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Clinical Nutrition > Gatrointestinal Lectures > Flashcards

Gatrointestinal Lectures Flashcards

0
Q

Dysphagia

-4 types-

A

pain during swallowing

  • anatomical - surgery
  • physiological - radiation such as chemo damages pharynx and larynx
  • neurological - stroke, Parkinson’s Disease
  • drug induced - sedation, atxia

estimated that over 2/3 of elderly patients have dysphagia

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1
Q

Disease of Upper GI
Disease of Lower GI
Accessory Organs

A

Peptic Ulcer - upper
Crohn’s Disease - lower

liver, gallbladder, pancreas

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2
Q

Dysphagia

-4 feeding concerns-

A
  1. patient safety; aspiration and regurgitation (can enter into the airway and cause aspiration pneumonia)
  2. Individual tolerances; hot vs cold, solid vs liquid, can the pt eat alone? Can the patient feed him/herself?
    (the pt could have dementia and not away of what food is) varying degrees of tolerance
  3. Meeting nutritional requirements?
  4. Pain Control; Odynophagia - head and neck cancers will experience burning in the throat

talk to a occupational therapist, swallowing therapist, or dietitian *

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3
Q

Aspiration

-5 types of food that may increase the risk-

A
  1. sticky foods - melted cheese, peanut butter, fresh bread
  2. foods with 2 or more consistencies - stew, pies, fruit yogurt (overrides the ability to coordinate the swallow)
  3. foods with stringy fibres - celery, spinach, meats
  4. foods with small pits - cherries, grapes, citrus fruits
  5. foods that do not easily form bolus - crackers, meat, dry bread

(only some are listed, must have a pre-existing dysphagia or be a baby)

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4
Q

Dysphagia

-signs of conditions-

A
  • drooling; inability to swallow saliva
  • coughing; while eating, drinking, or following a meal
  • some people have silent symptoms; chest may make noise after eating
  • voluntary change in choosing foods ;consistencies or texture changes, solid to liquid
  • eating slowly
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5
Q

Dysphagia

-nutrition management-

A
  • complete nutrition assessment
  • monitor every week (time it takes to eat a meal, size of meal, weight)
  • depends on location of dysphagia - mouth, tongue, larynx
  • type of dysphagia - temporary (car accident) or permanent (stroke)
  • what is the cause
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6
Q

Dysphagia

-nutrition management therapies-

A
  • alteration in food texture - pureed, minced, diced
  • alteration in fluid viscosity - thickened fluids
  • high protein/high energy recommendations - malnourished, anticipated decrease in volume consumed
  • alternative feeding routes - enteral or parenteral
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7
Q

Dysphagia

-suitability of foods-

A
  • increase in salivation (sweet, spicy, sour); may help or hinder swallow
  • even textures are the easiest to swallow (mixed foods are harder); pills with water, soup
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8
Q

GastroEsophageal Reflux Disease (GER, GERD)

-description-

A
  • occurs when gastric acid refluxes into the lower esophagus through the LES
  • when this reflux is chronic, the patient is considered to have GERD
  • changes in the mucosal lining, inflammatory infiltrates, acidic damage
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9
Q

GERD

-symptoms-

A
  • chronic heartburn
  • nocturnal coughing spasms
  • regurgitation
  • chest pain
  • one or all symptoms does not diagnose the disease
  • is reversible
  • overnight coughing in babies
  • can be caused by stress
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10
Q

GERD

-Associated Factors-

A
  • increase in abdominal pressure (LES is regulated partially by pressure); the pyloris generates too much pressure, forcing food up
  • relaxed LES
  • delayed gastric emptying
  • sensitive esophageal mucosa - allergies
  • pyloric obstruction - cancers

may be due to viruses, drugs etc

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11
Q

GERD

-Predisposing conditions-

A
  1. obesity
  2. ascites - excess fluid in the abdominal cavity usually associated with liver disease
  3. scleroderma - disease that leads to hardening of tissues
  4. pregnancy - increased abdominal pressure, delayed gastric emptying
  5. hiatus hernia - part of the stomach passes above the diaphragm
  6. Incompetent LES - congenital

inflammed GI tract = higher risk
underlying cause for GERD needed

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12
Q

GERD
-treatment-

1st line is medication
2nd line is to promote gastric emptying

A

first line of defense in management of symptomology is medication*

  1. dietary modification
  2. Lifestyle modification
    - upright position for 1 hour after eating
    - not eating 2-3 hours prior to going to bed
    - avoid tight clothing in abdominal area
    - stop smoking
    - achieve a healthy body weight
    - elevate head of bed 15-20 cm when sleeping
  3. Drug Therapy - antisecretory drugs that decrease the production of stomach acid
    - proton pump inhibitors / Histamine H2 receptor antagonists —> not good for long term use, bacteria grows
    - motility agents speed up gastric emptying
  4. Surgery (last resort)
    - tightening of LES; wrap upper stomach around
  5. antacids - if issue is milk, acid is not the problem the acid is just in wrong place
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13
Q

