NS 335 – Special Populations

1. NS 335 – Special Populations Unit 2 Seminar: GI Tract, Liver, Gallbladder, and Pancreas

2. The GI System • The gastrointestinal (GI) tract extends from the mouth to the anus. • All disturbances related to food intake, digestion, absorption, and elimination affect the GI tract and usually require special diets.

3. GI Tract National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

4. Mirror the Human Condition • Psychological factors play a role when we consider disorders of the GI tract. • The digestive system is said to “Mirror the Human Condition”: • Stress factors such as anxiety, fear, work pressure, grief, emotional makeup, and coping patterns have a great deal to do with how foods are tolerated. • Physiological factors can also be related with intolerances (such as an enzyme deficiency) which will eliminate foods that can be eaten

5. Let’s Play a Game!! What type of disorder am I?

6. How To Play • I will give you a word scrambled with a brief description of the disorder it is • “Buzz in” by typing a # into the chat box. • Wait until I call on you to type in your response. • The first person to correctly identify the type of assessment wins that question

7. Name the Disorder reutfacdrajw • Has high nutritional needs • May have to be wired which causes problems eating • Diet requires high calorie, high protein, vitamins, and minerals to promote healing • Liquid must pass through a straw without causing it to move

8. Diet for a Fractured Jaw Breakfast: Strained Juice, Hot Blended Drink, Coffee, Beverage of Choice Lunch: Fruit Drink, Hot Blended Drink, Coffee, Beverage of Choice Dinner: Fruit Eggnog, Hot Blended Drink, Beverage of Choice Table 17-1 of Text

9. Name the Disorder dlatne ierasc • Most is dietary in nature (high use of concentrated sweets) • Lack of Calcium, Phosphorus, Fluorine, Vitamins A, D, and C affect tooth and gum formation/development • Can occur with infants when milk, juice, or sweetened drinks are left in a bottle against an infant’s gums during sleep.

10. Name the Disorder fectl pil • A congenital defect of newborns • Can be corrected with a series of surgeries after the infant reaches a weight safe enough to withstand a surgical procedure

11. Name the Disorder pticpe uecrl • Most common of the problems affecting the upper GI tract • Causative factors include: • Increased acidity and secretion of gastric juices • Decreased secretion of mucous linings and buffers • Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and others. • Helico pylori (H. pylori) infection.

12. Peptic Ulcer National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

13. Peptic Ulcer • Treatment goals: relieve pain, heal erosion, prevent complications, prevent recurrences • Drug therapies are used • Diet Therapy: • Follow regular diet with guidelines based on the individual • 3 meals daily without snacks, especially at bedtime • Moderate meal size • No need to eliminate a food unless it causes discomfort • Avoid alcohol, coffee, tea, colas

14. Name that Disorder taiahl irnaeh • This results when the stomach partially protrudes above the diaphragm because of the weakening of the diaphragm opening

15. Hiatal Hernia National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

16. Hiatal Hernia • Usually treated with antacids and a low-fat diet • 6 small meals a day are recommended and fluids are taken between meals • Foods that irritate esophageal mucosa are eliminated such as alcohol

17. Gastric Surgery for Ulcer Disease • Perforation and hemorrhage are two major complications of ulcer disease for which surgery are indicated. • Dumping syndrome is complication of gastric surgery. • With part of the stomach removed, the food is not digested properly and instead of being delivered slowly, it is “dumped” quickly into the small intestine

18. Dumping Syndrome • Foods prohibited: Breads with nuts, jams, or dried fruits made with bran, presweetened cereals, highly seasoned or smoked meats, if not tolerated-milk, alcohol, carbonated beverages; creamed or gas forming vegetables, fruits canned with sugar syrup, sweetened dried fruits, pickles, peppers, chili powder, nuts, olives, candy, milk gravy

19. QUESTIONS?

20. Constipation • Involves many variables with its treatment • A regular, high fiber balanced diet and adequate fluid intake is recommended

21. Diarrhea • Can be serious if prolonged • Treatment involves eliminating the underlying cause, using antidiarrheal drugs as needed and appropriate diet therapy. • May need TPN if have prolonged diarrhea and need bowel rest.

