slide 1 lecture 8 chs 487 gastrointestinal and accessory organ problems chs 487 by dr. ebtisam...

Lecture 8 Lecture 8 Gastrointestinal and Accessory Organ Problems CHS 487CHS 487

By Dr. Ebtisam FetohyBy Dr. Ebtisam Fetohy

Part 1Part 1• Problems with the GI system can have

a major impact on a patient’s overall well-being.

• Careful assessment can identify problems early to prevent more serious complications.

Key ConceptsKey Concepts

Diseases of the gastrointestinal tract Diseases of the gastrointestinal tract and its accessory organs interrupt and its accessory organs interrupt the body’s normal cycle of:the body’s normal cycle of:

• Digestion,

• Absorption, and

• Metabolism.

Problems of the MouthProblems of the Mouth

• Dental problemsDental problems Tooth decay Ill-fitting dentures Mechanical soft diet helpful

• Surgical proceduresSurgical procedures Healing nutrients administered with:Healing nutrients administered with:A. High-protein,

B. High-caloric milk shakes

(Cont'd…)

Problems of the MouthProblems of the Mouth/2/2

• Oral tissue inflammationOral tissue inflammation Gingivitis Stomatitis Glossitis Cheilitis

• Salivary gland problemsSalivary gland problems Infections Excess salivation Xerostomia (permanent dry mouth)

(Cont'd…)

Problems of the Mouth/3Problems of the Mouth/3

• Swallowing disordersSwallowing disorders Dysphagia Dysphagia البلع في البلع صعوبة في fairly common fairly common صعوبة

problemproblem

• Insufficient production of saliva

• Dry mouth

• Abnormal peristaltic motility of the esophagus

• Complications of medication

• Neurologic problems

(Cont'd…)

Problems of the Mouth/4Problems of the Mouth/4

• Warning signs of swallowing disordersWarning signs of swallowing disorders Reluctanceالتردد 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, chokingخنق

(Cont'd…)

Problems of the Problems of the EsophagusEsophagus

• Central tube (esophagus)Central tube (esophagus) Muscle spasms or uncoordinated

contractions Stricture (narrowing) of the tube

• Lower esophageal sphincter problemsLower esophageal sphincter problems Achalasia انقباض or cardiospasm تشنج Changes in smooth muscle Nerve-muscle hormone control of peristalsis

(Cont'd…)

Problems of the Problems of the Esophagus/2Esophagus/2

• Lower esophageal sphincter problemsLower esophageal sphincter problems Swallowing problems Frequent vomiting Fullness in the chest Weight loss from eating difficulty Serious malnutrition Pulmonary complications and infections

caused by aspirationaspiration الشفط of food particles

(Cont'd…)


1. Gastroesophageal reflux disease (GERD1. Gastroesophageal reflux disease (GERD) Caused by constant regurgitation of acid gastric

contents into lower esophagus Pregnancy, obesity, pernicious vomiting, or

nasogastric tubes are factors Constant irritation and inflammation

(esophagitis) Stenosis most common complication

(Cont'd…)


2. Hiatal hernia2. Hiatal hernia Portion of upper stomach protrudes

through opening in the diaphragm membrane (hiatus)

Especially common in obese adults

Hiatal Hernia in Comparison with Hiatal Hernia in Comparison with Normal Stomach PlacementNormal Stomach Placement

A.A. Normal stomach:Normal stomach:

• Normal stomach placement below esophageal hiatus

(Cont'd…)

Hiatal Hernia in Comparison with Hiatal Hernia in Comparison with Normal Stomach Placement/2Normal Stomach Placement/2

B. B. Paraesophageal Paraesophageal hernia:hernia:

• Only a small portion of the stomach rises above the hiatus;

• No change in the position of the esophagus.

(…Cont’d)

Hiatal Hernia in Comparison with Hiatal Hernia in Comparison with Normal Stomach Placement/3Normal Stomach Placement/3

C. C. Esophageal hiatal Esophageal hiatal hernia:hernia:

In obese persons, excessive fat tissue pushes on the stomach and forces it through the diaphragm

(…Cont’d)

Problems of the Problems of the StomachStomach Peptic Ulcer Disease (PUD)Peptic Ulcer Disease (PUD)

• Caused by Helicobacter pylori infection

• Tobacco smoking linked to PUD

• Chronic use of nonsteroidal antiinflammatory (NSAIDs) drugs may contribute to development in some persons

• Lesion usually occurs in duodenal bulb-نبتة بداية

(Cont'd…)

Peptic Ulcer Disease Peptic Ulcer Disease (PUD)/2(PUD)/2

• Stress during young- and middle- adult years may contribute

• Symptoms include *increased gastric muscle toneincreased gastric muscle tone and *painful contractions when stomach empty

Management include:Management include:

• Smoking, alcohol use should be eliminated

• Rest, relaxation, and sleep help ease symptoms.

