GI Diseases Flashcards
What nutrients are absorbed in the Jejunum?
Major Macronutrients (Glucose, FA, Cholesterol, AA & Peptides)
Water Soluble Vitamins
Minerals
Electrolytes and Water
What Nutrients are absorbed in the Ileum?
Bile Acids
Fat and Cholesterol
Fat Soluble Vitamins
Vitamin B12
Electrolytes
Water
What happens to undigested carbohydrates in the colon?
They are converted to SCFA by colonic bacteria
What are symptoms of GERD?
Chronic heartburn
Chest pain
Nocturnal coughing spasm
Regurgitation
What are complications of GERD?
Inflammation of esophagus
Scar Tissue
Stricture: narrowing of esophagus
Esophageal Cancer
What are the associated factors with GERD?
Increased abdominal pressure (The lower esophageal sphincter is partially controlled by a pressure gradient)
Relaxed LES
Delayed gastric emptying
Sensitive esophageal mucosa
Pyloric obstruction
What are the pre-disposing conditions for GERD?
Obesity
Ascites - excessive fluid in the abdominal cavity associated with liver disease
Scleroderma - a disease that leads to the hardening of tissues
Pregnancy - causes increased abdominal pressure
Delayed gastric emptying
Hiatus Hernia - part of stomach passes above diaphragm
Incompetent LES - this is congenital
What are the Treatments for GERD?
Lifestyle modification
Drug Therapy
Surgery
Antacids
What lifestyle modifications can you make for GERD?
Sit in an upright position for 1 hour after eating
Avoid eating 2-3 hours prior to going to bed
Avoid tight clothing in abdominal area
Stop smoking
Achieve and maintain a healthy weight
Eat smaller meals with less fat and more fibre
Elevate head of bed 15-20cm when sleeping
What foods may need to be decreased or eliminated from the diet to treat GERD?
Less fatty foods - fat delays gastric emptying and this may also help with weight loss
Chocolate, Caffeine - not causative but may help with decreased LES pressure
Nicotine and alcohol - causitive
Spicy and acidic foods - NOT CAUSITIVE but my irritate esophageal mucosa
What therapies besides nutrition therapy is used to treat GERD?
Drug Therapy:
Anti Secretory drugs that help to decrease gastric acid production. Examples include proton pump inhibitors, histamine H2 receptor antagonists
Motility agents that speed up gastric emptying
Surgery: tightening of LES
Antacids: to alleviate symptoms but will not change the disease process
What are some potential causes of dysphagia?
Anatomical - structural abnormalities such as a cleft palate or surgery used to treat head and neck cancers
Physiological - radiation used to treat cancers
Neurological - stroke, cerebral palsy, muscular dystrophy
Drug induced - sedation, ataxia, some anti depressants
What are the major warning signs of oral dysphagia?
Drooling, expectoration during/after swallowing
Slow rate of intake/chewing
Altered posturing of head/neck
food residue in mouth after eating
Coughing before swallowing
Alterations in voice quality - sound of a wet voice or aphonia (inability to vocalize)
Abnormal/absent laryngeal elevation
Unexplained weight loss
Briefly outline the phases of the swallow:
Oral Phase - the bolus of the food travels to the back of the throat, the UES is still closed. Tongue is elevated from anterior to posterior to trigger the swallow. This phase is affected by surgical defects that may cause tongue weakness, neurological disability and cognitive statues/level of awareness.
Swallow/Pharyngeal phase - soft palate elevates (known as velar elevation) to close off nasopharynx and prevent nasopharyngeal regurgitation. Constrictor muscles contract (known as pharyngeal peristalsis) and the tongue base drives the bolus posteriorly.
Esophageal Phase - upper esophageal sphincter opens and then closes once bolus enters the esophagus where it is propelled through the esophagus through peristaltic contractions. The lower esophageal sphincter relaxes and the bolus moves into the stomach
What are the three types of thickened fluids?
Nectar - mildly thick
Honey - moderately thick
Pudding - extremely thick
What are the main AHS texture modified Diets?
Pureed, Minced, Dysphagia Soft
Bonus - easy to chew
What is Peptic Ulcer Disease?
Break in the mucosa an exposure to acid and pepsin - can occur in any area that is exposed to gastric acid and pepsin including the stomach, lower esophagus and duodenum
What are PUD symptoms?
Acute abdo-pain usually accompanying intake of food and fluid
Distension
Melena Stools - stools are black due to old blood
Hematemesis - vomiting old or fresh blood
What is the most common etiology of PUD?
H. Pylori - contaminated drinking water - secretes toxins that lead to inflammation, tissue damage and a break in the mucosa
What are risk factors for PUD?
Poor nutrition
Smoking
Genetics
Alcoholism
Use of NSAIDs or Salicylates
H. Pylori
What medications are used to treat PUD?
