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
2
Q
Two common disorders involving the esophagus:
A
1) dysphagia (difficulty swallowing)
2) gastroesophageal reflux disease
3
Q
Xerostomia
A
-dry mouth caused by reduced salivary secretion
-results from dysfunction or destruction of the salivary glands.
4
Q
Xerostomia is a side affect of…
A
-many medications and is associated with a number of diseases and disease treatments
5
Q
Medications that can cause dry mouth:
A
-anticholinergics
-antidepressants
-antihistamines
-antihypertensives
6
Q
What disease often causes dry mouth?
A
-diabetes mellitus
7
Q
Sjogren’s syndrome
A
-autoimmune disease characterized by the destruction of secretory glands
-results in dry mouth and dry eyes
8
Q
Other common causes of dry mouth:
A
-radiation therapy of neck and head can damage salivary glands
-dehydration
-excessive mouth breathing
9
Q
Ways dry mouth can impair health (4)
A
-interferes with swallowing and speaking
-dental diseases
-ulcers
-taste diminishes
10
Q
What kinds of foods causes pain in a person with a dry mouth?
A
-salty or spicy foods
11
Q
Dry mouth may cause a person to reduce ??, which in turn increases risk of malnutrition
A
-food intake
12
Q
The act of swallowing involves…
A
-multiple processes
13
Q
Oropharyngeal:
A
-involving the mouth and pharynx
14
Q
Oropharyngeal phase of swallowing
A
-initial phase
-muscles in mouth and tongue propel bolus of food through pharynx into the esophagus
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.
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.
17
Q
Because of the many tasks involved in swallowing, dysphagia can result from a number of different ??? or ??? problems
A
-physical or neurological
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
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
20
Q
What population is oropharyngeal dysphagia common?
A
-older adults
-frequently follows a stroke
21
Q
esophageal dysphagia:
A
-difficulty passing food through the esophagus into the stomach;
-usually caused by an obstruction or a motility disorder.
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
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
24
Q
Esophageal dysphagia motility hinders the passage of:
A
-hinders the passage of both solids and liquids
25
Achalasia
-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
26
complications of dysphagia:
-malnutrition
-weight loss
-dehydration
-if aspiration occurs= chocking, airway obstruction, respiratory infections (pneumonia)
27
If a person lacks a normal cough reflex, ??? is more difficult to diagnose and may go unnoticed
-aspiration
28
a person’s swallowing ability can fluctuate over time, so the dietary plan needs frequent ???
-reassessment
29
consultation with a swallowing expert, such as a ?? and
?? therapist, is often necessary for determining the best dysphagia diet for the patient:
-speech and language
30
National Dysphagia Diet,
-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.
31
3 levels of national dysphagia diet:
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)
32
national dysphagia diet liquid consistencies:
-thin (water, tea, coffee, juice)
-nectar-like (buttermilk, eggnog, tomato juice)
-honeylike (honey, tomato sauce, yogurt)
-spoonthick: (milk pudding, applesuace)
33
International Dysphagia Diet Standardisation Initiative (IDDSI):
-nonprofit international group
-developed an alternative framework for dysphagia diets, which is expected to be incorporated into clinical practice over the next decade.
34
IDDSI is the same as national dysphagia diet but...
-the characteristics of the foods permitted at each level are more clearly defined
35
According to the IDDSI framework, solid foods in dysphagia diets can be characterized
as:
-pureed,
-minced and moist,
- soft and bite-sized,
-regular
36
IDDSI website includes examples of specific testing methods that can be used to ensure that a food
-is appropriate for a particular category, based on its texture and other
characteristics.
37
Sticky or gummy foods, such as peanut butter and cream cheese, may be difficult to clear:
- clear from the mouth and throat.
38
Foods that have more than one texture, such as vegetable soup or cereal with milk, are difficult to ?? , so ingredients may be:
-manage
-blended to a single consistency with items such as nuts and seeds omitted
39
Consuming foods that have a similar consistency can quickly become ??? .
