medical nutrition therapy for gastrointestinal tract disorders n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Medical Nutrition Therapy for Gastrointestinal Tract Disorders PowerPoint Presentation
Download Presentation
Medical Nutrition Therapy for Gastrointestinal Tract Disorders

Loading in 2 Seconds...

play fullscreen
1 / 31

Medical Nutrition Therapy for Gastrointestinal Tract Disorders - PowerPoint PPT Presentation


  • 228 Views
  • Uploaded on

Medical Nutrition Therapy for Gastrointestinal Tract Disorders. By Gaga Irawan Nugraha & Nur Fatimah Department of Medical Nutrition Faculty of Medicine, Unpad. Hepatic Disorder. Dyspepsia/indigestion. Gastritis. Peptic Ulcer. Indigestion & Dyspepsia.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Medical Nutrition Therapy for Gastrointestinal Tract Disorders' - ianthe


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
medical nutrition therapy for gastrointestinal tract disorders

Medical Nutrition Therapy for Gastrointestinal Tract Disorders

By

Gaga Irawan Nugraha & Nur Fatimah

Department of Medical Nutrition

Faculty of Medicine, Unpad

slide2

Hepatic Disorder

Dyspepsia/indigestion

Gastritis

Peptic Ulcer

indigestion dyspepsia
Indigestion & Dyspepsia
  • Dyspepsia refers to persistent upper abdominal discomfort or pain
  • The discomfort may be related to organic causes such as esophageal reflux, gastri- tis, or peptic ulcer, gallbladder disease, or other identifiable pathology.
  • Functional dyspepsia is a term that de- scribes unexplained persistent or recurrent upper GI discomfort. It may also be described as non-ulcer dyspepsia
  • Symptoms of functional dyspepsia are reported in about 15%-20% of adults over a year's time and may include vague abdominal discomfort, bloating, early satiety, nausea, and belching.
  • May be caused by diet, stress, other lifestyle factors
nutritional recomendation
Nutritional Recomendation
  • Use of well-cooked foods
  • Adequate amount
  • Small meals best tolerated
  • Eat slowly
  • Chew thoroughly
  • Avoid excesses:
    • Excess volumes of food
    • High fat intake
    • Sugar, caffeine, spices, alcohol
  • Stress management
nutritional recomendation1
Nutritional Recomendation
  • If etiology psychogenic: removing the cause often results in the disappearance of the dyspepsia
  • If etiology organic: soft food, low-fat diet, low fiber
gastritis peptic ulcer disease
Gastritis & Peptic Ulcer Disease

Causes: disruption of mucosal integrity by infectious, chemical, neural abnormalities

Infection  chronic inflammatory state + damage by cytotoxins produced by the organism

Helicobacter pylori: G- bacteria with flagella. Resistant to acidic medium of stomach.

Chronic inflammation of the gastric mucosa; gastric and duodenal ulcers; some forms of atrophic gastritis & gastric cancer

Treatment:

Medications: bismuth, antibiotics, antisecretory agents

gastritis peptic ulcer disease1
Gastritis & Peptic Ulcer Disease

Gastritis 

  • Nausea, vomiting, malaise, anorexia, hemorrhage, epigastric pain
  •  Atrophy & loss of stomach parietal cells, with loss of HCl secretion(achlorhydria)and intrinsic factor.
  • Patients may have  serum B12 levels
gastritis peptic ulcer disease2
Gastritis & Peptic Ulcer Disease

Medical Treatment

  • Endoscopy to identify problems
  • Eradication of pathogenic organisms
  • Withdrawal of provoking agents
  • Antibiotics, antacids, H2-receptor antagonists, proton pump inhibitors

Nutritional Recommendation

  • Lack of acid & intrinsic factor  B12 malabsorption
  •  Evaluate vitamin B12 status
peptic ulcers
Peptic Ulcers

Pathophysiology

H. Pylori; NSAIDs; Corticosteroids; Stress; Alcohol; Tobacco

  • Gastric & duodenal mucosa protected from digestive acid & pepsin by:
  • Mucus
  • Bicarbonate
  • Removal of XS acid by normal blood flow
  • Rapid renewal & repair or epithelial cell injury

