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COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Nutrition Therapy 1 (Medical Nutrition Therapy 2) LECTURE...
COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Nutrition Therapy 1 (Medical Nutrition Therapy 2) LECTURE Module 3 Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Module 3 Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders Welcome to Module 3 Module: Overview In this module, we review the digestive and absorptive processes performed by the gastro-intestinal (GI) tract. We will identify some of the common disorders of both the upper and lower GI tract, their etiology, pathophysiology, and their nutritional management. Particularly we will discuss the diet prescribed for these diseases for example the gastro esophageal reflux disease (GERD), gastric and peptic ulcers, dysphagia, gastroparesis (upper GI tract). We will apply the nutrition care process steps in the nutrition management of these diseases. Learning information will be referenced from the main text book Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed.Elsevier, 3251 Riverport Lane, St. Louis Mo. USA. and web links and videos you will be directed to. Module 3: Learning objectives Upper Gastrointestinal Tract By the end of the module the student is expected to be able to: 1. review the digestive and absorptive process of the GI tract 2. describe the mechanics of normal swallowing and swallowing in dysphagia and its nutritional consequence 3. discuss the causes, signs and symptoms, and nutritional consequences of esophagitis, hiatus hernia, dyspepsia, gastritis, peptic ulcers, dumping syndrome, gastroparesis and gastroenteritis. 4. apply the NCP steps in medical nutrition management of the diseases of the upper gastrointestinal tract. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Description Time to Complete Module 3: Upper GI Tract Disorders Lesson 1 Overview of the digestive, absorptive process, and the gut 30minutes microbiota Activity 1 Readings and videos Lesson 2 The mouth and the mechanics of swallowing 45 minutes Activity 2 Video, readings and assignments Lesson 3 Esophagitis, gastro-esophageal reflux disease, hiatus 45 minutes hernia Activity 3 Videos Lesson 4 Dyspepsia, indigestion and bezoar formation Activity 4 Readings 40 minutes Lesson 5 Gastritis, gastroenteritis, gastric and peptic ulcers 40 minutes Activity 5 Readings and Assignment Lesson 6 Gastroparesis, gastric surgery and dumping syndrome 40 minutes Activity 6 Reading and Video Read: Chapter 27: Medical Nutrition Therapy for Upper Gastrointestinal Tract Disease pp.508-524. Chapter 28: Medical Nutrition Therapy for Lower Gastrointestinal Tract Disease pp. 525-556 Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed.Elsevier, 3251 Riverport Lane, St. Louis Mo. USA. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM MODULE 3 - UNIT MAP 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Module 3: Lesson 1: Overview of the digestive and absorptive process The understanding of the functions of the gastro-intestinal tract is essential to the nutritional management of its diseases and in the application of the nutrition care process. Several nutritional diagnoses can be identified when assessing the functions of the gastro-intestinal tract. The following are the most common nutritional diagnoses related to digestion or metabolism: 1 1. altered gastrointestinal function 4. altered nutrition biomarkers 2. imbalance of nutrient intake 5. inadequate or excessive fluid intake 3. altered nutrient utilization 6. food-drug nutrient interaction “ The gastro-intestinal tract is designed to (1) digest the macro nutrients, protein, carbohydrates, and lipids from ingested foods and beverages, (2) absorbs fluids, micro nutrients and trace elements, (3) provide a physical and immunological barriers to pathogens, foreign materials, and potential antigens consumed with foods or formed during the passage of food through the GI tract, and (4)provide regulatory and biochemical signaling to the nervous system, often involving the intestinal microbiota via the pathway known as the gut -brain axis.” 1 The digestive and absorptive process 1 ,2 Digestion is the physical and chemical breakdown of foods and beverages we eat in preparation for its absorption. Digestion starts in the mouth when food is chewed and mixed with salivary fluids and enzymes (oral phase). Then the chewed food is swallowed through the esophagus into the stomach where it is acted upon by pepsin and gastric acid (gastric phase). The resulting mixture is called chyme which is then delivered to the small intestines for mixing with pancreatic enzymes (pancreatic amylase and lipase, proteases, and phospholipase) and biliary juices (pancreatic phase). The intestinal phase involves disaccharidases enzymes (maltase, lactase and sucrase), peptidases, and cholecystokinin for bile salts. Any interference at any of these phases of digestion, either abnormal emptying of the stomach or pancreatic insufficiency is known as maldigestion. Absorption of digestion takes place in the small intestines primarily the duodenum. The small intestines consist of the duodenum, the jejunum, and the ileum. Its wall is arranged in folds of absorptive cells and villi (finger like) projections to facilitate better absorption of most molecular nutrients, including minerals, vitamins, proteins, and fats. Iron, calcium, magnesium, and zinc are absorbed almost immediately after leaving the stomach. Malabsorption can result from dysfunction in any of the absorptive processes. