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clinical nutrition > chapter 17 book notes > Flashcards

chapter 17 book notes Flashcards

1
Q

What kind of diet does a patient who has trouble swallowing and chewing follow?

A

-mechanically altered diet

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2
Q

Two common disorders involving the esophagus:

A

1) dysphagia (difficulty swallowing)
2) gastroesophageal reflux disease

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3
Q

Xerostomia

A

-dry mouth caused by reduced salivary secretion
-results from dysfunction or destruction of the salivary glands.

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4
Q

Xerostomia is a side affect of…

A

-many medications and is associated with a number of diseases and disease treatments

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5
Q

Medications that can cause dry mouth:

A

-anticholinergics
-antidepressants
-antihistamines
-antihypertensives

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6
Q

What disease often causes dry mouth?

A

-diabetes mellitus

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7
Q

Sjogren’s syndrome

A

-autoimmune disease characterized by the destruction of secretory glands
-results in dry mouth and dry eyes

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8
Q

Other common causes of dry mouth:

A

-radiation therapy of neck and head can damage salivary glands
-dehydration
-excessive mouth breathing

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9
Q

Ways dry mouth can impair health (4)

A

-interferes with swallowing and speaking
-dental diseases
-ulcers
-taste diminishes

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10
Q

What kinds of foods causes pain in a person with a dry mouth?

A

-salty or spicy foods

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11
Q

Dry mouth may cause a person to reduce ??, which in turn increases risk of malnutrition

A

-food intake

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12
Q

The act of swallowing involves…

A

-multiple processes

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13
Q

Oropharyngeal:

A

-involving the mouth and pharynx

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14
Q

Oropharyngeal phase of swallowing

A

-initial phase
-muscles in mouth and tongue propel bolus of food through pharynx into the esophagus

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15
Q

What else happens during the oropharyngeal phase of swallowing?

A

-tissues of the soft palate prevent food from entering the nasal cavity,
-the epiglottis blocks the opening to the trachea to prevent
aspiration of food substances or saliva into the lungs.

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16
Q

esophageal phase of swallowing:

A

-second phase of swallowing
-peristalsis forces bolus through the esophagus, and the lower esophageal
sphincter relaxes to allow passage of the bolus into the stomach.

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17
Q

Because of the many tasks involved in swallowing, dysphagia can result from a number of different ??? or ??? problems

A

-physical or neurological

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18
Q

oropharyngeal dysphagia:

A

-difficulty transferring food from the mouth and pharynx to the esophagus to initiate
the swallowing process;
-usually due to a neurological, muscular, or structural disorder

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19
Q

Symptoms of oropharyngeal dysphagia include: (5)

A

-an inability to initiate swallowing, coughing during or after swallowing (due to aspiration),
-nasal regurgitation
-gurgling noise after swallowing
-hoarse/wet voice
-speech disorder

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20
Q

What population is oropharyngeal dysphagia common?

A

-older adults
-frequently follows a stroke

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21
Q

esophageal dysphagia:

A

-difficulty passing food through the esophagus into the stomach;
-usually caused by an obstruction or a motility disorder.

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22
Q

symptoms of Esophageal dysphagia :

A

-sensation of food “sticking” in the esophagus after it is swallowed
-heartburn, chest pain, regurgitation (from the stomach), and bad breath

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23
Q

Esophageal dysphagia obstruction: caused by…
It affects the passage of solid foods but not…

A

-stricture (abnormal narrowing),
-tumor,
-compression of the esophagus by surrounding tissues.
-liquids

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24
Q

Esophageal dysphagia motility hinders the passage of:

A

-hinders the passage of both solids and liquids

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25
Q

Achalasia

A

-the most common motility disorder,
-degenerative nerve condition affecting the esophagus;
-characterized by the absence of peristalsis and impaired
relaxation of the lower esophageal sphincter when swallowing

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26
Q

complications of dysphagia:

A

-malnutrition
-weight loss
-dehydration
-if aspiration occurs= chocking, airway obstruction, respiratory infections (pneumonia)

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27
Q

If a person lacks a normal cough reflex, ??? is more difficult to diagnose and may go unnoticed

A

-aspiration

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28
Q

a person’s swallowing ability can fluctuate over time, so the dietary plan needs frequent ???