GERD

-nutrition care suggestions-

A
  • weight loss diet
  • may require eliminating specific foods from the diet
  • eating smaller meals; decrease abdominal pressure and volume of reflux
  • high dietary fibre decreases symptoms
  • high dietary fat increases symptoms (delays gastric emptying)
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14
Q

GERD

-some foods to lessen in diet-

A
  1. fatty foods - delays gastric emptying, decreases LES pressure, may help with weight loss
  2. chocolate - decreases LES pressure
  3. caffein - decreases LES pressure
  4. spicy or acidic - may irritate esophageal mucosa
  5. alcohol - decreases LES pressure
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15
Q

GERD

-4 complications-

A
  1. esophagitis - inflammation of esophagus
  2. scar tissue - lining of esophagus comes off and forms tissue
  3. stricture - tissue sticks together and narrows the passage
  4. esophageal cancer
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16
Q

PUD

-description-

A
  • due to the h pylori bacteria - dirty water exposure
  • some drugs can increase the risk
  • stomach, lower esophagus, duodenum
  • can just be due to stress
  • break in the protective mucosa and exposure to acid
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17
Q

PUD

-PreDisposing Risk Factors-

A
  • poor nutrition (can make symptoms worse)
  • smoking
  • genetics
  • excessive alcohol intake
  • use of salicylates (aspirin) or NSAIDS (non-steroidal anti-inflammatory drugs)
  • helicobacter pylori infection
18
Q

PUD

-symptoms-

A
  • acute abdominal pain - due to food or fluid intake
  • distention
  • melena stools - black due to old blood
  • hemataemesis - vomitting blood

psychosocial factors can affect treatment and reporting - some people don’t report symptoms

19
Q

PUD

-diagnosis-

A

endoscopy

  • long tube with a camera is inserted into the GI tract
  • biopsies can be taken
20
Q

PUD

-3 areas-

A

esophagus - rare, may occur with chronic and untreated reflux

gastric - most common, defective mucosal lining, decreased blood flow, due to poor nutriton

duodenal - hyper-secretion of acid in stomach, very acidic chyme

21
Q

PUD

-treatment-

A
  1. medication
  2. diet
    - strict diet is not necessary
  3. lifestyle
  4. surgery
22
Q

PUD

-medication treatment-

A
  1. H2 histamine antagonist receptor
    - decreases stimulation of parietal cells
    - ex cimetidine
    ~ works for 60 -70% of pts
  2. antacids - neutralizes acid
  3. antibiotics - four week treatment for H pylori bacteria
23
Q

PUD

-Diet treatment-

A
  • eat balanced diet
  • avoid eating before bed time
  • limit foods that may increase acid secretion; pepper, garlic, chili powder
24
Q

PUD

-lifestyle treatment-

A
  • stop smoking
  • decrease stress
  • decrease alcohol intake
  • decrease intake of aspirin or NSAIDs
25
Q

PUD

-surgery treatment-

A
  • bypass or excise the pyloric sphincter
  • no regulation of gastric emptying
  • partial or complete gastrectomy
26
Q

PUD

-Dumping Syndrome-

A
  • simple sugars empty out of the stomach fast, glucose enters the blood fast, fluid and electrolytes follow
  • occurs in response to undigested food or simple carbs in the duodenum/jejunum
  • no pyloric sphincter
  • who food dumped into intestine 10-15 minutes after intake
  • nausea, diarrhea and cramps due to rapid movement of water into the intestine to dilute it
  • low blood pressure may cause dizziness, faintness, weakness (hypotension
27
Q

PUD

-gastric surgery diet-

A
  • NPO: ice chips 24-48 hours, clear fluids
  • intake match output
  • take 1/2 - 1 serving before or after meals
  • gradual progression to general diet as tolerated
  • limit high fat foods
  • monitor for dumping syndrome
  • avoid simple carbs
  • moderate temperature
  • small and frequent meals
  • avoid natural laxatives
28
Q

PUD

-steatorrhea-

A
  • partial gastrectomy: fat malabsorption
  • total gastrectomy or gastrojejunostomy: pancreatic insufficiency, defective enzymes, increase transit time
  • MCT oil for adequate intake
  • if only stomach is involved you can supplement with vitmains
29
Q

