Clinical Nutrition Topic of the Day: Cholecystectomy

In the past 3 days of my clinical nutrition rotation at Monongalia General Hospital, I have come across several cholecystectomy patients. I have been doing some reading on the condition and the medical nutrition therapy that is appropriate for after the procedure.  For those who aren’t sur what a cholecystectomy is, here is some general information. Then I will delve into the MNT a dietitian should know relating to a patient post operative.

What is a cholecystectomy?  The surgical removal of the gallbladder. The gallbladder is not essential and can generally be tolerated by humans.

Where is the gallbladder located? It is pear-shaped organ just below the liver in the upper right side of the abdomen.

What is the function of the gallbladder?  The gallbladder collects and stores the bile that is produced by the liver. By storing bile in the gallbladder, the bile becomes more concentrated and thus more potent.  The gallbladder mainly aids in fat digestion.  When food containing fat enters the GI tract, it stimulated the release of cholecystokinin (CCK).  The release of CCK stimulates the relaxation of the Sphincter of Oddi and opens the common bile duct between the gallbladder and the small intestine.  The gallbladder can then release it’s bile contents into the duodenum (or small intestine) where it emulsifies fat and aids in the digestion of food.

What is the function of bile?  Bile consists mainly of cholesterol, bilirubin (from hemoglobin), and bile salts.  Bile has two main functions. (1) Breaks down fats from the diet so it can be utilized by the body.  Without adequate bile, a deficiency can result in the fat-soluble vitamins (A, D, E, & K).  (2) Bile aids in the removal of toxins that have been filtered out by the liver.

What are the causes for a cholecystectomy?  The gallbladder may be removed for a number of reasons, but typically to treat gallstones.  It may also be caused by:

  • Gallstones in the gallbladder (cholelithiasis)
  • Gallstones in the bile duct (choledocholithiasis)
  • Gallbladder inflammation (cholecystitis)
  • Pancreas inflammation (pancreatitis)

Gallstones are hardened deposits of bile that form in your gallbladder. These stones can create an obstruction into the bile ducts causing abdominal pain and cramping.

What are the risk factors for gallstones?

  • Female gender
  • Family history
  • Pregnancy
  • Older age
  • Obesity
  • Truncal body fat distribution
  • Diabetes
  • Inflammatory Bowel Disease
  • Certain drugs (lipid-lowering medications, oral contraceptives, estrogens)
  • Certain ethnicities (Pima Indians, Scandinavians, Mexican-Americans)
  • Rapid weight loss (i.e. after gastric bypass or severe calorie restriction)
  • Chronic low-grade infections
  • High dietary fat intake over a prolonged period of time

What role does the dietitian play in the treatment after a cholecystectomy?

  • Most patients after a cholecystectomy are not hypermetabolic or catabolic, and can be assessed at standard nutritional requirements for their height, age, and weight.
  • A low-fat nutrition prescription (<30% energy as fat) with a modest protein content may assist in controlling symptoms until surgery to remove the gallstones can occur.
  • Consuming a large amount of fat in one meal can overwhelm the bile needed to be produced by the liver. This can cause bloating, gas, and diarrhea due to undigested fat.
  • Cholecystectomy patients can advance to a regular diet as tolerated.
  • Patients should consume small, frequent meals.
  • Foods NOT recommended: high fat foods, fried foods, foods with strong odors, foods that cause gas.

1-Day Menu Fat-Restricted Diet

Breakfast ½ cup oatmeal with 1 cup skim milk
2 slices whole wheat toast with 1 teaspoon margarine and
2 teaspoons jam
½ cup orange juice
Lunch 1 cup chicken noodle soup
Turkey sandwich: 2 slices whole wheat bread, 2 oz turkey, and 1 teaspoon   mayonnaise 8 baby carrots
1 apple
1 cup skim milk
Evening   Meal 3 oz lean roast beef
1 cup potato
½ cup green beans
1 whole wheat dinner roll with 2 teaspoons margarine
1 orange
½ cup pudding made with skim milk
Snack ½ cup pretzels

Approximate Nutrient Analysis

Calories: 1,600
Protein: 85g (21% of calories)
Carbohydrate: 259g (63% of calories)
Fat: 29g (16% of calories)
Cholesterol: 107mg
Sodium: 2,191mg
Fiber: 25g

Sources:

ADA Nutrition Care Manuel

Krause’s Food & Nutrition Therapy 12th Ed.

http://www.mayoclinic.com/health/Cholecystectomy/my00372

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