NCM 211 NUTRITION AND DIET THERAPY (LECTURE)

Father Saturnino Urios University

Prepared by: REANNE MAE C. ABRERA SN
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2. Carminatives are drugs that relieve flatulence → Carminasan, Corzyme, Coconut

ESOPHAGITIS
Tree Brand Carminative Oil
❖ Inflammation of the mucosal lining of the esophagus.
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
❖ The symptoms are heartburn, regurgitation, and dysphagia.
❖ The classifications are: ❖ It is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of
1. Acute Esophagitis → caused by ingestion of an irritating agent, viral infection, or muscle between the esophagus and stomach.
prolonged gastric intubation. ❖ Many people, including pregnant women, suffer from heartburn or acid indigestion
2. Chronic or Reflux Esophagitis → result of recurrent GER (gastroesophageal caused by GERD.
reflux), hiatal hernia, reduces LES (lower esophageal sphincter) pressure, recurrent
REFLUX
vomiting, etc.
❖ Eat small, frequent meals. Large meals increase stomach pressure.
DIETARY MANAGEMENT: ESOPHAGITIS
❖ Reflux triggers vary from person to person. Eliminate trigger foods then reintroduce one
❖ Liquid diet in acute phase to reduce irritation at a time and determine tolerance.
❖ Limit use of irritating foods (too acidic or too spicy)
HIATAL HERNIA
❖ Limit or restrict foods that reduce LES (lower esophageal sphincter) pressure such as
❖ It is the outpouching of a portion of the stomach into the chest through the esophageal
alcohol, carminatives, chocolate, and caffeine containing beverages.
hiatus of the diaphragm.
❖ Low fat diet
❖ There are two types of hiatal hernia:
❖ Timing of evening meal should be three (3) hours before lying down.
1. Paraesophageal or sliding
1. Fat takes the longest time to leave the stomach.
2. Gastroesophageal
❖ The symptoms are discomfort after heavy meals; difficulty breathing, lying down, and
DIETARY MANAGEMENT: DUMPING SYNDROME OR JHS
bending over; esophageal reflux and esophagitis.
❖ Restrict simple CHO (carbohydrates) to prevent rapid passage of food and formation of a
❖ A hiatal hernia is a condition in which the upper part of the stomach bulges through an
concentrated hyperosmolar solution.
opening in the diaphragm.
❖ High CHON (protein) in order to rebuild tissue and maintain weight.
❖ Relative high fat to slow passage of food
❖ Five to six (5-6) meals daily
❖ Fluids in between meals
❖ Relatively low fiber foods

GASTRITIS

❖ It is the inflammation of the gastric mucosa.

❖ If left unresolved, it can lead to ulcers, hemorrhage, shock obstruction, perforation, and
gastric cancer.
❖ There are two (2) types of gastritis;
1. Acute Gastritis → follows repeated irritation of gastric mucosa; caused by H.

DIETARY MANAGEMENT: HIATAL HERNIA pylori and other bacterial infections, alcohol abuse, food irritants, food allergies,
food poisoning, radiation therapy, metabolic stress, and medications.
❖ Omit caffeine, chili powder, black pepper (omit means exclude).
2. Chronic Gastritis → associated with aging, H pylori infections and conditions that
❖ No eating for three (3) hours before reclining or sleeping.
cause the chronic reflux of basic fluids from the duodenum into the stomach.
DUMPING SYNDROME A.K.A JEJUNAL HYPEROSMOLIC SYDNDROME (JHS)
DIETARY MANAGEMENT: GASTRITIS
❖ The symptoms result from the rapid entry of undigested food into the jejunum, sweating,
❖ No food for 24 to 48 hours to allow the stomach to rest and heal
weakness, diarrhea, and hypoglycemia.
❖ Nasogastric lavage with iced water if there is bleeding
❖ The occurrence of dumping syndromes happens when the pyloric sphincter has been
➢ Nasogastric lavage means washing out the stomach to remove drugs and drugs
removed, bypassed, or disrupted.
or poison
❖ Liquid as tolerated
DIETARY MANAGEMENT: DYSPEPSIA OR INDIGESTION
❖ Avoid black pepper and chili powder, onion garlic
❖ Eat a well balanced diet.
❖ Bland diet
❖ Avoid rapid eating, poor mastication (chewing), and overindulgence (eating too much of
the same food).

