1 Write the major electrolyte alongside their role in our body

ELECTROLYTE

The ionized or ionizable constituent of a living cell or other organic matter

MAJOR ELECTROLYTES IN HUMAN BODY

1 Sodium

2 Potassium

3 Phosphate

4 Calcium

5 Bicarbonate

6 Magnesium

7 Chloride

ROLE OF ELECTROLYTE

Regulate nerve and muscle function

Proper hydration

Maintain acid base balance

Having electrolyte in right concentration is important in maintaining fluid balance among the
compartment

OSMOTIC PRESSURE

When water move from more dilute solution to more concentrated solution called osmosis

The pressure that is required to oppose osmosis called as osmotic pressure

SODIUM help to maintain a stable blood pressure

Responsible for one half of the osmotic pressure gradient

Na increases Hypernatremia Na decreases Hyponatremia

POTASSIUM regulate fluid balance

Help in muscle contraction

K increases Hyperkalemia K decreases Hypokalemia

CALCIUM essential in blood clotting

Building strong bones and teeth

Ca decreases Hypocalcemia Ca increases Hypercalcemia

CHLORIDE balance amount of fluid

Regulate pH of fluid

Cl decreases Hypochloremia Cl increases Hypochloremia

PHOSPHATE help in nerve function

Help in muscle function

PHOSPHATE decreases Hypophosphatemia PHOSPHATE increases Hyperphosphatemia

BICARBONATE maintain body balance

Regulate body pH
Enumerate the RAS SYSTEM and its role in body homeostasis

The renin – angiotensin system (RAS), or renin -angiotensin- aldosterone system (RAAS), is a
hormone system that regulate blood pressure and fluid and electrolyte balance, as well as
systemic vascular resistance. This increase the volume of extracellular fluid in the body, which
also increases blood pressure

RENIN HARMONE

Enzyme that released from kidney

Circulates in blood reacting with plasma protein

Regulate blood pressure when it is lowered

Explanation

• When renal blood flow is reduced, juxtaglomerular cells in the kidneys convert the

precursor prorenin (already present in the blood) into renin and secrete it directly into circulation.
Plasma renin then carries out the conversion of angiotensinogen, released by the liver,
to angiotensin I.
•
Angiotensin I is subsequently converted to angiotensin II by the angiotensin-converting
enzyme (ACE) found on the surface of vascular endothelial cells, predominantly those of the
lungs.
•
Angiotensin II is a potent vasoconstrictive peptide that causes blood vessels to narrow, resulting
in increased blood pressure.
•
Angiotensin II also stimulates the secretion of the hormone aldosterone from the adrenal
cortex. • Aldosterone causes the renal tubules to increase the reabsorption of sodium and water
into the blood, while at the same time causing the excretion of potassium (to
maintain electrolyte balance). • This increases the volume of extracellular fluid in the body,
which also increases blood pressure.
If the RAS is abnormally active, blood pressure will be too high.
• There are many drugs that interrupt different steps in this system to lower blood pressure.
• These drugs are one of the primary ways to control high blood pressure, heart failure, kidney
failure, and harmful effects of diabetes.
 • Renin activates the renin–angiotensin system by cleaving angiotensinogen, produced by the
liver, to yield angiotensin I, which is further converted into angiotensin II by ACE
• The angiotensin–converting enzyme primarily within the capillaries of the lungs
Mechanism of aldosterone
Aldosterone synthesis from corticosterone through the enzymes 11-B-hydroxylase
Enhanced by angiotensin II
Angiotensin II release is stimulated by low sodium level
 Write a detailed note on food and nutrition policy in hospital setting along side the food
delivery system in hospitals

•With awareness that 80 -100% of patients in hospitals rely completely on food provided by the
catering service for their nutritional support it is important to remember, many of the problems
that arise in the provision of nutritionally balanced food are potentially preventable with good
planning. 
•Planning a menu effectively requires the collection of a wide range of information and input
from numerous groups within a hospital. 

A planning group is responsible for implementing local protocol for provision of food and
fluid for patients. Core membership needs to include a senior member of catering staff, a
senior nurse, doctor, a senior dietitian and allied health professionals and patient
representative.

The planning group is responsible for:

Menu planning, including the use of standard recipes

Ensuring food and fluid meets the requirements of the individual

Setting meal times appropriate for patient groups.

