Medical Therapeutic Nutrition 1 Lecture Notes PDF

Medical Therapeutic Nutrition 1 Lecture: 8th Nutritional Management of Gastrointestinal Disorders Assistant Prof. Dr. Emad Ali AL-Shameri Consultant of Nutrition & Dietetics Email: [email protected] HP: 777772423 ...

Medical Therapeutic Nutrition 1 Lecture: 8th Nutritional Management of Gastrointestinal Disorders Assistant Prof. Dr. Emad Ali AL-Shameri Consultant of Nutrition & Dietetics Email: [email protected] HP: 777772423  GI Disorders (CONT) Effect of these disorders include: 1. Malabsorption, 2. discomfort associated with eating, 3. anorexia, 4. impaired intake, 5. and food intolerances.  GI Disorders (CONT) Major conditions associated with GI tract are: 1. Diarrhea and vomiting. 2. Dyspepsia. or gastric indigestion. 3. Peptic and duodenal ulcers. 4. Constipation, abdominal pain, and irritable bowel. 5. Hemorrhoids and anal fissure. 6. Dysphagia. 7. Hernia.  GI Disorders (CONT) Major conditions associated with GI tract are: 8. Gallstones. 9. Appendicitis. 10. Malabsorption syndromes. 11. Ulcerative colitis and Crohn’s disease. 12. Diverticular disease of the colon, Diverticulitis 13. Pancreatitis. 14. Liver disease. 15. Food intolerance.  GI Disorders (CONT) GI Disorders Upper GI Lower GI Disorders of the Disorders of Esophagus the Stomach  Disorders of the Esophagus The Esophagus Tube from pharynx to stomach  Disorders of the Esophagus 1. Dysphagia. 2. Esophagitis. 3. Gastroesophageal Reflux (GERD). 4. Hiatal hernia.  Disorders of the Esophagus (CONT) ❖ Disorders of the esophagus may be caused by: 1. Derangement of the swallowing mechanism, 2. Obstruction, 3. Inflammation, or 4. Abnormal sphincter function.  1. Dysphagia (CONT) ▪ Dysphagia is almost always accompanied by a reduced food intake leading to: 1. Significant weight loss, 2. Compromised immune function, 3. High risk of dehydration.  Primary aims of management of Dysphagia 1. Assess the nature of the swallowing problem. 2. Determine a safe and adequate feeding route. 3. Determine the appropriate texture and consistency of food and fluids. 4. Meet nutritional needs. 5. Ensure adequate hydration status. 6. Educate patient and\or careers. 7. Monitor progress and ensure continuity of care.  2. Esophagitis (CONT) ▪ Acute esophagitis can be caused by ingesting a caustic compound, often a medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs). ▪ It can arise from repeated vomiting, especially when self-induced as in anorexia and bulimia.  Dietary Recommendations for acute esophagitis 1. Avoid spicy foods (red, black pepper). 2. Follow a bland, soft diet. 3. Eat small frequent meals. 4. Severe esophagitis –low fat liquid diet. 5. Avoid acidic foods (citrus fruits, soft drinks, tomato..); may cause pain when the esophagus is inflamed.  3. Gastroesophageal Reflux Disorders (GERD) ▪ Defined as symptoms of mucosal damage produced by the abnormal reflux of gastric contents into the esophagus. i.e.: process in which acid from the stomach refluxes up into the esophagus.  3. Gastroesophageal Reflux Disorders (GERD) Symptoms of GERD: 1. Burning sensation after meals; 2. Heartburn, regurgitation or both, especially after meals. 3. Symptoms often aggravated by recumbency or bending over and are relieved by antacids. Chronic esophageal reflux results in: 1. Substernal pain. 2. Belching. 3. Esophageal spasm.  3. Gastroesophageal Reflux Disorders (GERD) Causes of GERD: 1. Esophageal sphincter weakness. 2. Increased pressure within the stomach. 3. High pressure from the abdominal area (obesity or pregnancy). 4. Hiatus hernia. 5. Tobacco use 6. Delayed gastric emptying 7. Recurrent vomiting…  3. Gastroesophageal Reflux Disorders (GERD) Complications of GERD: ▪ Prolonged reflux can result in: 1. Esophagitis – inflammation of the esophagus, 2. Ulceration of esophagus, 3. Scarring, 4. Strictures of esophagus, and 5. Dysphagia.  3. Gastroesophageal Reflux Disorders (GERD) Complications of GERD (CONT): ▪ GERD is distressing and its symptoms interfere with sleep, work and the overall quality of life. ▪ Prolonged and severe reflux can affect the tissues of esophagus and they can develop cancer.  Treatment and Nutritional Intervention of GERD ▪ Objectives of nutritional care. 1. Prevent esophageal reflux. 2. Prevent pain and irritation of the inflamed esophageal mucosa. 3. Decrease the erosive capacity (ability to erode) or acidity of gastric secretions. Treatment and Nutritional Intervention of GERD (CONT) ▪ Dietary changes that may help to manage (GERD) include: 1. Avoid eating several hours before sleep (late in night). 2. Avoid large meals especially desserts high in fat and protein (stimulate acid secretion and slow gastric emptying). Treatment and Nutritional Intervention of GERD (CONT) ▪ Dietary changes that may help to manage (GERD) include: 3. Eat small frequent meals. 4. Avoid drinking liquids with meals; drink between meals. 5. Avoid lying down, lifting after a large meal. 6. Avoid highly spiced foods when inflammation exist. Treatment and Nutritional Intervention of GERD (CONT) ▪ Dietary changes that may help to manage (GERD) include: 7. Avoid foods and drugs that lowering the pressure of the LES: Dietary fat, alcohol and Carminatives (peppermint and spearmint) lower LES pressure. 8. Avoid foods that increase gastric acidity: Black and red pepper, coffee and alcohol. 9. Reducing weight if overweight. 4. Hiatus Hernia (Hiatal hernia)  MNT for Hiatus Hernia ▪ Diet therapy for hiatal is aimed at decreasing symptoms in those who have reflux or esophagitis. ▪ Therapy is similar to that for (GERD) and esophagitis. ▪ Consumption of smaller, low-fat meals and the avoidance of foods that may increase gastric secretions or reduce LES pressure. ▪ Surgery is not always indicated for hiatal hernia; ▪ Symptoms control through medications. ▪ Diet is generally the preferred treatment. Thanks for your attention