UGI Flashcards
Impaired neuromuscular coordination of the lower esophagus due to disrupted
innervation is called _________
- Impaired swallowing due to:
- Decreased ________ in the ______ esophagus
- _____________ maintains an excessively high tone and fails to open properly during swallowing
- Food is prevented from entering the _______, causing esophageal distention
Achalasia
peristalsis
middle
Lower esophageal sphincter (LES)
stomach
Symptoms of Achalasia
Esophageal pain after swallowing
Feeling of fullness in the chest
Dysphagia
Frequent regurgitation
Aspiration
Poor intake & weight loss
Medical Treatment of Achalasia
Anticholinergic drugs (e.g. Bentyl)
Intrasphincteric botulism injection
Mechanical dilation of esophageal sphincter
Myotomy
MNT for Achalasia
Eat ______ & _____ thoroughly
_________ meals
Take ______ with meals
Altered texture based on tolerance=> _____________
High _________ nutrition supplements
slowly & chew
Small, frequent
fluids
easy to chew diet or blenderized liquid diet
calorie/protein
Reflux of gastric acid through the lower esophageal sphincter (LES) into the esophagus
GERD
GERD is caused by ______
Primarily due to spontaneous and transient _______
LES Pressure
relaxation of LES
LES pressure is decreased by:
- Smoking
- Certain foods
- Distention of the proximal stomach
- Hormone changes=> pregnancy, oral contraceptives
- Smooth muscle relaxants
- Scleroderma
Intragastric pressure can be increased by:
- Large meals
- Lifting/bending
- Obesity
- Tight fitting clothes
- Hiatal hernia
Hiatal Hernia
Symptoms of GERD
Heartburn
Odynophagia
Chronic cough, hoarseness, asthma
Complications of GERD
Esophagitis
Esophageal stricture=> dysphagia
Dental erosion
Respiratory problems
* asthma
* aspiration pneumonia
Barrett’s esophagus=> precancerous cells
goal of GERD medications
decrease gastric acid secretion
types of GERD medication
H2 receptor antagonists
proton pump inhibitors
FMI of meds that decrease acid secretion
Antacids
H2 receptor antagonists examples
fomotidine (Pepcid)
cimetidine (Tagamet)
Proton pump inhibitors are used for _______
examples?
more severe GERD
omeprazole (Prilosec)
pantoprazole (Protonix)
FMI of meds that decrease acid secretion
lower absorption of Fe, vitamin B12, Ca2+, and Mg2+
Antacids will _________
Examples?
neutralize gastric acids
Mylanta
Maalox
Tums
Lifestyle modifications to do for GERD
sleep with HOB elevated 6-8 inches
weight loss if overweight
stress management
lifestyle modifications to avoid for GERD
eating within 2-3 hours of bed
tobacco products
lying down, bending over, or straining immediately after eating
Tight fitting clothing
for GERD, a trial of the restriction of these foods that decrease LES pressure
coffee
chocolate
peppermint and spearmint
food with a high fat content
for GERD, a trial of the restriction of these foods that increase gastric secretion
black and red pepper
alcohol
coffee (reg or decaf)
tea (reg or decaf)
caffeinated beverages
For GERD avoid eating ____ meals or meals high in ____
also limit _____ beverages
large
high fat
carbonated
surgical treatment for GERD
Nissen fundoplication where funds of the stomach is wrapped around the lower esophagus to prevent reflux
problems that may occur after Nissen Fundoplication
esophageal swelling (dysphagia)
gas pain
dumping syndrome
Post-op MNT: Nissen Diet
* Follow a “_________” diet for ~ ________
- Avoid _____________________
- Avoid ______ foods=> peanut butter, untoasted white bread
- Consume small frequent meals to avoid distention
- No gassy foods; Limit aerophagia
- ____________________
Easy-to-Chew
2 months
nuts, seeds, tough meats, raw fruits & veg, and sharp edges
sticky
no drinking through a straw, no gum, no carbonated beverages, dried beans, cabbage family veg
MNT: Nissen Diet
* Avoid spicy foods
* Eat slowly, take small bites, & chew thoroughly
- Anti-dumping diet guidelines:
- Drink fluids ____________
- Limit fluid with meals to _____
- Limit ________
between meals
½ cup
concentrated sweets
Acute esophagitis is caused by:
- Viral or bacterial ______
- _____
- Ingestion of a _______
- ________ therapy
- Acute ________
- ___________ esophagitis
infection
GERD
corrosive agent
Radiation
vomiting
Eosinophilic
Chronic esophagitis is caused by:
* Chronic _____
* Recurrent _______
GERD
vomiting
Esophagitis
Symptoms=> __________
Complications:
___________
__________
____________
odynophagia
Hemorrhage
Stricture
Dysphagia
Goals of MNT for esophagitis
Prevent ____________
Prevent _____ to decrease exposure of esophagus to gastric contents
pain and irritation
GERD
MNT for Esophagitis
Avoid any foods that exacerbates symptoms:
- _________ foods=> citrus fruit & juice, tomatoes & tomato products, carbonated beverages
- ______ foods
- ______ foods
acidic
rough
spicy
MNT to prevent GERD for ppl with esophagitis
* Avoid ______ meals
* Limit dietary ____
* Avoid _____
* Avoid _____
large
fat
alcohol