All dishes and menus are analyzed for nutritional content by a state registered dietitian at
the planning stage.
Patient groups are consulted about new menus.
The planning process
Food provision should be planned in order to be responsive to patients' needs not those of
medical, nursing and other healthcare staff and should be managed as an integral component of
clinical care rather than a 'hotel' function. 
• Assessment of patient population dietary needs
 Nutritionally vulnerable' (normal nutritional requirements but with poor appetite and/or
unable to eat normal quantities at mealtimes; or with increased nutritional needs)
 'Nutritionally well' (normal nutritional requirements and normal appetite or those with a
condition requiring a diet that follows healthier eating principles)
 Special or personal dietary needs, e.g. religious or ethnic dietary requirements
 Requirement for a therapeutic diet, e.g. modified texture diet, allergy-free diet, renal
diet
• Cost and resources implications 

 Total budget per patient day/week

 Method of production

 Kitchen equipment and related budget

 Existing staff levels and rosters

 Staff skill level

 Food storage facilities

 Procurement and sustainability issues

 Method of distribution

include: 4, 7, 32

Total budget per patient day/week

Method of production

Kitchen equipment and related budget

Existing staff levels and rosters

Staff skill level

Food storage facilities

Procurement and sustainability issues

Method of distribution

Satisfied patient –Eat more food – Better nutrition – Faster recovery

FOOD SERVICE SYSTEM

 / \

Patient meal cafeteria

/ \

Food Serving

Preparation. Method

/ | \

Ordering Tray Delivery

Method assembly System

Method.

 Food group menu planning guidance

• Bread, rice, potatoes, pasta and other starchy cereals

•fruits and vegetables

•Meat, fish, eggs, beans and other non-dairy sources of protein

•Foods and/or drinks high in fat and/or sugar (and foods high in salt)

•Fluids

• Ward supplies

• List of minimum ward provisions

• Standard recipe

 Consistent quality - a dish prepared with exactly the same ingredients using the
same method should produce the same end product each time
 Consistent nutritional value - a nutrient profile of each dish can be established
 Consistent budgetary control - clearer planning for budgets and costing of menus
 Safe provision of therapeutic diets - coding for therapeutic diets are always reliable
 Recipe analysis
 • portion size

Essential criteria
Portion sizes must be set in order that they can deliver the required nutrition (as specified in this
document) to the relevant patient population in a size that can be eaten. 
At a local level, ingredient and therefore nutrient content, of individual recipes will vary from
hospital to hospital. Therefore, the appropriate portion sizes for individual meal items must:

 Be set locally and in agreement between dietitian(s) and catering.

 Have their nutrient content and size in relation to serving and food wastage audited
annually. 
Write a detailed note on alternative feeding routes

When patient is unable to eat with mouth .it is of two types

1. Enteral nutrition

When human GI track is working and appetite become lesser

Enteral administration is food or drug administration via the human gastrointestinal tract. This
contrasts with parenteral nutrition or drug administration, which occurs from routes outside the
GI tract, such as intravenous routes. Enteral administration involves the esophagus, stomach, and
small and large intestines.

Enteral feeding is often used as a short-term solution while someone

recovers from an illness, injury, or surgery. Most people receiving enteral

feeds return to regular eating.

• There are some situations where enteral feeding is used as a long-term

solution, such as for people with movement disorders or children with

physical disabilities.

• In some cases, enteral nutrition can be used to prolong life in someone

who is critically ill or an older person who can’t maintain their nutritional

needs. The ethics of using enteral feeding to prolong life have to be

evaluated in each individual case.

It can be further divided into 2 parts

1.1 Oral supplement

If appetite becomes lesser and oral supplement are given
 Oral nutritional supplement are sterile liquids, semi-solids or powders, which provide macro
and micro nutrients. They are widely used within the acute and community health settings
for individuals who are unable to meet their nutritional requirements through oral
diet alone.
1.2 Tube feeding
Patient is not able to eat physically but GI track is working
A feeding tube is a medical device used to provide nutrition to people who cannot obtain
nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. The
state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding

2. Parental Nutrition

When person’s GI track is working

• Parenteral nutrition (PN) is intravenous administration of nutrition, which may include protein,

carbohydrate, fat, minerals and electrolytes, vitamins and other trace elements for patients who
cannot eat or absorb enough food through tube feeding formula or by mouth to maintain good

nutrition status.

