NUTRITIONAL CARE FOR

MALABSORPTION SYNDROMES

NUTRITIONAL CARE FOR MALABSORPTION SYNDROMES

A. LACTOSERESTRICTED DIET - Which relieves the uncomfortable symptoms of lactose

B. POSTGASTRECTOMY DIET C. GLUTEN- FREE DIETS

intolerance. - Controls malabsorption that may occur following surgery of the stomach - Reverse malabsorption caused by celiac disease.

LACTOSE-RESTRICTED DIETS
Are highly individualized diets that most often limit, but do not exclude, milk and milk products.
Treat malabsorption caused by a deficiency of

lactase, the enzyme that splits lactose to glucose and galactose.

MEDICAL NUTRTION THERAPY FOR LACTOSE INTOLERANCE

Clients should test their tolerance for lactose by gradually increasing consumption of lactosecontaining foods the point that precipitates symptoms of lactose intolerance- bloating, cramps, and diarrhea.
Include 1 or 2 cups of milk per day, provided that

the milk is taken with food and in small at a time Yogurt contains bacteria that produce lactase and thus help digest lactose.

POSTGASTRECTOMY DIET
- POSTGASTRECTOMY
following surgery that removes all (total

gastrectomy) or part (subtotal or partial gastrectomy) of the stomach.

POSTGASTRECTOMY DIET
This diet aims:
to provide the energy and nutrients necessary to

support recovery and minimize complications associated with gastric surgery.

One complication that can arise when the

portion of the stomach containing the pyloric sphincter has been removed, bypassed, or disrupted is the DUMPING SYNDROME.

DUMPING SYNDROME
Rapid emptying of the stomach contents into the small intestine. The symptoms that result from the rapid

entry of undigested food into the jejunum:

3Ds Diaphoresis Drowsiness Diarrhea Hypoglycemia (late sign)

DIETARY MANAGEMENT OF DUMPING SYNDROME

Modifications:
Chew foods thoroughly

Rationale:

and eat slowly.

Avoid concentrated sweets Because the body digests

and absorbs these carbohydrates rapidly and breaks them down into many particles that draw fluids from the body into the intestine.

DIETARY MANAGEMENT OF DUMPING SYNDROME

Modifications:
SFF

Rationale:
To fit the reduced storage

capacity of the stomach.

THUS, IT PREVENTS

Drink fluids in small

DUMPING OF FOOD INTO THE INTESTINE

amounts about 45 mins., Before or after meals.

To prevent overloading the

stomachs reduced storage capacity and slows the transit of food from the stomach to the intestine.

DIEATRY MANAGEMENT OF DUMPING SYNDROME

Modifications:
Dry solid diet

Rationale:
Better than liquids as they

Lie down immediately after

eating for 30 to 60 mins.

Be aware that lactose

enter the jejunum less rapidly. To help to slow transit of food to the intestine. Clients who experience reflux, however, should not lie down after eating.

intolerance may develop and add to the problem diarrhea and abdominal pain

DIETARY MANAGEMENT OF DUMPING SYNDROME

Modifications:
DIET:
HIGH FAT HIGH CHON

Rationale:
Delays emptying of the

stomach
Increase colloidal osmotic

pressure and prevent shifting of plasma

LOW CHO

No simple sugars

POP QUIZ
Management of dumping syndrome is best accomplished by
A. Low CHON, High CHO B. Low residue, bland diet C. Fluid intake of at least

planning to maintain the patient on a:

500 ml with each meal

D. Small frequent feeding

schedule

GLUTEN FREE DIETS

GLUTEN
A protein found in wheat.

Eliminates certain grains that inflame the

intestine and lead to malabsorption for people with CELIAC DISEASE.

CELIAC DISEASE
Also called Celiac sprue/ Gluten-sensitive

enteropathy
PERMANENT inability to tolerate dietary gluten in the small intestine. A sensitivity to a part of the protein gluten that causes flattening of the intestinal villi and malabsorption.

DIETARY MANAGEMENT OF CELIAC DISEASE

Modifications:
HIGH Calories
HIGH CHON

Rationale:
To compensate for weight

loss
Gluten is the toxic factor

Gluten free diet

Low Fat

Impaired fat absorption

TREATMENT FOR CELIAC DISEASE

Lifelong adherence to a gluten free diet.
Serves as the primary treatment for celiac disease.

