case study on patients suffering from Cholelithiasis

1. CHOLELITHIASIS

2. Gall bladder
• Gall bladder is a pear shaped hollow organ
located just below the liver in the right
abdomen.
• Functions :
Store & concentrate the bile.
Alteration of bile.
Helps in fat digestion.

3. CHOLELITHIASIS
• Formation of gall stones.

4. Clinical presentation
1. DEMOGRAPHIC DATA
• AGE : 36 Yrs
• D.O.A : 29/04/2019
• D.O.D : 03/05/2019
• NO.OF HOSPITAL DAYS : 5 days
• ROOM NO : 1511

5. Medical History
PAST MEDICAL HISTORY:
• S/P Lower segment caesarean section (LSCS)
in 2012 & 2019 (January).
• S/P Right breast incision and drainage in 2012.

6. PRESENT COMPLAINTS
• P2L2 with H/O of gall stones.
• Case of upper abdominal pain more in right
hypochondrium region.
• One episode of vomitting on 28/04/19.
PROVISIONAL DIAGNOSIS:
• Cholelithiasis with dilated common bile duct

7. LAPAROSCOPIC CHOLECYSTECTOMY
• Surgical procedure to remove gall bladder.
• It is recommended if patients have
1. Cholelithiasis
2. Choledocholithiasis
3. Cholecystitis
4. Pancreatitis

8. Anthropometric Data
• Height : 162 cm
• Weight : 52 Kg
• Body Mass Index : 20 Kg/m2 (WHO)
(BMI) classification : Normal weight (18.5-24.9)
• Ideal Body Weight : 62 Kg ( Broca Index)
(IBW)

9. Blood parameters
PARAMETERS NORMAL VALUE 30/04/19 01/05/19
Haemoglobin 12.5 - 16 % 12. 9 12.6
Platelet 150 - 400 thou/UL 362 306
Bilirubin Total 0.3 – 1.2 mg/dl 1.26 1.01
SGOT 0 - 37 I.U/L 449 129
SGPT < 34.0 I.U/L 446 314
Alkaline
phosphatase
100 - 290 I.U/L 262 226
Total protein 6 - 8 g/dl 8.4 -
Albumin 3.5 - 5.0 g/dl 4.0 3.7
globulin 1.8 - 3.6 g/ dl 4.4 4.3

10. Subjective Assessment Tool (SGA)
• No weight loss - 1
• Sub optimal solid diet - 2
• No GI symptoms - 1
• Functional capacity (none) - 1
• Co- morbidity ( Healthy) - 1
• No decreased fat store or - 1
Subcutaneous loss
• No signs of muscle wasting - 1
SCORE : 8 WELL NOURISHED

11. Nutrient Requirements
• Energy : 1,550 Kcal
• Carbohydrates : 320g
• Protein : 40g
• Fat : 10g

12. Nutritional Review
DATE RECOMMENDED
DIET
ENERGY
(KCAL)
PROTEIN (G)
30/04/19 CLEAR LIQUID
DIET
600
01/05/19 NPO - -
02/05/19 FAT FREE SOFT
DIET
1400 40
03/05/19 FAT FREE SOFT
SOLID DIET
1400 40

13. 1 DAY OF ADMISSION : CLEAR LIQUID DIET
TIMING MENU QUANTITY
ENERGY
(Kcal)
CHO (g) PROTEIN(g) FAT (g)
6 AM
TENDER
COCONUT
WATER
200ml 30.59 6.32 0.52 0.32
8 AM
TROPICANA
APPLE JUICE
200ml 94 22.9 o.4 0
10 AM
VEGETABLE
SOUP
200ml 98 12 4.1 4.4
12 PM RICE KANJI 200ml 142 53.9 5.3 0.4
2 PM CLEAR SOUP 200ml 86 10.6 3.1 0.4
4 PM BLACK TEA 200ml 0 0 0 0
6 PM RICE KANJI 200ml 142 53.9 5.3 0.4
8 PM
TENDER
COCONUT
WATER
200ml 30.59 6.32 0.52 0.32
10 PM
TROPICANA
APPLE JUICE
100%
200ml 140 34 1 0
SUB TOTAL 763kcal 200g 20.24g 6.24g

