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Chapter 20
Diet and Gastrointestinal Problems
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Objectives
• Explain uses of diet therapy in gastrointestinal
disturbances
• Identify foods allowed and disallowed in
therapeutic diets discussed
• Adapt normal diets to meet requirements of
clients with conditions discussed
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Gastrointestinal Tract
• Where digestion and absorption of food occurs
• Primary organs:
– Mouth, esophagus, stomach, small intestine, and large
intestine
• Accessory organs:
– Liver, gallbladder, and pancreas
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Dyspepsia
• Also known as indigestion
• Discomfort in digestive tract of physical or
psychological origin
• Symptoms:
– Heartburn, bloating, pain and regurgitation
(continues)
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Dyspepsia
• Treatment:
– Treat underlying organic cause
– Stress management if psychological
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Esophagitis
• Irritation of mucosa of esophagus
• Causes heartburn, regurgitation, and dysphagia
• May be acute or chronic
• Causes:
– Hiatal hernia, reduced lower esophageal sphincter pressure,
abdominal pressure, recurrent vomiting, alcohol use,
overweight, and smoking
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Hiatal Hernia
• Part of stomach protrudes through diaphragm
into thoracic cavity
– Prevents food from moving normally along digestive tract
• Heartburn and food regurgitation into mouth
can occur
(continues)
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Hiatal Hernia
• Medical nutrition therapy
– Small, frequent meals of well-balanced diet
– Avoid irritants to esophagus
– Avoid foods that relax lower esophageal sphincter
– Weight loss recommended if necessary
– Avoid lying down two to three hours after eating
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Peptic Ulcers
• Erosion of mucous membrane
• May be gastric or duodenal
• Predisposing factors:
– Genetics, high secretion of hydrochloric acid, stress,
excessive use of aspirin or ibuprofen, smoking, or
Helicobacter pylori bacteria
• Symptoms:
– Gastric pain and sometimes hemorrhage
(continues)
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Peptic Ulcers
• Treatment:
– Drugs to control acid secretion and kill bacteria
– Stress management
– Sufficient low-fat protein
– Avoidance of caffeine, alcohol, aspirin, and smoking
– Well-balanced diet of three meals per day
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Diverticulosis and Diverticulitis
• Diverticulosis
– Formation of little pockets in sides of large intestine where
food gets trapped
• Diverticulitis
– Inflammation in these pockets
• Cause:
– Insufficient dietary fiber
(continues)
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Diverticulosis and Diverticulitis
• Treatment:
– For diverticulosis, high-fiber diet
– For diverticulitis, antibiotics and progressive diet to allow
bowel to rest
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Stop and Share
• Consider the following scenario:
– A client with severe diarrhea has been placed on a low-
residue diet. What kinds of foods would you recommend?
(continues)
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Stop and Share
• Milk and buttermilk
– Limit to 2 cups per day
• Cottage cheese and some mild cheeses
• Butter and margarine
• Eggs
– Except fried
(continues)
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Stop and Share
• Tender chicken, fish, sweetbreads, ground
beef, and ground lamb
• Soup broth
• Cooked, mild-flavored vegetables without
coarse fibers
• Refined breads and cereals, white crackers,
macaroni, spaghetti, and noodles
(continues)
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Stop and Share
• Custard, sherbet, or vanilla ice cream
• Coffee, tea, cocoa, or carbonated beverages
• Salt, sugar, or small amount of spices as
permitted
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Inflammatory Bowel Disease
• Chronic condition causing inflammation in
gastrointestinal tract
• Ulcerative colitis
– Inflammation and ulceration of colon, rectum, or entire
large intestine
• Crohn’s disease
– Chronic progressive disorder
– Can affect both small and large intestines
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Symptoms of Inflammatory Bowel
Disease• Bloody diarrhea
• Cramps
• Fatigue
• Nausea
• Anorexia
• Malnutrition
• Weight loss
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Treatment of Inflammatory Bowel
Disease• Anti-inflammatory drugs
• Medical nutrition therapy
– Low-residue diet
– When tolerated, 100 g of protein, additional calories,
vitamins, and minerals
– Severe cases may require total parenteral nutrition (TPN)
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Ileostomy or Colostomy
• Stoma or surgical opening from body surface
to intestine for purpose of defecation
• Ileostomy
– From ileum to abdomen surface
• Colostomy
– From colon to abdomen surface
• May be temporary or permanent
(continues)
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Ileostomy or Colostomy
• Clients with ileostomies have greater than
normal need for salt and water because of
excess losses
• Vitamin C supplement recommended
• In some cases, B12 supplement required
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Celiac Disease
• Also known as nontropical sprue or gluten
sensitivity
• Malabsorption of virtually all nutrients
• Symptoms:
– Diarrhea, weight loss, malnutrition, and foul-smelling,
light-colored, bulky stools
(continues)
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Celiac Disease
• Cause unknown
– Considered to be hereditary
• Treatment:
– Gluten-controlled diet
• Protein found in barley, oats, rye, and wheat
• May use rice and corn
• Must read food labels
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Cirrhosis
• General term for liver disease characterized by
cell loss
• May be acute or chronic
