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CSO Exam 2018 > Chapter 24: MNT for Pancreatic and Bile Duct Cancer > Flashcards

Chapter 24: MNT for Pancreatic and Bile Duct Cancer Flashcards

1
Q

Pancreatic tumors can either form on either ___ or ____ cells?

A

Exocrine or endocrine

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2
Q

T/F: Exocrine tumors are the most common?

A

True.

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3
Q

Estimated Nutritional needs?

A

25 kcal/kg for resectable preoperative patients and higher in those with advanced disease.

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4
Q

What vitamin should be supplemented in pancreatic cancer?

A

B12

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5
Q

Pancreaticoduodenectomy (PD) is also known as the ___?

A

Whipple

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6
Q

What are NIS of a distal pancreatectomy?

A

Exocrine insufficiency, diabetes

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7
Q

What are NIS of a total pancreatectomy (TP)?

A

Exocrine insufficiency, dumping syndrome, delayed gastric emptying, lactose intolerance, diabetes/IGT

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8
Q

What are NIS of Pylorus preserving whipple?

A

Exocrine insufficiency, delayed gastric emptying, lactose intolerance, diabetes/IGT

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9
Q

What are NIS of a Whipple Procedure?

A

Exocrine insufficiency, dumping syndrome, delayed gastric emptying, lactose intolerance, diabetes/IGT

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10
Q

MNT for delayed gastric emptying?

A

low-fiber, low fat, 6-8 small meals, avoid eating 2-3 hours before sleep, keep head of bed elevated.

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11
Q

MNT for lactose intolerance?

A

limit lactose containing foods, and/or use of lactase supplements with food containing lactose

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12
Q

MNT for Diabetes/IGT?

A

limit refined cho, consume meals and snacks at regular intervals, consume carbohydrate with fat and protein ast tolerated. (may need aggressive insulin management)

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13
Q

The anti-dumping diet is recommended for at least ____ weeks after surgery?

A

Six

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14
Q

What is the preferred kind of formula to use for EN after pancreatic reconstructive surgery?

A

Semi-elemental formula d/t high likelihood of pancreatic exocrine insufficiency.

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15
Q

After pancreatic reconstructive surgery, fat should be limited to ____ grams per day?

A

75

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16
Q

NIS of Capecitabine (Xeloda)?

A

Nausea, vomiting, diarrhea, myelo-suppuression

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17
Q

NIS of Cisplatin (Plainol AQ)?

A

Nausea, vomiting, diarrhea, altered taste, myelo-suppression.

18
Q

NIS of Docetaxel (Taxotere)?

A

Nausea, vomiting, mucositis, myelo-sppuression

19
Q

NIS of Doxorubcin (Adriamycin)?

A

Anorexia, nausea, vomiting, diarrhea, mucositis, myelo-suppuression

20
Q

NIS of Fluorouracil (5-FU)?

A

Nausea, vomiting, diarrhea, mucositis, myelo-suppuression

21
Q

NIS of Gemcitabine (Gemzar)?

A

Nausea, vomiting, diarrhea, mucositis, myelo-suppuression

22
Q

NIS of Irinotecan (Camptosar, CP-11)?

A

Anorexia, nausea, vomiting, diarrhea, myelo-suppuression

23
Q

NIS of Mitomycin C (Mutamycin)?

A

Anorexia, nausea, vomiting, diarrhea, mucositis, myelo-suppuression

24
Q

NIS of Oxaliplatin (Eloxitan)

A

Nausea, vomiting, myelo-suppuression

25
Q

NIS of Paclitaxel (Taxol, Abraxane)

A

Nausea, vomiting, Mucositis, myelo-suppuression

26
Q

What are common side effects of radiation to the pancreas?

A

Anorexia, diarrhea, fatigue, nausea/vomiting, weight loss

27
Q

What are popular Alternative or Integrative therapies for pancreatic cancer?

A

Tumeric/cucumin, Fish oil, Gonzalez regimen

28
Q

What is PEI?

A

Pancreatic exocrine insufficiency

29
Q

What are some of the symptoms of PEI?

A

Abdominal bloating, cramping after meals, excessive gas, fatty stools, frequent stools, foul smelling stools, floating tools, indigestion, loose stools, unexpected weight loss.

30
Q

What is the primary management of malabsorption?

A

Supplemental pancreatic enzymes.

31
Q

______ can be substituted for other fats if someone is having a hard time tolerating fat.

A

MCT oil

32
Q

Side effects of MCT oil?

A

Diarrhea, vomiting, nausea, stomach discomfort, and intestinal gas

33
Q

T/F: MCT oils can be used as a patient’s only source of fat?

A

False. MCT oils don’t provide essential fatty acids

34
Q

Recommend enzyme doses for meals and snacks.

A

10,000-40,000 lipsse units per meal and 5,000-25,000 lipase units per snack

35
Q

What is the max dose of pancreatic enzymes?

A

10,000 lipase units per kg per day (or 2500 lipase units per kg per meal up to 4 meals per day).

36
Q

T/F: for best results, enzymes should be taken throut the meal.

A

True

37
Q

What should you do if enzymes don’t seem to be working?

A

Evaluate enzyme compliance, adjust dose and timing, change brand of enzyme, add H2 receptor antagonists or Ppi, assess for bacterial overgrowth

38
Q

What is appropriate fiber dosing for patients with diarrhea?

A

Medicinal fiber 3.4 g fiber mixed with 2 oz of water, started once a day, taken after a meal, gradually increased as needed up to 4 times a day.

39
Q

Patients with altered taste and severe diarrhea should consider short-term _____ supplementation.

A

Zinc

40
Q

What are symptoms of gastric outlet or duodenal obstruction?

A

Nausea, vomiting (often retained food), abdominal distention and pain

CSO Exam 2018 (32 decks)

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