ELIMINATE B-R-O-W
B
R O W

BARLEY
RYE OAT WHEAT

POP QUIZ
Which of the statement needs further teaching, if

made by a parent of a two year old child recently diagnosed with celiac disease?
A. I dont have to make any major dietary changes until

my child reaches puberty. B. I have to keep my child on a gluten-free diet to prevent episodes of diarrhea. C. I should read the labels on any processed foods I offer to my child. D. I will need to notify my childs school about the special diet.

DIETARY MANAGEMENT OF DISEASES OF THE: GALLBLADDER PANCREAS LIVER

GALLBLADDER
LIVER PRODUCES BILE (CHOLESTEROL, BILE SALTS, BILIRUBIN & H2O) BILE DUCT

GALLBLADDER

REMAINS UNTIL NEEDED FOR FAT DIGESTION

GALLBLADDER
CHOLELITHIASIS
The formation or presence of stones in the

gallbladder or CBD.
CHOLECYSTITIS Is the inflammation of the gallbladder.

PREDISPOSING FACTORS: 5 FS
FEMALE
FAT (OBESE)
FAIR (CAUCASIAN)

FORTY
FERTILE (MULTIGRAVIDA)

CHOLELITHIASIS WITH CHOLECYSTITIS

DIETARY MANAGEMENT:
IV fluids and electrolytes

RATIONALE:
To rest inflamed

Clear liquid

gallbladder To prevent and correct dehydration and electrolyte abnormalities

Low calorie

For obese patients

CHOLELITHIASIS WITH CHOLECYSTITIS

Dietary management:
LOW FAT, BLAND

Rationale:
To prevent stimulation and

contraction of the gallbladder which causes pain.

High fat diet enters into the duodenum

Stimulates the pancreas To release CHOLECYSTOKININ
(a hormone is carried by way of the bloodstream to the GALLBLADDER)

Forces to contract to release BILE

Needed for the EMULSIFICATION OF FATS

POP QUIZ
Which of the following factors, if noted in patients history, would A. Hypertension B. Depression C. Obesity D. Childlessness

indicate a predisposition for developing cholecystitis?

PANCREAS
FUNCTIONS
Secretes the enzymes necessary for the digestion

of CHO, CHON and FAT , together with bicarbonate-rich juices that provide the optimal pH necessary to activate these enzymes.
Stores digestive enzymes in an inactive form to

protect itself from digestion.

PANCREATITIS
The pancreas becomes inflamed, digestive enzymes are activated within the pancreas, and the enzymes damage the pancreas itself.
The blood picks up some of these enzymes;

thus serum amylase and lipase rise and serve as indicators of pancreatitis

CAUSES:
Alchohol abuse
Drugs (antihypertensives, diuretics, oral

contraceptives) Biliary Obstruction Autoimmune Intestinal Diseases Unknown

ACUTE PANCREATITIS
Most often develops as a consequence of

gallstones or alcoholism
Sudden severe abdominal pain, n/v and diarrhea

often accompany acute pancreatitis

CHRONIC PANCREATITIS
When severe pancreatitis or repeated episodes of pancreatitis permanently damage the pancreas, absorption, especially of fat, becomes permanently damage.

DIETARY MANAGEMENT OF PANCREATITIS

Modifications:
NPO during acute phase

Rationale:
To prevent stimulation

pancreatic stimulations.
IVF Therapy
NGT To manage fluid deficit To remove gastrin from the

stomach and secretin from the duodenum and help relieve pain and digestion.

DIETARY MANAGEMENT OF PANCREATITIS

Modifications:
Alcohol is restricted
Low Fat, bland SFF Enzyme replacements

Rationale:
To prevent further damage to

the pancreas.

To control steatorrhea and

prevent stimulation for bile production.

Avoid distention. Taken with meals Helps digest and absorb CHON

and fat while minimizing steatorrhea.

POP QUIZ
THE DIET OF THE CLIENT WITH PANCREATITIS SHOULD BE:
A.
B.

