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MNT for GIT Disorder. Leny Budhi Harti Jurusan Gizi Fakultas Kedokteran Universitas Brawijaya Malang, 12 Maret 2012. nata03111990.blogspot.com. 1. Background. 2. Clasification. 3. Medical Nutrition Therapy. Contents. Background . Penyebab kematian : diare 3,5%

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mnt for git disorder

MNT for GIT Disorder

Leny Budhi Harti

Jurusan Gizi Fakultas Kedokteran

Universitas Brawijaya

Malang, 12 Maret 2012

www.themegallery.com

nata03111990.blogspot.com

contents

1

Background

2

Clasification

3

Medical Nutrition Therapy

Contents

www.themegallery.com

background
Background

Penyebab kematian :

  • diare 3,5%
  • gastric and duodenal ulcer 1,7%
  • Thypoid 1,6%

Riskesdas, 2007

www.themegallery.com

slide4

Classification

  • Lower GIT Disorder
  • Constipation
  • Diarrhea
  • Lactose Malabsorption
  • Thypoid
  • Inflammatory bowel disease
  • Hemoroid
  • Diverticular disease
  • Upper GIT Disorder
  • Dysphagia
  • GERD
  • Gastritis & Gastroenteritis
  • Peptic Ulcer

www.themegallery.com

medical nutrition therapy

Gastritis

GERD

Medical Nutrition Therapy

Upper GIT Disorder

Peptic

Ulcer

Dysphagia

nata03111990.blogspot.com

www.themegallery.com

dysphagia
Dysphagia
  • Dysphagia is defined as difficulty in swallowing caused by neurological or structure demage.

radiologyassistant.nl

Thomas, Briony & Jacki Bishop. Manual of Dietetic Practice. 2007

www.themegallery.com

dysphagia1

Mechanical

Neurological

  • Oesophageal strikture
  • Oesophageal spasm
  • Cancer in head, neck
  • and oesophageal areas
  • Stroke
  • Parkinson’s disease
  • Head injury
  • Cerebal palsy
  • Dementia
Dysphagia
  • Common Causes of Dysphagia

Thomas, Briony & Jacki Bishop. Manual of Dietetic Practice. 2007

www.themegallery.com

dysphagia2
Dysphagia

Tujuan Diet :

  • Mencegah aspirasi makanan dan minuman
  • Menyediakan makanan  merangsang fungsi menelan
  • Menjaga BB/ meningkatkan BB
  • Individualize diet
  • Menghindari defisinesi mikronutrient

Sylvia Escott – Stump, Nutrition and Diagnosis Related Care. 2008

www.themegallery.com

dysphagia3
Dysphagia
  • Energi : 30 – 35 kkal/kg BB
  • Protein : 1 – 1,5 g/kgBB
  • Bentuk makanan : soft diet,makanan sedikit air dan temperatur sedang
  • Monitor defisiensi serat, vitamin A dan C
  • Cara pemberian : oral, EN, PN
  • Makanan yang dihindari : alkohol, kafein, berbumbu tajam, asam, dry food

Sylvia Escott – Stump, Nutrition and Diagnosis Related Care. 2008

www.themegallery.com

slide10
GERD
  • gastroesophageal reflux disease (GERD) backward flow ofthe stomach or duodenal contents into the esophagus

burning inthe chest, with sour or bitter taste, and acid regurgitation

National Institute of Diabetes and Digestive and Kidney Diseases

Connie J Standiford, William E Chavey, R Van Harrison, UMHS GERD Guideline, January 2007

www.themegallery.com

slide11
GERD

www.themegallery.com

mnt for gerd
MNT for GERD

Nutritional care guidelines :

