CHOLELITHIASIS
▸The formation of gallstones (calculi) in the absence of infection of the
gallbladder is called cholelithiasis.
▸ Acute cholecystitis is inflammation of the gallbladder that develops
over hours, usually because a gallstone obstructs the cystic duct.
▸Acute cholecystitis develops in 1-3% of patients with symptomatic gall
stones.
ACUTE CHOLECYSTITIS
▸Obstruction of the cystic duct causes an
inflammatory process to start. This results
in acute cholecystitis.
▸If the inflammation persists it may cause
perforation or gangrene of the gall
bladder.
▸90% of cases of acute cholecystitis
result from obstruction of the cystic duct
by gall stones.
▸Obstruction of the cystic duct causes the
intraluminal pressure within the gall
bladder to increase and, together with
cholesterol supersaturated bile, triggers
an acute inflammatory response.
SYMPTOMS
• Severe pain in upper right abdomen
• Pain that radiates from the right shoulder or back
• Tenderness over the abdomen when touched
• Nausea
• Vomiting
• Fever
RISK FACTORS
Dietary factors: high caloric diets, high refined carbohydrate diets, low-fibre
diets
Dyslipidemia: hypertriglyceridemia
Hormonal factors: pregnancy, contraceptive pills, oestrogen
replacement therapy
Life style factors: sedentary life style, rapid weight loss
MANAGEMENT
Laparoscopic cholecystectomy – a
type of keyhole surgery where the
gallbladder is removed using special
surgical instruments inserted through
a number of small cuts (incisions) in
your abdomen
Open cholecystectomy – where the
gallbladder is removed through a
single larger incision in the abdomen
POST-CHOLECYSTECTOMY SYNDROME (PCS)
▸May occur when abdominal symptoms develop after surgery.
▸Prevalence of PCS has been reported from 5% to 40% of people following
cholecystectomy.
▸ Symptoms may include upset stomach, nausea, vomiting, gas, bloating,
diarrhea, or persistent pain in the upper right abdomen.
▸In addition, patients may experience symptoms of gastritis secondary to
duodenogastric reflux of bile acids.
▸The reflux may also be responsible for symptoms in the
postcholecystectomy syndrome.
▸In a recent article by yueh and colleagues, other issues noted were
indigestion, fatty food intolerance, and heartburn.
PATIENT PROFILE
▸Name: abc
▸Age: 47 Years
▸Gender: Female
▸Community: Hindu / Gujarati
▸Economic Status: Higher Socio Economic Group
▸Food Preference: Vegetarian
▸No of family members : 6
▸Date of admission: 14.12.2016
▸Date of discharge: 18.12.2016
▸Length of hospital stay: 5 days
▸SGA Score : A
ANTHROPOMETRIC MEASUREMENTS
MEASUREMENTS VALUES
Height 156cms
Weight 56kgs
5 kgs overweight
Body mass index (BMI) 23kg/m2
Ideal Body Weight (IBW) 51 kgs
TESTS RESULTS REFERENCE RANGE
14.12.2016 15.12.2016 16.12.2016
Hemoglobin 12.1g/dL 12g/dL 12g/dL 12.5-16g/dL
Sodium 138.00mmol/L 139mmol/L 138mmol/L 137-145 mmol/L
Potassium 4.30 mmol/L 4.3mmol/L 4mmol/L 3.5-5.1 mmol/L
Chloride 100.00 mmol/L 103mmol/L 101mmol/L 98-107 mmol/L
Serum Creatinine 0.70 mg/dl 0.7mg/dl 0.7mg/dl 0.7-1.2 mg/dl
Blood Sugar Random 143mg/dL - - 65-165 mg/dl
AST/SGOT 23.00 U/L 24U/L 22U/L 15-46 U/L
ALT/SGPT 36.00U/L 37U/L 35U/L 13-69 U/L
Bilirubin Total 0.79 mg/dl 0.80mg/dl 0.77mg/dl 0.2-1.3 mg/dl
Bilirubin Unconjugated 0.65mg/dl 0.66mg/dl 0.62mg/dl 0-1 mg/dl
Bilirubin Conjugated 0.00mg/dl 0.00mg/dl 0.00mg/dl 0-0.3 mg/dl
Bilirubin Delta 0.14mg/dl 0.14mg/dl 0.15mg/dl 0-0.2 mg/dl
Alkaline Phosphate 76.00U/L 78U/L 75U/L 38-126U/L
Total Proteins 7.18gm/dl 7.17gm/dl 7.19gm/dl 6.3-8.2 gm/dl
Albumin 3.98g/dl 3.99g/dl 3.98g/dl 3.5-5 g/dl
Globulin 3.20g/dl 3.18g/dl 3.21g/dl 2.4-3.5 g/dl
Albumin Globulin Ratio 1.25 1.25 1.23 1.1-2.2
Amylase 64.00 - - 30-110
Lipase 54.00 - - 23-300
Medication
Dosage
Mechanism of action
Side effects
Inj paracip 1g Treatment of headache, toothache, ear pain, joint
pain, periods pain, fever and other conditions.
