COMPILATIONDIETS

Myrrh Ariane Y.
Gaitano
MSU-IIT STUDENT NURSE
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TABLE OF CONTENTS
Eating Disorders (5-11)

 Bulimia Nervosa
 Anorexia Nervosa
Burns (12-17)
Cardiac Disorders (18-26)
 Coronary Artery Diseases
 Hypertension
 Congestive Heart Failure
Endocrine Disorders (26-55)
 Diabetes Mellitus
 Thyroid disorders
 Parathyroid disorders
 Pancreatitis (Acute and Chronic)
 Diabetes Insipidus
 Addison’s Disease
 Cushing’s Disease
 Pheochromocytoma
GI disorders (55-82)
 Gastroesophageal Reflux Disease
 Dumping Syndrome
 Irritable Bowel Syndromes
 Inflammatory Bowel Diseases
 Peptic Ulcer Diseases
 Cholecystitis
 Gastritis
 Gastroenteritis
 Peritonitis
 Paralytic Ileus
 Diverticulitis
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Respiratory Disorders (82-93)
 Acute Airway Attacks
 Chronic Obstructive Pulmonary
Disease
 Tuberculosis
Immune Disorders (93-107)
 HIV and AIDS
 Rheumatoid Arthritis
 Systemic Lupus Erythematosus
 Anaphylaxis
Liver Disorders (107-112)
 Hepatitis (All types)
 Liver Cirrhosis
Musculoskeletal Disorders (112-125)
 Fractures
 Osteoarthritis
 Osteoporosis
 Osteomyelitis
 Gouty Arthritis
Neurological Disorders (125-138)
 Guillain-Barre Syndrome
 Myasthenia Gravis
 Parkinson’s Disease
 Spinal Cord Injury
 Multiple Sclerosis
 Bell’s Palsy
 Meningitis
 Stroke
Hematologic Disorders (138-144)

 Iron Deficiency Anemia
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 Leukemia
 Sickle Cell Anemia
 Polycythemia Vera
 Pernicious Anemia
Genitourinary System (144-150)
 Benign Prostatic Hypertrophy
 Kidney Stones
 Urinary Tract Infection
 Acute Glomerulonephritis
 Renal Failure (Acute and Chronic)
REFERENNCES (150-154)
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EATING DISORDERS
Anorexia Nervosa
Overview
People who have anorexia have an intense fear of

gaining weight. They severely limit the amount of
food they eat and can become dangerously thin.
Anorexia affects both the body and the mind. It may
start as dieting, but it gets out of control. You think
about food, dieting, and weight all the time. You have
a distorted body image. Other people say you are too
thin, but when you look in the mirror, you see your
body as overweight.
Associated Nutritional Problems
In anorexia nervosa’s cycle of self-starvation, the

body is denied the essential nutrients it needs to
function normally. Thus, the body is forced to slow
down all of its processes to conserve energy,
resulting in serious medical consequences:
• Abnormally slow heart rate and low blood

pressure, which mean that the heart muscle is
changing. The risk for heart failure rises as
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the heart rate and blood pressure levels sink
lower and lower.
• Reduction of bone density (osteoporosis),

which results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in

kidney failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin; hair loss is common.
• Growth of a downy layer of hair called lanugo

all over the body, including the face, in an
effort to keep the body warm.
Dietary measures
The first priority in anorexia treatment is addressing

and stabilizing any serious health issues.
Hospitalization may be necessary if you are
dangerously malnourished or so distressed that you
no longer want to live. You may also need to be
hospitalized until you reach a less critical weight.
Often people with anorexia will be reluctant to admit

to their problem due to embarrassment or
trepidation about what the treatment might involve.
It can also feel like they are relinquishing the control
they fought so hard to obtain.
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If you suspect that a close friend or family member
has anorexia, it is advisable to try to get help as soon
as possible. A GP will conduct an assessment and
possibly refer the sufferer to a specialist care team (a
care team can include a specialist counsellor, a
psychologist, a psychiatrist, a dietician and a nurse).
Once any psychological or physical factors have been
assessed, a course of treatment can be established.
Nutritional Monitoring
For an anorexic sufferer, gaining weight is an

incredibly delicate process. The long periods of
starvation could have caused any number of
biochemical abnormalities such as deficiencies in
proteins, micronutrients and fatty acids.
This usually means that specialist dietary plans must

be made in order to correct the imbalances and not
cause additional problems. Experts believe that
weight should not be gained until these deficiencies
have been corrected. Aggressive attempts to boost
weight gain during the early stages of treatment
could be extremely hazardous.
Any course of treatment for anorexia is usually

considered within a wider psychological context. This
means that emphasis will be placed on speaking with
the patient and understanding their needs. A person
suffering from anorexia may find the treatment
challenging and upsetting. This is because their
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connection with food is more personal and complex
than most outsiders can understand, and may be
connected to underlying psychological issues.
Bulimia Nervosa
Overview
Bulimia nervosa, commonly called bulimia, is a

serious, potentially life-threatening eating disorder.
People with bulimia may secretly binge — eating
large amounts of food — and then purge, trying to get
rid of the extra calories in an unhealthy way. For
example, someone with bulimia may force vomiting
or engage in excessive exercise. Sometimes people
purge after eating only a small snack or a normal-size
meal.
Bulimia can be categorized in two ways:
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• Purging bulimia. You regularly self-induce
vomiting or misuse laxatives, diuretics or
enemas after bingeing.
• Nonpurging bulimia. You use other methods

to rid yourself of calories and prevent weight
gain, such as fasting, strict dieting or excessive
exercise.
However, these behaviors often overlap, and the
attempt to rid yourself of extra calories is usually
referred to as purging, no matter what the method.
Associated nutritional problems
 Dental
 Damaged skin
 Swollen glands
 Bowel issues
 Chemical imbalances
 Heart problems
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Dietary measures
Since negative body image and poor self-esteem are
often the underlying factors at the root of bulimia, it
is important that therapy is integrated in the
recovery process. Treatment for bulimia nervosa
usually includes:
• Discontinuing the binge-purge cycle: The

initial phase of treatment for bulimia nervosa
involves breaking this harmful cycle and
restoring normal eating behaviors.
• Improving negative thoughts: The next phase
of bulimia treatment concentrates on
recognizing and changing irrational beliefs
about weight, body shape, and dieting.
• Resolving emotional issues: The final phase of
bulimia treatment focuses on healing from
emotional issues that may have caused the
eating disorder. Treatment may address
interpersonal relationships and can include
cognitive behavior therapy, dialectic behavior
therapy, and other related therapies.
Don’t delay and risk serious medical complications.
Seek out an eating disorder treatment facility in your
area.
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Nutritional monitoring
Nutrition therapy is an integral part of the eating
disorder (ED) treatment and recovery process. The
primary role of nutrition therapy is to assist patients
in normalizing their eating patterns. Normalized
eating encompasses
Eating adequately to meet the body’s daily nutritional

needs
A balanced and sustainable relationship with food,

free from negative or distorted thoughts about
oneself
Listening to and trusting your body’s internal cues to

determine hunger and fullness
While underlying thoughts and emotions remain at

the core of a person’s illness and recovery, their
relationship with food, eating and nutrition can play a
major role in inhibiting or promoting the recovery
process. This is why The Center for Eating Disorders
incorporates nutrition counseling with specially
trained experts at every level of our program. Our
staff of Registered Dietitians (RD,) as part of an
interdisciplinary team of professionals, support and
assist individuals in meeting nutritional goals and
progressing in recovery. The nutrition staff facilitates
educational and supportive groups as well as
individual sessions tailored to each person’s unique
struggle with food and eating. Throughout the
program, many opportunities are provided for
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patients to incorporate and practice their new
balanced approach to eating.
BURNS
Overview
Burns are a type of injury caused by heat. The heat
can be thermal, electrical, chemical, or
electromagnetic energy. Most burn accidents occur at
home. About 75 percent of all burn injuries in
children are preventable.
Smoking and open flame are the leading causes of

burn injury for older adults, while scalding is the
leading cause of burn injury for children. Both infants
and the elderly are at the greatest risk for burn
injury.
A burn injury usually results from an energy transfer

to the body. There are many types of burns caused by
thermal, radiation, chemical, or electrical contact:
• Refeeding Syndrome -This potentially lethal

syndrome of severe electrolyte and fluid
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shifts associated with metabolic
abnormalities in malnourished patients
undergoing feeding orally enterally, or
parenterally has been well defined in the
malnourished free-living and sick populations
alike. The prerequisite for risk of refeeding is
recent dramatic or chronic nutrition
depletion. The burn patient is at risk if pre-
burn nutrition has been compromised.
• Non-obstructive Bowel Necrosis
Although rare, several case reports have

defined this syndrome of diffuse or defined
areas of full-thickness necrosis of small bowel
due to aggressive enteral feeding, without
obstruction. For high-risk patients, it is
recommended that initial cautious feeding is
effected, with a fibre-free enteral feed. Bowel
function and GIT symptoms need to be
monitored closely. (2) Burn patients at risk
include those experiencing severe trauma
shock, ventilator dependence, anaesthetic
and analgesic medications, general
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vasoconstriction (including pharmacological),
hypovolaemia, bowel dysmotility. (2)
Dietary Measures
 Minor burns can be treated with natural

products. However, severe burns always
require immediate medical attention. It is
especially important for people who have
been seriously burned to get enough
nutrients in their daily diet. Burn patients in
hospitals are often given high calorie, high
protein diets to speed recovery.
 DO NOT try to treat a second or third degree
burn by yourself. Always seek medical advice.
Ask your doctor which supplements are best
for you. Always tell your doctor about the
herbs and supplements you are using or
considering using, as some supplements may
interfere with conventional treatments.
 Following these tips may improve your
healing and general health.
 Eat antioxidant foods, including fruits (such
as blueberries, cherries, and tomatoes), and
vegetables (such as squash and bell peppers).
One study found that high doses of vitamin C
after a burn reduced fluid requirements by
40%, reduced burn tissue water content 50%,
and reduced ventilator days.
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 Avoid refined foods, such as white breads,
pastas, and sugar.
 Eat fewer red meats and more lean meats,
cold-water fish, tofu (soy) or beans for
protein.
 Use healthy cooking oils, such as olive oil or
coconut oil.
 Reduce or eliminate trans-fatty acids, found
in commercially baked goods, such as cookies,
crackers, cakes, French fries, onion rings,
donuts, processed foods, and margarine.
 Avoid caffeine and other stimulants, alcohol,
and tobacco.
 Drink 6 to 8 glasses of filtered water daily.
 The following supplements may also help. Be
sure to ask your doctor before taking them if
your burns are moderate or severe:
 A daily multivitamin, containing the
antioxidant vitamins A, C, E, the B-complex
vitamins and trace minerals such as
magnesium, calcium, zinc, and selenium.
 Omega-3 fatty acids, such as fish oil, 1 to 2
capsules or 1 tbsp of oil, 1 to 2 times daily, to
help reduce inflammation, and for healing
and immunity. Cold-water fish, such as
salmon or halibut, are good sources, but you
may need a supplement to get a higher dose.
Omega-3 fatty acids can interact with blood-
thinning medications such as warfarin
(Coumadin) and aspirin, and may decrease
clotting time.
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 Vitamin C (1,000 mg, 2 to 6 times per day)
helps skin heal by enhancing new tissue
growth and strength. Lower dose if diarrhea
develops. You should use vitamin C only
under a physician's guidance if you have
cancer, certain blood iron disorders, kidney
stones, diabetes, and a metabolic deficiency
called "glucose 6 phosphate dehydrogenase
deficiency" (G6PDD).
 Vitamin E (400 to 800 IU a day) promotes
healing. May be used topically once the burn
has healed and new skin has formed. Higher
doses may help in healing burns. Talk to your
doctor before taking vitamin E if you are
scheduled to have surgery. Vitamin E can
interact with certain medications, including,
but not limited to antiplatelet/anticoagulant
drugs. Speak with your doctor.
 Coenzyme Q10 (CoQ10), 100 to 200 mg at
bedtime, for antioxidant and immune activity.
CoQ10 may have a blood-clotting effect and
can interact with blood-thinning medications
(anticoagulant/antiplatelet drugs).
 L-glutamine, 500 to 1,000 mg, 3 times daily,
for support of gastrointestinal health and
immunity. Glutamine in high doses can affect
mood particularly in patients with mania.
There is some concern that people who are
sensitive to MSG (monosodium glutamate)
may also be sensitive to Glutamine. People
with hepatic encephalopathy, severe liver
disease with confusion, or a history of
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seizures, should not take Glutamine.
Glutamine can interact with certain
medications, so speak with your physician.
 Probiotic
supplement (containing Lactobacillus
acidophilus), 5 to 10 billion CFUs (colony
forming units) a day. Taking antibiotics can
upset the balance of bacteria in your
intestines. Probiotics or "friendly" bacteria
can help restore the balance, improving
gastrointestinal and immune health. Some
clinicians have raised concerns about giving
probiotics to severely immunocompromised
patients. More research is needed. Refrigerate
your probiotic supplements for best results.
 Coconut oil. After a burn heals, applying
coconut oil topically may be helpful for
reconditioning and moisturizing the skin.
The pediatric burn patient presents a particular

challenge nutritionally. Nutritional reserves are
limited, and excesses are often poorly tolerated.
Ongoing monitoring is essential for discovering at an
early stage the dynamic shifts in energy, protein, and
other nutrients that may be occurring. Adequate
enteral intake may be difficult to achieve as a result
of repeated holding of feedings on surgery days and
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gastrointestinal tolerance problems such as poor
gastric emptying and abdominal distention. This case
report illustrates techniques, such as the nutritional
assessment record and parenteral nutrition
evaluation form, which may assist the clinician in
optimizing the nutritional management of the
patient.
CARDIAC DISORDERS
Coronary Artery Disease

Overview
Coronary artery disease is the most common type

of heart disease. It's also the number one killer of
both men and women in the United States.
When you have it, your heart muscle doesn't get

enough blood. This can lead to serious problems,
including heart attack.
It can be a shock to find out that you have coronary

artery disease. Many people only find out when they
have a heart attack. Whether or not you have had
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a heart attack, there are many things you can do to
slow coronary artery disease and reduce your risk of
future problems.
Associated Nutrtional Problems
• Uncontrolled diabetes and impaired

glucose tolerance
In healthy people, insulin keeps the blood sugar level

relatively constant. However, for those vulnerable to
type 2 diabetes, the body gradually loses its
sensitivity to insulin. This leads to chronically
elevated blood sugar levels, also known as impaired
glucose tolerance.
Uncontrolled diabetes can damage the artery walls

and contribute to coronary heart disease. People who
are obese are more likely to develop type 2 diabetes
than people of normal weight.
Dietary measures
• Avoid fried fast food and processed foods containing

vegetable shortening.
• Choose a variety of oils (extra virgin olive oil, canola,
peanut) and foods containing natural fats (nuts,
seeds, avocado, olives, soy, fish).
• Switch to low-fat or non-fat dairy products.
• Increase the amount and variety of plant foods
consumed – eat more unrefined vegetables, fruits and
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wholegrain cereals. Reduce intake of refined sources
of carbohydrates with higher glycaemic indices.
• Include legumes (like baked beans, soybeans, lentils
and tofu) in your diet.
• Have a handful of a variety of raw, unsalted nuts on
most days of the week, especially walnuts and
almonds.
• Eat oily fish at least once per week.
• If you drink alcohol, have no more than two drinks
per day.
• Trim all visible fat from meat.
• Remove poultry skin and eat only the meat.
• Avoid added salt at the table and cooking and salty
foods. Check the sodium content of foods and choose
the lowest sodium products.
Hypertension
Overview
Blood pressure is the force of blood pushing against

blood vessel walls. The heart pumps blood into the
arteries (blood vessels) which carry the blood
throughout the body. High blood pressure, also called
hypertension, means the pressure in your arteries is
above the normal range. In most cases, no one knows
what causes high blood pressure. What you eat can
affect your blood pressure.
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In most people, the kidneys have trouble keeping up

with the excess sodium in the bloodstream. As
sodium accumulates, the body holds onto water to
dilute the sodium. This increases both the amount of
fluid surrounding cells and the volume of blood in the
bloodstream. Increased blood volume means more
work for the heart and more pressure on blood
vessels. Over time, the extra work and pressure can
stiffen blood vessels, leading to high blood pressure,
heart attack, stroke,. It can also lead to heart failure.
There is also some evidence that too much salt can
damage the heart, aorta, and kidneys without
increasing blood pressure, and that it may be bad for
bones, too.
Cancer- Research shows that higher intake of salt,

sodium, or salty foods is linked to an increase in
stomach cancer. The World Cancer Research Fund
and American Institute for Cancer Research
concluded that salt, as well as salted and salty foods,
are a “probable cause of stomach cancer.”
Osteoporosis- The amount of calcium that your body

loses via urination increases with the amount of salt
you eat. If calcium is in short supply in the blood, it
can be leached out of the bones. So, a diet high in
sodium could have an additional unwanted effect—
the bone-thinning disease known as osteoporosis.
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Dietary measures
DASH stands for Dietary Approaches to

