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Medical nutrition therapy 1
This document discusses medical nutrition therapy for various gastrointestinal disorders. It covers conditions affecting the esophagus like dysphagia and GERD. It also discusses stomach disorders like dyspepsia, gastritis, and peptic ulcer disease. The document outlines dietary interventions and considerations for these conditions. It further addresses gastric surgery, complications, and nutritional management after surgery.
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Medical nutrition therapy 1
- 1. Medical Nutrition Therapy العالجيةالتغذية 1 Dr. Louay Labban
- 2. •العلوي الهضمي الجهازأمراض •السفلي الهضمي الجهاز أمراض •السكري الداء •الدموية واالوعية القلب أمراض •الكلوية االمراض
- 3. NUTRITION AND DISORDERSOF THE UPPER GASTROINTESTINAL TRACT العلوي العضمي الجهاز أمراض في التغذية
- 4.
- 5. Conditions Affecting theEsophagus المري على تؤثر التي االمراض
- 6. Dysphagia البلع عسر Theact of swallowing is complex. The initial phase – oropharyngeal The second phase - esophageal
- 7.
- 8. Types of dysphagia –Oropharyngeal dysphagia – affects the transfer of food from the mouth and pharynx to the esophagus. • Symptoms include: • Inability to initiate swallowing • Coughing during or after swallowing • Nasal regurgitation • Other signs include: • Bad breath, gurgling noise after swallowing, a hoarse or “wet” voice, speech disorder
- 9. – Esophageal dysphagia– difficulty passing a bolus of food through the esophageal lumen and into the stomach due to either an obstruction in the esophagus (usually a stricture) or to a motility disorder (achalasia).
- 10. Complications of dysphagia –Aspiration – Malnutrition – Weight loss may occur – Increased risk of dehydration
- 11. Evaluating dysphagia – Bariumswallow study – Endoscopy – Neurological examination
- 12. Dietary interventions – factorsthat may help: – Physical properties of foods and beverages – Food preparation – Alternate feeding methods – Reassessment of the dietary plan over time
- 13. – Adjustment tosuit a person’s swallowing abilities and tolerances – Consultation with a swallowing expert – speech and language therapist
- 14.
- 15.
- 16. © 2006 Thomson-Wadsworth FoodProperties – Easy-to-manage textures and consistencies – Soft, cohesive foods – not hard or crumbly – Moist foods – not dry or sticky or gummy – Viscous beverages (milk shakes)
- 17. © 2006 Thomson-Wadsworth FoodPreparation – Alteration of food texture – pureed, mashed, ground, or minced – One consistency – Avoid nuts and seeds – Addition of commercial starch thickeners or baby cereals to thicken liquids
- 18. © 2006 Thomson-Wadsworth Feedingstrategies – Learn exercises that strengthen the jaws, tongue, or larynx – Changing head and neck posture while eating Speech and language therapists can help patients learn these techniques.
- 19. © 2006 Thomson-Wadsworth Enteralnutrition support – Tube feedings given to patients – unable to consume adequate amounts of foods – Intestinal feedings used if an individual is at high risk of aspiration
- 20. © 2006 Thomson-Wadsworth GastroesophagealReflux Disease – GERD الطعام أرتداد أو القلس
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- 22. © 2006 Thomson-Wadsworth Symptoms –Hearburn – most common GI complaint – Regurgitation – reflux of small amounts of stomach acid into the mouth With GERD – gastric reflux causes frequent discomfort and, sometimes, tissue damage.
- 23. © 2006 Thomson-Wadsworth Causesof GERD – Weakening or inappropriate relaxation of lower esophageal sphincter – Associated with pregnancy, asthma, and hiatal hernia
- 24.
