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

Contents 1 Background 2 Clasification 3 Medical Nutrition Therapy www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

Medical Nutrition Therapy nata03111990.blogspot.com Upper GIT Disorder Peptic Ulcer Gastritis Dysphagia GERD www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

GERD www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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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 www.themegallery.com

Lactose Malabsorption Thypoid Inflammatory bowel disease Hemoroid Lower GIT Disorder Constipation Diarrhea Lactose Malabsorption Thypoid Inflammatory bowel disease Hemoroid Diverticular disease www.themegallery.com

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 www.themegallery.com

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

Constipation www.themegallery.com

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

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 www.themegallery.com

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

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 www.themegallery.com

MNT For Diarrhea www.themegallery.com

Treatment Diarrhea in infants & Children www.themegallery.com

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 www.themegallery.com

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 50-100 ml 400 ml/hari (2 bungkus) 1-4 tahun 100-200 ml 600-800 ml/hari(3-4 bungkus) > 5 tahun 200 – 300 ml 800-1000ml/ hari (4-5 bungkus) Dewasa 300-400 ml 1200-2800 ml/hari Kapita Selekta Kedokteran Edisi ke-3 jilid 1 dan 2 www.themegallery.com

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 www.themegallery.com

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) www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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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 www.themegallery.com

MNT For IBD (Crohn’s Disease & Ulcerative Colitis) Kebutuhan energi : BMI < 15 : diberikan energi sebesar 35-45 Kkal/kgBB BMI 15-19 : energi diberikan sebesar 30-35 kkal/kg BB BMI 20-29 : energi diberikan sebesar 25-30 kkal/kgBB BMI > 30 : energi diberikan sebesar 15-25 kkal/kgBB Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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 www.themegallery.com

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

MNT For Hemoroid Energi dan zat gizi lain diberikan sesuai dengan kebutuhan Serat tinggi, 25-35 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 25-35 gram/hari Hindari laktosa dan BM yang merangsang GIT Nutrition and Diagnosis Related Care, Sylvia Escott-Stump, 2008 www.themegallery.com

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 www.themegallery.com

MNT For Diverticulosis Divertikulosis Energi dan zat gizi makro (protein dan karbohidrat) diberikan sesuai dengan kebutuhan Serat 25-35 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 www.themegallery.com

Thank You ! Selamat Belajar www.themegallery.com