MNT Biliary Disorders

Question 1

The function of the gallbladder is to ___, ____, and ____ bile

Answer 1

Concentrate, store, and exctete

Question 2

Bile is made up of…

Answer 2

-Bile salts
-Cholesterol
-Bilirubin
-H2O
-Phospholipids
-Electrolytes

Question 3

What are the functions of the gallbladder?

Answer 3

-Emulsification of fat for digestion
-Formation of micelles to transport fatty acids and fat-soluble vitamins to intestinal brush border for absorption

Question 4

_____ is the formation of stones in the gallbladder

Answer 4

Cholelithiasis

Question 5

Stones in the gallbladder are made up of a precipitation of…

Answer 5

-Cholesterol
-Bilirubin
-Calcium salts

Question 6

Gallstones form when…

Answer 6

-There is an imbalance in the substances that make up bile (too much free cholesterol)
-Inability of the gallbladder to empty properly

Question 7

What are risk factors for Cholelithiasis?

Answer 7

-Female gender
-Older age
-Family history/genetics
-Ethnic background: Native Americans, Scandinavians, Mexican Americans
-Pregnancy
-Diseases: diabetes mellitus, Crohn’s disease, cirrhosis
-Obesity and android fat distribution
-High dietary fat intake over a long period
-Rapid weight loss
-Medications: oral contraceptives, estrogen therapy, gemfibrozil
-Long-term parenteral nutrition

Question 8

_____ is when a gallstone becomes lodged in the common bile duct, causing an obstruction

Answer 8

Choledocholithiasis

Question 9

Signs and symptoms of Choledocholithiasis:

Answer 9

-Cramping pain
-Increased serum bilirubin
-Jaundice

Question 10

What are some possible complications with choledocholithiasis?

Answer 10

-Fat malabsorption
-Cholecystitis
-Liver damage
-Lodged in sphincter of Oddi-> gallstone pancreatitis

Question 11

What are possible treatments of cholelithiasis?

Answer 11

-Cholecystectomy
-Litholytic medications (ex: ursodeoxycholic acid)
-Extracorporeal shock wave lithotripsy
-ERCP (endoscopic retrograde cholangiopancreatography) for stones in the bile duct

Question 12

What can be done for the prevention of cholelithiasis?

Answer 12

-Recommend a diet low in saturated fatty acids and high in fiber
-Weight reduction to achieve desirable body weight (avoid severe fasting, VLCD, and weight cycling)
-Increase physical activity

Question 13

____ is inflammation of the gallbladder and can be acute or chronic

Answer 13

Cholecystitis

Question 14

Cholecystitis can be caused by…

Answer 14

-Choledocholithiasis-> bile backup
-Critical illness
-Cholestasis (reduced or no bile flow)
-Impaired gallbladder emptying

Question 15

What are symptoms of cholecystitis?

Answer 15

-Right upper quadrant pain
-N/V

Question 16

Eating foods high in ____ may aggravate the symptoms of cholecystitis

Answer 16

Fat

Question 17

What is the treatment for cholecystitis?

Answer 17

Cholecystectomy

Question 18

MNT for an acute attack of cholecystitis:

Answer 18

-Initially NPO
-When appropriate, initiate a low-fat diet (30-45 g/day) to decrease gallbladder stimulation

Question 19

After a cholecystectomy, advance to a ____ diet included sources of soluble fiber as tolerated

Answer 19

Regular

Question 20

MNT for chronic cholecystitis:

Answer 20

-Long-term low-fat diet (25-30% of kcal)-> lower in saturated fatty acids
-May need to restrict foods that cause gas