DYSPEPSIA OR INDIGESTION

❖ It is an indefinite term frequently used to descsribe any discomfort in the GIT

(gastrointestinal tract).
❖ Its’ causes are emotional tension or stress; eating too much, eating too rapidly, or
chewing poorly, and the result of an organic disease of the GIT (gastrointestinal tract)
❖ The symptoms are heartburn (pyrosis), nausea, epigastric pain, abdominal discomfort,
belching, distention, and flatulence.
 PEPTIC ULCER DIETARY MANAGEMENT: PEPTIC ULCER

❖ An eroded lesion in the mucous membranes of the esophagus, stomach, or duodenum. ❖ It is based on individual needs and food tolerances.
❖ There are two (2) types of peptic ulcers: ❖ Adequate CHON (protein) for healing.
1. Gastric Ulcer ❖ Moderate fat to suppress gastric secretion and motility.
2. Duodenal Ulcer ❖ SFF
❖ Its’ causes are H. pylori infection, long term use of NSAIDS, and cancerous tumors in the ❖ Regular meals, moderate size, regular intervals
stomach or pancreas. ❖ Omit (exclude) alcohol, caffeine, black pepper, chili powder, cocoa meat extractives
❖ The symptoms are epigastric pain for 1 to 3 hours after meals characterized as a burning, ❖ Give soluble fibers to prevent constipation.
gnawing, or sharp pain.
CELIAC DISEASE OR SPRUE

❖ It is also known as Gluten-Induced/Sensitive Enteropathy/Non-tropical Sprue

❖ It is a genetic disease characterized by intolerance to the gliadin fraction of gluten that
causes flattening of the intestinal villi and malabsorption.
❖ The symptoms are malabsorption, lactose intolerance, chronic diarrhea, weight loos,
failure to thrive, muscle wasting, and nutrient deficiencies.
 ❖ The causes are poor elimination habits, lack of fiber, insufficieint fluid intake, loss of
intestinal muscular tone, nervous strain or anxiety, fluid and electrolyte imbalances,
hormonal imbalances, diseases of the GIT (gastrointestinal tract), and chronic laxative
abuse.

DIETARY MANAGEMENT: CONSTIPATION

❖ High in both soluble and insoluble fiber

❖ High fluid intake
❖ Exercise

DIARRHEA

❖ Frequent passage of liquid stools, accompanied by excessive loss of fluid and electrolytes.
❖ Intractable diarrhea → severe, chronic diarrhea that does not respond to treatment.
DIETARY MANAGEMENT: CELIAC SPRUE ❖ There are four (4) types of diarrhea:

❖ Gluten free diet no wheat, barley, and rye as they contain gluten 1. Osmotic → presence of osmotically active solutes in the intestinal tract (dumping

❖ High caloric intake, CHON (protein) syndrome, lactose intolerance)

❖ Moderate fiber and fat 2. Secretory → result of secretion of electrolytes and water in the intestinal

❖ MCT (medium chain triglycerides) oil for improved fat absorption epithelium (bacterial toxins, viruses, and increased intestinal hormone secretion)

❖ Vitamin and Mineral supplementation 3. Exudative → mucosal damage which leads to an outpouring of mucus, blood, and