  • The diet should be so arranged as to provide adequate nutrition
  • Avoid large, high fat meals, especially 3 to 4 hours before retiring
  • Avoid smoking
  • Avoid chocolate, alcohol, caffeine-containing beverages, such as coffee
  • Avoid peppermint and spearmint oils
  • Stay upright and avoid vigorous activity soon after eating
  • Avoid acidity and highly spices food when inflamation exists
  • High in protein →increase LES pressure
  • Provide small, frequent feedings of soft food
  • Fluid will be taken between meals

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

www.themegallery.com

gastritis
Gastritis
  • Gastritis : inflammation of the stomach

medicastore.com

National Institute of Diabetes and Digestive and Kidney Diseases

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

gastritis1
Gastritis

Helicobacter pylori (H. pylori), NSAIDs, alcohol, tobacco, radiation

Acut Gastritis

Erosive gastritis

Chronic gastritis

low serum B12 level or elevated serum homocystine levels

  • blood in vomit
  • black, tarry stools
  • red blood in the stool
  • Pain, nusea, vomiting, usualy in short duration

National Institute of Diabetes and Digestive and Kidney Diseases

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

mnt for gastritis
MNT For Gastritis
  • Energi diberikan sesuai dengan kebutuhan pasien
  • Protein cukupsesuaidengankemampuanpasien
  • Lemakrendah 10-15% darikebutuhanenergi. Utamakanjenislemak PUFA
  • Karbohidrat, sisadarikebutuhanenergisetelahdikurangi protein danlemak
  • Vitamin C diberikantinggi
  • Pada gastritis kronikperlupemberianvit. B12
  • Rendahserat, utamakanseratlarut
  • Padafaseakut : diberikanmakananparenteral→mengistirahatkan lambung

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mnt for gastritis1
MNT For Gastritis
  • Cairandiberikancukup
  • Makanandiberikanbertahapsesuaidengankeadaanpasien
  • Porsikecildansering
  • Hindarimakanan yang merangsangsalurancerna, seperti : cabe, merica, minyak, cuka
  • Hindarimakanan yang bersifatmelekat, seperti: dodol, ketan
  • Hindarimakanan yang menimbulkan gas, seperti : kol, kubis, sawi, ksngkung, durian, nangka, dll

www.themegallery.com

peptic ulcer
Peptic Ulcer

peptic ulcer a lesion in either the esophageal,gastric,or duodenal mucosa resulting from the action of gastricsecretions and typically H. pylori bacterial inflammation

homeohealthcenter.com

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

mnt for peptic ulcer
MNT For Peptic Ulcer
  • Protein foods temporarily buffer gastric secretions, butthey also stimulate secretion of gastrin, acid, and pepsin
  • Avoid alcohol, caffeinne and coffee
  • Avoid large doses of certain spices without others food
  • Use probiotics
  • Use omega-3 and omega-6
  • Good dietary practice with adequate nutrient and fiber

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

slide20

Lower GIT Disorder

  • Constipation
  • Diarrhea
  • Lactose Malabsorption
  • Thypoid
  • Inflammatory bowel disease
  • Hemoroid
  • Diverticular disease

www.themegallery.com

constipation
Constipation

ellies-whole-grains.com

a condition in which the frequenry or quantity o fstools is reduced

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

constipation1
Constipation

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

constipation2
Constipation

www.themegallery.com

mnt for constipation
MNT For Constipation

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

diarrhea
Diarrhea

Diarrhea is characterizedby the frequent evacuation of liquidstools, usually exceeding 300 ml, accompanied by anexcessivel offluid and electrolytes, especially sodium and potassium.