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Large intestine. The large intestine (colon) is responsible for reabsorption of water, sodium, potassium, vitamin K, and small amounts of calcium and magnesium, bacterial fermentation of indigestible material, maintaining a resident population of over 500 species of bacteria and formation, storage, and propelling feces towards the rectum and anus for elimination. Rectum The rectum is a straight, 8-inch chamber that connects the colon to the anus. The rectum's job is to receive stool from the colon, let you know that there is stool to be evacuated (pooped out) and to hold the stool until evacuation happens 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Anatomy of the Digestive System Reference: https://www.pinterest.ph/pin/368591550754116896/ Accessed 15 September2021 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM What is microbiome, what is microbiota, what is microbiota diversity? To understand better some of the causation of disorders of the gastro-intestinal tract, let's talk a little bit about microbiome, microbiota, and microbiota diversity. Valdes et al 4 (BMJ) in Role of the gut microbiota in nutrition and health described “microbiome as the collective genomes (genome is the genetic material of an organism and consists of DNA) of the micro-organisms in a particular environment. Microbiota is the community of micro-organisms themselves, and microbiota diversity as a measure of how many different species.. how evenly distributed they are in the community. Lower diversity is considered a marker of dysbiosis (microbial imbalance) in the gut and has been found in autoimmune diseases, obesity, cardiometabolic conditions as well as in elderly.” They further reviewed and listed that “ Microbiota diversity and health and lower bacterial diversity has been reproducibly observed in people with inflammatory bowel disease, psoriatic arthritis, type 1 diabetes, atopic eczema, coeliac disease, obesity, type 2 diabetes, and arterial stiffness, in individuals with Crohn’s disease who are smokers, than in healthy controls. Other areas of concern include the side effects of popular restrictive diets on gut health. These include some strict vegan diets, raw food or “clean eating” diets, gluten-free diets, and low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diets used to treat irritable bowel syndrome.” 4 (BMJ) Intestinal microbiota Human gastrointestinal microbiota, also known as gut flora or gut microbiota, are the microorganisms that live in the digestive tracts of humans. 5 (Wikepedia) Thursby and Juge in their review article Introduction to the human gut microbiota (3) (BJ ) mentioned that the gut microbiota is “complex and dynamic and exerts a marked influence on the host during homeostasis and disease and diet is considered to be one of the main drivers in shaping the gut microbiota across the lifetime.” Both review articles summarise the current understanding of the development and composition of the human GI microbiota, and its impact on gut integrity and host health. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM https://www.google.com/search?q=what+is+intestinal+microbiota&tbm=isch&source Activity: Readings: 1. Introduction to the human gut microbiota by: Elizabeth Thursby and Nathalie Juge https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433529/pdf/BCJ-2016-0510C.pdf Accessed 23 August 2020 2. The role of the gut microbiota in nutrition and health https://www.bmj.com/content/361/bmj.k2179 Accessed 23 August 2020 Videos: 1. Introducing the Human Gut Microbiota https://www.youtube.com/watch?v=1cBmaRWIGn4 2. You're Not What You Think You Are https://www.youtube.com/watch?v=jIAltUyFo5o&feature=emb_title 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Diseases of the Digestive System 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Gastrointestinal Conditions that may lead to malnutrition: MALABSORPTION Celiac disease Pancreatic insufficiency Crohn’s disease Short bowel syndrome Disaccharidase deficiencies Ulcerative colitis Dumping syndrome HIV infections or AIDS MECHANICAL DISFUNCTION Achalasia or esophageal hypomotility Esophageal obstruction Adynamic ileus Hirschsprung disease Bezoar formation after gastric surgery Pyloric stenosis Bowel obstruction Tracheoesophageal fistula Esophageal stricture CONDITION THAT MAY CAUSE FEAR OF EATING Aspiration risk Chron’s disease Bloating/obstruction/distension/pain Dental disease Cholelithiasis and other biliary disease Diarrhea Diverticulitis Irritable bowel syndrome Dumping syndrome Lactose intolerance Dysphagia Pancreatitis (acute or chronic) Esophageal spasm Peptic ulcer Flatulence Proctitis Food allergies Rectal fissures Gastritis Reflux esophagitis III-fitting dentures Ulcerative colitis Reference: Escott-Stump, S. 2015. Nutrition Diagnosis-Related Care 8th ed. Wolsters Kluwer, USA p. 400. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Module 3: Lesson 2: The mouth and the mechanics of swallowing Reference: Swallowing pinterest.com Accessed 17-09-2021 Watch Video: Swallowing Reflex, Phases and Overview of Neural Control, Animation. https://youtu.be/YQm5RCz9Pxc 6,7 2.1 Stages of swallowing: Safe and effective swallowing is dependent upon perfect timing of the three basic stages, as well as the effective performance by many nerves and muscles involved in the process The three stages are: 1. Oral Phase This process is the only voluntary part of swallowing and it is under neural control of several areas of the cerebral cortex including the motor cortex. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM During the oral phase, food is chewed and moistened with saliva to form a soft bolus. The tongue then pushes the bolus towards the back of the throat. The lips close to facilitate this process, because if the mouth keeps open the jaw doesn’t have any stability and it is very difficult to swallow. Patients with impairment of the oral stage may experience difficulty creating a seal around a fork or spoon with their lips, chewing solid consistencies, forming chewed food into a bolus or moving the bolus to the back of the mouth 2. Pharyngeal phase During the pharyngeal phase, it starts with the stimulation of tactile receptors in the oropharynx, the swallow reflex is initiated. If there is sensory problem (taste/smell), this can affect the initiation of this phase or compromise swallow reflex. The vocal folds close to keep food and liquid from entering the airway. The larynx rises inside the neck and the epiglottis moves to cover it, the entry to the trachea to protect airways. This is the most important step since entry of food or drink into the lungs may potentially be life-threatening; we stop breathing when we swallow at