• Parenteral nutrition is slowly pumped into the blood stream through a drip. As it can be very
irritant

to blood vessels

Parenteral nutrition (PN) is the feeding of specialist nutritional products to a

person intravenously, bypassing the usual process of eating and digestion. Parenteral
nutrition provides liquid nutrients, including carbohydrates, proteins, fats, vitamins, minerals
and electrolytes. Some people use parenteral nutrition to supplement feeding through a tube
placed into the stomach or small bowel (enteral nutrition), and others use it by itself
It occurs through two ways
2.1 peripheral vein
It may be called peripheral parenteral nutrition (PPN) when administered
through vein access in a limb rather than through a central vein as central venous
nutrition (CVN)
2.2 Central vein
Central venous access (i.e. venous access which allows delivery of nutrients directly into the
superior vena cava or the right atrium) is needed in most patients who are candidates for
parenteral nutrition (PN).

Eternal vs. Parenteral Feeding:

• In some cases, enteral feeding may not be an option. If you’re at risk for
malnutrition and don’t have a functional GI system, you may need an
option called parenteral feeding.
• Parenteral feeding refers to giving nutrition through a person’s veins.
You’ll have a type of venous access device, such as a port or a
peripherally inserted central catheter (PICC or PIC line), inserted so you
can receive liquid nutrition.
• If this is your supplementary nutrition, it’s called peripheral parenteral
 nutrition (PPN). When you’re getting all of your nutritional requirements
through an IV, it’s often called total parenteral nutrition (TPN).
• Parenteral feeding can be a life-saving option in many circumstances.
However, it’s preferable to use enteral nutrition if at all possible. Enteral
nutrition most closely mimics regular eating and can help with immune
system function.
Who shouldn’t have Enteral Feeding?

• The main reason a person wouldn’t be able to have enteral feeds is if them
stomach or intestines aren’t working properly.
• Someone with a bowel obstruction, decreased blood flow to their intestines
(ischemic bowel), or severe intestinal disease such as Crohn’s disease
would likely not benefit from enteral feedings.

Please explain the following diseases with brief introduction, etiology, sign and symptoms
and medical nutrition therapy

OBESITY
 Introduction

Overweight and obesity are increasing problems that lead to significant health and social
difficulties for people. Commonly defined by a measurement of Body Mass Index (BMI -
calculated by dividing body weight (kilograms) by height (meters) squared), the prevalence of
overweight (adult BMI of between 25 and 29.9) and obesity (BMI of 30 or over) is increasing.
For children, these BMI standards require adjustments for age and gender. Overweight and
obesity are global problems and the World Health Organization (WHO) predicts that by 2015
approximately 2.3 billion adults worldwide will be overweight and more than 700 million obese.

Etiology

More consumption of fatty meal Genetics, environment, hormonal, medication, lack of exercise
etc.

Obesity is generally caused by eating too much and moving too little. If you consume high
amounts of energy, particularly fat and sugars, but do not burn off the energy through exercise
and physical activity, much of the surplus energy will be stored by the body as fat.
eating processed or fast food high in fat. not eating fruit, vegetables and unrefined
carbohydrates, such as whole meal bread and brown rice. drinking too much alcohol – alcohol
contains a lot of calories, and heavy drinkers are often overweight.

Sign and symptoms

Back and joints pain, feel very tired, sleep and breath

 increased sweating.
 snoring.
 inability to cope with sudden physical activity.
 feeling very tired every day.
 back and joint pains.
 low confidence and self-esteem.
 feeling isolated.

MNT

Consume low calorie and low fat diet

•Obesity is a common, major health problem. The trend of obesity incidence and prevalence in
Pakistan

• Thoughts and behaviors are major risk factors for specifically obesity and overall health status.

• Hence, the lifestyle modification (dietary, physical activity, and other behavioral measures) is
considered the first-line treatment in obese patient

• Changing thoughts and behaviors are feasible function of primary care physician, although not
easy at all time.

•The objective of this paper is to discuss the dietary management of obese patients using
illustrated case scenario approach.

• It's also for people with certain health conditions. During treatment, you will work with a
registered dietitian to make a nutrition plan just for you

DIABETES

Introduction

Diabetes is a term used to describe a cluster of conditions in which the

body is unable to produce any or enough effective insulin. This is a

hormone needed for glucose to enter the cells to be converted to energy.