• For certain susceptible individuals, NSAIDs should be avoided.

(Cont'd…)

(Cont'd…)

Peptic Ulcer Disease (PUD)/3Peptic Ulcer Disease (PUD)/3

• How is PUD diagnosedHow is PUD diagnosed? Confirmed by

1. X-ray tests and

2. Visualization by gastroscopy.

• Treatment goals are to:Treatment goals are to: Alleviate symptoms Promote healing Prevent complications Eliminate the cause

Slide 17


• Drug therapy can manage peptic ulcer Drug therapy can manage peptic ulcer disease:disease: Blocking agents control acid secretion Mucosal protectors inactivate pepsin and

produce gel-like substance to cover ulcer Antibiotics control H. pylori Antacids counteract or neutralize acid

(Cont'd…)

Peptic Ulcer Disease (PUD)/5Peptic Ulcer Disease (PUD)/5

• Treatments include:Treatments include: Blocking agentsBlocking agents include cimetidine (Tagamet),

ranitidine (Zantac), and omeprazole (Prilosec). Mucosal protectorMucosal protector: sucralfate (Carafate) AntibioticsAntibiotics: generally used in combination

(amoxicillin, proton pump inhibitor, tetracycline, and metronidazole)

AntacidsAntacids such as Mylanta and Maalox (magnesium-aluminum compounds)

Slide 19


• Dietary managementDietary management Well-balanced healthy diet الصحية الحمية Avoid acid stimulation Bland الرقيقة diets have been proven to be

ineffective and lacking in adequate nutrition

• Dietary managementDietary management includes adjustments in includes adjustments in the following areasthe following areas: *meal pattern, *food food quantityquantity, *milk intake, *seasoningsseasoningsتوابلتوابل , *dietary fiber, *coffeecoffee, *citric acid juices, *alcoholalcohol, *smoking, *food environmentfood environment

• Each person can have different triggers to acid production.

Small Intestine DiseasesSmall Intestine Diseases

1. Diarrhea: causes1. Diarrhea: causes Intolerance to specific foods Acute food poisoning Viral infections

• Diarrhea: definition:Diarrhea: definition:—loose, watery stools occurring more than three times in one day

(Cont'd…)

Small Intestine Diseases Small Intestine Diseases (…Cont’d)

What is the main complication associated with What is the main complication associated with diarrhea?diarrhea?

• Dehydration

• Chronic diarrhea can be life-threatening to young children or adults with weak immune systems.

• Until diarrhea subsides, patients should avoid milk milk productsproducts and foods that are greasy, high-fiberhigh-fiber, or very sweet. These foods tend to aggravate diarrhea.

• Health professional may recommend the BRATBRAT diet (bananasbananas, rice, applesapples, toast).

Cont'd…)

Slide 22


2.Malabsorption2.Malabsorption Maldigestion problems Intestinal mucosal changes Genetic disease Intestinal enzyme deficiency Cancer and its treatment Metabolic defects

• Can cause many problems, from diarrhea to malnutrition.

• Celiac sprueCeliac sprue, cystic fibrosis, and inflammatory bowel inflammatory bowel

diseasedisease are three diseases that cause malabsorption.(Cont'd…)

Small Intestine DiseasesSmall Intestine Diseases(…Cont’d)

A. Celiac sprue: A. Celiac sprue: نتيجة الحارة البالد نتيجة اسهال الحارة البالد اسهالالهضمي الجهاز الهضمي اضربات الجهاز اضربات

Hypersensitivity to the protein gluten in certain grains

Steatorrhea and progressive malnutrition are secondary effects to gluten reaction

Nutrition management controls dietary gluten intake and prevents malnutrition


• Celiac الهضمي الجهاز الهضمي اضربات الجهاز diseaseاضرباتdamages the small intestine and interferes with absorption of nutrients from food.

• The only treatment for celiac disease is to follow a gluten-free diet.