A

-reassessment

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29
Q

consultation with a swallowing expert, such as a ?? and
?? therapist, is often necessary for determining the best dysphagia diet for the patient:

A

-speech and language

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30
Q

National Dysphagia Diet,

A

-developed in 2002 by a panel of dietitians, speech and language therapists, and a food scientist,
-helps to standardize the nutrition care of dysphagia patients.

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31
Q

3 levels of national dysphagia diet:

A

Level 1: dysphagia pureed= foods are pureed or well mashed
Level 2: dysphagia mechanically altered= foods are moist, ground or soft-textured
Level 3:dysphagia advanced=foods are moist and bite size when swallowed (patients can chew)

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32
Q

national dysphagia diet liquid consistencies:

A

-thin (water, tea, coffee, juice)
-nectar-like (buttermilk, eggnog, tomato juice)
-honeylike (honey, tomato sauce, yogurt)
-spoonthick: (milk pudding, applesuace)

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33
Q

International Dysphagia Diet Standardisation Initiative (IDDSI):

A

-nonprofit international group
-developed an alternative framework for dysphagia diets, which is expected to be incorporated into clinical practice over the next decade.

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34
Q

IDDSI is the same as national dysphagia diet but…

A

-the characteristics of the foods permitted at each level are more clearly defined

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35
Q

According to the IDDSI framework, solid foods in dysphagia diets can be characterized
as:

A

-pureed,
-minced and moist,
- soft and bite-sized,
-regular

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36
Q

IDDSI website includes examples of specific testing methods that can be used to ensure that a food

A

-is appropriate for a particular category, based on its texture and other
characteristics.

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37
Q

Sticky or gummy foods, such as peanut butter and cream cheese, may be difficult to clear:

A
  • clear from the mouth and throat.
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38
Q

Foods that have more than one texture, such as vegetable soup or cereal with milk, are difficult to ?? , so ingredients may be:

A

-manage
-blended to a single consistency with items such as nuts and seeds omitted

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39
Q

Consuming foods that have a similar consistency can quickly become ??? .
Including a variety of ??? and ??? can make a meal more appealing

A

-monotonous
-flavors and colors

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40
Q

What is easier to swallow thin or thick lquids?

A

-thick

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41
Q

How to increase viscosity of food or beverages:

A

-stir in commercial thickeners (most often made from food starches or xanthan gum)

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42
Q

What is difficult to maintain when a patient has access to only thickened beverages?

A

-hydration, less acceptable for quenching thirst

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43
Q

To decrease the risk of dehydration and improve patient compliance with a
prescription for thickened liquids, some patients may be permitted

A

-regular drinking water between meals

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44
Q

Alternative Feeding Strategies for Dysphagia:

A

-changing the position of the head and neck while eating and drinking can minimize some swallowing difficulties.
-cups designed for patients
with dysphagia allow drinking without tilting the head back

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45
Q

Individuals with oropharyngeal dysphagia can be taught exercises that strengthen the ??, ?? , or ??, or they can learn new methods of swallowing that allow them to consume a normal diet.

A

-jaws, tongue, larynx

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46
Q

Who is responsible for teaching patients these techniques?

A

-speech and language therapists

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47
Q

gastroesophageal reflux disease (GERD):

A

-a condition characterized by recurrent reflux (backward flow) of
the stomach’s acidic contents into the esophagus.
-leads to pain, inflammation, and possibly tissue damage

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48
Q

Symptoms of GERD

A

-heartburn
-acid indigestion

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49
Q

Reflux occurs occasionally in healthy people and is a problem only if it creates
complications and requires

A

-lifestyle changes or medical treatment

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50
Q

causes of GERD

A

-sphincter muscle is weak or relaxes inappropriately
-high stomach pressures
-inadequate acid clearance from esophagus

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51
Q

Conditions associated with high rates of GERD include:

A

-obesity,
-pregnancy, (occurs in 2/3 of women, usually worsens in 3rd trimester).
-hiatal hernia (portion of stomach protrudes above diaphragm)

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52
Q

primary symptoms associated with GERD are acid
regurgitation and heartburn, which generally occur after

A

-meals

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53
Q

reflux esophagitis:

A

-gastric acid remaining in the esophagus long enough to damage the esophagus lining resulting in inflammation

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54
Q

Severe and chronic inflammation may lead to

A

-esophageal ulcers, with consequent bleeding

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55
Q

After healing begins, the scar tissue may

A

-narrow the inner diameter of the esophagus, causing esophageal stricture

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56
Q

Barrett’s esophagus:

A

-a condition in which esophageal cells damaged by chronic exposure to stomach acid are
replaced by cells that resemble those in the stomach or small intestine,
-sometimes becoming cancerous.

