Jean Inman- RD exam Domain 2 Topic C:
Planning and Intervention
Ulcer -✅✅ -Cause: H. Pylori.
Treatment: antacids, antibiotics, H2 blockers
diet: as tolerated, well-balanced, avoid snacks late at night
omit: gastric irritants- cayenne, black pepper, chili powder, excess caffeine & alcohol
✅✅
hiatal hernia - -protrusion of a part of the stomach upward through the opening
in the diaphragm to the chest
Main symptom: heart burn
Treatment: SFM, bland feedings, avoid late night snacks, caffeine, chili powder,
black pepper
Dumping syndrome (Billroth I, II) -✅✅ -follows gastrectomy; symptoms- cramps,
rapid pulse, weakness, perspiration, dizzy
Reactive hypoglycemia (simple CHOs)
Billroth I- (duodenum), calcium & iron
Billroth II- (jejunum)
deficiencies: folate, iron, B12- resolved with restrict simple sugars, fluids during
meals
Gastroparesis - ✅✅ -delayed gastric emptying: surgery, DM, viral infections,
obstructions
Hyperglycemia--> affects gastric nerves, prokinetics to increase stomach motility
Diet: SFM, pureed foods, avoid high fiber & high fat (liquid fat- more tolerated)
Tropical sprue -✅✅ -Bacterial, viral, parasitic infection
Chronic GI disease, intestinal lesions, may also affect stomach
Symptoms: diarrhea, malnutrition, def of B12 + folate d/t decreased HCl + IF
Treatment: high calories, high protein, IM B12 & folate supplements
Non-tropical sprue - ✅✅ -celiac disease. reaction to gliadin- affects jejunum and
ilium
malabsorption, macrocytic anemia, weight loss, diarrhea, steatorrhea, iron deficiency
anemia. NO wheat, rye, barley, oats, bran, graham, malt, bulgur, couscous, durum,
orzo, thickening agents
diverticular disease -✅✅ -Diverticulosis: presence of bulging pouches (diverticula)
on the mucosal lining of GI tract- d/t constipation and intra-colonic pressures
-diet: high fiber diet
,Diverticulitis- diverticula become inflamed; cause- food/residue accumulation and
bacterial action
-diet: clear liquids, low residue, slowly return to high fiber
Oat bran and soluble fibers - ✅✅ -Decrease serum cholesterol by binding bile acids
converting more cholesterol into bile
Gastritis -✅✅ -inflammation of the stomach; anorexia, N/V, diarrhea
-diet: clear liquids, adv. as tolerated, avoid gastric irritants
IBD - ✅✅ -Crohn's disease- anywhere from mouth--> anus; terminal ileum, healthy
mixed w/ inflamed parts
-B12 deficiency leads to megaloblastic anemia
Ulcerative colitis- disease limited to the the colon, begins in rectum; continuous
inflammation
-chronic bloody diarrhea, electrolytes disturbance
-treatment: Acute crohn's flare up- bowel reset, TPN?, Acute UC- elemental diet to
minimize fecal volume; limit fat ONLY w. steatorrhea, assess Ca, Mg, Zn (lost in
steatorrhea), high fat may improve energy balance
irritable bowel syndrome - ✅✅ -a common condition of unknown cause with
symptoms that can include intermittent cramping, abdominal pain, bloating,
constipation, and/or diarrhea
-MNT: avoid large meals, excess caffeine, alcohol, sugars; use food diary to track
intake, emotions, environment, symptoms
lactose intolerance - ✅✅ -Lactose intolerance test- measures glucose levels in the
blood; oral dose of lactose after a fast, if intolerant of lactose--> blood sugar will rise
<25 above fasting (flat curve); if tolerant of lactose, the rise would be above 25
(normal curve)
Steatorrhea - ✅✅ -malabsorption of fat
Normal stool fat 2-5g; >7g= malabsorption
High protein, high complex CHO, fat as tolerated, vitamins (fat soluble), minerals,
MCT
Short Bowel Syndrome (SBS) - ✅✅ -decreased digestion and absorption that result
from a large resection of the small intestine- severity depends on amount resected &
health of patient; concern- loss of ileum, (1/3), loss of ileocecal valve, loss of colon)
-jejunal resection- ileum can adapt to fxn for J
-ileal resection: distal- absorption of B12, IF, bile salts; ileum- absorbs all fluids-->
drink at least 1 liter more than ostomy output daily (water is priority w/o ileum)