any stage of development-protective reaction. Upper esophageal sphincter opens to allow passage of bolus to the esophagus. If the pharyngeal phase is impaired, food and liquid can move into the throat before the automatic swallow is triggered, resulting in the food or liquid touching the vocal folds or penetrating the vocal folds and entering the lungs. Common symptoms include: Coughing before, during or shortly after swallowing (we term this in the dialect natalangan, nasalim-ukan) A choking sensation (in dialect- nadunlan) Shortness of breath Changes in voice quality after swallowing Repeated pneumonia Weight loss 3. Esophageal phase During the final stage, the esophageal phase, the food bolus moves down the esophagus by peristalsis, a wave-like muscular contraction that pushes the bolus down to the stomach. The larynx moves down back to the original position. If there is a problem during this stage, the person might experience heartburn, vomiting, burping or abdominal pain 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 2.2 What is Dysphagia? Dysphagia is the medical term for difficulty swallowing which means it takes more time and effort to move food or liquid from your mouth to your stomach. Persistent dysphagia may indicate a serious medical condition requiring treatment. 2.2.1 Causes of dysphagia Mechanical: Seen in patients with esophageal stricture or spasm, cancer in the head and neck, cancer treatment/radiation of the head and neck areas, surgery to the tongue, lips, mouth and jaw, severe infection of the mouth or throat, postural problem as in severe kyphosis Neurological: As in stroke, Parkinson’s disease, motor neurone disease, head injury, multiple sclerosis, cerebral palsy, Huntington’s chorea, dementia, multiple sclerosis, myotonic dystonia Psychological In severe anxiety, severe depression, globus hystericus The consequence of dysphagia is compounded by concurrent, general illness and frailty, other comorbidities e.g. diabetes, difficulties with positioning and ill-fitting dentures. 2.3 Warning signs of dysphagia (1) Coughing/spluttering/choking during or after drinking (2) Coughing/spluttering/choking during or after eating (3) Dehydration (4) Difficulty chewing/manipulating food and drink in the mouth (5) Difficulty controlling food and drink in the mouth. (6) Drooling (7) Dry mouth (8) Easily distracted-forgetting to swallow. (9) Frequent chest infections (10) Gurgly voice or altered voice after eating and drinking (11) Increase shortness of breath/change in breathing after swallowing (12) Not being able to swallow mixed consistency meals (13) Not been able to swallow food sticking in the mouth (14) Pain on swallowing (15) Poor oral hygiene (16) Pouching of food in the mouth (17) Sensory loss and weakness in muscles of mouth and face (18) Spilling of food and drink in the mouth (19) Unable to clear own saliva secretions (20)Very poor physical posture with neck touching chest (21) Vomiting after meals 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM (22) Weight loss. Reference: Gandy, J. ed. (2014) BDA Manual of Dietetic Practice, 5th edn. West Sussex, John Wiley & Sons. P394.. Commercial proprietary thickeners in powdered form made up of modified food starch (generally maize) that can be used to thicken foods and liquids in the management of dysphagia: 1. Multi-thick (Abbott Nutrition) 2. Nutilis (Nutricia Advanced Medical Nutrition) 3. Resource Thicken Up Clear (Nestle Healthcare Nutrition) 4. Thick and Easy Instant Food Thickener (Fresenius Kabi Ltd.) 5. Thixo-D (Sutherland Health Ltd.) 6. Vitaquick (Vitaflo International Ltd.) 2.4 Nutrition Care Process in dysphagia management; 2.4.1. Nutrition assessment: height, weight, BMI, weight changes diet history and swallowing problem warning signs of swallowing problem swallowing assessment by video fluoroscopy (Speech and Language Therapist) lab works (physician) 2.4.2 Nutrition diagnosis based on the etiology and signs and symptoms of dysphagia 2.4.3.Nutrition intervention 2.4.3.1 Goals (1) correct nutritional deficit (2) prevent choking and aspiration of food and beverage (3) maintain weight or achieve weight gain if weight loss has occurred () individualized diet modification in terms of consistency recommended by the Speech Therapist (e) support independence in eating whenever possible by providing foods that stimulates the swallowing reflex and feeding aide equipment to help with eating/drinking. 2.4.3.2 Nutrition requirements (1) Calculate needs at 30-35 kcal/kg body weight; 1-1.5g protein/kg to assure adequacy and prevent loss of body mass 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM (2) Some patient can tolerate regular diet but for those who are not able, give Modified consistency and texture of meals as per advice of the speech therapist. Refer to the International Dysphagia Diet Standardisation Initiative (IDDSI) guidelines. IDDSI classification of food and liquid consistency/texture. British Dietetic Association -UK.COM UK.com https://ftp.iddsi.org/Documents/Consumer_Handouts_for_Adults_All_Levels.pdf Watch Video: IDDSI Overview - UK https://www.youtube.com/watch?v=Zd6prmzm39k (3) Enteral nutrition maybe recommended depending on the medical condition and cause of the dysphagia. Percutaneous Endoscopic Gastrostomy (PEG) is preferred to Nasogastric Tube Feeding (NGT) (4) Monitor for deficiencies for fiber and vitamin A and C if whole grain cereals, fruits and vegetables are not consumed (5) Provide good oral hygiene (6) Avoid high risk foods that causes choking: 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM High risk foods in dysphagia Reference:. Gandy, J. ed. (2014) BDA Manual of Dietetic Practice, 5th edn. West Sussex, John Wiley & Sons. P.396. High risk food s in dysphagia (modified from joint Working Party of the british Dietetic Association and Royal College of Speech and Language Therapist (2002, reviewed 2009) and Dietitian Association of Australia and The Speech Pathology Association of Australia Ltd. (2007) (7) Meeting nutritional needs in dysphagia Presentation and temperature of food Improving flavor, taste and palatability of meals Suitable texture of food (refer to IDDSI for guidance) Provide the needed nutrient requirement in the correct proportion Food fortification and/or enrichment to increase calorie and nutrient content of food/meals Use of appropriate food thickener to obtain correct consistency of food/liquid o Offer between meal snacks Ensure correct posture and physical access to eating and drinking Provide adequate fluid in correct consistency (refer to IDDSI for guidance) 2.4.4 Nutrition monitoring and evaluation (1) Food intake and weight (2) Oral hygiene especially after meals (3) Offer suggestions for specific changes in food preparation and cutting or mincing foods to increase control of the swallowing. