1. Upper Gastrointestinal Tract
KNH 411
Motility, secretions, digestion, absorption

3. Upper GI – A&P Stomach - Motility Filling, storage, mixing, emptying
50 mL empty – stretches to 1000 mL
Pyloric sphincter
Can be as small as 2 oz up to 6 oz
Key secretions: water, mucus, HCl , enzymes
© 2007 Thomson - Wadsworth

5. Monitor calories

6. Pathophysiology - Oral Cavity
Nutrition Therapy/Evaluation
Increase frequency of meals (6x/day)
Bland foods served at room temp.
Liberal use of fluids
Preference for cold and frozen foods
Oral hygiene
Monitor using food diary, observation, or kcal count
Monitor weight gain or maintenance
Fluids with the meal, easy movement into the system
M&E: monitor weight gain or maintenance

7. Pathophysiology - Esophagus
GERD - reflux of gastric contents into the esophagus
Incompetence of LES
Increased secretion of gastrin, estrogen, progesterone
Hiatal hernia
Cigarette smoking
Use of medications
Foods high in fat, chocolate, spearmint, peppermint, alcohol, caffeine

8. Pathophysiology - Esophagus
GERD - symptoms
Dysphagia
Heartburn
Increased salivation
Belching
Pain radiating to back, neck, or jaw
Aspiration
Ulceration
Barrett’s esophagus
Main concern is to avoid cancer
Want to avoid Barett’s esophagus

9. Pathophysiology - Esophagus
GERD - Treatment
Medical management
Modify lifestyle factors
Medications – 5 classes
Surgery
Fundoplication-wrapping fundus of stomach around around lower esophagus
Stretta procedure- looking at radio frequency that they would do in that area and cause it to increase function or strengthen muscle
Surgery is worst case scenario—to close or strengthen area—wrapping fundus of stomach around around esophagus

10. Lowers acidity but might cause concerns (drug-nutrient interaction)
**on syllabus

12. Pathophysiology - Esophagus
GERD - Nutrition Therapy
Identify foods that worsen symptoms
Assess food intake esp. those that reduce LES pressure, or increase gastric acidity
Assess smoking and physical activity
Small, frequent meals
Weight loss if warranted
Avoid: Caffeine, coffee, peppermints, tea, fried foods, alcohol, pepper, etc.
PA: losing weight could take that pressure off the area

13. Pathophysiology - Esophagus
Dysphagia – difficulty swallowing
Potential causes –
Drooling, coughing, choking
Weight loss, generalized malnutrition
Aspiration to aspiration pneumonia
Treatment requires health care team
Dysphagia diet—with team—barium swallow to see what
Types of diet: liquid, etc. (Thick it)
dg by bedside swallowing, videofluoroscopy, barium swallow
i.e. stroke patient
Food could end up in lungs or other areas
Idea is to get them enough fluids but ones they can tolerate

14. Pathophysiology - Esophagus
Dysphagia – Nutrition Therapy
Use acceptable textures to develop adequate menu
National Dysphagia Diet 1,2,3
Use of thickening agents and specialized products
Monitor weight, hydration, and nutritional parameters
3 levels
Puréed--Pudding like
Mechanically altered to moist & make soft (bread, etc.)
Dysphagia advanced: No hard foods

17. To recommend to the clients

18. Hiatal Hernia Contents being pushed up or pushed into a diff pocket
Sliding hernia
Rolling hernia (pocket where it can get caught)
© 2007 Thomson - Wadsworth

19. Pathophysiology - Stomach
Gastritis
Inflammation of the gastric mucosa
Primary cause: H. pylori bacteria
Alcohol, food poisoning, NSAIDs
Symptoms: belching, anorexia, abdominal pain, vomiting
Type A - automimmune
Type B – H. pylori
Increases with age, achlorhydria
Treat with antibiotics and medications
Number 1 line of defense: antibiotics
Tell them what can interfere: alc, food poisoning, aspritin
Type B driven by the bacteria
Happens are we age

20. Pathophysiology - Stomach
Peptic ulcer disease (PUD) - ulcerations of the gastric mucosa that penetrate submucosa
Gastric or duodenal
H. pylori
NSAIDS, alcohol, smoking
Certain foods, genetic link
Increased risk of gastric cancer
Can be related to smoking, alc, aspirin
Genetic component
Mainly look at lifestyle changes

21. 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 meal
Do not lie down after meals
Small, frequent meals

22. Alteration/surgery
3 kinds to avoid ulcer area:
Gastric bypass I II
Area of most concern for nutrients lost: A
© 2007 Thomson - Wadsworth

23. Pathophysiology - Stomach
Gastric Surgery - Nutrition Implications
Reduced capacity
Changes in gastric emptying & transit time
Diarrhea—not about to digest & absorb
Components of digestion altered or lost
Decreased oral intake, maldigestion, malabsorption

24. 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 intestine

26. Pathophysiology - Stomach
Gastric Surgery - Dumping Syndrome
Early dumping – min.; diarrhea, dizziness, weakness, tachycardia
Intermediate min.; fermentation of bacteria produces gas, abdominal pain, etc.
Late dumping hrs.; hypoglycemia

27. Pathophysiology - Stomach
Gastric Surgery - Dumping Syndrome
Other nutritional concerns: vitamin and mineral deficiencies, lack of intrinsic factor, iron deficiency, osteoporosis
Most of the time use supplements
Lack of intrinsic factor: vitamin B12—injections

28. Pathophysiology - Stomach
Dumping Syndrome - Nutrition
“Anti-dumping” diet
Slightly higher in protein & fat (to meet kcal)
Avoid simple sugars & lactose
Calcium & vitamin D
Liquid between meals (with meals it is more volume & goes faster—reflux)
Small, frequent meals
Don’t lie down after meals right away
Assess for weight loss, malabsorption, and steatorrhea

29. © 2007 Thomson - Wadsworth