14. 3Day on Admission: Fat free soft diet
TIMING MENU QUANTITY ENERGY
(Kcal)
CHO(g) PROTEIN(
g)
FAT(g)
EARLY
MORNING
(6 AM)
TENDER
COCNUT
WATER
200 ml
30.59 6.32 0.52 0.32
BREAKFAST
(8AM)
TROPICANA
APPLE JUICE
200 ml
94 22.9 o.4 0
MIDMORNI
G (10 AM)
VEGETABLE
SOUP
150 ml
98 12 4.1 4.4
LUNCH
(1PM)
DAL RICE
BOILED
VEGETABLES
1 cup
1 cup
293
147
48
23.19
13
5.06
5.8
3.88
TEA TIME
(4PM)
MILK 150 ml 109.35 7.41 4.89 6.72
DINNER
(7PM)
IDLY
SAMBAR
4 No.
1 cup
132.09
66.56
27.28
11.09
4.68
3.98
0.34
0.49
SUB TOTAL 971KCAL 158.2g 36.7g 22g

15. 4DAY ON ADMISSION : FAT FREE SOFT SOLID DIET
TIMING MENU QUANTITY ENERGY
(Kcal)
CHO (g) PROTEIN (g) FAT (g)
EARLY
MORNING
(6 AM)
MILK 200 ml 109.35 7.41 4.89 6.72
BREAKFAST
(8AM)
IDLY
SAMBAR
4 No.
1 cup
132.09
66.56
27.28
11.09
4.68
3.98
0.34
0.49
MIDMORNIG
(10 AM)
VEGETABLE
SOUP
BANANA
150 ml
1No.
98
110.66
12
24.95
4.1
1.25
4.4
0.32
LUNCH (1PM) SOFT RICE
SAMBAR
BOILED
VEGETABLE
KOOTU
CURD
1 cup
1 cup
1 cup
1 cup
50 ml
181.63
66.56
147
90.39
30
39.88
11.09
23.19
7.76
1.5
4.05
3.98
5.06
3.29
1.55
0.27
0.49
3.88
4.98
2
TEA TIME
(4PM)
MILK 150 ml 109.35 7.41 4.89 6.72
DINNER (7PM) IDLY
UPMA
SAMBAR
2 No.
1 cup
1 cup
100.39
160.63
66.56
20.74
19.31
11.09
3.56
4.16
3.98
0.26
7.17
0.49

16. SUMMARY
DATE MENU ENERGY
(Kcal)
PROTEIN (g) CHO(g) FAT (g)
30/04/19 CLEAR LIQUID
DIET
763 20.24 200 6.24
02/05/19 FAT FREE SOFT
DIET
971 158.2 36.7 22
03/05/19 FAT FREE SOFT
SOLID DIET
1478 224.7 53.42 38.8

17. RECOMMENDED DIET: FAT FREE SOFT SOLID DIET
TIMING MENU QUANTITY ENERGY
(Kcal)
CHO (g) PROTEIN (g) FAT (g)
EARLY
MORNING
(6 AM)
MILK 200 ml 109.35 7.41 4.89 6.72
BREAKFAST
(8AM)
IDLY
SAMBAR
EGG WHITE
4 No.
1 cup
1 No.
132.09
66.56
17
27.28
11.09
0.2
4.68
3.98
3.6
0.34
0.49
0.1
MIDMORNIG
(10 AM)
VEGETABLE SOUP
BANANA
150 ml
1No.
98
110.66
12
24.95
4.1
1.25
4.4
0.32
LUNCH (1PM) RICE
SAMBAR
BOILED VEGETABLE
KOOTU
1 cup
1 cup
1 cup
1 cup
181.63
66.56
147
90.39
39.88
11.09
23.19
7.76
4.05
3.98
5.06
3.29
0.27
0.49
3.88
4.98
TEA TIME
(4PM)
MILK 150 ml 109.35 7.41 4.89 6.72
DINNER (7PM) CHAPATHI
VEGETABLE
KOORMA
3No.
1 cup
2O4.75
109.47
51.99
11.04
9.35
2.58
2.48
5.98
SUB TOTAL 1506.2Kcal 236g 50g 37.1g

18. SPECIFIC GUIDELINES
• A number of post surgical complication – DIARRHEA due to
bile in large bowel.
• No standard guideline for post cholecystectomy.
• Fat intake is limited
• Use coconut oil – Medium chain Fatty acids
used for energy than stored.
breakdown without bile
• FIBER - Normalize bowel movement
soluble fiber act as sequestering agent
bind with bile to avoid gastritis
• Avoid alcohol, caffeine, citrus foods, chocolate and onion.
• Supplement with choline – absorption of fat & cholesterol
work with bile gas & bloating.