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM (4) Encourage review of swallowing ability to identify early decline or lessen restriction in diet modification (5) Monitor for quality of life factor; adjust dietary limitations where possible (6) Patient education for food borne illness and home enteral feeding 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM The Multi- Disciplinary Dysphagia Team Aims of management by the team are: 1. Assess the nature of the swallowing problems 2. Determine a safe and adequate feeding routre 3. Determine the appropriate texture and consistency of orally consumed food and fluids 4. Ensure nutritional needs are met 5. Ensure fluids needs are neet. 6. Educate the patients, carers and other members of the care team. 7. Monitor progress. 8. Ensure continuity of care. Reference: Gandy, J. ed. (2014) BDA Manual of Dietetic Practice, 5th edn. West Sussex, John Wiley & Sons. P.393. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Module 3: Lesson 3: Esophagitis, gastroesophageal reflux disease (GERD), hiatus hernia 2.5 Esophagitis is the inflammation the tissues of the esophagus, the muscular tube that delivers food from your mouth to your stomach. The condition that results from gastric juices being forced into the esophagus from the stomach, infection, oral medications (like aspirin, tetracycline, vitamin C, ferrous sulfate, potassium chloride, nonsteroidal anti-inflammatory drugs) and allergies. When taking these medications have plenty of water. Signs and symptoms Difficult swallowing Painful swallowing Chest pain, particularly behind the breastbone, that occurs with eating Swallowed food becoming stuck in the esophagus (food impaction) Heartburn Acid regurgitation In infants and young children: feeding difficulties, failure to thrive Treatment for esophagitis depends on the underlying cause and the severity of tissue damage. If left untreated, esophagitis can damage the lining of the esophagus and interfere with its normal function, which is to move food and liquid from your mouth to your stomach. ESOPHAGITIS: Reference: Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed.Elsevier, 3251 Riverport Lane, St. Louis Mo. USA p. 510 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 3.2 Gastroesophageal reflux disease (GERD) Watch Video: 1. Heartburn, Acid Reflux, GERD-Mayo Clinic https://www.youtube.com/watch?v=TdK0jRFpWPQ 2. GERD - Gastroesophageal Reflux Disease or Gastric Reflux, Animation. https://www.youtube.com/watch?v=dkRLqyJeplU Gastroesophageal reflux is a symptoms or complications resulting from the reflux of the gastric contents of the stomach into the esophagus or beyond, even into the oral cavity, larynx or lungs. Clinical symptoms associated with GERD Symptoms Description Dental erosion Slow, progressive tooth surface loss associated with acid regurgitation Dysphagia Difficulty initiating a swallow (oropharyngeal dysphagia) or sensation of food being hindered or “sticks” after swallowed (esophageal dysphagia) Odynophagia Painful swallow GA Backflow of gastric content into the mouth not associated with nausea or retching Non-cardiac chest Unexplained substernal chest pain resembling a myocardial infarction pain without evidence of coronary artery disease Extraesophageal Chronic cough, hoarseness, reflux-induced laryngitis or asthma symptoms Reference: Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed.Elsevier, 3251 Riverport Lane, St. Louis Mo. USA p. 512 Nutrition Care Guidelines for Reducing Gastroesophageal Reflux (GERD) and Esophagitis 1. Maintain upright posture during and for 45 to 60 minutes after eating. 2. Avoid eating 2 to 3 hours before lying down and/or bedtime 3. Elevate the head of bed by 6-8 inches for individuals who have reflux episodes at night 4. Elevate the head of bed (6-8 inches) when sleeping. 5. Avoid smoking. 6. Avoid alcoholic beverages. 7. Avoid caffeine containing foods and beverages. 8. Avoid large, high fat meals; avoid chocolate 9. Wear loose-fitting clothing around the stomach area; tight clothing can constrict the area and increase reflux. 10. Avoid acidic and highly spiced foods when inflammation exists. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 11. Consume a healthy, nutritionally complete diet with adequate fiber. 12. Loose weight if overweight. Reference: Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed.Elsevier, 3251 Riverport Lane, St. Louis Mo. USA.p 513. The treatment of GERD requires a multi-factorial approaches aimed at dietary and lifestyle modification, drug therapy, and occasionally surgery. Dietary management is influenced by the individual food tolerances, since the severity of GERD symptoms varies among individuals. Dietary modification is aimed to decrease or eliminate foods that cause reflux and/or irritate the esophagus. Identification and treatment of the mechanism underlying GERD is the first line of therapy. 3.3 Hiatus Hernia: Hiatus hernia is a condition caused by protrusion of part of the stomach through the diaphragm muscle, which separate the chest from the abdomen, which caused an enlarge opening in the diaphragm (hiatus) which the esophagus passes to join the stomach. Hiatus hernia may show no symptoms or may contribute to heartburn, epigastric pain, swallowing difficulty, reflux, or vomiting and development of gastroesophageal reflux and esophagitis (prolonged acid exposure due to hiatus hernia) Hiatus Hernia Reference: Escott-Stump, S. 2015. Nutrition Diagnosis-Related Care 8th ed. Wolsters Kluwer, USA p. 412. