营养与消化道疾病.ppt

1、营养与消化道疾病,主页目录-Home,第一节 反流性食管炎,一、概述 反流性食管炎（reflux esophagitis）是胃食管反流性疾病(gastroesophageal reflux disease，GERD)的一种常见形式，它是指由于胃、十二指肠内容物反流入食管引起的一组临床症状和食管的组织损害。,主页目录-Home,Reflux esophagitis falls into the category of reflux gastroesophagopathy. It is characterized by inflammation, erosion, ulcer formation

2、and fibrosis of the esophageal mucous membrane due to reflux of the content of the stomach and duodenum into the esophagus.,二、发生发展与营养的关系,影响LES的食物，如辣椒、酸果、油腻食物、浓茶、酒等 目前认为该类食物引起或加重溃疡病情的原因有：有高的张力，收敛性大，或是酸性强；引起胃强有力的分泌；通过释放胃肠道激素，或是刺激神经反射。,三、疾病与营养预防,1减少进食量 2. 改变生活方式 3. 情绪平稳，忌烟、酒、咖啡 4. 避免增加腹压,Reflux is very

3、 common and practise of simple measures may bring enough relief. The more the stomach is stretched by food, the higher the tendency to reflux. Eating fatty meals as fat delays gastric emptying also increases the tendency to reflux. Try to,1. Eat small meals 2. Eat regularly, this helps in reducing t

4、he pressure on the upper part of the stomach caused by large meals. 3. Avoid large rich meals, particularly in the evening this reduces the tendency to reflux. 4. Avoid eating late at night so as to keep the stomach relatively empty at bedtime.,5. Avoid alcohol, if it is being taken, it should be in

5、 moderation with meals.6. Smoking should be avoided. Tobacco prevents the esophageal sphincter from working properly, reduces the rate at which the stomach empties and increases stomach acid production.7. Bending should be kept to a minimum, especially after meals.,四、营养治疗,采用低脂肪饮食 1. 控制总能量 2. 减少脂肪摄入

6、3. 适当增加蛋白质摄入,4. 食物选择： （1）饮食中应吃些易消化、细软的食品 （2）少用刺激性食品 （3）戒烟酒 5. 其他治疗：晚餐不宜多，睡前不加餐， 避免餐后即平卧；避免使用减弱食管下括约肌张力的药物。,The lower esophageal muscle can be weakened by factors other than food. The following recommendations may be helpful in reducing symptoms: Stop using tobacco in all forms. Nicotine weakens the

7、lower esophageal muscle. Avoid chewing gum and hard candy. They increase the amount of swallowed air which, in turn, leads to belching and reflux.,Do not lie down immediately after eating. Avoid late evening snacks. Avoid tight clothing and bending over after eating. Eat small, frequent portions of

8、food and snack if needed.,Lose weight if overweight. Obesity leads to increased reflux. Elevate the head of the bed six to eight inches to prevent reflux when sleeping. Extra pillows, by themselves, are not very helpful.,The following foods aggravate acid reflux, and should be avoided: fatty or frie

9、d foods peppermint and spearmint whole milk oils chocolate creamed foods or soups most fast foods,The following foods irritate an inflamed lower esophagus and may need to be limited or avoided: citrus fruits and juices (grapefruit, orange, pineapple, tomato) coffee (regular and decaffeinated) caffei

10、nated soft drinks tea other caffeinated beverages Spicy or acidic foods may not be tolerated by some individuals.,第二节 胃炎,一、概述 胃炎是胃黏膜炎症的统称。 临床上根据病程长短可分为急性胃炎与慢性胃炎两类。急性胃炎是一种自限性的病理过程，病程短，一般预后良好。慢性胃炎病程迁延，大多无明显症状和体征。,Gastritis is inflammation of the gastric mucosa of the stomach. Depending on the cause, g

11、astritis may persist acutely or chronically and may coincide with more serious conditions such as atrophy of the stomach. Gastritis is not a single disease, but several different conditions that all have inflammation of the stomach lining.,Gastritis can be caused by drinking too much alcohol, prolon

12、ged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, or infection with bacteria such as Helicobacter pylori (H. pylori).,Sometimes gastritis develops after major surgery, traumatic injury, burns, or severe infections. Certain diseases, such as pernicious anemia, aut

13、oimmune disorders, and chronic bile reflux, can cause gastritis as well.,急性胃炎,一、概述 二、发生发展与营养的关系 1. 矿物质和水 可见低钾、低钠、低氯、 甚至脱水，严重者可出现休克 2. 维生素 易发生水溶性维生素缺乏 3. 能量代谢 呈现负平衡状态,三、急性胃炎的营养治疗 原则：严格限制刺激性食物，供给较多量的营养素 1. 食用流食 2. 大量饮水 3. 忌食粗糙和刺激性食物 5. 调整饮食行为 6. 食物选择,慢性胃炎,概述 慢性胃炎是胃黏膜的非特异性慢性炎症。慢性胃炎一般无黏膜糜烂，其病理特点为淋巴细胞和浆细

