NUTR 222 - Exam 3 - Coheley - Tamu

The GI tract is generally considered to the _______, _________, __________, and __________.

mouth, stomach, esophagus, and duodenum

Define dry mouth.

reduced salivary flow (xerostomia)

what causes dry mouth?

medications

medical conditions (Sjögren's syndrome)

treatment of disease (radiation therapy to head/neck)

what are the consequences of dry mouth?

difficulty swallowing

mouth infections

dental diseases

increased malnutrition risk

what are the steps in the swallowing process?

oral phase, pharyngeal phase, and esophageal phase

How can dry mouth be managed?

sip water and sugarless beverages

suck on ice chips

consume nutrient/energy dense foods that are liqiud

avoid dry and acidic foods

chew sugarless gum

what is the oral phase?

food placed in mouth (voluntary)

what is the pharyngeal phase?

food bolus is moved down pharynx (involuntary)

what is the esophageal phase?

peristaltic wave relaxes allowing bolus to pass through esophagus. (involuntary)

define dysphagia

difficulty swallowing foods and liquids

what are the categories of dysphagia

Oropharyngeal dysphagia

Esophageal dysphagia

define oropharyngeal dysphagia

difficulty emptying from mouth to pharynx to esophagus

define esophageal dysphagia

difficulty with trader of food from esophagus to stomach

what are symptoms of dysphagia

drooling

"pocketing" of food in buccal area

gurgling noise

"wet" voice

food sticking to esophagus

weight loss and dehydration

define aspiration

foods, liquids, saliva, or vomit is breathed into the airways

what are the nutrient intervention strategies for dysphagia?

physically modified foods

dietary plan

national dysphagia diet

international dysphagia diet

describe the national dysphagia diet

old method

level 1 - dysphagia pureed (consistency similar to baby food)

level 2 - dysphagia, mechanically soft (chopped fine, moist)

Level 3 - dysphagia advanced (bite-size, moist)

describe the international dysphagia diet standardization initiative

New diet

Level 0: thin (drinks)

Level 1: slightly thin (drinks)

Level 2: mildly thin (drinks)

Level 3: moderately thick (drink); liquidised (food)

Level 4: extremely thick (drink); pureed (food)

Level 5: niched and most (food)

Level 6: soft and bite-sized (food)

Level 7: regular (food)

what are some characteristics of gastroesophageal reflux disease

frequent reflux of stomach's acidic contents into esophagus

heartburn or acid ingestion

what are some cause of GERD?

- weak lower esophageal sphincter

- predisposing factors: high stomach pressures, inadequate acid clearance from esophagus

- High rates of GERN associated with obesity, pregnancy, and hiatal hernia

What are the consequences of GERD

- reflux esophagitis

- esophageal ulcers

- esophageal strictures

- dysphagia

- pulmonary disease (due to aspiration)

- barrett's esophagus

Describe lifestyle changes for GERD?

small frequent meals

avoid alcohol and smoking

limit caffeine

avoid laying down after eating

sleep with head raised

weight loss if obese

wear loose clothing

Define dyspepsia

Pain in upper abdomen after eating

what are some potential food intolerances that cause dyspepsia

consume small frequent meals

avoid fatty or highly spiced foods

avoid specific food believed to be a trigger

what are some treatment methods for nausea/vomiting?

1. Find and correct the underlying cause

2. restore hydration

3. take medicine with food

what is gastritis

inflammation of stomach

define acute gastritis

caused by irritating substances or treatments that damage gastric mucosa

define chronic gastritis

caused by long term infections:

helibactor pylori

autoimmune disease

Nonsteriodal anti-inflammatory drugs (NSAIDS)

what is peptic ulcer disease

Open sore in the GI mucosa - can be in esophagus, stomach, or duodenum

what is some causes of peptic ulcer disease

h. pylori (30-60% with gastric ulcers)(70-90 with duodenal ulcers)

NSAIDS

smoking

psychological stress

what are some symptoms of peptic ulcer disease

vary: asymptomatic or mild discomfort; hunger pain or burning pain in stomach; tends to recess and recur every few weeks or months

what are some nutrition care recommendations for peptic ulcer disease

- correct nutritional deficiencies

- minimize intake of caffeine, chocolate, pepper, and large meals

- If hurts, don't eat

what is a gastrectomy

removal of the stomach

what is patrial gastrectomy

part of the stomach is removed and the remaining portion is connected ti the duodenum

what is a total gastrectomy

entire stomach removed and the esophagus us directly attached to small intestine

what are the nutrition care recommendations for after a gastrectomy?

5-8 small meals (protein in each)

Avoid sweets and sugar

increase fiber

consume liquids between meals (restricted during meals)

Dairy as tolerated

Lie down for 20-30 min after eating

define dumping syndrome

symptoms cause by rapid gastric emptying due to loss of pyloric sphincter

what are nutrition care recommendations after bariatric surgery?

