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MNT for GIT Disorder
Leny Budhi Harti Jurusan Gizi Fakultas Kedokteran
Universitas BrawijayaMalang, 12 Maret 2012
nata03111990.blogspot.com
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Contents
Background1
Clasification2
Medical Nutrition Therapy3
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Background
Penyebab kematian : diare 3,5% gastric and duodenal ulcer 1,7% Thypoid 1,6%
Riskesdas, 2007
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Lower GIT Disorder- Constipation - Diarrhea- Lactose Malabsorption - Thypoid - Inflammatory bowel
disease- Hemoroid - Diverticular disease
Upper GIT Disorder- Dysphagia- GERD- Gastritis &
Gastroenteritis- Peptic Ulcer
Classification
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Medical Nutrition Therapy
Upper GIT
DisorderPeptic Ulcer
Gastritis
Dysphagia
GERD
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Dysphagia
Dysphagia is defined as difficulty in swallowing caused by neurological or structure demage.
Thomas, Briony & Jacki Bishop. Manual of Dietetic Practice. 2007
radiologyassistant.nl
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Dysphagia
Common Causes of Dysphagia
Mechanical
• Oesophageal strikture• Oesophageal spasm• Cancer in head, neck and oesophageal areas
Neurological
• Stroke• Parkinson’s disease• Head injury• Cerebal palsy• Dementia
Thomas, Briony & Jacki Bishop. Manual of Dietetic Practice. 2007
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Dysphagia
Tujuan Diet :1. Mencegah aspirasi makanan dan minuman2. Menyediakan makanan merangsang
fungsi menelan3. Menjaga BB/ meningkatkan BB4. Individualize diet5. Menghindari defisinesi mikronutrient
Sylvia Escott – Stump, Nutrition and Diagnosis Related Care. 2008
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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
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GERD
gastroesophageal reflux disease (GERD) backward flow of the stomach or duodenal contents into the esophagus
burning in the chest, with sour or bitter taste, and acid regurgitation
Connie J Standiford, William E Chavey, R Van Harrison, UMHS GERD Guideline, January 2007 National Institute of Diabetes and Digestive and Kidney Diseases
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GERD
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MNT for GERD
Nutritional care guidelines :1. The diet should be so arranged as to provide adequate nutrition2. Avoid large, high fat meals, especially 3 to 4 hours before
retiring3. Avoid smoking4. Avoid chocolate, alcohol, caffeine-containing beverages, such
as coffee5. Avoid peppermint and spearmint oils6. Stay upright and avoid vigorous activity soon after eating7. Avoid acidity and highly spices food when inflamation exists8. High in protein →increase LES pressure9. Provide small, frequent feedings of soft food10. Fluid will be taken between meals
Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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Gastritis
National Institute of Diabetes and Digestive and Kidney Diseases
medicastore.com
Gastritis : inflammation of the stomach
Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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Gastritis
Acut Gastritis
Pain, nusea, vomiting, usualy in short duration
low serum B12 level or elevated serum homocystine levels
blood in vomit black, tarry
stools red blood in the
stool
Chronic gastritis Erosive gastritis
National Institute of Diabetes and Digestive and Kidney Diseases
Helicobacter pylori (H. pylori), NSAIDs, alcohol, tobacco, radiation
Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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MNT For Gastritis
Energi diberikan sesuai dengan kebutuhan pasienProtein cukup sesuai dengan kemampuan pasienLemak rendah 10-15% dari kebutuhan energi. Utamakan jenis lemak PUFAKarbohidrat, sisa dari kebutuhan energi setelah dikurangi protein dan lemakVitamin C diberikan tinggiPada gastritis kronik perlu pemberian vit. B12Rendah serat, utamakan serat larutPada fase akut : diberikan makanan parenteral→mengistirahatkan lambung
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MNT For Gastritis
Cairan diberikan cukupMakanan diberikan bertahap sesuai dengan keadaan pasienPorsi kecil dan seringHindari makanan yang merangsang saluran cerna, seperti : cabe, merica, minyak, cukaHindari makanan yang bersifat melekat, seperti: dodol, ketanHindari makanan yang menimbulkan gas, seperti : kol, kubis, sawi, ksngkung, durian, nangka, dll
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Peptic Ulcer
peptic ulcer a lesion in either the esophageal,g astric, or duodenal mucosa resulting from the action of gastric secretions and typically H. pylori bacterial inflammation
homeohealthcenter.com
Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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MNT For Peptic Ulcer
Protein foods temporarily buffer gastric secretions, but they 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
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Lower GIT Disorder- Constipation - Diarrhea- Lactose Malabsorption - Thypoid - Inflammatory bowel disease- Hemoroid - Diverticular disease
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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
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Constipation
Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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Constipation
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MNT For Constipation
Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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Diarrhea
Diarrhea is characterizedby the frequent evacuation of liquid stools, usually exceeding 300 ml, accompanied by an excessivel of fluid and electrolytes, especially sodium and potassium.
Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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Diarrhea
Diarrhea Medication
Exudative
Osmotic
Secretory
Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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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
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MNT For Diarrhea
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Treatment Diarrhea in infants & Children
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Derajat Dehidrasi
Penilaian A B CKeadaan Umum Baik, sadar Gelisah, rewel Lesu, lunglai, atau
tidak sadarMata normal, Cekung Sangat cekung dan
keringAir mata Ada Tidak ada Tidak adaMulut dan lidah basah Kering Sangat keringRasa haus Minum biasa
tidak hausHaus, ingin minum banyak
Malas minum/ tidak bisa minum
Turgor kulit Kembali cepat Kembali lambat Kembali sangat lambat
Hasil Pemeriksaan Tanpa dehidrasi Dehidrasi ringan/sedang
Dehidrasi berat
Kapita Selekta Kedokteran Edisi ke-3 jilid 1 dan 2
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MNT For Diarrhea
Diare dengan dehidarsi ringan/sedang :o 3 jam pertama diberikan cairan sebanyak 75ml/kg BB
Umur Jumlah Oralit yang diberikan tiap BAB
Jumlah oralit yang disediakan dirumah
< 12 bulan 50-100 ml 400 ml/hari (2 bungkus)
1-4 tahun 100-200 ml 600-800 ml/hari(3-4 bungkus)
> 5 tahun 200 – 300 ml 800-1000ml/ hari (4-5 bungkus)
Dewasa 300-400 ml 1200-2800 ml/hari
Kapita Selekta Kedokteran Edisi ke-3 jilid 1 dan 2
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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
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Lactose Maldigestion
Laktosa : disakarida yang terdapat dalam susu
Jika tidak ada enzym lactase, maka dikolon akan difermentasi oleh bacteri
Kembung, nyeri perut, nusea, diare (feses cair berbau asam)
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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 mealsMany 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
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Thypoid
DefinitionA 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), urine and bone marrow. Positive Widal test
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MNT For Thypoid
Syarat Diet :1. Energi diberikan sesuai dengan kebutuhan ,
ditingkatkan bila ada demam dan sepsis2. Protein : 1,5 – 2 gram/kgBB/hr, protein yang bernilai
biologis tinggi3. Lemak mudah serap (MCT)4. Vitamin dan mineral cukup5. 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)
IBD : a general term for inflamatory disease of the bowel, including Crohn’s Disease and ulcerative colitisCharacteristics : diarrhea, fever, weight loss, anemia, food intolerance, malnutrition
cochrane.uottawa.ca
Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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Crohn’s Disease
Peradangan kronik pada usus yang ditandai oleh peradangan salah satu/ semua lapisan GITPenyebab tidak diketahui, kemungkinan autoimunGambaran klinis : panas, penurunan BB, nausea, vomiting, abdominal pain, intestinal dleedingPemeriksaan :leukosit, trombosit, LED yang tinggi. analisis kultur feses, sigmoidoskopi
Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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Ulcerative Colitis
Peradangan rektum dan kolon, terutama mengenai lapisan mukosa usus besar dan menyebar ke daerah yang terkena.
