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LOGO “ Add your company slogan ” MNT for GIT Disorder Leny Budhi Harti Jurusan Gizi Fakultas Kedokteran Universitas Brawijaya Malang, 12 Maret 2012 1www.themegallery.com.

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Presentasi berjudul: "LOGO “ Add your company slogan ” MNT for GIT Disorder Leny Budhi Harti Jurusan Gizi Fakultas Kedokteran Universitas Brawijaya Malang, 12 Maret 2012 1www.themegallery.com."— Transcript presentasi:

1 LOGO “ Add your company slogan ” MNT for GIT Disorder Leny Budhi Harti Jurusan Gizi Fakultas Kedokteran Universitas Brawijaya Malang, 12 Maret www.themegallery.com nata blogspot.com

2 Contents 2 Background 1 Clasification 2 Medical Nutrition Therapy 3

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

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

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

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

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

8 Dysphagia Tujuan Diet : 1.Mencegah aspirasi makanan dan minuman 2.Menyediakan makanan  merangsang fungsi menelan 3.Menjaga BB/ meningkatkan BB 4.Individualize diet 5.Menghindari defisinesi mikronutrient 8 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 9 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 10 burning in the chest, with sour or bitter taste, and acid regurgitation Connie J Standiford, William E Chavey, R Van Harrison, UMHS GERD Guideline, January 2007 National Institute of Diabetes and Digestive and Kidney Diseases

11 GERD 11

12 MNT for GERD 12 Nutritional care guidelines : 1.The diet should be so arranged as to provide adequate nutrition 2.Avoid large, high fat meals, especially 3 to 4 hours before retiring 3.Avoid smoking 4.Avoid chocolate, alcohol, caffeine-containing beverages, such as coffee 5.Avoid peppermint and spearmint oils 6.Stay upright and avoid vigorous activity soon after eating 7.Avoid acidity and highly spices food when inflamation exists 8.High in protein →increase LES pressure 9.Provide small, frequent feedings of soft food 10.Fluid will be taken between meals Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008 Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

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

14 Gastritis 14 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 Helicobacter pylori (H. pylori), NSAIDs, alcohol, tobacco, radiation Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

15 MNT For Gastritis 15 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 16 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 17 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 homeohealthcenter.com 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 19 Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

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

21 Constipation 21 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 22 Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

23 Constipation 23

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

25 Diarrhea 25 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 26 Diarrhea Medication Exudative Osmotic Secretory 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  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 27 Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

28 28 MNT For Diarrhea

29 Treatment Diarrhea in infants & Children 29

30 Derajat Dehidrasi 30 PenilaianABC Keadaan UmumBaik, sadarGelisah, rewelLesu, lunglai, atau tidak sadar Matanormal,CekungSangat cekung dan kering Air mataAdaTidak ada Mulut dan lidahbasahKeringSangat kering Rasa hausMinum biasa tidak haus Haus, ingin minum banyak Malas minum/ tidak bisa minum Turgor kulitKembali cepatKembali lambatKembali sangat lambat Hasil PemeriksaanTanpa dehidrasiDehidrasi ringan/sedang Dehidrasi berat Kapita Selekta Kedokteran Edisi ke-3 jilid 1 dan 2

31 MNT For Diarrhea Diare dengan dehidarsi ringan/sedang : o 3 jam pertama diberikan cairan sebanyak 75ml/kg BB 31 UmurJumlah Oralit yang diberikan tiap BAB Jumlah oralit yang disediakan dirumah < 12 bulan ml400 ml/hari (2 bungkus) 1-4 tahun ml ml/hari(3-4 bungkus) > 5 tahun200 – 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 32 Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

33 Lactose Maldigestion 33

34 MNT For Lactose Maldigestion 34 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 35  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 : 1.Energi diberikan sesuai dengan kebutuhan, ditingkatkan bila ada demam dan sepsis 2.Protein : 1,5 – 2 gram/kgBB/hr, protein yang bernilai biologis tinggi 3.Lemak mudah serap (MCT) 4.Vitamin dan mineral cukup 5.Cairan 3 – 4 liter/hari untuk mengganti cairan yang hilang akibat demam/diare 36 Adobted from Etik Sulistyowati Materi

37 Inflammatory Bowel Disease (IBD) 37 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 cochrane.uottawa.ca Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

38 Crohn’s Disease 38 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 39  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 41 Tujuan : 1.Memperbaiki ketidak seimbangan cairan dan elektrolit 2.Memberikan zat gizi untuk meningkatkan dan mempertahan status gizi agar tetap normal 3.Mencegah iritasi dan inflamasi lebih lanjut 4.Mencegah kehilangan zat gizi akibat malabsorbsi 5.Mempercepat proses penyembuhan Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008

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

43 MNT For Crohn’s Disease 43  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 44 Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008  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 Food, Nutrition, & Diet Therapy, L.Kathleen Mahan, Sylvia Escott-Stump, 12th Edition

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

46 Hemoroid 46 Derajat I EksternaInternaHemoroid AkutKronik Derajat II Derajat III Price, Sylvia A & Lorraine M. Wilson, Patofisiologi, 1994

47 MNT For Hemoroid 47  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 48 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 49 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 Rendah lemak 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

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