Feeling of sickness
Skin reddening
Allergic reactions
Shortness of
Ing fortwin 30mg Works in the brain and nervous system to decrease pain. Feel of faint
Skin rash or itchy skin
Fainting
Ing amikacin 750 mg Is an antibiotic used for A number of bacterial infections. Agitation
Black, tarry stools
Bloody or cloudy urine
Inj. Magnex forte 1.5gm Treatment of urinary tract infection, bacterial infections,
surgical infections, bacterial infection of the respiratory
tract, peritonitis
Diarrhea
Rash
Decrease in white blood cells
Decrease in
Inj. Emset 4 mg Treatment of nausea and vomiting Uneven heartbeats, headache,
low blood pressure leading to
fainting or dizziness,
Inj. Dynapar 75 Mg Treatment Of Joint Pain, Lower Back
Pain, Sprains, Bone Fractures, Inflammation
Of Joints, Pain Due To Skeletal Muscle And
Other Conditions.
Fluid Retention
Abnormal Liver Function Tests
Stomach Ulcers Or Bleeding
Spinning Sensation
Inj Pan 40 Mg Pan 40 Mg Injection Is Used In The
Treatment Of Acidity, Heartburn, Intestinal
Ulcers And Stomach Ulcers
Nausea, Headache, Abdominal
Pain, Constipation, Diarrhoea,
Flatulence
Inj Perfalgan 100 ml Sos For Pain Perfalgan Is Indicated For The Short-term
Treatment Of Moderate Pain, Especially
Following Surgery And For The Short-term
Treatment Of Fever
Pain And Burning Sensation At
Injection Site.
General Feeling Of Being
Unwell (Malaise).
CLINICAL PRESENTATION
Present Complaints:
•Pain in the right hypochrondrium radiating to back since 1 month which
increased from past few days
•Mild tenderness on right hypochondriam
•2-3 episodes of vomiting since afternoon
CT Scan - Mild Fatty Liver
Calculi In Gall Bladder Of 1.6 Cm And 1.7 Cm
Another Calculus Of 1.1 Cm
Gall Bladder Thickness 4.4 Cm
Gall Bladder Edematous
Thin Rim Of Pericholecystic Fluid Noted
Stone Obstructing The Hartmann’s Pouch
Final Medical Diagnosis: Acute Cholecystisis
Surgery performed:Laproscopic Cholecystectomy
Meal Ingredient Amounts
energy
(kcals) CHO (g) Protein(g) Fat (g) Na (mgs) K(mgs) Fe (mg) TDFf(g) IDFg) SDFg)
BREAKFAST
Cornflakes Cornflakes 30 gms 99 22.6 1.7 0.3 4.6 0.7
Milk Milk 100 ml 66 4 3.3 4 73 160 0.2
Sugar 10gms 40 10
MID MORNING
Thepla
Wheat
Flour 30gms 100 21 2.5 0.5 6 94.5 1.47 3.75 2.85 0.87
Oil 10 ml 90 10
Tea Milk 50 ml 33 2 1.62 2 36.5 80 0.1
Sugar 5 gms 20 5
LUNCH
Rotli
Wheat
Flour 45gms 150 31.5 3.75 0.75 9 141.75 2.2 5.6 4.2 1.3
Paneer Nu
Sakh Paneer 40 gms 100 2 7 8
Tomato 50 gms 12.5 3 0.5 6.45 73 0.32 0.85 0.6 0.25
Onion 100 gms 40 10 1 4 127 0.6
Rice Rice 30 gms 100 21 2.5 0.5 0.21 1.23 0.96 0.27
Dal Tur Dal 15 gms 50 8.5 3.5 0.25 8.55 331.2 0.81 2.73 2.04 0.69
Fat Oil 15 ml 135 15
Papad 1 no 50 8.5 3.5 0.25 195 0.69 0.18
Pickle 1 tsp 9 5.6 0.68
Meal Ingredient Amounts
energy
(kcals) CHO (g)
Protein(g
) Fat (g) Na (mgs) K(mgs) Fe (mg) TDFf(g) IDFg) SDFg)
MID EVENING
Pudla Besan 30gms 100 17 7 0.5 21.96 216 1.59 4.59 7.56 0.93
Peas 25gms 10 2.5 0.25 2.15 1.8 0.35
Tomato 25gms 6.25 1.5 0.25 3.15 36.5 0.16 0.42 4.8 0.12
Oil 5 ml 45 5
Tea Milk 50 ml 3 2 1.6 2 36.5 80 0.1
