A CASE STUDY ON A 58 YEAR

OLD MALE DIAGNOSED WITH

PELVOABDOMINAL COMPLEX
MASS
Adriel Francis P. Sison
PELVOABDOMINAL COMPLEX MASS

PELVOABDOMINAL - DESCRIBES
LOCATION

COMPLEX MASS - composed of

anechoic (cystic) and echogenic
(solid) components(Athanasiou et al.,
2014).

Sengar, & Kulkarni, 2010

PELVOABDOMINAL COMPLEX MASS

Abdominal masses may interact with nutritional status

through the inducement of early satiety via reduced
gastric capacity via :

Mechanical restriction of the stomach similar to

mechanisms involved in gastric bypass
surgery(Cummings et al., 2004).

Which may result in low oral intake and subsequently

malnutrition if unresolved
Sengar, & Kulkarni, 2010
Timeline of events

Reassessment
Provision of
Initial and Counselling Monitoring and Monitoring and
More Detailed
Assessment (through tele) Counselling Counselling
diet plan
Discharged

Surgery &
Start of N
provision

October 17 Nov 1 Nov 3 Nov 4 Nov 10 Nov 20

ASSESSMENT
ANTHROPOMETRICS

HEIGHT 5’5” = 165.1 CM

WEIGHT 57.6 KG
BMI 21.13 (NORMAL HOWEVER
CLASSIFICATION
SUSPECT)
BIOCHEMICAL
Patient Levels Normal Range
(Oct 25)

RBC 4.15 4.5-5.9 LOW

Hemoglobin 109 120-140 LOW

Hematocrit 0.32 0.38-0.48 LOW

Albumin 27 32-46 LOW

Sodium 130.6 136-145 LOW

CLINICAL

WEIGHT LOSS IN THE LAST 6 YES, HOWEVER EXACT AMOUNT

MONTHS LOST IS UNKNOWN

GI SYMPTOMS DROWNING FEELING AFTER

DRINKING OR EATING

SENSATION THAT FOOD/DRINK IS

RISING UP THE ESOPHAGUS
AFTER INGESTION

EARLY SATIETY

FUNCTIONAL ASSESSMENT AMBULATORY*

CONSTIPATION YES. FREQUENCY OF EXCRETION

- ONCE EVERY 3 DAYS
DIETARY

OCTOBER 17 NOVEMBER 1

C P F KCAL C P F KCAL

ACTUAL 120.2 49.4 36.4 1041 131.7 49.6 46.2 1129.6

INTAKE

REC 240 90 50 1750 240 90 50 1750

INTAKE

%ADEQ 50 54.8 72.8 59.5 54.8 55.1 92.4 64.5

DIETARY

1. Avoids tomatoes, eggplants, monggo, and other similar foods due

to self-diagnosed diet-related joint pain.
2. High Chon + EW in the Diet List.
DIAGNOSIS
PESS

INADEQUATE ORAL INTAKE RELATED TO EARLY SATIETY (PROBABLY) DUE TO

ABDOMINAL MASS AS EVIDENCED BY 24 HR RECALLS INDICATING 60-65%
%ADEQUACY(KCAL)
INTERVENTION
 DIET RX

CALCS RATIONALE

KCAL 1750 30 x kgDBW BED REST MULTIPLIER(35) REDUCED BY 5 TO MAKE ADHERENCE MORE REALISTIC
30 X 58.59
= 1757.7 KCAL

C 240 NPC(0.7) LEFTOVER KCALS

90 X 4 = 360
1750 - 360 = 1390 X 1390 X 0.7
973/4
= 243.25 G

P 90 1.6g/kgBW MAY HELP PRESERVE LEAN BODY MASS AT LOW ENERGY INTAKES(HELMS ET AL., 2014)
1.6 X 57.6
92.16 G

F 50 NPC(0.3) LEFTOVER KCALS

90 X 4 = 360
1750 - 360 = 1390
1390X 0.3
417/9
= 46.33 G

500 KCAL FROM +2 SERVINGS ENTRASOL(114G) NO OTHER DISEASE CONDITIONS

AVAILABLE
NUTRITIONAL WITH RELATIVELY HIGHER CALORIC DENSITY(4.34/G)
NUTRITIONAL WITH RELATIVELY HIGHER FIBER CONTENT(0.07/G)
Other dietary interventions

EATING STRATEGIES

1. USE THE LEAST AMOUNT OF WATER NEEDED

WHEN MIXING THE PROVIDED NUTRITIONALS
2. IF CONSUMPTION IN ONE SITTING IS
DIFFICULT, TRY TO TAKE SMALL SIPS
THROUGHOUT THE DAY
3. AVOID ALCOHOL, SMALL FISH, ORGAN MEATS
4. IF UNABLE TO FINISH MEAL, PRIORITIZE
PROTEIN FOODS
MONITORING AND EVALUATION
MONITORING AND EVALUATION

METRIC RATIONALE TARGET

MID-UPPER ARM USUAL METRICS SUCH AS ANY APPRECIABLE

MEASUREMENT WEIGHT AND INCREASE OVER INITIAL
SUBSEQUENTLY BMI ARE MEASUREMENT(6.875
CONFOUNDED BY WEIGHT INCHES OR 17.4625 CM)
OF GROWTH/MASS*

