Departemen Ilmu Gizi FK USU

MEDAN

Refers to nonspesific,persistent upper

abdominal discomfort or pain.
Causes of discomfort:

Ephageal reflux
Gastritis
Peptic ulcer
Gallbladder disease
Other identificable pathologic conditions.

Always misdiagosed with iiritble bowel

syndrome.
Diet,stress and other lifestyle factor may
contribute to the symptoms.

Goal:
Decrease exposure of esophagus to gastric
contents.
Avoid: large meals,dietary fat, alchohol

Goal:

Decrease acidity of gastric secretions.

Avoid coffee
Fermented alkoholic beverages.
Goal:

o Prevent pain and irritation

o Any food that the patient feels exacerbates his/her
symptoms.

Result when infectious (Heliobacter pylori),chemical

or neural abnormalities disrupt mucosal integrity of
the stomach.
Other causes of gastritis chronic: used of aspirin or
other NSAID,steroids,alcohol,erosive
substances,tobacco or any combination
acquiring acute or chronic gastritis.
Symptoms of gastritis:
Nausea,vomiting,malaise,anorexia,hemorrhage and
epigastric pain.
Prolonged gastritis
atrophy and loss of sotmach
parietal cells
achlorhydria & intrinsic factor
Pernicious anaemia

Peptic ulcer:

Typically : evidence of chronic inflammation and

repair processes surrounding the lesion.

Normally involve two major regions: gastric and

duodenal.

Characteristic peptic ulcers Abdominal

discomfort/abdominal pain

Other symptoms are: anorexia,weight loss, nausea

and vomiting and heartburn

In some patients :asymptomatic.

Complication : hemorrhage and perforation.

Ulcer can perforate into

Peritoneal cavity

Penetrate into an adjacent organ (usually pancreas)

Erode an artery and cause massive hemorrhage
Melena ( black,tarry stools) are common in peptic ulcer
disease especially in older adults.
Melena may suggest either acute or chronic upper GI

bleeding.

Atropic gastritis : lack of intrinsic factor and acid

malabsorbtion of vit.B12.
Acid <<
reduced absorption of Fe,Ca.
Decrease consumption of
Alcohol
Spices, particularly red and black peppers when inflammed
Coffe and caffeine.

Increase consumption of
3 and 6 fatty acids, which may have a protective effect.

Good nutrition helps defend against H.pylori

complications.

Omega 3 and omega 6 fatty acids are involved in

Inflamatory
Immune
Cryptoprotective physiologic conditions

of the GI
mucosa

But they have not yet been found to be effective

for treatment.

High quality diet without nutrient deficiencies may

offer protection and promote healing.
Advised :
Avoid foods that exacerbate their symptoms
Consume a nutritionally complete diet with
adequate dietary fiber from fruits and vegetables

Characterized by chronically recurring

abdominal discomfort or pain and altered
bowel habits.

Other symptoms:
bloating,feelings of incomplete evacuation
Presence of mucus in the stool
Increased GI distress associated with psychosocial
distress.

Diagnosis is based on international consensus

criteria (Rome criteria):
Symptoms of abdominal discomfort must be present for at
least 3 days per month for the past 3 months, include at
least 2 of 3 features:
1. Discomfort relieved by defication
2. Onset associated with a change in frequency of stool
3. Onset associated with a change in form of the stool

o Diagnosis futher categorizes the syndrome into one of 3

subtypes:
1. Diarrhea predominant
2. Constipation predominant
3. Mixed (1 + 2)

The goal :
To ensure adequate nutrient intake
Tailor the diet for the spesific GI pattern of IBS
Explain the potential roles of foods in the management of
symptoms.

Large meals and certain foods may be poorly

tolerated (excess quantities of dietary fat,
caffeine,lactose,fructose,sorbitol and alcohol)
found in persons with diarrhea predominant IBS or
mixed IBS.
Supplementation of insoluble fibre (wheat bran)
worsen symptoms.
Consumption of adequate fluid is recommended.