, - no bile salts--> malabsorbed fats combine with Ca, Zn, Mg- "soaps", renal oxalate
stones
-MNT: TPN to restore nutrient status, enteral- start early to stimulate growth,
continuous drip; Jejunal- normal balance of nutrients, Ileal- limit fat, use MCT (no bile
salts, needs less intestinal surface area), supplement fat soluble vitamins, CA, Mg,
Zn, Parenteral B12
Liver functions -✅✅ -stores and releases blood, filters toxic elements, metabolizes
and stores nutrients, regulates fluid and electrolyte balance
-Elevated enzymes in blood= tissue damage
ALP- 120
LDH-
AST/SGOT-35
ALT/SGPT-36
✅✅
acute viral hepatitis - -an inflammatory condition of the liver caused by viruses
-symptoms: anorexia, inflammation, necrosis, jaundice, fatigue, nausea
HAV (fecal)- most directly connected to food (raw oysters); HBV- sexually, HCV-
blood to blood
-treatment: increase fluids, 50-55% CHO to replenish glycogen, acute hepatitis (high
protein) 1-1.2 g protein/kg (lipotropic- helps prevent fatty liver), SFM- d/t anorexia
Cirrhosis -✅✅ -damaged liver tissue is replaced by bands of connective tissue,
blood flow is disrupted
-Ascites- accumulation of fluid (plasma) & the sodium that it carries-->d/t blood that
cannot leave the liver
Portal hypertension--> varicies
diet: high protein, high calories, moderate/low fat- fat is preferred fuel in cirrhosis
(omega 3); low fiber w/ varices, low sodium if edema or ascites
Alcoholic liver disease - ✅✅ -(3 stages): hepatic steatosis, alcoholic hepatitis,
cirrhosis
Alcohol--> acetylaldehyde--> excess hydrogen
H--> replaces fat as feul in Kreb's cycle, fat accumulates in liver= fatty liver, blood
and increased TG levels
-malnutrition: increased needs, thiamin deficiency- Wernicke-Korsakoff syndrome
Hepatic Failure (ESLD) - ✅✅ -liver function decrease to 25% or less
- liver cant convert ammonia to urea (NH3 accumulates)
- symptoms: apathy, drowsiness, confusion, coma (PSE), asterisk- sign of impending
coma
Planning and Intervention
Ulcer -✅✅ -Cause: H. Pylori.
Treatment: antacids, antibiotics, H2 blockers
diet: as tolerated, well-balanced, avoid snacks late at night
omit: gastric irritants- cayenne, black pepper, chili powder, excess caffeine & alcohol
✅✅
hiatal hernia - -protrusion of a part of the stomach upward through the opening
in the diaphragm to the chest
Main symptom: heart burn
Treatment: SFM, bland feedings, avoid late night snacks, caffeine, chili powder,
black pepper
Dumping syndrome (Billroth I, II) -✅✅ -follows gastrectomy; symptoms- cramps,
rapid pulse, weakness, perspiration, dizzy
Reactive hypoglycemia (simple CHOs)
Billroth I- (duodenum), calcium & iron
Billroth II- (jejunum)
deficiencies: folate, iron, B12- resolved with restrict simple sugars, fluids during
meals
Gastroparesis - ✅✅ -delayed gastric emptying: surgery, DM, viral infections,
obstructions
Hyperglycemia--> affects gastric nerves, prokinetics to increase stomach motility
Diet: SFM, pureed foods, avoid high fiber & high fat (liquid fat- more tolerated)
Tropical sprue -✅✅ -Bacterial, viral, parasitic infection
Chronic GI disease, intestinal lesions, may also affect stomach
Symptoms: diarrhea, malnutrition, def of B12 + folate d/t decreased HCl + IF
Treatment: high calories, high protein, IM B12 & folate supplements
Non-tropical sprue - ✅✅ -celiac disease. reaction to gliadin- affects jejunum and
ilium
malabsorption, macrocytic anemia, weight loss, diarrhea, steatorrhea, iron deficiency
anemia. NO wheat, rye, barley, oats, bran, graham, malt, bulgur, couscous, durum,
orzo, thickening agents
diverticular disease -✅✅ -Diverticulosis: presence of bulging pouches (diverticula)
on the mucosal lining of GI tract- d/t constipation and intra-colonic pressures
-diet: high fiber diet
,Diverticulitis- diverticula become inflamed; cause- food/residue accumulation and
bacterial action
-diet: clear liquids, low residue, slowly return to high fiber