❖ Lactose-free diet plasma proteins (Crohn’s disease, ulcerative colitis, radiation enteritis)
4. Limited mucosal contact diarrheas → results from conditions of inadequate
CONSTIPATION
absorptive area or rapid transit of chyme (Crohn’s disease, after extensive bowel
❖ It is the retention of the feces in the colon beyond the normal length of emptying time.
resction)
❖ The condition of having infrequent or difficult bowel movements; it is a symptom and NOT
a disease.
 DIETARY MANAGEMENT: DIARRHEA

❖ NPO (Nothing per oral) for 12 hours with IV fluids and electrolytes
❖ Give ORS (Oral Rehydration Solution)
❖ Infants → continue breastfeeding or full strength formula feeeding; supplement with
water or ORS
❖ Children → begin with cereals, starches, then meat, poultry, fish, and eggs then cooked
vegetables, and finally fruits and milk; SFF; give nutrient dense foods
❖ Adults → SFF; avoid fat, fiber, raw fruits (except bananas), fruit juice, and sweetened
beverages, lactose-containing products, caffeine, and spices

DIVERTICULAR DISEASE

❖ There are two types of diverticular diseases:

1. Diverticulosis → presence of mucosal sacs or herniations (diverticula) protruding
through the intestinal wall; which can lead to diverticulitis; Characterized by
long-term constipation and increased colonic pressure; incidence increased with
age; prevalent in diets with increased refined foods and lack of exercise.
2. Diverticulitis → inflammatory condition of a diverticulum or diverticula;
Characterized by inflammation caused by bacteria of fecal matter.
❖ The characteristics are presence of abdominal pain and stention, alternating episodes of
diarrhea and constipation, indigestion, flatus and fever, a diverticulum can rupter
(peritonitis), bleeding may occur; and if repeated inflammation occurs, it can lead to
fibrosis.
 DIETARY MANAGEMENT: DIVERTICULAR DISEASE 8 FOODS RICH IN COPPER

❖ Acute Stage Diverticulitis ❖ Liver

➢ IV feeding and NPO (nothing per oral) ❖ Oysters
➢ Start oral feeding with an elemental formula → low residue diet → increasing ❖ Spirulina
amounts of fiber → regular diet high in fiber ❖ Shiitake Mushrooms
➢ Avoid excess intake of fruits and vegetables and hot spices ❖ Nuts and Seeds
❖ Diverticulosis ❖ Lobster
➢ 15 to 25 grams of dietary fiber / day ❖ Leafy Greens
➢ High fiber diet may increase the need for Ca (calcium, Mg (magnesium), P ❖ Dark Chocolate
(phosphorus), and Cu (copper).

WHAT IS A LOW RESIDUE DIET?

❖ It limits high-fiber foods, like whol grain breads and cereals, nutes, seeds, raw or dried
fruits, and vegetables.
❖ “Residue” is undigested food, including fiber, that makes up stool.
❖ The goal of the diet is to have fewer, smaller bowel movements each day.
 ➢ As problem improves, oral feeding is resumed → fiber restricted, high caloric and
INFLAMMATORY BOWEL DISEASE (IBD)
protein intake
❖ It is the general name for disease that causes inflammation in the intestines.
➢ High MCT (medium chain triglycerides)
❖ There are two (2) types of inflammatory bowel disease (IBD):
➢ Avoid highly seasoned foods and restrict lactose during flare-ups
1. Crohn’s Disease / Regional Enteritis → inflammation and ulceration along the
length of the GIT (gastrointestinal tract), often with granulomas; Symptoms are ➢ Vitamin and mineral supplementations

fatigue, anorexia, variable malnutrition, weight loss, RLQ pain or cramping,

STEATORRHEA
diarrhea, and fever
2. Ulcerative Colitis → inflammation and ulceration of the colon; during active ❖ The presence of fat in stools which may be caused defective fat absorption, lack of bile, or

episodes, it can cause continuous diarrhea with malabsorption; Symptoms are lack of lipase.

bloody diarrhea, cramping, abdominal pain, anorexia, weight loss, and anemia ❖ They are also known as oily stools.

