Clinical Nutrition

Running head: CLINICAL NUTRITION
Clinical Nutrition
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CLINICAL NUTRITION
Lecture 1: Pathophysiology of Gastrointestinal Tract
The main organs of the digestive system are moth, parynx, esophagus, stomach, large
intestine, small intestine, rectum and anus. The organs are assisted by accessory organs and
this include salivary glands, liver, gall bladder and pancreas. The overall organs of the
digestive system made up the gastro-intestinal (GI) tract and its main action include transport
of the food partciles to the stomach, followed by digestion under the action of the digestive
juices secreted by the accessory organs. The final steps are absorption of the nutrients from
the small intestine and excretion of the undigested food through rectum. In order to detect any
abnormalities present in the GI tract the main mode of investigation used is endoscopy,
barium studies, gastric analysis, laparoscopy and bacterial culture of the stool along with
MRI and ultrasound. There are several manifestations that highlight malfunction in the GI
tract like dysphagia. It causes difficulty in swallowing and mainly results from neurological
impairment like Parkinson and development in the food pipe. Other problematic
manifestation of GI tract includes nausea, vomiting and diarrhoea. The smooth path of
digestion is hampered at times due to the formation of toxic mega-colon and diverticulitis
(hernia in the mucosa of colon) that increase the transit time of the food. One of the
significant problems in the GI tract that is an important consideration for the nutritionist is
gastritis. It is an inflammatory disorder of gastric mucosa leading to thinning or breakdown of
the stomach wall and are mainly common in adults. It falls under the category of the
inflammatory bowel disease (IBD). Ulcerative colitis and Crohns disease and coeliac disease
fall under the group of IBD. Other form of ulcer is peptic ulcer the causative agent is
Helicobacter pylori. Other form of ulcer in the GI tract include duodenal ulcer, perforated
ulcer. Apart from bacterial infection in the GI tract, protozoa and worms also found to
colonise inside the GI tract leading to the development of several infectious disease. The

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accessory organs of the GI tract are also affected like cirrhosis of liver or formation of
gallstones and chronic pancreatitis. The main reason behind the development of the
complication in the GI tract is skipping of meal, unhealthy food habits or high consumption
of alcohol and junk food. For the effective treatment of the IBD and infections associated
with the GI tract, proper diet plan is important. The diet plan must be low in salt, cholesterol
and fat while high on fresh fruits, vegetables, water (to keep the body hydrated) and strict
prohibition of alcohol and smoking of tobacco. If at point of time bleeding from GI tract is
noticed prompt interventions from doctor is recommended.
Lecture 2: Advanced Nutrition - Eating Disorders
Eating disorders are psychiatric disorders that lead to deviations in the eating
behaviour that lead to the generation of disease and disability. Two common eating disorders
are Anorexia Nervosa (AN) and Bulimia Nervosa (BM). AN individuals nurture a fear of
weight gain and thus they fail to consume food that is require to maintain minimal BMI.
Being under-weight for a prolong period of time leads multi-organ failure. The main reasons
behind the occurrence of AN are negative body image and adverse socio-cultural context
where begin voluptuous or over-weight is considered as a matter of shame. Main treatments
include voluntary or forced feeding, psychiatric treatment with anti-psychotic drugs, non-
pharmacological psychotherapy like cognitive behavioural therapy and counselling. BN
condition is opposite to AN. It is associated with recurrent episodes of binge eating. Binge
eating causes weakens the immune system along with the generation of abnormal heart
rhythms, renal failure, poor electrolyte balance and damage in the buccal cavity. Treatment of
BM includes psychotherapy along with reduction in the intake of alcohol and tobacco.
According to the review published in the Nature journal of neuroscience people who develop
AN are found to have negative emotions, drive for thinness, increased interceptive awareness

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and obsessive compulsive personality. During adolescence, there occurs development of
brain, secretion of hormones and this is added with cultural factors along with stress. These
factors cumulate into excessive dieting causing drastic weight loss (AN). Thus apart from
psychotherapy, for effective health-outcome in AN and BN is proper planning of diet. For
AN with will be protein rich diet and the formation of muscle mass and for BN calories
restricted diet (low in carbohydrate) and taken in small meals at regular intervals. Fruits and
green vegetables are the two common factors that must be included in both AN and BN.
Lecture 3: Nutrition & Cardiovascular Disease
Cardiovascular system consists of heart as the central organ long with intricate
networks of veins and arteries that help in transmitting blood to different parts of the body.
Lack of proper diet plan or unhealthy lifestyles like increased alcohol intake, high
consumption of junk food, predisposition to type 2 diabetes, hypertension and lack of proper
exercise leads to the deposition of cholesterol in the arteries leading to the development of
atherosclerosis and athero-thrombosis, one of the leading cause of death worldwide. Common
atherosclerotic disease includes cerebrovascular disease, coronary artery disease and
peripheral vascular disease. The pathogenesis of Atherosclerotic plaques cause endothelial
damage followed by production of cellular adhesion molecules as a protective response. The
monocytes and T-lymphocytes get attached with this sticky surface of the endothelial cells.
The sticky mass migrates through the arterial wall towards the sub-endothelial space. The
macrophages take up the oxidised low-density-lipoprotein cholesterol formation of lipid-rich
foam cells leading to narrowing and thinning of arteries. This causes development of chronic
heart disease (CHD). The main nutritional considerations of CVD or CHD include framing of
the diet plan that is low in dietary fats, cholesterols and sodium. Restricted intake of sodium
helps to maintain proper electrolyte balance (preventing oedema) and effective control of