1-What test can be used to test Jane’s gastric emptying rate? 2- How do pro-kine

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

CLINICAL CASE STUDY Jane is a 42-year-old female who presents with acute onset of epiga pain associated with nausea and bilious vomiting, po appe- e, and 20-pound (9-kg) unintentional weight loss over the past 3 months. A nutrition consult is requested for assessment of nutritional and strategies for treating nutritional issues associated with status gastroparesis Nutrition Assessment past medical history is significant for type l 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 Her medications on admission include insulin, Zofran, Prilosec, Reglan lisinopril, Ultram Oral intake has gradually decreased over the last 3 months to sips of liq uids (water, soup, tea, and toast or crackers for the past 2 weeks. Upon urther 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); Wt: 72.7 kg (160 lb); BMI 275 kg/m weight change: 11% change in Usual body weight: 81.8 kg (180 lbs 3 months (significant weight loss) Jane's nutrition-focused physical examination (NFPE) reveals the follow- ing: No evidence of muscle loss; stomach is smaller per patient report but otherwise no visible evidence of fat loss; no upper or lower extremity ema Tongue is beefy red and swollen for the past few weeks (glossitis sulting from possible iron, folate, and vitamin B12 deficiency) Functional capacity: Little energy or motivation to do anything for 3 months. Dizzy and lightheaded for past 1 week Laboratory data: Hb A1C (glycosylated hemoglobin) level: 9.5% blood pressure: 178/95 (high), blood glucose: 293 mg/dl (high) Nutrition Diagnostic Statements (PES Statements) Suboptimal ora ntake (P) related to inability to consume suf calories (E) as evidenced by report of nausea, vomiting, and pers abdominal pain (S) Unintended weight loss (P) related to altered Gl function (E) as evi by 11% Weight loss over past 3 months (S) Nutrition Interventions What would you estimate to be Jane's daily energy and protein ments 2) What would you work out with Jane for timing and size of her m 3) Would you recommend a trial of oral nutrition supplements? 4) In educating Jane on dietary guidelines for DM and gastropares would you discuss with her? 5) What concerns would you have related to her use of antiem prokinetic agents 6) Would you recommend any nutritional supplements for Jane nutrients would concern you? Nutrition Monitoring and Evaluation 1) What would you monitor during your followup visits with Jane that her nutrition goals are being met

Explanation / Answer

1. The solid and/or liquid component of the food is mixed with a little amount of radioactive material. To test the radioactivity of the ingested food, a scanner is placed over the stomach for several hours. The instrument measures the rate at which radioactivity leaves the stomach. This reflects the rate of passage of food from the stomach. This test is effective when medications interfering with the emptying of the stomach are withheld prior to carrying out the test. Controlling blood sugar levels is necessary for the accuracy of the results of the test.

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