may develop DIETARY MANAGEMENT: STEATORRHEA

DIETARY MANAGEMENT: INFLAMMATORY BOWEL DISEASE (IBD) ❖ High caloric and protein (CHON) intake

❖ Crohn’s Disease ❖ CHO (carbohydrates) and fats as tolerated

❖ Supplements of FSV (fat-soluble vitamins) , Ca (calcium), Zn (zinc), Mg (magnesium), and
➢ Increased caloric and protein (CHON) intake
Fe (iron)
➢ Give vitamin and mineral supplements
❖ MCT (medium chain triglycerides)
➢ Limit dietary fat to 40 to 50 grams a day if steatorrhea is evident
TROPICAL SPRUE
➢ Give MCT (medium chain triglycerides) and supplemental Ca (calcium), Zn (zinc),

and Mg (magnesium) if steatorrhea is sever ❖ A diarrheal syndrome that occurs in many tropical areas.
❖ An infectious type of diarrhea where intestinal villis are shortened and the surface cell
➢ Restrict lactose if there is intolerance
alterations are less severe than celiac sprue.
❖ Ulcerative Colitis: Acute Stage
❖ Gastric mucosa may be atrophied and inflamed, with diminished secretion of HCi and
➢ Minimal residue diet
intrinsic factor
➢ Intractable cases, TPN (Total Parenteral Nutrition) is required
❖ The symptoms are diarrhea, anorexia, abdominal distention, nutritional deficiencies, and
anemia.

DIETARY MANAGEMENT: TROPICAL SPRUE

❖ High CHON (protein)

❖ Low fat due to steatorrhea
❖ Vitamin supplementations

CIRRHOSIS

❖ Chronic, progressive diseases of the liver in which fibrous tissues replaces functioning
liver cells
❖ The characteristics are liver cells that are irreversible damaged and interrupted blood
flow.
❖ The causes are chronic alcoholism (Laennec’s cirrhosis), infections (chronic hepatitis),
diseases of the hepatobiliary tract, later stages of CHF (congestive heart failure), severe
reactions to medications or toxins, and inherited metabolic disorders (hemochromatosis
or Wilson’s disease).
❖ The symptoms are impaired circulation, anorexia, vomiting, epigastric pain, distention,
DIETARY MANAGEMENT: CIRRHOSIS
steatorrhea, jaundice, and nutritional deficiencies.
❖ The consequences are portal HPN (hypertension), collaterals and esophageal varices, ❖ High calories (45 to 50 kcal/kg DBW)
ascites and edema, elevated blood ammonia levels, hepatic encephalopathy and hepatic ❖ High CHON → 1.5 to 20g/kg DBW
coma, clotting abornamlities, insulin resistance, and malnutrition. ❖ High CHO → to spare CHON
❖ Moderate to low fat; MCT (medium chain triglycerides)
❖ Supplement vitamins
❖ Low sodium → 500 to 1000mg if edema and ascites are present
❖ Liquid to soft, low fiber diet, alcohol is not allowed