Peptic Ulcer

slide11

Stomach and Duodenum with Eroded Lesions

  • Gastric Ulcer
  • Duodenal Ulcer
gastric vs duodenal ulcers
Gastric vs. Duodenal Ulcers
  • Gastric ulcers:
    • Mostly along the lesser curvature of the stomach
    • Widespread gastritis, inflammatory involvement of oxyntic (acid-producing) cells, & atrophy of acid- and pepsin-producing cells
    • Antral hypomotility, gastric stasis, and duodenal reflux gastric injury severity
    • Higher hemorrhage and overall mortality than with duodenal ulcer.
gastric vs duodenal ulcers1
Gastric vs. Duodenal Ulcers
  • Duodenal ulcer:
    • Acid secretion, nocturnal acid secretion, &  bicarbonate secretion.
    • Mostly within the 1st few centimeters of the duodenal bulb.
    • Gastric outlet obstruction: common
    • Duodenal ulcer related to H. pylori  gastric metaplasia may occur
    • H2-receptor blockers or proton pump inhibitors for acid suppression
nutrition recommendation for ulcers
Nutrition Recommendationfor Ulcers
  • Protein foods:
    • Stimulate gastrin & pepsin secretion
  • Food pH:
    • Little importance unless presence of lesions of mouth or esophagus (normal gastric pH = 1-3)
  • Alcohol:
    • May cause superficial mucosal damage.
    • Beers & wines  gastric secretions  Avoid
  • Coffee& caffeine:
    • Stimulate acid secretion and may  LES pressure
  • Spices:
    • Very large doses  acid secretion; small superficial erosions; mucosal lining inflammation; altered GI permeability or motility.
    • Spicy foods not shown to cause or affect the healing of peptic ulcer
nutrition recommendation for ulcers1
Nutrition Recommendation for Ulcers
  • Prostaglandins from -3 & -6 FAs:
    • Conflicting studies: protective or harmful effects of -3 & -6 FAs.
    • -3: antiinflammatory properties, protective against mucosal injury by drugs and H. pylori.
    • Ideal dose or form of lipids in the diet has not been established.
  • Malnutrition:
    • Micronutrient deficiencies or protein-calorie malnutrition
    • Affect rapidly dividing cells such as in GI tract
    • Avoid deficiencies  protection from PUD + may help in wound healing.
  • Meal frequency:
    • Frequent small meals: comfort, acid reflux, & stimulate gastric blood flow – BUT – may  net acid output.
    • Avoid large meals esp. before bed to latent increases in acid secretion.
nutrition recommendation for ulcers2
Nutrition Recommendationfor Ulcers
  • Use small feeding and frequent
  • High protein foods and vitamin C
  • Avoid personal intolerance
  • Limit gastric stimulant:
    • Caffeine
    • Alcohol
    • Pepermint, garlic, black peppr, cloves, chili
  • Use fewer saturated fat and more polyunsaturated fat
  • Supplement with vitamin C-rich foods or oral supplement. Citrus foods may not be tolareated
  • High intake vitamin A, vitamin C, fruits and vegetables, Soluble fiber reduce the risk
  • Refined sugar a risk
metabolic function of liver
Metabolic function of liver
  • Carbohydrate, lipid and protein metabolism
  • Storage and activation of vitamins and mineral
  • Formation and excretion of bile
  • Metabolism of steroids

Company Logo

slide19

Intermediate metabolism

of carbohydrate

  • Heksose isomerization
  • Maintain blood glucose (glycogenesis/lysis)
  • Gluconeogenesis (from lactate,
  • glucogenic amino acid)

Company Logo

slide20

Intermediate metabolism

of lipid

  • Synthesis acetyl CoA from fatty acid
  • Synthesis and hydrolysis triglycerides,
  • phospholipids, cholesterol and lipoproteins
  • Synthesis of bile

Company Logo

slide21

Intermediate metabolism

of protein

  • Synthesis of visceral protein (albumin, transferin,
  • ceruloplasmin), coagulation factor, apolipoprotein
  • Gluconeogenesis
  • Urea cycle.
  • Synthesis of non essensial amino acid

Company Logo

slide22

Acute liver disorders:

  • Anoreksia
  • Nausea
  • Vomitus
  • Depletion of glycogen storage

Company Logo

slide23

Chronic liver disorder:

  • Maldigestion, malabsorption
  • Energy metabolism 
  • Hypoalbuminemia
  • Malnutrition
  • Vitamin deficiency

Company Logo

subjective global assessment for nutrition management in live disease
Subjective global assessment for nutrition management in live disease
  • History:
    • Weight change
    •  apetite
    • Persistent GI problem (nausea, vomitus, diarrhea, constipation)
  • Physical:
    • Edema, ascites, muscle wasting.
  • Existing condition:
    • Hepatic encephalopathy, GI bleeding, renal insufficiency, infection

Company Logo

slide25
Laboratory assessment:
    • Liver function
    • nutritional status:
      • nitrogen balance, visceral protein, immunologic parameter.

Company Logo

nutritional therapy
Nutritional therapy
  • Adequate energy intake
  • Malabsorption: specific nutrient
  • Adapted protein intake
  • Micronutrient supplementation

Company Logo

nutritional therapy1
Nutritional therapy
  • Energy intake need:
    • Basal metabolic rate:
      • Harris Benedict formula:
        • Men : 66 + (13,7 x BW kg) + (5 x BH cm) – (6,8 x age)
        • Women : 665 + (9,6 x BW kg) + (1,7 x BH cm) – (4,7 x age)
      • Correction factor:
        • Thermogenic effect of food (10% BMR)
        • Physical activity
        • Stress factor

TEE = BEE + PA + SDA (TEF) + stress factor

Company Logo

nutritional therapy2
Nutritional therapy
  • Composition:
    • Protein:
      • Branch chain amino acid (valine, leucine, isoleucine)
    • Lipid :
      • Medium chain fatty acid (MCT)
    • Carbohydrates :
      • complex carbohydrates

Company Logo

nutritional therapy3
Nutritional therapy
  • Consistency :
    • Adapted to liver capacity
    • Step by step to increase consistency.
  • Frequency:
    • Small frequent
  • Methods :
    • Intake >60%: per oral
    • Intake <60%: enteral
    • Contra indication via GI: parenteral

Company Logo

nutritional therapy with specific condition
Nutritional therapy with specific condition
  • Ascites: sodium restriction
  • Encephalopathy: BCAA
  • Glucose intolerance; adapted to blood glucose
  • Fat malabsorption: MCT

Company Logo