coffee
Indications for Esophageal Surgery
- Cancer
- Barrett’s esophagus
- GERD
- Achalasia
- Trauma
- Fistula
Esophagectomy Variations
Gastric pull-up
Colonic interposition
Complications of Esophagectomy
- Dysphagia
- Dumping syndrome
- Early satiety
- GERD
- Aspiration
- Weight loss & malnutrition
- Stricture
- Fistula (rare)
- Chylothorax (rare)
Injury to the thoracic duct is called ________ and its when _____________ into the ________
chylothorax
chyle leaks into the thoracic cavity
examples of Chyle
WBC
chylomicrons (LCT & Fat soluble vitamins)
proteins
fluid
electrolytes
consequences of chylothorax
pain
pleural effusion
anorexia
hypoalbuminemia
decreased electrolytes
fat soluble vit depletion
EFAD
Goal of MNT for Chylothorax
reduce chyle flow by decreasing LCT intake to <10 g/day
MNT for Chylothorax options
very low fat oral diet with MCT oil supplementation
NPO with TF using a very low fat elemental formula
NPO with TPN
MNT for Partial Esophagectomy
Oral diet:
- Begin with _____ and progress to _______ diet
- Avoid tough, sticky, or abrasive foods
- ________ meals per day
- Take small bites, chew thoroughly, eat slowly
- MNT to prevent ______
- MNT for dumping syndrome if needed
- MNT for _______ if needed
liquids
easy-to-chew
6 small
reflux
dumping syndrome
MNT for Total Esophagectomy
- NPO with JT feedings
- When approved by surgeon, begin esophagectomy diet and follow for ~3 months
Nonspecific, persistent upper abdominal discomfort
Dyspepsia
Symptoms of Dyspepsia
vague abdominal pain
bloating
belching
nausea
Dyspepsia Caused by:
- GERD
- Peptic ulcer disease
- Gastritis
- Gallbladder disease
- Emotional stress
- Eating habits=> eating too much, too
fast, high-fat foods
MNT for Dyspepsia
- Eat slowly & chew thoroughly
- Smaller size meals
- Decrease dietary fat
- Limit aerophagia=> eat slowly, chew with mouth closed, avoid straws, no chewing gum
- Limit alcohol
inflammation of the gastric mucosa
gastritis
acute gastritis is _______ of inflammation and symptoms
rapid onset
chronic gastritis is a ______ problem with periods of __________
more common in __________
long term
exacerbation and remission
older adults
symptoms of gastritis
epigastric pain
N/V
anorexia
GI bleeding (GIB)
causes of gastritis come from disruption of the _______ through…
Bacteria ?
Drugs ?
Excessive use of ?
acute, severe _______
_______ therapy
___________ (condition)
___________ (condition)
mucosal integrity
helicobacter pylori (H. pylori)
non-steroidal anti-inflammatory drugs (NSAIDS)
aspirin
corticosteroids
alcohol and tobacco
metabolic stress
radiation
pernicious anemia
bile reflux
rare complication of chronic gastritis that results in extensive degeneration of the gastric mucosa
atrophic gastritis
atrophic gastritis results in _______ and loss of ______ resulting in _________ __________
atrophy & loss of parietal cells
Achlorhydria (not enough acid secretion)
Decreased secretion of intrinsic factor (possible B12 deficiency)
medical treatment for gastritis
antibiotics for H. pylori
proton pump inhibitors; H2 receptor antagonists for Acid
discontinuing injurious drugs, alcohol, smoking
MNT for Acute Gastritis
follow bland diet and avoid gastric irritants
- pepper, chili powder, alcohol
avoid foods that increase acid secretion
- coffee, tea, caffeine, alcohol, pepper
if acute gastritis is severe, individual might need to follow __________ to decrease inflammation with _____, then later follow the ______
NPO 24-48 hours
IVF
bland diet
MNT for chronic gastritis
well balanced bland diet for healing
monitor for iron deficiency anemia
IM or sublingual vit B12 supplementation for atrophic gastritis
an ulceration in the mucosal lining of the ______, _____, ______, or ______ is called _________
duodenum
stomach
esophagus
jejunum
peptic ulcer disease (PUD)
peptic ulcer disease. exposes the ______ to ________ and _______
PUD can be acute or chronic with _____ erosions or _____ ulcers
submucosa
gastric secretions
auto digestion
superficial
deep
risk factors for PUD include…
_______ infection
habitual use of _______ or ________
excessive ________
high dose _______
use of ______
_____________
H. pylori infection
aspirin or NSAIDS
Excessive alcohol
high dose corticosteroids
tabacco
metabolic stress
PUD is a ______, ______, or ______ abnormalities that disrupt the factors that normally maintain mucosal integrity
it results in ___ and ____ penetrating the mucosal barrier creating ulceration
microbial
chemical
neural
acid and pepsin
clinical manifestations of PUD
epigastric pain
dyspepsia, N/V
anorexia and wt loss
epigastric pain can become worse when stomach is _______
may be relieved by ___________
_______ pain is common
pain may disappear and then return in a few _______
empty
ingestion of food or antacid
nocturnal
days or weeks
complications of PUD
Hemorrhage
gastric outlet obstruction
perforation
Medical management for PUD should be to eliminate the cause and decrease risk factors
