Ulcer
Tx: Antacids, antibiotics to eradicate H. Pylori
Drug Therapy: Cimetidine, Rantidine- H2 blocker; prevents binding of histamine to receptor, decreases acid secretion
Diet: As tolerated, well balanced, avoid late night snacks
Omit: Cayenne and black pepper, large amounts of chili powder, avoid excess caffeine and alcohol
Hiatal Hernia
Diet: small bland feeding; avoid late night snacks, caffeine, chili powder, black pepper
Dumping Syndrome
Symptoms: cramps, rapid pulse, weakness, perspiration, dizziness
CHO --> jejunum --> Increase in H20 --> decrease in BP
-2hrs later-
CHO abs rapidly --> BG increases --> insulin increases--> BG decreases
(reactive hypoglycemia)
Follows gastrectomy
Billroth I&II (gastroduodenunostomy) &(gastrojejunostomy)
The secretion of secretin and pancreozymin by the duodenum is reduced. These hormones stimulate the pancreas, so there is little pancreatic secretion. Ca (most rapid absorption is in the duodenum) and iron (requires acid) are adversely affected
Anemia: B12-lack of intrinsic factor and bacterial overgrowth in loop of intestine being bypassed interfere with B12 absorption (pernicious anemia is diagnosed with a Schilling test)
Folate deficiency-needs B12 for transport inside the cell; also from poor intake and low serum iron (cofactor in folate metabolism)
Diet: Frequent small, dry feedings, fluids before and after meals. Restrict simple sugars. Give 50-60% complex CHO, PRO at each meal, moderate fat, B12 injections may be needed
Lactose may be poorly tolerated due to rapid transport
Gastroparesis
Tx: prokinetics (erythromycin, metroclopramide) increase stomach contractility
Diet: small frequent meals, pureed foods, avoid high fiber, avoid high fat (liquid fat may be better tolerated)
Bezoar formation may be due to undigested food or medications; treatment includes enzyme or endoscopic therapy
Bezoar
A solid mass of indigestible material that accumulates in your digestive tract, sometimes causing a blockage
Tropical Sprue (bacterial, viral, parasitic infection)
Chronic GI disease, intestinal lesions, may also affect stomach
Symptoms: diarrhea, malnutrition, deficiencies of B12 and folate d/t decreased HCL and intrinsic factor
Tx: antibiotics, high calories, high protein, IM B12 and oral folate supplements
Non-tropical sprue, celiac disease, gluten-induced enteropathy
Malabsorption (leads to loss of fat soluble vitamins), macrocytic anemia, wt loss, diarrhea, steatorrhea, iron deficiency anemia
Diet: need gluten free diet; No wheat, rye, barley, oats
No bran, graham, malt, bulgur, couscous, durum, orzo, thickening agents
Constipation
Sometimes due to an atonic colon (weakened muscles)
Diet: high fluid, high fiber, exercise
Diverticular disease
Diverticulosis:
Diet- high fiber (increases volume and wt of residue and provides rapid transit)
Diverticulitis:
Diet- clear liquids, low residue or elemental, gradual return to high fiber
Dietary fiber
Nondigestible CHOs and lignin, binds water, increases fecal bulk; found in legumes, wheat bran, fruits, vegetables, whole grains
Soluble fiber
Fiber that dissolves in water or is broken down by bacteria in the large intestine
Soft and stick and absorbs water to form a gel like substance in the digestive system.
Includes beans, peas, oats, barley, fruits, vegetables, and avocadoes
Insoluble fiber
Form of dietary fiber that binds water but does not dissolve; it adds bulk to the diet and improves elimination.
Roughage
Includes whole grains, nuts, fruits, and vegetables (specifically in the stalk, skin, and seeds)
A high fiber diet may increase the need for Ca, _________, P, _______, Se, __________, Fe
Mg, Cu, Zn
Gastritis
Diet: clear liquids, advance as tolerated, avoid gastric irritants
Inflammatory bowel disease
The general name for diseases that cause inflammation in the intestines and is the umbrella term for Crohn's and UC
Diet: Maintain fluid and electrolyte balance; antidiarrheal agent (sulfasalazine).
