DIET THERAPY FOR GASTROINTESTINAL DISEASES

Question 1

These infants have a high nutritional requirement
to prepare for surgery and rapid growth.

The care provider must practice care in the
positioning and feeding of these children to
prevent aspiration.

Certain types of nipples and/or tubing may be
required for infant feeding.

Families need counseling

Answer 1

MOUTH: Cleft Lip and/or Palate

Question 2

The esophagus is separated from the stomach
by the diaphragm. When the stomach
partially protrudes above the diaphragm
because of the weakening of the diaphragm
opening, results.

Answer 2

hiatal hernia

Question 3

Hiatal hernia is usually treated with

Answer 3

antacids
and a low-fat diet.

Question 4

____ feedings per day are recommended,
and fluids are taken between meals for hiatal hernia

Answer 4

six small

Question 5

Foods that irritate esophageal mucosa are
eliminated—for example,

Answer 5

orange, tomato, or
grapefruit juices.

Question 6

is of concern for many reasons. Foods may
enter the trachea and aspirate into the lungs, allowing
bacteria to multiply, leading to pneumonia.

Answer 6

Dysphagia

Question 7

disabilities, and nervous
system diseases. It may be only temporary,
such as a piece of food lodged in the back of
the throat, for which the ________ is
appropriate first aid, or it may be involved
with insufficient production of saliva and
xerostomia.

Answer 7

abdominal thrust

Question 8

_____ are the most difficult food form to swallow.
Depending on the level of dysphagia, liquids may need
to be thickened. Thickening agents include baby rice,
commercially prepared thickeners, potato flakes, or
mashed potatoes.

Answer 8

Thin liquids

Question 9

Levels of thickness include thick ( and medium thick (nectar consistency).

Answer 9

yogurt or pudding
consistency)

Question 10

Regurgitation of acid gastric contents into the lower
part of the esophagus creates constant tissue irritation
because the wall of the esophagus is not protected
from the acid of the stomach.

Answer 10

Gastroesophageal reflux disease (GERD),

Question 11

During reflux, many patients feel a burning sensation
behind the sternum that radiates toward the mouth,
producing the most common symptom of GERD:
heartburn _______ , which is unrelated to disease of
the heart

Answer 11

(pyrosis)

Question 12

Additional symptoms of GERD include

Answer 12

acid indigestion
and regurgitation, which often have a negative effect
on quality of life.

Question 13

Areas affected include the lower portion of
the esophagus, stomach, and first portion of
the duodenum, called the duodenal bulb.
Esophageal and gastric ulcers are less
common.

occur
usually along the lesser curvature of the
stomach.

Answer 13

PEPTIC ULCER DISEASE

Question 14

Peptic ulcer is caused by ___ ____in
the stomach or intake of nonsteroidal anti
inflammatory drugs (NSAIDs).

Answer 14

Helicobacter pylori

Question 15

Intake of aspirin or other NSAIDs such as _____
induce ulcer formation by
interfering with formation of prostaglandins,
the chemicals that help the mucosal lining
resist caustic acid damage.

Answer 15

ibuprofen (Motrin), naproxen (Naprosyn), and
etodolac (Lodine)

Question 16

Dietary recommendations are formed from
individual tolerance and should be considered
supplemental to pharmaco- logic therapy. No
conclusive evidence supports use of a
traditional “bland” diet to decrease gastric
acid secretion or increase the time it takes to
heal ulcers. In short, individuals with PUD
should be

Answer 16

encouraged to eat a healthy diet
from foods they enjoy.

Question 17

Emphasize a balanced, nutritious diet.

Limit the following foods and seasonings, and
encourage

avoidance of lifestyle habits known to increase acid
secretion, inhibit healing, or both:

Caffeine (including coffee, tea, or decaffeinated
coffee)

Black pepper

Chocolate

Foods that are irritating or not well tolerated

Alcohol

Eating less than 2 hours before bedtime

Answer 17

recpommendations with people experiencing peptic ulcer disease

Question 18

Secretory, osmotic, and inflammatory processes in
the intestine result in increased losses of fluid and
electrolytes from

Answer 18

diarrhea.

Question 19

diarrheaoccurs either because a
disorder interferes with how food is digested
or because a disorder interferes with how
nutrients are absorbed.
change
in bowel habits, apathy, fatigue, and a smooth
surface on the lateral tongue.

Answer 19

MALABSORPTION

Question 20

Gluten molecules trigger an autoimmune and
inflammatory response in the small intestine,
causing the usually brush like lining of the
intestine to flatten, thereby becoming much
less able to digest and absorb foods.

Answer 20

CELIAC DISEASE

Question 21

The goal of nutritional management is to control
intake of dietary gluten and prevent
malnutrition. The diet is better defined as low
gluten rather than gluten free because it is
impossible to remove all gluten.

