chapter 18 - GI Flashcards
dyspepsia
indigestion
discomfort in digest tract (physical or psych in origin)
heartburn, bloating, pain, sometimes regurgitiation
phycial cause: overeating or spicy foods or symptom of another problwem like appendicitis or a kidney, gallbladder or colon disease ,or possibly cancer (if organic problem then tratment of underlyic cause)
psychological: find relief from underlying stress, allow sufficient time to relax and enjoy meals, learn to improve eating habits
esophagitis
irritating effect of acid reflux on the mucosa of the esophagus
heartburn, regurigtaiton, and dysphagia
acute could be irritating agent or GERD or hiatal hernia, reduced lower esophageal sphincter (LES) pressure, abd pressure, recurrent vomiting, alc use, overweight, or smoking
cancer of esophagus and silent aspiration may be life threatening for those w GERD
hiatal hernia
- condition in which a part of stomach protureds through the diaphragm into the thoarci cavity
hernia prevents food from movigng normally along diestive tract although food does somewhat mix w gastric juices
food might move back into esophagus, creating heartburm or regureigiation into mouth
medical nutrition therapy for dyspepsia, esophagitis and hiatal hernia
- small, frequent meals so amount of food in stomach is never large
- avoid irritatns to esophagus like carbonated becerages, chocolate, citurs fruits and uices, tomato products, spicy foods, coffee, pepper, and some herbs
some food can cause lower esophageal sphincter to relax like fatty and fried foods, spicy foods, cirtrus foods, tomato products, onions, chocolate, mint candy, caffeinated beverages, and alc so they should be avoided
if obese, wt loss
avoid late-night dinners and lyign down for 2-3 hours after eating (sleep w heads and upper toros somewhat elevated and wearning loose-fitting clothing)
may need sugery
peptic ulcers
erosion of mucous membranes
gastric ulcer in stomach or duodenal ulcer in duodenum
cause is unclear but could be genetic predisposition, abn high secretion of HCL in stomach, stress, excessive use of aspirin or ib uprofen, cig smoking, bacterium H. pylori
symptom is gastric pain and maybe hemorrhage
treatment for ulcers
treat gastric pain w food or antacids
hemorrhage traeated w surgery
ulcers treated w drugs such as antibiotics and cimetidine
antibiotics kill bacteria and cimetidine inhibits acidsecretion in stomach and thus helps ulcer hal
antacids contain calcium carbonate which neutraizes any excess acid
stress managemtnt
diet for ulcers
sufficient low-fat sources of protein but not in excess as it stimulates gastric acid secretion
(no more than 9,8g protein per kg body wt; if blood loss inc to 1-1.5 g per kg)
vitamin and mineral suppplements (esp uron if hemorrhage)
increased intake of fat as fat delayed emptying stomach in moderation as ppl w peptic ulcers are more prone to atherscleroris
spicy foods as tolerated; avoid coffee, tea, or caffeine, alc, aspirin as irritate mucous membrane; cig smokng decrease secretion of pancrease that buffers gastric acid in duodenum
diverticulosis/ diverticulitis
diverticulosis - intenstinal disorder charcteriszed by little pickets n side of large intenstine
diverticulitis - fecal matter collect in pockets, breeding bacteria, and infalammation and pain may reulst
deverticulum rupture = surgery
thought to be caused by diet lacking in fiber so high-fiber diet recommendnet
treatment for diverticulitis is antibotics, clear-liquid diet, low-residue diet to allow bowel to rest and heal, then high fiber diet to increase stool volume, reduce pressure in colon, and shorten time food is in intestine
irritable bowel syndrome
function gi disorder
gi tract not functioning properly
previously known as spastic colon or colitis
abn pain or discomfort for the last 3 months, at least 3x during those months
some indv may exp diarrhea, constipiation, mixutre of both, cramping, bloatin g
cause not welknown but may be genetics, food sensitivity, bacterial inection or overgrowht, motility issues, altered neurotransmitters, GI hormones, psych issues
treated by changes in diet, med, probiotics, therpaies for mental health
avoid food for IBS
- foods high in fat
- milk products
- alc or caffeine drinks
- drinks w large amoutns of artifical sweenters
- beans, cabbage, other gas-producing foods
FODMAP Diet
(feremtnable oligo-, di-, mono-saccharides and polyols)
- restirct fodos w constituents such as honey, high fructose corn syrup, fruits w pits or seeds, milk, wheat, onions, and garlic, starchy beans, and sugar alc
inflammatory bowel disease
chronic conditions causing inflammation in GI tract
- cause malabsorption that often leads to malnurition
- acute phase is irregular and are followed by symptom free preiod
- ex are ulcerative colitis and Crohns Disease
ulcertive colitis
inflammation and ulceration of the colon, rectum, and smoetmies entire large intstine
crohns disease
autoimmune disease
chronic progressive disorder that can affect both small and large intestine
