1-What test can be used to test Jane’s gastric emptying rate? 2- How do pro-kine
ID: 81633 • Letter: 1
Question
1-What test can be used to test Jane’s gastric emptying rate?
2- How do pro-kinetic medications work?
3- What can affect nutritional status with gastroparesis?
4-What is considered ”normal” gastric emptying time?
5- What foods will Jane want to avoid?
6-What foods lower LES pressure?
7-How can Jane prevent benzoar formation?
8- What are dietary recommendations for Jane’s diabetes and hypertension?
9- What factors could contribute to GERD?
10- List what to monitor in Jane’s follow-up visits
volume, liquids versus solids ycemia, Larger volumes of food MINICAL CASE STUDY abdominal ear-old female who presents with acute onset of epigastric pain associated with and bilious vo tite, and 20-pound kg) unintentional weight loss over the past months. A nutrition consult is requested for assessment of nutritional 3 status and strategies for treating nutritional issues associated with gastroparesis Nutrition Assessment Past medical history is significant for type DM, GERD, gastroparesis hypertension, chronic low back pain, and recent back surgery 3 months ago. Jane was discharged on narcotics, and then was recently hospital ized for similar symptoms that were attributed to diabetic gastroparesis exacerbated by narcotics use Zofran Her medications on admission include insulin rilosec, Reglan lisinopril, Ultram last 3 months to sips of liq Oral intake has gradually decreased over the uids (water, soup, tea), and toast or crackers for the past 2 weeks. Upon further questioning, Jane reports frequent hypoglycemia after meals early satiety, chronic constipation, and often wakes up in the morning feeling full. She has persistent epigastric abdominal pain accompanied by vomiting 72.7 kg (160 lb. BMI Anthropometrics: Ht: 162.5 cm (64 inches); Wit 275 kg/m weight change: 11% change in t: 81.8 kg (180 lbs Usual body weigh 3 months (significant weight loss (NFPE) reveals the follow. Jane's nutrition-focused physical examination ng: evidence of muscle loss, stomach is smaller per patient report but otherwise no visible evidence of fat loss, no upper or lower extremity edema. Tongue is beefy rec and swollen for the past few weeks (glossitis resulting from possible iron, folate, and vitamin B12 deficiency) restricted fat Well in liquid form. Fat should not be caloric in patients who are struggling to meet their daily needs Functional capacity: Little energy or motivation to do anything for past months. Dizzy and lightheaded for past 1 week Laboratory data: Hb A1c (glycosylated level 9.5% thigh blood pressure: 178/95 (high), blood glucose: 293 mg/dl (high Nutrition Diagnostic Statements (PES Statements) Suboptimal oral ntake (P) related to inability to consume sufficient calories (E) as evidenced by report of nausea, vomiting, and persistent abdominal pain (S) Unintended weight loss (P) related to altered Gl function (E) as evidenced by 11% weight loss over past 3 months (S) Nutrition Interventions What would you estimate to be Jane's daily energy and protein require- ments? What would you work out with Jane for timing and size of her meals? 3) Would you recommend a trial of oral nutrition supplements n educating Jane on dietary guidelines for DM and gastroparesis, what would you discuss with her? 5) What concerns would you have related to her use of antiemetics or prokinetic agents 6) Would you recommend any nutritional supplements for Jane? Which nutrients would concern you? Nutrition Monitoring and Evaluation What would you monitor during your followup visits with Jane to ensure that her nutrition goals are being met?Explanation / Answer
1.The test that can be used to test Jane’s gastric emptying rate is the test that, uses radioactive chemicals to measure the speed with which food passes from the stomach and enters the small intestine. This test is called gastric emptying scan.
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