HEPATITIS
❖ Inflammation of the liver marked by degenerative changes
❖ The causes are infectious agents (viruses and bacteria), transfusion of incompatible
blood, and toxic drugs
❖ The symptoms are anorexia, malaise, weakness, nausea, vomiting, diarrhea, headaches,
fever, enlarged liver and spleen, jaundice, and impaired immunocompetence
DIETARY MANAGEMENT: HEPATITIS
❖ High CHON → 1.0 to 1.5 g/kg BW
❖ High CHO → 50 to 55% of TER
❖ Moderate fat → 30 to 35%; use of MCT oil
❖ May be given in liquid form initially
❖ During acute phase of the disease: full liquid diet → soft diet → regular diet
❖ SFF; Encourage intake of fluids but avoid alcohol
❖ Vitamin and mineral supplementations
FULL LIQUID DIET
❖ It is made up only of fluids and foods that are normally liquid and foods that turn to
liquid when they are at room temperature, like ice cream. It also includes:
➢ Strained creamy soups, tea, juice, Jell-O, milkshakes, pudding, popsicles
❖ Patients can not eat solid foods when on a full liquid diet.
SOFT DIET
❖ It is made up of foods that are soft, easy to chew, and swallow. These foods may be
chopped, ground, mashed, pureed, and moist.
➢ Moist dry or cooke cereal
➢ Macaroni, pasta, noodles, or rice
➢ Cooked fruits or ripe, soft peeled fruits such as bananas, peaches, or melons
➢ Soft, well-cooked vegetables without seeds or skin
➢ Soups with small soft pieces of vegetables and meat
➢ Milk or milk drinks, milkshakes
➢ Ice cream, sherbet, or frozen yogurt without fruits or nuts
➢ Yogurt (plain or with soft fruits)
➢ Gelatin dessert with soft canned fruit, pudding, or custard
HEPATIC ENCEPHALOPATHY (HE)
❖ A type of brain damage caused by ammonia intoxication due to failure of the liver to
convert ammonia to urea.
❖ The symptoms are personality changes, disorientation, “flapping” tremors of the hands
and spasticity.
❖ The etiology comes from accumulation of serum ammonia.
❖ The characteristics are symptoms of impeding hepatic coma (confusion, apathy,
drowsiness, personality changes, muscle contractions, and spasms), electrolyte
imbalances, and breath has fecal odor.
DIETARY MANAGEMENT: HEPATIC ENCEPHALOPATHY (HE)
❖ Adequate calories to prevent tissue breakdown
❖ Low protein diet
 ➢ Zero protein for not more than three (3) days
➢ Gradual increase by 0.5g/kg BW to 1.0g/kg BW as condition improves
❖ BCAA supplementation and less AAA
CHOLECYSTITIS
➢ Branced-chain amino acids (BCAAs) are a group of three (3) essential amino
acids: leucine, isoleucine, and valine. BCAA supplements are commonly take in ❖ Inflammation of the gall bladder

order to boost muscle growth and enhance exercise performances. ❖ There are two (2) types of cholecystitis:

➢ Aromatic amino acids (AAA) are a group of three (3) essential amino acids: 1. Acute Cholecystitis without stones → can occur in critically ill problems or when

tryptophan, tyrosine, and phenylalanine. the gallbladder and its bile are stagnant; Symptoms are epigastric pain that

❖ Tube feeding if oral feeding is insufficient or not tolerated
HEPATIC COMA
❖ A neurologic disorder indicating extensive liver damage.
❖ It is characterized by varying degrees of consciousness, stupor, and lethargy.
❖ The symptoms are personality change, trembling of the hands, loss of memory,
hyperventilation, convulsions, and respiratory alkalosis.
❖ STAGE I: personality changes, vacant stare
❖ STAGE II: lethargy, flapping tremors, muscle twitching
radiates to the shoulder and lower abdominal region, nausea and vomiting, chills
and fever, and jaundice.
2. Chronic Cholecystitis → caused by diminished spontaneous contractile activity
and reduced contractile responsiveness to the hormone cholecystokinin;
Symptoms are colicky pain, belching, and flatulence; The cause is gallstones
blocking the bile ducts, leading to the backup of bile.
DIETARY MANAGEMENT: CHOLECYSTITIS
❖ Acute Cholecystitis

❖ STAGE III: noisy, abusive, violent ➢ NPO (Nothing per orem) for 24 hours or more