Glucose is the fuel that your body needs. In your diet, this comes from

foods such as fruit, milk, some vegetables, starchy foods and sugar. To

help control your blood glucose you will need to eat healthy foods and be

active. You may also need to take pills and/or insulin.

There are two main types of diabetes

Type 1:

Commonly diagnosed in children and adolescents, this occurs when the

pancreas is unable to produce insulin.

Type 2:

Usually developed in adulthood, this occurs when the pancreas does not

produce enough insulin and when the body does not effectively use the

insulin that is produced.

Etiology

genetic makeup, family history, ethnicity, health and environmental factors

Type 1 diabetes occurs when your immune system, the body's system for fighting infection,
attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type
1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the
disease.

Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas is
unable to produce enough insulin. Exactly why this happens is unknown, although genetics and
environmental factors, such as being overweight and inactive, seem to be contributing factors

Sign and symptoms

Poly-uria, Dehydration, poly-dipsia, lose weight, poly-phagia, Blurred vision, increased

infections, weak immune function,

 Fatigue

 Increased thirst

 Frequent urination

 Extreme hunger

 Unexplained weight loss

 Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and
fat that happens when there's not enough available insulin)

 Fatigue
  Irritability

 Blurred vision

 Slow-healing sores

 Frequent infections, such as gums or skin infections and vaginal infections

MNT

Sugar free diet

Whole bread and wheat Fruits Vegetables Salad Skim milk and yogurt etc.

Lean meat

The link between diabetes and diet has been well documented, as has the importance of diet in
conjunction with medical interventions for diabetes. Patients often look to their primary care
physicians for advice about general diabetes care, including diet, but survey studies have
revealed that doctors feel uncomfortable advising patients on the sensitive issues of weight loss
and diet.1 Research is increasingly demonstrating that medical nutrition therapy (MNT),
administered by a registered dietitian (RD) or nutrition professional, is a key component of
diabetes management and a complement to treatment of diabetes by physicians. Nutrition
Recommendations and Interventions for Diabetes” emphasizes the importance of MNT in
preventing diabetes, managing existing diabetes, and preventing and slowing the onset of
diabetes-related complications.3 The integration of MNT into diabetes care has the potential to
improve patients' diabetes management and to lessen the burden on physicians to provide
nutrition information.

CHRONIC OBSTRUCTIVE PLUMONARY DISEASE

Introduction

Chronic Obstructive Pulmonary Disease (COPD for short) occurs when permanent blockages
form within the pulmonary system (the term "pulmonary" refers to the lungs and respiratory
system) that interfere with the transfer of vital gasses. To be diagnosed with COPD means that
some portion of one's bronchi or alveoli have become permanently obstructed, reducing the
volume of air that can be handled by the lungs. As this process progresses, the overall efficiency
of the gas exchange process is reduced.

There are two underlying disorders that can cause COPD: Emphysema and chronic Bronchitis.

Etiology

Infections, Chemical damage, Immunological, hereditary disorders and Diabetes mellitus

included in the etiology of this disease.

Protein-uria, Low serum albumin, Edema, Elevated blood lipids, Blood coagulation

disorders involved in clinical finding.

Sign and symptoms

may include edema (swelling of face, abdomen and body),

proteinuria (passing of protein in urine), hypoalbuminemia (low level of proteins in blood),

and hyperlipidemia (high amount of lipids in blood).

Disturbances in protein metabolism

• Edema

• Sodium retention

• Risk of CVD

• Elevated LDL, VLDL & lipoprotein(a)

• Loss of blood clotting proteins

MNT

A low-sodium diet is also recommended with nephrotic syndrome. Too much sodium
through diet can cause further fluid retention and salt retention, resulting in uncomfortable

swelling and hypertension.