14、胞的黏膜浸润为主，从浅表逐渐向深扩展至腺层，继之腺体有破坏和减少（萎缩）的过程。,二、发生发展与营养的关系 1矿物质 易导致电解质代谢的紊乱 2维生素 多种维生素缺乏，尤其是B族维 生素 3能量和蛋白质 能量和蛋白质的负平衡,三、慢性胃炎营养治疗 1去除病因 2能量 同正常人或略高 3维生素和矿物质 增加 4高蛋白 5减少膳食纤维 6酸碱平衡 7养成良好饮食习惯,8. 食物选择 宜用： （1）发作期 流食或半流食 （2）间歇期 选用鱼、禽、肉类 选用鲜牛奶、奶油。 多新鲜不含粗纤维的蔬菜和水果。 易消化主食 饮用酸奶,禁食或忌食： （1）发作期应禁牛乳、豆浆、蔗糖 （2）禁食含膳食纤维多的蔬菜

15、、水果 （3）忌食油煎、油炸食物与腌、熏、腊、 酱的食物,（4）忌食糯米饭、年糕、玉米饼等食物 （5）避免食用生冷、酸辣、粗糙的食物 （6）禁用各种酒、含酒精的饮料、碳酸 饮料及刺激性调味品,Foods to Avoid ：Alcohol, black and red pepper, chilies, chili powder, and hot peppers often irritate the stomach lining. Foods with caffeine can increase the amount of stomach acid. These foods include co

16、ffee (regular and decaf), teas, colas, cocoa, chocolate.,Avoid or limit these items if they ause you pain. Limit your intake of tomatoes, tomato juice, peppermint, fatty foods, and citrus juices. If they cause heartburn or pain in your esophagus. You may need to limit seasonings such as onions, garl

17、ic, cinnamon, and cloves if they upset your stomach.,第三节 消化性溃疡,消化性溃疡主要指发生在胃和十二指肠粘膜处的慢性溃疡，故又称胃溃疡或十二指肠溃疡，是一种多发、常见病。主要与幽门处螺旋杆菌的感染有关。并发症有大出血、穿孔、幽门梗阻，约5的胃溃疡还可发生癌变。,A peptic ulcer is an open lesion on the mucosa of stomach or small intestine. When the ulcer is located in the stomach it is called a gastric

18、 ulcer, if it is located in the upper third of the small intestine, it is called a duodenal ulcer. The ulcerated area is thought to be the result of digestion of the membranous lining of the stomach or small intestine by the gastric juice.,二、发生发展与营养的关系 1蛋白质 易发生营养不良或低蛋白血症 2碳水化合物 碳水化合物不能满足机体需要 3脂肪 易发生

19、必需脂肪酸和脂溶性维生素的 缺乏,4维生素 易发生维生素缺乏 5膳食纤维 过粗对溃疡面会有损伤，但适量膳食纤维对黏膜有保护作用 6水 因摄入食物减少常伴水摄入不足,三、营养治疗 1合理摄入营养素 （1）足量蛋白 （2） 适量脂肪 （3） 多用碳水化合物 （4） 足够维生素 （5） 低盐,2养成良好饮食习惯 (1) 进食量与进食时间 (2) 避免食物的机械性、化学性和过冷过 热的刺激，以保护胃粘膜。 (3) 进食时要心情愉快，细嚼慢咽，减少 对消化道过强的机械性刺激。,3食物选择： 宜用食物：选择细软易消化刺激性弱的食物 禁用或忌用 ： （1）刺激性食物 （2） 易产酸食物 （3）易产气食物 （

20、4）生冷食物 （5）坚硬的食物 （6）强烈的调味品,4烹调方法：细、软 5饮食方案： （1）牛乳治疗 （2）少量多餐的温和食谱 (bland diet),溃疡病的饮食疗法的适用对象及其膳食原则 (1) 溃疡病的流质饮食 (2) 溃疡病少渣半流质饮食 (3) 溃疡病少渣软饭饮食,This diet is a guideline that may help to decrease gastric irritation and excessive gastric acid secretion. Eat three small meals and three snacks evenly spaced

21、throughout the day. Eat slowly and chew foods well. Be relaxed at mealtime. Sit up while eating and for 1 hour afterward. Avoid eating within 3 hours before bedtime.,Cut down on caffeine-containing foods and beverages, citrus and tomato products, and chocolate if these foods cause discomfort. Includ

22、e a good source of protein (milk, meat, egg, cheese, etc.) at each meal and snack. Antacids should be taken in the prescribed dose, One-hour and 3 hours after meals and prior to bedtime. This regimen is most likely to keep the acidity of the stomach at the most stable and lowest level.,Milk and crea

23、m feedings should not be used as antacid therapy. Although milk protein has an initial neutralizing effect on gastric acid, it is also a very potent stimulator. Hourly feedings of milk have been shown to produce a lower pH than three regular meals. Caffeine-containing beverages (coffee, tea, and col