❖ STAGE IV: ankle clonus, knee clonus, foetor hepaticus, babinski’s sign, and lastly in coma. ➢ Progress from clear → full liquid diet for 2-3 days → low fat diet (30g/day) →
moderate fat intake (50 to 60g/day)
DIETARY MANAGEMENT: HEPATIC COMA
■ A clear liquid diet consists of clear liquids – such as water, broth, and
❖ Protein restriction: 30 grams/day or less; as problem condition improves, gradually plain gelatin – that are easily digested and leave no undigested residue in
increase protein intake your intestinal tract.
❖ Provide sufficient calories from CHO (carbohydrates) and Fat ❖ Chronic Cholecystitis
❖ Supplement with BCAA ➢ Moderate fat intake
 ➢ Protein kept at 1g/kg BW
➢ Adjust calories to achieve and maintain DBW

CHOLELITHIASIS

❖ Formation of stones in the gallbladder; stones are made up of cholesterol, bile acids,
calcium and other organic salts and bilirubin.
❖ The causes are stones that slip into the bile duct causing obstruction, pain and cramps, as
well as bacterial infections.
❖ The risk factors are more severe from obese patients, women, increased age, diabetes
mellitus patients, use of cholesterol-lowering medications, TPN (total parenteral
nutrition) use, short bowel syndrome
➢ Short bowel syndrome (SBS, or simple short gut) is a malabsorption disorder
caused by a lack of functional small intestine. The primary symptoms is diarrhea,
which can result in dehydration, malnutrition, and weight loss.
DIETARY MANAGEMENT: CHOLELITHIASIS

❖ Acute Gallstone Attack

➢ Low fat diet → to decrease gallbladder contractions
❖ Sluggish Gallbladder
➢ Moderate fat intake – to stimulate gallbladder contraction, thus preventing
stagnation of bile
➢ High fiber

PANCREATITIS

❖ Inflammation of the pancrease

❖ It is characterized by edema, cellular exudates, and fat necrosis.
❖ The symptoms range from continuous or intermittent pain or varrying intensity to severe
upper abdominal pain which may radiate to the back.
❖ The clinical signs are nausea and vomiting, abdominal distention, and steatorrhea.
❖ The causes are chronic alcholism, biliary tract disease, gallstones, certain drugs, trauma,
hyperglyceridemia, hypercalcemia, and some infections.
➢ Biliary disease refers to disease affecting the bile ducts and other structures
involved in the production and transportation of bile.
■ Bile is a fluid produced by the liver that aids the digestion of fats. If any
duct in this complex system becomes diseased or blocked, a number of
serious diseases may result.
➢ Hypertriglyceridemia denotes high (hyper-) blood levels (-emia) of triglycerides,
the most abundant fatty molecule in most organisms. Elevated levels of
triglycerides are associated with atherosclerosis, even in the absence of
DIETARY MANAGEMENT: PANCREATITIS
hypercholesterolemia (high cholesterol levels), and predispose to cardiovascular
disease. ❖ Acute Pancreatitis
➢ Withhold oral and enteral feeding
➢ Support with IV fluids
➢ With the start of oral nutrition: easily digestible foods, low fat diet, SFF, adequate
caloric and protein intake
❖ Chronic Pancreatitis
➢ Provide oral diet if tolerated
➢ Supplement pancreative enzymes, FSV (fat-soluble vitamins) and Vitamin B12.

CYSTIC FIBROSIS
❖ It is a hereditary disorder characterized by the production of thick mucus that affects
many organs, lung congestion and infection, and malabsorption of nutrients by the
pancreas.
❖ The characteristics are generalized dysfunction of exocrine glands, sweat contains large
amounts of NaCl and K, thick mucus secretions causing obstruction, lack of pancreatic
enzymes, and vitamin deficiencies.
➢ Exocrine glands secrete substances onto an epithelial surface by way of a duct.
Examples include sweat, salivary, mammary, ceruminous, lacrimal, sebaceous,
and mucous.
❖ The consequences are chronic lung disease, malabsorption, and loss of electrolytes in
sweat.

DIETARY MANAGEMENT: CYSTIC FIBROSIS

❖ High caloric, protein, sodium, and liberal fat

❖ Supplements of WSV (water-soluble vitamins) and FSV (fat-soluble vitamins) as needed