Stop Hypertension. The diet is simple:
• Eat more fruits, vegetables, and low-fat dairy foods

• Cut back on foods that are high in saturated
fat, cholesterol, and trans fats
• Eat more whole-grain foods, fish, poultry, and nuts
• Limit sodium, sweets, sugary drinks, and red meats
A healthful eating pattern, regular physical activity,

and often pharmacotherapy are key components of
diabetes management. For many individuals with
diabetes, the most challenging part of the treatment
plan is determining what to eat. It is the position of
the American Diabetes Association (ADA) that there
is not a “one-size-fits-all” eating pattern for
individuals with diabetes. The ADA also recognizes
the integral role of nutrition therapy in overall
diabetes management and has historically
recommended that each person with diabetes be
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actively engaged in self-management, education, and
treatment planning with his or her health care
provider, which includes the collaborative
development of an individualized eating plan.
Therefore, it is important that all members of the
health care team be knowledgeable about diabetes
nutrition therapy and supports its implementation.
Congestive Heart Failure

Overview
Heart failure does not mean the heart has stopped
working. Rather, it means that the heart's pumping
power is less effective than normal. With heart
failure, blood moves through the heart and body at a
slower rate, and pressure in the heart increases. As a
result, the heart cannot pump enough blood carrying
oxygen and nutrients to meet the body's needs. The
chambers of the heart may respond by stretching to
carry more blood to pump through the body or by
becoming more stiff and thickened. This helps to
keep the blood moving for a while, but in time, the
heart muscle walls may weaken and are unable to
pump as strongly. As a result, the kidneys respond by
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causing the body to retain fluid (water) and sodium.
If fluid builds up in the arms, legs, ankles, feet, lungs,
or other organs, the body becomes congested,
and congestive heart failure is the term used to
describe the condition.
• Coronary artery disease. Coronary artery disease
(CAD), a disease of the arteries that supply blood and
oxygen to the heart, causes decreased blood flow to
the heart muscle. If the arteries become blocked or
severely narrowed, the heart becomes starved for
oxygen and nutrients.
• Heart attack. A heart attack may occur when a
coronary artery becomes suddenly blocked, stopping
the flow of blood to the heart muscle and damaging it.
All or part of the heart muscle becomes cut off from
its supply of oxygen. A heart attack can damage the
heart muscle, resulting in a scarred area that does not
function properly.
• Cardiomyopathy. Damage to the heart muscle. Causes
include artery or blood flow problems, infections, and
alcohol and drug abuse.
• Conditions that overwork the heart. Conditions
including high blood pressure, heart valve
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disease, thyroid disease, disease, diabetes, or heart
defects present at birth can all cause heart failure. In
addition, heart failure can occur when several
diseases or conditions are present at once.
Dietary measures
• Check food labels, and limit salt and sodium to 1,500
to 2,000 milligrams per day.
• Replace salt and other high-sodium seasonings with
alternatives that have no salt or are low in sodium
• When eating out, think about hidden sources of salt
and sodium, such as salad dressings and soups. Ask
for options low in salt and sodium.
• Choose meats and other foods that are low in
saturated fat to help lower your cholesterol levels.
• Avoid alcohol. If your heart failure is caused by
alcohol, it's especially important that you don't drink
any alcoholic beverages.
Reading labels for sodium content is recommended.
There are certain foods that are high in sodium that
should be avoided. These include vegetable or tomato
soups, salted crackers, bacon, canned meats or fish,
cold cuts, dehydrated soups and pickled vegetables.
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Canned foods and dehydrated prepared foods are
also high in sodium.
Instead of pre-packaged foods, try having fresh fruits
and vegetables. Since you are preparing them, you
know that there is no added salt. Check the labels of
enriched breads and cereals for sodium content prior
to purchasing. Lean protein sources, such as chicken
or tofu cooked without sodium, are healthy choices
for protein. For dairy products, try to stick with low
fat or non-fat milks, cheeses or yogurts.
Endocrine Disorders
Diabetes Mellitus
Overview
Diabetes is a disorder of metabolism -- the way our
bodies use digested food for growth and energy. Most
of the food we eat is broken down into glucose, the
form of sugar in the blood. Glucose is the main source
of fuel for the body.
After digestion, glucose passes into the bloodstream,

where it is used by cells for growth and energy. For
glucose to get into cells, insulin must be
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present. Insulin is a hormone produced by
the pancreas, a large gland behind the stomach.
When we eat, the pancreas automatically produces

the right amount of insulin to move glucose
from blood into our cells. In people with diabetes,
however, the pancreas either produces little or no
insulin, or the cells do not respond appropriately to
the insulin that is produced. Glucose builds up in the
blood, overflows into the urine, and passes out of the
body. Thus, the body loses its main source of fuel
even though the blood contains large amounts of
sugar.
Dietary measures
If you have high cholesterol along with diabetes, your
doctor will probably recommend the TLC
(Therapeutic Lifestyle Changes) plan.
The goal is to lower your cholesterol level, drop extra

weight, and get more active. That helps prevent heart
disease, which is more common when you have
diabetes.
On the TLC diet, you will:
• Limit fat to 25%-35% of your total daily calories.
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• Get no more than 7% of your daily calories from
saturated fat, 10% or less from polyunsaturated fats,
and up to 20% from monounsaturated fats (like plant
oils or nuts).
• Keep carbs to 50%-60% of your daily calories.
• Aim for 20-30 grams of fiber each day.
• Allow 15% to 20% of your daily calories for protein.
• Cap cholesterol at less than 200 milligrams per day.
You'll also need to get more exercise and keep up
with your medical treatment.
Although assessment is the initial step of the four-

step model, beginning the relationship or
establishing rapport with a client is an important
preliminary step. Usually, this begins during the
assessment phase and continues throughout the
educational process, to develop a genuine and
trusting relationship between diabetes educator and
client.
Nutrition assessment is the most crucial step in
diabetes MNT. The assessment forms the basis for
developing the intervention plan and identifying
potential changes to a client’s lifestyle and health
habits that will improve health. The main purpose of
an assessment is to gather information needed to
assist in the development of individual nutrition
goals and subsequently establish an appropriate
nutrition intervention.
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Thyroid disorders
Overview
The thyroid gland, located in the anterior neck just

below the cricoid cartilage, consists of 2 lobes
connected by an isthmus. Follicular cells in the gland
produce the 2 main thyroid hormones,
tetraiodothyronine (thyroxine, T4) and
triiodothyronine (T3). These hormones act on cells in
virtually every body tissue by combining with
nuclear receptors and altering expression of a wide
range of gene products. Thyroid hormone is required
for normal brain and somatic tissue development in
the fetus and neonate, and, in people of all ages,
regulates protein, carbohydrate, and fat metabolism.
T3 is the most active form in binding to the nuclear
receptor; T4 has only minimal hormonal activity.
However, T4 is much longer lasting and can be
converted to T3 (in most tissues) and thus serves as a
reservoir for T3. A 3rd form of thyroid hormone,
reverse T3 (rT3), has no metabolic activity; levels of
rT3increase in certain diseases.
Additionally, parafollicular cells (C cells) secrete the
hormone calcitonin , which is released in response to
hypercalcemia and lowers serum Ca levels

Hypothyroidism is one of the most commonly
diagnosed conditions in the United States today but
very few doctors actually pay attention to the
nutritional relationships between your thyroid and
vitamins and minerals. I want to talk today about
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what you can do to ensure that the reason your
thyroid isn’t working properly isn’t just something to
do with nutritional deficiency.
The first thing that we want to understand is that

there is a hormone your doctor typically measures
TSH (Thyroid Stimulating Hormone) that comes from
your brain and it travels to your thyroid gland and
tells your thyroid gland to produce T4. That T4 is
what we call inactive thyroid hormone. The T4
travels through the blood stream and when it gets to
the peripheral tissues it is converted into T3, what
we would call the active form of thyroid hormone. T3
then has to get inside of your cells. DNA is in the
center of the cell inside the nucleus. On the surface of
the cell nucleus we have this little tiny key hole called
the nuclear receptor and, in the case of thyroid
hormone, that little nuclear receptor is where thyroid
hormone binds. We get the binding of T3 onto that
nuclear receptor and that my friends is what
increases your metabolism.
What are the symptoms of low thyroid? With low

thyroid most people will experience energy loss,
weight gain, hair loss, dry skin, elevated cholesterol,
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constipation. These are all common symptoms of low
levels of T3 or low levels of thyroid hormone overall.
Now I hope you have a general understanding of the

way these hormones work. Now let’s insert the
nutritional parameters so that you have a better
understanding nutritionally of what needs to happen.
The very first thing is that this TSH doesn’t just

magically appear. In order to properly make TSH you
have to maintain adequate protein in your
diet.Magnesium, vitamin B-12, and zinc are also
required to make this particular hormone. These
three micronutrients (magnesium, B-12, zinc) and
this major macronutrient (protein) are all
responsible for helping us to properly produce TSH.
There are certain nutrients required to make T4. One

of them is iodine. That 4 in T4 refers to 4 molecules
of iodine, so to make T4 you have to have 4 molecules
of iodine. If you ever see iodized salt, salt in the
United States is iodized as a result of widespread
goiter epidemic. Goiter is when the thyroid enlarges
because of in this case iodine deficiency. This is why
table salt is iodized however I don’t recommend
trying to get your iodine from that particular source
31 | P a g e
because there are other negative consequences to
over-consumption of standard table salt. You can get
iodine from eating fresh vegetables, seafood, kelp,
and seaweed.
Iodine is not the only nutrient required to make T4.

There’s a mechanism inside your thyroid gland that
helps to draw iodine into the thyroid gland. That
mechanism is a little kind of doorway called a
symporter and it requires Vitamin B2 and Vitamin
C. That symporter won’t work to bring iodine into the
thyroid gland unless you have these two nutrients in
place to run that symporter pump.
So far we have talked about 7 different nutrients

associated with getting from TSH down to T4. Now
we have to get from T4 to T3. This process right here
also requires nutrition. There is an enzyme that does
this conversion for us and that enzyme is driven by
the nutrient or mineral selenium. Without selenium
we won’t convert T4 to T3. What we’ll actually do
without selenium is make another compound called
Reverse T3 (RT3). Reverse T3 is also inactive. The
problem is if your doctor doesn’t run a Reverse T3
lab test. Many doctors don’t run Reverse T3. Most
32 | P a g e
doctors from my experience look at TSH only and
they skip all these other components. If your doctor
isn’t looking at Reverse T3, and maybe they did
measure T3, you can’t differentiate Reverse T3 and
T3 from each other without actually teasing them out.
The way you do that is have your doctor measure
Reverse T3 as well as T3.
Dietary measures
The thyroid gland needs specific vitamins and
minerals to properly do its job. Since we are all
unique in how our hormones are functioning, the
best way to get a handle on what our body
specifically needs is to have a full thyroid panel done
to help pinpoint where individual levels may be off
balance. Research shows us that there are a few key
nutrients that are highly valuable for everyone.
Iodine (I): This is the most important trace element

found in thyroid functioning. Without iodine, our
thyroid does not have the basic building blocks it
needs to make the necessary hormones to support all
of the tissues in the body. Thyroxine (T4) and
Triiodothyronine (T3) are the most essential, active,
iodine-containing hormones we have. In 2012, a CDC
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report showed that women of childbearing years in
the United States, ages 20-39, had the lowest iodine
levels of any other age group. This is something we
can easily improve by eating more iodine-rich foods.
Selenium (Se): This element is indispensable to our
thyroid in several ways. Selenium-containing
enzymes protect the thyroid gland when we are
under stress, working like a “detox,” to help flush
oxidative and chemical stress, and even social stress
– which can cause reactions in our body. Selenium-
based proteins help regulate hormone synthesis,
converting T4 into the more accessible T3. These
proteins and enzymes help regulate metabolism and
also help maintain the right amount of thyroid
hormones in the tissues and blood, as well as organs
such as the liver, kidneys, and even the
brain.Selenium also helps regulate and recycle our
iodine stores. These are all very important functions!
Zinc (Zn), iron (Fe), and copper (CU): These three
trace metals are vital to thyroid function. Low levels
of zinc can cause T4, T3, and the thyroid stimulating
hormone(TSH) to also become low. Research shows
that both hyperthyroidism (overactive thyroids)
and hypothyroidism (under active thyroids), can
34 | P a g e
sometimes create a zinc deficiency leading to
lowered thyroid hormones.
Decreased levels of iron can result in decreased
thyroid function as well. When combined with an
iodine deficiency, iron must be replaced to repair the
thyroid imbalance. Copper is needed to help produce
TSH, and maintain T4 production. T4 helps
cholesterol regulation, and some research even
indicates copper deficiency may contribute to higher
cholesterol and heart issues for people with
hypothyroidism.
The best treatment for any disorder is to address the

causes. The medical treatment is to prescribe a
synthetic form of T4 and experiment with the dose
until the blood TSH level is normal. One point of view
is that the body is defective and the patient will have
to compensate by taking T4 for the rest of their life.
Another point of view is that T4 and possibly T3 or a
natural thyroid product should be supplemented to
get the TSH level down into the lower normal range.
The intent is to give the thyroid gland a rest period.
The doctor then gradually decreases the dosage of
the thyroid medication to allow the thyroid gland to
resume natural operation. Anecdotal evidence from
doctors who apply this philosophy indicates that it
works about half of the time.
35 | P a g e
Another point of view is that thyroid disorders of
most if not all types are often caused
by iodine deficiency. This view is supported by a
minority of medical doctors and alternative
practitioners who
apply orthoiodosupplementation as a primary
therapy. They advocate using high doses of iodine to
displace the fluorides and bromides in the body and
restore iodine reserves. In clinical practice, this
whole process is monitored by laboratory tests.
Parathyroid Disorders
Overview
Parathyroid glands are small glands of the endocrine
system that are located behind the thyroid. There are
four parathyroid glands which are normally about
the size and shape of a grain of rice. They are shown
in this picture as the mustard yellow glands behind
the pink thyroid gland. This is their normal color.
The sole purpose of the parathyroid glands is to
regulate the calcium level in our bodies within a very
narrow range so that the nervous and muscular
systems can function properly. Although they are
neighbors and both part of the endocrine system, the
thyroid and parathyroid glands are otherwise
unrelated. The single major disease of parathyroid
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glands is overactivity of one or more of the
parathyroids; that's hyperparathyroidism.

Calcium is a mineral that the body needs for good
health and healthy bones. It is also critical for the
body’s normal functioning. Calcium is naturally found
in some foods, or can be taken as a nutritional
supplement. When the body has too much or too little
calcium, calcium-related problems can occur. This
can be due to improper calcium intake or the inability
for the body to regulate calcium levels properly, such
as with parathyroid disorders.
The parathyroid glands regulate calcium levels in the

body. Parathyroid disorders may cause a loss of
energy, kidney stones, depression and many other
symptoms.
Calcium-related medical problems include

hypocalcemia, vitamin D deficiency, kidney stones
and osteoporosis. These disorders can have
devastating effects on your health and well-being.
Diagnosis and treatment are key to managing these
conditions, and will help to control symptoms and
decrease the risk of other related complex problems.
37 | P a g e
Dietary Measurements
Eating, diet, and nutrition have not been shown to

play a role in causing or preventing primary
hyperparathyroidism.
Vitamin D. Experts suggest correcting vitamin D
deficiency in people with primary
hyperparathyroidism to achieve a serum level of 25-
hydroxy-vitamin D greater than 20 nanograms per
deciliter (50 nanomoles per liter). Research is
ongoing to determine optimal doses and regimens of
vitamin D supplementation for people with primary
hyperparathyroidism.
For the healthy public, the Institute of Medicine
(IOM) guidelines for vitamin D intake are
• people ages 1 to 70 years may require 600
International Units (IUs)
• people age 71 and older may require as much
as 800 IUs
The IOM also recommends that no more than 4,000
IUs of vitamin D be taken per day.
Calcium. People with primary hyperparathyroidism
without symptoms who are being monitored do not
need to restrict calcium in their diet. People with low
calcium levels due to loss of all parathyroid tissue
from surgery will need to take calcium supplements
for the rest of their life.
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Some people who have mild primary

hyperparathyroidism may not need immediate or
even any surgery and can be safely
monitored. People may wish to talk with their health
care provider about long-term monitoring if they
• are symptom-free
• have only slightly elevated blood calcium
levels
• have normal kidneys and bone density
Long-term monitoring should include periodic
clinical evaluations, annual serum calcium
measurements, annual serum creatinine
measurements to check kidney function, and bone
density measurements every 1 to 2 years.
Vitamin D deficiency should be corrected if present.
Patients who are monitored need not restrict calcium
in their diets.
If the patient and health care provider choose long-
term monitoring, the patient should
• drink plenty of water
• exercise regularly
• avoid certain diuretics, such as thiazides
Either immobilization—the inability to move due to
illness or injury—or gastrointestinal illness with
vomiting or diarrhea that leads to dehydration can
cause blood calcium levels to rise further in someone
with primary hyperparathyroidism. People with
39 | P a g e
primary hyperparathyroidism should seek medical
attention if they find themselves immobilized or
dehydrated due to vomiting or diarrhea.
Pancreatitis
Overview
The pancreas is a large gland located behind the
stomach and beside the duodenum or upper part of
the small intestine. The pancreas works to:
 Facilitate the digestion of carbohydrates,