Peny.kronik dimana sel liver diganti o

jar.fibrosis dan infiltrasi lemak.
Causa: alkohol
hepatitis (post nekrotik)
kelainan biliaris
peny.autoimun
penggunaan obat hepatotoksik
Nutrition intake problem:
Adequate nutrition intake is difficult to achieve
because of anorexia,nausea, and other GIT
symptoms (+).

Energy.
In general Energy requirement for ESLD (End Stage
Liver Disease) 25 35 cal/ kg BW ( if ascites
,infection and malabsorption are present)
Oral nutrition supplement or tube feeding
Increase optimal intake
Reducing compli
cation and prolonged survival.

Carbohydrate.
Liver failure reduces glucose production &
peripheral glucose use.
CH 60-70% total energy (complexs)

Lipid.
The body prefers lipids as an energy sThe
body preferlipids as an energy substrate.
Range 25-40% of calories as fat is generally
recommended.
Protein.
Cirrhosispatient increase protein use.
0.8 g/kg/day is the mean requirement to
achieve nitrogen balance in stable cirrhosis.
To promote nitrogen accumulation
(positivebalance) : 1.2-1.3 g/kg daily.
Alcoholic hepatitis or decompensated disease
: 1.5 g /kg BW/day.

Vitamin & Mineral.

Vitamin & mineral supplementation is needed for

ESLD because of the intimate role of the liver in:
Nutrient transport
Storage
Metabolosm
Side eefct of drug.
Iron stores depleted in GIT bleeding need Fe
supplementation,but do not give to the patient with
hemochromatosis or hemosiderosis.
Ca,Mn and Zn may be malabsorbed with steatorrhea
Fo
therefore the patient should take mineral
r
supplement.

The formation of gallstones (calculi) is cholelithia

sis.
In most cases :Asymptomatic
Choledocholithiasis (+) when stones slip into the
bile ducts
obstruction,pain and cramps (+).
Obstruction of the distal common bile duct
Pancreatitis (+) if the pancreatic duct is blocked.
Most gallstone are unpigmented cholesterol stones
composed primaliry :Cholesterol,bilirubin,Ca salts.
Causes of gallstone:
bacteria
high dietary fat intake over a prolonged period.
Rapid weight loss.

Risk factors for cholesterol stone

formation
Female gender
Pregnancy
Older age
Family history
Obesity
DM

IFD (Inflamatory
Bowel Disease)
Drugs(lipid lowering
medications,oral contraseptive,estrogen

Medical nutrition therapy.

No spesific dietary treatment is available to prevent

cholelithiasis in susceptible persons.
Replace simple sugar and refined starches with
high fibre carbohydrate.
Individual who consuming refined CH have 60%
greater risk for developing gallstones >< who
consumed the most fibre (in particular insoluble
fibre)
plant based diets reduced the risk of
Cholelithiasis
After surgical removal of the gallbladder
oral feeding can be advance to a regular diet as
tolerated

Is the inflammation of the gallbladder(acute or

chronic)
Caused by: gallstones obstructing the bile
ducts.
Acute cholecystitis without stones occur in
Critically ill patients
When the GB (gallbladder) and its bile are stagnant

The walls of the GB become inflamed &

distended
infection (+).
Symptoms : upper quadrant abdominal pain +
nausea, vomiting & flatulence

Chronic Cholecystitis is :
Long standing inflammation of the GB.
Caused by repeated,mild attack of Acute Chole

cystitis.
Eating food high in fat may aggragavate the
symptoms
More often in women than in men.
Increase after the age of 40

Risk factor :

The presence of gallstones

History of acute cholecystitis.

Acute cholecystitis.

In acut attack oral feedings are discontinued.

Parenteral Nutrition is indicates if
The patient is malnourished
Not taking anything orally for a prolonged period.
When feeding are resumed: give a low fat diet (3040 g of fat/day)

Chronic cholecystitis.
Require a long term,low fat diet that contains 25%30% of total calories as fat.
Stricter limitation is undesirable because fat in the
intestine is important for stimulate and drainage of
the biliary tract.