0. Upper Gastrointestinal Tract
KNH 411

1. Motility
Secretions
absorption *

2. Upper GI – A&P Stomach - Motility Filling, storage, mixing, emptying
50 mL empty – stretches to 1000 mL
Pyloric sphincter
2 oz. – 6 oz.
Every 30 cc’s is one ounce
HCL and enzymes help digest
© 2007 Thomson - Wadsworth *

4. Texture, calories being eaten, especially meats and proteins*

5. Pathophysiology - Oral Cavity
Nutrition Therapy/Evaluation
Increase frequency of meals
6 small feeding per day
Bland foods served at room temp.
Sphincter may not function properly or hot foods, passageway altered
Liberal use of fluids
Help the food move from mouth to stomach easily
Preference for cold and frozen foods
Oral hygiene
Monitor using food diary, observation, or kcal count
Monitor weight gain or maintenance *

6. 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
Consult on avoiding high fat foods, caffeinated beverages, etc.

7. Pathophysiology - Esophagus
GERD - symptoms
Dysphagia
Heartburn
Increased salivation
Belching
Pain radiating to back, neck, or jaw
Aspiration
Ulceration
Barrett’s esophagus

8. Pathophysiology - Esophagus
GERD - Treatment
Medical management
Modify lifestyle factors
Medications – 5 classes
Surgery
Fundoplication: wrapping the fundus of the stomach around the lower esophagus
Stretta procedure: radio frequency energy that is delivered to the lower esophageal sphincter and cause it to increase/strengthen the muscle

9. Medications for administration to help GERD

11. Pathophysiology - Esophagus
GERD - Nutrition Therapy
Identify foods that worsen symptoms
Caffeinated, chocolate, tea, high fats, fried foods, whole milk, pepper, whole milk
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
Losing weight can take the pressure off the LES and allow it to open up

12. Pathophysiology - Esophagus
Dysphagia – difficulty swallowing
Potential causes –
Drooling, coughing, choking
Weight loss, generalized malnutrition
Aspiration to aspiration pneumonia
Common in elderly
Post stroke
Treatment requires health care team
Dysphagia diet
dg by bedside swallowing, videofluoroscopy, barium swallow
Possible outcomes: malnourishment
Acceptable diet for them to ingest reasonably

13. Pathophysiology - Esophagus
Dysphagia – Nutrition Therapy
Use acceptable textures to develop adequate menu
National Dysphagia Diet 1,2,3
Level one: pureed pudding like, full liquid
Level two: mechanical altered, make soft foods, breads, rice, soupy consistency
Level 3: no hard foods, no fruit, veg., nuts & seeds
Use of thickening agents and specialized products
Thick it
Monitor weight, hydration, and nutritional parameters

17. Hiatal Hernia
© 2007 Thomson - Wadsworth

18. 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
Peptic ulcer is caused by bacteria, not stress!

19. Pathophysiology - Stomach
Peptic ulcer disease - 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
Related to smoking, alcohol, aspirin, genetic component

20. 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
Multiple small meals rather than one or two large meals
Do not lie down after meals
Small, frequent meals

21. © 2007 Thomson - Wadsworth

22. Pathophysiology - Stomach
Gastric Surgery - Nutrition Implications
Reduced capacity
Changes in gastric emptying & transit time
Components of digestion altered or lost
Decreased oral intake, maldigestion, malabsorption

23. 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

25. 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

26. Pathophysiology - Stomach
Gastric Surgery - Dumping Syndrome
Other nutritional concerns: vitamin and mineral deficiencies, lack of intrinsic factor, iron deficiency, osteoporosis
Lack of intrinsic factor: effects vitamin B12 absorption → alternate plan is a B12 shot

27. Pathophysiology - Stomach
Dumping Syndrome - Nutrition
“Anti-dumping” diet
Slightly higher in protein & fat
Avoid simple sugars & lactose
Calcium & vitamin D
Liquid between meals
Small, frequent meals
Lie down after meals
Assess for weight loss, malabsorption, and steatorrhea

28. © 2007 Thomson - Wadsworth