proteins and fat by the secretion of very
powerful digestive enzymes into the small
intestine.
 Release two hormones, insulin and glucagon,

into the bloodstream. These hormones are
involved in blood glucose metabolism.
 Pancreatitis is a rare disease in which the
pancreas becomes inflamed. Pancreatic
damage occurs when the digestive enzymes
are activated and begin attacking the
pancreas. In very severe cases, pancreatitis
can result in bleeding into the gland itself;
serious tissue damage, infection and fluid
collections may occur. Severe pancreatitis can
result in damage to other vital organs such as
the heart, lung and kidneys.
40 | P a g e
There are two forms of pancreatitis:
 Acute pancreatitis occurs suddenly and may

result in life-threatening complications;
however the majority of patients (80 percent)
recover completely.
 Chronic pancreatitis is usually the result of

longstanding damage to the pancreas from
alcohol ingestion. Chronic pancreatitis is
primarily marked by severe pain and loss of
pancreatic function.
Acute pancreatitis is a sudden attack causing
inflammation of the pancreas and is usually
associated with severe upper abdominal pain. The
pain may be severe and last several days. Other
symptoms of acute pancreatitis include nausea,
vomiting, diarrhea, bloating, and fever. In the United
States, the most common cause of acute pancreatitis
is gallstones. Other causes include chronic alcohol
consumption, hereditary conditions, trauma,
medications, infections, electrolyte abnormalities,
high lipid levels, hormonal abnormalities, or other
unknown causes. The treatment is usually supportive
with medications showing no benefit. Most patients
with acute pancreatitis recover completely.
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Chronic pancreatitis is the progressive disorder
associated with the destruction of the pancreas. The
disease is more common in men and usually develops
in persons between 30 and 40 years of age. Initially,
chronic pancreatitis may be confused with acute
pancreatitis because the symptoms are similar. The
most common symptoms are upper abdominal pain
and diarrhea. As the disease becomes more chronic,
patients can develop malnutrition and weight loss. If
the pancreas becomes destroyed in the latter stages
of the disease, patients may develop diabetes
mellitus.
The most common cause of chronic pancreatitis in

the United States is chronic alcohol consumption.
Additional causes include cystic fibrosis and other
hereditary disorders ofthe pancreas. For a significant
percentage of patients there is no known cause. More
research is needed to determine other causes of the
disease.
The treatment for chronic pancreatitis depends on

the symptoms. Most therapies center on pain
management and nutritional support. Oral pancreatic
enzyme supplements are used to aid in the digestion
42 | P a g e
of food. Patients who develop diabetes require
insulin to control blood sugar. The avoidance of
alcohol is central to therapy.
Dietary Measures
People with pancreatic cancer who have a Whipple’s
procedure may have many questions and concerns
about their diet following the operation. The
suggestions on the below may be helpful when you
start to eat after surgery.
• Have small meals every 2–3 hours rather than three
large meals.
• Ensure that meals and snacks are nourishing and
include protein, e.g. meat, chicken, fish, dairy
products, eggs, legumes, tofu and nuts. This will help
recovery and improve your nutrition.
• Sip only small amounts of liquids during meals to
avoid filling up too quickly.
• Limit foods that produce wind (gas), e.g. legumes
(dried beans, peas or lentils); vegetables such as
broccoli, Brussels sprouts, cabbage, cauliflower or
asparagus; and carbonated (gassy) drinks.
• Talk to a dietitian or your doctor about vitamin and
enzyme supplements you may need if you can’t digest
and absorb food properly. You may need a
multivitamin supplement to provide calcium, folic
43 | P a g e
acid, iron, vitamin B12 and the fat- soluble vitamins
A, D, E and K.
• Take the right amount of digestive enzyme
supplements, if prescribed.
• Limit or avoid eating fatty, greasy or fried foods if
these cause discomfort, even when taking adequate
pancreatic enzymes.
• Nutritional supplements drinks, such as Sustagen®
Hospital Formula, Ensure® and Resource®, are high
in energy and protein and have important vitamins
and minerals. These may be prescribed after surgery.
The pancreas is a major player in nutrient digestion.
In chronic pancreatitis both exocrine and endocrine
insufficiency may develop leading to malnutrition
over time. Maldigestion is often a late complication of
chronic pancreatic and depends on the severity of the
underlying disease. The severity of malnutrition is
correlated with two major factors: (1) malabsorption
and depletion of nutrients (e.g., alcoholism and pain)
causes impaired nutritional status; and (2) increased
metabolic activity due to the severity of the disease.
Nutritional deficiencies negatively affect outcome if
they are not treated. Nutritional assessment and the
44 | P a g e
clinical severity of the disease are important for
planning any nutritional intervention. Good
nutritional practice includes screening to identify
patients at risk, followed by a thoroughly nutritional
assessment and nutrition plan for risk patients.
Treatment should be multidisciplinary and the
mainstay of treatment is abstinence from alcohol,
pain treatment, dietary modifications and pancreatic
enzyme supplementation. To achieve energy-end
protein requirements, oral supplementation might be
beneficial. Enteral nutrition may be used when
patients do not have sufficient calorie intake as in
pylero-duodenal-stenosis, inflammation or prior to
surgery and can be necessary if weight loss
continues. Parenteral nutrition is very seldom used in
patients with chronic pancreatitis and should only be
used in case of GI-tract obstruction or as a
supplement to enteral nutrition.
Diabetes Insipidus
Overview
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Diabetes insipidus (die-uh-BEE-teze in-SIP-uh-dus) is
an uncommon disorder that causes an imbalance of
water in the body. This imbalance leads to intense
thirst even after drinking fluids (polydipsia), and
excretion of large amounts of urine (polyuria).
While the names diabetes insipidus and diabetes

mellitus sound similar, they're not related. Diabetes
mellitus — which can occur as type 1 or type 2 — is
the more common form of diabetes.
There's no cure for diabetes insipidus, but treatments

are available to relieve your thirst and normalize
your urine output.

If your body's thirst control is normal and you drink
enough fluids, there are no significant effects on body
fluid or salt balance.
Not drinking enough fluids can lead

to dehydration and electrolyte imbalance.
If DI is treated with vasopressin and your body's
thirst control is not normal, drinking more fluids than
your body needs can cause dangerous electrolyte
imbalance.
46 | P a g e
Dietary Measures
No specific dietary considerations exist in chronic DI,
but the patient should understand the importance of
an adequate and balanced intake of salt and water. A
low-protein, low-sodium diet can help to decrease
urine output.
Monitor for fluid retention and hyponatremia during
initial therapy. Follow the volume of water intake and
the frequency and volume of urination, and inquire
about thirst. Monitor serum sodium, 24-hour urinary
volumes, and specific gravity. Request
posthospitalization follow-up visits with the patient
every 6-12 months. Patients with normal thirst
mechanisms can usually self-regulate.
Addison’s Disease
Overview
Addison's disease is a disorder that occurs when your
body produces insufficient amounts of certain
hormones produced by your adrenal glands. In
47 | P a g e
Addison's disease, your adrenal glands produce too
little cortisol and often insufficient levels of
aldosterone as well.
Also called adrenal insufficiency, Addison's disease

occurs in all age groups and affects both sexes.
Addison's disease can be life-threatening.
Treatment for Addison's disease involves taking

hormones to replace the insufficient amounts being
made by your adrenal glands, in order to mimic the
beneficial effects produced by your naturally made
hormones.

Most cases of Addison’s disease result from a
problem with the adrenal glands themselves
(primary adrenal insufficiency). Autoimmune
disease accounts for 70% of Addison’s disease. This
occurs when the body's immune system mistakenly
attacks the adrenal glands. This autoimmune assault
destroys the outer layer of the glands.
Long-lasting infections -- such as tuberculosis, HIV,

and some fungal infections -- can harm the adrenal
48 | P a g e
glands. Cancer cells that spread from other parts of
the body to the adrenal glands also can cause
Addison's disease.
Dietary Measures
Corticosteroids generally impact bone health by
decreasing bone formation, and regular use of this
medication may increase your risk of osteoporosis.
Thirty to 50 percent of people taking corticosteroids
for other conditions suffer from osteoporotic
fractures, according to an April 2009 review article
published in "Therapeutic Advances in
Musculoskeletal Diseases." To prevent osteoporosis
due to your long-term need for corticosteroids, your
doctor may recommend calcium and vitamin D
supplements. Including calcium- and vitamin D-rich
foods may also help maintain bone health.
Mineralocorticoids help the body maintain normal
levels of sodium. People with untreated Addison’s
disease have low levels of sodium, which can cause
serious problems such as low blood pressure,
seizures and even coma. Treatment with
mineralocorticoids will maintain normal levels of
sodium most of the time. However, if a lot of sodium
49 | P a g e
is being lost from the body, as may occur with
excessive sweating, sodium levels may fall. Talk to
your doctor about whether you should increase your
sodium intake in hot weather, especially if you are
exercising outside.
When people with Addison’s disease are aldosterone
deficient, they can benefit from a high sodium diet. Their
physicians will be able to give them specific suggestions and
guidelines on the amount of sodium required.
Treatment with steroids is associated with an increased risk
of osteoporosis which is a condition which may cause bones
to fracture or become less dense. By consuming enough
calcium in their diet along with vitamin D, they may help
protect against this condition and maintain good bone
health.
Cushing’s Disease
Overview
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Cushing syndrome occurs when your body is exposed
to high levels of the hormone cortisol for a long time.
Cushing syndrome, sometimes called
hypercortisolism, may be caused by the use of oral
corticosteroid medication. The condition can also
occur when your body makes too much cortisol on its
own.
Too much cortisol can produce some of the hallmark

signs of Cushing syndrome — a fatty hump between
your shoulders, a rounded face, and pink or purple
stretch marks on your skin. Cushing syndrome can
also result in high blood pressure, bone loss and, on
occasion, type 2 diabetes.
Treatments for Cushing syndrome can return your

body's cortisol production to normal and noticeably
improve your symptoms. The earlier treatment
begins, the better your chances for recovery.

Pituitary Adenomas
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Pituitary adenomas cause 70 percent of Cushing's
syndrome cases,1 excluding those caused by
glucocorticoid use. These benign, or noncancerous,
tumors of the pituitary gland secrete extra
ACTH. Most people with the disorder have a single
adenoma. This form of the syndrome, known as
Cushing's disease, affects women five times more
often than men.
Ectopic ACTH Syndrome

Some benign or, more often, cancerous tumors that
arise outside the pituitary can produce ACTH. This
condition is known as ectopic ACTH syndrome. Lung
tumors cause more than half of these cases, and men
are affected three times more often than women. The
most common forms of ACTH-producing tumors are
small cell lung cancer, which accounts for about 13
percent of all lung cancer cases,2 and carcinoid
tumors-small, slow-growing tumors that arise from
hormone-producing cells in various parts of the
body. Other less common types of tumors that can
produce ACTH are thymomas, pancreatic islet cell
tumors, and medullary carcinomas of the thyroid.
Adrenal Tumors
In rare cases, an abnormality of the adrenal glands,
most often an adrenal tumor, causes Cushing's
syndrome. Adrenal tumors are four to five times
more common in women than men, and the average
age of onset is about 40. Most of these cases involve
noncancerous tumors of adrenal tissue called adrenal
52 | P a g e
adenomas, which release excess cortisol into the
blood.
Adrenocortical carcinomas-adrenal cancers-are the
least common cause of Cushing's syndrome. With
adrenocortical carcinomas, cancer cells secrete
excess levels of several adrenocortical hormones,
including cortisol and adrenal androgens, a type of
male hormone. Adrenocortical carcinomas usually
cause very high hormone levels and rapid
development of symptoms.
Dietary Measures
Beware of too much sodium
Excess sodium can affect your blood pressure, cause
swelling, and make you gain weight. So, try to follow
these tips:
• Don’t add extra salt to your food
• Avoid food that is prepared with added salt1
Be sure to get enough daily calcium and vitamin D

People with Cushing’s disease often
develop osteoporosis (fragile bones). Calcium and
vitamin D can be important in strengthening bones.
Here are guidelines for daily calcium and vitamin D
intake based on age. These recommendations are the
same for the general population.
Try to keep cholesterol in check

 Cushing’s disease can cause cholesterol levels
to go up. So you should try to limit your
53 | P a g e
intake of fatty foods and eat dairy products
(such as milk and cheese) that are low in fat.1
High blood sugar may require special dietary

changes
 Cushing’s disease can also cause high blood
sugar levels (called hyperglycemia). If this
happens, special medicine and a special diet
may be needed.1
Getting proper nutrition through a well-balanced diet
is very important for people living with Cushing’s.
Because this condition can affect how your body
processes some foods, it’s a good idea to consult with
your doctor or a registered dietician, who can advise
you on your diet.
Pheochromocytoma
Overview
Pheochromocytoma is a rare endocrine tumor

originating in the adrenal glands, specifically, the
medulla of adrenal glands. The adrenal glands are
two small glands that sit on top of the kidneys and
produce hormones called catecholamines.
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Catecholamines include metanephrine,
norepinephrine (noradrenaline), epinephrine
(adrenaline), and dopamine. These hormones help
regulate your responses to stress, heart rate, and
blood pressure. Once your body encounters any
stress, your adrenal glands secrete these hormones
into your bloodstream which in turn affects the
functions of other organs and tissues in your body. In
patients with pheochromocytoma there is a release of
excessive amounts of these hormones, which can
potentially increase your heart rate and blood
pressure. Having pheochromocytoma may become
life threatening when the tumor goes unrecognized
or untreated.
Decreased appetite
Lack of appetite, or decreased hunger, is one of the
most troublesome nutrition problems you can
experience. Although it is a common problem, its
cause is unknown. There are some medicines that
might stimulate your appetite. Ask your doctor if
such medicines would help you.
Diarrhea
Diarrhea is an increase in either the number of stools,
the amount of liquid in the stools, or both. Medicines,
a reaction to certain foods, stress, and ordinary colds
or flu can cause diarrhea.
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Prolonged diarrhea can cause dehydration,
weakness, fatigue, and weight loss. When you have
diarrhea, important nutrients such as calories,
protein, vitamins, water, sodium, and potassium are
lost. This loss can be serious if you are already ill or
trying to recover from an illness. Your doctor must
know the cause of diarrhea to treat it correctly.
Try the following solutions for two days. If after that

time you are still having diarrhea, call your doctor.
Liquids and nutrients are lost quickly, and treatment
must begin before prolonged diarrhea causes harm.
Constipation
Constipation occurs when bowel movements become
difficult or infrequent, usually more than 48 hours
apart. Constipation can be caused by medicines and
by not drinking or eating enough liquids or food, and
inactivity.
GASTROINTESTINAL
DISORDER
Gastroesophageal Reflux
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Overview
Gastroesophageal reflux disease occurs when the
amount of gastric juice that refluxes into the
esophagus exceeds the normal limit, causing
symptoms with or without associated esophageal
mucosal injury
• Belching
• Difficulty or pain when swallowing
• Waterbrash (sudden excess of saliva)
• Dysphagia (the sensation of food sticking in

the esophagus)
• Chronic sore throat
• Laryngitis
• Inflammation of the gums
• Erosion of the enamel of the teeth
• Chronic irritation in the throat
• Hoarseness in the morning
• sour taste
• Bad breath
Dietary measures used as treatment

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 Losing weight (if overweight)or maintain a
healthy weight

Avoiding alcohol, chocolate, citrus juice, and
tomato-based products

Avoiding peppermint, coffee, and possibly the
onion family

Eating small, frequent meals rather than large
meals

Waiting 3 hours after a meal to lie down

Refraining from ingesting food (except
liquids) within 3 hours of bedtime

Elevating the head of the bed 8 inches

Avoiding bending or stooping positions

Eat slow. Eat smaller, frequent meals

Avoid fried junk food

Choose foods with care

Quit smoking

Don’t eat within two to three hours before
bedtime

Wear loose-fitting clothes

Manage stress
58 | P a g e
Common Trigger Foods for People with Reflux:
High-Fat Foods- Fried and fatty foods can cause the
LES to relax, allowing more stomach acid to back up
into the esophagus. They also delay stomach
emptying. Eating such foods puts you at greater risk
for reflux symptoms. Reducing your total daily fat
intake can help.
The following foods have high fat content. Avoid

them or eat them only sparingly.
-french fries and onion rings

-full-fat dairy products like butter, whole milk,
regular cheese, and sour cream
-fatty or fried cuts of beef, pork, or lamb-bacon fat,
ham fat, and lard-high
-fat desserts or snacks like ice cream and potato chips
-cream sauces, gravies, and creamy salad dressings
Tomatoes and Citrus Fruit- Fruits and vegetables are

important to a healthy diet. However, certain fruits
can cause or worsen GERD symptoms. Specifically,
highly acidic fruits are more likely to make your
symptoms worse. If you suffer from frequent acid
reflux, you may want to reduce or eliminate your
intake of:
-oranges
-grapefruit
-lemons
-limes
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-pineapple
-tomatoes
-tomato sauce (or foods where tomato sauce or paste
is a main ingredient, such as pizza or chili)
-salsa
Chocolate- Chocolate contains an ingredient called

methylxanthine. It has been shown to relax the
smooth muscle in the LES. This can increase reflux.
Garlic, Onions, and Spicy Foods- Spicy and tangy

foods trigger heartburn symptoms in many people.
This includes foods such as onions and garlic.
Pharmacotherapy
The following medications are used in the
management of gastroesophageal reflux disease:
-H2 receptor antagonists (eg, ranitidine, cimetidine,

famotidine, nizatidine)
-Proton pump inhibitors (eg, omeprazole,
lansoprazole, rabeprazole, esomeprazole,
pantoprazole)
-Prokinetic agents (eg, aluminum hydroxide)
-Antacids (eg, aluminum hydroxide, magnesium
hydroxide)
DUMPING SYNDROME
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Overview
Dumping syndrome is a condition that can develop
after surgery to remove all or part of your stomach or
after surgery to bypass your stomach to help you lose
weight. Also called rapid gastric emptying, dumping
syndrome occurs when food, especially sugar, moves
from your stomach into your small bowel too quickly.
Most people with dumping syndrome develop signs
and symptoms, such as abdominal cramps and
diarrhea, 10 to 30 minutes after eating. Other people
have symptoms one to three hours after eating, and
still others have both early and late symptoms.