Answer 21

CELIAC DISEASE

Question 22

is inherited as an autosomal recessive
trait in about 3% of the Caucasian population.

It is the most common fatal genetic disease among
Caucasians, occurring in about 1 in 3300 live
Caucasian births, 1 in 15,300 African-American
births, and 1 in 32,000 Asian-American births.

Approximately one third of CF cases in the United
States involve adults.

The leading characteristic of CF is hypersecretion of
abnormal, thick mucus that obstructs exocrine
glands and ducts.

Therefore it can be classified as a respiratory disease
or GI disorder.

Answer 22

Cystic fibrosis

Question 23

The overall nutritional goal is to support
normal nutrition and growth for all ages15:

Answer 23

• Unrestricted diet, including high-fat foods
  and additives
• Three meals and two to three snacks each
  day
• Vitamin supplementation
• Pancreatic enzymes
• Supplements and nutrient-dense
  nourishments may help

Encouragement to consume whole grains,
nuts, fruits, and vegetables for adequate
vitamin and mineral intake

• Extra salt to replace that lost in sweat
• Adequate calcium, vitamin D, and vitamin K

Question 24

The two most common forms ofINFLAMMATORY BOWEL DISEASE
are

Answer 24

Crohn’s disease and ulcerative
colitis (UC).

Question 25

is particularly prevalent in
industrialized areas of the world.

Also called regional enteritis and
granulomatous colitis, inflammation
produced by _______extends
through all layers of the intestinal wall,
most commonly in the proximal portion of
the colon and less often the terminal
ileum.

Answer 25

Crohn’s disease

Question 26

Because the cause of IBD is unknown, treatment is
focused on

Answer 26

alleviating and reducing inflammation.

Question 27

Similar drug therapies are used for Crohn’s disease and
UC:

Answer 27

antibiotics, immunosuppressants,
immunomodulators, and biologic therapies.

Question 28

A small percentage of patients with UC require

Answer 28

surgery

Question 29

Approximately 80% of patients with ___
will eventually require surgery.

Answer 29

Crohn’s disease

Question 30

Fifty percent of these patients will require a second
surgery within __ years as a result of disease
recurrence. Strictures often require minimal resection;
colitis may require colectomy with ileorectal
anastomosis or ileostomy. Abscesses are drained, and
enteric fistulas are resected.

Answer 30

10

Question 31

When an oral diet cannot meet nutritional needs, enteral
nutrition (EN) or PN is used:

Answer 31

Enteral feedings or total parenteral nutrition (TPN)

Progression to low-fat, low-residue, high-protein, high-

calorie, small, frequent meals

Vitamin and mineral supplements: vitamin D, zinc,

calcium, magnesium, folate, vitamin B12, iron

Question 32

Nutrition therapy in remission includes the following19:

Answer 32

Tailor for the patient’s current GI function

Energy and protein at levels to maintain weight and

replenish nutrient stores

Avoid foods high in oxalate

Increase antioxidant intake

Consider supplementation with omega-3 fatty acids
and glutamine

Use probiotics and prebiotics

Diet as complete as possible

Question 33

is a malabsorptive condition
secondary to surgical removal of parts of the small
intestine with extensive dysfunction of the remaining
portion of the organ.

Severity of malabsorption is contingent on the amount
and location of bowel resection. Removal of the distal
two thirds

of ileum and ileocecal valve often results in severe
malnutrition because the ileocecal valve controls the
transit time of intestinal contents. Removal often
promotes a transit time too rapid for sufficient absorption
of nutrients.

Absorption of water, electrolytes, protein, fat,
carbohydrates, vitamins, and minerals is significantly
reduced when large portions of the small intestine are
lost.

Answer 33

Short bowel syndrome

Question 34

Degrees of surgical resection create different problems,
and nutrition therapy must be tailored to

Answer 34

individual’s
remaining functional capacity.

Question 35

Nutritional status should continue to be monitored. As
adaptation progresses, early restriction of fat may be
liberalized somewhat with moderate use of the more
easily absorbed MCT oil to obtain needed

Answer 35

Kilocalories.

Question 36

Sometimes called spastic colon, is a
recurring functional disorder typified by
abdominal pain or discomfort with
alternating diarrhea and constipation for
which no organic explanation is available.

Answer 36

IBS -IRRITABLE BOWEL DISEASE

Question 37

Malabsorption of lactose, fructose, and sorbitol can
cause ____
assortment of foods can trigger flatulence which may
cause pain and distention in some patients.

Answer 37

bloating, distention, flatulence, and diarrhea. An

Question 38

To identify triggers, follow a low ______ 6
weeks and add high FODMAP food one at a time in small
amounts to identify food that triggers the symptoms.
Once identified, these foods can be limited to prevent
“triggers.”

Answer 38

FODMAP (fermentable
oligo-, di-, and monosaccharides and polyols) diet for