Dietary Management

7/30/2019 Dietary Management

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Geofrey P. Maglalang


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Endoscopy reveals

severe withgastrointestinal bleeding.


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Acute or chronic inflammation of themucous membrane of the stomachresulting in tissue damage and erosion,

which expose the underlying cells togastric secretions and pathogens.


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Anorexia

Nausea

Vomiting Malaise

Belching (gas) feeling of fullness

Epigastric pain Occasionally, fever and diarrhea is presented


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Bacterial or viral infection, excess stomach acid, use ofNSAIDs, and stress are among the causative factorsare gastritis. Helicobacter pyloriinfection has been

specifically identified as primary contributory.


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In acute gastritis, it may be necessary to withholdfood for 24 hours to allow stomach to rest.

Initiate oral diet the following day beginning withclear liquids, then full liquids to soft diet as perindividual tolerance.

They require folate and vitamin B12supplementation


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Milk or cream as treatment component of gastritisand ulcer is no longer considered beneficial. Milk asa protein food has temporary neutralizing effect on

gastric acid, but also stimulate secretion of gastrinand pepsin.

Alcohol may cause superficial mucosal damage and

therefore should be avoided by the patient withgastritis.

The pH of food prior to ingestion is not likely to

cause tissue damage or interfere with healing


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Coffee, red and black pepper, and large intake ofchilli pepper must be avoided. These are strongirritants of mucosal cells.

It is better to consume three meals per day toprevent an increase in acid production.


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Duodenal Ulcer


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A peptic ulcer is a chronic sore orcrater extending through theprotective mucous membrane liningand penetrating the underlyingmuscular tissue of the gut.

An ulcer can form in any areaexposed to gastric acid and pepsin, a

digestive enzyme instrumental in thebreak down of protein and hence thename peptic ulcer


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pylorus Gastric ulcer

duodenum

Duodenalulcer


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H. pyloriresponsible for the majority of ulcer

- Weakens protective mucous coating ofstomach and duodenum, which allows

acid to get through the sensitive lining

beneath.

Long term use of NSAIDs


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Smokingcause duodenal ulcer and has beenshown to delay ulcer healing

Poor nutritionpoor supply of needed nutrientsfor defense and repair

Stressit may worsen the pain or indigestionassociated with ulcer

Alcohol abusecauses irritation of lining of thestomach but has not been proven to cause duodenalulceration

Heredit increased threefold


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Signs ofuncomplicatedPUD

Heartburn

Nausea

Abdominal distention

Flatulence

Regurgitation


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Outstanding

symptoms

Sudden weakness

Melena


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Use of antibiotics, antacids, H2 blocker, orcytoprotective agents


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No food is allowed while an ulcer is bleeding;instead the patient may be given IV feedings ofdextrose and amino acids

As the condition improves, patient progresses fromfull liquid diet to regular diet with omission ofirritants based on individual tolerance

Highly spiced dishes, fatty foods, or fruit juices canprovoke ulcer symptoms but may be consumedfreely if they do not


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Gastric surgery / gastrectomy

Usually advised when ulcer is complicated byperforation, obstruction, and hemorrhage. Damagefollowing trauma, such as gunshot wound, or auto

accidents may also need surgical measures.


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results from bypass ofduodenum. Bacteria multiply within the bypass,and bacteria deconjugate bile salts making micelle

formation and fat absorption inadequate dizziness and tachycardia

occurs because food no longer empties at a control

rate into the intestine. Instead, food rapidlydumped into jejunum.


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Intestinal contentsbecome hypertonic

Water from the lumen ofintestinal capillaries

moves into the lumen ofjejunum to equalize load

Volume of circulatingblood is reduces Blood pressure fallsdown


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After 23 hours,dizziness, fainting

nausea, and sweatingrecur from hypoglycemia

Carbs from meal rapidlyhydrolyzed and

absorbed

hyperglycemiaPancreas will respond byoverproducing insulin


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Post-surgery for patients with symptoms of DumpingSyndrome

Foods containing proteins and fat

Small frequent dry meals should be taken

The patient should wait 45 min after eating beforedrinking liquid and suggest to lie down after meals


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Other nutrition concerns:

IronDeficiency Anemiablood loss fromsurgery, accompanied by poor nutrition and pooriron absorption. Iron supplements help correctdeficiency

Calciummay be poorly absorbed post-op.supplements may be prescribed.

Anemia caused by Vit. B12 deficiency. It is injectedmonthly to correct deficiency


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After gastrectomy:

Limit sources of simple sugars (glucose, fructose,sucrose) lessen hypersomolar load

Small frequent dry meals are encouraged; fluidsshould be taken between meals (3045 min aftermeal)

Avoid excess fat intake (30% of total kCal or less)

Use less milk and milk products because lactoseintolerance is common. Emphasize other sources ofcalcium and Vitamin D


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Avoid extremes in temperature

Diet should provide sufficient fiber, Vitamin B12and B2, iron, folacin, and chromium. Thesenutrients may be given in supplemental forms asappropriate.

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Dietary Management