Chapter 24: MNT for Pancreatic and Bile Duct Cancer

Question 1

Pancreatic tumors can either form on either ___ or ____ cells?

Answer 1

Exocrine or endocrine

Question 2

T/F: Exocrine tumors are the most common?

Answer 2

True.

Question 3

Estimated Nutritional needs?

Answer 3

25 kcal/kg for resectable preoperative patients and higher in those with advanced disease.

Question 4

What vitamin should be supplemented in pancreatic cancer?

Answer 4

B12

Question 5

Pancreaticoduodenectomy (PD) is also known as the ___?

Answer 5

Whipple

Question 6

What are NIS of a distal pancreatectomy?

Answer 6

Exocrine insufficiency, diabetes

Question 7

What are NIS of a total pancreatectomy (TP)?

Answer 7

Exocrine insufficiency, dumping syndrome, delayed gastric emptying, lactose intolerance, diabetes/IGT

Question 8

What are NIS of Pylorus preserving whipple?

Answer 8

Exocrine insufficiency, delayed gastric emptying, lactose intolerance, diabetes/IGT

Question 9

What are NIS of a Whipple Procedure?

Answer 9

Exocrine insufficiency, dumping syndrome, delayed gastric emptying, lactose intolerance, diabetes/IGT

Question 10

MNT for delayed gastric emptying?

Answer 10

low-fiber, low fat, 6-8 small meals, avoid eating 2-3 hours before sleep, keep head of bed elevated.

Question 11

MNT for lactose intolerance?

Answer 11

limit lactose containing foods, and/or use of lactase supplements with food containing lactose

Question 12

MNT for Diabetes/IGT?

Answer 12

limit refined cho, consume meals and snacks at regular intervals, consume carbohydrate with fat and protein ast tolerated. (may need aggressive insulin management)

Question 13

The anti-dumping diet is recommended for at least ____ weeks after surgery?

Answer 13

Six

Question 14

What is the preferred kind of formula to use for EN after pancreatic reconstructive surgery?

Answer 14

Semi-elemental formula d/t high likelihood of pancreatic exocrine insufficiency.

Question 15

After pancreatic reconstructive surgery, fat should be limited to ____ grams per day?

Answer 15

75

Question 16

NIS of Capecitabine (Xeloda)?

Answer 16

Nausea, vomiting, diarrhea, myelo-suppuression

Question 17

NIS of Cisplatin (Plainol AQ)?

Answer 17

Nausea, vomiting, diarrhea, altered taste, myelo-suppression.

Question 18

NIS of Docetaxel (Taxotere)?

Answer 18

Nausea, vomiting, mucositis, myelo-sppuression

Question 19

NIS of Doxorubcin (Adriamycin)?

Answer 19

Anorexia, nausea, vomiting, diarrhea, mucositis, myelo-suppuression

Question 20

NIS of Fluorouracil (5-FU)?

Answer 20

Nausea, vomiting, diarrhea, mucositis, myelo-suppuression

Question 21

NIS of Gemcitabine (Gemzar)?

Answer 21

Nausea, vomiting, diarrhea, mucositis, myelo-suppuression

Question 22

NIS of Irinotecan (Camptosar, CP-11)?

Answer 22

Anorexia, nausea, vomiting, diarrhea, myelo-suppuression

Question 23

NIS of Mitomycin C (Mutamycin)?

Answer 23

Anorexia, nausea, vomiting, diarrhea, mucositis, myelo-suppuression

Question 24

NIS of Oxaliplatin (Eloxitan)

Answer 24

Nausea, vomiting, myelo-suppuression

Question 25

NIS of Paclitaxel (Taxol, Abraxane)

Answer 25

Nausea, vomiting, Mucositis, myelo-suppuression

Question 26

What are common side effects of radiation to the pancreas?

Answer 26

Anorexia, diarrhea, fatigue, nausea/vomiting, weight loss

Question 27

What are popular Alternative or Integrative therapies for pancreatic cancer?

Answer 27

Tumeric/cucumin, Fish oil, Gonzalez regimen

Question 28

What is PEI?

Answer 28

Pancreatic exocrine insufficiency

Question 29

What are some of the symptoms of PEI?

Answer 29

Abdominal bloating, cramping after meals, excessive gas, fatty stools, frequent stools, foul smelling stools, floating tools, indigestion, loose stools, unexpected weight loss.

Question 30

What is the primary management of malabsorption?

Answer 30

Supplemental pancreatic enzymes.

Question 31

______ can be substituted for other fats if someone is having a hard time tolerating fat.

Answer 31

MCT oil

Question 32

Side effects of MCT oil?

Answer 32

Diarrhea, vomiting, nausea, stomach discomfort, and intestinal gas

Question 33

T/F: MCT oils can be used as a patient’s only source of fat?

Answer 33

False. MCT oils don’t provide essential fatty acids

Question 34

Recommend enzyme doses for meals and snacks.

Answer 34

10,000-40,000 lipsse units per meal and 5,000-25,000 lipase units per snack

Question 35

What is the max dose of pancreatic enzymes?

Answer 35

10,000 lipase units per kg per day (or 2500 lipase units per kg per meal up to 4 meals per day).

Question 36

T/F: for best results, enzymes should be taken throut the meal.

Answer 36

True

Question 37

What should you do if enzymes don’t seem to be working?

Answer 37

Evaluate enzyme compliance, adjust dose and timing, change brand of enzyme, add H2 receptor antagonists or Ppi, assess for bacterial overgrowth

Question 38

What is appropriate fiber dosing for patients with diarrhea?

Answer 38

Medicinal fiber 3.4 g fiber mixed with 2 oz of water, started once a day, taken after a meal, gradually increased as needed up to 4 times a day.

Question 39

Patients with altered taste and severe diarrhea should consider short-term _____ supplementation.

Answer 39

Zinc

Question 40

What are symptoms of gastric outlet or duodenal obstruction?

Answer 40

Nausea, vomiting (often retained food), abdominal distention and pain