how the patient swallows foods of different textures to detect aspiration or other problems.Treatment is usually a modification in the texture of the diet.
Esophageal disorders usually require medical intervention such as stretching or surgery.
The term cardiospasm is misleading because the condition does not affect the heart.Complications can be quite serious and usually require surgical intervention.
What is the classic symptom of GERD? (Frequent and severe heartburn)GERD is quite common, but many people do not seek treatment.Methods for controlling GERD include staying upright for 2 hours after meals and avoiding common irritants.
Case Study:Mr. Max is a 38-year-old male who has been diagnosed with GERD. Testing revealed he has a narrowing of his esophagus from the GERD. His symptoms consisted of food (even though chewed thoroughly) getting caught in his throat, and frequent and severe heartburn about 1 hour after eating. He also complained of some pain in and around his jaw and neck.
The risk for GERD and erosive esophagitis increase with being overweight, so weight reduction would be beneficial.Low-fat diet would be beneficial.Advise to avoid lying down after eating and to sleep with the head of the bed elevated.Avoid common irritants such as coffee, strong tea, chocolate, carbonated beverages, tomato and citrus juices, spicy foods, smoking, and alcohol to decrease eosphageal irritation.Increase lean protein, avoid peppermint and spearmint, and decrease fat to increase lower esophageal sphincter pressure.Eat small frequent meals, decrease liquids with meals (have between meals), avoid eating 3 to 4 hours before bed to decrease reflux frequency and volume.
85% to 90% of patients achieve improvement of symptoms with weight loss.May require surgery if hernia is very large.
A, Normal stomach placement below esophageal hiatusB, Only a small portion of the stomach rises above the hiatus; no change in the position of the esophagusC, In obese persons, excessive fat tissue pushes on the stomach and forces it through the diaphragm
Imbalance between gastric acid and pepsin secretions and degree of tissue resistance to secretions and H. pylori infection.H. pylori are responsible for 80% to 90% of gastric and duodenal ulcers.H. pylori are spiraling, rod-shaped bacteria that inhabit the gastrointestinal area around the pyloric valve.Not all carriers of the bacteria develop a peptic ulcer.Can contribute to higher incidence of gastric cancer and lymphoma.
Rest, relaxation, and sleep help ease symptoms.For certain susceptible individuals, nonsteroidal antiinflammatory drugs should be avoided.How is peptic ulcer disease diagnosed? (Confirmed by radiographs and visualization by gastroscopy)Treatment goals are to:Alleviate symptomsPromote healingPrevent complicationsEliminate the cause
Can cause many problems from diarrhea to malnutrition.Celiac sprue, cystic fibrosis, and inflammatory bowel disease are three diseases that cause malabsorption.
Thick mucus in the lungs leads to damaged airways, difficulty breathing, and lung infections.Thick secretions also obstruct the pancreas, preventing digestive enzymes from reaching the intestines to help break down and absorb food.Causes malabsorption of foods, liver disease, and increased salt concentration in the tissues.
More than 90% of cystic fibrosis patients take supplemental pancreatic enzymes.Supplement salt by adding salt and salty snacks.Use foods that are high in calories to promote weight gain. Additional nutrition resources at www.cff.org/home/.
Diet gradually advanced to restore nutrient intake:High protein (100 g/day)High energy (2500 to 3000 kcal/day)Increased vitamins and minerals (supplements)Refer to www.ccfa.org (Crohn’s & Colitis Foundation of America).
Comparison of the distribution pattern of CD and ulcerative colitis.
Patients should avoid foods that upset the intestines, such as highly seasoned foods, raw fruits and vegetables, or milk sugar (lactose).
The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea.
Diarrhea is not a disease in itself, but rather is typically a symptom of another underlying condition.
Diverticulosis is caused by progressive increase in pressure within the bowel; affects approximately 10% of Americans older than 40 years.The condition becomes more common as people age. Approximately half of all people older than 60 years have diverticulosis.Chronic diverticular disease is managed with increased dietary fiber. Dominant theory is that a low-fiber diet is the main cause of diverticular disease.