Acute Crohn's flare ups- bowel rest, PN or minimal residue
Acute UC- elemental diet may be needed to minimize fecal volume
Energy needs according to current BMI, limit fat if steatorrhea; water and fat soluble vitamins, iron, folate; assess Ca, Mg, Zn, MCT oil, watch lactose, frequent feedings; high fat may improve energy balance
When IBD is in remission or under control, high fiber to stimulate peristalsis
Crohn's Disease
Symptoms: Wt loss, anorexia, diarrhea
B12 def leads to megablastic anemia
Iron def anemia d/t blood loss, decreased absorption
Ulcerative Colitis
Symptoms: chronic bloody diarrhea, wt loss, anorexia, electrolyte disturbance, dehydration, anemia, fever, negative nitrogen balance
Crohn's affects?
The whole GI tract from mouth to anus
Ulcerative colitis affects?
Only involves the colon
IBS
Symptoms: chronic abdominal discomfort, altered intestinal motility, bloating
Diet: adequate nutrient intake, tailor pattern to specific GI issues; avoid large meals;, excess caffeine, alcohol, sugars
Use food diary to track intake, emotions, environment, symptoms
Identify food allergies and hypersensitivities
Work with client to alleviate stress during eating
Lactose intolerance
Symptom: bloating and gas and diarrhea that exhibit when a person produces very little lactase and can only digest very small amounts of lactose at a time.
Detected by breath hydrogen test or lactose tolerance test
Diet: lactose free diet; no animal milk, no whey
calcium and riboflavin supplements recommended
Yogurt and small amounts of aged cheese may be tolerated
Diarrhea
Children: Acute- replace fluids and electrolytes
Chronic-consider ratio of fat to CHO calories
Diet: Give 40% calories as fat, balanced with limited fluids; restrict or dilute fruit juices with high osmolar loads; no more than 4 oz of juice per day
Adults: remove cause; bowel rest; replace lost fluids and electrlytes
When diarrhea stops, begin with low fiber foods, followed by protein foods, fat does not need to be limited
Avoid lactose at first; look for foods that contain prebiotics (pectin, fructose, oats, banana flakes)
Probiotics reestablish bacterial gut flora
Steatorrhea
Consequence of malabsorption
Normal stool fat 2-5g >7g indicative of malabsorption
Determine cause and treat
Diet: high protein, high complex CHO, fat as tolerated, vitamins (especially fat soluble), minerals, MCT (rapidly hydrolyzed in GI tract)
Short Bowel Syndrome
Malabsorption, malnutrition, fluid and electrolyte imbalances, wt loss
Severity reflects length and location of resection, age of patient, health of remaining tract; loss of ileum, loss of ileocecal valve, loss of colon are of particular concern
Most digestion takes place in the first 100 cm of intestine, what remains, small amounts of sugar, starches, fiber, and lipids
Jejunal resection- ileum can adapt and take over jejunal functions
Ileal resection
Distal- aboorption of B12, intrinsic factor, bile salts
Patients have higher than average needs for water to compensate for excessive losses in the stool. Drink at least 1 L more than ostomy output daily
If ileum cannot recycle bile salts-lipids are not emulsified; leads to malabsorption of fat soluble vitamins
Malabsorbed fats combine with Ca, Zn, Mg and lead to soaps
Colonic absorption of oxalate increases-renal oxalate stones
Increased fluid and electrolyte secretion; increased colonic motility
Short Bowel Diet
PN initially to restore nutrient status
Enteral- start early to stimulate growth, increase over time; continuous drip; may take weeks to transition to food
Jejunal- normal balance of CHO, PRO, fat, avoid lactose, oxalates, large amounts of concentrated sweets, vitamin, mineral supplements
Ileal- limit fat, use MCT (does not require bile salts, needs less intestinal surface area)
Supplement fat soluble vitamins, Ca, Mg, Zn, parenteral B12, followed by monthly injections