Biliary

Question 1

what is the fancy term for “gallstones”

Answer 1

cholelithiasis

Question 2

t/f: the dietary treatment after cholelithiasis removal is diet as tolerated by patient

Answer 2

true!… adjustments are made to diet based on patient’s rxn

Question 3

in the short term, what 3 things might help cholelithiasis post-op patients?

Answer 3

1. small frequent meals
2. easily digested CHO
3. low fat(no bile storage!)

Question 4

what is a potential GI complication of gallbladder removal?

Answer 4

diarrhea… fats not easily digested and increase solute load in colon

Question 5

t/f: acute pancreatitis patients should wait the normal 7 day period before starting enteral feeding

Answer 5

false! nutrition support should be initiated within 24-48 hours after admission

**later initiation is associated with POORER outcomes!

Question 6

what must occur before pancreatitis patients receive enteral support?

Answer 6

must be fluid resuscitated

Question 7

what are the 2 recommended enteral feeding routes for pancreatitis patients? why only these?

Answer 7

orogastric or nasogastric

**should be into stomach if possible b/c too hard to place in SI past pancreas b/c so much inflammation

Question 8

t/f: pancreatitis patients should be started on a polymeric formula

Answer 8

true! only switch to elemental if tolerance is poor

Question 9

besides changing to an elemental formula what are 2 options to increase tolerance to enteral feeds in acute pancreatitis patients?

Answer 9

1. feed more distally past the Ligament of Treitz (muscle that suspends duodenum)
2. feed continuously, rather than in boluses

Question 10

if EN is not feasible, use of PN should be considered after _______(time period) from _________ of pancreatitis episode

Answer 10

1 week from ONSET of pancreatitis episode(NOT hospital admittance!)

Question 11

t/f: patients with chronic pancreatitis tend to have worse symptoms than acute

Answer 11

false… chronic is usually a milder presentation

Question 12

t/f: chronic pancreatitis patients should consume lower fat, but normal diet, during a flare

Answer 12

false! they cannot eat during a flare

Question 13

what might chronic pancreatitis patients need regularly (including a specific example) to aid digestion?

Answer 13

enzymes, esp. lipase

Question 14

what should be done about malabsorption of macro and micronutrients in chronic pancreatitis patients?

Answer 14

macro: increase calories and protein slightly, SMALL FREQUENT MEALS
micro: give MVM

Question 15

what would the protein and calorie needs of a 145 lb. female with chronic pancreatitis be? (get that calculator out!)

Answer 15

protein: 66-99 g (1-1.5 g/kg)
cal: 1648-1977 kcal(25-30 kcal/kg)

Question 16

what are the two main LT nutrition problems associated with chronic pancreatitis?

Answer 16

1. fat soluble vitamin deficiency

2. osteoporosis (secondary to Vit D deficiency)

Question 17

what is the difference b/t cholelithiasis and cholecystitis?

Answer 17

cholelithiasis: stones in gallbladder
cholecystitis: inflammation of gallbladder, often times due to cholelithiasis

Question 18

why is the gallbladder often the “culprit” of pancreatitis?

Answer 18

gallstones travel through common bile duct up into pancreas and cause irritation–> inflammation

Question 19

why is timing of enteral feeding and nutrition support crucial with moderate-severe pancreatitis patients?

Answer 19

because moderate-severe pancreatitis involves transient organ failure, which is a great tax on the body