Question

C.B. is a 45 y.o. man with a history of pain  and N/V with eating for 2 months resulting in 10# weight loss.  He is admitted and during admission upper endoscopy indicated a duodenal ulcer.  C.B. was placed on H-2 blocker and instructed on an appropriate diet.  Unfortunately, he continued to experience pain, N/V with eating and weight loss.  He was readmitted one month later for a gastrojejunostomy and instructed on the appropriate diet. At this second admission, C.B. reports he has now lost 20# from his usual weight of 200#. He still has been going to work at his office everyday, but admits he is very tired and often goes to bed once he is home. He is only able to consume small amounts of food at a time. Upon examination, there is not indication of muscle or fat loss; edema or ascites.

Ht:  5'10"    UBW:  200#                        IBW: ??

Wt at first admission:  190#

Wt at second admission:  180#

Labs: Low albumin, high sodium low Hgb and low Hct

1.  Use SGA to determine nutritional status C.B.’s at his second admission.

2.  Describe the diet that C.B. should have been instructed on prior to first discharge.

3.  Draw a gastrojejunostomy.

4.  State the type of diet and the restrictions of the diet after the gastrojejunostomy.

5.  State the nutrients that may be malabsorbed due to the gastrojejunostomy and the complications related to this surgery.

Answer 1

1.Nutritional status of CB

SGA​​​​ Is gold standard for assessing malnutrition and identifying those who will benefit from nutritional care.

assessment involves:

. history of recent food intake

.weight loss

.GIT symptoms

. clinical evaluation

On the basis of assessment patients nutritional status can be categorised into following categories:

A:well nourished

B:moderately malnourished/suspected malnourishment

C:severe malnourishment

on the basis of above information CB can be categorised as category B

2.Diet for CB after first discharge:

.Foods rich in probiotics like yoghurt,kimchi,miso,kombucha should be taken.

.Fiber rich food like apples,pears,oats as they decrease acid production.

. food rich in vitamin A like sweet potatoes ,carrots , cantaloupe,beef as it helps in shrinking of stomach ulcer

.Food rich in vitamin C like bell pepper, strawberry,kiwi, broccoli as it promotes healing.

.Avoid milk , alcohol, fatty foods, spicy foods,citrus fruits and caffeine.

3.Draw gastrojejunostomy:
Juke Jefmum stomach Duodenum Gastro je punostomy
Diet and Diet restrictions after gastrojejunostomy:

.Eat and drink slowly

.chew Google thoroughly

.Drink liquid in between the meals

.Take small meals ,start with liquid first n slowly shift to semisolids n then solid foods.

.The lean protein rich foods.

.Avoid fatty foods