• What are some foods that contain gluten? (foods prepared with wheat wheat , oatالشوفان , or barleybarleyالشعير ; luncheon meats)

• More info: http://www.celiac.org/(Cont'd…)

Slide 25


B. Cystic fibrosis (CF):B. Cystic fibrosis (CF): Genetic disease of childhood Inhibits movement of chloride and sodium ions in the

body tissue fluids

• Thick mucus in the lungs leads to damaged airways, difficulty breathing, and lung infections.

• Thick secretions also obstruct the pancreas, preventing digestive enzymes from reaching the intestines to help break down and absorb food.

• Causes malabsorption of undigested foodsmalabsorption of undigested foods, liver disease, and increased salt concentration in the tissues.increased salt concentration in the tissues.

(Cont'd…)


B. Cystic fibrosis (CF):/2B. Cystic fibrosis (CF):/2 Treated with pancreatic replacement

products Children with CF require 105% - 150% of

recommended nutrients for their age Nutritionally adequate high-protein, normal-

to-high fat diet recommended

(Cont'd…)


C. Inflammatory bowel diseaseC. Inflammatory bowel disease Applies to both ulcerative colitis and Crohn’s diseaseApplies to both ulcerative colitis and Crohn’s disease Short-bowel syndrome results from repeated surgical Short-bowel syndrome results from repeated surgical

removal of parts of the small intestine as disease removal of parts of the small intestine as disease progressesprogresses

Reduces absorption of nutrientsReduces absorption of nutrients

• Diet gradually advanced to restore nutrient intake:Diet gradually advanced to restore nutrient intake: High protein (100 g/day)High protein (100 g/day) High-energy (2500-3000 kcal/day)High-energy (2500-3000 kcal/day) Increased vitamins and minerals (supplements)Increased vitamins and minerals (supplements)


C. Inflammatory bowel disease C. Inflammatory bowel disease (…Cont’d)

• The most common symptoms of ulcerative colitis are abdominal painabdominal pain and bloody diarrhea.bloody diarrhea.

• Patients should avoid foods that upset the should avoid foods that upset the intestinesintestines, such as highly seasoned highly seasoned متبلةمتبلة foodsfoods, raw fruits and vegetables, or milk sugar milk sugar (lactose). (lactose).

• Check out: http://www.ccfa.org/ (Crohn’s & Colitis Foundation of America)

Slide 29

Large Intestine DiseasesLarge Intestine Diseases

1. Diverticular (blow out 1. Diverticular (blow out ألنبوبة ألنبوبة انتفاخ انتفاخطرفيها أحد طرفيها مسدود أحد disease) disease (مسدود

DiverticulosisDiverticulosis: formation of many small pouches جيوب(diverticula) along muscular mucosal lining

Diverticulitis caused by pockets becoming infected

(Cont'd…)

Mechanism By Which Low-Fiber, Low-Mechanism By Which Low-Fiber, Low-Bulk Diets Might Generate DiverticulaBulk Diets Might Generate Diverticula

Large Intestine DiseasesLarge Intestine Diseases (…

Cont’d)

2. Irritable bowel syndrome (IBS)2. Irritable bowel syndrome (IBS) Multicomponent disorderMulticomponent disorder ofof::

1. Physiologic,

2.2. EmotionalEmotional, عاطفي3. Environmental,

4.4. Psychologic functionPsychologic function Common recurrent pain in abdomen Small-volume bowel dysfunction Excess gas formation

(Cont'd…)

Large Intestine DiseasesLarge Intestine Diseases (…Cont’d)

• One in five Americans has IBSIBS, making it one of the most common disorders diagnosed by doctors.

• It occurs more often in womenoften in women than in men, and it usually begins around age 20.

• More information: http://www.iffgd.org/

Slide 33

Large Intestine Diseases Large Intestine Diseases (…Cont’d)

2. Irritable bowel syndrome (2. Irritable bowel syndrome (IBS):IBS): Individual approach to nutrition care essentialIndividual approach to nutrition care essential

• Increase dietary fiber

• Recognize gas formers

• Respect food intolerances

• Reduce total fat content

• Avoid large meals

• Decrease air-swallowing habits

(Cont'd…)

Irritable Bowel SyndromeIrritable Bowel Syndrome

Large Intestine Diseases Large Intestine Diseases (…Cont’d)

3.Constipation:3.Constipation: Common short-term problemCommon short-term problem

• Nervous tension and worry

• Changes in routines

• Constant laxative use

• Low-fiber diets

• Lack of exercise

Dietary management rather than laxatives

Large Intestine Diseases Large Intestine Diseases (…Cont’d) 3. Constipation

• Dietary management calls for:Dietary management calls for: Increased fiber Fruits that act as a natural laxative Adequate fluid intake

• Engaging in daily exercise is also effective in preventing constipation.

