Ch. 23 Upper GI Diseases

Question 1

Name all the parts of the upper GI tract. [10]

Answer 1

1. Mouth
2. Pharynx
3. Epiglottis
4. Upper Esophageal Sphincter (UES)
5. Esophagus
6. Lower Esophageal Sphincter (LES)
7. Stomach
8. Pyloric Sphincter
9. Salivary glands
10. Trachea*

*Not sure why trachea was on the slides about the GI organs…it’s technically part of the respiratory system.

Question 2

What are some reasons for difficulty in chewing?

Answer 2

Problems with teeth or lack thereof

Poor oral care

Dentures

Mouth surgery

Question 3

What are the 6 types of diets people can be on (think in terms of texture and consistency)?

Answer 3

1. Clear liquid diet
2. Full liquid diet
3. Pureed
4. Mechanical Soft (M/S)
5. Soft
6. Regular

Question 4

Clear Liquid Diet

Answer 4

Least texture

Broth, jello, coffee, tea, juice

Question 5

Full Liquid Diet

Answer 5

Anything on the clear liquid diet + cream soups, milk, ice cream, pudding…

Question 6

Pureed Diet

Answer 6

Blenderized foods

Question 7

Mechanical Soft Diet

Answer 7

Altering texture of meat
–ex: hamburger patty chopped up really fine, or ground up into tiny pieces

Canned fruits, canned vegetables

Question 8

Soft Diet

Answer 8

Meat (as long as it’s very tender)

Fresh food as long as it’s very soft

Question 9

Regular Diet

Answer 9

Most texture

Regular food

Question 10

What is the importance of thickening liquids?

Answer 10

To keep liquids from going into the lungs

Question 11

Can you thicken coffee?

Answer 11

NO

Question 12

Mouth Ulcers

Answer 12

Lesions or sores in lining of mouth

Causes: Radiation treatment, viral infections, chemo meds

Dietary intervention:

• -decrease spicy, salty, or acidic foods
• -may need softer texture
• -prefer cold food and beverages

Question 13

Dry Mouth

Answer 13

Causes: radiation therapy, chemo meds, aging

Dietary Intervention: lemon drops, sugarless gum; moist, soft foods (use gravy, margarine/butter)

Need proper oral hygiene.

• -Saliva is needed to help prevent cavities and such
• -DO NOT OVERLOOK THE IMPORTANCE OF THIS

Question 14

What is Dysphagia?

Answer 14

Difficulty swallowing

Question 15

Oropharyngeal Phase of Dysphagia

Answer 15

Involves mouth and pharynx

Reasons/At Risk: Alzheimer’s, Lou Gehrig’s (ALS), MS, Parkinson’s, Stroke

People with Dysphagia are at risk for Aspiration Pneumonia

Question 16

What is Aspiration Pneumonia? Who is at risk for it?

Answer 16

Food can end up in lungs because they can’t swallow properly, and the bacteria can form and cause pneumonia.

People with dysphagia are at risk for aspiration pneumonia

Question 17

Esophageal Phase of Dysphagia

Answer 17

Involves Esophagus

Causes: cancer (CA), Stricture (narrowing of the esophagus)

Question 18

What are complications of dysphagia?

Answer 18

Aspiration
Malnutrition
Weight loss may occur
Increased risk of dehydration

Question 19

What is Gastroesophageal Reflux Disease (GERD)?

Answer 19

Weakening or inappropriate relaxation of the LES –> get back flow of gastric contents into esophagus

Question 20

What are causes of GERD?

Answer 20

Hormonal
Medical conditions (obesity, hiatal hernia)
Smoking
Medications the patient is taking
Diet (one of the causes we’re most interested in)

Question 21

What foods should you avoid/limit in people who have GERD?

Answer 21

ETOH
Peppermint
Spearmint
Garlic
Onion
Chocolate
High fat foods
Caffeine (including decaf)

Question 22

What are some lifestyle modifications people with GERD can make?

Answer 22

Lose weight
Wear loose fitted clothing
Avoid over-drinking and overeating
Consume small meals
Drink liquids between meals
Remain elevated during and after eating
Quit smoking

Question 23

What are Peptic Ulcers?

Answer 23

Erosion of GI mucosa in stomach or small intestine
–esophagus (rare), stomach, duodenum

Ex: Gastric Ulcer
–H. pylori: 60% of patients with gastric ulcers

Question 24

What are some contributors to Peptic Ulcers?

Answer 24

Pain medications
Other medications (ex: osteoporosis meds, anti-inflammatory meds)
Smoking (increases stomach acid)
ETOH

Question 25

What are some treatments for Peptic Ulcer Disease?

Answer 25

Treatment depends on cause. Primarily treated with medications.

• -antibiotics that treat H.pylori
• -block/reduce acid function
• -antacids
• -protect lining of stomach (ex: Pepto-Bismol)

Question 26

What are dietary considerations of Peptic Ulcer Disease?

Answer 26

They’re individualized to personal tolerances. Each ‘diet’ will vary from person to person because of individual tolerance

Question 27

What does a post-gastrectomy diet NOT include?

Answer 27

Unlimited liquids with meals

Question 28

What is Dumping Syndrome? What can cause it?

Answer 28

Undigested contents of stomach “dumped” too rapidly into jejunum

Surgical procedures:

• -Bariatric (gastric bypass, gastric restriction) - for severe obesity
• -Gastrectomy (partial or total removal of stomach) - stomach cancer

Question 29

What are Postprandial symptoms of Dumping Syndrome?

Answer 29

Postprandial: period after dinner or lunch

Initial (15-30 minutes):
–diarrhea

Later (1-3 hours):
–hypoglycemia

Question 30

Dumping Syndrome: Diet

Answer 30

Avoid concentrated sweets, including high sugar beverages
Eat small, frequent meals
Take fluids 45-60 minutes after eating
Avoid lactose
Include soluble fiber - can help with alleviating diarrhea
Eat PRO foods first

Question 31

What are some dietary considerations of Total Gastrectomy and Gastric Bypass?

Answer 31

Fat malabsorption
Vitamin D and Calcium deficiencies
Anemia (iron, vitamin B12)

Question 32

How is protein absorbed/digested in a person who had gastric bypass surgery?

Answer 32

After gastric bypass, there is a pouch that’s created for protein digestion. The protein should be very high quality and easily digested.