- ensure appropriate nutrient intakes

- Maintain hydration

-Diet progression

- Small portions of foods; liquids separately

- Protein: 1.0 to 1.5 g/kg of ideal body weight

- Vitamin and mineral supplementation (B12, D, Calcium, Iron)

- Avoid foods that obstruct gastric outlet

- Control food portions , avoid high-sugar foods, consume liquids between meals

Fewer than three bowel movements per week

Hard stools and excessive straining

More prevalent in women and older adults

constipation

Low-fiber diet

Inadequate fluid intake

Low level of physical activity

Some medical conditions and medications, eg. opioids

causes of constipation

Gradual increase of fiber intake (Goal is 20-25 g/day; Wheat bran, fruits, and vegetables; Increases stool weight; Fiber supplements may be indicated)

Adequate fluids (1.5 to 2 liters per day; Prunes or prune juice; Laxative effect) Increase physical activity if inactive

treatment for constipation

Fermentation of undigested food in colon (High fiber intake)

Swallowing air

Excessive sugar alcohols

causes of intestinal gas

Nutrition therapy: restrict FODMAPs may help (Fermentable oligosaccharides, disaccharides, monosaccharides,and polyols)

treatment for intestinal gas

Corn, carbonated beverages (no FODMAPs)

FODMAPs sources: apples, broccoli, cabbage, dried beans andpeas, fructose-sweetened products, pears, etc.

foods associated with intestinal gas

Passage of frequent, watery stools

diarrhea

Inadequate fluid reabsorption in the intestines, sometimes inconjunction with an increase in intestinal secretions

Bacterial infections (eg. Food poisoning)

Certain medications (eg. antibiotics)

Dietary substances

GI dysmotility problems increasing transit time

Malabsorption disorders

causes of diarrhea

If severe of persistent = dehydration and electrolyte imbalance

If chronic = weight loss or malnutrition

consequences of diarrhea

Unabsorbed nutrients or other substances attract water to the colon and increasefecal water content (Sugar alcohols, lactase deficiency)

Osmotic diarrhea

Fluid secreted by the intestines exceeds the amount that can be reabsorbed byintestinal cells (Usually from foodborne illness creating excessive fluid)

secretory diarrhea

Start abruptly and may persist for several weeks.

acute diarrhea

Persist for about four weeks or longer.

Result from malabsorption disorders, inflammatory diseases, motility disorders,infections, etc.

chronic diarrhea

Antibiotics for intestinal infections

Eliminating responsible foods that are malabsorbed

Bulk-forming agent

Antidiarrheal drugs

Probiotics

In severe cases of intractable diarrhea: parenteral nutrition orfeeding nutrition in the veins

medical treatments for diarrhea

for severe chronic diarrhea

Replace lost fluid and electrolytes (Sodium in form of salts)

Rehydration solutions contain: (Water, salts, glucose; Add ½ teaspoon of salt and 6 teaspoons of sugar to 4 cups of drinking water)

oral rehydration therapy

Why are commercial sport drinks not ideal fluids for rehydration?

too low in sodium

vegetables with peels or skin (high fiber foods)

fresh fruit, fruit juices, sugar free gums (contain fructose or sugar alcohols)

Milk and milk products (if lactose intolerant)

coffee, tea, sodas, and energy drinks (caffeine containing beverages)

foods that worsen diarrhea

high fiber foods rationale

they increase colonic residue

foods with ingestible carbohydrates rationale?

they contribute to osmotic diarrhea

foods that contain fructose or sugar alcohols rationale?

they contribute to osmotic diarrhea

Milk products, if person is lactose intolerant rationale?

they contribute to osmotic diarrhea

gas-producing foods rationale?

they increase abdominal discomfort

caffeine-containing beverages rationale?

they increase intestinal motility

banana, rice, applesauce, and toast

diet to help treat diarrhea

BRAT diet

Normal digestion is necessary to absorption nutrients

Healthy mucosa needed for absorption to take place

Adequate absorptive area

If nutrients not digested or absorbed may lead to: Nutritional deficiencies, weight loss and GI distress

malabsorption

-Pancreatic disorders leading to enzyme or bicarbonatedeficiencies

-Disorders leading to bile deficiency

-Inflammatory diseases or medical treatments involving GI tract damaging intestinal tissue

- celiac disease

- crohns disease

- radiation enteritis

- liver disease (bile insufficiency)

- Chronic pancreatitis

- Cystic fibrosis

- Intestinal resection (short bowel syndrome)

causes of malabsorption

_________ nutrient most frequently malabsorbed because it requires both digestive enzymes and bile for its digestion

fat

excessive fat in stools

steatorrhea

Fat-restricted diet (Fat restricted no more than necessary; Try to provide some essential fatty acids)

Medium-chain triglycerides (MCT): Alternative dietary fat source for energy (Does not require bile for absorption; Lacks essential fatty acids; MCT oil)

nutrition therapy for fat malabsorption

loss or reduction of lactose is

lactose intolerance

- losses of food energy, essential fatty acids, fat-soluble vitamins and some minerals

- Weight loss and malnutrition

- Essential fatty acids

- vitamin deficiencies (increased risk of bone loss)

- Increased absorption of oxalate which leads to increased risk of oxalate stone formation

consequences of fat malabsorption

Lactose intolerance is ___________ prevalent worldwide

75%

-Diarrhea

-Increased intestinal gas

primary symptoms of lactose intolerance

what nutrients are most of concern with fat malabsorption?

calcium and magnesium

what nutrients are most of concern with lactose malabsorption?

