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xerostomia

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caused by reduced salivary flow, is a side effect of man medications and is associated with a number of diseases and disease treatments.

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Medications that cause dry mouth

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Antidepressants, antihistamines, antihypertensive, antineoplastic, bronchodilators and other meds.

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Sjorgren's Syndrome

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an autoimmune disease characterized by the destruction of secretory glands, resulting in dry mouth and dry eyes.

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Other conditions affecting dry mouth

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Radiation therapy that treats head and neck cancers, excessive mouth breathing, uncontrolled diabetes mellitus.

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Oropharyngeal

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involving the mouth and pharynx.

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esophageal

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involving the esophagus.

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oropharyngeal dysphagia

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an inability to transfer food from the mouth and pharynx to the esophagus usually caused by a neurological or muscular disorder.

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Complications of dry mouth

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interfere with speaking and swallowing, mouth infections, bad breath, dental diseases. Dentures my be uncomfortable to wear and ulcerations may develop where they contact the mouth. Taste sensations is often diminished, salty or spicy foods may cause pain. Reduce food intake can cause malnutrition.

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Epiglottis

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blocks the opening to the trachea to prevent aspiration of food substances or saliva into the lungs.

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Peristalsis

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forces the bolus through the esophagus and the lower esophageal sphincter relaxes to allow passage of bolus into the stomach.

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symptoms of dysphagia

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inability to initiate swallowing, coughing during or after swallowing( due to aspiration), and nasal regurgitation. Frequently follows a stroke

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Suggestions for dry mouth

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take frequent sips of water or another sugarless beverage, suck on ice cubes or frozen fruit juice bars, eat foods such as soups, stews, sauces, gravies yogurt, pureed fruit, avoid dry foods like toast , chips, crackers, avoid citrus juices, spicy or salty foods if they cause irritation.

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lifestyle practices for dry mouth

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chew sugarless gum to help stimulate salivary flow, avoid caffeine, alcohol, and smoking, use humidifier during the night

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Saliva Substitutes

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use over the counter saliva substitutes (available as gels, sprays, and tablets, especially just before meals and at bedtime.

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Medications

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if meds cause dry mouth as for an alternative med, take meds that stimulate saliva secretion such as cevimeline,( Evoxac) and pilocarpine (Salagen).

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Esophageal dysphagia

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interferes with the passage of materials through the esophageal lumen and into the stomach, and is usually cause by an obstruction in the esophagus or a motility disorder.

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Achalasia

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most common motility disorder , is a degenerative nerve condition affecting the esophagus, it is characterized by impaired peristalsis and incomplete relaxation of the lower esophageal sphincter when swallowing.

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symptoms of esophageal dysphagia

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sensation of food "sticking" in the esophagus after its swallowed.

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causes of an obstruction

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stricture (abnormal narrowing) , tumor, compression of the esophagus by surrounding tissues. Motility disorder hinders the passage of both solids and liquids, obstruction only hinders passage of solid foods.

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Complications of Dysphagia

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if conditions restricts food consumption, malnutrition and weight-loss may occur. Individuals who cannot swallow liquids are at increase risk for dehydration. If aspiration occurs , may cause choking, airway obstruction, or respiratory infections (pneumonia).

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Nutrition intervention for Dysphagia

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individual for dysphagia may need to consume foods and beverages that have been physically modified so that they are easier to swallow. A persons swallowing ability can fluctuate over time so the dietary plan needs frequent reassessment. Dysphagia diet - presents brief descriptions of the different levels of the diet and some sample meals. Diet is selected through trial and error usually by a speech and language therapist.

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Causes of Oropharyngeal Dysphagia

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Alzheimer's disease, Amyotrophic lateral sclerosis (lou Gehrig's disease), Cerebral palsy, MS, Muscular dystrophy, Parkinson's disease , stroke

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Causes of esophageal dysphagia

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Achalasia, esophageal cancer, esophageal spasm, external compression (tumor, enlarged thyroid gland, or enlarged left atrium), scleroderma, strictures (from inflammation, scarring, or a congenital abnormality.