24 HR RECALL PROVIDES RECALL INDICATING

SEMI-OBJECTIVE INFO ON COMPLETE CONSUMPTION
INTAKE OF HOSPITAL RATIONS AND
NUTRITIONAL

DIET HISTORY PROVIDES SUBJECTIVE

INFORMATION THAT MAY
BE USEFUL IN INFORMING
DIET INTERVENTION OR
EVALUATION
MUAC

6.875 INCHES OR 17.4625 CM 7.5 INCHES OR 19.05 CM(8% INCREASE)

NOVEMBER 3 NOVEMBER 10
MUAC STANDARDS(TANG ET AL., 2020)

STANDARD UTILITY LIMITATION

LOW BMI = <24CM MUAC PROVIDES A ROUGH CURRENTLY STILL IN

IDEA OF WHERE THE DEVELOPMENT. NOT AN
PATIENT’S NUTRITIONAL ESTABLISHED STANDARD
STATUS IS AT

MAKES ASSESSMENT OF UNCLEAR WHETHER

IMPROVEMENT OR CUTOFF IS ASSOCIATED
WORSENING POSSIBLE WITH SIMILAR
OUTCOMES AS LOW BMI
24 RECALL(NOV 3)

C P F KCAL

ACTUAL 149.8 48.5 46.2 1257

INTAKE

REC 240 90 50 1750

INTAKE

%ADEQ 62.4 53.9 92.4 71.8

DIET HISTORY

1. INCREASED CONSUMPTION CAPACITY

2. REDUCTION IN SENSATION THAT FOOD/DRINK IS RISING UP THE
ESOPHAGUS AFTER INGESTION
3. HOSPITAL RATION(INCLUDING NUTRITIONAL) IS COMPLETELY
CONSUMED
POST DISCHARGE DIET
INTERVENTION
 DIET RX

CALCS RATIONALE

KCAL 2050 35 x kgDBW INCREASED CAPACITY FOR ORAL INTAKE MAKES INCREASING KCAL PRESCRIPTION POSSIBLE
35 X 58.59
= 2050.65 KCAL

C 250 NPC(0.6) LEFTOVER KCALS

100 X 4 = 400
2050 - 400 = 1650 X 0.6
990/4
= 247.5 G

P 100 1.7g/kgBW FOR UPBUILDING

1.7 X 57.6
97.92 G

F 75 NPC(0.4) HIGHER. TO AID ADHERENCE TO INCREASED TER IN VIRTUE OF HIGHER CALORIC DENSITY.
100 X 4 = 400
2050 - 400 = 1650 X 0.4
660/9
= 73.33 G

AROUND 550 KCAL FROM POWDERED WHOLE MILK (AROUND 550 NO OTHER DISEASE CONDITIONS
KCAL) MEETS PATIENT CAPACITY TO PURCHASE COMPARED TO NUTRITIONALS
POWDERED FORM MAKES KCAL DENSITY MANIPULATION POSSIBLE
Other dietary interventions

REITERATION OF PREVIOUSLY DISCUSSED

EATING STRATEGIES

1. USE THE LEAST AMOUNT OF WATER NEEDED

WHEN MIXING THE MILK
2. IF CONSUMPTION IN ONE SITTING IS
DIFFICULT, TRY TO TAKE SMALL SIPS
THROUGHOUT THE DAY
3. AVOID ALCOHOL, SMALL FISH, ORGAN MEATS
4. IF UNABLE TO FINISH MEAL, PRIORITIZE
PROTEIN FOODS
WHAT I WOULD HAVE CHANGED

1. SHOULD HAVE ENSURED THAT PROTEIN INTAKE WAS MET

a. + BENEPROTEIN TO NUTRITIONALS PROVIDED
APPENDIX
Intervention
Intervention
SAMPLE MENU
RECALL(OCT 17)
RECALL(NOV 1)
RECALL(NOV 3)
WORKS CITED

1. Athanasiou, A., Aubert, E., Salomon, A. V., & Tardivon, A. (2014). Complex cystic breast masses in
ultrasound examination. Diagnostic and interventional imaging, 95(2), 169-179.
2. Sengar, A. R., & Kulkarni, J. N. (2010). Growing teratoma syndrome in a post laparoscopic excision of
ovarian immature teratoma. Journal of Gynecologic Oncology, 21(2), 129-131.
3. Cummings, D. E., Overduin, J., & Foster-Schubert, K. E. (2004). Gastric bypass for obesity: mechanisms of
weight loss and diabetes resolution. The Journal of Clinical Endocrinology & Metabolism, 89(6), 2608-2615.
4. Helms, E. R., Zinn, C., Rowlands, D. S., & Brown, S. R. (2014). A systematic review of dietary protein during
caloric restriction in resistance trained lean athletes: a case for higher intakes. International Journal of
Sport Nutrition & Exercise Metabolism, 24(2).
5. Tang, A. M., Chung, M., Dong, K. R., Bahwere, P., Bose, K., Chakraborty, R., ... & Maalouf-Manasseh, Z. (2020).
Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and
non-pregnant women). Public Health Nutrition, 23(17), 3104-3113.