- 25. © 2006 Thomson-Wadsworth Consequencesof GERD – Reflux esophagitis – Esophageal ulcers – Scarring of ulcerated tissue – Strictures – Barrett’s esophagus – increased risk of cancer – Pulmonary disease
- 26. © 2006 Thomson-Wadsworth Treatmentof GERD – drug therapy – Proton-pump inhibitors – Histamine-2-receptor blocking agents – Antacids
- 27. © 2006 Thomson-Wadsworth lifestylemodifications – Avoid eating bedtime snacks or lying down immediately after meals – Consume meals 2-3 hours before bedtime – Elevate head of bed on 6-inch blocks – Prop pillows under the head and upper torso
- 28. © 2006 Thomson-Wadsworth –Consume small meals and drink liquids between meals – Limit foods that weaken lower esophageal sphincter pressure or increase gastric acid secretion – Avoid smoking and alcohol
- 29. © 2006 Thomson-Wadsworth –Avoid bending over and wearing tight clothing that increases pressure in the stomach – Lose weight if needed – Avoid foods and beverages that irritate the esophagus during periods of esophagitis
- 30. © 2006 Thomson-Wadsworth –Avoid use of non-steroidal anti-inflammatory drugs (NSAIDS)
- 31. © 2006 Thomson-Wadsworth •Other interventions – Surgery – fundoplication – Esophageal strictures – dilatation of the esophagus
- 32. © 2006 Thomson-Wadsworth ConditionsAffecting the Stomach المعدة على تؤثر التي االمراض
- 33. © 2006 Thomson-Wadsworth Dyspepsiaالهضم عسر • Symptoms – Indigestion in the upper abdominal area – Stomach pain – Heartburn – Fullness – Nausea – Bloating
- 34. © 2006 Thomson-Wadsworth Causesof dyspepsia – Medical conditions – peptic ulcers, GERD, motility disorders, malabsorptive disorders, gallbladder disease, abdominal tumors – Medications – Dietary supplements
- 35. © 2006 Thomson-Wadsworth –Systemic disorders – Diabetes mellitus, renal disease, thyroid disease, heart failure – Lactose intolerance and irritable bowel syndrome can mimic dyspesia
- 36. © 2006 Thomson-Wadsworth •Bloating and stomach gas – Chewing gum – Smoking – Rapid eating, drinking carbonated beverages – Using a straw
- 37. © 2006 Thomson-Wadsworth Potentialfood intolerances – Overeating – Specific foods – spicy – Coffee including decaffeinated – High-fat foods – Advised to consume small meals, well-cooked foods - not overly seasoned, in a relaxed atmosphere
- 38. © 2006 Thomson-Wadsworth Nauseaand Vomiting • Causes – Side effects of medications – Triggered by motion sickness, food odors, and emotional stress – Common in pregnancy – Chronic vomiting can lead to malnutrition and nutrient deficiencies
- 39. © 2006 Thomson-Wadsworth Treatmentof nausea and vomiting – Correct the underlying disorder – Restore hydration – Intractable vomiting may require intravenous nutrition support
- 40. © 2006 Thomson-Wadsworth Dietaryinterventions – Eating and drinking slowly – Drinking clear, cold beverages – carbonated drinks or fruit juices may ease symptoms – Dry, salty foods – crackers or pretzels – Avoid fried or spicy foods at bedtime – Avoid foods with strong odors – Cold or room temperature foods better tolerated
- 41. © 2006 Thomson-Wadsworth Gastritis Inflammationof the stomach mucosa • Causes – H. pylori, use of NSAIDS • Can lead to disruption of gastric secretory functions – Hypochlorhydria – Achlorhydria – Pernicious anemia
- 42.
- 43. © 2006 Thomson-Wadsworth –Avoid irritating food and beverages – Avoid food intake for 24-48 hours if food consumption increases pain or causes nausea and vomiting – Nutrition support may be needed if food not tolerated for prolonged period – Supplementation of iron and B12 may be warranted
- 44. © 2006 Thomson-Wadsworth PepticUlcer Disease Primary cause – H. pylori • Gastric ulcers – 60% • Duodenal ulcers 80% • Zollinger-Ellison syndrome
- 45. © 2006 Thomson-Wadsworth •Effects of emotional stress – Has effects on physiological processes • Rapid stomach emptying • Hormonal changes that impair wound healing • Increased acid and pepsin secretions – Behavioral changes • Use of alcohol • Tobacco use • NSAID use
- 46. © 2006 Thomson-Wadsworth PepticUlcer Disease • Signs and symptoms – Hunger pain – Gnawing or burning pain in stomach region – Sometimes aggravated by food – causes loss of appetite and weight loss
- 47. © 2006 Thomson-Wadsworth Complications –GI bleeding, hemorrhage – Perforations of the stomach or duodenum – Gastric outlet obstruction
- 48. © 2006 Thomson-Wadsworth Drugtherapy – Proton-pump inhibitors – H2 blockers – Antacids – Bismuth preparations – Triple therapy – two antibiotics (amoxicillin, tetracycline, metronidazole, or clarithromycin) and one other drug
- 49. © 2006 Thomson-Wadsworth Dietaryconsiderations – Individualized to personal tolerances – Avoid foods that irritate – alcohol, coffee, caffeine, spicy foods – Avoid large meals
- 50. © 2006 Thomson-Wadsworth GastricSurgery • Effective treatment for severe obesity • Treat peptic ulcers – resistant to drug therapy or to correct ulcer complications • Treat stomach cancer
- 51. © 2006 Thomson-Wadsworth Surgicalprocedures Bariatric surgery – Gastroplasty المعدة رأب – Gastric bypass surgery المعدة تجاوز Total gastrectomy المعدة أستئصال Gastric resection المعدة تقسيم أعادة Vagotomy المبهم فطع Pyloroplasty البواب رأب
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- 53. © 2006 Thomson-Wadsworth Thepost-gastrectomy diet – Fluids and food withheld until some healing has occurred – Fluids initially given intravenously – Fluid balance carefully monitored – Ice chips or small sips of water allowed 24-48 hours post-op – Progressed from clear liquids to solid foods by 4th or 5th post-op day
- 54. © 2006 Thomson-Wadsworth –Dietary adjustments influenced by the size of the remaining stomach – Small, frequent meals and snacks – Includes mostly soft, low-fat foods – High in complex carbohydrates – Avoid sweets and sugars – Liquids limited during meals (½ cup) – Specific food intolerances
- 55.
