nutrition- chapter 18

Question 1

mouth

Answer 1

dental problems

• tooth decay
• ill-fitting dentures
• mechanical soft diet can be helpful

surgical procedures
- nutrients can be supplies with high protein, high calorie milkshakes

Question 2

problems of the mouth

Answer 2

oral tissue inflammation

• gingivitis
• stomatitis
• glossitis
• cheilosis
• mouth ulcers

salivary gland problems

• infections (ex. mumps)
• mucous cysts and obstructed salivary ducts
• excess salivation vs dry mouth
• xerostomia (chronic dry mouth)

Question 3

dysphagia

Answer 3

• difficulty swallowing
• common with Alzheimer’s, Parkinson’s stroke
• head and neck cancer, tooth loss, xerostomia, and muscular weakness of larynx
• symptoms: unexplained drop in food intake or repeated episodes of pneumonia
• usually diagnosed by a speech-language pathologist

Question 4

swallowing disorder warning signs

Answer 4

• reluctance to eat certain consistencies or any food at all
• very slow chewing or eating
• fatigue from eating
• frequent throat clearing
• complaints of food “sticking” in throat
• holding pockets of food in cheeks
• painful swallowing
• regurgitation, coughing, choking during attempted eating

Question 5

central tube problems

Answer 5

• muscle spasms, uncoordinated contractions
• stricture or narrowing of the tube
• ingestion of caustic chemicals or a tumor
• esophagitis (inflammation)
• treatment: widening of the tube
• diet: liquid to soft

Question 6

lower esophageal sphincter problems

Answer 6

• changes in smooth muscle
• nerve, muscle, and hormone control of peristalsis
• achalasia (“cardiospasm”)
• post-op nutrition therapy

Question 7

gastroesophageal reflux disease (GERD)

Answer 7

• caused by constant regurgitation of acidic gastric contents into lower esophagus
• pregnancy, pernicious vomiting, or extended use of nasogastric tubes are factors
• risk for GERD symptoms and erosive esophagitis increases with obesity and waist circumference
• constant irritation and inflammation (esophagitis)
• long-term complications include stenosis, Barrett’s esophagus and esophageal ulcer

Question 8

hiatal hernia

Answer 8

• portion of upper stomach protrudes through opening in the diaphragm (hiatus)
• especially common in obese adults

Question 9

peptic ulcer disease

Answer 9

• eroded mucosal lesion in the central portion of the GI tract, though it usually occurs in the duodenal bulb (first portion of duodenum)
• Two most common causes:
  
  • Helicobacter pylori (H. pylori)
    infection
  • Long-term use of NSAIDs irritates the gastric mucosa and decreases the mucosal integrity

Question 10

peptic ulcer disease

Answer 10

symptoms:
- increased gastric muscle tone
- painful contractions when stomach empty
- diagnosis via radiographs and gastroscopy

medical management:

• antibiotics, antacids, HCl secretion controllers (H2- blockers or proton pump inhibitors), mucosal protectors
• rest, sleep, coping and relaxation skills, avoid aggravating factors
• eliminate habits that contribute to ulcer development (smoking, alcohol use) and avoid irritating drugs (NSAIDs)
• well balanced healthy diet promotes tissue healing and maintenance

avoiding acid stimulation:

• food quantity – eat small quantities, avoid eating immediately prior to bedtime
• irritants – common irritants include hot chili peppers, black pepper, chili powder, caffeine, chocolate, and alcohol
• smoking – complete cessation is preferred

Question 11

malabsorption symptoms

Answer 11

• defect in absorption of essential nutrients, leading to chronic nutrient deficiencies
• can include any of 3 digestive processes
• digestion of macronutrients
• terminal digestion at the brush border mucosa
• absorption
• most common symptoms are chronic diarrhea and steatorrhea
• cystic fibrosis and inflammatory bowel disease specifically trigger malabsorption

Question 12

cystic fibrosis

Answer 12

• most common fatal genetic disease in North America for white people
• multisymptom disorder
• inhibits normal movement of chloride and sodium ions in the body tissue fluids. these ions become trapped in cells, causing thick mucus to form and clog ducts/passageways
• Lungs—damages airways, difficult breathing, infections
• Pancreas—lack of normal pancreatic enzyme secretion
• Malabsorption—food is left undigested and unabsorbed
• Liver and gallbladder—clogged bile ducts lead to degeneration
• Inflammatory complications—arthritis, vasculitis

