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Clinical 2 > Upper GI > Flashcards

Upper GI Flashcards

1
Q

which types of reflexes produce saliva?

A
  • Autonomic = pressure exerted by food in mouth (i.e., oral stimulation)
  • Acquired = sight or smell of food
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2
Q

name a condition resulting from altered salivary gland function

A

Xerostomia (reduced saliva and dry mouth)

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3
Q

nutrition intervention with xerostomia?

A

• Small, frequent meals may be tolerated best
• Soft, moist foods
• Liquids with all meals sips intermixed with bites, so liquid
• Blended foods can act as saliva
• Use of gravies,sauces
• Cold foods sometimes preferred
• Avoid foods that are dry, crunchy, sharp
edges, extreme temperatures
• Mouthcare after each meal/snack
• Rinse mouth to get rid of food particles (1/4tsp baking soda in 1 cup water)
• Saliva substitutes (e.g., biotene) put not every pt
• Maybehelpful:spraymouthwithlikwesatietr,suck on ice chips or mints, lemon, sugar-free beverages containing citric acid (e.g., lemonade)

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4
Q

complications/problems with xerostomia

A
  • Foods may be difficult to swallow
  • Tasteless
  • Increased risk of mouth infection

xerostomia is associated with cancer
complications are specific for the location of the cancer
e.g. head and neck> xerostomia is very common

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5
Q

what is dysgeusia and ageusia?

causes?

A

dysgeusia:
- common in head/neck radiation
- pts and elderly pts (due to meds)
- usually related to a metallic taste (usually red meats)
- Medications E.g., methotrexate 􏰀 strong
metallic taste

ageusia

  • can’t taste anything all
  • usually due to zinc deficiency, however it is not specific
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6
Q

Dysgeusia/Ageusia nutrition interventions

A
  • Zinc supplementation if needed
  • Avoid use of metallic utensils
  • Avoid foods that taste metallic or bitter: red meats, coffee, tea
  • Encourage chicken, fish, dairy, eggs, cheese instead of red meats
  • Eat meat with something sweet (e.g., pork and applesauce)
  • Encourage vegetarian proteins
  • Add seasonings or spices (not salt)
  • Cold temperature foods
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7
Q

swallowing phases

A
  • Preparatory: Food is chewed and mixed with saliva
  • Transit: Voluntary movement of bolus from front of oral cavity to back
  • Pharyngeal
  • Bolus is directed into esophagus and prevented from entering trachea
  • Uvula seals off nasal passage so food does not enter nose
  • Laryngeal muscles contract and seal off entrance to larynx (voice box)
  • Epiglottis folds backwards to seal off entrance to larynx

• Esophageal

  • Upper esophageal sphincter, opens and allows bolus to enter esophagus
  • Lower esophageal sphincter (LES) controls passage into stomach & prevents stomach acid from refluxing into esophagus
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8
Q

Factors that can lower LES pressure and lead to incompetence of LES

A
  • Increased secretion of gastrin, estrogen, progesterone
  • Hiatal hernia, obesity
  • Cigarette smoking
  • Use of medications (e.g., morphine)
  • Foods high in fat, chocolate, spearmint, peppermint, alcohol, caffeine
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9
Q

Diagnosis of gerd

A

most frequent method of diagnosis: give meds-> if symptoms go away-> GERD
• Sx: Difficult swallowing, heartburn, increased saliva, belching

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10
Q

treating GERD

A
  • Goal: increase LES competence, decrease acid secretion & protect esophageal mucosa, clear contents from esophagus

Modify lifestyle factors
• Smoking, obesity, wear loose-fitting clothing, remain upright after eating
• Medications to reduce acidity Surgery
• Fundoplication: Laparoscopically performed-> Fundus of stomach is wrapped around the lower esophagus

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11
Q

nutritional implications of GERD

A
  • Nutritional deficiency and/or weight loss if avoid food groups
  • Long-term use of GERD medications can impair absorption of calcium, iron and B12
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12
Q

Nutrition and Lifestyle Therapy for GERD

A

• Smaller meals
- Large quantity = greater gastric distention = greater acid production
• Avoid high fat meals
- Delays gastric emptying; prolongs gastric secretions
• Avoid spicy food (e.g., pepper), coffee, alcohol
- Stimulates gastric acid production
• Avoid smoking
• ID foods that cause problems
• May include chocolate, mint, fried foods, alcohol, coffee (lower LES pressure)
• Remain upright at least 45 minutes after eating
• Elevate HOB 45-degree angle at night
• Avoid eating or drinking three hours before bed

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13
Q

what can esophagectomy be used to treat?

