Top Banner
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 20 Diet and Gastrointestinal Problems
45

Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Jul 11, 2020

Download

Documents

dariahiddleston
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Chapter 20

Diet and Gastrointestinal Problems

Page 2: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Objectives

• Explain uses of diet therapy in gastrointestinal

disturbances

• Identify foods allowed and disallowed in

therapeutic diets discussed

• Adapt normal diets to meet requirements of

clients with conditions discussed

Page 3: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Gastrointestinal Tract

• Where digestion and absorption of food occurs

• Primary organs:

– Mouth, esophagus, stomach, small intestine, and large

intestine

• Accessory organs:

– Liver, gallbladder, and pancreas

Page 4: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Dyspepsia

• Also known as indigestion

• Discomfort in digestive tract of physical or

psychological origin

• Symptoms:

– Heartburn, bloating, pain and regurgitation

(continues)

Page 5: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Dyspepsia

• Treatment:

– Treat underlying organic cause

– Stress management if psychological

Page 6: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Esophagitis

• Irritation of mucosa of esophagus

• Causes heartburn, regurgitation, and dysphagia

• May be acute or chronic

• Causes:

– Hiatal hernia, reduced lower esophageal sphincter pressure,

abdominal pressure, recurrent vomiting, alcohol use,

overweight, and smoking

Page 7: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Hiatal Hernia

• Part of stomach protrudes through diaphragm

into thoracic cavity

– Prevents food from moving normally along digestive tract

• Heartburn and food regurgitation into mouth

can occur

(continues)

Page 8: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Hiatal Hernia

• Medical nutrition therapy

– Small, frequent meals of well-balanced diet

– Avoid irritants to esophagus

– Avoid foods that relax lower esophageal sphincter

– Weight loss recommended if necessary

– Avoid lying down two to three hours after eating

Page 9: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Peptic Ulcers

• Erosion of mucous membrane

• May be gastric or duodenal

• Predisposing factors:

– Genetics, high secretion of hydrochloric acid, stress,

excessive use of aspirin or ibuprofen, smoking, or

Helicobacter pylori bacteria

• Symptoms:

– Gastric pain and sometimes hemorrhage

(continues)

Page 10: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Peptic Ulcers

• Treatment:

– Drugs to control acid secretion and kill bacteria

– Stress management

– Sufficient low-fat protein

– Avoidance of caffeine, alcohol, aspirin, and smoking

– Well-balanced diet of three meals per day

Page 11: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diverticulosis and Diverticulitis

• Diverticulosis

– Formation of little pockets in sides of large intestine where

food gets trapped

• Diverticulitis

– Inflammation in these pockets

• Cause:

– Insufficient dietary fiber

(continues)

Page 12: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diverticulosis and Diverticulitis

• Treatment:

– For diverticulosis, high-fiber diet

– For diverticulitis, antibiotics and progressive diet to allow

bowel to rest

Page 13: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Stop and Share

• Consider the following scenario:

– A client with severe diarrhea has been placed on a low-

residue diet. What kinds of foods would you recommend?

(continues)

Page 14: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Stop and Share

• Milk and buttermilk

– Limit to 2 cups per day

• Cottage cheese and some mild cheeses

• Butter and margarine

• Eggs

– Except fried

(continues)

Page 15: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Stop and Share

• Tender chicken, fish, sweetbreads, ground

beef, and ground lamb

• Soup broth

• Cooked, mild-flavored vegetables without

coarse fibers

• Refined breads and cereals, white crackers,

macaroni, spaghetti, and noodles

(continues)

Page 16: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Stop and Share

• Custard, sherbet, or vanilla ice cream

• Coffee, tea, cocoa, or carbonated beverages

• Salt, sugar, or small amount of spices as

permitted

Page 17: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Inflammatory Bowel Disease

• Chronic condition causing inflammation in

gastrointestinal tract

• Ulcerative colitis

– Inflammation and ulceration of colon, rectum, or entire

large intestine

• Crohn’s disease

– Chronic progressive disorder

– Can affect both small and large intestines

Page 18: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Symptoms of Inflammatory Bowel

Disease• Bloody diarrhea

• Cramps

• Fatigue

• Nausea

• Anorexia

• Malnutrition

• Weight loss

Page 19: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Treatment of Inflammatory Bowel

Disease• Anti-inflammatory drugs

• Medical nutrition therapy

– Low-residue diet

– When tolerated, 100 g of protein, additional calories,

vitamins, and minerals

– Severe cases may require total parenteral nutrition (TPN)

Page 20: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Ileostomy or Colostomy

• Stoma or surgical opening from body surface

to intestine for purpose of defecation

• Ileostomy

– From ileum to abdomen surface

• Colostomy

– From colon to abdomen surface

• May be temporary or permanent

(continues)

Page 21: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Ileostomy or Colostomy

• Clients with ileostomies have greater than

normal need for salt and water because of

excess losses

• Vitamin C supplement recommended

• In some cases, B12 supplement required

Page 22: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Celiac Disease

• Also known as nontropical sprue or gluten

sensitivity

• Malabsorption of virtually all nutrients

• Symptoms:

– Diarrhea, weight loss, malnutrition, and foul-smelling,

light-colored, bulky stools

(continues)

Page 23: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Celiac Disease

• Cause unknown

– Considered to be hereditary

• Treatment:

– Gluten-controlled diet

• Protein found in barley, oats, rye, and wheat

• May use rice and corn

• Must read food labels

Page 24: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Cirrhosis

• General term for liver disease characterized by

cell loss

• May be acute or chronic

• Most often caused by alcohol abuse

• Other causes:

– Congenital defects, infections, or other toxic chemicals

(continues)

Page 25: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Cirrhosis

• Liver does regenerate

– But replacement during cirrhosis does not match loss

• Complications:

– Hypertension, anemia, hemorrhage in esophagus, ascites,

and death

(continues)

Page 26: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Cirrhosis

• Dietary treatment:

– 25 to 35 calories or more per kg per day

– 0.8 to 1.0 g of protein per kg per day

– May not tolerate fats or proteins well

– May need to increase CHO

– May supplement with vitamins and minerals

– May need to restrict fibers if bleeding

– No alcohol allowed

Page 27: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Hepatitis

• Acute or chronic inflammation of liver

• Causes:

– Viruses

– Toxic agents

• E.g., drugs, alcohol

(continues)

Page 28: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Hepatitis

• Hepatitis A virus (HAV) contracted through

contaminated drinking water, food, and

sewage via fecal-oral route

(continues)

Page 29: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Hepatitis

• Hepatitis B virus (HBV) and hepatitis C virus

(HCV) transmitted through blood, blood

products, semen, and saliva

– Can lead to chronic active hepatitis (CAH)

• Diagnosed by liver biopsy

• Chronic active hepatitis can lead to liver

failure and end-stage liver disease (ESLD)

(continues)

Page 30: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Hepatitis

• Symptoms:

– Nausea, headache, fever, fatigue, tender and enlarged liver,

anorexia, and jaundice

• Weight loss can be pronounced

• Treatment:

– Bed rest, fluids, and medical nutrition therapy

Page 31: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Medical Nutrition Therapy for

Hepatitis• 35 to 40 calories per kg of body weight per day

• Provide most calories by carbohydrates

• Have moderate fat intake

• If necrosis not severe, up to 70 to 80 g of

protein needed for cell regeneration

(continues)

Page 32: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Medical Nutrition Therapy for

Hepatitis• If necrosis severe, limit proteins to prevent

accumulation of ammonia in blood

• Clients may prefer frequent, small meals

– Rather than three large meals

Page 33: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Cholecystitis and Cholelithiasis

• Cholecystitis

– Inflammation of gallbladder

• Cholelithiasis

– Gallstones

(continues)

Page 34: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Cholecystitis and Cholelithiasis

• Contributing factors:

– Being female, obesity, TPN, very low calorie diets for

rapid weight loss, estrogen use, and various diseases of

small intestine

• Both may inhibit flow of bile

• Symptoms:

– Pain, indigestion, and vomiting

(continues)

Page 35: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Cholecystitis and Cholelithiasis

• Treatment:

– Medication to dissolve stones

– Diet therapy

• Abstinence during acute phase followed by clear liquid diet and,

gradually, regular fat-restricted diet

– Surgery may be indicated

Page 36: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Pancreatitis

• Inflammation of pancreas

• Causes:

– Infections, surgery, alcoholism, biliary tract disease, or

certain drugs

• May be acute or chronic

• Symptoms:

– Abdominal pain, nausea, steatorrhea, and weight loss

(continues)

Page 37: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Pancreatitis

• Diabetes mellitus may be complication

• Diet therapy:

– During acute phase, strict parenteral nutrition

– Later, liquid diet of carbohydrates to minimize stimulatory

effect on pancreatic secretions

– As recovery progresses, small, frequent feedings of

carbohydrates and protein with little fat or fiber

(continues)

Page 38: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Pancreatitis

• May give vitamin supplements

• Alcohol forbidden in all cases

Page 39: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Residue-Controlled Diets

• Residue made up of all undigested and

unabsorbed parts of food, connective tissue in

animal foods, dead cells, and intestinal bacteria

and their products

– Most composed of fiber

• Diets can be adjusted to increase or decrease

fiber and residue

Page 40: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

High-Fiber Diet

• Often 30 g or more

• Helps prevent diverticulosis, constipation,

hemorrhoids, and colon cancer

• Sources:

– Coarse and whole-grain breads and cereals, bran, all fruits,

vegetables (especially raw), and legumes

Page 41: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Low-Residue Diet

• 5 to 10 g of fiber per day intended to reduce

normal work of intestines by reducing food

residue

• May be used in cases of severe diarrhea,

diverticulitis, ulcerative colitis, intestinal

blockage, and in preparation for and

immediately after intestinal surgery

Page 42: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Conclusion

• Wide variety of therapeutic diets used for

clients with gastrointestinal disturbances

– Peptic ulcers

• Medications, avoidance of alcohol, and caffeine

– Diverticulosis

• High-fiber diet

(continues)

Page 43: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Conclusion

• Wide variety of therapeutic diets used for

clients with gastrointestinal disturbances

– Diverticulitis

• Gradual progression from clear liquid to high-fiber diet

– Ulcerative colitis

• Low-residue diet combined with high protein and high calories

(continues)

Page 44: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Conclusion

• Wide variety of therapeutic diets used for

clients with gastrointestinal disturbances

– Cirrhosis

• Substantial, balanced diet, with occasional restrictions of fat,

protein, salt, or fluids

– Hepatitis

• Full, well-balanced diet

– Although protein may be restricted

(continues)

Page 45: Fundamentals of Nutrition · •Medical nutrition therapy –Small, frequent meals of well-balanced diet –Avoid irritants to esophagus –Avoid foods that relax lower esophageal

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Conclusion

• Wide variety of therapeutic diets used for

clients with gastrointestinal disturbances

– Cholecystitis and cholelithiasis

• Fat-restricted diet and, in cases of overweight, addition of calorie-

restricted diet

– Pancreatitis

• TPN to individualized diet as tolerated