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MNT for GIT Disorder

MNT for GIT Disorder

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MNT for GIT Disorder

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  1. MNT for GIT Disorder Leny Budhi Harti Jurusan Gizi Fakultas Kedokteran Universitas Brawijaya Malang, 12 Maret 2012 www.themegallery.com nata03111990.blogspot.com

  2. 1 Background 2 Clasification 3 Medical Nutrition Therapy Contents www.themegallery.com

  3. Background Penyebab kematian : • diare 3,5% • gastric and duodenal ulcer 1,7% • Thypoid 1,6% Riskesdas, 2007 www.themegallery.com

  4. 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

  5. Gastritis GERD Medical Nutrition Therapy Upper GIT Disorder Peptic Ulcer Dysphagia nata03111990.blogspot.com www.themegallery.com

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. GERD www.themegallery.com

  12. 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

  13. 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

  14. 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

  15. 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 www.themegallery.com

  16. 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

  17. 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

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  19. 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

  20. Lower GIT Disorder • Constipation • Diarrhea • Lactose Malabsorption • Thypoid • Inflammatory bowel disease • Hemoroid • Diverticular disease www.themegallery.com

  21. 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

  22. Constipation Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition www.themegallery.com

  23. Constipation www.themegallery.com

  24. MNT For Constipation Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition www.themegallery.com

  25. 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

  26. Exudative Secretory Diarrhea Diarrhea Medication Osmotic Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition www.themegallery.com

  27. 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

  28. MNT For Diarrhea www.themegallery.com

  29. Treatment Diarrhea in infants & Children www.themegallery.com

  30. Derajat Dehidrasi KapitaSelektaKedokteranEdisi ke-3 jilid 1 dan 2 www.themegallery.com

  31. MNT For Diarrhea Diaredengandehidarsiringan/sedang : • 3 jam pertamadiberikancairansebanyak 75ml/kg BB KapitaSelektaKedokteranEdisi ke-3 jilid 1 dan 2 www.themegallery.com

  32. 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

  33. Lactose Maldigestion www.themegallery.com

  34. 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

  35. 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

  36. 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 www.themegallery.com

  37. 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

  38. 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

  39. 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

  40. www.themegallery.com

  41. 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

  42. 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

  43. 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

  44. 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

  45. 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 www.themegallery.com

  46. Hemoroid Eksterna Interna Derajat I Akut Kronik Derajat II Derajat III Hemoroid Price, Sylvia A & Lorraine M. Wilson, Patofisiologi, 1994 www.themegallery.com

  47. 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

  48. 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

  49. MNT For Diverticulosis Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008 www.themegallery.com

  50. Thank You ! Selamat Belajar www.themegallery.com