Sugar 5 gms 20 5
Fruit Apple 1 ex 50 10 28 75 0.66 3.2 2.3 0.9
DINNER
Dal Dhokli
Wheat
Flour 30 gms 100 21 2.5 0.5 6 94.5 1.47 3.75 2.85 0.87
Dal 15 gms 50 8.5 3.5 0.25 8.55 331.2 0.81 2.73 2.04 0.69
Sugar 5 gms 20 5
Oil 10 ml 90 10
Peanuts 5 gms 33.3 1.1 0.5 2.6
Total 1622.05 228.3 46.47 63.08 442.66 1840.65 15.99 31.88 32 7.24
INTERPRETATION
▸High calorie consumption
▸Fat consumption – 35 % of total calories
▸Cooking oil used at home – groundnut oil
▸Protein consumption- 0.8g/ kg body weight
▸Processed food consumption
▸Refined sugar consumption
MEDICAL NUTRITION THERAPY
ENERGY:
25-30 calories / kg body weight
PROTEIN
Adequacy of protein through the diet is essential to maintain positive nitrogen balance.
0.8g to 1g of protein is recommended.
More than 50% of the protein provided to the patient should be HBV
CARBOHYDRATES
Dietary fiber intake decreased the prevalence of gastroesophageal reflux disease
(GERD), peptic ulcer disease, gallbladder disease, diverticular disease, colorectal cancer,
and hemorrhoids.
High intake of dietary fiber reduced acute intestinal infections and significantly slowed
diarrhea
(Ötles S., Ozgoz S., 2014. Health eff ects of dietary fi ber. Acta Sci. Pol., Technol.
Aliment. 13(2), 191-202)
FAT Fat intake should be limited for several months to allow the liver to
compensate for the gallbladder’s absence, should be introduced gradually,
and excessive amounts at any one meal should be avoided. (Escott-stump s. Nutrition and diagnosisrelated care. 7th ed. Baltimore, MD: lippincott williams &
wilkins; 2012:516-518.)
Patients who have undergone laparoscopic cholecystectomy to follow a
low-fat diet for at least 1 week to reduce the possibility of diarrhea (Diarrhea after laparoscopic cholecystectomy: associated factors and predictors.Yueh TP, chen FY, lin
TE, chuang MT. Asian J surg. 2014 oct;37(4):171-7. Doi: 10.1016/j.Asjsur.2014.01.008. Epub 2014 mar)
Trans-fats and saturated fats have been correlated with the development of
gallstones. A diet high in saturated fat increases the risk for gallstones and
cholecystectomy
VITAMIN C
Vitamin C supplementation is associated with reduced incidence of
gallstones and appears to be protective against the development of
gallstones.
Vitamin C deficiency is associated among the risk factors for gallstones. Walcher, T.et al. (2009). Vitamin C Supplement Use May Protect Against Gallstones: an Observational
Study on Randomly Selected Population. BMC Gastroenterology, 2009, Vol 9., p 74-82
CURCUMIN
An interesting study researched the effects of the spices capsaicin (from
red pepper) and curcumin (from turmeric), and their combination on mice
Both spices are known for their hypolipidemic properties, including
improving lipid profile and had been studied previously for their
antilithogenic potential in mice. The study showed the combination to be
beneficial in both the prevention and regression of cholesterol gallstones. Applied Physiology, Nutrition, and Metabolism, 2011, 36(2): 201-209, 10.1139/h10-102 Malenahalli C.
