UPPER GI DISEASES 11/15/2014. Lesson Objectives. GI Tract Review. NUTR 2050 Nutrition for Nursing Professionals. Mrs. Deborah A. Hutcheon, MS, RD, LD

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UPPER GI DISEASES NUTR 2050 Nutrition for Nursing Professionals Mrs. Deborah A. Hutcheon, MS, RD, LD Lesson Objectives At the end of the lesson, the student will be able to: 1.

1 UPPER GI DISEASES NUTR 2050 Nutrition for Nursing Professionals Mrs. Deborah A. Hutcheon, MS, RD, LD Lesson Objectives At the end of the lesson, the student will be able to: 1. Describe causes and contributing risk factors for the development of GERD and PUD. 2. Describe dietary modification strategies to prevent and control GERD and PUD. 3. Identify potential drug-nutrient interactions with medications used to manage GERD and PUD. 4. Describe dietary modification strategies to manage liver disease, gallbladder disease, and pancreatitis. GI Tract Review Upper GI Tract: Lower GI Tract: Accessory Organs: 1

Gastric Esophageal Reflux Disease (GERD) Causes of

2 Gastric Esophageal Reflux Disease (GERD) Causes of GERD 1. Weakening/Relaxation of LES Muscle 2. Reduced LES Pressure: smoking, diet, smooth muscle relaxants, NSAID use, oral contraceptives, pregnancy, auto-immune disorders 3. Increased Abdominal Pressure 4. Delayed Gastric Emptying 5. Hiatal Hernia 2

3 Medications Medical Intervention GERD Proton-pump inhibitors (decrease acid secretion) most effective: omeprazole (Prilosec), Prevacid, Protonix, Aciphex, and Nexium H2 antagonists (decrease acid secretion): cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75) Antacids (neutralize acid): Alka-Seltzer, Maalox, Mylanta, Rolaids, Tums (Side Effects: constipation, diarrhea) Limit and avoid NSAIDs use MNT Intervention Strategies for GERD Avoid consuming large, high fat meals Avoid carminitives, caffeine, chocolate Avoid garlic and onions Avoid acidic and spicy foods (irritants to inflammation) Avoid alcohol use and smoking MNT Intervention Strategies for GERD Avoid eating several hours (3 to 4 hrs) before bed Stay upright & avoid vigorous activity after eating Increase protein intake raise LES pressure Consume beverages between meals Lose weight if overweight Avoid wearing tightly fitting clothing Reduce stress 3

Gastritis & Peptic Ulcer Disease Definition: inflammation of the stomach mucosa, may result in ulceration of mucosa Symptoms: nausea, vomiting, malaise, anorexia, hemorrhage, epigastric pain, melena

4 Gastritis & Peptic Ulcer Disease Definition: inflammation of the stomach mucosa, may result in ulceration of mucosa Symptoms: nausea, vomiting, malaise, anorexia, hemorrhage, epigastric pain, melena (black, tarry stools hemorrhage) Chronic gastritis may result in achlorhydria. Decreased intrinsic factor & vitamin B12 absorption. Decreased Ca and Iron absorption (pernicious anemia). Causes of Gastritis & PUD Infection: bacterial**, fungal, parasitic, viral Chronic use: alcohol, aspirin/nsaids** Smoking Autoimmune, systemic illness Emotional/Physical Stress Food insensitivity Genetics Causes of Gastritis & PUD Most Common Cause: Helicobacter pylori infection within mucosa of stomach. Gram-negative bacterium with flagella. Resistant to acidic medium of stomach. Produce urease ammonia generating byproduct of H. pylori used to create alkaline environment for survival. Standard medical treatment: 2 antibiotics & proton pump inhibitor (termed tri-therapy) 4