 hypoglycemia
 sweating
 weakness
 rapid or irregular heartbeat
 flushing
 dizziness
Dietary Measures
 eating five or six small meals a day instead of
three larger meals
 delaying liquid intake until at least 30
minutes after a meal
 increasing intake of protein, fiber, and
complex carbohydrates—found in starchy
foods such as oatmeal and rice
 avoiding simple sugars such as table sugar,
which can be found in candy, syrup, sodas,
and juice beverages
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 increasing the thickness of food by adding
pectin or guar gum—plant extracts used as
thickening agents
Foods to avoid.
 Avoid eating sugar and other sweets such as:
 Candy
 Sweet drinks
 Cakes
 Cookies
 Pastries
 Sweetened breads
Also avoid dairy products and alcohol. And
avoid eating solids and drinking liquids
during the same meal. In fact, don't drink 30
minutes before and 30 minutes after meals.
Foods to eat. To help with symptoms, also try these

tips:
 Use fiber supplements, such as psyllium
(Metamucil or Konsyl), methylcellulose
(Citrucel), or guar gum (Benefiber).
 Use sugar replacements, such as Splenda,
Equal, or Sweet'N Low, instead of sugar.
 Go for complex carbohydrates, such as
vegetables and whole-wheat bread, instead of
simple carbohydrates, such as sweet rolls and
ice cream.
 To prevent dehydration, drink more than 4
cups of water or other sugar-free,
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decaffeinated, noncarbonated beverages
throughout the day.
IRRITABLE BOWEL SYNDROME

Overview
Irritable bowel syndrome (IBS) is a common disorder
that affects the large intestine (colon). Irritable bowel
syndrome commonly causes cramping, abdominal
pain, bloating, gas, diarrhea and constipation. IBS is a
chronic condition that you will need to manage long
term.

 Abdominal pain or cramping
 Bloated feeling
 Gas
 Diarrhea or constipation — sometimes
alternating bouts of constipation and
diarrhea
 Mucus in the stool
 Rectal bleeding
 Abdominal pain that progresses or occurs at
night
 Weight loss
Dietary Measures used as Treatment

 Acupuncture
 Herbs
 Hypnosis
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 Probiotics
 Regular exercise, yoga, massage or
meditation.
 Experiment with fiber.
 Avoid problem foods
 Eat at regular times
 Take care with dairy products
 Drink plenty of liquids.
 Exercise regularly
 Use anti-diarrheal medications and laxatives

with caution
Medication specifically for IBS:

Alosetron (Lotronex)
Lubiprostone (Amitiza)
INFLAMMATORY BOWEL DISEASES

Overview
Inflammatory bowel disease (IBD) is an idiopathic
disease caused by a dysregulated immune response
to host intestinal microflora. The two major types of
inflammatory bowel disease are ulcerative colitis
(UC), which is limited to the colon, and Crohn disease
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(CD), which can affect any segment of the
gastrointestinal tract from the mouth to the anus,
involves "skip lesions," and is transmural. There is a
genetic predisposition for IBD, and patients with this
condition are more prone to the development of
malignancy.

 Diarrhea
 Constipation
 Bowel movement abnormalities
 Abdominal cramping and pain
 Nausea and vomiting

Testing:
 Complete blood count
 Nutritional evaluation: Vitamin B12
evaluation, iron studies, red blood cell folate,
nutritional markers
 Erythrocyte sedimentation rate and C-
reactive protein levels
 Fecal calprotectin level
 Serologic studies: Perinuclear antineutrophil
cytoplasmic antibodies, anti- Saccharomyces
cerevisiae antibodies
 Stool studies: Stool culture, ova and parasite
studies, bacterial pathogens culture, and
evaluation for Clostridium difficile infection
Imaging studies:
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 Upright chest and abdominal radiography
 Barium double-contrast enema radiographic
studies
 Abdominal ultrasonography
 Abdominal/pelvic computed tomography
scanning/magnetic resonance imaging
 Computed tomography enterography
 Colonoscopy, with biopsies of tissue/lesions
 Flexible sigmoidoscopy
 Upper gastrointestinal endoscopy
 Capsule enteroscopy/double balloon
enteroscopy
 Corticosteroids such as prednisone and
methylprednisolone
 Aminosalicylates such as sulfasalazine and
olsalazine
 Immunosuppressives such as 6-
mercaptopurine and azathioprine
 Metronidazole, an antibiotic with immune
system effects.
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PEPTIC ULCER DISEASES
Overview
A peptic ulcer is a sore in the inner lining of the
stomach or upper small intestine.
Ulcers form when the intestine or stomach's
protective layer is broken down. When this happens,
digestive juices-which contain hydrochloric acid and
an enzyme called pepsin-can damage the intestine or
stomach tissue.
Peptic ulcers that form in the stomach are called
gastric ulcers. Those that form in the upper small
intestine are called duodenal (say "doo-uh-DEE-nul"
or "doo-AW-duh-nul") ulcers.
The two most common causes of peptic ulcers are:
Infection with Helicobacter pyloriHelicobacter pylori
(H. pylori) bacteria.
Use of nonsteroidal anti-inflammatory drugs
(NSAIDs), such as aspirin, ibuprofen, and naproxen.

 A burning, aching, or gnawing pain between
the belly button (navel) and the breastbone
 Some people also have back pain
 Pain that usually goes away for a while after
you take an antacid or acid reducer.
 Loss of appetite and weight loss.
 Bloating or nausea after eating.
 Vomiting.
 Vomiting blood or material that looks like
coffee grounds.
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 Passing black stools that look like tar, or
stools that contain dark red blood.

 Not taking nonsteroidal anti-inflammatory
drugs (NSAIDs), if possible. These include
aspirin, ibuprofen (such as Advil), and
naproxen (such as Aleve).
 Quitting smoking.
 Not drinking too much alcohol (no more than
2 drinks a day for men and 1 drink a day for
women).
Medicines to reduce stomach acid:
 Proton pump inhibitors (PPIs) (such as

Prilosec).
 H2 blockers (such as Zantac). Some H2
blockers are available without a prescription.
 Antacids (such as Tums).
Medicines to kill H. pylori bacteria:

Doctors prescribe combination drug therapy to cure
infection with H. pylori bacteria. This usually includes
at least two antibiotics, a proton pump inhibitor, and
sometimes a bismuth compound.
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Medicines to protect the stomach:
 Proton pump inhibitors (PPIs) (such as
Prilosec).
 H2 blockers (such as Zantac).
 Prostaglandin analogs (such as Cytotec).
CHOLECYSTITIS
Overview
Cholecystitis is inflammation of the gallbladder that
occurs most commonly because of an obstruction of
the cystic duct by gallstones arising from the
gallbladder (cholelithiasis). Uncomplicated
cholecystitis has an excellent prognosis; the
development of complications such as perforation or
gangrene renders the prognosis less favorable.

Fever, tachycardia, and tenderness in the RUQ or
epigastric region, often with guarding or rebound
Palpable gallbladder or fullness of the RUQ (30-40%
of patients)
Jaundice (~15% of patients)

You should avoid excessive consumption of white
flour, sugar and highly processed foods. You may also
be intolerant of spicy foods. While you need some
fiber in your diet, too much of it may actually
exacerbate symptoms of cholecystitis if they cause
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you to have gas. You may be able to tolerate only
small amounts of foods such as beans, cabbage,
cauliflower, broccoli and whole grain products, all of
which are high in fiber
In acute cholecystitis, the initial treatment includes
bowel rest, IV hydration, correction of electrolyte
abnormalities, analgesia, and IV antibiotics. Options
include the following:
 Sanford guide – Piperacillin-tazobactam,
ampicillin-sulbactam, or meropenem; in
severe life-threatening cases, imipenem-
cilastatin
 Alternative regimens – Third-generation
cephalosporin plus metronidazole
 Emesis can be treated with antiemetics and
nasogastric suction
 Because of the rapid progression of acute
acalculous cholecystitis to gangrene and
perforation, early recognition and
intervention are required.
 Supportive medical care should include
restoration of hemodynamic stability and
antibiotic coverage for gram-negative enteric
flora and anaerobes if biliary tract infection is
suspected.
 Daily stimulation of gallbladder contraction
with IV cholecystokinin (CCK) may help
prevent formation of gallbladder sludge in
patients receiving TPN
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In cases of uncomplicated cholecystitis, outpatient
treatment may be appropriate. The following
medications may be useful in this setting:
 Levofloxacin and metronidazole for
prophylactic antibiotic coverage against the
most common organisms
 Antiemetics (eg, promethazine or
prochlorperazine) to control nausea and
prevent fluid and electrolyte disorders
 Analgesics (eg, oxycodone/acetaminophen)
Surgical and interventional procedures used to treat

cholecystitis include the following:
 Laparoscopic cholecystectomy (standard of
care for surgical treatment of cholecystitis)
 Percutaneous drainage
 ERCP
 Endoscopic ultrasound-guided transmural
cholecystostomy
 Endoscopic gallbladder drainage
GASTRITIS
Overview
Gastritis describes a group of conditions with one
thing in common: inflammation of the lining of the
stomach. The inflammation of gastritis is most often
the result of infection with the same bacterium that
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causes most stomach ulcers. Injury, regular use of
certain pain relievers and drinking too much alcohol
also can contribute to gastritis.
Gastritis may occur suddenly (acute gastritis), or it

can occur slowly over time (chronic gastritis). In
some cases, gastritis can lead to ulcers and an
increased risk of stomach cancer. For most people,
however, gastritis isn't serious and improves quickly
with treatment.

 Eat smaller, more-frequent meals.
 Avoid irritating foods. Avoid foods that
irritate your stomach, especially those that
are spicy, acidic, fried or fatty.
 Avoid alcohol.
 Consider switching pain relievers.
 Manage stress.
 Antibiotic medications to kill H. pylori. For H.
pylori in digestive tract
 Medications that block acid production and
promote healing. Proton pump inhibitors
reduce acid by blocking the action of the parts
of cells that produce acid. Long-term use of
proton pump inhibitors, particularly at high
doses, may increase your risk of hip, wrist
and spine fractures.
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 Medications to reduce acid production. Acid
blockers — also called histamine (H-2)
blockers — reduce the amount of acid
released into your digestive tract, which
relieves gastritis pain and promotes healing.
 Antacids that neutralize stomach acid. Your
doctor may include an antacid in your drug
regimen. Antacids neutralize existing
stomach acid and can provide rapid pain
relief. Side effects can include constipation or
diarrhea, depending on the main ingredients.
GASTROENTERITIS
Overview
Gastroenteritis is inflammation of the lining of the
stomach and small and large intestines. Most cases
are infectious, although gastroenteritis may occur
after ingestion of drugs and chemical toxins (eg,
metals, plant substances). Acquisition may be
foodborne, waterborne, or via person-to-person
spread. In the US, an estimated 1 in 6 people
contracts foodborne illness each year. Symptoms
include anorexia, nausea, vomiting, diarrhea, and
abdominal discomfort. Diagnosis is clinical or by
stool culture, although PCR and immunoassays are
increasingly used. Treatment is symptomatic,
although some parasitic and some bacterial
infections require specific anti-infective therapy.
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Lack of fluid (dehydration) and salt (electrolyte)
imbalance in your body.
 Reactive complications.
 Spread of infection to other parts of your
body such as your bones, joints, or the
meninges that surround your brain and
spinal cord.
 Persistent diarrhoea syndromes may rarely
develop.
 Irritable bowel syndrome
 Lactose intolerance can sometimes occur for
a while after gastroenteritis.
 Haemolytic uraemic syndrome is another
potential complication.
 Reduced effectiveness of some medicines.

 Rehydrate orally or intravenously as needed.
 Treat symptoms (eg, fever, pain) as indicated.
 Identify complications.
 -Prevent the spread of infections.
 Identify public health concerns and treat
certain cases with specific or empiric
antibiotic therapy.
 Antiemetics- may be useful in the treatment
of nausea and vomiting in adults
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 Empiric therapy- for infectious diarrhea is
sometimes indicated. Food-borne toxigenic
diarrhea usually requires only supportive
treatment, not antibiotics
 Rehydration
 Antibiotics
PERITONITIS
Overview
Peritonitis is defined as an inflammation of the
serosal membrane that lines the abdominal cavity
and the organs contained therein. The peritoneum,
which is an otherwise sterile environment, reacts to
various pathologic stimuli with a fairly uniform
inflammatory response. Depending on the underlying
pathology, the resultant peritonitis may be infectious
or sterile (ie, chemical or mechanical). Intra-
abdominal sepsis is an inflammation of the
peritoneum caused by pathogenic microorganisms
and their products.[1] The inflammatory process may
be localized (abscess) or diffuse in nature.

 A ruptured appendix, diverticulum, or
stomach ulcer
 Digestive diseases such as Crohn's disease
and diverticulitis
 Pancreatitis
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 Pelvic inflammatory disease
 Perforations of the stomach, intestine,
gallbladder, or appendix
 Surgery
 Trauma to the abdomen, such as an injury
from a knife or gunshot wound

 Hospitalisation – often in an intensive care
unit
 Antibiotics – tailored to the specific bacteria
to kill the infection
 Intravenous fluids – to rehydrate the body
and replace lost electrolytes
 Surgery – to repair the ruptured organ and
wash out the abdominal cavity of blood and
pus
 Treatment for the underlying cause – such as
a perforated ulcer.
 Thoroughly wash your hands, including the
areas between your fingers and under your
fingernails, before touching the catheter.
 Wear a mouth/nose mask during exchanges.
 Observe the proper sterile exchange
technique.
 Apply an antibiotic cream to the catheter exit
site every day.
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Antibiotics-You'll likely be given a course of antibiotic
medication to fight the infection and prevent it from
spreading. The type and duration of your antibiotic
therapy depend on the severity of your condition and
the kind of peritonitis you have.
Surgery-Surgical treatment is often necessary to

remove infected tissue, treat the underlying cause of
the infection, and prevent the infection from
spreading, especially if peritonitis is due to a
ruptured appendix, stomach or colon.
Other treatments- Depending on your signs and

symptoms, your treatment while in the hospital may
include pain medications, intravenous (IV) fluids,
supplemental oxygen and, in some cases, a blood
transfusion.
PARALYTIC ILEUS
Overview
Obstruction of the intestine due to paralysis of the
intestinal muscles. The paralysis does not need to be
complete to cause ileus, but the intestinal muscles
must be so inactive that it prevents the passage of
food and leads to a functional blockage of the
intestine. Ileus commonly follows some types of
surgery, especially abdominal surgery. It also can
result from certain drugs, spinal injuries,
inflammation anywhere within the abdomen that
touches the intestines, and diseases of the intestinal
muscles themselves. Irrespective of the cause, ileus
causes constipation, abdominal distention, and
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nausea and vomiting. On listening to the abdomen
with a stethoscope, few or no bowel sounds are heard
(because the bowel is inactive). Also called paralytic
ileus. Also simply called ileus.

 Electrolyte (blood chemical and mineral)
imbalances
 Dehydration
 Hole (perforation) in the intestine
 Infection
 Jaundice (yellowing of the skin and eyes)
 If the obstruction blocks the blood supply to
the intestine, it may cause infection and tissue
death (gangrene). Risks for tissue death are
related to the cause of the blockage and how
long it has been present. Hernias, volvulus,
and intussusception carry a higher gangrene
risk.
 In a newborn, paralytic ileus that destroys the
bowel wall (necrotizing enterocolitis) is a life-
threatening condition. It may lead to blood
and lung infections.