Diverticulosis is best managed with a gradual increase of fiber into the diet for a goal amount of 6 to 10 grams above the normal recommendation of 20 to 35 g/day.Avoiding certain foods such as nuts and seeds are important to avoid accumulation in the small diverticuli pouches has been traditionally recommended.Additional emerging therapies include the use of probiotics.
Mechanism by which low-fiber, low-bulk diets might generate diverticula. Where the colon contents are bulky (top), muscular contractions exert pressure longitudinally. If the lumen is small in diameter (bottom), contractions can produce occlusions and exert pressure against the colon wall, which may produce a diverticular “blowout.”
One in five Americans has irritable bowel syndrome, making it one of the most common disorders diagnosed by physicians. It occurs more often in women than in men and usually begins around age 20 years.Refer to www.iffgd.org.
Keeping a journal of foods that cause symptoms can be helpful.Meals that are low in fat and high in carbohydrates can be helpful as well.
If the muscles of the colon, sphincters, and pelvis do not contract in a coordinated way, the contents do not move smoothly, resulting in abdominal pain, cramps, constipation, or diarrhea.
Dietary management calls for:Increased fiberFruits that act as a natural laxativeAdequate fluid intakeMany people think they are constipated when, in fact, their bowel movements are regular. Constipation is one of the most common gastrointestinal complaints in the United States.Engaging in daily exercise is also effective in preventing constipation.Laxatives should be avoided, if possible, to prevent dependence.
Adequate fluid intake is important to move food with fiber along the digestive tract.
An allergic condition results from a disorder of the immune system.
Scientists estimate that approximately 11 million Americans have true food allergies. Avoidance is the only way to prevent an allergic reaction.
Children tend to become less allergic as they get older.What are the common symptoms of a reaction? (Hives, nausea, diarrhea, and abdominal pain)A food intolerance is an adverse food-induced reaction that does not involve the immune system. More information: www.foodallergy.org/index.html.
Celiac disease damages the small intestine and interferes with absorption of nutrients from food.
Celiac disease (gluten-sensitive enteropathy). A, Normal mucosal biopsy. B, Peroral jejunal biopsy specimen of diseased mucosa shows severe atrophy and blunting of villi, with a chronic inflammatory infiltrate of the lamina propria.
The only treatment for celiac disease is to follow a gluten-free diet.What are some foods that contain gluten? (Foods prepared with wheat, rye, oat, or barley; luncheon meats)More information: www.celiac.org.
Three major accessory organs: liver, gallbladder, and pancreas.Important in digestion; diseases affect normal gastrointestinal function and how the body digests certain foods.
Excess fatty acids in circulation are stored in the liver.
Nutrition therapy includes:High-protein, high-carbohydrate, moderate-fat, and high-energy dietForms of hepatitis include:Infectious hepatitis (hepatitis A)Serum hepatitis, or hepatitis BToxic hepatitis (caused by toxins such as alcohol)Treatment of hepatitis involves bed rest and restriction of activity for approximately 1 month, removal of liver toxins, and carefully supervised diet. Untreated hepatitis can lead to extensive liver damage, coma, and death.
Progressive cirrhosis caused by alcoholism is a leading cause of death in the United States.
Known as hepatic encephalopathy because the ammonia goes to the brain.Patients should follow low-protein diets and take a medication such as lactulose, which promotes removal of nitrogen from the body.
Why is protein intake limited with cirrhosis? (Excess protein can exacerbate hepatic encephalopathy from nitrogen loading.)
The disease is seen in approximately one in 10 people and is more frequent in women. Individuals may lead an essentially normal life without a gallbladder, although a low-fat diet may be advisable.
Pancreas produces two hormones, insulin and glucagon, which are responsible for the body’s metabolism of carbohydrates, lipids, proteins, and electrolytes (minerals). People with pancreatitis should avoid alcohol and excess coffee and follow a light diet used to reduce stimulation of pancreatic secretions.Acute pancreatitis may be brought on by gallbladder disease, overeating, or excessive alcohol consumption. It is most common in persons aged 40 to 50 years and is a serious condition.