Shubha, Raghunatha R.L. Reddy, Krishnapura SrinivasanDepartment of Biochemistry and Nutrition,
Central Food Technological Research Institute, CSIR, Mysore 570 020, India.
▸Turmeric (curcumin) improves postoperative pain- and fatigue-related
PROs(patient related outcome )following LC. Agarwal, K.A., Tripathi, C.D., Agarwal, B.B. et al. Surg Endosc (2011) 25: 3805. doi:10.1007/s00464-
011-1793-z
CASE PROGRESSION
Day 1 NBM For Surgery, Post Surgery Clear Liquids Were
Started
Day 2 Full Liquids + Soft Diet
Day 3 Soft Diet
Day 4 Soft Diet
Day 5 Full Diet – Discharge
GOALS FOR MEDICAL NUTRITION THERAPY
▸To provide early recovery from the surgery
▸To prevent and reduce the symptoms of post cholecystectomy syndrome
(PCS)
▸To decrease the incidence of gastroesophageal reflux seen
after cholecystectomy.
▸To further reduce the risk of gall stone formation
▸To treat and prevent nutritional deficiency
▸To improve and maintain quality of life
NUTRITIONAL CALCULATION
Full liquids + soft diet and Soft Diet
▸Energy -1400 kcals (25 calories / kg present body wt)
▸Proteins -56 gms (1 g /kg present body wt)
▸Fat -31 gms (20% of total calories)
▸Carbohydrate- 896 gms (64% of total calories)
▸MCT
▸Dietary fiber
Menu Amounts
Energy
(Kcals) CHO(g) Protein (g) Fat (g) Na (mg) K (mg) Fe (mg) TDF(g) IDF(g) SDF (g)
BREAKFAST
Milk Milk 100 ml 29 4.6 2.5 0.1 73 160 0.2
Sugar 5g 20 5
SMP 15g 50 7.65 5.7 0.21
Upma Rawa 30gms 100 21 2.5 0.5 6.3 24.9 0.48
Peas 25gms 10 2.5 0.25 2.15 1.8 0.35
Onion 25gms 10 2.5 0.25 4 127 0.6
Oil 5 gms 45 5
MID MORNING
St apple puree Apple 1 no 50 10 28 75 0.66 3.2 2.3 0.7
Porridge Milk 100ml 29 4.6 2.5 0.1 73 160 0.2
Oats 30gms 100 21 2.5 0.5
Sugar 5 gms 20 5
SMP 15gms 50 7.65 5.7 0.21
LUNCH
Fat free soup
Tomato
soup 50 gms
Rice Rice 30 100 21 2.5 0.5 0.21 1.23 0.96 0.27
Saute french
beans
Boil french
beans 30gms 7.5 1.5 1.29 36
Butter 5 gms 35 5
Boil dal
Dal
(moong) 30gms 100 17 7 0.5 8.16 345 1.17 2.46 1.95 0.51
Butttermilk Curd 50gms 14.75 2.3 1.25 0.25 36.5 80 0.1
Menu Amounts
Energy
(Kcals) CHO(g) Protein (g) Fat (g) Na (mg) K (mg) Fe (mg) TDF(g) IDF(g) SDF (g)
TEA TIME
Banana Milk
Shake Banana
1/2ex/ 25
gms 25 5 18.3 44 1.6 0.55 0.35
Milk 100 ml 29 4.6 2.5 0.1 73 160 0.2
Sugar 5gms 20 5
Smp 15gms 50 7.65 5.7 0.21
Evening
Bread Bread 40gms 100 21 2.5 0.5 8 216 0.88 5 3.84 1.16
Butter Butter 10gms 70 10
DINNER
Fat Free
Khichdi Rice 15gms 50 10.5 2.5 0.5 0.1 0.61 0.48 0.13
Dal (Moong) 15gms 50 8.5 3.5 0.5 4.08 172.5 0.58 1.23 0.97 0.25
