MNT for GIT Disorder nata blogspot.com Leny Budhi Harti

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1 MNT for GIT Disorder nata03111990.blogspot.com Leny Budhi Harti
Jurusan Gizi Fakultas Kedokteran Universitas Brawijaya Malang, 12 Maret 2012

2 Contents 1 Background 2 Clasification 3 Medical Nutrition Therapy

3 gastric and duodenal ulcer 1,7% Thypoid 1,6%
Background Penyebab kematian : diare 3,5% gastric and duodenal ulcer 1,7% Thypoid 1,6% Riskesdas, 2007

4 Classification Upper GIT Disorder Lower GIT Disorder Constipation
Diarrhea Lactose Malabsorption Thypoid Inflammatory bowel disease Hemoroid Diverticular disease Upper GIT Disorder Dysphagia GERD Gastritis & Gastroenteritis Peptic Ulcer Classification

5 Medical Nutrition Therapy
nata blogspot.com Upper GIT Disorder Peptic Ulcer Gastritis Dysphagia GERD

6 Dysphagia radiologyassistant.nl Dysphagia is defined as difficulty in swallowing caused by neurological or structure demage. Thomas, Briony & Jacki Bishop. Manual of Dietetic Practice. 2007

7 Common Causes of Dysphagia
Neurological Stroke Parkinson’s disease Head injury Cerebal palsy Dementia Mechanical Oesophageal strikture Oesophageal spasm Cancer in head, neck and oesophageal areas Thomas, Briony & Jacki Bishop. Manual of Dietetic Practice. 2007

8 Mencegah aspirasi makanan dan minuman
Dysphagia Tujuan Diet : Mencegah aspirasi makanan dan minuman Menyediakan makanan  merangsang fungsi menelan Menjaga BB/ meningkatkan BB Individualize diet Menghindari defisinesi mikronutrient Sylvia Escott – Stump, Nutrition and Diagnosis Related Care. 2008

9 Dysphagia Energi : 30 – 35 kkal/kg BB Protein : 1 – 1,5 g/kgBB
Bentuk makanan : soft diet,makanan sedikit air dan temperatur sedang Monitor defisiensi serat, vitamin A dan C Cara pemberian : oral, EN, PN Makanan yang dihindari : alkohol, kafein, berbumbu tajam, asam, dry food Sylvia Escott – Stump, Nutrition and Diagnosis Related Care. 2008

10 GERD gastroesophageal reflux disease (GERD) backward flow of the stomach or duodenal contents into the esophagus burning in the chest, with sour or bitter taste, and acid regurgitation National Institute of Diabetes and Digestive and Kidney Diseases Connie J Standiford, William E Chavey, R Van Harrison, UMHS GERD Guideline, January 2007

11 GERD

12 MNT for GERD Nutritional care guidelines :
The diet should be so arranged as to provide adequate nutrition Avoid large, high fat meals, especially 3 to 4 hours before retiring Avoid smoking Avoid chocolate, alcohol, caffeine-containing beverages, such as coffee Avoid peppermint and spearmint oils Stay upright and avoid vigorous activity soon after eating Avoid acidity and highly spices food when inflamation exists High in protein →increase LES pressure Provide small, frequent feedings of soft food Fluid will be taken between meals Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

13 Gastritis Gastritis : inflammation of the stomach medicastore.com
National Institute of Diabetes and Digestive and Kidney Diseases Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

14 Helicobacter pylori (H. pylori), NSAIDs, alcohol, tobacco, radiation
Gastritis Helicobacter pylori (H. pylori), NSAIDs, alcohol, tobacco, radiation Acut Gastritis Pain, nusea, vomiting, usualy in short duration low serum B12 level or elevated serum homocystine levels blood in vomit black, tarry stools red blood in the stool Chronic gastritis Erosive gastritis National Institute of Diabetes and Digestive and Kidney Diseases Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

15 MNT For Gastritis Energi diberikan sesuai dengan kebutuhan pasien
Protein cukup sesuai dengan kemampuan pasien Lemak rendah 10-15% dari kebutuhan energi. Utamakan jenis lemak PUFA Karbohidrat, sisa dari kebutuhan energi setelah dikurangi protein dan lemak Vitamin C diberikan tinggi Pada gastritis kronik perlu pemberian vit. B12 Rendah serat, utamakan serat larut Pada fase akut : diberikan makanan parenteral→mengistirahatkan lambung

16 MNT For Gastritis Cairan diberikan cukup
Makanan diberikan bertahap sesuai dengan keadaan pasien Porsi kecil dan sering Hindari makanan yang merangsang saluran cerna, seperti : cabe, merica, minyak, cuka Hindari makanan yang bersifat melekat, seperti: dodol, ketan Hindari makanan yang menimbulkan gas, seperti : kol, kubis, sawi, ksngkung, durian, nangka, dll