A
  • Uncontrolled GERD
  • Cancer
  • Hiatal Hernia
  • Achalasia oesophagus
  • Zenker􏰅s diverticulectomy
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14
Q

diet progression after esophagectomy

A

NPO-> fluids-> soft diet-> regular diet

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15
Q

hwo long does diet progression after esophagectomy take place

A

6-8 weeks

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16
Q

what classifies as soft foods?

A
  • Most cereals soaked in milk
  • Scrambled eggs and omelets
  • Canned or cooked fruits.
  • Finely ground beef, chicken, turkey, and pork with sauces/gravies
  • Mashed potatoes, squash, carrots
  • Cooked or pureed vegetables
  • Yogurt
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17
Q

Long term nutritional considerations with esophagectomy

A
  • Early satiety
  • GERD
  • Weight loss
  • Dumping syndrome
  • Swallowing difficulties
  • Nutrient deficiencies
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18
Q

which method of swallowing assessment will be used Post-Esophagectom

A

barium contrast leakage is more prone to causing infection vs gastrografin
thus gastrografin will be used

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19
Q

when can EN be discontinued after surgery?

A

when PO >60% for 2+ days

20
Q

which parts of stomach are responsible for mixing/ storage?

A

mixing- antrum

storage- body/corpus

21
Q

cells found in the stomach and their functions

A
  • Mucous cells: Protect lining of stomach
  • Chief cells: Gastric lipase and pepsinogen

• Parietal cells

  • HCl and intrinsic factor
  • HCl activates pepsinogen and denatures proteins

• ECL cells: Assist in control and production of gastric juices

22
Q

what controls gastric secretions?

A
  • Chemical messengers stimulate secretin: acetylcholine, histamine, gastrin
  • Act to increase H+ available for HCl formation in parietal cells
  • Chemical messengers inhibit secretion: somatostatin
  • Basal secretions
23
Q

what are the phases of gastric release?

A
  • Cephalic phase: Release of HCl and Pepsinogen when stimulated by tasting, smelling, seeing food
  • Gastric phase: Food enters stomach and stimulates gastric juices
  • Other factors that contribute to stimulation of gastric secretions
  • Presence of protein
  • Distension of the stomach
  • Caffeine
  • Alcohol

• Intestinal phases: Slows gastric secretions and prepares small intestine for acidic chyme

24
Q

Absorption in the stomach

A

• Limited - no food, small amounts of water
• Alcohol and some meds (e.g., aspirin) are exceptions
- Alcohol is absorbed in gastric mucosa and enters bloodstream through capillaries of stomach
- Presence of food slows this process

25
Q

consequences of prolonged vomiting

A
  • Rupture
  • Hematemesis (bleeding)
  • Dehydration
  • Acid-base imbalances
  • Malnutrition
  • Aspiration pneumonia
26
Q

Which acid-base disturbance is common with vomiting?
A. Metabolic acidosis
B. Metabolic alkalosis

A

B. Metabolic alkalosis

27
Q

Tips for managing nausea

eat crackers

A
  • Small frequent meals
  • Avoid being too hungry or too full
  • Eat slowly
  • Eat plain foods
  • Eat cold foods
  • Drink liquids 30-60 minutes after or before meals
  • Wear loose fitting clothing
  • Try ginger (like ginger popsicle: hydration + nausea help; ginger ale)
28
Q

tips after prolonged vomiting

A

1: Liquids to avoid: water, apple juice, sports drink, warm or cold tea, lemonade

Suck on ice chip first, if tolerated-> 1 teaspoon every 10min.
Increase to 1 tbsp.
Double the amount of lfid every hour. If diarrhea-> only use rehydration beverage

  1. Solid food intro: add one solid food at a time if no vomiting for at least 8h
    Avoid high fiber and fat foods
    Recommended foods:
    - Crackers, grains, milk and dairy products, meat and poultry, dry toast, yogurt, clear broth
29
Q

where are ulcers most commonly found?

A

duodenum and antrum

30
Q

what are the causes of ulcers

A

• H.Pylori- main cause
- lives under mucus layer of stomach; attached to mucus-secreting cells
- Produces proteins that damage mucosa and cause inflammation
• Decreased mucosal integrity:
- Use of NSAIDs (e.g., ibuprofen) or steroids
- Alcohol abuse
• May be a genetic link
• Reduced blood supply caused by shock, stress, smoking
• Exacerbation of symptoms with certain foods and stress

31
Q

what is similar and different between GERD and ulcers?

