MNT Exam III Gallbladder lies underneath the right lobe of the liver Main Function concentrate store and excrete bile that is produced by the liver Bile cholesterol bilirubin and bile salts excreted into the small intestine duodenum with pancreatic juice Cholestasis condition where little or no bile is secreted or the flow of bile into the digestive tract is obstructed Pathophysiology often occurs in patients who are NPO without enteral feedings for a prolonged period genetics intrahepatic cholestasis of pregnancy MNT need stimulation of biliary motility and secretions by enteral feedings if NPO Cholelithiasis formation of gallstones calculi composed of cholesterol bilirubin and calcium salts generally asymptomatic and may pass into the common bile duct and remain there indefinitely or may pass into the duodenum Choledocholithiasis stones slip into the bile ducts and produce obstructions pain and cramps Pathophysiology high fat diet may cause liver to synthesize more bile rapid weight loss obesity insulin resistance and diabetes IBD medications lipid lowering drugs oral contraceptives avoid obesity and fasting follow a low fat diet MNT Cholecystectomy Cholecystitis surgical removal of the gallbladder when gallstones are numerous large or calcified inflammation of the gallbladder acute or chronic usually caused by gallstones obstructing the bile ducts Acute MNT hold feedings or provide PN then low fat diet chronic cholecystitits is caused by repeated mild attacks of acute cholecystitits o leads to thickening of the walls of the gallbladder o gallbladder shrinks and loses functional ability o aggravated by high fat diet Chronic MNT long term low fat diet Cholangitis inflammation of the bile ducts sclerosing cholangitis can result in sepsis and liver failure Pancreas elongated flattened gland that lies in the upper abdomen behind the stomach has endocrine and exocrine functions produces glucagon insulin and somatostatin for absorption into the blood stream endocrine they also secrete enzymes and other substances directly into the intestinal lumen for digesting proteins fats and carbohydrates Tests of Pancreatic Function Secretin stimulation test Glucose Tolerance Test 72 hr stool fat test Pancreatitis measure pancreatic secretion bicarb in response to secretin stimulation assesses endocrine function of the pancreas by measuring insulin response to a glucose load assesses exocrine function of the pancreas by measuring fat absorption that reflects pancreatic lipase secretion inflammation of the pancreas characterized by edema cellular exudates and fat necrosis symptoms may include continuous or intermittent pain of varying intentsity to sever upper abdominal pain that may radiate to the back nausea vomiting abdominal distension and steatorrhea Ranson s Criteria At admission or diagnosis age older than 55 yrs WBC 15000 m Glucose 200mL lactic dehydrogenase 350 units L Aspartate transaminase 250 units L During the Initial 48 hours hematocrit decrease of 10 mg BUN increase of 5 mg Arterial PO2 60 mm Base deficit 4 mEq L Serum Ca 8 mg mL fluid sequestration 6000 mL If the score 3 severe pancreatitis likely If the score 3 severe pancreatitis is unlikely Pancreatitis Risk Factors Alcohol use Smoking Body weight Diet Genetic factors Medications may lead to depressed serum Ca levels and hypoalbuminemia MNT for Pancreatitis acute pancreatitis Chronic withhold oral feeding maintain hydration through IV high risk for PRO malnutrition antioxidant pancreatic enzymes 30 000 units of lipase with each meal MCTs avoid large meals high fat foods and alcohol glucose intolerance due to pancreatic cell destruction Enteral Nutrition for Severe Acute Pancreatitis use of the GIT decreases the stress response Pancreatic duodenectomy whipple procedure A cholecystectomy vagotomy or a partial gastrectomy may also be done often used for pancreatic cancer pancreatic duct reanastomosed to the jejunum may result in partial or complete pancreatic insufficiency Pancreatic Cancer 10th most common cancer and fourth leading cause of cancer related deaths for both men and women 5 year survival rate for 5 10 of patients hard to diagnose early Symptoms weight loss malnutrition and anorexia risk factors chronic pancreatitis diabetes smoking obesity Pancreatic exocrine insufficiency due to obstruction of the pancreatic duct w surgery Common Side Effects Diarrhea 20 000 40 000 units of lipase per meal 10 000 20 000 units of lipase per snack Glucose intolerance diabetes w surgery Follow a carbohydrate controlled diet syndrome w surgery Whipple Procedure pancreaticduodenectomy Nausea and or vomiting loss of appetite weight loss taste changes early satiety dumping surgical procedure used for pancreatic cancer removal of the pancreatic head duodenum gallbladder and bile duct wih or without the gasgtric antrum the pancreatic duct is reanastomosed to the jejunum may be accompanied by a cholecystectomy vagotomy or a partial gastrectomy may cause partial or complete pancreatic insufficiency KNOW THIS http www youtube com watch v lri67wwamx8 MNT for Pancreatic Cancer prevent or reverse poor nutrition maintain dose and schedule of cancer treatments manage symptoms maintain or improve weight and strength maximize quality of life The Pulmonary System major function is gas exchange provide oxygen and remove carbon dioxide nose pharynx larynx trachea bronchi bronchioles alveolar ducts and Alveoli metabolic functions help regulate acid base balance Respiratory acidosis increased blood CO2 concentration lungs convert angiotensin I to angiotensin II by the angiotensin converting enzyme found in the capillary beds of the lungs alveolar cells secrete surfactant which serves to maintain the stability of pulmonary tissue mucus in lungs keeps lungs moist and traps microorganisms and particls Major function is to provide oxygen for cellular metabolism and to remove CO2 that is produced but Understand Gas Exchange not needed http www youtube com watch v HiT621PrrO0 Medical Treatment primary tuberculosis asthma lung cancer secondary when associated with cardiovascular disease obesity HIV etc can be acute or chronic Pulmonary assessment Physical exam using percussion and auscultation Diagnostic and monitoring tests imaging blood gas sputum cultures and biopsies Signs of pulmonary disease cough early satiety anorexia weight loss dyspnea fatigue Pulmonary function tests Spirometry involves breathing into a spirometer that measures lung volume and the