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57
Q

Severe ulcerative disease may require immediate
???, whereas a mild case may be managed with ????

A

-acid-suppressing medication
-dietary and lifestyle changes.

58
Q

Medications that suppress gastric acid secretion help the healing process by reducing the

A

-damaging effects of acid on esophageal tissue

59
Q

Proton-pump inhibitors

A

-most effective of the antisecretory agent
- a class of drugs that inhibit the enzyme that pumps hydrogen ions (protons)
into the stomach

60
Q

histamine-2 receptor blockers:

A

-a class of drugs that suppress acid secretion by inhibiting receptors on acid-producing cells;
-commonly called H2 blockers

61
Q

Antacids,

A

-neutralize stomach acid,
-used to relieve occasional heartburn,

62
Q

Why is using antacids not appropriate for GERD?

A

-they have only short-term effects and are ineffective for healing esophagitis.

63
Q

??? may be required in severe cases of GERD that are unresponsive to
medications and lifestyle changes

A

-surgery

64
Q

fundoplication

A

-popular procedure
-upper section of the stomach (the fundus) is gathered up around the lower esophagus
and sewn in such a way that the lower esophagus and sphincter are surrounded by
stomach muscle;

65
Q

fundoplication increases pressure within:

A

-the esophagus and fortifies the sphincter muscle

66
Q

Esophageal strictures are often treated by dilating the esophagus
with an:

A

-inflatable balloon-like device or a fixed-size dilator

67
Q

dyspepsia:

A

-symptoms of pain or discomfort in the upper abdominal area,
- often called “indigestion”;
-a symptom of illness rather than a disease itself.

68
Q

These symptoms sometimes indicate the presence of more serious diseases, such as

A

-GERD or peptic ulcer disease.

69
Q

about ?? percent of the population experiences dyspepsia, only ?? of
those affected ultimately seek medical care.

A

-25
-half

70
Q

To minimize discomfort, people with dyspepsia are typically advised to avoid:

A

-large or fatty meals, highly spiced foods, and any foods or substances believed to trigger symptoms.

71
Q

The feeling of bloating may be caused by excessive
??? in the stomach, which accumulates when:

A

-gas
-air is swallowed

72
Q

What causes air swallowing? (5)

A

-chewing’
-smoking
-rapid eating
-drinking carbonated beverages
-using a straw

73
Q

Which medication also contribute to stomach gas?

A

-antacids (especially sodium bicarbonate)

74
Q

Chronic vomiting can reduce food intake and lead to

A

-malnutrition and nutrient deficiencies.

75
Q

The symptoms that accompany vomiting may give clues about its ???.1

A

-cause

76
Q

If abdominal pain is present when vomiting…,

A

-a GI disorder or obstruction is often the cause.

77
Q

if abdominal pain is not present when vomiting the cause may be..

A

-medications
-foodborne illness
-pregnancy
-motion sickness
-inner ear disorders
-haptitis

78
Q

main goal of treating nausea and vomiting?

A

-to find and correct the underlying disorder
-restoring hydration

79
Q

If a medication is the cause of nausea/vomiting then what can you do?

A

-eating food with medication can help

80
Q

If the cause for nausea/vomiting is unknown what can one do?

A

-take medications that suppress nausea and vomiting

81
Q

intractable vomiting:

A

-vomiting that is not easily managed or controlled.
-may require intravenous nutrition support

82
Q

to minimize stomach distention, patients should consume..

A

-small meals and drink beverages between meals rather than during a meal

83
Q

What kinds of foods help reduce nausea? What kinds of foods worse symtpoms?

A

-dry, starchy foods (toast, crackers, pretzels)
-fatty foods and foods with strong odors

84
Q

What is better tolerated for nausea… cold/room temp. foods or hot foods/beverages?

