CA Of The Gastrointestinal Tract - Chapter 20

Question 1

What are the protein needs of patients with gastric cancer

Answer 1

1.0-1.5g/kg

Question 2

What are the calorie needs of those with gastric cancer

Answer 2

25-35kcal/kg

30-35 if weight gain needed

35 if hypermetabolic or stressed

Question 3

The stomach is separated into two parts the upper and the lower section. Describe the upper section

Answer 3

The upper section is referred to as the PROXIMAL stomach. It contains the CARDIA, Which is closest to the esophagus, the fundus and the body.

Question 4

Stomach is separated into two parts the upper and lower sections. Describe the lower section

Answer 4

The lower section is known as the DISTAL stomach. It contains the Antrim and the pylorus, which is the closest part of the stomach to the duodenum.

Question 5

What is the liquid remaining after food is blenderized and liquefied in the stomach?

Answer 5

Chyme

Question 6

The stomach in the duodenum trigger feedback mechanisms that do what?

Answer 6

Control appetite and affect the pace of stomach emptying into the small bowel

Question 7

What is believed to be the leading cause of gastric

Answer 7

Helicobacter pylori , especially in the distal stomach

Question 8

Gastric cancer stent in metastasized where?

Answer 8

Liver, lung, or bone

Question 9

What are risk factors of upper gastric cancers are Cancers of the gastric esophageal Junction?

Answer 9

Being overweight or obese

Gastroesophageal reflux disease or GERD

Question 10

What are risk factors of both upper and lower gastric cancers

Answer 10

Heavy alcohol intake

Smoking/tobacco product use

Lack of physical activity

Question 11

What are risk factors of the lower gastric cancer or non cardia gastric cancer?

Answer 11

H-pylori
Gastritis
Autoimmune disorders with pernicious anemia
Stomach surgeries or gastric bypass
Childhood malnutrition
Salted or smoked Foods
High heme iron intake from meat
High intake of grilled and processed meat
Low intake of fruit and veggies particularly of foods with beta-carotene and vitamin C

Question 12

What sex and race is gastric cancer most common in?

Answer 12

More common in men

Higher incidence in Hispanic, African and Asian Americans

Question 13

What are the symptoms of gastric cancer?

Answer 13

Feeling full, bloated after eating
Heartburn or indigestion
Abdominal pain and discomfort
Nausea, vomiting
Anorexia and unintentional weight loss

Question 14

What nutritional situations might having a gastrectomy put a person at risk of?

Answer 14

OSTEOPOROSIS
So do bone scan over 2 years
Monitor vitamin D levels
Encourage calcium citrate intake of 1500 mg per day
Separate calcium supplement from iron foods

NUTRITIONAL ANEMIAS
Due to possible malabsorption of iron, folate, and B12
Monitor and supplement if indicated

Question 15

What are three types of partial gastrectomy?

Answer 15

Billroth 1 (gastroduodenostomy)

Bill Roth 2 (gastrojejunostomy)

Rouex-en-Y

Most surgeons prefer to avoid preoperative gastrectomy to beating placements in patients with favorable proptosis

Question 16

When jujenal tube feedings are used for nutrition support what is the standard protocol for use?

Answer 16

Continuous feedings via pump are indicated

Fiber free, 1.0 standard formula, / 8 to 20 hours, advancing as tolerated

Begin with small volumes of full strength formula (about 20 to 30 cc’s per hour) and advance as tolerated

Question 17

After gastrectomy either partial or total surgery what type of diet intervention should be followed?

Answer 17

More or less the diet for anti-dumping diet

Small frequent meals
Limit  concentrated sugars and lactose
Avoid greasy fried foods
Include protein sources at each meal
Separate liquids from meal times

Question 18

What is the main function of the colon or large bowel?

Answer 18

To maintain hydration and conserve electrolytes by reabsorbing fluid and salts

It also produces short-chain fatty acids that support colon health

Question 19

Colorectal cancer is the_______most common cancer and more often is found in which sex?

Answer 19

It is the third most common cancer

, It is most often found in men

Question 20

If colorectal cancer is going to metastasize where is it likely to metastasize?

Answer 20

To the liver

Question 21

What are the risk factors for colorectal?

Answer 21

Being over the age of 50
Colon polyps
Inherited syndromes
Being African-American or Ashkenazi Jews
Having type 2 diabetes
Being overweight or obese, especially in the abdomen
Smoking
Heavy alcohol use
Physical inactivity
History of ulcerative colitis or Crohn’s disease
Grilling at high temperatures
Diets high in red meat and processed meat
Low serum vitamin D levels and low calcium intake

Question 22

What is the most common symptom of colorectal cancer?

Answer 22

A change in the bowel habits particularly diarrhea constipation or narrowing of the stool

Others:
Heme positive stools
Unexplained anemia
Abdominal pain or bloating
Nausea and vomiting
Blood in the stool
Unintended weight loss and fatigue

Question 23

If the terminal ileum has been resected what things will need to be considered

Answer 23

Monitor serum vitamin B12 levels

Monitor for diarrhea

Additional bile acid sequestrants may be needed

Because of losses, fat soluble vitamins a, d, e k and calcium zinc and magnesium supplements may be needed

Question 24

What are the calorie needs for a patient with liver cancer

Answer 24

25 to 40 KCAL 4 kilogram if I acites
35 to 40 KCAL per kilogram if stable cirrhosis
25 to 35 KCAL without encephalopathy
35 KCAL per kilogram with a cute encephalopathy
30 to 40 KCAL if malnourished

Question 25

What are the protein needs for liver cancer patients

Answer 25

1 to 1.5 grams kilogram for all except those with encephalopathy

.6 to .8 grams her kilogram for patients with acute encephalopathy

Question 26

What are estimated fluid needs and liver patients with ascites

Answer 26

If mild ascites 3 to 5 kilograms

If moderate ascites 7 to 9 kilograms

If severe ascites 14 to 15 kilograms