ulcers can penetrate entire intestinal wall
chronic inflammation can thicken the intestinal wall causing obstruction
IBD symptoms
bloody diarrhea
cramps
fatigue
nausea
anorexia
malnutrition
wt loss
electroylte, fluids, vitamins, anod other minerals are lost in diarrhea, and bleeding can cuase loss of iron and protein
clients w crohsn are often thin and may be malnoursihed due to malabsorption of nutrients
treatments for IBD
anti-inflammatory drugs + med nutrition therapy
low-resideu diet to avoid irritating inflamed area and avoid danger of obstruction
when tolerated include abt 100g protein, addition cal, vitamins, and minerals
in severe cases total parenteral nutrition
ileostomy or colostomy
severe IBD may need stoma for defectation (size of nickel)
ileostomy if entire colon, rectum and anus msy be removed
colostomy - enterance to colon if rectum and anus are removed (temp or permanent)
short bowel syndrome
after surgical removal of small intstine (at least half) and/or dysfunction or removal of colon
patient lacks sufficient bowel length or function to support nutrient neesd
reduced intestinal lenght and decreased transit results in nutrient malabsorption and fluid losses
may need parenteral or specialized enteral formula after surgery, need food asap as nuteints from food are the most potent stimuli to foster bowel adaptation
successful adaption more liekely in pt whose colons reamin
treatment for short bowel syndrome
anti-diarrheal and anti-secretory medication + pancreatic enzumes, oral rehydration solutions and soluble fibers
larger instutuets have intesitnal rehab programs devoted to weaning idn off parenteral nutritio nand IV fluids
diet for short bowel syndrome
diet focus on six small meals per day and low fat, no concetrated swee emphasis
w ilesotaomtes hve greater need for salt and water
vitamin C and B12 supplement as well as fat-soluble vitamins
liquid or cheweable multivitmain
celiac disease
gluten-sensitive enteropathy or sprue
chronic autoimmune disorder caused by interolanerce to gluten (protein wheat, barley and rye)
produce antibodies that attack intestine when they ingest gluten
1/3 ppl have genes for celiac but unknown environemntal factors determine who get celiac dsease or glyen sensitivity
celiac disease symptoms
diarrhea
constpiation
wt loss or gain
abd cramping and bloating
malnutrition
joint pain
anemia
fatigue
growht compromised in children with untreated celiac
1 in ___ americans have celiac
133
celiac is _____ as common as crohns, ulcerticatives colitis, and CF. ombined and -__$ celiac indv remain undaginosed or misdaginsed
twice
83
_____ year lapse before celiac diagnosis
6 to 10 year
celiac diagnosis and treatment
celiac panel - blood tests that measure immune response to gluten which nust be done prior to start of glutenfree diet
biopsy of intestine
strict-gluten free diet
—% of pop are neg for celiac but have gluten sensitivty
6%
how to assess non celiac gluten intolerance
trial of 2 to 3 weeks of gluten free diet (elimination) and challenge of returningback to gluten
then monitor synmptoms
non-celiac gluten sensitivity dont have damange to intestinal villi compared to someone w celiac disease
gluten-containing grains to avoid
barley (malt extract, beer, and ale), rye, wheat (all wheat flours and products made w wheat, bran, germ, starch), spelt, triticale, and farro
gluten free grains and starches
rice
wild rice
millet
amaranth
arrowroot
corn
flax
buckwheat
soy
teff
flours made from ntus, beans, seeds, potato, tapioca, and sorghum
most nutritious high giber gluten-free grains
brown rice
wild rice
quinoa
amaranth
buckwheat
gluten-free steel cut oats
rice bran
liver function
all nutrients expect for a few fatty acids are absorbed in intestines and transported to liver
liver then dismantles some of nutrients, stores others, anuses some to synthesize other substances
liver determine where amino acids are needed, synthesizes some proteins, enzymes, and uera
changes simple sugars to glycogen, provides glucse to body cells, sythesizes glucose from anio acids if needed
converts fats to lipoproteins and syhtesizes cholesterol
stores iron, copper, zinc, mangeiusm, fati-soluble vitmains, and b viitamin
synehzies bile
detoxifies many substances such as barbiturates and morphine
cirrhosis
general term for all liver disease characteriszed by cell loss
alc abuse is most common cause but could also be congential defects, infections, or other otxic chemicals
replacement does not match loss of cells in cirrhosis
also has fatty infilatration and fibrosis
blood flow thorugh liver is upset, form of phyertension, anemia, and hemorrhage
dietary treatment of cirrhosis
25-35 cal or more + 0.8-1g of protein per kg
if hepatic coma is imminent then lower amt
supplements of vitmains and minerals
advanced chirrhosis: 50-60% of call from carb
in some cirrhosis fat is not tolerated well so restricted
if protein not toelrated well its restricted to 35-40g a day
cirrhosis can cuase ascites
sodium and fluids may be restricted
fluid may be restircted if bleeding in esophagus
