Exam 2 - pancreas & gallbladder

Question 1

What is Cholelithiasis?

Gallbladder disease

Answer 1

• formation of stones within the gallbladder or biliary duct
• caused by: obesity, diabetes, IBD, cystic fibrosis, rapid wegiht loss, very low/high fat diet
• treatment: typical to eventually have a cholecystectomy

Question 2

What is the recommended MNT for Cholelithiasis?

Answer 2

• low fat diet
• small, frequent feedings until surgery
• may need to be nothing by mouth (NPO) to keep gallbladder inactive

Chronic condition:
- low fat (25% kcal and very low SF), primarily plant based
- gradual weight reduction - include exercise
- replace sugar with high fiber foods
- fat soluble vitamins
- moderate alcohol intake

Question 3

What is Cholecystitis?

Answer 3

acute and chronic inflammation of the gallbladder
- usually caused by an obstruction of the cystic duct by gallstones

Question 4

What is the MNT for acute and chronic Cholecystitis?

Answer 4

• Acute: NPOl progress to low fat (30-45 g/d)
• Chronic: low fat diet (25%), plant-based diet

Question 5

What is cholangitis?

Answer 5

inflammation of bile ducts
- Usually 2 degree to obstruction of common bile duct leading to infection

Question 6

What is cholestasis?

Answer 6

no bile secretion or flow of bile is obstructed
- caused by prolonged PN, minimal feeding into gut
- can increase risk of developing stones
- prevention: stimulation of gallbladder with at least trickle enteral feeds

Question 7

What is the recommended MNT after a cholecytectomy (gallbladder surgery)?

Answer 7

• low fat (less than 3 g fat per serving)
• small, frequent meals throughout day
• slowly increase soluble fiber
• easy on caffeine, dairy, sweets (can cause diarrhea)
• fat-soluble vitamins
• we can give water miscible forms of fat-soluble vitamins containing MCT’s

Question 8

What is pancreatitis?

Answer 8

• inflammation of pancreas (acute or chronic)
• chronic pancreatitis is irreversible inflammation that leads to fibrosis, tissue calcification
• loss of endocrine/exocrine function
• etiology (cause): alcoholism, cholelithiasis
• symptoms: upper abdominal pain radiating to back that is worse with food intake, nausea, vomiting, abdominal distention, steatorrhea, hypotension, dehydration (in severe cases)

Question 9

What is the pain felt from pancreatitis caused from?

Answer 9

• pancreatitis is being stimulated when the pancreas is releasing hormones to digest food
• patients have issues with eating during the disease and even after it is resolved

Question 10

Recommended MNT for acute pancreatitis?

Answer 10

• If oral nutrition cannot be initiated in 5-7 days, start tube feeding
• Once oral nutrition is started, provide: Easily digestible foods, low fat diet, 6 small meals, adequate protein, increased calories

Question 11

Recommended MNT for chronic pancreatitis?

Answer 11

• higher risk of PEM
• 25-35 kcals and 1.2-1.5 g/kg protein (NCM)
• Provide oral diet as in acute phase (fat 40-60 grams per day)
• TF can be used when oral diet is inadequate or as a treatment to reduce pain
• Supplement pancreatic enzymes
• Supplement fat-soluble vitamins and vitamin B12
• Some evidence that antioxidants (via f/v) can help alleviate symptoms

Question 12

General MNT rules for pancreatitis

Answer 12

• parenteral nutrition only if complete ileus
• volume of TPN slowly increased to 25 kcals/kg
• lipids 15-30% kcal, protein individualized