Gejala khas : diare berdarah bercampur dengan mukus dan semakin intensif seiring dengan keparahan penyakit
Gejala lain : nyeri abdomen, anemia, anoreksia dan demam
Penyebab tidak diketahui, kemungkinan karena autoimun
Pemeriksaan : sigmoidoskopi, sinar -X
Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008
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MNT For IBD
Tujuan :1. Memperbaiki ketidak seimbangan cairan dan elektrolit2. Memberikan zat gizi untuk meningkatkan dan
mempertahan status gizi agar tetap normal3. Mencegah iritasi dan inflamasi lebih lanjut4. Mencegah kehilangan zat gizi akibat malabsorbsi5. Mempercepat proses penyembuhan
Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008
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MNT For IBD (Crohn’s Disease & Ulcerative Colitis)
Kebutuhan energi :o BMI < 15 : diberikan energi sebesar 35-45
Kkal/kgBBo BMI 15-19 : energi diberikan sebesar 30-35
kkal/kg BBo BMI 20-29 : energi diberikan sebesar 25-30
kkal/kgBBo BMI > 30 : energi diberikan sebesar 15-25
kkal/kgBB
Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008
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MNT For Crohn’s Disease
Protein tinggi : 1-1,5 gram/kg BB Lemak relatif tinggi, utamakan MCT dan omega-3 Karbohidrat : sisa dari kebutuhan energi Kebutuhan mikronutrien ditingkatkan terutama : vitamin
B1, B12, vitamin A,D,E,K,Zn, Fe, Mg, Ca Mengurangi laktosa, jika terjadi laktose intolerance Probiotik untuk meingkatkan bakteri khusus dalam usus Rendah serat
Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008
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MNT For Ulcerative Disease
Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008
Akut : low fiber diet, TPN for 2 week/ longer during acute stage Protein tinggi : 1-1,5 gram/kg BB Lemak relatif tinggi, utamakan MCT dan omega-3 Karbohidrat : sisa dari kebutuhan energi Kebutuhan mikronutrien ditingkatkan terutama : vitamin B1,
B12, vitamin A,D,E,K,Zn, Fe, Mg, Ca Mengurangi laktosa, jika terjadi laktose intolerance Prebiotik mengubah flora dan produksi SCFAs melindungi
proses inflamasi Six small feeding
Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition
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Hemoroid
elec-intro.com
Konstipasi, sering mengejan, kongesti pelvis pada kehamilan, pembesaran prostat,fibroma uteri, tumor rektum
Price, Sylvia A & Lorraine M. Wilson, Patofisiologi, 1994
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Hemoroid
DerajatI
Eksterna Interna
Hemoroid
Akut Kronik DerajatII
DerajatIII
Price, Sylvia A & Lorraine M. Wilson, Patofisiologi, 1994
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MNT For Hemoroid
Energi dan zat gizi lain diberikan sesuai dengan kebutuhan
Serat tinggi, 25-35 gram/hari Cairan tinggi : 8-10 gelas/hari Setelah operasi diberikan makanan rendah serat dan
bentuk makanan lunak. Jika kondisi pasien sudah membaik dapat diberikan serat 25-35 gram/hari
Hindari laktosa dan BM yang merangsang GIT
Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008
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Diverticular Disease
Diverticulosiiss a situationo f saclikeh herniations( diverticula)of the colonic wall, thought to result from long-term constipationa nd increasedc olonic pressure
Diverticulitis : inflamation of diverticula
Causes :The causes is not known for certain. Increase intracolonic pressure → herniations of the mucosal wallLack of activityLow fiber diet
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MNT For Diverticulosis
Divertikulosis
• Energi dan zat gizi makro (protein dan karbohidrat) diberikan sesuai dengan kebutuhan
• Serat 25-35 g/ hari. Hindari serat yang berlebihan karena dapat mengganggu absorbsi mineral
• Cairan tinggi, 2-2,5 liter/hari• Rendah lemak
Divertikulitis
• Energi, protein, dan karbohidrat diberikan sesuai dengan kebutuhan
• Rendah lemak• Cairan diberikan 8 gelas/hari• Makanan diberikan bertahap
mulai dari makanan cair jernih dengan rendah serat
• Hindari makanan berupa biji2an
• Akut : diet rendah sisi/ TPN
Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008
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