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

diarrhea1

Exudative

Secretory

Diarrhea

Diarrhea

Medication

Osmotic

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

mnt for diarrhea
MNT For Diarrhea
  • Replacement of necessary fluid and electrolytes
  • Use starchy carbohydrate
  • Modest amounts of fat
  • Avoid sugar alcohols, lactose, fructose, and sucrose in large amounts
  • Use amount of food containing prebiotic an probiotic

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

mnt for diarrhea1
MNT For Diarrhea

www.themegallery.com

derajat dehidrasi
Derajat Dehidrasi

KapitaSelektaKedokteranEdisi ke-3 jilid 1 dan 2

www.themegallery.com

mnt for diarrhea2
MNT For Diarrhea

Diaredengandehidarsiringan/sedang :

  • 3 jam pertamadiberikancairansebanyak 75ml/kg BB

KapitaSelektaKedokteranEdisi ke-3 jilid 1 dan 2

www.themegallery.com

lactose malabsorbtion maldigestion
Lactose Malabsorbtion/ Maldigestion
  • Lactose maldigestion : the inability to digest lactose to galactose and glucose because of a deficiency of the enzyme lactase with resulting intolerance to normal amounts of lactose
  • Etiologi : deficiency lactase, infection of the small intestine, HIV, inflamatory disorder, malnutrition
  • Diagnosis : (1) histori of GIT symptoms after milk ingestion, (2) abnormal hydrogen level in the breath, (3) abnormal lactose tolerance test

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

lactose maldigestion
Lactose Maldigestion

www.themegallery.com

mnt for lactose maldigestion
MNT For Lactose Maldigestion
  • The diet should be so arranged as to provide adequate nutrition (energy, protein, fat, and carbohydrat)
  • A completely lactose – free diet is not necessary in lactase – deficiency persons.
  • Most lactose maldigesters can consume some lactose (6 to 12g), without major symptoms, especially when taken with meals
  • Many adults with tolerance to moderate amount of milk can ultimately adapt to and tolerate 12 g or equivalent 240 ml of full-lactose milk

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

thypoid
Thypoid
  • Definition

A systemic, infectious disease caused by Salmonella typhi.

  • Diagnostic criteria

Clinical:

• Fever, headache, anorexia, vomiting, diarrhoea or constipation..

  • Investigations:

• Leucopenia, anaemia, thrombocytopenia.

• Positive cultures from blood (1st week), stools (after 1st week), urineand bone marrow. Positive Widal test

www.themegallery.com

mnt for thypoid
MNT For Thypoid

Syarat Diet :

  • Energi diberikan sesuai dengan kebutuhan , ditingkatkan bila ada demam dan sepsis
  • Protein : 1,5 – 2 gram/kgBB/hr, protein yang bernilai biologis tinggi
  • Lemak mudah serap (MCT)
  • Vitamin dan mineral cukup
  • Cairan 3 – 4 liter/hari untuk mengganti cairan yang hilang akibat demam/diare

Adobted from Etik Sulistyowati Materi

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inflammatory bowel disease ibd
Inflammatory Bowel Disease (IBD)
  • IBD : a general term for inflamatory disease of the bowel, including Crohn’s Disease and ulcerative colitis
  • Characteristics : diarrhea, fever, weight loss, anemia, food intolerance, malnutrition

cochrane.uottawa.ca

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

crohn s disease
Crohn’s Disease
  • Peradangankronikpadausus yang ditandaiolehperadangansalahsatu/ semualapisan GIT
  • Penyebabtidakdiketahui, kemungkinanautoimun
  • Gambaranklinis : panas, penurunan BB, nausea, vomiting, abdominal pain, intestinal dleeding
  • Pemeriksaan :leukosit, trombosit, LED yang tinggi. analisiskulturfeses, sigmoidoskopi

Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

ulcerative colitis
Ulcerative Colitis
  • Peradanganrektumdankolon, terutamamengenailapisanmukosaususbesardan menyebarkedaerah yang terkena.
  • Gejalakhas : diareberdarahbercampurdenganmukusdansemakinintensifseiringdengankeparahanpenyakit
  • Gejala lain : nyeri abdomen, anemia, anoreksiadandemam
  • Penyebabtidakdiketahui, kemungkinankarenaautoimun
  • Pemeriksaan : sigmoidoskopi, sinar -X

Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

www.themegallery.com

mnt for ibd
MNT For IBD

Tujuan :