A

-cold/room temp. foods

85
Q

gastroparesis:

A

-motility disorder characterized by delayed stomach emptying;
-most often a consequence of diabetes, gastric surgery, or
neurological disorders.

86
Q

what % of gastroparesis is unkown?

A

-40%

87
Q

Symptoms of gastroparesis include:

A

-nausea, vomiting, stomach pain or discomfort, bloating, and loss of appetite

88
Q

Medical treatments for gastroparesis include:

A

-drug therapies (helps improves stomach motility and nausea/vomiting)
-electrical stimulation of stomach tissue (promotes muscle contractions)

89
Q

Dietary practices that may improve stomach
emptying include

A

-chewing foods well
-remaining upright
-walking after meals are consumed.
-eating small frequent meals
-avoid meals high in fat and soluble fibers

90
Q

gastritis:

A
  • inflammation of stomach tissue.
    -results from irritating substances or treatments that damage stomach tissue
91
Q

Gastritis can often lead to:

A

-tissue erosion
-ulcers
-hemorrhaging (severe bleeding)

92
Q

Chronic gastritis is frequently caused by long term infection or autoimmune disease and may progress to

A

-atrophic gastritis

93
Q

atrophic gastritis

A

-characterized by widespread gastric inflammation and tissue atrophy

94
Q

In most cases, gastritis results from: (2)

A

-Helicobacter pylori (H. pylori) infection
-the use of nonsteroidal anti-inflammatory drugs (NSAIDs)

95
Q

Helicobacter pylori (H. pylori):

A
  • a species of bacterium that colonizes the GI mucosa
    -primary cause of gastritis & peptic ulcer disease
96
Q

The extensive tissue damage that develops in longterm gastritis may disrupt -

A

gastric secretory functions and increase the risk of cancer.

97
Q

complications of gastritis: (5)

A

-hypochlorhydria
-achlorhydria
-nutrient deficiencies
-lack of intrinsic factor
-pernicious anemia

98
Q

hypochlorhydria:

A

-abnormally low gastric acid secretions.

99
Q

achlorhydria:

A

-absence of gastric acid secretions.

100
Q

What two nutrients does gastritis affect absorption?

A

-nonheme iron and vitamin B12

101
Q

Lack of intrinsic factor results in:

A

-vitamin B12 malabsorption and vitamin B12 deficiency

102
Q

pernicious anemia:

A

-vitamin B12 deficiency that results from lack of intrinsic factor;
- symptoms are macrocytic anemia, muscle weakness, and neurological damage.

103
Q

Dietary recommendations of gastritis depends on the individuals..

A

-symptoms

104
Q

if pain and discomfort is present during gastritis the patient should..

A

-avoid irritating foods & beverages (alcoholic beverages, coffee, acidic beverages and spicy foods)

105
Q

If hypochlorhydria or achlorhydria is present during gastritis:

A

-supplementation of iron and vitamin B12 may be warranted.

106
Q

peptic ulcer:

A

-an open sore in the GI mucosa
-caused by gastric acid and pepsin overwhelming muccosal defenses and destroy mucosal tissue
-may develop in the esophagus, stomach, or duodenum.

107
Q

A primary factor in peptic ulcer development is ??? , which is present in up to 30 to 60
percent of patients with gastric ulcers and ??to ?? percent of those with duodenal ulcers.

A

-H. pylori infection
-70 to 90

108
Q

One other factor of peptic ulcer development:

A

-use of NAIDS (anti-inflammatory drugs)

109
Q

the specific reasons why ulcers develop are unknown; only ?? to ??
percent of people with chronic H. pylori infection actually develop
a peptic ulcer

A

-5 to 15%

110
Q

Psychological stress by itself is not believed to cause ulcers, but it has effects on physiological processes and behaviors that may increase a person’s ??.

A

-vulnerability

111
Q

The physiological effects of stress vary among individuals but may
include hormonal changes that impair…

A

-immune responses
-wound healing,
-increased secretions of hydrochloric acid and pepsin,
-rapid stomach emptying

112
Q

Stress may also lead to what behavioral changes that can lead to development of ulcers?

