Upper Gastrointestinal Tract

KNH 411

Upper GI – A&PStomach - Motility

Filling, storage, mixing, emptying50 mL empty – stretches to 1000 mLPyloric sphincter

© 2007 Thomson - Wadsworth

Pathophysiology - Oral CavityNutrition Therapy/Evaluation

Increase frequency of meals- tired quickly- 6 small feeding, high cal, high pro

Bland foods served at room temp.Liberal use of fluids- be careful with water, make sure

it is high energy density food Preference for cold and frozen foods- takes away some

of the smell if ill (chemo)Oral hygiene- embarrassed maybe Monitor using food diary, observation, or kcal count- a

lot of this done by computers but need to know how to do by hand

Monitor weight gain or maintenance

Pathophysiology - Esophagus

GERD - reflux of gastric contents into the esophagus Incompetence of LES

Increased secretion of gastrin, estrogen, progesterone Hiatal hernia Cigarette smoking- can losen Use of medications Foods high in fat, chocolate, spearmint, peppermint,

alcohol, caffeine (fried foods)

Pathophysiology - Esophagus

GERD - symptomsDysphagia- difficulty swallowingHeartburn- antiacids Increased salivationBelchingPain radiating to back, neck, or jawAspiration- refluxing of the contents of the stomachUlcerationBarrett’s esophagus- change in epithelial cells,

abnormal pH- squamous cell carcinoma- cancer a concern

Pathophysiology - Esophagus

GERD - TreatmentMedical management- antiacids, histamine blocker,

mucousal protectants Modify lifestyle factorsMedications – 5 classes (in book) to strengthen LES Surgery- most severe

Fundoplication- fundus, wrap it around the LES, tightens Stretta procedure- radiofrequency is energy is used,

increases the function

Pathophysiology - EsophagusGERD - Nutrition Therapy

Identify foods that worsen symptoms- previously mentioned

Assess food intake esp. those that reduce LES pressure, or increase gastric acidity

Assess smoking and physical activity- smoking cessation

Small, frequent meals- lessens the pressureWeight loss if warranted

Pathophysiology - EsophagusDysphagia – difficulty swallowing

Potential causes – GERD, StrokeDrooling, coughing, choking- could aspirate Weight loss, generalized malnutritionAspiration to aspiration pneumonia- inhalation into the

oral pharynx, constant oral problem 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 Use of thickening agents and specialized productsMonitor weight, hydration, and nutritional parameters

© 2007 Thomson - Wadsworth

Hiatal Hernia

Pathophysiology - Stomach

GastritisInflammation of the gastric mucosaPrimary cause: H. pylori bacteriaAlcohol, food poisoning, NSAIDsSymptoms: belching, anorexia, abdominal

pain, vomitingType A – automimmune- upper section of the

section- antibodies of the peritoneal cellsType B – H. pylori- atropy Increases with age, achlorhydria- lack of HClTreat with antibiotics and medications

Pathophysiology - StomachPeptic ulcer disease - ulcerations of the gastric

mucosa that penetrate submucosaGastric or duodenalH. pyloriNSAIDS, alcohol, smokingCertain foods, genetic link Increased risk of gastric cancer

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 mealsSmall, 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

Alter their diet, chart about these

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