_______ for H. pylori
reduce use of ______, quit ________, avoid ________
Decrease gastric secretion with ______ and ______
neutralize gastric acid with ________
_____________ may be required for PUD complications
antibiotics
NSAIDS, smoking, alcohol
proton pump inhibitors and H2 receptor antagonists
antacids
surgical resection
proton pump inhibitor examples
Omeprazole (Prilosec)
Pantoprazole (Protonix)
H2 receptor antagonists example
famotidine (Pepcid)
examples of antacids
Mylanta
Maalox
Tums
MNT for PUD
well balanced bland diet
avoid alcohol, red and black pepper, coffee, tea, and caffeine
smaller frequent meals
avoid food not individually tolerated
why would someone need gastric surgery
gastric cancer
complications of PUD
surgical widening of the pylorus
pyloroplasty
why does some one need pyloroplasty
gastric outlet obstruction
enhance gastric emptying
removal of part of the stomach is _______
removal of whole stomach is _______
partial gastrectomy
total gastrectomy
reconstructive procedures that accompany partial gastrectomy
billroth operations
reattachment of remaining stomach to the duodenum
billroth I (gastroduodenostomy)
reattachment of the remaining stomach to the jejunum
Billionth II (gastrojejunostomy)
Nutritional Consequences of Gastric Surgery
Early ________; inadequate ______
Malabsorption due to ___________
Fluid & electrolyte imbalances due to ______
___________; Malnutrition
_________ deficiencies
Nutritional ________
satiety; intake
dumping syndrome
diarrhea
Micronutrient
anemias
gastric surgeries can cause anemias
- _____ due to __________
- ______ due to __________
Iron deficiency due to lack of gastric acid
vitamin B12 deficiency dure to decreased IF
what is dumping syndrome
rapid emptying of hypertonic chyme from the residual stomach into the small intestine 10-20 minutes after eating
factors that promote dumping syndrome include
- loss of ______________
- loss of ________ control when ______ is removed
- loss of ________ control by the _______ when it is removed
gastric capacity
emptying
pylorus
feedback
duodenum
dumping syndrome resulting in rapid gastric emptying results in __________ in small intestine so _____ shifts from __________ to ___________
high osmotic load
fluid
vasculature
intestinal lumen
early dumping syndrome occurs ______ after eating
10-30 min
dumping syndrome can cause ________, __________, and ____________.
Along with distention of the intestine which results in ______, _______, _______, and _______
weakness
dizziness
rapid heartbeat
cramping
diarrhea
nausea
bloating
late stage during syndrome occurs ____ after eating and is _________. Often occurs after eating a _____ meal
1-3 hours
less common
high carb
late dumping syndrome causes _________ due to rapid rise in ________ level
symptoms include _____, _______, _______, and _______.
reactive hypoglycemia
insulin
weakness
diaphoresis
shakiness
confusion
what is the Post-Gastrectomy/ Anti-Dumping Syndrome Diet
5-6 small meals
limit simple sugars
high protein & moderate fat (every meal should have pro)
Avoid liquids with meals (drink >30-40 min after eating)
for after gastric surgery consider ________ sources and eat slowly and chew well.
_______ after meals and avoid ________________(4)
soluble fiber
relax and recline
caffeine, alcohol, prunes, sorbitol
after gastric surgery, patients should be prescribed ___________ and may need additional ____ and _____ supplements
advance to a regular diet within _____
if a total gastrectomy, diet should be____________
MVI with minerals
B12
iron
6-8 weeks
NPO with jejunal time feeding
nausea and vomiting are caused by the stimulation of ___________ in the __________
chemoreceptor trigger zone
medulla
nausea and vomiting zone can be triggered by …
Infections; Toxins
Diseases
Medications
Gastric or duodenal distention
Severe pain
Motion sickness; vertigo
Nutritional Consequences of Vomiting (_________)
1.
2.
3.
4.
5.
Emesis
- Dehydration
- Electrolyte depletion
- Poor intake and weight loss
- Acid base imbalance (blood too basic)
- Learned food aversions
After vomiting stops, begin with ________ then small amounts of ____________ and then ______________ after _____ hours of not vomiting
ice chips
clear liquids
solid foods
8 hours
for nausea and vomiting, eat _____, ______ meals
Avoid high _____ foods and high ____ foods
Also avoid ______ foods
Avoid ________ flavored, highly ______, or foods with strong ______
small, frequent
fat and fiber
gassy
strong
spiced
odors
for N/V try to eat ____, _______ and/or _____ foods
dry, starchy, or salty foods
for N/V sip ______ between meals, _______ may be helpful
avoid eating ________ when nauseous
replace _____ and _______, may consider oral _________
may require _____ status with ______ if severe and prolonged
cold liquids
ginger ale
favorite foods
fluid and electrolytes
rehydration solutions
NPO
parenteral nutrition
