MNT Exam IIIGallbladder-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 juiceCholestasis=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 pregnancyMNT: need stimulation of biliary motility and secretions by enteral feedings if NPOCholelithiasis-the 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 duodenumCholedocholithiasis= 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)MNT-avoid obesity and fasting; follow a low-fat dietCholecystectomy=surgical removal of the gallbladder when gallstones are numerous, large or calcifiedCholecystitis=inflammation of the gallbladder-can be acute or chronic-usually caused by gallstones obstructing the bile ducts-acute cholecystitis may occur in critically ill patients or if the flow of bile is impairedMNT: hold feedings or provide PN; then low-fat diet-chronic cholecystitits is caused by repeated, mild attacks of acute cholecystitits-leads to thickening of the walls of the gallbladder-gallbladder shrinks and loses functional ability-aggravated by high fat dietMNT: -long term low-fat dietCholangitis-inflammation of the bile ducts-sclerosing cholangitis can result in sepsis and liver failure-acute cholangitis-fluidsPancreas=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 carbohydratesTests of Pancreatic Function1. Secretin stimulation test=measure pancreatic secretion (bicarb) in response to secretin stimulation2. Glucose Tolerance Test=assesses endocrine function of the pancreas by measuring insulin response to a glucose load3. 72-hr stool fat test=assesses exocrine function of the pancreas by measuring fat absorption that reflects pancreatic lipase secretionPancreatitis=inflammation of the pancreas-characterized by edema, cellular exudates and fat necrosis-can result in autodigestion, necrosis and hemorrhage of pancreatic tissue-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 steatorrheaRanson’s CriteriaAt admission or diagnosis-age older than 55 yrs-WBC>15000 m-Glucose> 200mL-lactic dehydrogenase > 350 units/L-Aspartate transaminase > 250 units/LDuring 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 mLPancreatitis Risk FactorsAlcohol useSmokingBody weightDietGenetic factorsMedications-may lead to depressed serum Ca levels and hypoalbuminemiaMNT for Pancreatitis-acute pancreatitis-withhold oral feeding; maintain hydration through IV-Chronic -high risk for PRO malnutrition-antioxidant, pancreatic enzymes, MCTs-avoid large meals, high-fat foods and alcohol-glucose intolerance due to pancreatic cell destructionEnteral Nutrition for Severe Acute Pancreatitis-use of the GIT decreases the stress responsePancreatic duodenectomy (whipple procedure)-often used for pancreatic cancer-pancreatic duct reanastomosed to the jejunum-may result in partial or complete pancreatic insufficiencyPancreatic 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, obesityCommon Side EffectsDiarrheaPancreatic exocrine insufficiency due to obstruction of the pancreatic duct (w/surgery)Glucose intolerance, diabetes (w/ surgery)Nausea and/or vomitingLoss of appetite, weight lossTaste changesEarly satietyPain with eatingFatigueConstipationDumping syndrome (w/ surgery)Whipple Procedure=pancreaticduodenectomy-surgical procedure used for pancreatic cancer-removeal 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 insufficiencyKNOW THIS 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 lifeMNT for Pancreatic CancerDiarrhea-limit or avoid lactose, insoluble fiber, sugar alcohols and sweetened beverages-increase soluble fiber and fluidsPancreatic Insufficiency-take pancreatic enzymes with meals and snacksGlucose Intolerance-limit refined CHO and eat CHO with PRO, fiber and fatNausea and Vomiting-eliminate strong odors-dry crackers/toast-avoid overly sweet, greasy or spicy foods-eat room temperature foods-small, frequent meals and snacksPoor appetite-avoid overly sweet, greasy, fried or spicy foods-small, frequent meals and snacks-liquid nutritional supplements-light exerciseEarly satiety-liquids between meals-small frequent meals and snacks-limit high fat or fried foods-limit fiber-limit exerciseConstipation-hot fluids-high fiber if no early satiety-limit gas-forming foods, carbonated beverages, straws and chewing gumPain with eating-avoid high fiber-chew wellTaste changes-rinse mouth often-use plastic utensils-use tart flavorsFatigue-physical activity-use easily prepared foods that are easy to eatDumping syndrome-limit portions-liquids between meals-avoid high sugar foods and beverages-avoid hot liquids-add soluble fiberThe Pulmonary System-major function is gas exchange-provide oxygen and remove carbon dioxide-metabolic functions-help regulate acid-base balance-lungs synthesize