Chapter 24: MNT for Pancreatic and Bile Duct Cancer Flashcards
Pancreatic tumors can either form on either ___ or ____ cells?
Exocrine or endocrine
T/F: Exocrine tumors are the most common?
True.
Estimated Nutritional needs?
25 kcal/kg for resectable preoperative patients and higher in those with advanced disease.
What vitamin should be supplemented in pancreatic cancer?
B12
Pancreaticoduodenectomy (PD) is also known as the ___?
Whipple
What are NIS of a distal pancreatectomy?
Exocrine insufficiency, diabetes
What are NIS of a total pancreatectomy (TP)?
Exocrine insufficiency, dumping syndrome, delayed gastric emptying, lactose intolerance, diabetes/IGT
What are NIS of Pylorus preserving whipple?
Exocrine insufficiency, delayed gastric emptying, lactose intolerance, diabetes/IGT
What are NIS of a Whipple Procedure?
Exocrine insufficiency, dumping syndrome, delayed gastric emptying, lactose intolerance, diabetes/IGT
MNT for delayed gastric emptying?
low-fiber, low fat, 6-8 small meals, avoid eating 2-3 hours before sleep, keep head of bed elevated.
MNT for lactose intolerance?
limit lactose containing foods, and/or use of lactase supplements with food containing lactose
MNT for Diabetes/IGT?
limit refined cho, consume meals and snacks at regular intervals, consume carbohydrate with fat and protein ast tolerated. (may need aggressive insulin management)
The anti-dumping diet is recommended for at least ____ weeks after surgery?
Six
What is the preferred kind of formula to use for EN after pancreatic reconstructive surgery?
Semi-elemental formula d/t high likelihood of pancreatic exocrine insufficiency.
After pancreatic reconstructive surgery, fat should be limited to ____ grams per day?
75
NIS of Capecitabine (Xeloda)?
Nausea, vomiting, diarrhea, myelo-suppuression
NIS of Cisplatin (Plainol AQ)?
Nausea, vomiting, diarrhea, altered taste, myelo-suppression.
NIS of Docetaxel (Taxotere)?
Nausea, vomiting, mucositis, myelo-sppuression
NIS of Doxorubcin (Adriamycin)?
Anorexia, nausea, vomiting, diarrhea, mucositis, myelo-suppuression
NIS of Fluorouracil (5-FU)?
Nausea, vomiting, diarrhea, mucositis, myelo-suppuression
NIS of Gemcitabine (Gemzar)?
Nausea, vomiting, diarrhea, mucositis, myelo-suppuression
NIS of Irinotecan (Camptosar, CP-11)?
Anorexia, nausea, vomiting, diarrhea, myelo-suppuression
NIS of Mitomycin C (Mutamycin)?
Anorexia, nausea, vomiting, diarrhea, mucositis, myelo-suppuression
NIS of Oxaliplatin (Eloxitan)
Nausea, vomiting, myelo-suppuression
NIS of Paclitaxel (Taxol, Abraxane)
Nausea, vomiting, Mucositis, myelo-suppuression
What are common side effects of radiation to the pancreas?
Anorexia, diarrhea, fatigue, nausea/vomiting, weight loss
What are popular Alternative or Integrative therapies for pancreatic cancer?
Tumeric/cucumin, Fish oil, Gonzalez regimen
What is PEI?
Pancreatic exocrine insufficiency
What are some of the symptoms of PEI?
Abdominal bloating, cramping after meals, excessive gas, fatty stools, frequent stools, foul smelling stools, floating tools, indigestion, loose stools, unexpected weight loss.
What is the primary management of malabsorption?
Supplemental pancreatic enzymes.
______ can be substituted for other fats if someone is having a hard time tolerating fat.
MCT oil
Side effects of MCT oil?
Diarrhea, vomiting, nausea, stomach discomfort, and intestinal gas
T/F: MCT oils can be used as a patient’s only source of fat?
False. MCT oils don’t provide essential fatty acids
Recommend enzyme doses for meals and snacks.
10,000-40,000 lipsse units per meal and 5,000-25,000 lipase units per snack
What is the max dose of pancreatic enzymes?
10,000 lipase units per kg per day (or 2500 lipase units per kg per meal up to 4 meals per day).
T/F: for best results, enzymes should be taken throut the meal.
True
What should you do if enzymes don’t seem to be working?
Evaluate enzyme compliance, adjust dose and timing, change brand of enzyme, add H2 receptor antagonists or Ppi, assess for bacterial overgrowth
What is appropriate fiber dosing for patients with diarrhea?
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.
Patients with altered taste and severe diarrhea should consider short-term _____ supplementation.
Zinc
What are symptoms of gastric outlet or duodenal obstruction?
Nausea, vomiting (often retained food), abdominal distention and pain