A

both ulcer and GER show a sign of pain

the difference between GERD and peptic ulcer is that with ulcers pain will go away after eating

32
Q

signs and symptoms of ulcers

A 
• Epigastric pain that occurs 90min-
3 hours after eating and is usually relieved by eating or use of antacids
- Rebound gastrin
• Presence of blood in vomit or stool
> bleeding ulcer
33
Q

ulcer treatment

A

• Dx: Endoscopy and tissue biopsy;
Urea breath test
• Triple/quadruple therapy for H.
Pylori (disgusting, thus important to motivate the pt to finish the course)
• Meds to reduce acid secretion (e.g., proton pump inhibitor)
• Surgical resection if disease is refractory or complications develop

34
Q

diet that may cause ulcer

A

no evidence that diets can cause ulcers

35
Q

micronutrients of concern with PUD

A

iron, B12 and calcium

36
Q

what are the reasons for gastrectomy

A
  • Complications of peptic ulcer disease (PUD)->hemorrhage, perforation, obstruction of pyloric sphincter
  • Malignancy
  • Weight loss
37
Q

types of gastrectomy

A

• Gastrectomy- stomach resection
• Selective Vagotomy: eliminate innervations from the vagus nerve to parietal cells in order to decrease gastric acid production poor gastric emptying
• Total Vagotomy with pyloroplasty: innervations to parietal cells severed + portion of vagus nerve controlling gastric emptying no acid production
• Reconstruction with Billroth I (gastroduodenostomy- stomach connected to duodenum) & II (gastrojejunostomy- stomach connected to jejunum), Roux-en-Y:
- reconstruction always has to be performed with gastrectomy

38
Q

Gastrectomy - Nutrition Implications

A

• Nutritional risk related to:
1) Reduced capacity of stomach-> early satiety
2) Changes in gastric emptying & transit time (could either lead to dumping or gastroparesis_
• Food normally remains in stomach 1-3 hrs in order to liquefy and partially digest. Chyme should enter duodenum slowly via pyloric sphincter and is neutralized by pancreatic bicarb
3) Components of digestion altered or lost
• E.g., Reduction in intrinsic factor secretion (required for B12 absorption)
• Standard practice to prescribe prophylactic B12 injections
• Most common deficiencies documented: B12, thiamin, vitamin D, iron, copper
• Common nutritional problems: dumping

39
Q

early vs late dumping

A

early dumping (75%)
- 10-30 min after eating
- fluid gets moved from blood to intestine in an attempt to dilute food
- bloating, nause, vomiting, diarrhea
- due to decreased blood volume: reapid heart rate, dizziness
late dumping:

1-3 hours

  • rapid increase of insulin production in an attempt to prevent hyperglycemia
  • result in overproduction of insulin and hypoglycemia (-> weakness, sweating, confusion, tremors)

may experience both late and early

40
Q

Post gastrectomy or “anti-dumping” diet

A 
• Prophylactic B12 injection
• Liquid multivitamin/mineral
• 5-6 small meals per day
• May need to lie down after eating for early dumping
• Nutrient dense
• Limit simple sugars to prevent hyperosmolality and hypoglycemia- late dumping
• Avoid sweetened beverages esp.
•  Lactose is often not tolerated
• Do not restrict unless have to!
• Liquids in between meals
- Liquids facilitate quick movement through GI
• Soluble Fibre, Pectin
41
Q

what is gastroparesis?

A

syndrome of objectively delayed gastric emptying in the ABSENCE of mechanical obstruction. Cardinal symptoms including early satiety, postprandial fullness, nausea, vomiting, bloating, and upper abdominal pain

42
Q

gastroparesis DX and sx

A
  • Dx: when gastric retention of food continues after 4 hours

* Sx: nausea, vomiting, early satiety

43
Q

what are the causes of gastroparesis

A

Gastric emptying is complex and involves:
• Hormones
• Muscles
• Nervous system
Abnormalities in any of the above can lead to delayed gastric emptying
• E.g., autonomic nerve damage d/t diabetes or surgery

44
Q

implications of gastroparesis

A
  • High risk of malnutrition d/t intolerance of oral intake and subsequent reduced intake
  • Dehydration
  • If DM, glycemic control is difficult d/t unpredictable absorption of food
45
Q

gastroparesis nutritional treatment

A

• 5-6 small meals per day
• Avoid lying down after eating, try to be active instead.
• Low in fat (<3-5g/serving) and low in fiber (<3g/serving)
• Modular supplements may be needed to enhance nutrient density
• ONS may be needed
• Chew well
• Avoid carbonated beverages and gas- producing foods legumes, cruciferous foods
• If enterally fed, may need post-pyloric
feeding

Clinical 2 (14 decks)

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