A

-use of cigarettes, alcohol, and NAIDS

113
Q

Symptoms of peptic ulcers

A

-some people of asymptomatic or experience mild discomfort

114
Q

Ulcer pain may be experienced as

A

-hunger pain

115
Q

Severe bleeding is evidenced by

A

-black, tarry stools or, occasionally, vomit that resembles coffee grounds

116
Q

gastric outlet obstruction:

A

-complication of peptic ulcers
-an obstruction that prevents the normal emptying of stomach contents into
the duodenum.

117
Q

treatment of peptic ulcers requires using a combination of

A

-antibiotics to eradicate H. pylori infection and/or discontinuing the use of aspirin and other NSAIDs,

118
Q

most frequently prescribed drug regimen for peptic ulcers is
a:

A
  • “triple therapy” that includes two antibiotics and a proton-pump inhibitor
119
Q

gastrectomy:

A

-surgical removal of part of the
stomach

120
Q

partial gastrectomy

A

-only part of the stomach is removed and remaining potion is connected to the duodenum or jejunum

121
Q

(total gastrectomy

A

-entire stomach is removed and connects the esophagus directly to the small intestine

122
Q

Common complication of gastric surgeries

A

-dumping syndrome
-large amount of chyme passes rapidly into the small intestine

123
Q

Following a gastrectomy, the oral ingestion of fluids and foods is ??until
some healing has occurred, and fluids are supplied ??

A

-suspended -
-intravenously

124
Q

Oral intakes after a gastrectomy begins with:

A

-small sips of water
-ice chips
-broth

125
Q

Once fluids are tolerated the patient is offered:

A

-liquid meals (with no sugars) at first

126
Q

After solid foods are started meals may contain only

A

-one or two food items at a time so that patients tolerance for them can be evaluated

127
Q

Dietary measures after a gastrectomy are determined by:

A
  • the size of the remaining stomach, influences meal size,
    -the stomach emptying rate, affects food tolerances
128
Q

Depending on the amount of food tolerated, the patient may need to eat as
many as ??? to ?? small meals and snacks per day. And what should be included in each meal?

A

-5 to 8
-protein

129
Q

What should patients avoid after gastric surgeries?

A

-sweets and sugars because they increase osmolarity in the small intestine and thereby increase the risk of dumping syndrome

130
Q

Soluble fibers may be added to meals to slow ??? and reduce the risk of
??

A

-stomach emptying rate
-diarrhea

131
Q

??? are restricted during meals (and for up to ??to ?? minutes after meals)
due to limited stomach capacity and because ?? can increase the stomach emptying
rate

A

-liquids
-30 to 60 minutes

132
Q

Nutrition Problems after a Gastrectomy

A

-weight loss
-fat malabsorption
-bone disease
-anemia

133
Q

Most popular surgical option of weight reduction:

A

-gastric bypass operation (45-50% of bariatric surgeries)
-adds a small gastric pouch that reduces stomach capacity and is connected directly to the jejunum

134
Q

Gastric banding procedure

A

-fluid filled inflatable band is placed around the uppermost portion of the stomach; adjusting the bands fluid level can tighten or loosen the band and alter size of opening to rest of stomach.

135
Q

Sleeve gastrectomy procedure

A

-removes a large portion of the stomach, leaving a narrow gastric tube (sleeve) that holds only about 3-5 ounces of food.

136
Q

Whereas the gastric bypass and sleeve gastrectomy
operations are ??? , the gastric banding procedure is fully reversible

A

-permanent

137
Q

which two surgeries results in greater weight loss??

A

-gastric bypass and sleeve gastroectomy

137
Q

patients who have had gastric bypass surgery are at risk of
multiple nutrient deficiencies due to ?? , whereas the gastric banding and
sleeve gastrectomy procedures have little impact on nutrient absorption because

A

-malabsorption
-none of the small intestine is bypassed

138
Q

To compensate for nutrient malabsorption,
patients who have had gastric bypass surgery usually require additional
supplementation of which vitamins?

A

-vitamin B12, folate, vitamin D, calcium, and iron

139
Q

foods to avoid after gastric bypass surgery:

A

-doughy/sticky breads/ pasta
-rice
-melted cheese
-raw veggies
-foods with hulls, peels, seeds

140
Q

Rapid weight loss increases a person’s risk of developing ?? disease;
patients at especially high risk sometimes have their ?? removed while
undergoing bariatric surgery

A

-gallbladder

clinical nutrition (26 decks)

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