1. G.I. Disorders Upper G.I.

2. Problems of the Mouth Difficulty chewing: Difficulty chewing: –AIDS –Parkinson’s Disease –Radiation Therapy –Missing (no) teeth – ill fitting dentures –Stroke

3. Problems of the Mouth Dysphagia - difficulty Swallowing Dysphagia - difficulty Swallowing As a result of: As a result of: –Aging process –Stroke –Developmental disease –Diseases of the nervous system Could lead to Aspiration Pneumonia Could lead to Aspiration Pneumonia

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5. Signs of Dysphagia Repeated bouts of pneumonia Repeated bouts of pneumonia Food “sticking” in the throat Food “sticking” in the throat Pocketing food Pocketing food Wet, gurgled or hoarse sounding voice Wet, gurgled or hoarse sounding voice Coughing/ choking during eating Coughing/ choking during eating

6. Problems of the Mouth Medical Nutrition Therapy Medical Nutrition Therapy –Adjust texture of food  Mechanical soft  pureed –Adjust consistency of liquids  Thin (normal)  Nectar consistency  Honey consistency  Spoon Thick (yogurt) consistency

7. Problems of the Mouth Mouth Ulcers Mouth Ulcers Medical Nutrition Therapy Medical Nutrition Therapy –Moist, soft textured foods –Practice good oral hygiene –Avoid salty foods and snacks –Avoid “dry” foods

8. Gastro-esophageal Reflux Disease GERD GERD Reflux Esophagitis Reflux Esophagitis –Occurs in the lower esophagus –The effect of acidic gastric reflux on the esophageal mucosa –Results from:  Hiatal hernia  Increased abdominal pressure due to obesity or pregnancy  Viral infection  Ingestion of an irritant, or recurrent vomiting

9. Medical Nutrition Therapy Small, frequent, low fat meals Small, frequent, low fat meals Do not lie down for 2 hours after eating Do not lie down for 2 hours after eating Do not eat within 2 – 3 hours before bedtime Do not eat within 2 – 3 hours before bedtime Avoid stimulants (caffeine, alcohol, citrus, peppermint) Avoid stimulants (caffeine, alcohol, citrus, peppermint) Weight loss diet (if indicated) Weight loss diet (if indicated) Wear loose, comfortable clothing Wear loose, comfortable clothing No smoking No smoking

10. Gastritis Inflammation of the gastric mucosa (stomach) Inflammation of the gastric mucosa (stomach) May be acute or chronic May be acute or chronic

11. Gastritis Acute Acute –Alcohol abuse –Aspirin or other medication –Food poisoning –Radiation therapy –Bacterial infection Chronic Chronic –Gastric surgery –Chronic stomach diseases –No known cause

12. Medical Nutrition Therapy Acute Acute –Treat the cause  Antibiotics for Helicobacter pylori –NPO for nausea/ vomiting then progress diet –Avoid stimulants Chronic Chronic –Avoid foods that irritate gastric mucosa –Vitamin B 12 for pernicious anemia –Antacids, anti-ulcers and antibiotics as needed

13. ULCERS Peptic Ulcers Peptic Ulcers –Erosion of the top layer of cells from the lining of the esophagus (<1%), stomach (15%) or small intestine(85%) –Underlying layers of cells are exposed to gastric juices –Gastric juices reach the nerves, causing pain causing pain

14. Peptic Ulcers Causes Causes –Bacterial infection (H Pylori) –Anti-inflammatory drugs (ibuprofen, naproxen) –Disorders that cause excessive gastric acid secretion

15. Medical Nutrition Therapy Antibiotic therapy and antacids Antibiotic therapy and antacids Avoid foods that may cause gastric irritation Avoid foods that may cause gastric irritation Correct anemia (B 12 ) if present Correct anemia (B 12 ) if present Avoid aspirin Avoid aspirin No smoking No smoking

16. Foods that may cause Gastric Irritation Alcohol Alcohol Caffeine Caffeine Peppermint Peppermint Cola beverages Cola beverages High energy drinks High energy drinks Coffee, tea, decaf Coffee, tea, decaf Pepper and spicy foods Pepper and spicy foods Any foods not tolerated. Any foods not tolerated.

17. Gastric Surgery Gastrectomy Gastrectomy –Removal of a portion or all of the stomach Side effects Side effects –Dumping Syndrome Dizziness and weakness (due to rapid fall in circulating blood volume) Dizziness and weakness (due to rapid fall in circulating blood volume) Rapid heart rate and sweating (due to hypoglycemia) Rapid heart rate and sweating (due to hypoglycemia) Diarrhea (hyper peristalsis due to large volume of hypertonic fluids) Diarrhea (hyper peristalsis due to large volume of hypertonic fluids)

18. Medical Nutrition Therapy Goal Goal –To provide energy (avoid weight loss) –Slow the passage of foods through the stomach –Minimize diarrhea –Avoid anemia  Iron deficiency – not converted to a usable form  Malabsorption lead to Folate and Vit B 12 anemia –Prevent bone disease  Vit D and Calcium malabsorption lead to Osteomalacia

19. Medical Nutrition Therapy High Protein High Protein Complex carbohydrates (50 – 60%) Complex carbohydrates (50 – 60%) –Simple sugars 0-15%) Moderate fat (30% of kcalories) Moderate fat (30% of kcalories) –Use medium chain triglycerides (MCT) Low (no) Lactose Low (no) Lactose Moderate sodium intake; Moderate sodium intake; Vitamin and mineral supplementation Vitamin and mineral supplementation Frequent small meals, fluids between meals Frequent small meals, fluids between meals

20. Client Education Stress importance of self-care Stress importance of self-care –Stress, eating away from home Discuss Artificial sweeteners Artificial sweeteners Eating slowly in an upright position Eating slowly in an upright position Social significance of food and alcohol Social significance of food and alcohol Dumping syndrome and how to overcome reluctance and fear of pain with eating Dumping syndrome and how to overcome reluctance and fear of pain with eating

21. Bariatric Surgery Goal is weight loss Goal is weight loss Complications Complications –Ruptured staples –Bowel obstruction –Infections, nausea, vomiting, dehydration –Dumping syndrome –Esophageal reflux –depression

22. Bariatric Surgery Medical Nutrition Therapy Medical Nutrition Therapy Clear liquids ~ 4 oz per hour (sugar free) Clear liquids ~ 4 oz per hour (sugar free) Progress to full liquids – low lactose Progress to full liquids – low lactose Pureed, high protein Pureed, high protein No Sugar, very low carbohydrates No Sugar, very low carbohydrates Common deficiencies Common deficiencies –Vitamins B 12, D –Iron