Chapter 20 Diet and Gastrointestinal Problems
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
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
Dyspepsia Also known as indigestion Discomfort in digestive tract of physical or psychological origin Symptoms: Heartburn, bloating, pain and regurgitation (continues)
Dyspepsia Treatment: Treat underlying organic cause Stress management if psychological
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
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)
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
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)
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
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)
Diverticulosis and Diverticulitis Treatment: For diverticulosis, high-fiber diet For diverticulitis, antibiotics and progressive diet to allow bowel to rest
Stop and Share Consider the following scenario: A client with severe diarrhea has been placed on a lowresidue diet. What kinds of foods would you recommend? (continues)
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)
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)
Stop and Share Custard, sherbet, or vanilla ice cream Coffee, tea, cocoa, or carbonated beverages Salt, sugar, or small amount of spices as permitted
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
Symptoms of Inflammatory Bowel Bloody diarrhea Cramps Fatigue Nausea Anorexia Malnutrition Weight loss Disease
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)
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)
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, B 12 supplement required
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)
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
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)
Cirrhosis Liver does regenerate But replacement during cirrhosis does not match loss Complications: Hypertension, anemia, hemorrhage in esophagus, ascites, and death (continues)
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
Hepatitis Acute or chronic inflammation of liver Causes: Viruses Toxic agents E.g., drugs, alcohol (continues)
Hepatitis Hepatitis A virus (HAV) contracted through contaminated drinking water, food, and sewage via fecal-oral route (continues)
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)
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
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)
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
Cholecystitis and Cholelithiasis Cholecystitis Inflammation of gallbladder Cholelithiasis Gallstones (continues)
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)
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
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)
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)
Pancreatitis May give vitamin supplements Alcohol forbidden in all cases
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
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
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
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)
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)
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)
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 calorierestricted diet Pancreatitis TPN to individualized diet as tolerated