Curd Curd 100gms 29 4.6 2.5 0.1 73 160 0.2
Fat Free Mash
Potato Potatoes 50gms 50 12 0.5 8.25 185.2 0.36 1.27 0.51 0.24
Dudhi Bhaji Dudhi 50gms 12.5 1.5 1.2 38.1 0.18 0.75 0.51 0.24
Tomato 50 gms 12.5 1.5 3.87 43.8 0.19 0.5 0.36 0.15
Oil 5gms 45 5
Plain Custard Milk 100ml 29 4.6 2.5 0.1 73 140 0.2
Sugar 5 gms 20 5
BEDTIME
Fruit Watermelon ½ ex 50 10 13.65 80 3.95 0.3 0.15 5.5
Total 1424kcal 237.7g 55g 29g 513mg 2320mg 11.4mg 21.16g 15.29g 10.3g
Menu Ingredients Amounts
Energy(kc
al) CHO (g) Protein (g) fFat(g) Na [mgs] K [mgs] Fe [mgs] TDF [gms] IDF[gms] SDF[gms]
Calcium
[mgs]
BREAKFAST
Milk Milk 150ml 43.5 6.9 3.75 0.15 109.5 210 0.3 180
Smp 15gms 50 7.65 5.7 0.21 205.5
Sugar 5gms 20 5
Poha
Rice
Flakes 30gms 100 21 2.5 0.5 3.27 46.2 6 6
Tomato 30gms 12 2.5 0.3 3.87 43.8 0.192 0.51 0.36 0.15 14.4
Onion 30gms 12 2.5 0.3 1.2 38.1 0.18 0.75 0.51 0.24 14.07
Oil 5 gms 45 5
Fruit Banana 1 ex 50 10 18.3 44 0.18 0.9 0.55 0.35 8.5
MID MORNING
Porridge Milk 100ml 29 4.6 2.5 0.1 73 140 0.2 120
Oats 30gms 100 22 5 3 1.2 1.3 1.28 1.88
Sugar 5 gms 20 5
Smp 15 gms 50 7.65 5.7 0.21 205.5
LUNCH
Fat Free
Soup
Tomato
Soup 50 gms 12.5 1.5 1.935 21.9 0.096 0.255 0.18 0.075 7.2
Soft Rice Rice 30 gms 100 21 2.5 0.5 0.21 1.23 0.96 0.27
Curd Curd 100 gms 29 4.6 2.5 0.5 32 130 0.2 149
Dal Dal 30 gms 100 17 7 0.5 8.55 331.2 0.81 2.73 2.04 0.69 21.9
Saute Mix
Veg Chop
Boiled
Cauliflowe
r 30 gms 7.5 1.5 0.3 15.9 41.4 0.369 1.11 0.78 0.33 9.9
Boiled
Carrot 30 gms 12 2.5 0.3 10.68 32.4 0.309 1.32 0.9 0.42 24
Boiled
Beans 30 gms 12 2.5 0.3 1.29 36 0.183 15
Butter 10 gms 70 10
Menu Ingredients Amounts
Energy(kc
al) CHO (g) Protein (g) fFat(g) Na [mgs] K [mgs] Fe [mgs] TDF [gms] IDF[gms] SDF[gms]
Calcium
[mgs]
TEA TIME
Fruit
Muskmelo
n 1 ex 50 10 104.6 341 1.4 0.8 0.5 0.3 32
Evening
Threptin
Biscuits Biscuits 2 no 44 48 3 1.4
Milk Milk 100 ml 29 4.6 2.5 0.1 73 140 0.2 120
DINNER
Fat Free
Khichdi Rice 15 gms 50 10.5 1.25 0.25 0.1 0.61 0.48 0.13
Dal 15gms 50 8.5 3.5 0.25 4.275 165.6 0.405 1.365 1.02 0.345 10.95
Curd Curd 100 gms 29 4.6 2.5 0.1 32 130 0.2 149
Aloo Bhaji Potato 75 gms 75 18 0.75 8.25 185.25 0.36 1.275 0.825 0.45 7.5
Onion 30gms 10 12 2.5 0.3
Oil 5 gms 45 5
Saute
Doodhi
Saute
Doodhi 30gms 7.5 1.8 0.3 1.2 38.1 0.18 0.75 0.51 0.24 14.07
Butter 5 gms 35 5 0.54 26.1 0.138 0.6 0.51 0.09 6
Plain
Custard Milk 100 ml 29 4.6 2.5 0.1 73 140 0.2 120
Sugar 5 gms 20 5
BED TIME
Fruit
Watermelo
n 100 gms 50 10 0 0 27.3 160 7.9 0.6 0.3 0.3 11