smaller feedings
no alc
hepatitis
inflammation of the liver
caused viruses or toxic agents sucha sdrugs and alc
necrosis
in mild cases cells can be replaced, in severe cases damage is extensive and then lver failure and dath and bile stasis, decreased blood albumin level,s nausea, heachae, fever, fatigue, tender and enerlaged liver, anorexia, and handice, wt loss
types of hepatitis
hep A: contaminatd drinking water, food, and sweage vita fecal-oral route
hep B and hep C: blood, blood products, semen and salivia (Hep b and C can lead to chronic active hep (CAH))
CAH can lead to liver failure and end stage liver disease
treatment for hepatitsi
bed rest
plenty of fluids
med nutriton therapy
35-40 g cal per kg
most of cal from carb, mod fat, and 70-80g protein if necrosis no severe
limit protein if necrosis is not severe
smal lfrequent meals
clients w liver disease requre a great deal of encouargement bc anorexia and conseuqnet feelings of general malaise can be severe
recovery take patience rest and time
cholecystitis and cholelithiasis
may inhibits flow of bile and cause pain
cholecystitis can cuase changes in gallbladder tissue which in turns affect cholesterol, causing it to harden and form stones
thought chronic overindulgence in fats may contribute to gallstones bc fat stmiaultes liver to prodcue more cholesterol for bile which is necessary for digestion of fat
etiology of gallbladder disease
heredity factors
women develop gallbladder disease more oftne than men
boesity, TPN, very-low-cal diet for rapid wt loss, use of estrogen, various small intestien disease
function of gallbalder
dual function of gallbladder is concentration and storage of bile
gallbaldder contecntates ble formed in liver
fat in duodenum triggers gallbladder to cntract and release bile in common duct
symptoms and treatment for gallbladder inflammation and sotnes
symtpoms: pain, indgiestion, vomiting (particularly after ingestion of fatty foods)
treatment - mediciatio nto dissolve stones, diet therapy, cholescystectomy
med nutritoin therapy for gallbladder stones
clear-liquid diet
rgular but fat-restircted diet (40-45g fat daily)
chronic cases: fat restricted on permanent basis
wt loss if obsese
water-misicle forms of fat-soluble vitmaisnp
pancreas function
prodcues insulin and other hormones and enzymes essnetial to digetion of protein, fats, and carbs
pancreatitis
inflammation of pancrease
caused by infection, surgery, alcholism, biliary tract disease pr certain drugs
symptoms of pancreatitis
abd pain, nausea, steatorrhea
malabsopriton of fat-solube vitmains
wt loss
if islet of Langerhans are destroyed, diabetes mellitus
diet therapy for pancreatitis
protein and HCL stimualte pancrease thus during acute pancreatitis client is noursihed stricly parenterally
later liquid diet of mainly carb
then small ,fdreuqnt feedings of carbs and proteins w little fat or fiber bc deficiency of pancreatic lipase
vitamin supplements
residue controlled diets
dietary fib er is mostly found in plant foods
resude is solid part of feces
reside made up of all undigested and unabsorbed parts of food, connective tissue in animal foods, dead cells, and inestinal bacteria and prodcts (mostly fiber)
diets can be adjusted to increae or decrease fiber and residue
high fiber diet
30g or more
bleieved to help prevent diverticulosis, constipation, hemorrhoids, and colon cancer
helpful in treatment of diabetes mellitus and athersclerosis
normal diet in US contains about 15g of dietary fiber, rec is for 38g men and 25g women byt not to exceed 50g
intrudce gradually
8 8-oz glasses of water must also be consumed
recommendent foods for high fiber diet
coarse and hwole grain breads and cerea;s
bran
all fruits and veg (esp raw) and legumes
low residue diet
5-10 g ietary fiber to reduce normal work of interstines by reduced amt of dietary fiber and thus residue
may be used in cases of severe diarrhea, diverticultisi, ulcerative colitis, and intestinal blockage and in prep for and immeiatley after instential surgery
no more than 3g of fiber in some facitlirs
diarrhea
frequent expulsion of watery feces
causes food to move through the digestive system too quickly for nutrients to be fully absorbed + loss of liquid
may be caused by Food sensitivity, harmful bacteria, and stress
constipation
- chyme moves v slow hrough large intestine so too much water is absorbed
- feces become hard,bowel movement becomes painful
- excess straining can lead to hemorrhoids
- caused by erratic eating habits, low fiber, lack of physical activity, too little water, ignoring bowel movements
indigestion
- abd discomfort after eating and relates to difficulty digesting food
- caused by stress, eating too fast or much, particular foods
- symptoms include gas, stomach cramps, nausea
heartburn
burning sensation in middle of chest
caused by stomach acid into esophagus; aka reflux
prevent by avoiding certain foods or drinks, decrease fatty and spicy food intake, small frequent meals > large meals, no eating several hours before bed
