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  • 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.
  • Transcript

    • 1. Williams' Basic Nutrition & Diet Therapy Chapter 18 Gastrointestinal and Accessory Organ Problems Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 1 14th Edition
    • 2. Lesson 18.1: Diseases of the GI Tract and Accessory Organs  Diseases of the GI tract and its accessory organs interrupt the body’s normal cycle of digestion, absorption, and metabolism 2Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 3. The Upper Gastrointestinal Tract (p. 352)  Problems of the mouth  Dental problems • Tooth decay • Ill-fitting dentures • Mechanical soft diet helpful  Surgical procedures • Healing nutrients administered with high-protein, high- caloric milkshakes 3Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 4. The Upper Gastrointestinal Tract (cont’d) (p. 353) 4Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 5. Problems of the Mouth (p. 352)  Oral tissue inflammation  Gingivitis  Stomatitis  Glossitis  Cheilosis  Mouth ulcers  Salivary gland problems  Disorders of nervous system  Infections  Excess salivation  Xerostomia (permanent dry mouth) 5Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 6. Problems of the Mouth (cont’d) (p. 353) 6Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 7. Swallowing Disorders (p. 354)  Heimlich maneuver for choking  Dysphagia fairly common problem  Common with Alzheimer’s, Parkinson’s, stroke  Symptoms: unexplained drop in food intake or repeated episodes of pneumonia 7Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 8. Swallowing Disorders - Warning Signs (p. 355)  Reluctance to eat certain food consistencies or any food at all  Very slow chewing or eating  Fatigue from eating  Frequent throat clearing  Complaints of food “sticking” in throat  Holding pockets of food in cheeks  Painful swallowing  Regurgitation, coughing, choking  Referred to team of experts  Diet adapted to individual needs 8Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 9. Problems of the Esophagus (p. 355)  Central tube problems  Muscle spasms, uncoordinated contractions  Stricture or narrowing of the tube  Treatment: widening of the tube  Diet: liquid to soft 9Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 10. Lower Esophageal Sphincter Problems (p. 355)  Achalasia or cardiospasm  Changes in smooth muscle  Nerve-muscle hormone control of peristalsis  Treatment: dilating the LES or cutting the muscle  Postop nutrition therapy 10Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 11. Gastroesophageal Reflux Disease (p. 355)  Caused by constant regurgitation of acidic gastric contents into lower esophagus  Pregnancy, obesity, pernicious vomiting, or nasogastric tubes are factors  Constant irritation and inflammation (esophagitis)  Stenosis most common complication 11Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 12. 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. 12Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 13. Case Study (cont’d)  Mr. Max is 5 feet 8 inches tall and weighs 215 lbs.  Mr. Max has been started on a proton pump inhibitor per his physician  What are some appropriate nutritional recommendations for Mr. Max? 13Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 14. Hiatal Hernia (p. 356)  Portion of upper stomach protrudes through opening in the diaphragm membrane (hiatus)  Especially common in obese adults 14Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 15. Peptic Ulcer Disease (p. 357) 15Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 16. Peptic Ulcer Disease (cont’d) (p. 357)  Caused by Helicobacter pylori infection  Lesion usually occurs in duodenal bulb  Long-term use of nonsteroidal antiinflammatory drugs may contribute to development in some persons  Psychological factors 16Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 17. Peptic Ulcer Disease (cont’d) (p. 358)  Clinical symptoms  Increased gastric muscle tone  Painful contractions when stomach empty  Medical management  Rest: foundation of general care  Drug therapy: Four types of drugs  Dietary management: well-balanced diet, avoidance of acid stimulation 17Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 18. Lower Gastrointestinal Tract: Small Intestine Diseases (p. 361)  Malabsorption  Maldigestion problems  Can occur in any of three digestive processes  Can lead to chronic deficiencies of vitamins, minerals, nutrients  Most common symptom is diarrhea or steatorrhea 18Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 19. Cystic Fibrosis (p. 361)  Genetic disease of childhood  Inhibits movement of chloride and sodium ions in the body tissue fluids 19Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 20. Nutrition Management of Cystic Fibrosis (p. 362)  Nutrition therapy is critical  Enzyme replacement products  Nutritional supplements to maintain weight 20Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 21. Inflammatory Bowel Disease (p. 363)  Chronic inflammation of GI tract  Persistent activation of mucosal immune system against normal gut flora  Disrupts protective epithelial barrier, destroying segments of GI tract  Crohn’s disease, ulcerative colitis two most common forms 21Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 22. Crohn’s Disease and Ulcerative Colitis (p. 364) 22Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 23. Crohn’s Disease (p. 364)  Most common locations are ileum and colon  Risk factors of family history and smoking  Symptoms vary  Iron deficiency anemia 23Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 24. Ulcerative Colitis (p. 365)  Limited to colon  Progressive beginning at anus  Resulting malnutrition hinders healing  Dietary management differs during inflammation and remission 24Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 25. Diarrhea (p. 365)  Usually a symptom of other underlying condition  Intolerance to specific foods  Acute food poisoning  Viral infections 25Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 26. Large Intestine Diseases (p. 366)  Diverticular disease  Diverticulosis: formation of many small pouches (diverticula) along muscular mucosal lining  Diverticulitis caused by pockets becoming infected 26Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 27. Case Study (cont’d)  When Mr. Max had his colonoscopy, it was noted that he has diverticulosis.  