TOTAL 1398 283 54.95 30.25 603.66 2441.05 21.932 16.105 11.705 6.26 1451.49
COMPLIANCE
Case progression Compliance
Day 1 NBM For Surgery, Post Surgery Clear Liquids
Were Started
Day 2 Full Liquids + Soft Diet Energy 86 %
Protein 96%
Day 3 Soft Diet Energy 88%
Protein 97%
Day 4 Soft Diet Energy 90%
Protein 98%
Day 5 Full Diet – Discharge
NUTRITIONAL CALCULATION
Full Diet
▸Energy -1400 kcals (25 calories / kg present body wt)
▸Proteins -56 gms (1 g /kg present body wt)
▸Fat -31 gms (20% of total calories)
▸Carbohydrate- 896 gms (64% of total calories)
▸Dietary fiber
▸Iron
▸Calcium
EXCHANGE LIST
Food group No of
exchanges
Amounts
[gms/ml]
Calories
[Kcals]
CHO
[gms]
Proteins[gms] Fats [gms]
Cereal 4 120 gms 400 84 10 2
Pulse 1 ½ 45 gms 150 42.5 10.5 0.75
Milk
[skimmed]
2 ½ 350 ml 116.6 14 11.6 -
Skim Milk
Powder
1 30 gms 100 15.3 11.4 -
Oats 1 30 gms 100 22 5 3
Veg A 1 ½ 100 gms 50 9 1.5 -
Veg B 1 ½ 150 gms 60 15 1.5 -
Veg C 1 100 gms 100 24 1 -
Fruits 2 2 ex 100 20 - -
Sugar 10 gms 10 gms 40 9.6 - -
Oil 2 ½ 25 ml 225 25
Total 1441kcals 255.4gms 53gms 31gms
65% 15% 20%
Menu Ingredients Amounts
Energy(
kcals) CHO(g)
Protein
(g) Fat (g)
Calcium
[mgs] Fe[mgs] Na [mgs] K [mgs]
TDF
[gms] IDF [gms] SDF[gms]
BREAKFAST
Oats
Porridge Oats 30 gms 100 22 5 3 1.2 1.3 3.11 1.28 1.88
Milk 100 ml 33.3 4 3.33 120 0.2 73 140
Sugar 5 gms 20 4.8
Smp 15 gms 50 7.65 5.7 205.5 0.21
Fruit Banana 50 gms 50 10 8.5 0.18 18.3 44 0.9 0.55 0.35
MID MORNING
Yogurt Curd 100 gms 33.3 4 3.33 149 0.2 32 130
Pomogranat
e 25 gms 16.2 3.62 2.5 0.4475 0.225 33.25 0.7 0.575 0.125
Lunch
Rotli Wheat Flour 45 gms 150 31.5 3.75 0.75 4.5 0.21 0.27 0.96
Dudhi Nu
Sakh
100 gms 25 6 1 4.5 6 1.8 87 2 0.28
Oil 5 ml 45 5
Salad
Sweet
Potato Salad 100gms 100 24
46 0.21 9 393 3.9 2.6 1.3
Oil 5 ml 45 5
TEA TIME
Pudla Moong Dal 15 gms 50 8.5 3.5 0.25 11.25 0.585 4.08 172.5 1.23 0.975 0.255
Mint
Chutney Rice 30 gms 100 21 2.5 0.5 3 0.2 1.22 0.96 0.26
Oil 5 ml 45 5
Menu Ingredients Amounts Energy Cho Protein Fat
Calcium
[mgs] Fe[mgs] Na [mgs] K [mgs]
TDF
[gms] IDF [gms] SDF[gms]
EVENING
Soup
Pumpkin And
Carrot Soup Pumpkin 50 gms 12.5 3 0.5
5 0.22 2.8 69.5
Carrot 50 gms 20 5 0.5 40 0.515 17.8 54 2.2 1.5 0.7
Oil 5 ml 45 5
DINNER
Vegetable
Khichdi Rice 45 gms 150 31.5 3.75 0.75 4.5 0.31 1.84 1.44 0.4
Dal 30 gms 100 17 7 0.5 21.9 0.81 8.55 331.2 2.73 2.04 0.69
Onion 50 gms 20 5 0.5 20 0.6
Peas 25gms 10 2.5 0.5 5 0.375 1.95 19.75 2.15 1.8 0.35
Carrot 25 gms 10 2.5 0.5 20 0.2575 8.9 27 1.1 0.75 0.35
