Gastroparesis: A Case Study Questions For Medical Nutrition Therapy

Questions for Medical Nutrition Therapy: A Case Study Approach 5th ed.
Case 8 – Gastroparesis

1. Identify the major physiological controls for gastric emptying.

• Contraction and motility are major controls for gastric emptying involving autocrine, paracrine, and neuronal systems.
• The interstitial cells of Cajal control the smooth muscle activity and the autonomic nervous system relays the message from input for the smooth muscle. o Neuropeptides, hormones and neurotransmitters affect gastric emptying
• Anatomical controls: o Sphincters: esophageal and stomach
 LES, which controls the release of food into the stomach and prevents from reflux
• Nitric oxide and VIP inhibit closure of LES
• Secondary peristalsis occurs if not all
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Williams would most likely be classified in grade 4 for severity meaning that she is very severe o Grade 4 : >50% retention after 4 hours
• Other diagnostic tests for gastroparesis include: Radiopaque markers, Ultrasonography, MRI, single photon emission CT, stable isotope breath tests, swallowed capsule telemetry, antroduodenal manometry, and EGG

4. What are the common signs and symptoms of gastroparesis? Explain how they may lead to nutritional deficits.
• Common signs and symptoms include: Nausea, vomiting, bloating, early satiety, GERD, weight loss, and abdominal pain. Nausea and vomiting can decrease total energy intake and absorption which can lead to nutrient loss. Signs such as bloating, early satiety, and weight loss decreases total oral intake and thus increases risk for a person diagnosed with gastroparesis to have malnutrition and inadequate energy intake.
• Because of these factors and overall decrease in energy intake, there is also a high risk for malnutrition, and vitamin and nutrient deficiency in Fe, Zn, B12, and D
• Can be particularly challenging for diabetes due to impaired glucose absorption and monitoring of carbohydrate intake and preventing
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Identify the most pertinent nutrition problems and corresponding nutrition diagnoses and write at least two PES statements for them.
• Malnutrition r/t decreased appetite, nausea, vomiting, and abdominal pain secondary to diagnosis of gastroparesis aeb reported weight loss of 40 lbs over the previous year.
• Inadequate energy intake r/t symptoms associated with gastroparesis diagnosis aeb 24 hour food recall

12. Determine the appropriate intervention for each nutrition diagnosis.

• Inadequate energy intake
a. Provide basic education and counseling on increasing total energy intake and having patient be able to identify foods that can be included in usual diet to help increase daily caloric intake.
b. Have patient identify foods which are higher in calories, but nutritious and follow the lower fiber, lower fat restrictions
• Inadequate protein intake
• Provide basic education and counseling on increasing total daily protein and have patient identify protein-rich foods (both meat and non-meat protein options) which can be included in her usual diet
a. Provide education on patient’s daily needs for protein (~71 grams daily)
b. Recommend to patient to eat protein foods in smaller amounts throughout the day to help decrease symptoms such as abdominal pain
• Inadequate oral

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