Calcium and Vitamin D

inflammation of the pancreas

pancreatitis

severe abdominal pain (radiating to back)

nausea

vomiting

Digestive enzymes become prematurely activated

leaned to pancreatic tissue destruction and subsequent inflammation

consequences of acute pancreatitis

- Initial treatment:

- Pain control and intravenous hydration

- Typically, oral fluids and food withheld (NPO)

- Usually progress to regular diet

- Diet as tolerated, as pain subsides

- Fat-restricted diet if malabsorption symptoms occur

- In severe cases, May require care in intensive care unit; Specialized nutrition support for energy and protein

treatments for acute pancreatitis

Progressive, permanent damage of pancreas

consequences of chronic pancreatitis

- Pancreatic enzyme replacement therapy (PERT)for steatorrhea/malabsorption

- Increased energy and protein: 1.0-1.5 g/kg protein, 35 kcal/kg

- Dietary supplements to correct nutrient deficiencies

- Avoid alcohol completely

- Quit smoking

treatments for chronic pancreatitis

genetic disorder that alters the ion concentration and/or viscosity of exocrine secretions

cystic fibrosis

- Lung disease: chronic respiratory infections, progressive inflammation, airway obstruction

- Pancreatic disease: obstructed pancreatic ducts

- Excessive salt losses in sweat

- Others: intestinal obstruction, glucose intolerance/diabetes, gallbladder and liver diseases, abnormalities in genital tissues

consequences of cystic fibrosis

- High-kcal, high-protein diet, liberal fat intake

- Oral supplements and/or tube feedings

- Pancreatic enzyme therapy

- Liberal use of table salt and slaty foods

Nutrition therapy of cystic fibrosis

autoimmune disease: abnormal response to wheat gluten and related proteins

celiac disease

- blunts height of villi

- reduces surface area - -> malabsorption

causes of celiac disease

- GI disturbances: diarrhea, steatorrhea, and flatulence

consequences of celiac disease

- Gluten-free diet: avoid products made with wheat, barley, rye, malt and some oats

- Avoid lactose until recovered if lactase deficiency suspected

- Dietary supplements as needed to correct nutritional deficiencies: calcium and iron

treatments of celiac disease

chronic inflammatory illnesses characterized by abnormal immune responses to microbes that inhibit the GI tract (crohns disease and ulcerative colitis)

inflammatory bowel disease

- ulcerations, fissures, fistulas, strictures

- 40% require surgery within 10 years of diagnosis

- At risk of malnutrition

- B12 deficiency, anemia, and anorexia

consequences of inflammatory bowel disease

- Mucosal atrophy, thin walls, colon dilation (megacolon)

- Varying symptoms include: diarrhea, constipation, rectal bleeding, and abdominal pain

- weight loss, fever, and weakness

- Severe cases: anemia, dehydration, and electrolyte imbalances

- colon cancer risk substantially increased

consequences of ulcerative colitis

immunosuppressants, anti-inflammatory drugs, and antibiotics

drug treatment for inflammatory bowel disease

- aggressive dietary management

nutrition therapies of crohns disease

- few adjustments to diet

- restore fluid and electrolyte balances

- correct deficiencies

- low-fiber diet may reduce irritation

- severely impaired colon function

nutrition therapies of ulcerative colitis

malabsorption syndrome following resection of a major portion of small intestine

short bowel syndrome

- Initially following resection: fluids and electrolytes must be supplied intravenously; Total parenteral nutrition (vein feeding) may be required

- Rehydration therapy after first few weeks

- Gradual transition from parenteral nutrition to tube feedings and/or oral feedings

nutrition therapies of short bowel syndrome

Chronic and recurring intestinal symptoms

Irritable bowel syndrome

- diarrhea and/or constipation

- abdominal discomfort, bloating or pain

symptoms of irritable bowel syndrome

- stress management, and behavioral therapies; medication

- avoid foods that aggravate symptoms (fried fatty foods, gas producing foods, and milk products)

- small frequent meals

- low FODMAP diet

- Psyllium supplementation

- under investigation: peppermint oil, probiotics

treatments for irritable bowel syndrome

presence of small herniations (diverticula) in the intestinal mucosa (asymptomatic)

diverticulosis

- inflammation or infection involving diverticula

- persistent abdominal pain, tenderness in the affected area, fever, constipation, and diarrhea

Diverticulitis

- obesity

- sedentary

- alcohol and caffeine intake

- cigarette smoking

- age

risk factors of diverticular disease

- Increased (insoluble) fiber intakes often recommended

treatment for diverticular disease