17 Peptic Ulcer homeohealthcenter.com peptic ulcer a lesion in either the esophageal,g astric, or duodenal mucosa resulting from the action of gastric secretions and typically H. pylori bacterial inflammation Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

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19 MNT For Peptic Ulcer Protein foods temporarily buffer gastric secretions, but they also stimulate secretion of gastrin, acid, and pepsin Avoid alcohol, caffeinne and coffee Avoid large doses of certain spices without others food Use probiotics Use omega-3 and omega-6 Good dietary practice with adequate nutrient and fiber Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

20 Lactose Malabsorption Thypoid Inflammatory bowel disease Hemoroid
Lower GIT Disorder Constipation Diarrhea Lactose Malabsorption Thypoid Inflammatory bowel disease Hemoroid Diverticular disease

21 Constipation ellies-whole-grains.com a condition in which the frequenry or quantity o fstools is reduced Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

22 Constipation Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

23 Constipation

24 MNT For Constipation Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

25 Diarrhea Diarrhea is characterizedby the frequent evacuation of liquid stools, usually exceeding 300 ml, accompanied by an excessivel of fluid and electrolytes, especially sodium and potassium. Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

26 Diarrhea Diarrhea Medication Secretory Exudative Osmotic
Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

27 MNT For Diarrhea Replacement of necessary fluid and electrolytes
Use starchy carbohydrate Modest amounts of fat Avoid sugar alcohols, lactose, fructose, and sucrose in large amounts Use amount of food containing prebiotic an probiotic Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

28 MNT For Diarrhea

29 Treatment Diarrhea in infants & Children

30 Derajat Dehidrasi Penilaian A B C Keadaan Umum Baik, sadar
Gelisah, rewel Lesu, lunglai, atau tidak sadar Mata normal, Cekung Sangat cekung dan kering Air mata Ada Tidak ada Mulut dan lidah basah Kering Sangat kering Rasa haus Minum biasa tidak haus Haus, ingin minum banyak Malas minum/ tidak bisa minum Turgor kulit Kembali cepat Kembali lambat Kembali sangat lambat Hasil Pemeriksaan Tanpa dehidrasi Dehidrasi ringan/sedang Dehidrasi berat Kapita Selekta Kedokteran Edisi ke-3 jilid 1 dan 2

31 MNT For Diarrhea Diare dengan dehidarsi ringan/sedang :
3 jam pertama diberikan cairan sebanyak 75ml/kg BB Umur Jumlah Oralit yang diberikan tiap BAB Jumlah oralit yang disediakan dirumah < 12 bulan ml 400 ml/hari (2 bungkus) 1-4 tahun ml ml/hari(3-4 bungkus) > 5 tahun 200 – 300 ml ml/ hari (4-5 bungkus) Dewasa ml ml/hari Kapita Selekta Kedokteran Edisi ke-3 jilid 1 dan 2

32 Lactose Malabsorbtion/ Maldigestion
Lactose maldigestion : the inability to digest lactose to galactose and glucose because of a deficiency of the enzyme lactase with resulting intolerance to normal amounts of lactose Etiologi : deficiency lactase, infection of the small intestine, HIV, inflamatory disorder, malnutrition Diagnosis : (1) histori of GIT symptoms after milk ingestion, (2) abnormal hydrogen level in the breath, (3) abnormal lactose tolerance test Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

33 Lactose Maldigestion Laktosa : disakarida yang terdapat dalam susu Jika tidak ada enzym lactase, maka dikolon akan difermentasi oleh bacteri Kembung, nyeri perut, nusea, diare (feses cair berbau asam)

34 MNT For Lactose Maldigestion
The diet should be so arranged as to provide adequate nutrition (energy, protein, fat, and carbohydrat) A completely lactose – free diet is not necessary in lactase – deficiency persons. Most lactose maldigesters can consume some lactose (6 to 12g), without major symptoms, especially when taken with meals Many adults with tolerance to moderate amount of milk can ultimately adapt to and tolerate 12 g or equivalent 240 ml of full-lactose milk Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

35 Thypoid Definition A systemic, infectious disease caused by Salmonella typhi. Diagnostic criteria Clinical: • Fever, headache, anorexia, vomiting, diarrhoea or constipation.. Investigations: • Leucopenia, anaemia, thrombocytopenia. • Positive cultures from blood (1st week), stools (after 1st week), urine and bone marrow. Positive Widal test

36 MNT For Thypoid Syarat Diet :
Energi diberikan sesuai dengan kebutuhan , ditingkatkan bila ada demam dan sepsis Protein : 1,5 – 2 gram/kgBB/hr, protein yang bernilai biologis tinggi Lemak mudah serap (MCT) Vitamin dan mineral cukup Cairan 3 – 4 liter/hari untuk mengganti cairan yang hilang akibat demam/diare Adobted from Etik Sulistyowati Materi

