1. Upper Gastrointestinal Tract KNH 411

3. Upper GI – A&P Stomach - Motility Filling, storage, mixing, emptying 50 mL empty – stretches to 1000 mL Pyloric sphincter © 2007 Thomson - Wadsworth

6. Pathophysiology - Oral Cavity Nutrition Therapy/Evaluation Increase frequency of meals (get tired of chewing quickly) 6 small feedings, high protein, high calorie diet Bland foods served at room temp. Liberal use of fluids Fluids tend to fill up your system Would want it to be high protein, high calorie (milk powder) Preference for cold and frozen foods Takes away the smell, taste fatigue ameliorated Oral hygiene Monitor using food diary, observation, or kcal count Monitor weight gain or maintenance

7. Pathophysiology - Esophagus GERD - reflux of gastric contents into the esophagus Incompetence of LES Occurs because: Increased secretion of gastrin, estrogen, progesterone Hiatal hernia (causing a pushing up of contents/HCl into esphagus Cigarette smoking Use of medications Foods high in fat (fried foods), chocolate, spearmint, peppermint, *alcohol, caffeine

8. Pathophysiology - Esophagus GERD – symptoms/signs Dysphagia (difficulty swallowing) Heartburn Increased salivation Belching Pain radiating to back, neck, or jaw Aspiration (contents being pushed into into esophagus Ulceration Barrett’s esophagus (change in lining of mucous of esph=abnormal change in pH resulting in squamous cell carinoma)

9. Pathophysiology - Esophagus GERD - Treatment Medical management (antacids, antihistamines, mucosal protectants—so acidity wont erode lining) Modify lifestyle factors (diet, smoking) Medications – 5 classes Surgery (most severe treatment) Fundoplication (wrapping of the fundus of stomach around the lower esophagus which tightens area and acts as the LES) Stretta procedure (radiofrequency E is delivered to the LES to increase the function because it’s strengthening the LES area)

12. Pathophysiology - Esophagus GERD - Nutrition Therapy Identify foods that worsen symptoms (ex: *coffee, tea, cocoa, fatty fried foods, peppermint, high fat desserts, *pepper, whole milk, *alcohol) Assess food intake esp. those that reduce LES pressure, or increase gastric acidity Assess smoking and physical activity Small, frequent meals (lessen pressure in that area so less chance of reflux) Weight loss if warranted

13. Pathophysiology - Esophagus Dysphagia – difficulty swallowing (concern with GERD) Potential causes – GERD, stroke Drooling, coughing, choking Weight loss (tell tale sign), generalized malnutrition Aspiration to aspiration pneumonia (inhalation into the oral pharynx can result in pneumonia) Treatment requires health care team dg by bedside swallowing, videofluoroscopy, barium swallow

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 (multivitamins)

18. © 2007 Thomson - Wadsworth Hiatal Hernia

19. Pathophysiology - Stomach Gastritis Inflammation of the gastric mucosa (PU) Treatment: antibiotics Primary cause: H. pylori bacteria Alcohol, food poisoning, NSAIDs Symptoms: belching, anorexia, abdominal pain, vomiting Type A – automimmune (involved with fundus—upper stomach) Type B – H. pylori (to tolerate some foods: liquid diet, milk powder) Increases with age, achlorhydria—lack of HCl Treat with antibiotics and medications

20. Pathophysiology - Stomach Peptic ulcer disease - ulcerations of the gastric mucosa that penetrate submucosa (1 of 10 Americans) Gastric or duodenal H. pylori NSAIDS, alcohol, smoking Certain foods, genetic link Increased risk of gastric cancer (once tissue is perforated)

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 (30 minutes- 1 hr) Small, frequent meals Concerns with vitamins/minerals

22. © 2007 Thomson - Wadsworth

23. Pathophysiology - Stomach Gastric Surgery - Nutrition Implications Endpoint: Reduced capacity Changes in gastric emptying & transit time (want to avoid dumping syndrome) Components of digestion altered or lost Decreased oral intake, maldigestion, malabsorption—what we usually chart about

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 – 10-20 min.; diarrhea, dizziness, weakness, tachycardia Intermediate - 20-30 min.; fermentation of bacteria produces gas, abdominal pain, etc. Late dumping - 1-3 hrs.; hypoglycemia

27. Pathophysiology - Stomach Gastric Surgery - Dumping Syndrome Other nutritional concerns: vitamin and mineral deficiencies, lack of intrinsic factor, iron deficiency, osteoporosis All long-term concerns

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

29. © 2007 Thomson - Wadsworth