In patients with uncomplicated obstruction,
management is conservative, including fluid
resuscitation, electrolyte replacement, intestinal
decompression and bowel rest. Endoscopy can be
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used for bowel decompression, dilation of strictures
or placement of self-expandable metal stents to
restore the luminal flow either as a final treatment or
to allow for a delay until elective surgical therapy.
When gastrointestinal obstruction results in
ischaemia, perforation or peritonitis, then emergency
surgery is required.[9]
Resuscitation is very important. Correction of fluid

and electrolytes considerably reduces the operative
risk before surgery for obstruction. In pseudo-
obstruction, correction of such abnormalities will
facilitate the return of normal bowel function. Note
urine output as a sign of adequate replacement. In
paralytic ileus a nasogastric tube will reduce
vomiting.
Hospitalization to stabilize your condition
When you arrive at the hospital, the doctors will first
work to stabilize you so that you can undergo
treatment. This process may include:
-Placing an intravenous (IV) line into a vein in
your arm so that fluids can be given
-Putting a nasogastric tube through your nose
and into your stomach to suck out air and fluid and
relieve abdominal swelling
-Placing a thin, flexible tube (catheter) into
your bladder to drain urine and collect it for testing
Treating intussusception
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A barium or air enema is used both as a
diagnostic procedure and a treatment for children
with intussusception. If an enema works, further
treatment is usually not necessary.
Treatment for partial obstruction

If you have an obstruction in which some
food and fluid can still get through (partial
obstruction), you may not need further treatment
after you've been stabilized. Your doctor may
recommend a special low-fiber diet that is easier for
your partially blocked intestine to process. If the
obstruction does not clear on its own, you may need
surgery to relieve the obstruction.
Treatment for complete obstruction

If nothing is able to pass through your
intestine, you'll usually need surgery to relieve the
blockage. The procedure you have will depend on
what's causing the obstruction and which part of
your intestine is affected. Surgery typically involves
removing the obstruction, as well as any section of
your intestine that has died or is damaged.
Alternatively, your doctor may recommend treating
the obstruction with a self-expanding metal stent.
The wire mesh tube is inserted into your colon via an
endoscope passed through your mouth or colon. It
forces open the colon so that the obstruction can
clear.
Stents are generally used to treat people with colon
cancer or to provide temporary relief in people for
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whom emergency surgery is too risky. You may still
need surgery, once your condition is stable.
Treatment for pseudo-obstruction

If your doctor determines that your signs and
symptoms are caused by pseudo-obstruction
(paralytic ileus), he or she may monitor your
condition for a day or two in the hospital, and treat
the cause if it's known. Paralytic ileus can get better
on its own. In the meantime, you'll likely be given
food through a nasal tube or an IV to prevent
malnutrition.
If paralytic ileus doesn't improve on its own, your
doctor may prescribe medication that causes muscle
contractions, which can help move food and fluids
through your intestines. If paralytic ileus is caused by
an illness or medication, the doctor will treat the
underlying illness or stop the medication. Rarely,
surgery may be needed to remove part of the
intestine.
In cases where the colon is enlarged, a treatment
called decompression may provide relief.
Decompression can be done with colonoscopy, a
procedure in which a thin tube is inserted into your
anus and guided into the colon. Decompression can
also be done through surgery.
DIVERTICULITIS
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Overview
Diverticula are bulging sacs that can appear in the
lining of your large intestine. The condition is often
referred to as diverticulosis. Diverticulitis occurs
when these sacs get acutely infected or inflamed.
Although diverticula are most common in the large
intestine (colon), they can develop anywhere in your
digestive tract. Pain in the lower left side of your
abdomen may indicate diverticulitis, especially when
it’s accompanied by rectal bleeding. The condition is
treatable, but it can recur.

 An abscess, which occurs when pus collects in
the pouch.
 A blockage in your colon or small intestine
caused by scarring.
 An abnormal passageway (fistula) between
sections of bowel or the bowel and bladder.
 Peritonitis, which can occur if the infected or
inflamed pouch ruptures, spilling intestinal
contents into your abdominal cavity.
Peritonitis is a medical emergency and
requires immediate care.

 bedrest
 a liquid diet to allow your diverticula to heal
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 prescription antibiotics
 pain medication, such as acetaminophen or
codeine products
 Add more fiber to your diet slowly by eating
more fresh fruits and vegetables, such as:
 pears
 apples
 oranges
 bananas
 mangos
 carrots
 broccoli
 beets
 collard greens
 spinach
 raspberries
 sweet potatoes with the skin on
 black beans
 kidney beans
 whole grains or cereals with 5 or
more grams of fiber per serving
 Going to the bathroom when you feel the urge
is also important for avoiding constipation.
Waiting too long before going to the
bathroom can cause your stool to harden,
which can increase the pressure in your
bowels.
Diverticulosis is treated with lifelong dietary
modification. Antibiotics are used for every stage of
diverticulitis. Empiric therapy requires broad-
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spectrum antibiotics effective against known enteric
pathogens. For complicated cases of diverticulitis in
hospitalized patients, carbapenems are the most
effective empiric therapy because of increasing
bacterial resistance to other regimens.
RESPIRATORY DISORDERS
ACUTE AIRWAY ATTACKS

Overview
This occurs when fluid builds up in the air sacs in
your lungs. When that happens, your lungs can’t
release oxygen into your blood. In turn, your organs
can’t get enough oxygen-rich blood to function. You
can also develop acute respiratory failure if your
lungs can’t remove carbon dioxide from your blood.
Respiratory failure happens when the capillaries in

your air sacs can’t properly exchange carbon dioxide
for oxygen. The condition can be acute or chronic.
Acute respiratory failure causes you to experience
immediate symptoms from not having enough
oxygen in your body. In most cases, this failure may
lead to death if it’s not treated quickly.
Dietary Measures
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Your doctor may prescribe pain medications or other
medicines to help you breathe better.
For severe cases, a tracheostomy, an operation that
creates an artificial airway in the windpipe, may be
necessary.
You may receive oxygen via an oxygen tank or
ventilator to help you breathe better. Portable air
tanks are available to go home with you if your
condition requires one.
 Anticholinergics
 Corticosteroids
 Other pharmacological agents, such as
Xanthienes (Theophylline) and Anti-
leukotrienes (Montelukasts)
 Other nonpharmacological therapies:
o Smoking cessation
o Vaccination against influenza
o The use of bronchial thermoplasty
o Pulmonary rehabilitation and an
increase in physical activity
interventions
CHRONIC OBSTRUCTIVE PULMONARY

DISEASE
Overview
COPD, or chronic obstructive pulmonary (PULL-mun-
ary) disease, is a progressive disease that makes it
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hard to breathe. "Progressive" means the disease gets
worse over time.
COPD can cause coughing that produces large

amounts of mucus (a slimy substance), wheezing,
shortness of breath, chest tightness, and other
symptoms.
Cigarette smoking is the leading cause of COPD. Most

people who have COPD smoke or used to smoke.
Long-term exposure to other lung irritants—such as
air pollution, chemical fumes, or dust—also may
contribute to COPD.
Two main conditions—emphysema and chronic

bronchitis
In emphysema, the walls between many of the air
sacs are damaged. As a result, the air sacs lose their
shape and become floppy. This damage also can
destroy the walls of the air sacs, leading to fewer and
larger air sacs instead of many tiny ones. If this
happens, the amount of gas exchange in the lungs is
reduced.
In chronic bronchitis, the lining of the airways is

constantly irritated and inflamed. This causes the
lining to thicken. Lots of thick mucus forms in the
airways, making it hard to breathe.
Most people who have COPD have both emphysema

and chronic bronchitis. Thus, the general term
"COPD" is more accurate.
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 Heart problems: COPD can cause an irregular
heartbeat (called arrhythmia) and heart
failure.
 High blood pressure: COPD can cause high
pressure in the vessels that bring blood to
your lungs. This is called pulmonary
hypertension.
 Respiratory infections: You are more likely to
have frequent colds, the flu, or even
pneumonia. These infections can make your
symptoms worse or cause more lung damage.
You should have a flu shot every year and talk
to your doctor about whether you need a
pneumonia shot. You are less likely to get flu
or pneumonia if you have these shots.
Dietary Measures
 Stop smoking
 Medicines: Your doctor may prescribe one or
more medicines to make you feel better and
help you breathe. These medicines may
include:
 Antibiotics: These medicines help
treat bacterial respiratory infections,
which can make your symptoms
worse.
 Bronchodilators: These medicines
help relax the muscles around your
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airways and may make it easier for
you to breathe.
 Steroids: These medicines may help
make it easier for you to breathe, but
usually are only used in people who
have more severe COPD.
 Vaccines: Vaccines can help prevent
certain respiratory infections, such as
influenza and pneumonia. These
infections can make your symptoms
worse or cause more lung damage.
Talk to your doctor about when and
how often you should receive
vaccines.
 Oxygen therapy: Some people who have more
advanced COPD need to use oxygen. You
breathe the oxygen through tubes that you
put in your nose or through a mask that goes
over your mouth and nose.
 Pulmonary rehabilitation
 -Surgery
The best way to keep COPD from starting or from
getting worse is to not smoke.
There are clear benefits to quitting, even after years
of smoking. When you stop smoking, you slow down
the damage to your lungs. For most people who quit,
loss of lung function is slowed to the same rate as a
nonsmoker's.
Stopping smoking is especially important if you have
low levels of the protein alpha-1 antitrypsin. People
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who have an alpha-1 antitrypsin deficiency may
lower their risk for severe COPD if they get regular
shots of alpha-1 antitrypsin. Family members of
someone with alpha-1 antitrypsin deficiency should
be tested for the condition.
Avoid bad air

Other airway irritants (such as air pollution, chemical
fumes, and dust) also can make COPD worse, but they
are far less important than smoking in causing the
disease
Get vaccines
Flu vaccines
If you have COPD, you need to get a flu vaccine every
year. When people with COPD get the flu, it often
turns into something more serious, like pneumonia. A
flu vaccine can help prevent this from happening.
Pneumococcal vaccine
People with COPD often get pneumonia. Getting a
shot can help keep you from getting very ill with
pneumonia. People younger than 65 usually need
only one shot. But doctors sometimes recommend a
second shot for some people who got their first shot
before they turned 65. Talk with your doctor about
whether you need a second shot. Two different types
of pneumococcal vaccines are recommended for
people ages 65 and older.
Pertussis vaccine
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Pertussis (also called whooping cough) can increase
the risk of having a COPD flare-up.8 So making sure
you are current on your pertussis vaccinations may
help control COPD.
TUBERCULOSIS
Overview
Tuberculosis, or TB, is an infectious bacterial disease
caused by Mycobacterium tuberculosis, which most
commonly affects the lungs. It is transmitted from
person to person via droplets from the throat and
lungs of people with the active respiratory disease.
In healthy people, infection with Mycobacterium

tuberculosis often causes no symptoms, since the
person's immune system acts to “wall off” the
bacteria. The symptoms of active TB of the lung are
coughing, sometimes with sputum or blood, chest
pains, weakness, weight loss, fever and night sweats.
Tuberculosis is treatable with a six-month course of
antibiotics.
Dietary Measures
Physical measures (if possible or practical) include
the following:
 Isolate patients with possible TB in a private
room with negative pressure
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 Have medical staff wear high-efficiency
disposable masks sufficient to filter the
bacillus
 Continue isolation until sputum smears are
negative for 3 consecutive determinations
(usually after approximately 2-4 weeks of
treatment)
Initial empiric pharmacologic therapy consists of the

following 4-drug regimens:
 Isoniazid
 Rifampin
 Pyrazinamide
 Either ethambutol or streptomycin
Special considerations for drug therapy in pregnant

women include the following:
 Streptomycin should not be used
 Preventive treatment is recommended during
pregnancy
 Pregnant women are at increased risk for
isoniazid-induced hepatotoxicity
 Breastfeeding can be continued during
preventive therapy
Special considerations for drug therapy in children

 Most children with TB can be treated with
isoniazid and rifampin for 6 months, along
with pyrazinamide for the first 2 months if
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the culture from the source case is fully
susceptible.
 For postnatal TB, the treatment duration may
be increased to 9 or 12 months
 Ethambutol is often avoided in young
children
Special considerations for drug therapy in HIV-

infected patients include the following:
 Dose adjustments may be necessary
 Rifampin must be avoided in patients
receiving protease inhibitors; rifabutin may
be substituted
 Considerations in patients receiving
antiretroviral therapy include the following:
 Patients with HIV and TB may develop a
paradoxical response when starting
antiretroviral therapy
 Starting antiretroviral therapy early (eg, < 4
weeks after the start of TB treatment) may
reduce progression to AIDS and death [4]
 In patients with higher CD4+ T-cell counts, it
may be reasonable to defer antiretroviral
therapy until the continuation phase of TB
treatment [5]
 Multidrug-resistant TB
When MDR-TB is suspected, start treatment

empirically before culture results become available,
then modify the regimen as necessary. Never add a
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single new drug to a failing regimen. Administer at
least 3 (preferably 4-5) of the following medications,
according to drug susceptibilities:
 An aminoglycoside: Streptomycin, amikacin,
capreomycin, kanamycin
 A fluoroquinolone: Levofloxacin (best suited
over the long term), ciprofloxacin, ofloxacin
 A thioamide: Ethionamide, prothionamide
 Pyrazinamide
 Ethambutol
 Cycloserine
 Terizidone
 Para-aminosalicylic acid
 Rifabutin as a substitute for rifampin
 A diarylquinoline: Bedaquiline
Surgical resection is recommended for patients with
MDR-TB whose prognosis with medical treatment is
poor.
Procedures include the following:
 Segmentectomy (rarely used)
 Lobectomy
 Pneumonectomy
 Pleurectomy for thick pleural peel (rarely
indicated)
 Latent TB
Recommended regimens for isoniazid and rifampin

for latent TB have been published by the US Centers
for Disease Control and Prevention (CDC) : An
alternative regimen for latent TB is isoniazid plus
rifapentine as directly observed therapy (DOT) once-
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weekly for 12 weeks; it is not recommended for
children under 2 years, pregnant women or women
planning to become pregnant, or patients with TB
infection presumed to result from exposure to a
person with TB that is resistant to 1 of the 2 drugs.
Screening methods for TB include the following:
 Mantoux tuberculin skin test with purified
protein derivative (PPD) for active or latent
infection (primary method)
 In vitro blood test based on interferon gamma
release assay (IGRA) with antigens specific
for Mycobacterium tuberculosis for latent
infection
Obtain the following laboratory tests for patients

with suspected TB:
 Acid-fast bacilli (AFB) smear and culture
using sputum obtained from the patient:
Absence of a positive smear result does not
exclude active TB infection; AFB culture is the
most specific test for TB
 HIV serology in all patients with TB and
unknown HIV status: Individuals infected
with HIV are at increased risk for TB
Other diagnostic testing may warrant consideration,

including the following:
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 Specific enzyme-linked immunospot
(ELISpot)
 Nucleic acid amplification tests
 Blood culture
IMMUNE DISORDERS
HIV and AIDS
Overview
HIV stands for human immunodeficiency virus. If left
untreated, HIV can lead to the disease AIDS (acquired
immunodeficiency syndrome).
Unlike some other viruses, the human body can’t get
rid of HIV completely. So once you have HIV, you
have it for life.
HIV attacks the body’s immune system, specifically
the CD4 cells (T cells), which help the immune system
fight off infections. If left untreated, HIV reduces the
number of CD4 cells (T cells) in the body, making the
person more likely to get infections or infection-
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related cancers. Over time, HIV can destroy so many
of these cells that the body can’t fight off infections
and disease. These opportunistic infections or
cancers take advantage of a very weak immune
system and signal that the person has AIDS, the last
state of HIV infection.
No effective cure for HIV currently exists, but with
proper treatment and medical care, HIV can be
controlled. The medicine used to treat HIV is called
antiretroviral therapy or ART. If taken the right way,
every day, this medicine can dramatically prolong the
lives of many people with HIV, keep them healthy,
and greatly lower their chance of transmitting the
virus to others. Today, a person who is diagnosed
with HIV, treated before the disease is far advanced,
and stays on treatment can live a nearly as long as
someone who does not have HIV.