Including a variety of ??? and ??? can make a meal more appealing
-monotonous
-flavors and colors
40
What is easier to swallow thin or thick lquids?
-thick
41
How to increase viscosity of food or beverages:
-stir in commercial thickeners (most often made from food starches or xanthan gum)
42
What is difficult to maintain when a patient has access to only thickened beverages?
-hydration, less acceptable for quenching thirst
43
To decrease the risk of dehydration and improve patient compliance with a
prescription for thickened liquids, some patients may be permitted
-regular drinking water between meals
44
Alternative Feeding Strategies for Dysphagia:
-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
45
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.
-jaws, tongue, larynx
46
Who is responsible for teaching patients these techniques?
-speech and language therapists
47
gastroesophageal reflux disease (GERD):
-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
48
Symptoms of GERD
-heartburn
-acid indigestion
49
Reflux occurs occasionally in healthy people and is a problem only if it creates
complications and requires
-lifestyle changes or medical treatment
50
causes of GERD
-sphincter muscle is weak or relaxes inappropriately
-high stomach pressures
-inadequate acid clearance from esophagus
51
Conditions associated with high rates of GERD include:
-obesity,
-pregnancy, (occurs in 2/3 of women, usually worsens in 3rd trimester).
-hiatal hernia (portion of stomach protrudes above diaphragm)
52
primary symptoms associated with GERD are acid
regurgitation and heartburn, which generally occur after
-meals
53
reflux esophagitis:
-gastric acid remaining in the esophagus long enough to damage the esophagus lining resulting in inflammation
54
Severe and chronic inflammation may lead to
-esophageal ulcers, with consequent bleeding
55
After healing begins, the scar tissue may
-narrow the inner diameter of the esophagus, causing esophageal stricture
56
Barrett’s esophagus:
-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.
57
Severe ulcerative disease may require immediate
???, whereas a mild case may be managed with ????
-acid-suppressing medication
-dietary and lifestyle changes.
58
Medications that suppress gastric acid secretion help the healing process by reducing the
-damaging effects of acid on esophageal tissue
59
Proton-pump inhibitors
-most effective of the antisecretory agent
- a class of drugs that inhibit the enzyme that pumps hydrogen ions (protons)
into the stomach
60
histamine-2 receptor blockers:
-a class of drugs that suppress acid secretion by inhibiting receptors on acid-producing cells;
-commonly called H2 blockers
61
Antacids,
-neutralize stomach acid,
-used to relieve occasional heartburn,
62
Why is using antacids not appropriate for GERD?
-they have only short-term effects and are ineffective for healing esophagitis.
63
??? may be required in severe cases of GERD that are unresponsive to
medications and lifestyle changes
-surgery
64
fundoplication
-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
fundoplication increases pressure within:
-the esophagus and fortifies the sphincter muscle
66
Esophageal strictures are often treated by dilating the esophagus
with an:
-inflatable balloon-like device or a fixed-size dilator
67
dyspepsia:
-symptoms of pain or discomfort in the upper abdominal area,
- often called “indigestion”;
-a symptom of illness rather than a disease itself.
68
These symptoms sometimes indicate the presence of more serious diseases, such as
-GERD or peptic ulcer disease.
69
about ?? percent of the population experiences dyspepsia, only ?? of
those affected ultimately seek medical care.
-25
-half
70
To minimize discomfort, people with dyspepsia are typically advised to avoid:
-large or fatty meals, highly spiced foods, and any foods or substances believed to trigger symptoms.
71
The feeling of bloating may be caused by excessive
??? in the stomach, which accumulates when:
-gas
-air is swallowed
72
What causes air swallowing? (5)
-chewing'
-smoking
-rapid eating
-drinking carbonated beverages
-using a straw
73
Which medication also contribute to stomach gas?
