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Upper Gastrointestinal Tract
KNH 411
Upper GI – A&PStomach – 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 - Wadsworth
Pathophysiology - Oral CavityNutrition Therapy/Evaluation
Increase frequency of mealsBland 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 maintenance
Pathophysiology - Esophagus
GERD - reflux of gastric contents into the esophagus Incompetence of LES
Increased secretion of gastrin, estrogen, progesterone(loosens sphincter)
Hiatal hernia Cigarette smoking Use of medications Foods high in fat, chocolate, spearmint, peppermint,
alcohol, caffeine
Pathophysiology - Esophagus
GERD - symptomsDysphagia- difficulty swallowingHeartburn Increased salivationBelchingPain radiating to back, neck, or jawAspirationUlcerationBarrett’s esophagus-change in epithelial cells, can
result in cancer
Pathophysiology - Esophagus
GERD - TreatmentMedical management
Antacids, histamine blockers, mucosal protectants
Modify lifestyle factorsMedications – 5 classes Surgery
Fundoplication- wrap stomach under esophagus Stretta procedure- transmit radio frequency to lower
part of stomach
Pathophysiology - EsophagusGERD - Nutrition Therapy
Identify foods that worsen symptoms Avoid fat and caffeine
Assess food intake esp. those that reduce LES pressure, or increase gastric acidity Alcohol, pepper, and coffee produces more gastric acids
Assess smoking and physical activitySmall, frequent mealsWeight loss if warranted- fat adds pressure
Pathophysiology - EsophagusDysphagia – difficulty swallowing
Potential causes – GERDDrooling, coughing, chokingWeight loss, generalized malnutrition
Often stop eating because of difficulties
Aspiration(inhalation of food-constant, ongoing) to aspiration pneumonia
Treatment requires health care teamdg by bedside swallowing, videofluoroscopy, barium
swallow
Pathophysiology - Esophagus
Dysphagia – Nutrition TherapyUse acceptable textures to develop adequate menuNational Dysphagia Diet 1,2,3
1- pudding-like diet (pureed) 2- mechanically altered- soft, liquid, moist 3- advanced- no hard food
Use of thickening agents and specialized productsMonitor weight, hydration, and nutritional parameters
© 2007 Thomson - Wadsworth
Hiatal Hernia
Pathophysiology - Stomach
Gastritis (in upper stomach)Inflammation of the gastric mucosaPrimary cause: H. pylori bacteriaAlcohol, food poisoning, NSAIDsSymptoms: belching, anorexia, abdominal
pain, vomitingType A - automimmuneType B – H. pyloriIncreases with age, achlorhydriaTreat with antibiotics and medications
Pathophysiology - StomachPeptic ulcer disease (“PUD”) - ulcerations of the
gastric mucosa that penetrate submucosaGastric or duodenalH. pyloriNSAIDS, alcohol, smokingCertain foods, genetic link Increased risk of gastric cancer1 in 4 Americans develop
Pathophysiology - StomachPeptic 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 meals
© 2007 Thomson - Wadsworth
Pathophysiology - StomachGastric Surgery - Nutrition Implications
Reduced capacityChanges in gastric emptying & transit timeComponents of digestion altered or lostDecreased oral intake, maldigestion, malabsorption
Pathophysiology - StomachGastric 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
Pathophysiology - StomachGastric 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
Pathophysiology - StomachGastric Surgery - Dumping Syndrome
Other nutritional concerns: vitamin and mineral deficiencies, lack of intrinsic factor, iron deficiency, osteoporosis
Pathophysiology - Stomach
Dumping Syndrome - Nutrition“Anti-dumping” dietSlightly higher in protein & fatAvoid simple sugars & lactoseCalcium & vitamin DLiquid between mealsSmall, frequent mealsLie down after mealsAssess for weight loss, malabsorption, and
steatorrhea
© 2007 Thomson - Wadsworth
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