1-What test can be used to test Jane’s gastric emptying rate? 2- How do pro-kine
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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
Ser volu umes of f NICAL CASE STUDY Jane is a -year-old female who w pain associated with na b acute onset of ous vomit and 20-pound (9 kg) uninte and weight tite hs. A nutrition consult is re oss and strategies for treatin nutritiona status ssues ass Nutrition Assessment Past medical hist is significant for type l DM, GERD, gastr hypertension, chronic low back pain, and recent back surgery 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 Her medications on admission include insulin, Zofran, Prilosec, Reglan, lisinopril, Ultram. intake has gradually decreased over the last 3 months to sps of 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 Anthropometrics: Ht: 162.5 cm (64 inches): 72.7 kg (160 lbl BMI 275 kg/m2 Usual body 3 months (significant weight loss). S nutrition-focused physical examination (NFPE) reveals report ing: No loss, stomach is smaller per patient evidence of muscle loss; no upper or glossits no visible evidence of fat few weeks ema Tongue is beefy red for the past sulting from possible and and B12 iron, folate,Explanation / Answer
1-Gastric emptying rate test is done by Nuclear medicine physicians using radioactive chemicals that measure the speed in which food leaves the stomach.This is called Scintigraphy.
2-Prokinetic drugs increase the LES(lower esophageal sphincter) pressure and enhance Gastric Emptying.
3-Gastroparesis alters nutritional status and can cause Malnutrition and loss of Appetite.
4-Gastric emptying time depends upon type of food,Normal for liquid meal is around 2hrs and 30 minutes and for solid meal is around 4hrs and 30 minutes.
5-Foods to be avoided include Fatty foods and oil, legumes (beans),gluten rich foods, Caffeine and Alcohol.
6-Fatty foods that are rich in oil tend to lower LES pressure.
7-Bezoars can be prevented by avoiding consumption of food that lower Gastric motility and lowers Gastric acidity.
8-Jane should avoid foods that are rich in calorie content and consume more protein and fiber rich foods to control Diabetes.For hypertension Jane should reduce salt intake in food.
9-Factors that contribute to GERD are weak LES, Lifestyle factors like Stress,poor diet and bad sleeping habits and structural factors like Hiatus Hernia.
10-In follow up visits physician should moniter the 24 hr pH of Esophagus, Gastric Emptying time along with complaince of patient in taking medications.
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