Oat bran and soluble fibers - ✅✅ -Decrease serum cholesterol by binding bile acids
converting more cholesterol into bile
Gastritis -✅✅ -inflammation of the stomach; anorexia, N/V, diarrhea
-diet: clear liquids, adv. as tolerated, avoid gastric irritants
IBD - ✅✅ -Crohn's disease- anywhere from mouth--> anus; terminal ileum, healthy
mixed w/ inflamed parts
-B12 deficiency leads to megaloblastic anemia
Ulcerative colitis- disease limited to the the colon, begins in rectum; continuous
inflammation
-chronic bloody diarrhea, electrolytes disturbance
-treatment: Acute crohn's flare up- bowel reset, TPN?, Acute UC- elemental diet to
minimize fecal volume; limit fat ONLY w. steatorrhea, assess Ca, Mg, Zn (lost in
steatorrhea), high fat may improve energy balance
irritable bowel syndrome - ✅✅ -a common condition of unknown cause with
symptoms that can include intermittent cramping, abdominal pain, bloating,
constipation, and/or diarrhea
-MNT: avoid large meals, excess caffeine, alcohol, sugars; use food diary to track
intake, emotions, environment, symptoms
lactose intolerance - ✅✅ -Lactose intolerance test- measures glucose levels in the
blood; oral dose of lactose after a fast, if intolerant of lactose--> blood sugar will rise
<25 above fasting (flat curve); if tolerant of lactose, the rise would be above 25
(normal curve)
Steatorrhea - ✅✅ -malabsorption of fat
Normal stool fat 2-5g; >7g= malabsorption
High protein, high complex CHO, fat as tolerated, vitamins (fat soluble), minerals,
MCT
Short Bowel Syndrome (SBS) - ✅✅ -decreased digestion and absorption that result
from a large resection of the small intestine- severity depends on amount resected &
health of patient; concern- loss of ileum, (1/3), loss of ileocecal valve, loss of colon)
-jejunal resection- ileum can adapt to fxn for J
-ileal resection: distal- absorption of B12, IF, bile salts; ileum- absorbs all fluids-->
drink at least 1 liter more than ostomy output daily (water is priority w/o ileum)
, - no bile salts--> malabsorbed fats combine with Ca, Zn, Mg- "soaps", renal oxalate
stones
-MNT: TPN to restore nutrient status, enteral- start early to stimulate growth,
continuous drip; Jejunal- normal balance of nutrients, Ileal- limit fat, use MCT (no bile
salts, needs less intestinal surface area), supplement fat soluble vitamins, CA, Mg,
Zn, Parenteral B12
Liver functions -✅✅ -stores and releases blood, filters toxic elements, metabolizes
and stores nutrients, regulates fluid and electrolyte balance
-Elevated enzymes in blood= tissue damage
ALP- 120
LDH-
AST/SGOT-35
ALT/SGPT-36
✅✅
acute viral hepatitis - -an inflammatory condition of the liver caused by viruses
-symptoms: anorexia, inflammation, necrosis, jaundice, fatigue, nausea
HAV (fecal)- most directly connected to food (raw oysters); HBV- sexually, HCV-
blood to blood
-treatment: increase fluids, 50-55% CHO to replenish glycogen, acute hepatitis (high
protein) 1-1.2 g protein/kg (lipotropic- helps prevent fatty liver), SFM- d/t anorexia
Cirrhosis -✅✅ -damaged liver tissue is replaced by bands of connective tissue,
blood flow is disrupted
-Ascites- accumulation of fluid (plasma) & the sodium that it carries-->d/t blood that
cannot leave the liver
Portal hypertension--> varicies
diet: high protein, high calories, moderate/low fat- fat is preferred fuel in cirrhosis
(omega 3); low fiber w/ varices, low sodium if edema or ascites
Alcoholic liver disease - ✅✅ -(3 stages): hepatic steatosis, alcoholic hepatitis,
cirrhosis
Alcohol--> acetylaldehyde--> excess hydrogen
H--> replaces fat as feul in Kreb's cycle, fat accumulates in liver= fatty liver, blood
and increased TG levels
-malnutrition: increased needs, thiamin deficiency- Wernicke-Korsakoff syndrome
Hepatic Failure (ESLD) - ✅✅ -liver function decrease to 25% or less
- liver cant convert ammonia to urea (NH3 accumulates)
- symptoms: apathy, drowsiness, confusion, coma (PSE), asterisk- sign of impending
coma