• Laxatives should be avoided, if possible, to prevent dependence.

• Many people think they are constipated when, in fact, Many people think they are constipated when, in fact, their bowel movements are regulartheir bowel movements are regular.

• Constipation is one of the most common gastrointestinal complaints in USA.

Slide 37

Part 2Part 2

Key ConceptsKey Concepts• Allergic conditions produce sensitivity to certain

food components.• Underlying genetic diseases may cause metabolic

defects that block the body’s ability to handle specific food nutrients.

Food AllergiesFood Allergies

• Allergic reaction is body’s immune system reacting to a protein as a threatening foreign object

• Anaphylactic الحساسية shock is the mostفرطsevere form of allergic reaction

• Common food allergensCommon food allergens Peanutsالفستق , tree nutsبندق Shellfish الصدفية fish , األسماك Milk, soyصويا , egg, wheat

Food Allergies Food Allergies (…Cont’d)

• Scientists estimate that approximately 11 million Americans suffer from true food allergies.

• Avoidance is the only way to prevent an allergic reaction.

• Food elimination sometimes used to identify disagreeable foods

• Dietitian can provide guidance on food substitutions or special food products

• Recipes الوصفات modified to maintain nutritional needs for growth

Food Allergies Food Allergies (…Cont’d)

• Children tend to be less allergic as they get older.

• What are the common symptoms of a What are the common symptoms of a reaction?reaction? (hiveshives جلدي جلدي طفح ,nausea, diarrhea,diarrhea , طفحand abdominal pain)

• A food intolerance is an adverse food-induced reaction that doesn't involve the immune system.

• More information: http://www.foodallergy.org/index.html(Cont'd…)

Genetic Disease & Food Genetic Disease & Food IntolerancesIntolerances

1. Phenylketonuria1. Phenylketonuria Phenylalanine hydroxylase enzyme not produced

in body Causes profound mental retardation and central

nervous system damage Treated with low-phenylalanine diet using special

formulas and low-protein food products

• Adherence to the diet is crucial in infancy and childhood.

• Diet is revised over time as the child's nutritional needs change.

(Cont'd…)

Genetic Disease & Food Genetic Disease & Food Intolerances Intolerances (…Cont’d)

2. Galactosemia2. Galactosemia Missing galactosiase (GALT) cell enzyme that

converts galactose to glucose Causes liver and brain damage Treated by galactose-free diet with special

formulas for infants and lactose-free food guides

• Identified in newborn screening programs.

• Treatment should begin immediately and must be followed for life.

(Cont'd…)

Genetic Disease & Food Genetic Disease & Food Intolerances Intolerances (…Cont’d)

3. Lactose intolerance3. Lactose intolerance Deficiency of any of the disaccharidase in small

intestine Produces wide range of GI problems Milk and all lactose products avoided Milk treated with commercial lactosecommercial lactose product or

soy milksoy milk are safe substitutes

Biliary System OrgansBiliary System Organs

Liver DiseaseLiver Disease

• Hepatitis Inflammatory condition caused by virus,

alcohol, drugs, toxins Treatment based on bed rest and nutrition

therapy

(Cont'd…)

Liver StructureLiver Structure

Liver Diseases Liver Diseases

• Cirrhosis Fatty cirrhosis associated with malnutrition

and alcoholism Fatty infiltration kills liver cells, leaving

nonfunctioning scar tissue

(Cont'd…)

Comparison of Normal Liver and Comparison of Normal Liver and Liver with Cirrhotic Tissue ChangesLiver with Cirrhotic Tissue Changes

Liver DiseasesLiver Diseases (…Cont’d)

• Hepatic comaHepatic coma 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

Gallbladder DiseaseGallbladder Disease

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

ingredients

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

Pancreatic DiseasePancreatic Disease

• PancreatitisPancreatitis Obstruction of common duct causes enzymes

and bile to back up into pancreas Results in acute inflammation as enzymes

digest organ tissue Caused by:Caused by: 1. Gallstones and

2. Excessive alcohol consumption

slide 1 lecture 8 chs 487 gastrointestinal and accessory organ problems chs 487 by dr. ebtisam...

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