5 Peptic Ulcer Disease (PUD) 1. Gastric Ulcers: anywhere in stomach but normally along lesser curvature of stomach Low acid secretion 2. Duodenal Ulcer: in duodenum Increased acid secretion & nocturnal acid secretion, decreased carbonate secretion 3. Stress Ulcers: result from stress placed upon body system from severe burns, trauma, stress, shock, failure, radiation therapy MNT for Peptic Ulcer Disease Same Intervention Strategies as for GERD Milk & cream do not buffer gastric secretion but stimulate secretion of gastrin, acid, and pepsin. Food ph of very little importance as most are still higher than stomach secretions. Alcohol can promote mucosal damage & interfere with treatment. Coffee & caffeine stimulate acid secretion & decrease LES pressure. Chili, cayenne, & black peppers can promote increased acid production, erosions, & inflammation but may be protective. Drug-Nutrient Considerations Interaction with Dietary Substances Antacids Antibiotics Antisecretory Agents Coating Agents May absorption: Fe, folate, Vit B12 Tetracycline: absorption Fe & binds Ca in GI tract May absorption: Fe, folate, Vit B12 Hypophosphatemia & Ca retention 5

LIVER, GALLBLADDER, & PANCREAS Liver Function 1.

Metabolism of Steroids & Drugs 6. Detoxification of Chemicals & Toxins 7.

6 LIVER, GALLBLADDER, & PANCREAS Liver Function 1. Production & Excretion of Bile 2. Metabolism of CHO, Protein, Fat, Alcohol 3. Storage & Activation of Vitamin/Minerals 4. Conversion of Ammonia to Urea 5. Metabolism of Steroids & Drugs 6. Detoxification of Chemicals & Toxins 7. Filter & Flood Chamber for Blood 8. Blood Pressure Regulation Non-Alcoholic Fatty Liver Disease (NAFLD) Steatosis NASH NASH + Fibrosis Cirrhosis Carcinoma or Liver Failure 6

Non-Alcoholic Fatty Liver Disease (NAFLD) Treatment of NAFLD 1. Weight Loss: most effective intervention Via diet modification with or without exercise. 1. Seek gradual weight loss of <2lbs per week.

7 Non-Alcoholic Fatty Liver Disease (NAFLD) Treatment of NAFLD 1. Weight Loss: most effective intervention Via diet modification with or without exercise. 1. Seek gradual weight loss of <2lbs per week. 2. Follow hypocaloric diets (1200 to 1500 kcal/day). Lose 3% to 10% of initial body weight over the course of one year. Loss of 3% to 5%: improves steatosis. Loss of 7% to 10%: reduces inflammation. Treatment of NAFLD McCarthy EM et al. J Acad Nutr Diet. 2012;112:401. 7

Liver Disease Manifestations Liver Disease Complication Interventions Low Sodium Diet with Fluid Restriction Soft, Bland, Low Residue, Low Acid Foods Small, Frequent Meals Adequate Protein as part of

8 Liver Disease Manifestations Liver Disease Complication Interventions Low Sodium Diet with Fluid Restriction Soft, Bland, Low Residue, Low Acid Foods Small, Frequent Meals Adequate Protein as part of Mixed Diet BCAA vegetable & casein AAAs meat Cholelithiasis, or Gallstones Cholecystectomy: surgical removal of gallbladder Risk Factors: female, pregnancy, older age, family hx, obesity, DM, IBD, medications, rapid wt loss (fasting), long-term high dietary fat intake MNT: low-fat diet to prevent GB contractions 8

9 Pancreas Gland with endocrine & exocrine functions Endocrine: glucagon, insulin, somatostatin Exocrine: enzymes for nutrient digestion Pancreatic Secretion Stimulation 1. Cephalic Phase (vagus nerve): initiated by sight, smell, taste, anticipation of food 2. Gastric Phase: gastric distention with food 3. Intestinal Phase (CCK): most potent effect on pancreatic secretions Pancreatitis MNT for Acute MNT for Chronic NPO with hydration via IV Low-Fat Diet 6 Small Meals Clear Liquid Diet Consider Use of MCT Oil Progress to Low-Fat Diet May need 6 small meals Consider Use of MCT Oil EN into Jejunum TPN with Limiting Fat 9

KK College of Nursing Peptic Ulcer Badil D ass Dass, Lecturer 25th July, 2011

KK College of Nursing Peptic Ulcer Badil Dass, Lecturer 25 th July, 2011 Objectives: By the end of this lecture, the students t will be able to: Define peptic pp ulcer Describe the etiology and pathology