✓ Energy, enough to maintain healthy weight & prevent wasting

✓ Low-protein diet, can increase when on dialysis

✓ Lipids, Restrict saturated fat & cholesterol

✓ Fluids, not restricted until output decreases

✓ Sodium, Mild restriction

✓ Potassium, may need to restrict high-potassium foods

✓ Calcium & vitamin D needs increase

✓ May need phosphorus restrictions

✓ Restrict protein, Restrict milk & milk products

✓ Dietary supplements

✓ Generous folate and B6

✓ Recommended amounts of water-soluble vitamins except vitamin C

✓ IV iron administration

✓ Intradialytic parenteral nutrition

KIDNEY DISEASES

Introduction

Chronic kidney disease (CKD) means your kidneys are damaged and can't filter blood the way
they should. The disease is called “chronic” because the damage to your kidneys happens
slowly over a long period of time. This damage can cause wastes to build up in your body. CKD
can also cause other health problems.
Etiology

Syndrome

Infections, Chemical damage, Immunological, hereditary disorders and Diabetes Mellitus

Sign and symptom

Edema (swelling of face, abdomen and body), proteinuria, hypoalbuminemia, and

hyperlipidemia

MNT

low-sodium diet

lean meats (poultry, fish, shellfish), dried beans, peanut butter, soybeans, fresh or frozen fruit and
vegetables

CVD CARDIO VASCULAR DISEASES

Introduction

Cardiovascular disease is a general term which describing diseases of the heart and

blood vessels especially coronary heart disease (CHD) is most common form of CVD.

Heart attack and stroke (blood supply to brain tissue is blocked) may result in disablement

or death.

CVD is a global health issue which is responsible for nearly 40 percent of deaths in the

United States; many people assume that heart problems are men’s diseases while CVD

deaths in women have exceeded those of men for the past 20 years.

The term cardiovascular disease refers to any disorder of the heart and blood vessels, including
hypertension, coronary artery disease (CAD), cardiac dysrhythmias, cerebrovascular disease,
valvar heart disease, cardiomyopathies, peripheral vascular disease, and congenital cardiac
abnormalities. Each disorder has been characterized epidemiologically; incidence and
prevalence rates vary widely by country and culture.
Etiology

Because hypertension, coronary artery disease, cardiac dysrhythmias, and cerebrovascular

disease account for the majority of cardiovascular morbidity and mortality in developed
countries, those topics are the focus of this chapter. For each of the disease categories, the
epidemiology, etiology, risk indicators and primary prevention, diagnostic assessment, and
treatment and prognosis are discussed.

Sign and symptom

Chest pain: People describe it as a squeezing, pressure, heaviness, tightening, burning,

or aching across the chest, usually starts behind the breastbone. The pain often spreads

to the neck, jaw, arms, shoulders, throat, back, or even the teeth Other symptoms include
indigestion, heartburn, weakness, sweating, nausea, cramping,

and shortness of breath.

MNT

1. Choose whole grain and high fiber diet

2. Consume fish at least twice a week

3. Consume diet rich in Vegetables and fruits

4. Choose lean meat

5. Consume egg twice or thrice a week

6. Choose low fat milk and milk products

NUTRITION IN INFECTION

Introduction

Nutrition and infectious diseases are related to each other in some aspects. First, nutrition affects
the development of human body immune system. Moreover, nutrition can influence emerge of
infectious diseases (e.g., gastrointestinal infections), food poisoning, intestinal diseases, and
systemic infectious diseases. In this review, the mentioned aspects of the relationship between
nutrition and infections are discussed. Furthermore, the relationship between malnutrition and
infectious diseases, nutrition in patients with severe combined immunodeficiency and
relationship between overeating and infection are reviewed. Overall, some factors can weaken
the body's ability to fight infection and cause malnutrition. The factors include anorexia,
traditional behaviors, reduction of intestinal absorption, metabolic damage, disorder metabolism
of lipids and carbohydrates, reduction of vitamins, iron, zinc, and copper.

. Etiology

Sign and symptom

MNT

METABOLIC AND RESPIRATORY STRESS

Introduction

Respiratory distress is defined as labored breathing and is characterized by an inappropriate

degree of effort to breathe based on rate, rhythm, and subjective evaluation of respiratory 

Metabolic stress is a physiological process that occurs during exercise in response to low energy
that leads to metabolite accumulation [lactate, phosphate inorganic (Pi) and ions of hydrogen
(H+)] in muscle cells

Etiology

Sign and symptoms

MNT

DISEASE OF UPPER GI TRACT

Introduction

There are many diseases of the upper digestive tract; some of which include hiatal hernia,
gastritis, ulcers, gastro-esophageal reflux disease (GERD), Barrett's esophagus, and mouth,
esophageal, gastric and small intestinal cancers.