H2 Histamine receptor antagonists - decrease H2 secretion from parietal cells
Antacids - neutralize gastric acids by acting as a buffer
Antibiotics - effective against H. Pylori
What diet recommendations can be made for treatment of PUD?
Avoid frequent meals/bedtime eating that promotes acid secretion
Limit foods that may increase Gastric acid secretion (caffeine, black pepper, garlic, cloves, chilis)
What lifestyle recommendations can be made for PUD?
Stop smoking
Eliminate alcohol
Avoid aspirin and other NSAIDs
What are signs and symptoms of dysphagia in infants and children?
Back Arching
breathing difficulties
decreased responsiveness when feeding
difficulty chewing food that are texturally appropriate for age, refusing foods of certain textures/types, loss of food/liquid from mouth when eating, crying or grimacing at mealtimes
Frequent congestion after meals, frequent respiratory illness, vomiting, choking, pharyngeal residue and nasopharyngeal reflux
What is the hydration goal for adults with dysphagia?
1500 ml of total fluids as 1000ml thick fluids and 500ml high fluid foods through meals and snacks
Pediatric patients 2/3 of fluid is provided as thick fluids and remainder as high fluid foods
What are strategies for managing hydration in dysphagia individuals?
Intake needs to be sufficient to meet requirements - can use water, milk, juice, pop, soup, tea, coffee, oral nutrition supplements and energy drinks. For infants, include breastmilk and infant formula.
A fluid can be food that melts at body temperature like ice cream and jell-o
What is the free water protocol?
Allow some patients at risk of aspirating thin liquids to safely include thin water for improved hydration and comfort as well as quality of life
Free water is separated from meal times and provided in between meals - used to augment daily fluid intake
looks at safest means to deliver - via cup sips, teaspoon, ice chips or strict supervision
Good oral hygiene as a frame work
What are the nutrients absorbed in the duodenum?
Divalent cations
What are mixed consistency foods? Give examples?
Foods containing a thin fluid and solid foods together ex. canned fruit with juice, soup with pieces of veggies, noodles and meat, cold cereal with milk, water melon, cherry tomatoes (foods that release water when chewed)
When would you use easy to chew diet?
Patients with difficulties chewing hard and or crunchy foods
patients with dentition concerns, missing teeth etc.
Jaw concerns, healing fractures to jaw
What is a therapeutic feed?
Therapy/exercise for the swallow to strengthen it again
Small amount of foods or fluid given 1-3 times a day to help with strengthening the swallow - done under supervision with SLP who determines the safest consistency and fluid level
What should be assessed when doing a swallowing assessment?
assess weight loss
review medications
changes in appetite
hydration concerns
What the patient is eating/avoiding
independent or dependent for feeding?
What factors does the severity of short bowel syndrome depend on?
Amount of bowel resected
site of removal
whether or not the ileocecal valve has been resected or is still in place
condition of the remaining bowel
Why are thickened fluids a concern for dysphagia patients?
Hydration can be a problem as free fluid content of thickened fluids can be significantly reduced
Describe the pureed diet and who it would be good for.
Patients with, sore or dry mouth, strictures, mucositis, esophagitis, poor or absent dentition.
Foods must be pureed to the texture of a pudding or mousse, moist, smooth, cohesive siwth small consistent sized particles (roughly applesauce consistency) and no water separation.
Includes pureed bread products, no mixed consistency modifications.
Describe the Minced diet and who it would be good for.
Patients with sore or dry mouth and limited dentition.
Diet of minced foods that require little chewing, are moist and coheseive and have the texture of a pudding or mousse. May eat food sthat are finely chopped, grated, ground or mashed to a size that is less than 1/2 cm. Some foods can be eaten whole such as soft, moist bread, buttereed toast, or soft sandwhiches with minced fillings.
Exclude dry or chewy breads such as english muffins or bagels.
Describe the Dysphagia soft diet and who it would be good for.
Patients with limited dentition ex. poorly fitting dentures, missing teeth, children going through tooth development.
Soft moist foods served with a sauce or gravy. Foods can be mashed by a patient using a fork in one hand. Firm foods are diced to 1 cm cubed or less.
Exclusde dry, crumbly, sticky, gummy foods (raw veggies, whole or chopped nuts, hard large seeds, dried fruits) etc.
DOES NOT INCLUDE NO MIXED CONSISTENCIES MODIFICATION
Characterize PUD in the different locations it can occur
Esophageal: rare, may occur with chronic untreated reflux
Gastric - a defective mucosal lining due to decreased mucosal bood flow, generally caused by poor nutrition
Duodenal - hypersecretion of acid in stomach that leads to overly acidic chyme
What are some fluids that are considered Thin fluids?
Fluids that melt in the mouth or at body temperature such as ice cream, Jello, Smoothies, popsicles - these cannot be thickened
What is eating at risk?
When the patient does not want to follow the recommendations of the feed swallow team and has been given all the risks of choosing to eat orally, does so knowingly.