Infections common to HIV/AIDS:
 Tuberculosis
 Cytomegalovirus
 Candidiasis.
 Cryptococcal meningitis
 Cryptosporidiosis
Cancers common to HIV/AIDS:

 Kaposi's sarcoma
 Lymphomas
Other complications:
96 | P a g e
 Wasting syndrome
 Neurological complications
 Kidney disease

Although it's important to receive medical treatment
for HIV/AIDS, it's also essential to take an active role
in your own care. The following suggestions may help
you stay healthy longer:
 Eat healthy foods. Emphasize fresh fruits and
vegetables, whole grains, and lean protein.
Healthy foods help keep you strong, give you
more energy and support your immune
system.
 Avoid certain foods. Foodborne illnesses can
be especially severe in people who are
infected with HIV. Avoid unpasteurized dairy
products, raw eggs and raw seafood such as
oysters, sushi or sashimi. Cook meat until it's
well-done.
 Get immunizations. These may prevent
infections such as pneumonia and the flu.
Make sure the vaccines don't contain live
viruses, which can be dangerous for people
with weakened immune systems.
 Take care with companion animals. Some
animals may carry parasites that can cause
infections in people who are HIV-positive. Cat
feces can cause toxoplasmosis, reptiles can
carry salmonella, and birds can carry the
fungus cryptococcus or histoplasmosis. Wash
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hands thoroughly after handling pets or
emptying the litter box.
If you receive a diagnosis of HIV/AIDS, several types
of tests can help your doctor determine what stage of
the disease you have. These tests include:
 CD4 count. CD4 cells are a type of white blood

cell that's specifically targeted and destroyed
by HIV. Even if you have no symptoms, HIV
infection progresses to AIDS when your CD4
count dips below 200.
 Viral load. This test measures the amount of
virus in your blood. Studies have shown that
people with higher viral loads generally fare
more poorly than do those with a lower viral
load.
 Drug resistance. This blood test determines
whether the strain of HIV you have will be
resistant to certain anti-HIV medications.
There's no cure for HIV/AIDS, but a variety of drugs

can be used in combination to control the virus. Each
class of anti-HIV drugs blocks the virus in different
ways. It's best to combine at least three drugs from
two classes to avoid creating strains of HIV that are
immune to single drugs.
The classes of anti-HIV drugs include:
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 Non-nucleoside reverse transcriptase
inhibitors (NNRTIs). NNRTIs disable a
protein needed by HIV to make copies of
itself. Examples include efavirenz (Sustiva),
etravirine (Intelence) and nevirapine
(Viramune).
 Nucleoside or nucleotide reverse
transcriptase inhibitors (NRTIs). NRTIs are
faulty versions of building blocks that HIV
needs to make copies of itself. Examples
include Abacavir (Ziagen), and the
combination drugs emtricitabine-tenofovir
(Truvada), and lamivudine-zidovudine
(Combivir).
 Protease inhibitors (PIs). PIs disable
protease, another protein that HIV needs to
make copies of itself. Examples include
atazanavir (Reyataz), darunavir (Prezista),
fosamprenavir (Lexiva) and indinavir
(Crixivan).
 Entry or fusion inhibitors. These drugs block
HIV's entry into CD4 cells. Examples include
enfuvirtide (Fuzeon) and maraviroc
(Selzentry).
 Integrase inhibitors. These drugs work by
disabling integrase, a protein that HIV uses to
insert its genetic material into CD4 cells.
Examples include raltegravir (Isentress),
elvitegravir (Vitekta) and dolutegravir
(Tivicay).
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Rheumatoid Arthritis
Overview
Rheumatoid arthritis is a chronic inflammatory
disorder that can affect more than just your joints. In
some people, the condition also can damage a wide
variety of body systems, including the skin, eyes,
lungs, heart and blood vessels.
An autoimmune disorder, rheumatoid arthritis
occurs when your immune system mistakenly attacks
your own body's tissues.
Unlike the wear-and-tear damage of osteoarthritis,
rheumatoid arthritis affects the lining of your joints,
causing a painful swelling that can eventually result
in bone erosion and joint deformity.
The inflammation associated with rheumatoid
arthritis is what can damage other parts of the body
as well. While new types of medications have
improved treatment options dramatically, severe
rheumatoid arthritis can still cause physical
disabilities.

 Osteoporosis
 Rheumatoid nodules
 Dry eyes and mouth
 Infections
 Abnormal body composition
 Carpal tunnel syndrome
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 Heart problems
 Lung disease
 Lymphoma

 Exercise regularly.
 Avoid exercising tender, injured or severely
inflamed joints.
 Apply heat or cold.
 Alternative medicines:
 Fish oil
 Plant oil
 Tai chi
The types of medications recommended by your
doctor will depend on the severity of your symptoms
and how long you've had rheumatoid arthritis.
 NSAIDs. Nonsteroidal anti-inflammatory

drugs (NSAIDs) can relieve pain and reduce
inflammation. Over-the-counter NSAIDs
include ibuprofen (Advil, Motrin IB) and
naproxen sodium (Aleve). Stronger NSAIDs
are available by prescription. Side effects may
include ringing in your ears, stomach
irritation, heart problems, and liver and
kidney damage.
 Steroids. Corticosteroid medications, such as
prednisone, reduce inflammation and pain
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and slow joint damage. Side effects may
include thinning of bones, weight gain and
diabetes. Doctors often prescribe a
corticosteroid to relieve acute symptoms,
with the goal of gradually tapering off the
medication.
 Disease-modifying antirheumatic drugs
(DMARDs). These drugs can slow the
progression of rheumatoid arthritis and save
the joints and other tissues from permanent
damage. Common DMARDs include
methotrexate (Trexall, Otrexup, Rasuvo),
leflunomide (Arava), hydroxychloroquine
(Plaquenil) and sulfasalazine (Azulfidine).
Side effects vary but may include liver

damage, bone marrow suppression and
severe lung infections.
Systemic Lupus Erythematosus
Overview
Systemic lupus erythematosus (also known as lupus
or SLE) is a chronic inflammatory disease that can
affect various parts of the body. Lupus is an
autoimmune condition, meaning that your body's
immune system attacks your own tissues, thinking
that they are foreign. This can lead to pain, swelling,
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and damage to organs such as the kidneys. The cause
of lupus is not clear.
People with lupus often have disease flares, in which

symptoms worsen, followed by a period of remission,
in which symptoms improve. Lupus is mild in some
people and is life-threatening in others. However,
treatments are available to reduce symptoms,
reverse inflammation, and minimize organ damage.

 Anemia
 Antiphospholipid Syndrome
 Vasculitis
 Thrombocytopenia
 Leukopenia and Neutropenia
 Blood Cancers
 Atherosclerosis, or plaque buildup in the
arteries
 Unhealthy cholesterol and lipid (fatty
molecules) levels
 High blood pressure, often associated with
kidney damage and corticosteroid treatments
 Heart failure
 Pericarditis, inflammation of the tissue
surrounding the heart
 Endocarditis, inflammation in the lining of the
heart
 Myocarditis, inflammation of the heart
muscle itself
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 Coronary vasculitis, inflammation of the
blood vessels of the heart
 Inflammation of the membrane lining the
lung (pleurisy) is the most common problem,
which can cause shortness of breath and
coughing.
 In some cases, fluid accumulates, a condition
called pleural effusion.
 Inflammation of the lung tissue itself is called
lupus pneumonitis. It can be caused by
infections or by the SLE inflammatory
process. Symptoms are the same in both
cases: fever, chest pain, labored breathing,
and coughing. Rarely, lupus pneumonitis
becomes chronic and causes scarring in the
lungs, which reduces their ability to deliver
oxygen to the blood.
 A very serious and rare condition called
pulmonary hypertension occurs when high
pressure develops as a result of damage to
the blood vessels of the lungs.
 Inflammation of the kidneys (lupus nephritis)
 Complete kidney failure
 Irritability
 Emotional disorders (anxiety, depression)
 Mild impairment of concentration and
memory
 Migraine and tension headaches
 Problems with the reflex systems, sensation,
vision, hearing, and motor control
 Infections
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 GI complications
 Joint, muscle and bone complications
 Eye complications
 Pregnancy complications

Diet and nutrition — Most people with lupus do not
require a special diet but should instead eat a well-
balanced diet. A well-balanced diet is one that is low
in fat; high in fruits, vegetables, and whole grains;
and contains a moderate amount of meat, poultry,
and fish.
However, you may need to make changes to your

diet, depending upon how lupus has affected your
body. In general:
 People with active lupus and fever may

require more calories.
 Glucocorticoids (prednisone) increase
appetite, potentially causing you to gain a lot
of weight. Try to control your appetite and to
stay active. Weigh yourself daily while taking
prednisone, and talk to your healthcare
provider if you gain more than five pounds.
 If your cholesterol or triglyceride levels
become elevated, you may be advised to eat a
special diet.
 If you have swelling (edema) in your feet or
lower legs, decrease the amount of salt and
sodium in your diet.
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 Extra vitamins are rarely needed if you eat a
balanced diet. If you are not able to eat a
balanced diet or are dieting to lose weight,
you should take a multivitamin.
 If you take glucocorticoids every day or are a
postmenopausal woman, you should take
1000 to 1500 mg of calcium and 400 to 800
units of vitamin D per day to minimize bone
loss. ●Drinking a moderate amount of alcohol
(one drink or less for women and two drinks
or less per day for men) is usually safe for
people with lupus. However, alcohol can
interact with medications used to treat lupus.
Talk to your healthcare provider if you have
questions.
 Herbal and other dietary supplements are not
recommended and may even cause harm.
 Exercise — Being inactive while ill can cause
you to lose muscle and energy quickly. A
separate article discusses how to incorporate
exercise into your life.
 Immunizations — Vaccines to prevent
pneumonia and the flu are recommended for
people with lupus.
 Medication precautions — A number of
medications are known to worsen lupus. You
should not take these medications if there is
an acceptable alternative. Sulfa-containing
antibiotics are examples of medicines that
should be avoided.
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 Pregnancy and birth control — Women with
lupus are at increased risk of miscarriage;
however, the majority of women with lupus
who get pregnant are able to carry to term.
-Avoid the sun. Strong sunlight can aggravate
symptoms of SLE. Long-sleeved clothing and wide-
brimmed hats are best in sunny weather. On hot
sunny days you should wear a sunblock on exposed
skin, with a protection factor of 25 or above that
protects against UVA and UVB.
-Try to avoid infections. If you have SLE you are more
prone to infection, particularly if you take steroids or
immunosuppressant medication. Avoid contact with
people who have infections.
-Pregnancy. Although fertility is not usually affected
in people with SLE, some women with SLE have a
higher chance of miscarriage. Women who have
badly inflamed kidneys, due to SLE, may have high
blood pressure in pregnancy. However, most women
with mild or well-controlled SLE at the start of
pregnancy are likely to go through pregnancy with
few problems.
-Some contraceptive pills may not be advised
depending on disease severity. A doctor or nurse will
advise on the best method of contraception.
-Other autoimmune diseases such as Sjögren's
syndrome and thyroid problems are more common
than average if you have SLE. These are sometimes
tested for in people with SLE.
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Anaphylaxis
Overview
Anaphylaxis is an acute, potentially fatal, multiorgan
system reaction caused by the release of chemical
mediators from mast cells and basophils. The classic
form involves prior sensitization to an allergen with
later reexposure, producing symptoms via an
immunologic mechanism.

An anaphylactic reaction can be life-threatening
when a severe attack occurs; it can stop breathing or
stop your heartbeat. In this case, you'll need
cardiopulmonary resuscitation (CPR) and other
emergency treatment right away.

Supportive care for patients with suspected
anaphylaxis includes the following:
 Airway management (eg, ventilator support
with bag/valve/mask, endotracheal
intubation)
 High-flow oxygen
 Cardiac monitoring and/or pulse oximetry
 Intravenous access (large bore)
 Fluid resuscitation with isotonic crystalloid
solution
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 Supine position (or position of comfort if
dyspneic or vomiting) with legs elevated
The primary drug treatments for acute anaphylactic
reactions are epinephrine and H1 antihistamines.
Medications used in patients with anaphylaxis
 Adrenergic agonists (eg, epinephrine)
 Antihistamines (eg, diphenhydramine,
hydroxyzine)
 H2 receptor antagonists (eg, cimetidine,
ranitidine, famotidine)
 Bronchodilators (eg, albuterol)
 Corticosteroids (eg, methylprednisolone,
prednisone)
 Positive inotropic agents (eg, glucagon)
 Vasopressors (eg, dopamine)
LIVER DISORDERS
HEPATITIS (ALL TYPES)

Overview
Hepatitis means inflammation of the liver. Many
illnesses and conditions can cause inflammation of
the liver, for example, drugs, alcohol, chemicals, and
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autoimmune diseases. Many viruses, for example, the
virus causing mononucleosis and the
cytomegalovirus can inflame the liver. Most viruses,
however, do not attack primarily the liver; the liver is
just one of several organs that the viruses affect.
When most doctors speak of viral hepatitis, they are
using the definition that means hepatitis caused by a
few specific viruses that primarily attack the liver
and are responsible for about half of all human
hepatitis. There are several hepatitis viruses; they
have been named types A, B, C, D, E, F (not
confirmed), and G. As our knowledge of hepatitis
viruses grows, it is likely that this alphabetical list
will become longer. The most common hepatitis
viruses are types A, B, and C. Reference to the
hepatitis viruses often occurs in an abbreviated form
(for example, HAV, HBV, HCV represent hepatitis
viruses A, B, and C, respectively.) The focus of this
article is on these viruses that cause the majority of
human viral hepatitis.
Hepatitis viruses replicate (multiply) primarily in the
liver cells. This can cause the liver to be unable to
perform its functions.
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For patients with milder alcoholic hepatitis, a general
diet containing 100 g/d of protein is appropriate.
Provide supplemental multivitamins and minerals,
including folate and thiamine. Salt restriction may be
required in patients with ascites.
111 | P a g e
Acute Hepatitis
- initial treatment consists of relieving the symptoms
of nausea, vomiting, and abdominal pain (supportive
care). Careful attention should be given to
medications or compounds, which can have adverse
effects in patients with abnormal liver function. Only
those medications that are considered necessary
should be administered since the impaired liver is
not able to eliminate drugs normally, and drugs may
accumulate in the blood and reach toxic levels.
Moreover, sedatives and "tranquilizers" are avoided
because they may accentuate the effects of liver
failure on the brain and cause lethargy and coma. The
patient must abstain from drinking alcohol, since
alcohol is toxic to the liver. It occasionally is
necessary to provide intravenous fluids to prevent
dehydration caused by vomiting. Patients with severe
nausea and/or vomiting may need to be hospitalized
for treatment and intravenous fluids.
Acute HBV is not treated with antiviral drugs. Acute
HCV - though rarely diagnosed - can be treated with
several of the drugs used for treating chronic HCV.
Treatment of HCV is recommended primarily for the
80% of patients who do not eradicate the virus early.
Treatment results in clearing of the virus in the
majority of patients.
Chronic Hepatitis
Treatment of chronic infection with hepatitis B and
hepatitis C usually involves medication or
combinations of medications to eradicate the virus.
Alcohol aggravates liver damage in chronic hepatitis,
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and can cause more rapid progression to cirrhosis.
Therefore, patients with chronic hepatitis should
stop drinking alcohol. Smoking cigarettes also can
aggravate liver disease and should be stopped.
LIVER CIRRHOSIS
Overview
Cirrhosis is defined histologically as a diffuse hepatic
process characterized by fibrosis and the conversion
of normal liver architecture into structurally
abnormal nodules. The progression of liver injury to
cirrhosis may occur over weeks to years. Indeed,
patients with hepatitis C may have chronic hepatitis
for as long as 40 years before progressing to
cirrhosis.

 Variceal bleeding
 Confused thinking and other mental changes

Regular exercise, including walking and even
swimming should be encouraged in patients with
cirrhosis, to prevent these patients from slipping into
a vicious cycle of inactivity and muscle wasting.
Debilitated patients frequently benefit from a formal
exercise program supervised by a physical therapist.
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 Help limit the damage to your liver and
control the symptoms by:
Do not drink any alcohol. If you don't stop
completely, liver damage may quickly get
worse.
 Talk to your doctor before you take any
medicines. This includes prescription and
over-the-counter drugs, vitamins,
supplements, and herbs. Medicines that can
hurt your liver include acetaminophen (such
as Tylenol) and other pain medicines such as
aspirin, ibuprofen (such as Advil or Motrin),
and naproxen (Aleve).
 Make sure that your immunizations are up-
to-date. You are at higher risk for infections.
 Follow a low-sodium diet. This can help
prevent fluid build-up, a common problem in
cirrhosis that can become life-threatening.
Once treatment for these complications

becomes ineffective, a liver transplant is
considered. Almost all of the complications
can be cured by liver transplantation;
however, in many circumstances, careful
management can reduce the harmful effects
of cirrhosis and delay or even prevent the
need for a liver transplant.
Musculoskeletal Disorders
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Fractures
Overview
A fracture is a break in a bone. Most involve a

single, significant force applied to normal bone.
May also seriously damage other tissues,
including the skin, nerves, blood vessels, muscles,
and organs
In a closed fracture, the overlying skin is intact.

