MNT Exam 1- Upper GI
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. What would you like to do?
What are the tansitional diets?
Clear liquid (Juice, tea, broth) >> Full liquid (can add dairy, soy milk, etc)>> Soft (not masticat much)>> regular
- can take from 1 to a couple of weeks
- if person cant really swallow/chew
What does the clear liquid diet involve?
- mono/disaccahrides + electrolytes
- easy abs, minimal gut use, small residue
- nutritionally inadequate, hydrating
- short use only (1-2 days)
What does the full liquid diet invlove?
- liquid/semi-solid at rt
- need more GI funct
- more nutrient mix, low fiber
- not adequate, except protein, ca, vit c, riboflavin
- watch lactose intolerance
What are the dysphagia diets?
- NDD-1: pureed = oral/esopha. tenderness due to surgery, ulceration, etc.
- NDD-2: mechanical altered/soft= texture ease of mastication
- NDD-3: advanced "soft"= transitional for acute illness
What are the consistencies of the liquids for the dysphagia?
- Thin (water, ice, milk, juice coffee)
- Nectar-like (smotthie, some juice, ensure)
- Honey-like (thicker)
- Spoon-thick (yogurt, pudding)
What parts does the upper GI consist of?
mouth, pharynx, esopahgus, stomach, digestion secretions (water, enz, bile salt, mucus)
What is digestion and what does it break down?
Complex molecules convert to simple molecules
- CHO= polysach to glucose/fruc/galac
- PRO= polypep to aa/di/tripeptides
- FAT= lipid to ffa and monogly
guided by auto NS, parasym +sym
What are the phases of swallowing?
- 1. oral prep:aroma of food, bile secretions
- 2. oral phase:bite + chew (vol)
- 3. pharayngeal phase: swallow reflex (invol)
- aiways protected
- 4. esophageal phase: food move from esophagus to stomach (invol)
What is the gastric function(gas tank)?
- to store, mix, release food into sm intestine
- mucosa have gastic glands to protect lining
- parietal cells secrete HCL and intrinsic facotr (B12)
- no abs
- acid denautres proteins
What is the pathiophys of the mouth?
- peridontal dz (teeth caries, gingavitis, stomatis, glottitis)
- stomatitis (herpes)
- xerostomia (dry mouth)
- dysguenia/ageusia (taste loss)
- jaw frac./surgery
What is the intervention of pathophys of mouth?
- modify texture, consistency, temp
- eval kcal/food diary
What are some important things about dysphagia?
- difficulty chewing/swallow
- symptoms: drool, food in mouth, cough/choke, change in voice
- can come from conditions, neurological: alzheimers, etc.
- require speech therapist eval.
What is the Tx for dysphagia?
- barium swallowed to study severity
- prescribed diet varies (sm. meals, cold food better, consistent food)
- may need nutrition support
What is GERD?
- reflux of gastric contents into the esophagus
- LES control the entrance
- cause burning in chest and throat
What is the nutrition therapy for GERD?
- improve LES pressure: avoid high fat, alcohol spearamint,
- coffee, tea, chocolate, stop smoking
- decrease esophagus irritation: aviod citrus, cofffee, spicy
- food, co2 drink, tomatoe
What are the levels of modified solids?
- level 1: dysphagia puree(pudding like)
- level 2: dysphagia mechanical/altered(moist, semi-solid)
- level 3: dysphagia advanced (soft solid, more chew)
- level 4: reguler (any solid)
What are the eating strategies for GERD?
- decrease frequency/vol of reflux:
- elevate HOB
- upright for 3-4 hrs
- sm. frequent meals
- loose wieght
- liquid betwen meals
- find out food/activity that cause pain: record log
what is the pharmalogical Tx for GERD?
- *proton pump inibitors: decrease acid production by parietal cells (secrete HCL in stomach, will decrease)
- antacids: decrease ph
- histamin H2 receptor antagonists: decrease HCL secretion (change tummy envirn.)
- metacloporide: increase motility/ gastric emptying and LES tone( more mechanical)
what is the surgical intervention for GERD?
nissen fundoplication: fund wrap around LES to limit reflux
What is a hiatal hernia?
- thin muscle layer that come up over stomach
- need surgery to remove
- cause nausea+vomit
what is pud?
- peptic ulcer dz
- ulceration of mucosal lining (duodenal, gastric, esphagus)
- H.pylori cause 95%
- stressors can cause it too
- gastritis, aspirin, etc can also cause
what is medical mgmt of PUD?
- use antibio, antacids, hist h2 beta blockers
- avoid aspirin
- control diet
- not smoke
what are dietary recommendations for pud?
- milk diets work, but no strong evidence
- different for everyone
- avoid: alcohol, coffee, capcacian, reduce food before sleep, big/ frequent meals
what surgery is required for pud?
- gastric surgery, when ulcer is linked to hemorrhage
- upper GI trauma, cancer
- bariatric surgery
- gastrectomy (remove tummy)
what is important regarding dumping syndrme?
- happens post gastrectomy or gastrojejunostomy
- because of quick entry of stomach content into intestine
- increase osmolar load
what are the two onsets on dumping syndrome?
- early onset: 30 min after meal, more common
- late onset: 2 hrs after meal
What is involved in early onset dumping syn.?
- fulless/nasaue followed by cramping/pain 15 min after meal
- flushing, rapid HR, sweating, faintness
- because of distention of sm. liquid bowels from food
- less peripheral resistance and pool of blood happen
what happens in late dumping?
- 1-3 hrs after meal
- quick digestion + abs of sugar >> increase BG >> too much insulin made >> hypoglycemia(weak, anxious, shaky, hun.)
what is important regarding malnutrition in post-gastrectomy patients?
- malabsorption due to inadequate secretions of pancreatic enzymes
- diarrhea/ cramping
- poor intake
what is the diet mgmt of dumping syndrom?
- limit simple CHO
- limit lactose (replace w ca, vit D)
- more complex CHO, fat 30-40%, pro 20%
- sm meals frequent
- avoid temp extreme
- lie down hr after meal
- eat slow
- take supplements for pancreatic enzymes
what is the ANT for Tx of upper GI issues?
- brewers yeast, chamomile, ginger, nutmeg, peppermint, probiotics, tumeric, aloe vera
- stress reduction
What would you like to do?
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