NS 335 – Special Populations

Unit 2 Seminar:GI Tract, Liver, Gallbladder,

and Pancreas

The gastrointestinal (GI) tract extends from the

mouth to the anus.

All disturbances related to food intake, digestion,

absorption, and elimination affect the GI tract and

usually require special diets.

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

Psychological factors play a role when we consider disorders of the GI tract.

The digestive system is said to “Mirror the Human Condition”:◦ Stress factors such as anxiety, fear, work pressure, grief,

emotional makeup, and coping patterns have a great deal to do with how foods are tolerated.

Physiological factors can also be related with intolerances (such as an enzyme deficiency) which will eliminate foods that can be eaten

What type of

disorderam I?

How To PlayHow To Play

I will give you a word scrambled with a brief description of the disorder it is

“Buzz in” by typing a # into the chat box.

Wait until I call on you to type in your response.

The first person to correctly identify the type of assessment wins that question

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Has high nutritional needs

May have to be wired which causes problems eating

Diet requires high calorie, high protein, vitamins, and

minerals to promote healing

Liquid must pass through a straw without causing it to

move

Breakfast: Strained Juice, Hot Blended Drink, Coffee,Beverage of Choice

Lunch: Fruit Drink, Hot Blended Drink, Coffee, Beverageof Choice

Dinner: Fruit Eggnog, Hot Blended Drink, Beverage of Choice

Table 17-1 of Text

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Most is dietary in nature (high use of concentrated

sweets)

Lack of Calcium, Phosphorus, Fluorine, Vitamins A, D,

and C affect tooth and gum formation/development

Can occur with infants when milk, juice, or sweetened

drinks are left in a bottle against an infant’s gums

during sleep.

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A congenital defect of newborns

Can be corrected with a series of surgeries after the infant reaches a weight safe enough to withstand a surgical procedure

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Most common of the problems affecting the upper GI tract

Causative factors include:1) Increased acidity and secretion of gastric juices2) Decreased secretion of mucous linings and buffers3) Prolonged use of nonsteroidal anti-inflammatory drugs

(NSAIDs) such as aspirin, ibuprofen, and others.4) Helico pylori (H. pylori) infection.

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

Treatment goals: relieve pain, heal erosion, prevent

complications, prevent recurrences

Drug therapies are used

Diet Therapy:1) Follow regular diet with guidelines based on the

individual2) 3 meals daily without snacks, especially at bedtime3) Moderate meal size4) No need to eliminate a food unless it causes

discomfort5) Avoid alcohol, coffee, tea, colas

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This results when the stomach partially protrudes above the diaphragm because of the weakening of the diaphragm opening

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Usually treated with antacids and a low-fat diet

6 small meals a day are recommended and fluids are taken between meals

Foods that irritate esophageal mucosa are eliminated such as alcohol

Perforation and hemorrhage are two major

complications of ulcer disease for which surgery

are indicated.

Dumping syndrome is complication of gastric

surgery.◦ With part of the stomach removed, the food is not

digested properly and instead of being delivered slowly, it is “dumped” quickly into the small intestine

Foods prohibited: Breads with nuts, jams, or dried fruits made with bran, presweetened cereals, highly seasoned or smoked meats, if not tolerated-milk, alcohol, carbonated beverages; creamed or gas forming vegetables, fruits canned with sugar syrup, sweetened dried fruits, pickles, peppers, chili powder, nuts, olives, candy, milk gravy

QUESTIONS?

Involves many variables with its treatment

A regular, high fiber balanced diet and adequate

fluid intake is recommended

Can be serious if prolonged

Treatment involves eliminating the underlying

cause, using antidiarrheal drugs as needed and

appropriate diet therapy.

May need TPN if have prolonged diarrhea and

need bowel rest.

Diverticulosis: pockets of intestinal mucosa; high fiber recommended

vs.

Diverticulitis: inflammation of pockets; low fiber/low residue until resolved

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

Inflammatory Bowel Disease: a term used for Ulcerative Colitis and Crohn’s

disease

Characterized by widespread ulceration and inflammation of the colon and rectum, chronic bloody diarrhea, edema, and anemia.

Diet therapy includes: Regular, high fiber diet as tolerated High Protein diet: 120-150 grams daily High Calorie: 3000 calories daily High vitamins/minerals Moderate fat as tolerated Dairy products usually eliminated to avoid secondary lactose

intolerance or lactose free products used IV fluids in addition to oral feedings TPN is most effective if the bowel has been shortened or the

disease is extensive.

Can occur anywhere in GI tract.

It has onset characterized by tenderness, pain, diarrhea, and cramping in the right lower quadrants of the bowel. There is less blood in the stool than in ulcerative colitis, but more mucous secretions by the bowel.

Widespread problems of malabsorption of fat, protein, carbohydrates, vitamins, minerals, and subsequent weight loss.

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Diet Therapy for Diseases of the Liver, Gallbladder, & Pancreas

Diet Therapy: Protein: 1.2-1.5 gm/kg BW per day No CHO restriction, but may need to monitor Glu

levels resulting from liver dysfunction Fat: 30% of calories Energy: 25-35 kcals/kg BW Multivitamin used Fluids and Sodium Restriction if edema or ascites

present. If adequate nutrition cannot be maintained by oral

feedings, TF or TPN are appropriate.

Cirrhosis is the final stage of certain liver injuries including alcoholism, untreated hepatitis, biliary obstruction, Vitamin A overdose, and drug and poison ingestion.

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

Protein: If hepatic coma is not indicated, protein remains at 75-100g daily. If the patient shows signs of impending coma, protein intake should be reduced to lessen the chance of coma.

Sodium: Edema or ascites is counteracted by a 500-1000 mg sodium diet daily. Fluid restriction may be limited.

Texture: Esophageal varices, if present, are managed by semisolid or liquid diets to avoid potential rupture and hemorrhage. TF not recommended. Coffee, tea, pepper, chili powder, and other irritating seasonings should be avoided.

Protein: intake limited to 0 to 50g protein daily, depending on blood ammonia level.

Calories: 1500-2000 calories daily mainly from carbohydrate and fat

Vitamins: Given IVFluid: Output is balanced by equal intake

TPN or enteral nutrition are standard forms of diet therapy if unable to meet nutrition needs by eating

Terms to Know:Cholecystitis

Cholelithiasis

Dietary fat is reduced to diminish gallbladder

contraction, which is responsible for pain and

associated symptoms. Reduced to 40-50g/day.

Protein comprises 10-12% of total daily calories.

Calories reduced if weight loss indicated.

These modifications are generally used before

surgery/cholecystectomy.

1) Initial measures are lifesaving-IV and TPN feedings, replacement of fluid and electrolytes, blood transfusions, and drugs for pain and inhibiting gastric secretions. Nothing given by mouth.

2) As healing progresses, the first oral diet usually consists of clear liquid with amino acids, predigested fats, and other commercial preparations added gradually. The patient progresses to a bland diet, given in 6 small meals. No stimulants: coffee, caffeine, tea, colas, alcohol are allowed.

Focus should be on preventing malnutrition and treating malabsorption.

Diet therapy for chronic pancreatitis usually consists of a bland diet of soft or regular consistency in small meals at frequent intervals (6 feedings) and contains no stimulant foods. Pancreatic enzymes are given usually with food. Alcohol is strictly forbidden.

1) Low fat diet2) Vitamin and Mineral supplementation may be

necessary3) Tube feedings or TPN may be necessary

QUESTIONS?

Take Quiz #1 by Tuesday at midnight ET

Quiz is worth 40 points