What nutritional recommendations would be appropriate for him? 27Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 28. Diverticular Disease (p. 366) 28Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 29. Irritable Bowel Syndrome (p. 366)  Multicomponent disorder of physiologic, emotional, environmental, psychologic function  Common recurrent pain in abdomen  Small-volume bowel dysfunction  Excess gas formation 29Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 30. Irritable Bowel Syndrome (cont’d) (p. 367)  Individual approach to nutrition care essential  Normalize eating patterns  Eliminate food allergens and intolerances  Recognize, avoid gas formers  Increase fiber/bulking agents  Consider use of prebiotics/probiotics  Consider use of food diaries 30Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 31. Irritable Bowel Syndrome (cont’d) (p. 367) 31Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 32. Constipation (p. 367)  Common short-term problem  Nervous tension and worry  Changes in routines  Constant laxative use  Low-fiber diets  Lack of exercise  Dietary management rather than laxatives 32Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 33. Case Study (cont’d)  Since Mr. Max will try to increase fiber in his diet, what other recommendation should he be given to avoid constipation? 33Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 34. Lesson 18.2: Food Allergies and Intolerances  Food allergies result from sensitivity to certain proteins.  Underlying genetic diseases may cause metabolic defects that block the body’s ability to handle specific foods. 34Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 35. Food Allergies and Intolerances (p. 367)  Food allergies  Allergy: body reacts to protein as if it were a threatening foreign object and launches powerful attack  Intolerance: not life-threatening and are non- immunologic in origin 35Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 36. Common Food Allergies (p. 368)  Peanuts, tree nuts  Shellfish, fish  Milk, soy, egg, wheat 36Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 37. Common Food Allergies (cont’d) (p. 368)  Food elimination sometimes used to identify disagreeable foods  Dietitian can provide guidance on food substitutions or special food products  Recipes modified to maintain nutrition needs for growth 37Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 38. Celiac Disease (p. 368)  Hypersensitivity to the protein gluten in certain grains  Steatorrhea and progressive malnutrition are secondary effects to gluten reaction 38Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 39. Celiac Disease (cont’d) (p. 368) 39Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 40. Celiac Disease (cont’d) (p. 369)  Avoid all dietary sources of gluten  Wheat, rye, barley eliminated from diet  Corn, potato, rice used as substitutes  Careful label reading for parents and children  Monitor for vitamin, mineral deficiencies 40Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 41. Problems of the Gastrointestinal Accessory Organs (p. 369) 41Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 42. Liver Disease (p. 369)  Steatohepatitis  Fat accumulation and inflammation in the liver  Alcoholic and nonalcoholic  Malnutrition is common  Aggressive enteral nutrition therapy 42Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 43. Hepatitis (p. 371)  Inflammatory condition caused by virus, alcohol, drugs, or toxins  Treatment based on bed rest and nutrition therapy 43Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 44. Cirrhosis (p. 372)  Associated with alcoholism, hepatitis, inherited diseases  Fatty infiltration kills liver cells, leaving nonfunctioning scar tissue 44Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 45. Hepatic Encephalopathy (p. 372)  As cirrhosis continues, blood can no longer circulate normally through liver  Ammonia and nitrogen cannot be eliminated, which produces ammonia intoxication and coma  Treatment focuses on removing sources of excess ammonia 45Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 46. Management of Cirrhosis (p. 372)  Energy  Protein  Enteral/parenteral nutrition support  Vitamin/mineral supplementation  Small, frequent meals 46Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 47. Gallbladder Disease (p. 373)  Cholecystitis  Usually results from low-grade chronic infection  Continued infection alters solubility of bile ingredients  Cholelithiasis  Cholesterol separates out and causes gallstones  Diet therapy centers on controlling fat intake 47Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 48. Pancreatic Disease (p. 374)  Pancreatitis  Inflammation of the pancreas  Excessive alcohol consumption is most common cause  Supplements with pancreatic enzymes 48Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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