PUD

-Gastric Surgery nutrient deficiencies-

A
  • iron: HCl in stomach reduceds Fe3 to Fe2 which aids absorption; absorption is therefore reduced
  • vitamin b12: requires intrinsic factor from the parietal cells of stomach
  • folic acid: may have decreased intake, is secondary to low B12 intake
30
Q

Lower GI

-6 disorders-

A
  1. inflammatory Bowel Disease
    - Crohn’s disease
    - UC
  2. Celiac Disease
  3. Irritable Bowel Syndrome
  4. Diverticular Disease
  5. Hemorroids
  6. Short Gut Syndrome
31
Q

Lower GI

-fat malabsorption-

A

-normal consumption is 50-100 g/day
- 95% absorbed
- <7g in stool
- malabsorption if >7g of fat in stool
(light, flats, liver disease - no bile, no fat absorption)

  • steatorrhea; loose, hard to flush, strong odor
  • fecal fat test: diet record of 75-100g of fat for 6 days, collect stool from last 3 days and measure
32
Q

Inflammatory Bowel Disease IBD

-2 types-

A
  • no known cause or cure
  • malnutrition is common in both when disease is active
  • bloody diarrhea is common in both
  • differentiate with scope testing

Crohn’s

  • can be anywhere in the lower GI
  • if cut out of the bowel it CAN reappear elsewhere

UC

  • effects mucosal layer only *
  • no goblet cells
33
Q

IBD

-malnutrition associates-

A
  • not all malnutrition may be due to the disease (underweight pts due to decreased oral intake)
  • Crohn’s causes dysphagia
  • increased risk for infection
  • increased hospital costs
  • increased morbidity and mortality
  • decreased immunocompetence
  • decreased enzyme function
  • decreased tolerance to medication
  • altered fluid and electrolyte balance
34
Q

IBS

-pathophysiology-

A

UC

  • mucosal inflammation
  • colon and rectum
  • continuous lesions
  • removal may cure; can end up with ostomy

Crohn’s Disease

  • transmural inflammation
  • anywhere in GI tract (70% at terminal ilium)
  • skip lesions
35
Q

IBD

-complications of UC-

A
  • malabsorption
  • weight loss
  • colon cancer
  • toxic mega colon(colon crumbles, very rare)

-* no fistulas, strictures, or obstructions

36
Q

IBD

-complications of CD-

A
  • fistulas
  • obstructions
  • strictures
  • malabsorption
  • weight loss
  • maybe toxic mega colon
  • maybe colon cancer
37
Q

IBD

- 2 complications-

A

fistula - created by an abces that fills with stool preventing healing and eventually breaks

blind loop syndrome - fistulas create a blind loop in the intestine

38
Q

IBD

-inadequate intake and decreased absorbance malnutrition-

A

low intake

  • anorexia
  • nausea
  • vomiitting
  • dietary restriction without supplementation
  • restrictions due to pain (underlying disease causes pain)
  • pt are both very thin
  • UC pts don’t tend to be malnourished
39
Q

IBD

-excessive losses and increase intake needs-

A

excess losses

  • diarrhea
  • blood loss
  • trace elements
  • proteins losing entropathy - leaky bowel, proteins leak into bowel, decreased albumum
  • bile salts

increase intake

  • inflammation
  • fever
  • surgery
  • infection
  • repletion of stores
  • consider other supplements being taken
  • stress factor due to these
40
Q

IBD

-drug interactions malnutrition-

A
  1. corticosteroids (prednisone)
    - increased requirement for protein, vitamin B6, zinc, vitaminD
  2. Sulfasalzine (NSAID)
    - folic acid absorb inhibitor
  3. Cholestyramine
    - reduced absorption of fat soluble vitamins

rapid transit time

41
Q

IBD

-critical spots of intestine-

A

Distal Jejunum
- major area of nutrient absorption

Distal Ileum <100 cm resection

  • bile wasting
  • diarrhea, mild steatorrhea

Distal Ileum >100 cm resection

  • severe steatorrhea
  • depletion of bile
  • fat soluble vitamin deficiency
  • electrolyte and fluid imbalance
  • hypomagnesemia, hypocalcemia

Ileocecal Valve

  • bacterial overgrouth –> diarrhea / steatorrhea
  • reduced mucosal contact time
  • colerrheic diarrhea
  • byproducts can product gases and cause distention and twisting

Ascending Colon
- fluid and electrolyte imbalance

42
Q

IBD

-3 treatments-

A
  1. Nutrition Therapy
  2. Drug Therapy
  3. Surgical Therapy
    - bowel resection with/out ileostomy
43
Q

IBD

-medication-

A
  1. analgesic - pain control
  2. antibiotic - stop bacterial growth
  3. anti-inflammatory - decrease inflammatory response

Clinical Nutrition (14 decks)

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