Etiology
 Viruses, Bacteria, Parasites are most common sign and included medications, such as antibiotics
Other common causes include bacteria, such as salmonella, campylobacter, Escherichia coli
certain medical conditions (such as Celiac disease or Crohn's disease); food intolerance or
medicines. Gastric diseases refer to diseases affecting the stomach. Inflammation of
the stomach by infection from any cause is called gastritis, and when including other parts of
the gastrointestinal tract called gastroenteritis. ... Peptic ulcers are most commonly caused by a
bacterial Helicobacter pylori infection.

Sign and symptom

Frequent loose, watery stools, Abdominal cramps Abdominal Pain Fever

 Bleeding
 Heartburn.
 Difficulty swallowing.
 Stomach pain.
 Nausea.
 Vomiting.
 Problems in the passage of food.
 Any combination of these symptoms.

MNT

Simple chow and brat diet

Low fat milk, well cooked meat and vegetables without adding fat, white flour, fruit juices
etcWhole milk, fried meat (fish, poultry), fatty meal, raw and fried vegetable, caffeinated

•Apply the factors affecting diet modification to planning and calculation of quantitative

and qualitative modified diets 

Develop the ability to evaluate and interpret data to establish needs for dietary information

and treatment and for problem-solving (decision-making)

DISEASE OF LOWER GI TRACT

Introduction
The GI tract is involved in transforming food that eaten into energy to meet the human

body’s needs for its function.

They consist of esophagus (food tube), stomach (mixes food and forms chyme), small

intestine (duodenum, the jejunum and the ileum) and large intestine (cecum, colon,

rectum and anal canal).

The dietary factors associated with ailments of the gastrointestinal tract (G.I.) are Acidity,

inadequate fiber, fat, substances (gluten in wheat) and lactose. Also alcohol affects the

health of G.I. tract.

The lower gastrointestinal tract, commonly referred to as the large intestine, begins at the
cecum and also includes the appendix (humans only) colon, rectum, and anus. ... All three
species have abundant bacterial flora within the colon, which carry out a rumen-like function that
is more prominent in rodents ...

Etiology

Antibiotics and other medications may cause diarrhea. These medications generally

cause diarrhea either by increasing GI motility or by altering the normal flora of the colon.

Many gastrointestinal diseases have diarrhea as a common symptom. If the underlying

disease disrupts normal digestion and absorptive capabilities, diarrhea will most often

result e.g. Crohn’s disease, ulcerative colitis and celiac disease.

These diagnoses can also result in malabsorption of lipids and other nutrients, which

further contribute to the diarrhea.

Other diseases that do not originate in the gastrointestinal tract can also present with

symptoms of diarrhea. These may include, but are not limited to, AIDS enteropathy with

HIV infection, thyroid dysfunction, and some malignancies.

 Common conditions associated with the lower GI tract include diverticular disease, polyps,
irritable bowel syndrome (IBS), cancer, or Crohn's disease, and usually require prompt clinical
care by a gastroenterologist or a colorectal surgeon.

Other common causes include bacteria, such as salmonella, campylobacter

, Sign and symptom

Abdominal pain especially cramping include in symptoms of diarrhea. Other symptoms

 depend on the cause of the diarrhea

 Bleeding.
 Bloating.
 Constipation.
 Diarrhea.
 Heartburn.
 Incontinence.
 Nausea and vomiting.
 Pain in the belly.

MNT

Milk and milk products

Food allowed: Buttermilk, skim and low-fat milk, Yogurt with live active cultures, Cheese,

Sherbet

Not allowed: whole milk, cream, Regular (whole milk) ice cream, Yogurt with berries, dried

fruit, or nuts

Meat and Other Protein Foods

Food allowed: Tender, well-cooked meat, poultry, fish, eggs, or foods made without

added fat

Not allowed: Fried meat, poultry, or fish, Sausage, Hot dogs, Fatty meats, Nuts, Chunky
nut butters

Grains

Food allowed: White flour, Bread, bagels, rolls, crackers, and pasta made from white or

refined flour, Cold or hot cereals made from white or refined flour

Not allowed: Whole-wheat or whole-grain breads, rolls, crackers, or pasta, Brown or wild

rice, Barley, oats, and other whole grains, Cereals made from whole grain or bran, Breads

or cereals made with seeds or nuts, Popcorn

Increase exercise

Intake more fibers

Sufficient fluid balance in body

Drink prune and prunes juice

DISEASE OF LIVER

Introduction

Liver is the largest organ in human body, they play a vital role, performing many complex

functions that is essential for human life. They serve as human body’s internal chemical

power plant. The quality of our life depends on health of the liver.

