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 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 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 MNT avoid obesity and fasting follow a low fat diet Cholecystectomy surgical removal of the gallbladder when gallstones are numerous large or calcified Cholecystitis 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 impaired MNT 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 diet MNT long term low fat diet Cholangitis inflammation of the bile ducts sclerosing cholangitis can result in sepsis and liver failure acute cholangitis fluids 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 1 Secretin stimulation test 2 Glucose Tolerance Test 3 72 hr stool fat test 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 Pancreatitis 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 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 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 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 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 Common Side Effects Diarrhea Pancreatic exocrine insufficiency due to obstruction of the pancreatic duct w surgery Glucose intolerance diabetes w surgery Nausea and or vomiting Loss of appetite weight loss Taste changes Early satiety Pain with eating Fatigue Constipation Dumping 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 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 MNT for Pancreatic Cancer Diarrhea limit or avoid lactose insoluble fiber sugar alcohols and sweetened beverages increase soluble fiber and fluids Pancreatic Insufficiency take pancreatic enzymes with meals and snacks Glucose Intolerance limit refined CHO and eat CHO with PRO fiber and fat Nausea and Vomiting eliminate strong odors dry crackers toast avoid overly sweet greasy or spicy foods eat room temperature foods small frequent meals and snacks Poor appetite avoid overly sweet greasy fried or spicy foods small frequent meals and snacks liquid nutritional supplements light exercise Early satiety liquids between meals small frequent meals and snacks limit high fat or fried foods limit fiber limit exercise Constipation hot fluids high fiber if no early satiety limit gas forming foods carbonated beverages straws and chewing gum Pain with eating avoid high fiber chew well Taste changes rinse mouth often use plastic utensils use tart flavors Fatigue physical activity use easily prepared foods that are easy to eat Dumping syndrome limit portions liquids between meals avoid high sugar foods and beverages avoid hot liquids add soluble fiber The Pulmonary System major function is gas exchange provide oxygen and remove carbon dioxide metabolic functions help regulate acid base balance lungs synthesize