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Nutrition management: 1. Avoid large energy-dense meals. Instead have smaller size meals. 2. If overweight/obese aim for weight reduction 3. Include iron rich-foods if iron deficiency anemia is present 4. Aim for healthy balanced meals. Module 3: Lesson 4: Dyspepsia (indigestion) and bezoar formation 4.1 Dyspepsia, also known as indigestion, is a term that describes non-specific persistent discomfort or pain in the upper abdomen. It is not a disease. The term refers to a group of symptoms that often include bloating, discomfort, postprandial nausea, and burping. The term discomfort is used is emphasized, because many patients does not experience any pain rather complain of burning, pressure, or fullness in the epigastric area, or unable to finish a normal-sized meal due to early satiety (“na busog dayon”). The underlying cause of dyspepsia may include peptic ulcer disease, gastritis, gallbladder disease, hiatus hernia, or other identifiable pathologic conditions. Overeating and consuming Greasy foods can cause indigestion. 4.2 Bezoar formation “A bezoar (BE-zor) is a solid mass of indigestible material that accumulates in your digestive tract, sometimes causing a blockage. Bezoars usually form in the stomach, sometimes in the small intestine or, rarely, the large intestine. They can occur in children and adults.” 9 Common type of bezoars| 1. Phytobezoars: the most common type of bezoar and are composed of indigestible vegetable fibers. 2. Trichobezoars: these bezoars are composed of hair and food particles and can weigh several kilograms. 3. Pharmacobezoars: these are composed of medications that haven’t dissolved. 4. Lactobezoar: these are composed of milk protein and mucus. 5. Foreign body bezoars: Tissue paper, plastic, polystyrene foam cups, and parasitic worms are other examples of material found in bezoars. Activity: Read: 1. Bezoars Accessed 28 August 2020 By Zubair Malik MD, Temple University Hospital https://www.msdmanuals.com/professional/gastrointestinal-disorders/bezoars-and- foreign-bodies/bezoars 2. Bezoars Accessed 28 August 2020 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM https://www.healthline.com/health/bezoar 4.3 Medical Nutrition Therapy: Dyspepsia/Bezoars Food and nutrition (1) Use a food and symptoms diary and assessing symptoms associated with eating pattern and to help patients identify problematic food(s). (2) If dyspepsia is organic in etiology, soft, low fat diet, and small meals may be helpful (3) Alcoholic beverages and caffeine should be limited or avoided. (4) If the patient has an obstruction or a bezoar, a liquid diet may be helpful until the bezoar is resolved. Nutrition education, counseling and care management (1) Encourage the patient to eat in a relaxed atmosphere (2) Discuss with patient the usefulness of a food-symptoms diary to enable identification of food(s) causing the problem, so the patient is able to eliminate this from the diet. (3) Discuss tips for preparing meals that are lower in acid, stimulants, or other irritants. (4) Food safety: careful handling and hand washing are important to prevent introduction of foodborne pathogens to the diet, proper preparation, cooking and storage practices are also important. Sample Nutrition Care Process Steps : DYSPEPSIA Assessment data: Weight, BMI, recent GI surgery for extensive peptic ulcer disease, positive history of H. pylori infection, heartburn with every meal and complaints of indigestions. Nutrition diagnosis (PES): Inadequate oral food and beverage intake related to frequent bouts of indigestion after GI surgery as evidenced by unplanned weight loss, reports of heartburn, and indigestions with meals. Nutrition Intervention: Alter foods served to decrease use of acidic foods or stimulants such as caffeine and alcoholic beverages. Educate about simplifying meals and small snacks to increase intake. Counseling on food choices and lifestyle changes to improve intake and decrease discomfort. Monitoring and evaluation: Improved intake for meals and snacks. Fewer complaints of dyspepsia. No further weight loss. Reduced need for use of antacids for heartburn. Reference: Escott-Stump, S. 2015. Nutrition Diagnosis-Related Care 8th ed. Wolsters Kluwer, USA p.415 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Module 3: Lesson 5: Gastritis, gastroenteritis, and gastric and peptic ulcers 5.1 Gastritis Gastritis is a non-specific inflammation of the gastric mucosa (stomach). Gastritis could be acute when it is rapid onset or chronic when it occurs over a period of time may be months or decades. Types of gastritis Chronic gastritis may follow repeated attacks of acute gastritis and closely associated with Helicobacter pylori (H.pylori) infection. H.pylori is a gram-negative bacteria that appears to be resistant to the acidic environment in the stomach. H. pylori infection is implicated for most cases of chronic inflammation of the gastric mucosa, peptic ulcer, gastric cancer and atrophic gastritis. Atrophic gastritis is the chronic inflammation of the gastric mucosa without inflammation without erosion but with hypochlorhydria or achlorhydria and loss of intrinsic factor. Hemorrhagic gastritis may result from chronic intake of alcohol or medication, Crohn’s disease or HIV infection. Autoimmune gastritis with pernicious anemia Erosive gastritis from use of aspirin or NSAID (non-steroidal anti-inflammatory drugs) Bile reflux gastritis Symptoms of gastritis Nausea Vomiting Anorexia Malaise Hemorrhage Epigastric pain Dietary and care management should be based on the following: 2,8 Identifying and attempting to correct dietary and lifestyle factors that are contributing to the conditions e.g. alcohol, caffeine, smoking, drugs and poor eating habits. Encouraging a balanced diet based on healthy eating principles with sensible meal pattern Correcting deficiencies e.g. iron, vitamin B12, that have resulted from repeated bleeding and reduced production of intrinsic factors. Patients with chronic gastritis should be assessed for folate and vitamin B12 status. Atrophy of the stomach and intestinal lining interferes with iron, vitamin B12 absorption. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Discuss the role of fiber in achieving or maintaining bowel integrity. 5.2 Gastroenteritis Gastroenteritis (GE) is an inflammation of the stomach and intestinal lining that may occur from eating, chemical toxins in food (e.g. seafoods, mushrooms, arsenic, or lead), drinking excessive alcohol, food-borne illness or viruses, cathartics or other drugs. Viral gastroenteritis is contagious. Many different viruses can cause gastroenteritis, including rotaviruses or adenoviruses. Contaminate shellfish and raw oysters are major contributors of viral GE. Symptoms of gastroenteritis may include malaise, nausea and vomiting, intestinal rumbles, diarrhea with or without blood and mucus, fever and prostration. Care management: During gastroenteritis, it is important to eat as normally as possible. Eating helps the lining of the intestine to heal quickly and allows the body to regain strength but not eating may prolong diarrhea and make the body even weaker. Start by eating small amounts of food. Then, gradually increase quantities depending on your appetite and the improvement of your condition. It is important to rehydrate well by drinking or a rehydration solution preferably, especially if you cannot eat, to replenish mineral salts to prevent dehydration and promote recovery Since when you have gastroenteritis, your body eliminates large quantities of water and mineral salts that are essential to your body’s proper functioning. If your child is breast or bottle-fed, he or she can continue drinking his or her regular milk, without diluting it. Offer it more often, in small quantities. Infants and children are most vulnerable to dehydration when they suffer from gastroenteritis, hence it is important that they should be rehydrated. Diarrhea-induced dehydration will be further discussed in Module 4: MNT for Lower Gastro-intestinal Tract Diseases. Activity: Read: 1. Practical Guidelines for the Management of Gastroenteritis in Children https://journals.lww.com/jpgn/fulltext/2001/10002/practical_guidelines_for_the_management_of. 7.aspx Accessed 30-Agust 2020 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 2. nutritional management for infants with gastroenteritis - Nestlé... www.nestlenutrition-institute.org › docs › imports-library Accessed 30-August 2020 5.3 Gastric and duodenal (peptic ulcers) A peptic ulcer is a sore on the lining of the stomach or the first part of the small intestine (duodenum). If the ulcer is in the stomach, it is called a gastric ulcer. If the ulcer is in the duodenum, it is called a duodenal ulcer. Normal gastric and duodenal mucosa is protected from the digestive actions of acid and pepsin by the secretion of mucus, the production of bicarbonate, the removal of excess acid by normal blood flow and repair of epithelial cell injury. Peptic ulcer results from the breakdown of these normal defenses and repair mechanisms. 1 Causes of peptic ulcers include:1, 14 1. H. pylori bacteria (Helicobacter pylori). Most ulcers are caused by an infection from a bacteria or germ called H. pylori. This bacteria hurts the mucus that protects the lining of your stomach and the first part of your small intestine (the duodenum). Stomach acid then gets through to the lining. 2. NSAIDs (nonsteroidal anti-inflammatory drugs). These are over-the-counter pain and fever medicines such as aspirin, ibuprofen, and naproxen. Over time they can damage the mucus that protects the lining of your stomach 3. Stress ulcers may occur as a complication of metabolic stress due to trauma, surgery, shock, renal failure, or radiation therapy. 4. Gastritis Symptoms of peptic ulcers 1 Most common symptom is abdominal discomfort characterized by dull or burning pain in your belly between your breastbone and your belly button (navel). This pain often occurs around meal times and may wake you up at night. It can last from a few minutes to a few hours. Other symptoms may include: Bloating or feeling full after eating a small amount of food Burping Nausea Vomiting 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Poor appetite Not feeling hungry Losing weight without trying Peptic ulcers may also have “emergency symptoms that needs immediate medical attention. When there is Sharp, sudden, persistent and severe stomach pain Bloody or black stool (melena) Vomiting blood (hematemesis) or vomit that looks like coffee grounds These symptoms could be signs of serious problems like acute or chronic GI bleeding (when acid or peptic ulcer breaks a blood vessel), perforation (when peptic ulcer burrows completely through the stomach or duodenal wall, potentially penetrating an adjacent organ like the pancreas), or obstruction (when peptic ulcers blocks the path of the food trying to leave the stomach). Complication of hemorrhage or perforation contribute significantly to the morbidity and mortality of peptic ulcers. Reference : Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed.Elsevier, 3251 Riverport Lane, St. Louis Mo. USA p. 517. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Gastric ulcer is typically associated with widespread gastritis, inflammatory involvement of the parietal cells, and atrophy of acid-pepsin producing cells occurring with advancing age. Duodenal ulcer is characterized by increased acid secretion throughout the whole day with decreased bicarbonate secretion. Medical Nutrition Therapy: 1, 2 1. Objectives: Evaluate vitamin B12 status because of lack of intrinsic factor and gastric acid results in malabsorption of this vitamin, especially in the presence of atrophic gastritis. Eradicate any H. pylori infection where present as this will improve iron absorption and increase ferritin levels. H. pylori has been implicated in iron deficiency anemia. Reduce pain; avoid distention from large meals 2. Food and nutrition: Have small frequent feedings to avoid feeling of bloating Limit gastric stimulants, if not tolerated, like caffeine, alcohol, black pepper, chili, chili powder, garlic, and cloves. Avoid food that is not well tolerated like citrus and acidic juices as this may cause pain and may exacerbate the symptoms.. High quality diet, nutritionally balanced diet with adequate dietary fiber from fruits and vegetables may offer protection and promote healing. Monitor source of water for H. pylori. 