Oil 5 ml 45 5
Raita Curd 100 gms 33.3 4 3.33
149 0.2 32 130
Dill Leaves
BED TIME
Fruit Custard Milk 50 ml 16.65 2 1.66
60 0.1 36.5 70
Apple 50 gms 29.5 6.7 5 0.33 14 37.5 1.6 1.15 0.45
SMP 15 gms 20 4.8
Sugar 5 gms 50 7.65 5.7 0 0 0 0 0 0 0 0
TOTAL 1424.75 238.72 53 30.75 928.65 8.1 273.305 1797.7 26.22 18.26 8.01
MENU ALTERNATIVES PHYTONUTRIENTS
Oats porridge
Fruit
Oats milkshake
Cinnamon powder
Yoghurt Buttermilk
Rotli
Dudhi nu sakh
Sweet potato salad
Bhakri , rice chilla
Methi nu sakh , tamatanu sakh
Yam salad
Turmeric
Pudla
Mint chutney
Dhokla , handva
Coriander chutney
Turmeric
Ginger
Pumpkin and carrot soup Celery soup Garlic
Veg khichdi
Raita
Dal khichdi , dal dhokli
Curd, buttermilk
Turmeric
Pepper
Garlic
Fruit custard Pudding Cinnamon powder
FAT CALCULATION
Amounts SFA MUFA PUFA Omega 6 Omega 3
Rice 75 gms 0.33 0.3 0.38 0.37 0.0075
Wheat 45 gms 0.225 0.13 0.57 0.49 0.07
Potato 100 gms 0.152 0.15 0.14 0.08 0.06
Green Gram 15 gms 0.06 0.0075 0.12 0.09 0.03
Red Gram 30 gms 0.14 0.03 0.33 0.3 0.03
Total 0.907 0.6175 1.54 1.33 0.1975
Coconut Oil 5 ml 4.48 0.39 0.1 0.1
Flaxseed Oil 5 ml 0.25 0.25 2 0.4 1.6
Rice Bran Oil 10 ml 2.21 4.1 3.57 3.43 0.14
Olive Oil 5 ml 0.72 3.72 0.5 0.5
Total 7.66 8.46 6.17 4.43 1.74
Grand Total 8.567 9.0775 7.71 5.76 1.9375
SUPPLEMENTATION
SR. NO NUTRIENT SOURCE NAME COMPOSITION COST PER USE
1. Fiber Fenu G
6g soluble fiber per
sachet
Rs 6.50/- Per use
2. Omega 3 SanofiTriomega (Capsule)
Omega3- 300mg
EPA -180mg
DHA-120mg 4/-
3. Symbiotic INLIFE Prebiotics And
Probiotic Capsules
Lactobacillus
rhamnosus , Bifobact
erium bifidum,
Lactobacillus
acidophillis,
Bifidobacterium
longum,
Sacchromyces
Boulardi,Fructo
Oligosaccharides
(150g)
Rs 8/-
4. Celiin Vitamin C 500mg Vit C
1.5Rs
RECOMMENDATIONS
▸Add foods back into your diet gradually
▸low-fat and smaller portions- avoid high fat foods for the discomfort
which includes :
▸Fried foods , such as farsans
High-fat dairy, such as cheese, ice cream and whole milk
Creamy soups and sauces and gravies
Chocolates
Slowly reintroduce high fiber foods
▸Maintain a journal or a dairy – to record any side effects
OPD FOLLOW UP
▸Patient was tolerating the low fat diet well
▸There were no GI related symptoms which were noted
▸Patient was advised to continue on a low fat diet
▸ No changes in the weight was observed
▸High fiber food list was given to the patient – to gradually increase
and incorporate in the diet
▸Hemoglobin levels were normal