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