Question 13

nutrition management of cystic fibrosis

Answer 13

• nutrition therapy is critical
• patients who are able to maintain an age-appropriate BMI percentile have better overall health outcomes
• pancreatic enzyme replacement products
• nutritional supplements to maintain weight

Question 14

inflammatory bowel disease (IBD)

Answer 14

• general term to describe chronic inflammation of GI tract
• persistent activation of mucosal immune system against normal gut flora
• disrupts protective epithelial barrier, destroying the function of segments of GI tract
• 2 common forms are idiopathic
• Crohn’s disease
• ulcerative colitis

Question 15

Crohn’s disease

Answer 15

• most common locations are ileum and colon
• risk factors: family history, jewish ancestry, smoking
• may cause deficiencies of vitamins A and D, iron, zinc, and protein-energy malnutrition

common symptoms:

• abdominal pain
• fever
• fatigue
• anorexia
• weight loss
• painful/urgent defecation
• diarrhea

Question 16

ulcerative colitis

Answer 16

• involvement limited to colon, but similar manifestations to Crohn’s disease
• progressive, beginning at anus
• resulting malnutrition hinders healing, but not associated with as many deficiencies as Crohn’s
• however, as pain increases, food intake decreases, or inflammation extends beyond the colon, the same deficiencies as are seen with Crohn’s disease may occur

common symptoms:

• urgent diarrhea with blood and mucus
• abdominal pain
• weight loss
• fever
• rectal pain
• iron-deficiency anemia

Question 17

nutrition therapy of IBD

Answer 17

• use enteral or parenteral nutrition feedings if necessary
• progress to low-fat, high-protein, high-kilocalorie, small, frequent meals when returning to a normal diet as tolerated
• the diet should be low in fiber only during acute attacks or with strictures. otherwise, fiber should be increased gradually
• vitamin and mineral supplementation should include vitamin D, zinc, calcium, magnesium, folate, vitamin B12, and iron
• during periods of remission: meet energy and protein needs that are specific for weight, and replenish nutrient stores
• avoid foods that are high in oxalates for patients with Crohn’s disease
• increase antioxidant intake, and consider supplementation with omega-3 fatty acids and glutamine
• consider the use of probiotics and prebiotics

Question 18

diarrhea

Answer 18

• symptom of another underlying condition
• intolerance to specific foods or nutrients
• acute food poisoning
• parasites, bacteria, and viral infections
• chronic diarrhea (more than 2 weeks) can be life threatening
• 4th or 5th leading cause of death globally
• IV fluid and electrolytes replacement or rehydration solutions may be used

Question 19

large intestine diseases

Answer 19

• diverticulosis: formation of many small pouches (diverticula) along mucosal lining in the colon
  
  • caused by progressive increase in pressure
    within the bowel resulting from a low-fiber diet
• diverticulitis: caused by pockets becoming inflamed and infected
• underlying age-related pathogenesis may develop in response to chronic low-grade inflammation, microbiome shifts, visceral hypersensitivity, and abnormal gut motility

Question 20

irritable bowel syndrome (IBS)

Answer 20

• most commonly diagnosed GI disorder
• functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit
• common recurrent pain in lower abdomen
• small-volume bowel dysfunction (constipation and/or diarrhea)
• excess gas formation
• multicomponent disorder
• genetic predisposition, altered GI tract sensation and motility, infection, inflammation, increased intestinal permeability, dietary intolerances, dysbiosis, and psychosocial stressors

Question 21

nutrition care for IBS

Answer 21

• regular diet containing optimal amounts of energy and nutrients
• eliminate food allergens and intolerances
• omit foods that increase gas and flatulence
• consider use of prebiotics/probiotics
• consider use of food diaries

Question 22

constipation

Answer 22

• “normal” intestinal elimination not clearly defined and varies greatly
• common short term problem
• dietary and lifestyle management should be primary focus for treatment

causes:
- nervous system tension and worry
- neurologic or neuromuscular problems
- changes in routines
- side effect of medications
- frequent laxative use
- low-fiber diets
- lack of exercise

Question 23

food allergy

Answer 23

• body’s immune system reacts to a protein as if it were a threatening foreign object and launches powerful attack
• anaphylactic shock = most severe reaction

Question 24

food intolerance

Answer 24

• not life-threatening
• nonimmunologic
• adverse reactions to foods or food constituents
• lactose intolerance most common
• avoid offending food