In an open fracture, the overlying skin is
disrupted and the broken bone is in
communication with the environment.
Types:
Pathologic fractures occur when mild or
minimal force fractures an area of bone
weakened by a disorder (eg, osteoporosis, cancer,
infection, bone cyst). When the disorder is
osteoporosis, they are often called insufficiency
or fragility fractures.
Stress fractures (see page Stress Fractures)

result from repetitive application of moderate
force, as may occur in long-distance runners or
in soldiers marching while carrying a heavy load.
Normally, bone damaged by microtrauma from
moderate force self-repairs during periods of
rest, but repeated application of force to the
same location predisposes to further injury and
causes the microtrauma to propagate.
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 Greenstick fracture: In a greenstick
fracture, the bone sustains a small,
slender crack. This type of fracture is
more common in children, due to the
comparative flexibility of their bones.
 Comminuted fracture: In a comminuted

fracture, the bone is shattered into small
pieces. This type of complicated fracture
tends to heal at a slower rate.
 Simple fracture: In a simple fracture, or
'closed' fracture, the broken bone has not
pierced the skin.
 Compound fracture: In a compound
fracture, or 'open' fracture, the broken
bone juts through the skin, or a wound
leads to the fracture site. The risk of
infection is higher with this type of
fracture.
 Avulsion fracture: Muscles are anchored

to bone by tendons, which are a type of
connective tissue. In an avulsion fracture,
powerful muscle contractions can wrench
the tendon free and pull out pieces of
bone. This type of fracture is more
common in the knee and shoulder joints.
Avulsion fractures are reported to be
more common in children than adults. In
adults, the ligaments and tendons tend to
be injured, whereas in children the bone
may fail before the ligament or tendon is
injured. Children have a particularly weak
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point in their skeleton called the growth
plate. This is the area of bone that is
actively growing. In children, tendons or
ligaments near a growth plate can pull
hard enough to cause the growth plate to
fracture.
 Compression fracture: A compression
fracture occurs when two bones are
forced against each other. The bones of
the spine, called vertebrae, are prone to
this type of fracture. Elderly people,
particularly those with osteoporosis, are
at increased risk.
 Hip fracture: A broken hip is a common

injury, especially in elderly individuals. In
the United States, hip fractures are the
most common broken bone that requires
hospitalization; about 300,000 Americans
are hospitalized for a hip fracture every
year. Women are two to three times as
likely as men are to experience a hip
fracture, because women lose bone
density at a greater rate than men do. A
hip fracture is a serious injury,
particularly if the individual is older, and
complications can be life-threatening.
Fortunately, surgery to repair a hip
fracture is usually very effective, although
recovery often requires time and
patience. Most people make a good
recovery from a hip fracture. Generally,
the better the individual's health and
117 | P a g e
mobility before a hip fracture, the better
their chances for a complete recovery.
 Malnourished
 Undernourished
 Fat embolism syndrome
 Exacerbation of underlying diseases
such as diabetes or coronary artery
disease (CAD)
 Bone deformities
Dietary Measures
 Calcium-Rich Foods & vitamin D-rich

foods: best for maintaining bone
integrity and preventing future bone
fractures
 Calcium: for repair and regeneration of
bone cells
 Lysine-rich foods: a building block for
cellular repair
 Vitamin C-rich foods: essential for
efficient calcium use and bone repair
 High Protein Diet: improved bone health
and reducing the risk for hip fractures
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 Vitamin K-rich foods: improves your
body's ability to absorb and use calcium
from food sources
 Malnutrition risk assessment

 Osteoporosis risk assessment
 Monitor metabolic status
Osteoathritis
Overview
Osteoarthritis, also called degenerative joint

disease and osteoarthrisis, is the most common
form of arthritis. It is characterized by the
breakdown of cartilage in joints (i.e.,
intersections of two bones) and is often caused
by "wear and tear."
Cartilage cushions the ends of the bones and

allows for easier movement within the joints. As
osteoarthritis progresses, bone spurs
(osteophytes) develop within the affected joint
and the joint space narrows, increasing pain and
decreasing mobility.
Osteoarthritis causes joint pain and stiffness and

may result in loss of joint function. The disease,
which can cause significant disability, is the
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reason for most knee and hip
replacement surgeries.
Symptoms of osteoarthritis (e.g., joint pain and

stiffness, loss of joint function) usually develop
between the ages of 40 and 60. The condition
primarily affects the weight-bearing joints (e.g.,
knees, hips, feet, back). It also may affect the
neck and the joints in the fingers and hands.
There are 2 types of osteoarthritis—primary and

secondary:
 Primary osteoarthritis is associated with

aging.
 Secondary osteoarthritis is associated
with an additional cause, such as injury,
heredity or obesity.
 Estrogen Deficiency
 Hematochromatosis
 Vitamin D deficiency
Dietary measures
 Vitamin D, vitamin C, beta-carotene,

and niacin: helps reduce progression
of osteoarthritis
 Vitamin E, boron, niacinamide,
and omega-3 fatty acids: help
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reduce the pain and swelling that
comes with osteoarthritis
 Foods that may help: whole foods,
fish, ginger
Substances to avoid:
 Vitamin and retinoids

 Iron
Though no specific diet will necessarily

make your arthritis better, eating right
and controlling your weight can help by
minimizing stress on the weight-bearing
joints such as the knees and the joints of
the feet. It can also minimize your risk of
developing other health problem
Osteoporosis
Overview
Osteoporosis, or porous bone, is a disease

characterized by low bone mass and structural
deterioration of bone tissue, leading to bone
fragility and an increased risk of fractures of the
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hip, spine, and wrist. Men as well as women are
affected by osteoporosis, a disease that can be
prevented and treated. Osteoporosis is the most
common type of bone disease. There are no
symptoms in the early stages of osteoporosis.
Many times, people will have a fracture before
learning they have the disease
 Celiac Disease
 Anorexia Nervosa
 Asthma
 Diabetes
 Inflammatory bowel disease
 Lactose Intolerance
 Lupus
Dietary measures
Eating a balanced diet that contains a variety of foods

is important when looking at bone health. This
ensures you get enough vitamins, minerals and
energy you need to maintain health and reduces your
risk of developing chronic conditions.
 Vitamin D-rich foods

 Calcium rich foods
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Foods to limit:
 Salt
 Carbonated drinks
 Caffeine
Osteomyelitis
Overview
Osteomyelitis is an infection in a bone. Infections
can reach a bone by traveling through the
bloodstream or spreading from nearby tissue.
Infections can also begin in the bone itself if an
injury exposes the bone to germs.
In children, osteomyelitis most commonly affects

the long bones of the legs and upper arms. Adults
are more likely to develop osteomyelitis in the
bones that make up the spine (vertebrae). People
who have diabetes may develop osteomyelitis in
their feet if they have foot ulcers.
 Patients with acute osteomyelitis of

peripheral bones usually experience
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weight loss, fatigue, fever, and localized
warmth, swelling, erythema, and
tenderness.
 Diabetic foot ulcers
 Growth arrest
Dietary measures
 Foods that contain significant amounts of
vitamins A, C and E, selenium and zinc
may be helpful in treating this health
problem
 Probiotics -- acidophilus and
bifidobacteria -- may also be beneficial in
treating osteomyelitis
 Spinach may be a beneficial food in
treating your osteomyelitis
 increasing your consumption of fresh
fruits and vegetables, whole grains and
fish are important general dietary
strategies in treating this condition
 Avoid alcohol
Gouty Arthritis
Overview
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Gout is a form of inflammatory arthritis that
develops in some people who have high levels of
uric acid in the blood. The acid can form needle-
like crystals in a joint and cause sudden, severe
episodes of pain, tenderness, redness, warmth
and swelling.
There are several stages of gout:
 Asymptomatic hyperuricemia is the

period prior to the first gout attack. There
are no symptoms, but blood uric acid
levels are high and crystals are forming in
the joint.
 Acute gout, or a gout attack, happens

when something (such as a night of
drinking) causes uric acid levels to spike
or jostles the crystals that have formed in
a joint, triggering the attack. The resulting
inflammation and pain usually strike at
night and intensify over the next eight to
12 hours. The symptoms ease after a few
days and likely go away in a week to 10
days. Some people never experience a
second attack, but an estimated 60% of
people who have a gout attack will have a
second one within a year. Overall, 84%
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may have another attack within three
years.
 Interval gout is the time between attacks.

Although there’s no pain, the gout isn’t
gone. Low-level inflammation may be
damaging joints. This is the time to begin
managing gout – via lifestyle changes and
medication – to prevent future attacks or
chronic gout.
 Chronic gout develops in people with gout

whose uric acid levels remain high over a
number of years. Attacks become more
frequent and the pain may not go away as
it used to. Joint damage may occur, which
can lead to a loss of mobility. With proper
management and treatment, this stage is
preventable.

 Kidney stones
 Hyperuricemia
Dietary measures
 Drink plenty of fluids (no alcohol or sweet
sodas)
 Coffee
 Vitamin C
 Cherries
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 Limiting alcoholic beverages and drinks

sweetened with fruit sugar (fructose).
Instead, drink plenty of nonalcoholic
beverages, especially water.
 Limit intake of foods high in purines, such as
red meat, organ meats and seafood.
 Exercising regularly and losing weight.
Keeping your body at a healthy weight
reduces your risk of gout.
Neurologic Disorders
Guillain-Barre Syndrome
Overview
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Guillain-Barre (gee-YAH-buh-RAY) syndrome is a
rare disorder in which your body's immune
system attacks your nerves. Weakness and
tingling in your extremities are usually the first
symptoms
These sensations can quickly spread, eventually
paralyzing your whole body. In its most severe
form Guillain-Barre syndrome is a medical
emergency. Most people with the condition must
be hospitalized to receive treatment.
Guillain-Barré syndrome can affect anybody. It

can strike at any age and both sexes are equally
prone to the disorder. No one yet knows why
Guillain-Barré — which is not contagious —
strikes some people and not others. Nor does
anyone know exactly what sets the disease in
motion.

 Sluggish bowel function
 Urine retention
 Significant weight loss
 antecedent viral illness with
gastrointestinal sequelae
 cranial nerve deficits impairing oral
intake and gastrointestinal motility
 depressed serum transferrin
 Hypermetabolic
 Hypercatabolic
Dietary measures
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Nutritional changes, such as eating more fresh
fruits and vegetables and less red meats, may be
effective in reducing symptoms associated with
neurological disorders such as Guillain-Barre
syndrome (GBS)
 High-protein feedings
 Zinc rich foods
 It is best to avoid caffeine and other

stimulants, alcohol, and smoking.
 It may be best to eliminate potential food
allergens, including dairy (e.g. milk,
cheese, and sour cream), eggs, nuts,
shellfish, wheat (gluten), corn,
preservatives, and food additives (such as
dyes and fillers). Food allergies can be a
contributing factor in neurological
imbalances.
 It may be best to avoid refined foods such
as white breads, pastas, and sugar.
Doughnuts, pastries, bread, candy, soft
drinks, and foods with high sugar content
may all contribute to worsening
symptoms of neurological disorder
 Maintaining physical fitness is important
to those suffering from movement
disorders.
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Myasthenia Gravis
Overview
Myasthenia gravis (MG) is a chronic autoimmune

disorder that results in progressive skeletal
muscle weakness. Skeletal muscles are primarily
muscle fibers that contain bands or striations
(striated muscles) that are connected to bone.
MG causes rapid fatigue (fatigability) and loss of
strength upon exertion that improves after rest.
The most common primary disorder of
neuromuscular transmission. The usual cause is
an acquired immunological abnormality, but
some cases result from genetic abnormalities at
the neuromuscular junction.

 weakness of the tongue, jaw, mouth
and throat muscles may make it
difficult for some to chew or swallow
food
 malnutrition and unexpected weight
loss
 Bone loss
 Diarrhea
 Stomach upset
Dietary measures
 Soft Diet
 Puree Diet
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 Liquid Diet
 Tube Feeding
 it is best to eat small meals and
snacks 5-6 times a day
 Milk is a good base for snacks and
meals throughout the day
 When portions are small – it is
necessary to make the food as
nutritious as possible
 Avoid certain foods such as
commercially prepared soups,
smoked of prepared meats such as
bacon, sausage, lunchmeat, ham and
other pork products
 Don’t add salt to foods when cooking
or at the table. Removing the
saltshaker from the table is good idea
Parkinson’s disease
Overview
Parkinson's disease (PD) is a chronic and

progressive movement disorder, meaning that
symptoms continue and worsen over time.
Nearly one million people in the US are living
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with Parkinson's disease. The cause is unknown,
and although there is presently no cure, there
are treatment options such as medication and
surgery to manage its symptoms.
Parkinson’s involves the malfunction and death

of vital nerve cells in the brain, called neurons.
Parkinson's primarily affects neurons in an area
of the brain called the substantia nigra. Some of
these dying neurons produce dopamine, a
chemical that sends messages to the part of the
brain that controls movement and coordination.
As PD progresses, the amount of dopamine
produced in the brain decreases, leaving a
person unable to control movement normally.

 Dysphagia
 Constipation
Dietary measures
While there is no special diet for people
with Parkinson's disease, eating a well-balanced,
nutritious diet is extremely beneficial. With the
proper diet, our bodies work more efficiently, we
have more energy
To control nausea:
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 Avoid fried, greasy, or sweet foods
 Drink clear or ice-cold drinks. Drinks
containing sugar may calm the
stomach better than other liquids.
 Eat light, bland foods (such as saltine
crackers or plain bread)
Spinal Cord Injury
Overview
Spinal cord injury is damage to the spinal cord as
a result of a direct trauma to the spinal cord
itself or as a result of indirect damage to the
bones, soft tissues, and vessels surrounding the
spinal cord. The spinal cord is the major bundle
of nerves carrying nerve impulses to and from
the brain to the rest of the body. Rings of bone
called vertebrae surround the spinal cord. These
bones constitute the spinal column (back bones).
Spinal cord damage results in a loss of function,

such as mobility or feeling. In most people who
have spinal cord injury, the spinal cord is intact.
Spinal cord injury is not the same as back injury,
which might result from causes such as pinched
nerves or ruptured disks. Even when a person
sustains a break in a vertebra or vertebrae, there
133 | P a g e
might not be any spinal cord injury if the spinal
cord itself is not affected.
The effects of a spinal cord injury can vary based

on the injury’s location. Injuries that are
sustained near the top of the spine result in more
extensive disability (numbness and paralysis,
breathing difficulty) than injuries low in the
spine. Some common outcomes are muscle
spasms, the loss of sensation in parts of the body,
numbness, and paralysis. Death can result if
there is a paralysis of the breathing muscles.

 Malnutrition
 Hyper catabolic
 Altered glucose and lipid metabolism
 Pressure Ulcer
 Osteoporosis
 Neurogenic Bowel and bladder
Dietary measures
 Low Fat diet
 Calcium
 Vitamin D
 Dietary Fiber
 Physical activity is important
 Dont skip meal
 Monitor your BMI
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Multiple Sclerosis
Overview
Multiple sclerosis, or MS, is a long-lasting disease
that can affect your brain, spinal cord, and the
optic nerves in your eyes. It can cause problems
with vision, balance, muscle control, and other
basic body functions.
The effects are often different for everyone who

has the disease. Some people have mild
symptoms and don’t need treatment. Others will
have trouble getting around and doing daily
tasks.
MS happens when your immune system attacks a

fatty material called myelin, which wraps around
your nerve fibers to protect them. Without this
outer shell, your nerves become damaged. Scar
tissue may form.
The damage means your brain can’t send signals

through your body correctly. Your nerves also
don’t work as they should to help you move and
feel.

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 Fractures
 Osteoporosis
 Intestinal gas and bowel problems
 UTI
 Uric Acid and Gout
Dietary measures
 Diet low in fats, high in fiber
 Vitamin D
 Biotin
 Gluten-Free Diet
 Skip saturated fats
 Skip full-fat dairy products
 Avoid diet drinks
 Fruits instead of sugar replacers
Bell’s palsy
Overview
Bell's palsy causes sudden weakness in your
facial muscles. This makes half of your face
appear to droop. Your smile is one-sided, and
your eye on that side resists closing.
Bell's palsy, also known as facial palsy, can occur

at any age. The exact cause is unknown, but it's
136 | P a g e
believed to be the result of swelling and
inflammation of the nerve that controls the
muscles on one side of your face. It may be a
reaction that occurs after a viral infection.
For most people, Bell's palsy is temporary.

Symptoms usually start to improve within a few
weeks, with complete recovery in about six
months. A small number of people continue to
have some Bell's palsy symptoms for life. Rarely,
Bell's palsy can recur.
 Deficiency in Vitamin B which leads to

stress that can result to herpes simplex
virus
Dietary measures used as treatments

 High intake of carbohydrates
 Fruits
 Vitamin B-rich foods
 Avoid caffeinated products
 Avoid artificial sweeteners
 Eat nuts or seeds for snacks
Meningitis
137 | P a g e
Overview
Meningitis is an inflammation (swelling) of the

protective membranes covering the brain and
spinal cord known as the meninges. This
inflammation is usually caused by an infection of
the fluid surrounding the brain and spinal cord.
Meningitis is usually caused by bacteria or

viruses, but can be a result of injury, cancer, or
certain drugs.
It is important to know the specific cause of

meningitis because the treatment differs
depending on the cause.