3.Nutrition education, counseling and care management: Suggest dietary changes that would help reduce symptoms. Reduce intake of alcoholic beverages and stop smoking 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Patient education on foodborne illnesses and food safety, such as careful food handling and hand washing to reduce spread of H. pylori. Always wash hand after using the bathroom and before/after eating. Sample nutrition care process steps: Peptic ulcer Reference: Undesirable food choices: Assessment data: Food and symptoms diary. Positive stool guaiac test. Altered GI lab results. No H. pylori present Nutrition Diagnosis (PES): Undesirable food choices related to chronic alcohol intake (beer and wine, 10 drinks per week) as evidenced by nausea, sharp stomach pain, abdominal discomfort, black tarry stools, and altered GI labs. Intervention: Teach about the role of alcohol in GI mucosal damage. Counsel about alternative lifestyle changes that will help alleviate GI pain. Encourage intake of broccoli for its chemoprotective effects. Monitoring and evaluation: Report of decreased alcohol consumption and less GI discomfort and pain. Resolution of peptic ulcer symptoms; improved lab results. No further tarry stools. Module 3: Lesson 6: Gastroparesis, gastric surgery and dumping syndrome Activity: Watch Video 1. Gastroparesis (Stomach Paralysis) | Causes and Risk Factors, Signs & Symptoms, Diagnosis, Treatment https://www.youtube.com/watch?v=X7oTBUffUSc 2. Understanding diabetic gastroparesis https://www.youtube.com/watch?v=gW07lSaNPdw 6.1 Gastroparesis is a problem with the stomach not working properly. It is also called delayed gastric emptying. With gastroparesis, food in the stomach empties slowly into the small intestine. This can cause symptoms such as nausea, vomiting, fullness after meals, bloating (usually above the belly button), and pain. Gastroparesis is common in people with diabetes and more common in women than in men. Learn more at www.gastro.org/gastroparesis. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Reference: Gandy, J. ed. (2014) BDA Manual of Dietetic Practice, 5th edn. West Sussex, John Wiley & Sons. pp.411-414 Chronic gastroparesis may contribute to patient morbidity and severely affect quality of life and in severe cases needs hospital admission and longer length of stay. Types of gastroparesis: 1. Idiopathic gastroparesis 2. Diabetic gastroparesis 3. Post surgical gastroparesis Medical Nutrition Therapy Nutrition assessment: Anthropometry: height, weight, BMI, waist circumference, weight history, % weight loss if Relevant, presence of ascites, edema , dehydration Biochemistry: Urea, creatinine, sodium, potassium, magnesium, phosphate and correct calcium to assess hydration, renal function, electrolyte depletion and 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM risk of refeeding syndrome For patients with diabetes: blood glucose levels pre and post meals and HbA1c Hemoglobin, ferritin, folate and B12 levels to detect anaemia. Clinical status: Establish underlying etiology e.g. diabetes, post surgery or idiopathic Bowel form. Frequency and incidence of constipation or diarrhea Observations for fever and fluid intake/output Symptoms history, type and pattern, duration frequency and severity. Socio-economic status: Smoking, use of illicit drugs, physical activity, history of depression/stress, patient’s understanding of normal digestion, motivation and support, readiness and barrier to change, cooking skills Dietary assessment Diet history = current intake vs usual intake Previous dietary interventions tried Evidence of disordered eating e.g. bingeing, self-induced vomiting Meal pattern and portion size; Food intolerance and/or allergies Tolerance to different textures: solid, soft, pureed, liquid and fibre intake Fluid intake: alcohol, carbonated beverages, caffeine Dietary sources of iron, folate, thiamine, calcium, vitamin D and other at risks micro-nutrients Nutrition Intervention A soft to liquid diet lower in fat may be useful to prevent delay in gastric emptying time Six small frequent feedings maybe better tolerated than large meals Calculate protein and energy requirements according to underlying conditions Alter fiber intake according to needs (more to alleviate diarrhea; less with history of bezoar formation). If a patient complains of dry mouth, add extra fluids and moisten food with broth or allowed sauces and gravies. For patients with greater obstruction of the stomach, use a low fiber-diet or tube feed, checking residuals frequently. If oral intake is not adequate, then enteral nutrition via jejunostomy needs to be considered. Nutrition education, counselling and care management Support patients, determine specific dietary regimen, if there is diabetes, optimize glycemic control. Discuss ways of modifying texture and fluid consistency as needed. Refer to IDDSI guidelines. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Lesson 6: Gastric surgery (Gastrectomy) 6.2 Gastric surgery is a medical procedure where all or parts of the stomach is surgically removed. Activity: Read Gastrectomy https://www.nhs.uk/conditions/gastrectomy/ Gastrectomy https://www.healthline.com/health/gastrectomy#lifestyle Watch video: Sleeve Gastrectomy https://www.ypo.education/bariatrics/sleeve-gastrectomy-t200/video/ Sleeve gastrectomy, also referred to as vertical sleeve, gastric sleeve or tube gastrectomy, is a surgical procedure performed for the treatment of obesity. The procedure is a restrictive bariatric surgery to treat extremely obese patients with a high BMI of 40 and above. It encourages weight loss. 6.3 Dumping Syndrome Dumping syndrome is a complex GI and vasomotor response to the presence of large amount of hypertonic foods and liquids in the proximal small intestines. It usually occur as a result of surgical procedures that allow excessive amount of liquid or sold foods to enter the small intestines in the concentrated form. Early symptoms can occur within 10-30 