Liver manufactures proteins, carbohydrates, absorbs fat products and makes them

available as fuel. Liver and biliary system diseases are caused by infections (virus,

bacteria and parasites), alcohol intake, toxic chemicals, poor nutrition and metabolic

disorders.

Chronic liver disease is characterized by scarring and destruction of the liver tissue. ... Causes of

death from cirrhosis include development of liver failure, brain damage (encephalopathy),
catastrophic internal bleeding (esophageal varices) and also primary liver cancer.
 Etiology

Jaundice

Jaundice is a yellow discoloration of skin and tissues. In this condition the blood levels of

bile pigments are higher as compare to normal. This is a frequent sign of liver and biliary

tract diseases. The bilirubin is a byproduct of daily natural breakdown and destruction of

red blood cells in the body. Normally, liver metabolizes and excretes the bilirubin in the

form of bile. So, if there is a disruption in this normal metabolism and production of

bilirubin, jaundice may result.

5.2.1 Etiology of Jaundice

The abnormal metabolism and/or excretion of bilirubin cause the jaundice. Alcohol abuse
and liver disease: Alcohol abuse is the most common cause of liver disease in North America.
Alcohol is directly toxic to liver cells and can cause liver inflammation, referred to as alcoholic
hepatitis. In chronic alcohol abuse, fat accumulation occurs in liver cells affecting their ability
to function.

Sign and symptom

that may include nausea, vomiting, abdominal pain and small spider like blood vessels

that visible in the skin (spider angiomas). Men may have enlarged breasts, shrunken

testes, and pubic hair that grows as it does in women.

Serious problems can include Ascites, Coagulopathy (tendency to bleed), Portal

hypertension (High blood pressure in veins that bring blood to the liver, that can lead to

bleeding in esophagus and sometimes stomach). The common symptoms in individuals

with jaundice included the yellow discoloration of skin, mucous membranes, and the

 whites of the eyes, light-colored stools, dark-colored urine and itching of the skin.
 Skin and eyes that appear yellowish (jaundice)
 Abdominal pain and swelling.
 Swelling in the legs and ankles.
 Itchy skin.
 Dark urine color.
 Pale stool color.
 Chronic fatigue.
 Nausea or vomiting.

MNT

High protein and low fat

Eat a balanced diet: Select foods from all food groups: Grains, fruits, vegetables, meat and beans,
milk, and oil. Eat food with fiber: Fiber helps your liver work at an optimal level. Fruits,
vegetables, whole grain breads, rice and cereals can take care of your body's fiber needs.

DYSPHAGIA

Introduction

Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have
problems swallowing certain foods or liquids, while others can't swallow at all. Other signs
of dysphagia include: coughing or choking when eating or drinking. bringing food back up,
sometimes through the nose.

Etiology

neurological or structural damage, Congenital and developmental, Obstruction, Muscular

In some cases, swallowing difficulties can be a symptom of cancer, but the most common causes
of dysphagia are the consequences of a stroke or a hiatus hernia

Sign and symptom

Pain, difficulty in swallowing, feeling like food stuck in their throat and chest part etc.

 Having pain while swallowing (odynophagia)

 Being unable to swallow.
 Having the sensation of food getting stuck in your throat or chest or behind your
breastbone (sternum)
 Drooling.
 Being hoarse.
 Bringing food back up (regurgitation)
 Having frequent heartburn.

MNT

Level 1 (Pureed food),

Level 2 (Minced food),

Level 3 (Ground food),

Level 4 (Chopped

food), Level 5 (Modified

 Regular Diet)
 Pureed breads (also called “pre-gelled” breads)
 Smooth puddings, custards, yogurts, and pureed desserts.
 Pureed fruits and well-mashed bananas.
 Pureed meats.
 Soufflés.
 Well-moistened mashed potatoes.
 Pureed soups.
 Pureed vegetables without lumps, chunks, or seeds.