-antacids (especially sodium bicarbonate)
74
Chronic vomiting can reduce food intake and lead to
-malnutrition and nutrient deficiencies.
75
The symptoms that accompany vomiting may give clues about its ???.1
-cause
76
If abdominal pain is present when vomiting...,
-a GI disorder or obstruction is often the cause.
77
if abdominal pain is not present when vomiting the cause may be..
-medications
-foodborne illness
-pregnancy
-motion sickness
-inner ear disorders
-haptitis
78
main goal of treating nausea and vomiting?
-to find and correct the underlying disorder
-restoring hydration
79
If a medication is the cause of nausea/vomiting then what can you do?
-eating food with medication can help
80
If the cause for nausea/vomiting is unknown what can one do?
-take medications that suppress nausea and vomiting
81
intractable vomiting:
-vomiting that is not easily managed or controlled.
-may require intravenous nutrition support
82
to minimize stomach distention, patients should consume..
-small meals and drink beverages between meals rather than during a meal
83
What kinds of foods help reduce nausea? What kinds of foods worse symtpoms?
-dry, starchy foods (toast, crackers, pretzels)
-fatty foods and foods with strong odors
84
What is better tolerated for nausea... cold/room temp. foods or hot foods/beverages?
-cold/room temp. foods
85
gastroparesis:
-motility disorder characterized by delayed stomach emptying;
-most often a consequence of diabetes, gastric surgery, or
neurological disorders.
86
what % of gastroparesis is unkown?
-40%
87
Symptoms of gastroparesis include:
-nausea, vomiting, stomach pain or discomfort, bloating, and loss of appetite
88
Medical treatments for gastroparesis include:
-drug therapies (helps improves stomach motility and nausea/vomiting)
-electrical stimulation of stomach tissue (promotes muscle contractions)
89
Dietary practices that may improve stomach
emptying include
-chewing foods well
-remaining upright
-walking after meals are consumed.
-eating small frequent meals
-avoid meals high in fat and soluble fibers
90
gastritis:
- inflammation of stomach tissue.
-results from irritating substances or treatments that damage stomach tissue
91
Gastritis can often lead to:
-tissue erosion
-ulcers
-hemorrhaging (severe bleeding)
92
Chronic gastritis is frequently caused by long term infection or autoimmune disease and may progress to
-atrophic gastritis
93
atrophic gastritis
-characterized by widespread gastric inflammation and tissue atrophy
94
In most cases, gastritis results from: (2)
-Helicobacter pylori (H. pylori) infection
-the use of nonsteroidal anti-inflammatory drugs (NSAIDs)
95
Helicobacter pylori (H. pylori):
- a species of bacterium that colonizes the GI mucosa
-primary cause of gastritis & peptic ulcer disease
96
The extensive tissue damage that develops in longterm gastritis may disrupt -
gastric secretory functions and increase the risk of cancer.
97
complications of gastritis: (5)
-hypochlorhydria
-achlorhydria
-nutrient deficiencies
-lack of intrinsic factor
-pernicious anemia
98
hypochlorhydria:
-abnormally low gastric acid secretions.
99
achlorhydria:
-absence of gastric acid secretions.
100
What two nutrients does gastritis affect absorption?
-nonheme iron and vitamin B12
101
Lack of intrinsic factor results in:
-vitamin B12 malabsorption and vitamin B12 deficiency
102
pernicious anemia:
-vitamin B12 deficiency that results from lack of intrinsic factor;
- symptoms are macrocytic anemia, muscle weakness, and neurological damage.
103
Dietary recommendations of gastritis depends on the individuals..
-symptoms
104
if pain and discomfort is present during gastritis the patient should..
-avoid irritating foods & beverages (alcoholic beverages, coffee, acidic beverages and spicy foods)
105
If hypochlorhydria or achlorhydria is present during gastritis:
-supplementation of iron and vitamin B12 may be warranted.
106
peptic ulcer:
-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
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.
