chapter 018

Williams' Basic Nutrition & Diet Therapy

Chapter 18

Gastrointestinal and Accessory Organ Problems

Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 1

14th Edition

Lesson 18.1: Diseases of the GI Tract and Accessory Organs

Diseases of the GI tract and its accessory organs interrupt the body’s normal cycle of digestion, absorption, and metabolism

2Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

The Upper Gastrointestinal Tract (p. 352)

Problems of the mouth Dental problems

• Tooth decay• Ill-fitting dentures• Mechanical soft diet helpful

Surgical procedures• Healing nutrients administered with high-protein, high-

caloric milkshakes


The Upper Gastrointestinal Tract (cont’d) (p. 353)


Problems of the Mouth (p. 352)

Oral tissue inflammation Gingivitis Stomatitis Glossitis Cheilosis Mouth ulcers

Salivary gland problems Disorders of nervous system Infections Excess salivation Xerostomia (permanent dry mouth)


Problems of the Mouth (cont’d) (p. 353)


Swallowing Disorders (p. 354)

Heimlich maneuver for choking Dysphagia fairly common problem

Common with Alzheimer’s, Parkinson’s, stroke Symptoms: unexplained drop in food intake or

repeated episodes of pneumonia


Swallowing Disorders - Warning Signs (p. 355)

Reluctance to eat certain food consistencies or any food at all Very slow chewing or eating Fatigue from eating Frequent throat clearing Complaints of food “sticking” in throat Holding pockets of food in cheeks Painful swallowing Regurgitation, coughing, choking Referred to team of experts Diet adapted to individual needs


Problems of the Esophagus(p. 355)

Central tube problems Muscle spasms, uncoordinated contractions Stricture or narrowing of the tube Treatment: widening of the tube Diet: liquid to soft


Lower Esophageal Sphincter Problems (p. 355)

Achalasia or cardiospasm Changes in smooth muscle Nerve-muscle hormone control of peristalsis Treatment: dilating the LES or cutting the muscle Postop nutrition therapy


Gastroesophageal Reflux Disease (p. 355)

Caused by constant regurgitation of acidic gastric contents into lower esophagus

Pregnancy, obesity, pernicious vomiting, or nasogastric tubes are factors

Constant irritation and inflammation (esophagitis) Stenosis most common complication


Case Study

Mr. Max is a 38-year-old male who has been diagnosed with GERD. Testing revealed he has a narrowing of his esophagus from the GERD. His symptoms consisted of food (even though chewed thoroughly) getting caught in his throat, and frequent and severe heartburn about 1 hour after eating. He also complained of some pain in and around his jaw and neck.


Case Study (cont’d)

Mr. Max is 5 feet 8 inches tall and weighs 215 lbs. Mr. Max has been started on a proton pump inhibitor

per his physician What are some appropriate nutritional

recommendations for Mr. Max?


Hiatal Hernia (p. 356)

Portion of upper stomach protrudes through opening in the diaphragm membrane (hiatus)

Especially common in obese adults


Peptic Ulcer Disease (p. 357)


Peptic Ulcer Disease (cont’d)(p. 357)

Caused by Helicobacter pylori infection Lesion usually occurs in duodenal bulb Long-term use of nonsteroidal antiinflammatory drugs

may contribute to development in some persons Psychological factors


Peptic Ulcer Disease (cont’d)(p. 358)

Clinical symptoms Increased gastric muscle tone Painful contractions when stomach empty

Medical management Rest: foundation of general care Drug therapy: Four types of drugs Dietary management: well-balanced diet,

avoidance of acid stimulation


Lower Gastrointestinal Tract: Small Intestine Diseases (p. 361) Malabsorption

Maldigestion problems Can occur in any of three digestive processes Can lead to chronic deficiencies of vitamins,

minerals, nutrients Most common symptom is diarrhea or steatorrhea


Cystic Fibrosis (p. 361)

Genetic disease of childhood Inhibits movement of chloride and sodium ions in the

body tissue fluids


Nutrition Management of Cystic Fibrosis (p. 362)

Nutrition therapy is critical Enzyme replacement products Nutritional supplements to maintain weight


Inflammatory Bowel Disease(p. 363)

Chronic inflammation of GI tract Persistent activation of mucosal immune system

against normal gut flora Disrupts protective epithelial barrier, destroying

segments of GI tract Crohn’s disease, ulcerative colitis two most common

forms


Crohn’s Disease and Ulcerative Colitis (p. 364)