  • Memperbaikiketidakseimbangancairandanelektrolit
  • Memberikanzatgiziuntukmeningkatkandanmempertahan status gizi agar tetap normal
  • Mencegahiritasidaninflamasilebihlanjut
  • Mencegahkehilanganzatgiziakibatmalabsorbsi
  • Mempercepatprosespenyembuhan

Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

www.themegallery.com

mnt for ibd crohn s disease ulcerative colitis
MNT For IBD (Crohn’s Disease & Ulcerative Colitis)

Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

www.themegallery.com

  • Kebutuhanenergi :
  • BMI < 15 : diberikanenergisebesar 35-45 Kkal/kgBB
  • BMI 15-19 : energidiberikansebesar 30-35 kkal/kg BB
  • BMI 20-29 : energidiberikansebesar 25-30 kkal/kgBB
  • BMI > 30 : energidiberikansebesar 15-25 kkal/kgBB
mnt for crohn s disease
MNT For Crohn’s Disease

Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

www.themegallery.com

  • Protein tinggi : 1-1,5 gram/kg BB
  • Lemakrelatiftinggi, utamakan MCT dan omega-3
  • Karbohidrat : sisadarikebutuhanenergi
  • Kebutuhanmikronutrienditingkatkanterutama : vitamin B1, B12, vitamin A,D,E,K,Zn, Fe, Mg, Ca
  • Mengurangilaktosa, jikaterjadilaktose intolerance
  • Probiotikuntukmeingkatkanbakterikhususdalamusus
  • Rendahserat
mnt for ulcerative disease
MNT For Ulcerative Disease

Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

www.themegallery.com

  • Akut : low fiber diet, TPN for 2 week/ longer during acute stage
  • Protein tinggi : 1-1,5 gram/kg BB
  • Lemakrelatiftinggi, utamakan MCT dan omega-3
  • Karbohidrat : sisadarikebutuhanenergi
  • Kebutuhanmikronutrienditingkatkanterutama : vitamin B1, B12, vitamin A,D,E,K,Zn, Fe, Mg, Ca
  • Mengurangilaktosa, jikaterjadilaktose intolerance
  • Prebiotik  mengubah flora dan produksi SCFAs melindungi proses inflamasi
  • Six small feeding
hemoroid
Hemoroid

Konstipasi, sering mengejan, kongesti pelvis pada kehamilan, pembesaran prostat,fibroma uteri, tumor rektum

Price, Sylvia A & Lorraine M. Wilson, Patofisiologi, 1994

elec-intro.com

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hemoroid1

Hemoroid

Eksterna

Interna

Derajat

I

Akut

Kronik

Derajat

II

Derajat

III

Hemoroid

Price, Sylvia A & Lorraine M. Wilson, Patofisiologi, 1994

www.themegallery.com

mnt for hemoroid
MNT For Hemoroid

Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

www.themegallery.com

  • Energidanzatgizi lain diberikansesuaidengankebutuhan
  • Serattinggi, 25-35 gram/hari
  • Cairantinggi : 8-10 gelas/hari
  • Setelahoperasidiberikanmakananrendahseratdanbentukmakananlunak. Jikakondisipasiensudahmembaikdapatdiberikanserat 25-35 gram/hari
  • Hindarilaktosadan BM yang merangsang GIT
diverticular disease
Diverticular Disease

Causes :

  • The causes is not known for certain.
  • Increase intracolonic pressure → herniations of the mucosal wall
  • Lack of activity
  • Low fiber diet

Diverticulosiiss a situationo f saclikeh herniations( diverticula)

of the colonic wall, thought to result from long-termconstipationandincreasedcolonic pressure

Diverticulitis : inflamation of diverticula

www.themegallery.com

mnt for diverticulosis
MNT For Diverticulosis

Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

www.themegallery.com

selamat belajar

Thank You !

Selamat Belajar

www.themegallery.com