 Kidney problems
 Arthritis

 fruits and vegetables that are rich in
vitamins A, B, C, D and E
 essential fatty acids
 Ices from citrus fruits like lemons,
pineapples and oranges are also
helpful. Other foods like chicken, lean
meats, salmon and peanuts
 Deli meats, processed foods, smoked
138 | P a g e
fish and sushi are other foods that
must be completely avoided in a
meningitis recovery diet.
 include dairy products, meats, sugary
foods, white flour foods, salt,
caffeinated beverages and even
alcoholic drinks should be avoided
Stroke
Overview
Stroke, also called “brain attack” or
cerebrovascular accident, occurs when blood
flow to the brain is disrupted. Disruption in
blood flow is caused when either a blood clot or
piece of plaque blocks one of the vital blood
vessels in the brain (ischemic stroke), or when a
blood vessel in the brain bursts, spilling blood
into surrounding tissues (hemorrhagic stroke).
A loss of brain function occurs with brain cell
death. This may include impaired ability with
movement, speech, thinking and memory, bowel
and bladder, eating, emotional control, and other
vital body functions. Recovery from stroke and
the specific ability affected depends on the size
and location of the stroke. A small stroke may
result in problems such as weakness in an arm or
leg. Larger strokes may cause paralysis (inability
to move part of the body), loss of speech, or even
death.
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 Malnutrition
 Lack gag reflex
 Choke
 Chronic respiratory infection
 Poor appetite
 Weight loss
Dietary measures
 Fruits and vegetables
 Lean protein
 Grains
 High Fiber diet
 Limit salt
 Don’t skip meals
Hematologic Disorders
Iron Deficiency Anemia
Overview
Iron deficiency anemia develops when body
stores of iron drop too low to support normal red
blood cell (RBC) production. Inadequate dietary
iron, impaired iron absorption, bleeding, or loss
of body iron in the urine may be the cause. Iron
equilibrium in the body normally is regulated
140 | P a g e
carefully to ensure that sufficient iron is
absorbed in order to compensate for body losses
of iron

 Growth problems
 Heart problems
 Increase risk of infections
 Restless leg syndrome
Dietary measures
 Iron-rich foods
 food and drink containing vitamin C are
important as vitamin C helps your body
absorb iron
 recheck complete blood counts every
three months for one year
 Substances that impair iron absorption
include: coffee, tea, high fiber, calcium and
eggs
Leukemia
Overview
Leukemia is a cancer of cells in the bone marrow
(the cells which develop into blood cells). With
leukemia, the cancerous cells in the bone
marrow spill out into the bloodstream. There are
several types of leukemia. Most types arise from
cells which normally develop into white blood
cells. (The word leukemia comes from a Greek
141 | P a g e
word which means 'white blood'.) If you develop
leukemia it is important to know exactly what
type it is. This is because the outlook (prognosis)
and treatments vary for the different types.

 Weight loss
 Fatigue
 Nausea
 Anemia
 Low blood count
 Constipation

 neutropenic diet
 High antioxidants food
 Fruits and vegetables
 Adequate water intake
 Diet recommendations may include
avoiding raw/undercooked foods (e.g.,
meats, seafood, eggs, vegetables or
unpeeled fruits) or unpasteurized dairy
products.
 Maintaining a healthy body weight
 Daily activity, such as walking
 Relaxing (managing stress)
 Getting enough sleep
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Sickle Cell Anemia
Overview
Sickle cell disease changes normal, round
red blood cells into cells that can be shaped like
crescent moons. The name "sickle cell" comes
from the crescent shape of the cells. (A sickle is a
tool with a crescent-shaped blade.)
Having sickle cell disease means a lifelong battle
against the health problems it can cause, such as
pain, infections, anemia, and stroke. But many
people are able to have a very good quality of life
by learning to manage the disease.

 Infections
 Anemia
 Stroke
Dietary measures
 High calorie, nutrient-dense diet
 folic acid and vitamin B12 and B6
supplements
 Protein Diet
 Fat Diet
 Do not smoke and avoid smoking
areas
 Avoid crowded areas
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Polycythemia Vera
Overview
Polycythemia vera (pol-e-sigh-THEE-me-uh
VEER-uh) is a slow-growing type of blood cancer
in which your bone marrow makes too many red
blood cells. Polycythemia vera may also result in
production of too many of the other types of
blood cells — white blood cells and platelets.
These excess cells thicken your blood and cause
complications, such as such as a risk of blood
clots or bleeding.
Polycythemia vera isn't common. It usually

develops slowly, and you may have it for years
without noticing signs or symptoms. Often,
polycythemia vera is found during a blood test
done for some other reason.
Without treatment, polycythemia vera can be

life-threatening. However, with proper medical
care, many people experience few problems
related to this disease. Over time, there's a risk of
progressing to more-serious blood cancers, such
as myelofibrosis or acute leukemia

144 | P a g e
 Stroke
 Heart attack
 Enlarged spleen
 Peptic Ulcers
 Gout
Dietary measures
 Balanced Diet: right amount of calories,
protein, vitamins and minerals your body
needs (nutrient-rich foods from each of
the food groups, including fruits,
vegetables, whole grains, lean proteins
and low-fat dairy food)
 Low-Sodium Diet
 Iron-rich foods
 Avoid tobacco
 Avoid asparagus
 Exercise regularly
Pernicious Anemia
Overview
Pernicious anemia is a decrease in red blood cells
that occurs when the intestines cannot properly
absorb vitamin B12.
Pernicious anemia is a type of vitamin B12
anemia. The body needs vitamin B12 to make
145 | P a g e
red blood cells. You get this vitamin from eating
foods such as meat, poultry, shellfish, eggs, and
dairy products.
A special protein, called intrinsic factor (IF),

helps your intestines absorb vitamin B12. This
protein is released by cells in the stomach. When
the stomach does not make enough intrinsic
factor, the intestine cannot properly absorb
vitamin B12.

 Constipation
 PICA
 Fatigue
 Lack of energy
 Bleeding gums
 Swollen, red tongue
 Gastric Polyps
Dietary measures
 High in Vitamin B12 foods
 Folic Acid-rich foods
 Avoid drinking tea
 Avoid smoking
 Try not to overcook foods containing folic
acid
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Genitourinary System
Benign Prostatic Hypertrophy
Overview
Benign prostatic hyperplasia (BPH), also known
as benign prostatic hypertrophy, is a histologic
diagnosis characterized by proliferation of the
cellular elements of the prostate. Chronic
bladder outlet obstruction (BOO) secondary to
BPH may lead to urinary retention, renal
insufficiency, recurrent urinary tract infections,
gross hematuria, and bladder calculi.

 UTI
 Kidney stones
 Urinary retention
 Bladder Stones
 Bladder Damage
Dietary measures
 Vitamin E-rich foods
 Vitamin B6-rich foods
 Fruits and vegetables diet
 Vegan Diet
 Low Fat Diet
147 | P a g e
 Avoid caffeine
 Limiting or avoiding animal products and
vegetable oils
Kidney Stones
Overview
Kidney stones are made of salts and minerals in
the urine that stick together to form small
"pebbles." They can be as small as grains of sand
or as large as golf balls. They may stay in
your kidneys or travel out of your body through
the urinary tract. The urinary tract is the system
that makes urine and carries it out of your body.
It is made up of the kidneys, the tubes that
connect the kidneys to the bladder (the ureters),
the bladder, and the tube that leads from the
bladder out of the body (the urethra).
Kidney stones form when a change occurs in the
normal balance of water, salts, minerals, and
other things found in urine. The most common
cause of kidney stones is not drinking enough
water. Try to drink enough water, enough so that
your urine is light yellow or clear like water
(about 8 to 10 glasses a day). Some people are
more likely to get kidney stones because of a
medical condition, such as gout.
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Kidney stones may also be an inherited disease.
If other people in your family have had kidney
stones, you may have them too.
Kidney stones often cause no pain while they are

in the kidneys. But they can cause sudden, severe
pain as they travel from the kidneys to the
bladder.

 Stomach Upset
 Nausea and Vomiting that might result to
dehydration
 UTI
Dietary measures
 Plenty of fluids especially water
 Low sodium diet
 Low protein diet
 Calcium-rich foods
 Monitor your weight
 Avoid low carbohydrate foods
 Avoid meat
Urinary Tract Infection
Overview
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A urinary tract infection (UTI) is an infection in
any part of your urinary system — your kidneys,
ureters, bladder and urethra. Most infections
involve the lower urinary tract — the bladder
and the urethra.
Women are at greater risk of developing a UTI

than men are. Infection limited to your bladder
can be painful and annoying. However, serious
consequences can occur if a UTI spreads to your
kidneys

 Sepsis
 Kidney Problems
 Diarrhea
 Dehydration
Dietary measures
 Water intake
 Cranberry Juice
 Antioxidant-rich foods
 Drink plenty of fluids
 Eat fruits and vegetables
 Monitor your urine output
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Acute Glomerulonephritis
Overview
Acute glomerulonephritis is a syndrome
characterized by the abrupt onset of hematuria
often accompanied by proteinuria, hypertension,
edema, and renal dysfunction. Acute
glomerulonephritis can be subdivided into
primary glomerular disease, post infectious
glomerulonephritis, and glomerulonephritis
associated with systemic disease. With few
exceptions, the underlying mechanism of acute
glomerulonephritis is an immunologic one.

 Lack of appetite
Dietary measures
 Low Salt Diet
 Diuretics
 Calcium supplements
 Sodium and fluid restriction
 Protein restriction for patients
with azotemia should be advised if
there is no evidence of malnutrition
Renal Failure (Acute and Chronic)

151 | P a g e
Overview
Acute renal failure (ARF) is the rapid breakdown
of renal (kidney) function that occurs when high
levels of uremic toxins (waste products of the
body's metabolism) accumulate in the blood.
ARF occurs when the kidneys are unable to
excrete (discharge) the daily load of toxins in the
urine.
Chronic renal failure (CRF) or kidney failure is

the progressive loss of kidney function. The
kidneys attempt to compensate for renal damage
by hyper filtration (excessive straining of the
blood) within the remaining functional nephrons
(filtering units that consist of a glomerulus and
corresponding tubule). Over time, hyper
filtration causes further loss of function.

 Decreased urine output
 Food distaste
 Anemia
Dietary measures
ARF:
 Low Protein Diet
 Carbohydrate and Fat Diet
 Fluid Intake
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CRF:
 Sodium intake
 Protein Diet
ARF:
 Restrict sodium
 Less protein intake
CRF:
 Fluid consumption should be controlled
 Restrict potassium consumption
REFERENCES
http://umm.edu/health/medical/altmed/condition/
bulimia-nervosa
http://www.nutritionist-
resource.org.uk/articles/bulimia-nervosa.html
http://www.eatingdisorderhope.com/information/b
ulimia
http://www.webmd.com/mental-health/eating-
disorders/bulimia-nervosa/bulimia-nervosa-topic-
overview?page=2
http://www.ncbi.nlm.nih.gov/pubmed/17186637
http://eatingdisorder.org/treatment-and-
support/therapeutic-modalities/nutritional-therapy/
http://www.uptodate.com/contents/bulimia-
153 | P a g e
nervosa-in-adults-cognitive-behavioral-therapy-cbt
http://www.nutritionmd.org/health_care_providers/
integumentary/burns_nutrition.html
http://www.aci.health.nsw.gov.au/__data/assets/pdf
_file/0009/162639/SBIS_Nutrition_CPG_new_format.
pdf
http://www.webmd.com/heart-
disease/tc/coronary-artery-disease-overview
http://www.nutritionmd.org/consumers/cardiovasc
ular/coronary_heart_disease_nutrition.html
https://my.clevelandclinic.org/health/diseases_cond
itions/hic_Hypertension_High_Blood_Pressure/hic_Hi
gh_Blood_Pressure_and_Nutrition
http://www.webmd.com/heart-disease/heart-
failure/heart-failure-overview
http://www.ghc.org/healthAndWellness/?item=/co
mmon/healthAndWellness/conditions/heartDisease
/chfNutrition.html
http://www.merckmanuals.com/professional/endoc
rine-and-metabolic-disorders/thyroid-
disorders/overview-of-thyroid-function
https://my.clevelandclinic.org/health/transcripts/1
540_calcium-disorders-and-parathyroid-disease
http://www.lifeextension.com/magazine/2013/6/N
utritional-Dangers-of-Acid-Reflux-Medications/Page-
01
http://emedicine.medscape.com/article/176595-
overview
http://www.niddk.nih.gov/health-
information/health-topics/digestive-
diseases/dumping-syndrome/Pages/facts.aspx
http://www.webmd.com/digestive-
disorders/dumping-syndrome-causes-foods-
treatments?page=2
http://www.mayoclinic.org/diseases-
conditions/irritable-bowel-
154 | P a g e
syndrome/basics/definition/con-20024578
syndrome/basics/symptoms/con-20024578
syndrome/basics/treatment/con-20024578
overview
https://my.clevelandclinic.org/health/diseases_cond
itions/hic_Inflammatory_Bowel_Disease_IBD_QandA/
inflammatory-bowel-disease-overview
disorders/tc/peptic-ulcer-disease-topic-overview
disorders/tc/peptic-ulcer-disease-medications
disorders/tc/peptic-ulcer-disease-home-treatment
overview
http://www.livestrong.com/article/540661-list-of-
foods-to-avoid-for-cholecystitis/
conditions/gastritis/basics/definition/con-
20021032
conditions/gastritis/basics/treatment/con-
20021032
https://www.msdmanuals.com/professional/gastroi
ntestinal-disorders/gastroenteritis/overview-of-
gastroenteritis
http://patient.info/health/gastroenteritis-in-adults
treatment
overview
155 | P a g e
disorders/peritonitis-symptoms-causes-
treatments?page=3
http://www.medicinenet.com/script/main/art.asp?a
rticlekey=7886
http://patient.info/doctor/intestinal-obstruction-
and-ileus
http://www.healthline.com/health/diverticulitis#Re
adThisNext8
conditions/diverticulitis/basics/complications/con-
20033495
http://www.healthline.com/health/acute-
respiratory-failure#ReadThisNext9
overview
http://familydoctor.org/familydoctor/en/diseases-
conditions/chronic-obstructive-pulmonary-
disease.printerview.all.html
http://www.webmd.com/lung/copd/tc/chronic-
obstructive-pulmonary-disease-copd-prevention
http://www.who.int/topics/tuberculosis/en/
overview
https://www.aids.gov/hiv-aids-basics/hiv-aids-
101/what-is-hiv-aids/
http://www.mayoclinic.org/diseases-conditions/hiv-
aids/basics/tests-diagnosis/con-
20013732http://www.mayoclinic.org/diseases-
conditions/hiv-aids/basics/treatment/con-
20013732
http://www.mayoclinic.org/diseases-conditions/hiv-
aids/basics/lifestyle-home-remedies/con-20013732
conditions/rheumatoid-arthritis/diagnosis-
treatment/treatment/txc-20197400
156 | P a g e
conditions/rheumatoid-arthritis/manage/ptc-
20197414
conditions/rheumatoid-arthritis/home/ovc-
20197388
http://www.uptodate.com/contents/systemic-lupus-
erythematosus-sle-beyond-the-basics
http://www.uptodate.com/contents/systemic-lupus-
erythematosus-sle-beyond-the-basics
http://www.nutritionmd.org/health_care_providers/
howto_allergy/lupus_nutrition.html
http://patient.info/health/systemic-lupus-
erythematosus-leaflet
http://umm.edu/health/medical/reports/articles/sy
stemic-lupus-erythematosus
overview
conditions/anaphylaxis/basics/complications/con-
20014324
157 | P a g e

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COMPILATIONDIETS

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Myrrh Ariane Y.

Eating Disorders (5-11)

Hematologic Disorders (138-144)

People who have anorexia have an intense fear of

Associated Nutritional Problems

In anorexia nervosa’s cycle of self-starvation, the

• Abnormally slow heart rate and low blood

• Reduction of bone density (osteoporosis),

• Muscle loss and weakness.

• Severe dehydration, which can result in

• Fainting, fatigue, and overall weakness.

• Dry hair and skin; hair loss is common.

• Growth of a downy layer of hair called lanugo

The first priority in anorexia treatment is addressing

Often people with anorexia will be reluctant to admit

For an anorexic sufferer, gaining weight is an

This usually means that specialist dietary plans must

Any course of treatment for anorexia is usually

Bulimia nervosa, commonly called bulimia, is a

Bulimia can be categorized in two ways:

• Nonpurging bulimia. You use other methods

Associated nutritional problems

• Discontinuing the binge-purge cycle: The

Eating adequately to meet the body’s daily nutritional

A balanced and sustainable relationship with food,

Listening to and trusting your body’s internal cues to

While underlying thoughts and emotions remain at

Smoking and open flame are the leading causes of

A burn injury usually results from an energy transfer

Associated Nutritional Problems

• Refeeding Syndrome -This potentially lethal

• Non-obstructive Bowel Necrosis

Although rare, several case reports have

 Minor burns can be treated with natural

The pediatric burn patient presents a particular

Coronary Artery Disease

Coronary artery disease is the most common type

When you have it, your heart muscle doesn't get

It can be a shock to find out that you have coronary

Associated Nutrtional Problems

• Uncontrolled diabetes and impaired

In healthy people, insulin keeps the blood sugar level

Uncontrolled diabetes can damage the artery walls

• Avoid fried fast food and processed foods containing

Blood pressure is the force of blood pushing against

In most people, the kidneys have trouble keeping up

Cancer- Research shows that higher intake of salt,

Osteoporosis- The amount of calcium that your body

DASH stands for Dietary Approaches to

• Eat more fruits, vegetables, and low-fat dairy foods

A healthful eating pattern, regular physical activity,

Congestive Heart Failure

After digestion, glucose passes into the bloodstream,

When we eat, the pancreas automatically produces

The goal is to lower your cholesterol level, drop extra

On the TLC diet, you will:

• Limit fat to 25%-35% of your total daily calories.

Although assessment is the initial step of the four-

The thyroid gland, located in the anterior neck just

Associated Nutritional Problems

The first thing that we want to understand is that

What are the symptoms of low thyroid? With low

Now I hope you have a general understanding of the

The very first thing is that this TSH doesn’t just