Question 25

common food allergies

Answer 25

- eggs - milk - peanuts - tree nuts - wheat - shellfish - soy signs and symptoms: hives, nausea, diarrhea, abdominal pain, and respiratory symptoms such as wheezing

Question 26

food allergy diagnostics

Answer 26

- food elimination diet - skin-prick test - allergen-specific serum IgE immunoassays - oral food challenge

Question 26

food allergy diagnostics

Answer 26

- food elimination diet - skin-prick test - allergen-specific serum IgE immunoassays - oral food challenge

Question 27

current recommendations for prevention of food allergies

Answer 27

- pregnant women: eat a well-balanced healthy diet and not avoid any specific allergens - exclusively breastfeed infants for a minimum of 4 months. mother should not avoid eating food allergens during lactation - introduce solid foods to infants between 4 and 6 months. include allergenic foods after the initial period of weaning - include probiotics and prebiotics in the diet

Question 28

celiac disease

Answer 28

autoimmune response to the proteins in certain grains: - gluten in wheat - hordein in barley - secalin in rye - oats not problematic for celiac disease but can be cross-contaminated symptoms: diarrhea, steatorrhea, unintended weight loss, progressive malnutrition

Question 29

celiac disease

Answer 29

- avoid all gluten - avoid wheat, rye, and barley - corn, potato, rice, and others used as substitutes - careful label reading because many products use gluten-containing grains as thickeners or fillers - monitor for vitamin/ mineral deficiencies

Question 30

GI accessory organs

Answer 30

produce digestive agents that help with digestion and absorption of food - liver - gallbladder - pancreas

Question 31

fatty liver disease

Answer 31

- if from alcohol abuse: alcoholic liver disease (ALD) - otherwise called nonalcoholic fatty liver disease (NAFLD) - steatosis: fat accumulation in the liver - excess fatty acids in circulation stored in the liver - treatment: balanced diet, alcohol avoidance and weight loss (if indicated), possible antioxidant supplementation, tight blood glucose level control - enteral nutrition therapy recommended for malnourished patients with alcoholic steatohepatitis (ASH)

Question 32

hepatitis

Answer 32

- inflammatory condition of the liver caused by virus, bacteria, parasite, or toxins (chloroform, alcohol, drugs) - most common causes are viral infections (Hep A&B) and alcohol abuse treatment: - avoid hepatotoxic substances (alcohol, drugs, toxins) - balanced diet of adequate energy - 4 to 6 small meals daily - protein intake of 1.0-1.2 g/kg body weight per day - limit sodium to 2000 mg/day

Question 33

cirrhosis

Answer 33

- a chronic state of liver disease in which the liver is damaged beyond repair with scar tissue and fatty infiltration - nearly ½ of all cases are a result of hepatitis C and alcoholism - medications limited. nutrition therapy used results in: - portal hypertension - hepatic encephalopathy - esophageal varices - ascites

Question 34

hepatic encephalopathy

Answer 34

- as cirrhosis continues, blood can no longer circulate normally through liver - ammonia and nitrogen cannot reach the liver to be eliminated, which produces ammonia intoxication and coma - treatment focuses on removing sources of excess ammonia

Question 35

management of cirrhosis

Answer 35

- avoid hepatotoxic substances 4 to 6 small meals daily - 20% increase above basal energy needs - carbohydrates ~ 50% of total energy intake - protein – 0.8-1.2 g/kg/day - fat limited to 30% kcals if steatorrhea present - may need enteral/parenteral nutrition support - may need vitamin/mineral supplementation - sodium limited to 2000 mg/ d - fluids may be restricted

Question 36

gallbladder disease

Answer 36

- cholecystitis = gallbladder inflammation - usually results from low-grade chronic infection or obstruction - cholelithiasis = gallstone formation - cholesterol may separates out and crystallize to form gallstones - diet therapy centers on controlling fat intake and eating small, frequent meals - treatments: cholecystectomy, litholysis, nutrition therapy

Question 37

pancreatic disease

Answer 37

- inflammation of the pancreas inhibits its release of digestive enzymes - can be acute or chronic - acute treatment: NPO with hydration - chronic treatment: adequate energy and nutrients, especially protein; lower in fat; avoid alcohol and smoking - supplemental pancreatic enzymes with each meal causes: - excessive alcohol consumption is most common - pancreatic duct can be blocked by gallstones - heredity, CF, autoimmune disorders