• Most often caused by alcohol abuse
• Other causes:
– Congenital defects, infections, or other toxic chemicals
(continues)
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Cirrhosis
• Liver does regenerate
– But replacement during cirrhosis does not match loss
• Complications:
– Hypertension, anemia, hemorrhage in esophagus, ascites,
and death
(continues)
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Cirrhosis
• Dietary treatment:
– 25 to 35 calories or more per kg per day
– 0.8 to 1.0 g of protein per kg per day
– May not tolerate fats or proteins well
– May need to increase CHO
– May supplement with vitamins and minerals
– May need to restrict fibers if bleeding
– No alcohol allowed
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Hepatitis
• Acute or chronic inflammation of liver
• Causes:
– Viruses
– Toxic agents
• E.g., drugs, alcohol
(continues)
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Hepatitis
• Hepatitis A virus (HAV) contracted through
contaminated drinking water, food, and
sewage via fecal-oral route
(continues)
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Hepatitis
• Hepatitis B virus (HBV) and hepatitis C virus
(HCV) transmitted through blood, blood
products, semen, and saliva
– Can lead to chronic active hepatitis (CAH)
• Diagnosed by liver biopsy
• Chronic active hepatitis can lead to liver
failure and end-stage liver disease (ESLD)
(continues)
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Hepatitis
• Symptoms:
– Nausea, headache, fever, fatigue, tender and enlarged liver,
anorexia, and jaundice
• Weight loss can be pronounced
• Treatment:
– Bed rest, fluids, and medical nutrition therapy
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Medical Nutrition Therapy for
Hepatitis• 35 to 40 calories per kg of body weight per day
• Provide most calories by carbohydrates
• Have moderate fat intake
• If necrosis not severe, up to 70 to 80 g of
protein needed for cell regeneration
(continues)
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Medical Nutrition Therapy for
Hepatitis• If necrosis severe, limit proteins to prevent
accumulation of ammonia in blood
• Clients may prefer frequent, small meals
– Rather than three large meals
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Cholecystitis and Cholelithiasis
• Cholecystitis
– Inflammation of gallbladder
• Cholelithiasis
– Gallstones
(continues)
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Cholecystitis and Cholelithiasis
• Contributing factors:
– Being female, obesity, TPN, very low calorie diets for
rapid weight loss, estrogen use, and various diseases of
small intestine
• Both may inhibit flow of bile
• Symptoms:
– Pain, indigestion, and vomiting
(continues)
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Cholecystitis and Cholelithiasis
• Treatment:
– Medication to dissolve stones
– Diet therapy
• Abstinence during acute phase followed by clear liquid diet and,
gradually, regular fat-restricted diet
– Surgery may be indicated
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Pancreatitis
• Inflammation of pancreas
• Causes:
– Infections, surgery, alcoholism, biliary tract disease, or
certain drugs
• May be acute or chronic
• Symptoms:
– Abdominal pain, nausea, steatorrhea, and weight loss
(continues)
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Pancreatitis
• Diabetes mellitus may be complication
• Diet therapy:
– During acute phase, strict parenteral nutrition
– Later, liquid diet of carbohydrates to minimize stimulatory
effect on pancreatic secretions
– As recovery progresses, small, frequent feedings of
carbohydrates and protein with little fat or fiber
(continues)
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Pancreatitis
• May give vitamin supplements
• Alcohol forbidden in all cases
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Residue-Controlled Diets
• Residue made up of all undigested and
unabsorbed parts of food, connective tissue in
animal foods, dead cells, and intestinal bacteria
and their products
– Most composed of fiber
• Diets can be adjusted to increase or decrease
fiber and residue
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High-Fiber Diet
• Often 30 g or more
• Helps prevent diverticulosis, constipation,
hemorrhoids, and colon cancer
• Sources:
– Coarse and whole-grain breads and cereals, bran, all fruits,
vegetables (especially raw), and legumes
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Low-Residue Diet
• 5 to 10 g of fiber per day intended to reduce
normal work of intestines by reducing food
residue
• May be used in cases of severe diarrhea,
diverticulitis, ulcerative colitis, intestinal
blockage, and in preparation for and
immediately after intestinal surgery
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Conclusion
• Wide variety of therapeutic diets used for
clients with gastrointestinal disturbances
– Peptic ulcers
• Medications, avoidance of alcohol, and caffeine
– Diverticulosis
• High-fiber diet
(continues)
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Conclusion
• Wide variety of therapeutic diets used for
clients with gastrointestinal disturbances
– Diverticulitis
• Gradual progression from clear liquid to high-fiber diet
– Ulcerative colitis
• Low-residue diet combined with high protein and high calories
(continues)
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Conclusion
• Wide variety of therapeutic diets used for
clients with gastrointestinal disturbances
– Cirrhosis
• Substantial, balanced diet, with occasional restrictions of fat,
protein, salt, or fluids
– Hepatitis
• Full, well-balanced diet
– Although protein may be restricted
(continues)
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Conclusion
• Wide variety of therapeutic diets used for
clients with gastrointestinal disturbances
– Cholecystitis and cholelithiasis
• Fat-restricted diet and, in cases of overweight, addition of calorie-
restricted diet
– Pancreatitis
• TPN to individualized diet as tolerated