-H. pylori infection
-70 to 90
108
One other factor of peptic ulcer development:
-use of NAIDS (anti-inflammatory drugs)
109
the specific reasons why ulcers develop are unknown; only ?? to ??
percent of people with chronic H. pylori infection actually develop
a peptic ulcer
-5 to 15%
110
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 ??.
-vulnerability
111
The physiological effects of stress vary among individuals but may
include hormonal changes that impair…
-immune responses
-wound healing,
-increased secretions of hydrochloric acid and pepsin,
-rapid stomach emptying
112
Stress may also lead to what behavioral changes that can lead to development of ulcers?
-use of cigarettes, alcohol, and NAIDS
113
Symptoms of peptic ulcers
-some people of asymptomatic or experience mild discomfort
114
Ulcer pain may be experienced as
-hunger pain
115
Severe bleeding is evidenced by
-black, tarry stools or, occasionally, vomit that resembles coffee grounds
116
gastric outlet obstruction:
-complication of peptic ulcers
-an obstruction that prevents the normal emptying of stomach contents into
the duodenum.
117
treatment of peptic ulcers requires using a combination of
-antibiotics to eradicate H. pylori infection and/or discontinuing the use of aspirin and other NSAIDs,
118
most frequently prescribed drug regimen for peptic ulcers is
a:
- “triple therapy” that includes two antibiotics and a proton-pump inhibitor
119
gastrectomy:
-surgical removal of part of the
stomach
120
partial gastrectomy
-only part of the stomach is removed and remaining potion is connected to the duodenum or jejunum
121
(total gastrectomy
-entire stomach is removed and connects the esophagus directly to the small intestine
122
Common complication of gastric surgeries
-dumping syndrome
-large amount of chyme passes rapidly into the small intestine
123
Following a gastrectomy, the oral ingestion of fluids and foods is ??until
some healing has occurred, and fluids are supplied ??
-suspended -
-intravenously
124
Oral intakes after a gastrectomy begins with:
-small sips of water
-ice chips
-broth
125
Once fluids are tolerated the patient is offered:
-liquid meals (with no sugars) at first
126
After solid foods are started meals may contain only
-one or two food items at a time so that patients tolerance for them can be evaluated
127
Dietary measures after a gastrectomy are determined by:
- the size of the remaining stomach, influences meal size,
-the stomach emptying rate, affects food tolerances
128
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?
-5 to 8
-protein
129
What should patients avoid after gastric surgeries?
-sweets and sugars because they increase osmolarity in the small intestine and thereby increase the risk of dumping syndrome
130
Soluble fibers may be added to meals to slow ??? and reduce the risk of
??
-stomach emptying rate
-diarrhea
131
??? 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
-liquids
-30 to 60 minutes
132
Nutrition Problems after a Gastrectomy
-weight loss
-fat malabsorption
-bone disease
-anemia
133
Most popular surgical option of weight reduction:
-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
Gastric banding procedure
-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
Sleeve gastrectomy procedure
-removes a large portion of the stomach, leaving a narrow gastric tube (sleeve) that holds only about 3-5 ounces of food.
136
Whereas the gastric bypass and sleeve gastrectomy
operations are ??? , the gastric banding procedure is fully reversible
-permanent
137
which two surgeries results in greater weight loss??
-gastric bypass and sleeve gastroectomy
137
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
-malabsorption
-none of the small intestine is bypassed
138
To compensate for nutrient malabsorption,
patients who have had gastric bypass surgery usually require additional
supplementation of which vitamins?
-vitamin B12, folate, vitamin D, calcium, and iron
139
foods to avoid after gastric bypass surgery:
-doughy/sticky breads/ pasta
-rice
-melted cheese
-raw veggies
-foods with hulls, peels, seeds
140
Rapid weight loss increases a person’s risk of developing ?? disease;
patients at especially high risk sometimes have their ?? removed while
undergoing bariatric surgery
-gallbladder