- 56. © 2006 Thomson-Wadsworth Dumpingsyndrome – Group of symptoms resulting from abnormally rapid gastric emptying – Common complication of gastrectomy and gastric bypass surgery – Caused by hypertonic gastric contents rushing into the intestines after meals
- 57. © 2006 Thomson-Wadsworth –Early symptoms occur within 30 minutes – Early symptoms include nausea, vomiting, abdominal cramping, diarrhea, lightheadedness, rapid heartbeat – Above symptoms caused from • Large fluid shift from blood plasma to intestines that lowers blood volume • An increase in peristaltic activity
- 58. © 2006 Thomson-Wadsworth –Later symptoms occur several hours later – Hypoglycemia due to spike in blood glucose following meal – and excessive insulin response – Small frequent meals, limit fluids during meals, sugars restricted – Addition of pectin and guar gum – Medications – octreotide – Additional surgery
- 59.
- 60. © 2006 Thomson-Wadsworth Post-surgicalcomplications and nutrition status – Discomfort with meals – Food avoidance – Weight loss – Malnutrition – Steatorrhea
- 61. © 2006 Thomson-Wadsworth Steatorrhea –Fat malabsorption – Bacterial overgrowth – Treat with medium chain triglycerides and supplemental pancreatic enzymes
- 62. © 2006 Thomson-Wadsworth Bonedisease – Fat malabsorption – calcium and vitamin D malabsorption – Avoidance of milk to minimize dumping syndrome – increases risk of calcium and vitamin D deficiencies – Osteoporois and osteomalcia incidence is high in gastrectomy patients – monitor bone density – during years after surgery – Supplementation of calcium and vitamin D
- 63. © 2006 Thomson-Wadsworth Anemia –High risk for iron and B12 anemia – May take several years to develop – Reduced gastric secretions impair absorption of iron and B12 – Duodenum is major site of iron absorption – iron absorption reduced if duodenum has been removed or bypassed – Supplementation of iron and B12
- 64. © 2006 Thomson-Wadsworth Bariatricsurgery – Effective treatments for morbid obesity – Can dramatically affect health and nutrition status – Patients require lifelong management – Weight loss most rapid in first six months after surgery – stabilizes after 18-24 months
- 65. © 2006 Thomson-Wadsworth Dietaryguidelines after bariatric surgery – First day or two – ice chips and small sips of water – Full liquid diet – given 1-2 weeks – Progressed to pureed foods for 1-2 weeks – Progressed to soft foods and finally regular foods – 5-6 small meals per day
- 66. © 2006 Thomson-Wadsworth –Patient education and counseling – critical – Food portion sizes – controlled – Teach patient elements of a healthy diet – Avoid foods that may cause abdominal discomfort, vomiting or dumping syndrome – Dietary supplements
- 67. © 2006 Thomson-Wadsworth Post-surgicalconcerns – Dumping syndrome – Malabsorption – Multiple nutrient deficiencies – Gallbladder disease – patients at risk may have their gallbladders removed during bariatric surgery – Plastic surgery may be necessary to remove extra skin
- 68. © 2006 Thomson-Wadsworth DentalHealth and Its Relationship with Chronic Illness
- 69. © 2006 Thomson-Wadsworth DentalHealth • Periodontal disease – Inflammatory conditions involving the periodontium – tissues that support the tooth in its bony socket (gingiva, connective tissues, and bone underneath) – Gingivitis – characterized by redness, bleeding, and swelling of gum tissue – Periodontitis – inflammation of tissues surrounding the tooth; may cause tooth loss if untreated
- 70.
- 71. © 2006 Thomson-Wadsworth –Risk factors • Dental plaque • Tobacco smoking • Impaired immunity – Signs and symptoms • Gingivitis – bleeding, swollen, tender gums • Gap between infected gum and tooth deepens • Bad taste in mouth / persistent bad breath • Treatments: cleaning, antimicrobial rinses, topical antibiotics, surgery
- 72. © 2006 Thomson-Wadsworth Drymouth – Many medications reduce salivary flow – Poorly controlled diabetes – Conditions that affect salivary gland function (e.g. Sjögren’s syndrome) – Radiation therapy – Can impair health: interferes with speech, bad breath, mouth infections, difficulty chewing/swallowing, discomfort or ulcerations from dentures
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- 74. © 2006 Thomson-Wadsworth Dentalhealth and chronic illness – Diabetes mellitus • Periodontal disease is more prevalent • High risk of dental caries and oral fungal infections – Human immunodeficiency virus (HIV) / AIDS • Decreased immunity increases risk of periodontal disease
- 75. © 2006 Thomson-Wadsworth –Oral cancers • Radiation treatment can cause severe oral and dental complications
- 76. © 2006 Thomson-Wadsworth –Dental health and disease risk • Immune response – inflammatory process induced by periodontal disease activates cytokines and other mediators • Respiratory illnesses – caused by bacteria which colonize teeth • Atherosclerosis and heart disease – blood vessel cells attacked by bacteria associated with gingivitis • Diabetes mellitus – periodontal disease can make attaining glucose control difficult