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Dysphagia diet food examples

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food textures altered to make easier to swallow- solid foods: pureed , mashed, ground or minced. Liquid consistencies: thin, nectar-like, honey-like, and spoon thick.

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Alternative feeding strategies for Dysphagia

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changing position of the head and neck while eating/drinking can minimize some swallowing difficulties learn new methods of swallowing that allow them to consume normal diet. Taught exercises that strengthen the jaws, tongue, larynx.

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GERD

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is characterized by the backward flow (reflux) of the stomach's acidic contents into the esophagus leading to pain, inflammation, and possibly tissue damage. Heartburn or acid indigestion

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Causes of GERD

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weak lower esophageal sphincter or relaxes inappropriately. predisposing factors : high stomach pressures , inadequate acid clearance ( esophagus) higher rates associated with obesity, pregnancy and hiatal hernia

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Hiatal hernia

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a condition in which the upper portion of the stomach protrudes above the diaphragm; most cases are asymptomatic

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consequences of GERD

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if gastric acid remains in the esophagus long enough to damage the esophageal lining, the resulting inflammation is called reflux esophagitis. Severe and chronic inflammation may lead to esophageal ulcers with the consequent bleeding. Pulmonary disease may develop if gastric contents are aspirated into the lungs. Barrett's Esophagus: a condition in which damaged esophageal cells are gradually replaced by cells that resemble those in gastric or intestinal tissue ; such cellular changes increases the risk of developing esophageal cancer. GERD can cause sore throat, cough, laryngitis, eroded tooth enamel.

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Proton-Pump inhibitors (most effective of the anti-secretory agents)

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a class of drugs that inhibit the enzyme that pumps hydrogen ions (protons) into the stomach. Examples: omeprazole (Prilosec) and lansoprazole (prevacid). Used for rapid healing of esophagitis and maintenance treatment.

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Treatment of GERD

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Objective: to alleviate symptoms and facilitate the healing of damaged tissue. severe cases: may require immediate acid suppressing meds mild cases: managed with dietary lifestyle changes medications: suppress gastric acid secretion to help healing process

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histamine- 2 receptor blockers

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a class of drugs that suppress acid secretion by inhibiting receptors on acid-producing cells; commonly called H2 blockers. Examples: cimetidine (Tagamet) ranitidine (Zantac) and famotidine (Pepcid).

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Conditions/Substances that increase pressure within the stomach

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Ascites ( abdominal fluid accumulation) Carbonated beverages delayed gastric emptying eating large meals obesity pregnancy wearing tight clothing around the wrist or abdomen

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Conditions/substances that weaken the lower esophageal sphincter

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Alcohol, anticholinergic drugs, antihistamines, caffeine beverages, calcium and channel blockers, chocolate, cig smoking, diazepam, estrogen, progesterone, fatty foods, peppermint, spearmint,

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Properties of liquids

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Thickened liquids are easier to swallow than thin liquids such as water or juice. 4 levels of liquid consistencies prescribed for dysphagia patients: thin, nectar like, honey-like, and spoon-thick. Hydration is more difficult to obtain when patient has access to only thickened beverages.

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Diet Modifications of GERD

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small meals, drink liquids between meals so stomach does not become overly distended which can exert pressure on the lower esophageal sphincter. Limit foods that weaken lower esophageal sphincter pressure or increase gastric secretion: chocolate, fried and fatty foods, spearmint, peppermint, coffee, and tea. During esophagitis avoid foods and beverages that irritate esophagus: citrus fruits, and juices, tomato products, garlic, onions, pepper, spicy foods, carbonated drinks, and very hot or cold foods.

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Diet Modifications for GERD

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Avoid eating bedtime snacks or lying down after a meal. Meals should be consumed 3 hours before bedtime. Elevate head of the bed, avoid tight clothes, NSAIDS because they damage esophageal mucosa, avoid cigarettes, and alcohol.

