Quiz 13

Q1. Which one of the following diets is suitable for a patient with ileal resection (80 cm) and fecal fat excretion of 12 gm/day?

1. Elemental diet
2. Cholestyramine & low fat diet with medium chain triglycerides
3. Cholestyramine & Short chain fatty acids
4. Micellar emulsion
5. Total parenteral nutrition and H2 blocking agents

The answer is choice 2.(Cholestyramine & low fat diet with medium chain triglycerides) The key fact here is that less than 100 cm has been resected. Cholestyramine is uncontroversially the right choice for this question. If this were given as a choice alone, it would be the best choice as the initial step. This is because the diarrhea in such cases is due to bile salts. Cholestyramine sequesters them and prevents the diarrhea. Low fat diet too  is a wise adjunct, as is medium chain triglycerides.

Q2. Which one of the following diets is useful in a patient with extensive ileal resection during the first 6 months post-op ?

1. Elemental diet
2. Total parenteral nutrition
3. Short chain fatty acids
4. Mercaptan free diet
5. Micellar emulsion given orally

The answer is choice 2.(Total parenteral nutrition) The buzz word in this question is "EXTENSIVE". A question like this was there in the boards that I took. TPN is very useful in the initial stages post-op. Diet should be gradually introduced to rehabilitate the gut. Elemental diet was believed to be an option for patients with inflammatory bowel disease. Short chain fatty acids and mercaptans are chemicals related to hepatic encephalopathy. Mercaptans are also responsible for the mousy odor in liver failure.