HIGH FIBER, LOW FAT DIET

HIGH CALORIE, HIGH FAT DIET

C.
D.

LOW FAT, BLAND DIET

HIGH PROTEIN, HIGH FAT DIET

CYSTIC FIBROSIS
A hereditary disorder characterized by the production of thick mucus(exocrine glands) that affects many organs including the

pancreas, lungs, liver, heart, gallbladder, and small intestine.

CONSEQUENCES OF CYSTIC FIBROSIS

Produce secretions of thick, sticky mucus
Impairs the function of lungs and pancreas

Nutrition implication: Chronic lung disease Malabsorption Loss of electrolytes in sweat

NUTRITION THERAPY FOR CYSTIC FIBROSIS

Dietary management:

Rationale:
Provide for weight gain.
To compensate for the

High Calories
High CHON Low Fat

loss.
Lack of enzyme to digest.

NUTRITION THERAPY FOR CYSTIC FIBROSIS

Dietary management:

Rationale
To provide deficient

Enzyme Replacements

pancreatic enzymes Help control steatorrhea Liberal use of salt

Increase fluid intake
To replace the losses of

electrolytes in the sweat

To liquefy thick secretions

LIVER

FUNCTIONS:

Metabolizes carbohydrate, protein, and fat so that energy is available to body cells. Stores glycogen, most vitamins, and many minerals. Manufactures cholesterol, which serves as a precursor for steroid hormones.

Packages lipids in lipoproteins for transport throughout the body. Manufactures bile to aid fat digestion.
Makes nonessential amino acid and keeps amino acid composition in the balance for energy use.

LIVER

Converts amino acid to glucose for energy use.

Converts ammonia from the blood to urea so that it can excreted by the kidneys.

Makes plasma proteins including lipoproteins, clotting and immune system factors, and protein that carry nutrients throughout the body.
Activates many nutrients.

Detoxifies drugs (including alcohol) and other substances that are harmful to the body.
Dismantles worn-out red blood cells and recycles the iron they contain.

HEPATITIS
Any acute inflammation disease of the liver.
TYPES:
ACUTE CHRONIC-

viral, drug-induced, toxic active or persistent

It can be caused by viruses, bacteria or toxic

injury to the liver.

 A. ACUTE
1.) VIRAL

HEPATITIS A
Is the highly contagious form that can be spread through contaminated foods and H2O and it between people living together, although usually resolves and does not become chronic.

HEPATITIS B
Can lead to a serious, permanent liver damage.
S/S: Fatigue high levels of ALT, AST Anorexia n/v Diarrhea or constipation fever Liver- tender and enlarged

HEPATITIS
2.) TOXIC HEPATITIS
Can be caused by drugs, alcohol, industrial toxins

and plant poisons.

 B. CHRONIC
1.) ACTIVE
A d/o characterized by continuing hepatic necrosis, active inflammation and fibrosis which may lead to cirrhosis.

 2.) PERSISTENT

Rare extra hepatic involvement, may be secondary to viral hepatitis.

MEDICAL NUTTRITION THERAPY

The person with

hepatitis: Good nutrition status

Malnourished
Anorexia vomiting

Regular, well-balanced diet

High calorie, high protein

SFF
IV fluids replacement

LIVER CIRRHOSIS
Slow destruction of liver cells and proliferation of fibrous tissues eventually leading to scarring of the liver tissues.
Characterized by:
jaundice CNS dysfunction portal HPN splenomegaly ascites cachexia esophageal varices

DIETARY MANAGEMENT OF LIVER CIRRHOSIS

Modifications:
High CHON

Rationale:
To regenerate hepatic cells
To prevent

hypoproteinemia
High CHO Low Fat Low Na Fluid restriction

To spare CHON To prevent fatty liver To prevent ascites and

edema

DIETARY MANAGEMENT OF LIVER CIRRHOSIS

Modifications:
SFF
Full liquid diet

Rationale:
Better tolerance
To prevent irritation of

esophageal varices.
Thiamin supplements To prevent complications:
WERNICKE-KORSAKOFF

SYNDROME

POP QUIZ
On admission, a patient is having a symptoms of pancreatitis. Which of the following would have most likely contribute

to this diagnosis A. Increased CHON intake B. Smoking C. Excessive alcohol ingestion D. High cholesterol level

THANK YOU

AND MAY GOD BLESS US ALL...