KNH 411 Upper GI AampP Stomach Motility Stomach can stretch up to a liter 2oz32oz Filling storage mixing emptying 50 mL empty stretches to 1000 mL Pyloric sphincter ID: 224255
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Upper Gastrointestinal Tract
KNH 411Slide2Slide3
Upper GI – A&P
Stomach
– Motility
Stomach can stretch up to a liter (2oz-32oz)
Filling, storage, mixing, emptying50 mL empty – stretches to 1000 mLPyloric sphincterStomach secretes water, Mucous, HCL
© 2007 Thomson - WadsworthSlide4Slide5Slide6
Pathophysiology - Oral Cavity
Nutrition Therapy/Evaluation
Increase frequency of meals
Bland foods served at room temp.
Liberal use of fluids (calorie dense fluids)Preference for cold and frozen foodsOral hygieneMonitor using food diary, observation, or kcal countMonitor weight gain or maintenanceSlide7
Pathophysiology - Esophagus
GERD - reflux of gastric contents into the esophagus
Incompetence of LES
Increased secretion of
gastrin, estrogen, progesterone(loosens sphincter)Hiatal herniaCigarette smokingUse of medications
Foods high in fat, chocolate, spearmint, peppermint, alcohol, caffeineSlide8
Pathophysiology - Esophagus
GERD - symptoms
Dysphagia
- difficulty swallowing
HeartburnIncreased salivationBelchingPain radiating to back, neck, or jawAspirationUlceration
Barrett’s esophagus-change in epithelial cells, can result in cancerSlide9
Pathophysiology - Esophagus
GERD - Treatment
Medical
management
Antacids, histamine blockers, mucosal protectantsModify lifestyle factorsMedications – 5 classes SurgeryFundoplication- wrap stomach under esophagusStretta procedure- transmit radio frequency to lower part of stomachSlide10Slide11Slide12
Pathophysiology - Esophagus
GERD - Nutrition Therapy
Identify foods that worsen
symptoms
Avoid fat and caffeine Assess food intake esp. those that reduce LES pressure, or increase gastric acidityAlcohol, pepper, and coffee produces more gastric acidsAssess smoking and physical activitySmall, frequent mealsWeight loss if warranted- fat adds pressure
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Pathophysiology - Esophagus
Dysphagia
– difficulty swallowing
Potential causes
– GERDDrooling, coughing, chokingWeight loss, generalized malnutrition Often stop eating because of difficulties Aspiration(inhalation of food-constant, ongoing) to aspiration pneumoniaTreatment requires health care team
dg by bedside swallowing, videofluoroscopy, barium swallowSlide14
Pathophysiology - Esophagus
Dysphagia
– Nutrition Therapy
Use acceptable textures to develop adequate menu
National Dysphagia Diet 1,2,3 1- pudding-like diet (pureed)2- mechanically altered- soft, liquid, moist3- advanced- no hard foodUse of thickening agents and specialized productsMonitor weight, hydration, and nutritional parametersSlide15Slide16Slide17Slide18
© 2007 Thomson - Wadsworth
Hiatal HerniaSlide19
Pathophysiology - Stomach
Gastritis (in upper stomach)
Inflammation of the gastric mucosa
Primary cause:
H. pylori bacteriaAlcohol, food poisoning, NSAIDsSymptoms: belching, anorexia, abdominal pain, vomitingType A - automimmuneType B – H. pylori
Increases with age, achlorhydria
Treat with antibiotics and medicationsSlide20
Pathophysiology - Stomach
Peptic ulcer
disease (“PUD”)
- ulcerations of the gastric mucosa that penetrate
submucosaGastric or duodenalH. pyloriNSAIDS, alcohol, smokingCertain foods, genetic linkIncreased risk of gastric cancer1 in 4 Americans developSlide21
Pathophysiology - Stomach
Peptic Ulcer Disease - Nutrition
Restrict only those foods known to increase acid secretion
Black and red pepper, caffeine, coffee, alcohol, individually non-tolerated foods
Consider timing and size of mealDo not lie down after meals (30-60 minutes after)Small, frequent mealsSlide22
© 2007 Thomson - WadsworthSlide23
Pathophysiology - Stomach
Gastric Surgery - Nutrition Implications
Reduced capacity
Changes in gastric emptying & transit time
Components of digestion altered or lostDecreased oral intake, maldigestion, malabsorptionSlide24
Pathophysiology - Stomach
Gastric Surgery - Dumping Syndrome
Increased osmolar load enters small intestine too quickly from stomach
Release of hormones, enzymes, other secretions altered
Food “dumps” into small intestineSlide25Slide26
Pathophysiology - Stomach
Gastric Surgery - Dumping Syndrome
Early dumping
– 10-20 min.; diarrhea, dizziness, weakness, tachycardia
Intermediate - 20-30 min.; fermentation of bacteria produces gas, abdominal pain, etc.Late dumping - 1-3 hrs.; hypoglycemiaSlide27
Pathophysiology - Stomach
Gastric Surgery - Dumping Syndrome
Other nutritional concerns: vitamin and mineral deficiencies, lack of intrinsic factor, iron deficiency, osteoporosisSlide28
Pathophysiology - Stomach
Dumping Syndrome - Nutrition
“Anti-dumping” diet
Slightly higher in protein & fat
Avoid simple sugars & lactoseCalcium & vitamin DLiquid between mealsSmall, frequent mealsLie down after mealsAssess for weight loss, malabsorption, and steatorrheaSlide29
© 2007 Thomson - WadsworthSlide30