Gatrointestinal Lectures Flashcards
Dysphagia
-4 types-
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
Disease of Upper GI
Disease of Lower GI
Accessory Organs
Peptic Ulcer - upper
Crohn’s Disease - lower
liver, gallbladder, pancreas
Dysphagia
-4 feeding concerns-
- patient safety; aspiration and regurgitation (can enter into the airway and cause aspiration pneumonia)
- 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 - Meeting nutritional requirements?
- Pain Control; Odynophagia - head and neck cancers will experience burning in the throat
talk to a occupational therapist, swallowing therapist, or dietitian *
Aspiration
-5 types of food that may increase the risk-
- sticky foods - melted cheese, peanut butter, fresh bread
- foods with 2 or more consistencies - stew, pies, fruit yogurt (overrides the ability to coordinate the swallow)
- foods with stringy fibres - celery, spinach, meats
- foods with small pits - cherries, grapes, citrus fruits
- 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)
Dysphagia
-signs of conditions-
- 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
Dysphagia
-nutrition management-
- 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
Dysphagia
-nutrition management therapies-
- 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
Dysphagia
-suitability of foods-
- 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
GastroEsophageal Reflux Disease (GER, GERD)
-description-
- 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
GERD
-symptoms-
- 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
GERD
-Associated Factors-
- 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
GERD
-Predisposing conditions-
- obesity
- ascites - excess fluid in the abdominal cavity usually associated with liver disease
- scleroderma - disease that leads to hardening of tissues
- pregnancy - increased abdominal pressure, delayed gastric emptying
- hiatus hernia - part of the stomach passes above the diaphragm
- Incompetent LES - congenital
inflammed GI tract = higher risk
underlying cause for GERD needed
GERD
-treatment-
1st line is medication
2nd line is to promote gastric emptying
first line of defense in management of symptomology is medication*
- dietary modification
- 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 - 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 - Surgery (last resort)
- tightening of LES; wrap upper stomach around - antacids - if issue is milk, acid is not the problem the acid is just in wrong place
GERD
-nutrition care suggestions-
- 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)
GERD
-some foods to lessen in diet-
- fatty foods - delays gastric emptying, decreases LES pressure, may help with weight loss
- chocolate - decreases LES pressure
- caffein - decreases LES pressure
- spicy or acidic - may irritate esophageal mucosa
- alcohol - decreases LES pressure
GERD
-4 complications-
- esophagitis - inflammation of esophagus
- scar tissue - lining of esophagus comes off and forms tissue
- stricture - tissue sticks together and narrows the passage
- esophageal cancer
PUD
-description-
- 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
PUD
-PreDisposing Risk Factors-
- 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
PUD
-symptoms-
- 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
PUD
-diagnosis-
endoscopy
- long tube with a camera is inserted into the GI tract
- biopsies can be taken
PUD
-3 areas-
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
PUD
-treatment-
- medication
- diet
- strict diet is not necessary - lifestyle
- surgery
PUD
-medication treatment-
- H2 histamine antagonist receptor
- decreases stimulation of parietal cells
- ex cimetidine
~ works for 60 -70% of pts - antacids - neutralizes acid
- antibiotics - four week treatment for H pylori bacteria
PUD
-Diet treatment-
- eat balanced diet
- avoid eating before bed time
- limit foods that may increase acid secretion; pepper, garlic, chili powder
PUD
-lifestyle treatment-
- stop smoking
- decrease stress
- decrease alcohol intake
- decrease intake of aspirin or NSAIDs
PUD
-surgery treatment-
- bypass or excise the pyloric sphincter
- no regulation of gastric emptying
- partial or complete gastrectomy
PUD
-Dumping Syndrome-
- 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
PUD
-gastric surgery diet-
- 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
PUD
-steatorrhea-
- 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
PUD
-Gastric Surgery nutrient deficiencies-
- 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
Lower GI
-6 disorders-
- inflammatory Bowel Disease
- Crohn’s disease
- UC - Celiac Disease
- Irritable Bowel Syndrome
- Diverticular Disease
- Hemorroids
- Short Gut Syndrome
Lower GI
-fat malabsorption-
-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
Inflammatory Bowel Disease IBD
-2 types-
- 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
IBD
-malnutrition associates-
- 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
IBS
-pathophysiology-
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
IBD
-complications of UC-
- malabsorption
- weight loss
- colon cancer
- toxic mega colon(colon crumbles, very rare)
-* no fistulas, strictures, or obstructions
IBD
-complications of CD-
- fistulas
- obstructions
- strictures
- malabsorption
- weight loss
- maybe toxic mega colon
- maybe colon cancer
IBD
- 2 complications-
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
IBD
-inadequate intake and decreased absorbance malnutrition-
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
IBD
-excessive losses and increase intake needs-
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
IBD
-drug interactions malnutrition-
- corticosteroids (prednisone)
- increased requirement for protein, vitamin B6, zinc, vitaminD - Sulfasalzine (NSAID)
- folic acid absorb inhibitor - Cholestyramine
- reduced absorption of fat soluble vitamins
rapid transit time
IBD
-critical spots of intestine-
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
IBD
-3 treatments-
- Nutrition Therapy
- Drug Therapy
- Surgical Therapy
- bowel resection with/out ileostomy
IBD
-medication-
- analgesic - pain control
- antibiotic - stop bacterial growth
- anti-inflammatory - decrease inflammatory response