minutes post prandially and late symptoms happen within 1-3 hours post prandially. Early dumping is characterized by symptoms like abdominal pain, bloating, nausea, vomiting, diarrhea, headache, flushing, fatigue, tremors, diarrhea, and hypotension. Late dumping are characterized by perspiration, weakness, confusion, shakiness, hunger and hypoglycemia and is a likely result of reactive hypoglycemia. Medical Nutrition Therapy Patients with dumping syndrome may experience weight loss and malnutrition caused by inadequate intake, malabsorption or combination of both. Objective: 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Nutrition therapy is aimed to restore nutrition status and quality of life Food and nutrition: Basic Guidelines for Dumping Syndrome 1 Eat small, frequent “meals” per day. Limit fluids to four ounces (1/2) at a meal, just enough to “wash” food down. Drink remaining fluids at 30 to 40 minutes before and after meals. Eat slowly and chew food thoroughly. Avoid extreme temperatures of food. Use seasonings and spices as tolerated (may want to avoid pepper, hot sauce). Remain reclined at least 30 minutes after eating. Sugar-containing foods and liquids are limited. Examples: fruit juice, Gatorade, PowerAde, Kool Aid, sweet tea, sucrose, honey, jelly, com syrup, cookies, pie, doughnuts. Complex carbohydrates are unlimited (e.g., bread, pasta, rice, potatoes, vegetables). Include a protein-containing food at each meal. Limit fats (less than 30% of total calories. Avoid fried foods, gravies, fat containing sauces, mayonnaise, fatty meats, (sausage, hotdogs, ribs), chips, biscuits, pancakes. Milk and dairy products may not be tolerated because of lactose. Introduce these slowly in the diet if they were tolerated preoperatively. Lactose free-milk or soy milk is suggested. Nutrition Education, Counseling and Care Management Patient is able to verbalize the effect of dietary choices in dumping syndrome e.g. simple CHO and liquids Patient is able to verbalize the guidelines to prevent dumping syndrome Stress the importance of self-care and optimal functioning, what to do for illness, episodes of vomiting and eating away from home. Instruct patients to eat slowly in an upright position and to remain upright for a while after meals. Help the patient to overcome the fear and reluctance of eating. Discuss the effect of dumping syndrome on nutrient absorption if untreated. 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Activity: Watch Video: What is Dumping Syndrome? https://www.youtube.com/watch?v=VMOQoirKYlk Dumping Syndrome, Animation https://www.youtube.com/watch?v=mXhNYj_oqEU END OF MODULE 3 MEDICAL NUTRITION THERAPY FOR UPPER GASTROINTESTINAL TRACT DISORDER References: Module 3 1. Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed. Elsevier, 3251 Riverport Lane, St. Louis Mo. USA 2. Escott-Stump, S. 2015. Nutrition Diagnosis-Related Care 8th ed. Wolsters Kluwer, USA 3. Introduction to the human gut microbiota by: Elizabeth Thursby and Nathalie Juge https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433529/pdf/BCJ-2016-0510C.pdf Accessed 23 August 2020 4. The role of the gut microbiota in nutrition and health https://www.bmj.com/content/361/bmj.k2179 Accessed 23 August 2020 5. Anatomy and Physiology of Feeding and Swallowing – Normal and Abnormal Koichiro Matsuo, DDS, PhDa and Jeffrey B. Palmer, MDb,c,d https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597750/ Accessed 24 August 2020 Matsuo, K., & Palmer, J. B. (2008). Anatomy and physiology of feeding and swallowing: normal and abnormal. Physical medicine and rehabilitation clinics of North America, 19(4), 691–vii. https://doi.org/10.1016/j.pmr.2008.06.001 6. Feeding and the swallow mechanism https://www.physio-pedia.com/Feeding_and_the_Swallow_Mechanism Accessed 24 August 2020 7.Stages of swallowing https://www.uwhealth.org/voice-swallow/stages-of-swallowing/11463 Accessed 28 August 2020 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 8. Gandy, J. ed. (2014) BDA Manual of Dietetic Practice, 5th edn. West Sussex, John Wiley & Sons 9. Bezoars: how do they happen https://www.mayoclinic.org/diseases-conditions/gastroparesis/expert-answers/bezoars/faq Accessed 28 August 2020 10. Bezoars https://www.healthline.com/health/bezoar#complications Accessed 28 August 2020 11. Foods to eat when you have gastroenteritis https://www.quebec.ca/en/health/health-issues/flu-cold-and-gastroenteritis/gastroenteritis/foods- to-eat-when-you-have-gastroenteritis/ Accessed 30-August 2020 12. Practical Guidelines for the Management of Gastroenteritis in Children https://journals.lww.com/jpgn/fulltext/2001/10002/practical_guidelines_for_the_management_of. 7.aspx Accessed 30-Agust 2020 13. nutritional management for infants with gastroenteritis - Nestlé... www.nestlenutrition-institute.org › docs › imports-library Accessed 30 August 2020 14. Stomach and duodenal ulcers (Peptic Ulcers) Accessed 31 August 2020 https://www.hopkinsmedicine.org/health/conditions-and-diseases/stomach-and-duodenal-ulcers-peptic -ulcers Accessed 30 August 2020 15. Gastrectomy https://www.nhs.uk/conditions/gastrectomy/ Accessed 31 August 2020 16. Gastrectomy https://www.healthline.com/health/gastrectomy#lifestyle Accessed 31 August 2020 Videos 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 1. Introducing the Human Gut Microbiota https://www.youtube.com/watch?v=1cBmaRWIGn4 2. You're Not What You Think You Are https://www.youtube.com/watch?v=jIAltUyFo5o&feature=emb_title 3. Swallowing Mechanism https://youtu.be/YQm5RCz9Pxc 4. Stomach Ulcer | Nucleus Health https://www.youtube.com/watch?v=lnVjXuyM6xk 5. Foods to avoid if you have stomach ulcer | what Foods are bad for stomach ulcer. https://www.youtube.com/watch?v=FU1tj4sbOTE 6. Sleeve Gastrectomy https://www.ypo.education/bariatrics/sleeve-gastrectomy-t200/video/ 7. What is Dumping Syndrome? https://www.youtube.com/watch?v=VMOQoirKYlk 8. Dumping Syndrome, Animation https://www.youtube.com/watch?v=mXhNYj_oqEU 2020-21 Module 3 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Nursing, Nutrition & Dietetics: Nutrition and Dietetics Program. University of San Agustin, Iloilo City, Philippines