22. Diverticular Disease Diverticulosis: pockets of intestinal mucosa; high fiber recommended vs. Diverticulitis: inflammation of pockets; low fiber/low residue until resolved

23. Diverticulosis National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

24. IBD • Inflammatory Bowel Disease: a term used for Ulcerative Colitis and Crohn’s disease

25. Ulcerative Colitis • Characterized by widespread ulceration and inflammation of the colon and rectum, chronic bloody diarrhea, edema, and anemia. Diet therapy includes: • Regular, high fiber diet as tolerated • High Protein diet: 120-150 grams daily • High Calorie: 3000 calories daily • High vitamins/minerals • Moderate fat as tolerated • Dairy products usually eliminated to avoid secondary lactose intolerance or lactose free products used • IV fluids in addition to oral feedings • TPN is most effective if the bowel has been shortened or the disease is extensive.

26. Crohn’s Disease • Can occur anywhere in GI tract. • It has onset characterized by tenderness, pain, diarrhea, and cramping in the right lower quadrants of the bowel. There is less blood in the stool than in ulcerative colitis, but more mucous secretions by the bowel. • Widespread problems of malabsorption of fat, protein, carbohydrates, vitamins, minerals, and subsequent weight loss.

27. Lining of the Digestive Tract National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

28. Diet Therapy for Diseases of the Liver, Gallbladder, & Pancreas

29. Hepatitis Diet Therapy: • Protein: 1.2-1.5 gm/kg BW per day • No CHO restriction, but may need to monitor Glu levels resulting from liver dysfunction • Fat: 30% of calories • Energy: 25-35 kcals/kg BW • Multivitamin used • Fluids and Sodium Restriction if edema or ascites present. • If adequate nutrition cannot be maintained by oral feedings, TF or TPN are appropriate.

30. Cirrhosis • Cirrhosis is the final stage of certain liver injuries including alcoholism, untreated hepatitis, biliary obstruction, Vitamin A overdose, and drug and poison ingestion.

31. Stages of Liver Damage National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

32. Diet Therapy for Cirrhosis Protein: If hepatic coma is not indicated, protein remains at 75-100g daily. If the patient shows signs of impending coma, protein intake should be reduced to lessen the chance of coma. Sodium: Edema or ascites is counteracted by a 500-1000 mg sodium diet daily. Fluid restriction may be limited. Texture: Esophageal varices, if present, are managed by semisolid or liquid diets to avoid potential rupture and hemorrhage. TF not recommended. Coffee, tea, pepper, chili powder, and other irritating seasonings should be avoided.

33. Diet Therapy for Hepatic Encephalopathy Protein: intake limited to 0 to 50g protein daily, depending on blood ammonia level. Calories: 1500-2000 calories daily mainly from carbohydrate and fat Vitamins: Given IV Fluid: Output is balanced by equal intake TPN or enteral nutrition are standard forms of diet therapy if unable to meet nutrition needs by eating

34. The Gallbladder Terms to Know: Cholecystitis Cholelithiasis

35. Diet Therapy for Gallbladder Disease • Dietary fat is reduced to diminish gallbladder contraction, which is responsible for pain and associated symptoms. Reduced to 40-50g/day. • Protein comprises 10-12% of total daily calories. • Calories reduced if weight loss indicated. • These modifications are generally used before surgery/cholecystectomy.

36. Diet Therapy for Acute Pancreatitis • Initial measures are lifesaving-IV and TPN feedings, replacement of fluid and electrolytes, blood transfusions, and drugs for pain and inhibiting gastric secretions. Nothing given by mouth. • As healing progresses, the first oral diet usually consists of clear liquid with amino acids, predigested fats, and other commercial preparations added gradually. The patient progresses to a bland diet, given in 6 small meals. No stimulants: coffee, caffeine, tea, colas, alcohol are allowed.

37. Diet Therapy for Chronic Pancreatitis • Focus should be on preventing malnutrition and treating malabsorption. • Diet therapy for chronic pancreatitis usually consists of a bland diet of soft or regular consistency in small meals at frequent intervals (6 feedings) and contains no stimulant foods. Pancreatic enzymes are given usually with food. Alcohol is strictly forbidden. • Low fat diet • Vitamin and Mineral supplementation may be necessary • Tube feedings or TPN may be necessary

38. QUESTIONS?

39. Reminder: • Take Quiz #1 by Tuesday at midnight ET • Quiz is worth 40 points