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Dyspepsia

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symptoms of pain or discomfort in the upper abdominal area, often called indigestion; a symptom of illness rather than a disease itself

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Causes of Dyspepsia

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foodborne illness, GERD, peptic ulcers, gastric motility disorders, gallbladder and pancreatic diseases, and tumors in the upper GI tract. Heart disease, Hypothyroidism, diabetes and medications can cause Gastric symptoms as well

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Causes for vomiting

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medications, foodborne illness, pregnancy, motion sickness, neurological disease, inner ear disorders, hepatitis, chronic illnesses.

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intractable vomiting

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vomiting that is not easily managed or controlled ; ,may require intravenous nutrition support if not easily controlled

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gastritis

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inflammation of stomach tissue

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Treatment of Nausea and Vomiting

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Restoring hydration, if medication is the cause take it with food If cause unknown medications may be prescribed to suppress the nausea and vomiting

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Dietary Interventions for Nausea

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consume small meals, drink beverages in between meals, dry starchy foods such as toast, pretzels, crackers may help, fatty or spicy can worsen symptoms or strong odor foods, cold or at room temp foods

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Causes of Acute Gastritis

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result from irritating substances, or treatments that damage the gastric mucosa resulting in tissue erosions, ulcers, or severe bleeding. Chronic cases : caused by long term infections or autoimmune disease and progress to widespread gastric inflammation and tissue atrophy.

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Causes of Gastritis

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Helicobacter pylori= infection or the ue of NSAIDS which are primary causes of peptic ulcer disease.

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Dietary Interventions for Gastritis

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Asymptomatic= no dietary adjustments needed Pain or discomfort= avoid irritating foods (spicy, cola, coffee, fried, fatty foods.

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Peptic Ulcer Disease

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an open sore in the gastrointestinal mucosa; may develop in the esophagus ,, stomach or duodenum. develops from gastric acid and pepsin overwhelm mucosal defenses and destroy mucosal tissue.

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Primary Factors of Peptic Ulcers

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development of H. pylori infection, NSAIDS (damage lining) otherwise cigarette smoking or psychological stress.

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Drug therapy for Peptic Ulcers

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treatment uses a combo of different antibiotics to eradicate H.Pylori infection and or discontinuing the use of aspirin and other NSAIDS. Meds: amoxicillin, clarithromycin, metronidazole, tetracycline. Triple Therapy: includes two antibiotics and an ant secretory drug.

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Nutrition care for Peptic ulcers

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correct nutrient deficiencies; avoid dietary items that increase acid secretion or irritate the gastrointestinal lining. Examples: alcohol, coffee, chocolate, pepper, Eat small meals, avoid consumption two hours before bedtime, avoid cigarette smoking

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complications of Peptic Ulcers

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major cause of gastrointestinal bleeding , perforations of the stomach or duodenum, penetration of the ulcer into an adjacent organ, and gastric outlet obstruction.

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Gastrectomy

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the surgical removal of part of the stomach or the entire stomach mainly diseased areas of the stomach

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bariatric surgery

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surgery that treats severe obesity.

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Nutrition care after gastrectomy

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to meet nutritional needs of the postsurgical patient and promote the healing of stomach tissue and to prevent nutrient deficiencies. following gastrectomy , oral intakes of fluids and foods is suspended until some healing has occurred, and fluids are supplied intravenously.

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Dumping syndrome

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a cluster of symptoms that result from the rapid emptying of an osmotic load from the stomach into the small intestine.

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Nutrition problems following a gastrectomy

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after a gastrectomy, takes time for patient to learn the amount of food that can be consumed without discomfort. Fat malapsorption, bone disease, and anemia

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Bariatric Surgery

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is currently considered the most effective and durable treatment for morbid obesity. Must have BMI of greater than 40 or BMI of 35-40 accompanied by severe weight related problems such as diabetes, hypertension, or debilitating osteoarthritis. Patient must of attempted a variety of nonsurgical weight loss measures.

Medical Nutrition Therapy 2 – Upper GI disorders – Flashcards

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