24、a drinks) and decaffeinated coffee cause increased gastric acid production but may be taken in moderation at or near mealtime, if tolerated.,复习题：1、反流性食管炎的营养治疗原则2、急性胃炎的营养治疗原则3、慢性胃炎发生发展与营养的关系及 其营养治疗原则4、消化性溃疡发生发展与营养的关系及其营养治疗原则5、溃疡病的流质饮食、少渣半流质饮食、少渣软饭饮食 的适用对象及其膳食原则。,梁 惠,第十三章 营养与消化道疾病第四节第六节,主页目录-Home,第四节

25、肠结核 （intestinal tuberculosis） 肠结核是由结核杆菌经消化道、血液循环等途径感染的肠道炎症性疾病。肠黏膜呈干酪样坏死，脱落后成深浅不一的溃疡，溃疡病灶沿肠管横轴分布，愈合后易发生肠狭窄和肠梗阻。,Intestinal tuberculosis,A condition of sub-acute or chronic disease of the walls of the intestines, in which there is the characteristic deposit of tubercle, with the constitutional evidenc

26、es.,一、病因(cause),肠结核通常继发于肠道外结核灶，一般都由人型结核杆菌引起，偶有因饮用带菌牛奶或乳制品罹患牛型结核者。,二、症状(symptoms),1腹痛 2腹泻与便秘 3腹部肿块 主要见于增生型肠结核，肠壁局部增厚形成肿块。 4全身症状 溃疡型肠结核常有结核毒血症 。,三、营养代谢特点 (nutritional metabolism),肠结核同肺结核一样是慢性消耗性疾病，患者食欲差，进食少，极容易发生营养不良。,四、营养治疗 (nutritional treatment)：,（一）营养治疗的目的 (purpose of nutritional treatment) （二）营养治

27、疗要点(main points of nutritional treatment),第五节 炎症性肠病（inflammatory bowel disease）,炎症性肠病是指迄今病因尚未明确的肠道亚急性与慢性炎症疾病，主要包括溃疡性结肠炎（ulcerative colitis）与克罗恩病（Crohns disease）。 这两种肠道炎症性疾病以腹痛与腹泻为主要症状。,Inflammatory bowel diease(IBD) encompasses at least two forms of chronic intestinal inflammation:Crohns disease and

28、 ulcerative colitis.,1克罗恩病（Crohns disease）: 克罗恩病是一种肠道非特异性炎症，本病可分布于从口腔到肛门的整个胃肠道的任何部位，主要受累部位为末段回肠，其次是各段小肠及结肠。 其特点为肠道节段性分布和肠壁全层炎，易形成瘘管。高发年龄为青壮年。,Crohns disease :,CD is a panenteric inflammatory process with focal microscopic inflammation identifiable throughout the gastrointestinal tract.,2溃疡性结肠炎（ulcer

29、ative colitis） 溃疡性结肠炎属非特异性炎症性肠病。病变主要侵犯大肠黏膜层，呈连续分布。多数在直肠与乙状结肠，可扩展至降、横结肠，少数累及全结肠，偶可涉及末段回肠。 发病年龄以青壮年为多。,Ulcerative colitis:,A digestive disease characterized by an inflammation, with the formation of ulcers in the mucosa of the colon.,（一）炎症性肠病营养状况 (nutritional status of IBD) 营养障碍普遍存在炎症性肠病患者中，是炎症性肠病患者常见

30、和突出的并发症，对病程的进展起着重要作用 。 1蛋白-能量营养不良 2贫血,3钙和维生素D缺乏 4叶酸缺乏 5矿物质和微量元素缺乏 6维生素及酶缺乏 7生长迟缓,（二）炎性肠道疾病的营养支持治疗(nutritional support treatment of IBD) 1、营养支持治疗的目的 (purpose of nutritional support treatment) 2、营养支持治疗的实施 (practice of nutritional support treatment),（三）肠内营养饮食治疗原则 (enteral nutrition treatment principles

31、 ) 1.高热能、高蛋白质以补偿长期腹泻而导致的营养消耗。 2.维生素无机盐要充足，以补偿腹泻引起的营养丢失。 3.限制脂肪和膳食纤维。,4.少食多餐，以减轻肠道负担。 5.慢性肠炎病人的消化吸收功能差，应采用易消化的半流少渣饮食、少量多餐的方法，以增加营养，改善症状。 6由于腹泻便血、长期摄食过少和吸收营养不良等因素，患者可能有缺铁、叶酸缺乏或贫血、应给予适量补充。长期腹泻者，要补充钙以及镁、锌等微量元素。,7.补充含有益生菌和益生元的食物 8纠正水和电解质平衡紊乱 9慢性肠炎病人多是身体虚弱、抵抗力差，尤其胃肠道易并发感染，因而更应注意饮食卫生，不吃生冷、坚硬及变质的食物，禁酒及辛辣刺激性强的调味品。,第六节 腹泻与便秘 (Diarrhea and Constipation),腹泻（Diarrhea）是一种常见的临床症状，其表现是未经完全消化、吸收的食物残渣经过胃肠过快，排便次数增加，每天大便多在2次以上，且粪便稀薄，内含未消化的食物、黏液和脓血。,Diarrhea：In diarrhea, the stools are frequent and liquid. Although diarrhea is usually a symptom rather than a disease, it is