37 Inflammatory Bowel Disease (IBD)
cochrane.uottawa.ca IBD : a general term for inflamatory disease of the bowel, including Crohn’s Disease and ulcerative colitis Characteristics : diarrhea, fever, weight loss, anemia, food intolerance, malnutrition Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

38 Crohn’s Disease Peradangan kronik pada usus yang ditandai oleh peradangan salah satu/ semua lapisan GIT Penyebab tidak diketahui, kemungkinan autoimun Gambaran klinis : panas, penurunan BB, nausea, vomiting, abdominal pain, intestinal dleeding Pemeriksaan :leukosit, trombosit, LED yang tinggi. analisis kultur feses, sigmoidoskopi Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008 Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

39 Ulcerative Colitis Peradangan rektum dan kolon, terutama mengenai lapisan mukosa usus besar dan menyebar ke daerah yang terkena. Gejala khas : diare berdarah bercampur dengan mukus dan semakin intensif seiring dengan keparahan penyakit Gejala lain : nyeri abdomen, anemia, anoreksia dan demam Penyebab tidak diketahui, kemungkinan karena autoimun Pemeriksaan : sigmoidoskopi, sinar -X Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

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41 MNT For IBD Tujuan : Memperbaiki ketidak seimbangan cairan dan elektrolit Memberikan zat gizi untuk meningkatkan dan mempertahan status gizi agar tetap normal Mencegah iritasi dan inflamasi lebih lanjut Mencegah kehilangan zat gizi akibat malabsorbsi Mempercepat proses penyembuhan Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

42 MNT For IBD (Crohn’s Disease & Ulcerative Colitis)
Kebutuhan energi : BMI < 15 : diberikan energi sebesar Kkal/kgBB BMI : energi diberikan sebesar kkal/kg BB BMI : energi diberikan sebesar kkal/kgBB BMI > 30 : energi diberikan sebesar kkal/kgBB Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

43 MNT For Crohn’s Disease
Protein tinggi : 1-1,5 gram/kg BB Lemak relatif tinggi, utamakan MCT dan omega-3 Karbohidrat : sisa dari kebutuhan energi Kebutuhan mikronutrien ditingkatkan terutama : vitamin B1, B12, vitamin A,D,E,K,Zn, Fe, Mg, Ca Mengurangi laktosa, jika terjadi laktose intolerance Probiotik untuk meingkatkan bakteri khusus dalam usus Rendah serat Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

44 MNT For Ulcerative Disease
Akut : low fiber diet, TPN for 2 week/ longer during acute stage Protein tinggi : 1-1,5 gram/kg BB Lemak relatif tinggi, utamakan MCT dan omega-3 Karbohidrat : sisa dari kebutuhan energi Kebutuhan mikronutrien ditingkatkan terutama : vitamin B1, B12, vitamin A,D,E,K,Zn, Fe, Mg, Ca Mengurangi laktosa, jika terjadi laktose intolerance Prebiotik  mengubah flora dan produksi SCFAs melindungi proses inflamasi Six small feeding Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008 Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

45 Hemoroid Konstipasi, sering mengejan, kongesti pelvis pada kehamilan, pembesaran prostat,fibroma uteri, tumor rektum elec-intro.com Price, Sylvia A & Lorraine M. Wilson, Patofisiologi, 1994

46 Hemoroid Derajat I Eksterna Interna Hemoroid Akut Kronik II III
Price, Sylvia A & Lorraine M. Wilson, Patofisiologi, 1994

47 MNT For Hemoroid Energi dan zat gizi lain diberikan sesuai dengan kebutuhan Serat tinggi, gram/hari Cairan tinggi : 8-10 gelas/hari Setelah operasi diberikan makanan rendah serat dan bentuk makanan lunak. Jika kondisi pasien sudah membaik dapat diberikan serat gram/hari Hindari laktosa dan BM yang merangsang GIT Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

48 Diverticular Disease Diverticulosiiss a situationo f saclikeh herniations( diverticula) of the colonic wall, thought to result from long-term constipationa nd increasedc olonic pressure Diverticulitis : inflamation of diverticula Causes : The causes is not known for certain. Increase intracolonic pressure → herniations of the mucosal wall Lack of activity Low fiber diet

49 MNT For Diverticulosis
Divertikulosis Energi dan zat gizi makro (protein dan karbohidrat) diberikan sesuai dengan kebutuhan Serat g/ hari. Hindari serat yang berlebihan karena dapat mengganggu absorbsi mineral Cairan tinggi, 2-2,5 liter/hari Rendah lemak Divertikulitis Energi, protein, dan karbohidrat diberikan sesuai dengan kebutuhan Cairan diberikan 8 gelas/hari Makanan diberikan bertahap mulai dari makanan cair jernih dengan rendah serat Hindari makanan berupa biji2an Akut : diet rendah sisi/ TPN Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

50 Thank You ! Selamat Belajar