hiatal hernia食道裂孔脱疝.ppt

Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders 上消化道疾病 Gastroesophgeal Reflux and Esophagitis (endoscope 檢查) Heartburn：胃食物(胃酸) 逆流至食道導致發炎 (gastroesophageal reflux disease ; GERD) 50% 新生兒最常見；20-40% adult 徵狀：打嗝、咽喉刺激、聲音沙啞、惡化氣喘 發生在吃下食物後、突然改變飲食習慣(特別在晚上) - 食道burning Barrett’s esophagus (BE)：長期胃食物逆流至食道導致遠端食道變得不正常和形成癌病前期?食道癌 (5-10% adult，male, age 50, family history) Esophagitis (潰爛型GERD )：較嚴重食道發炎 Etiology Acute：Ingestion of irritating agents, viral infection, intubation插管 Chronic：Reduced LES pressure, increased abdominal pressure, recurrent vomiting, delayed gastric emptying, hiatal hernia Medical Nutrition Therapy (p. 596) Objective： 防止食道逆流 (LES) ?avoid large meals (少量多餐)、 dietary fat、 alcohol 預防發炎黏膜疼痛刺激? avoid acid foods (酸果汁), spices 減少侵蝕力、胃酸 ? avoid coffee, 吸煙、fermented alcoholic beverages 出血?補充Fe, B12, protein Behavioral Modification Avoid Eating within 3-4 hrs of retiring(休息) Lying down after meals：提高床頭4-6 in Tight-fitting garments：減肥 Cigarette smoking：LES Nutritional Care Guidelines for Patients with Reflux and Esophagitis Avoid large, high-fat meals. Avoid eating at least 3 to 4 hours before retiring. Avoid smoking. Avoid alcoholic beverages. Avoid caffeine-containing foods and beverages. Stay upright and avoid vigorous activity soon after eating. Avoid tight-fitting clothing, especially after a meal. Consume a healthy, nutritionally complete diet with adequate fiber. Avoid acidic and highly spiced foods when inflammation exists. Lose weight if overweight. Medical management Proton pump inhibitors氫離子幫浦抑制劑：下降胃璧細胞分泌胃酸 (最有效) 反流較輕微： Histamine-2 (H2) receptor antagonist Antacids制酸劑：降低胃酸分泌 胃排空較慢者：Prokinetic agents助動劑： 增加胃排空、LES壓力 藥物治療無效：Fundoplication胃底摺疊術： 胃底纏繞至下食道防止逆流 Hiatal Hernia食道裂孔脫疝 Sliding hernia Paraesophageal hernia 增加逆流危險 大餐後上腹部不舒服 原因 食道裂孔處肌肉張力不足 腹壓過大 衣服太緊 Medial Nutrition Therapy 目的：減少逆流 (減重、防止大餐) 治療方法與食道炎同 少量多餐、低脂肪飲食、避免胃酸分泌和降低 LES 壓力之食物 治療方法：藥物與飲食控制(不需手術) Oral cavity cancer and surgery 口腔、咽、食道癌 原因：腫瘤、阻塞、口腔感染、潰瘍