Crohn’s Disease (p. 364)

Most common locations are ileum and colon Risk factors of family history and smoking Symptoms vary Iron deficiency anemia


Ulcerative Colitis (p. 365)

Limited to colon Progressive beginning at anus Resulting malnutrition hinders healing Dietary management differs during inflammation and

remission


Diarrhea (p. 365)

Usually a symptom of other underlying condition Intolerance to specific foods Acute food poisoning Viral infections


Large Intestine Diseases (p. 366)

Diverticular disease Diverticulosis: formation of many small pouches

(diverticula) along muscular mucosal lining Diverticulitis caused by pockets becoming infected



When Mr. Max had his colonoscopy, it was noted that he has diverticulosis.

What nutritional recommendations would be appropriate for him?


Diverticular Disease (p. 366)


Irritable Bowel Syndrome (p. 366)

Multicomponent disorder of physiologic, emotional, environmental, psychologic function

Common recurrent pain in abdomen Small-volume bowel dysfunction Excess gas formation


Irritable Bowel Syndrome (cont’d) (p. 367)

Individual approach to nutrition care essential Normalize eating patterns Eliminate food allergens and intolerances Recognize, avoid gas formers Increase fiber/bulking agents Consider use of prebiotics/probiotics Consider use of food diaries


Irritable Bowel Syndrome (cont’d) (p. 367)


Constipation (p. 367)

Common short-term problem Nervous tension and worry Changes in routines Constant laxative use Low-fiber diets Lack of exercise

Dietary management rather than laxatives



Since Mr. Max will try to increase fiber in his diet, what other recommendation should he be given to avoid constipation?


Lesson 18.2: Food Allergies and Intolerances

Food allergies result from sensitivity to certain proteins.

Underlying genetic diseases may cause metabolic defects that block the body’s ability to handle specific foods.


Food Allergies and Intolerances (p. 367)

Food allergies Allergy: body reacts to protein as if it were a

threatening foreign object and launches powerful attack

Intolerance: not life-threatening and are non-immunologic in origin


Common Food Allergies (p. 368)

Peanuts, tree nuts Shellfish, fish Milk, soy, egg, wheat


Common Food Allergies (cont’d) (p. 368)

Food elimination sometimes used to identify disagreeable foods

Dietitian can provide guidance on food substitutions or special food products

Recipes modified to maintain nutrition needs for growth


Celiac Disease (p. 368)

Hypersensitivity to the protein gluten in certain grains Steatorrhea and progressive malnutrition are

secondary effects to gluten reaction


Celiac Disease (cont’d) (p. 368)


Celiac Disease (cont’d) (p. 369)

Avoid all dietary sources of gluten Wheat, rye, barley eliminated from diet Corn, potato, rice used as substitutes Careful label reading for parents and children Monitor for vitamin, mineral deficiencies


Problems of the Gastrointestinal Accessory Organs (p. 369)


Liver Disease (p. 369)

Steatohepatitis Fat accumulation and inflammation in the liver Alcoholic and nonalcoholic Malnutrition is common Aggressive enteral nutrition therapy


Hepatitis (p. 371)

Inflammatory condition caused by virus, alcohol, drugs, or toxins

Treatment based on bed rest and nutrition therapy


Cirrhosis (p. 372)

Associated with alcoholism, hepatitis, inherited diseases

Fatty infiltration kills liver cells, leaving nonfunctioning scar tissue


Hepatic Encephalopathy (p. 372)

As cirrhosis continues, blood can no longer circulate normally through liver

Ammonia and nitrogen cannot be eliminated, which produces ammonia intoxication and coma

Treatment focuses on removing sources of excess ammonia


Management of Cirrhosis (p. 372)

Energy Protein Enteral/parenteral nutrition support Vitamin/mineral supplementation Small, frequent meals


Gallbladder Disease (p. 373)

Cholecystitis Usually results from low-grade chronic infection Continued infection alters solubility of bile

ingredients Cholelithiasis

Cholesterol separates out and causes gallstones Diet therapy centers on controlling fat intake


Pancreatic Disease (p. 374)

Pancreatitis Inflammation of the pancreas Excessive alcohol consumption is most common

cause Supplements with pancreatic enzymes


chapter 018

Health & Medicine

imprint of elsevier

mouth contd

tube diet

lower gastrointestinal

peptic ulcer disease

common problem common

food intake

pockets of food