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Cystic fibrosis exocrine effects and EER calculation guide

A five-part CF assignment: list the digestive effects in pancreas, liver, and large intestine, extract Miriam's dietary regimen from her case, compute an EER with the given formula, reflect on treatment, and optionally analyze caregiver coping.

Aug 12, 2026

Editorial process

Last reviewed · August 12, 2026

Written by

Aaron Bishop

MA, Education

assignment interpretation and research-methods coaching across disciplines

Reviewed by

Dr. Nathan Cole

PhD, Rhetoric & Composition

Argumentation and thesis development

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Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

How does one exocrine defect produce three organ pictures?

Item one names three organs, so answer it in three parts rather than as a general account of cystic fibrosis, and let the exocrine mechanism do the organizing. The shared cause is defective chloride transport producing thick, obstructive secretions in ducted glands, and each organ shows that mechanism differently. In the pancreas, blocked ducts cause enzyme insufficiency, so fats, proteins, and fat-soluble vitamins go unabsorbed — the direct reason the calorie requirement in item three runs so high — with pancreatitis and CF-related diabetes as later consequences. In the liver, obstructed bile ducts drive focal biliary changes that can progress to cirrhosis and portal hypertension in a minority of patients. In the large intestine, thickened contents cause distal intestinal obstruction syndrome and constipation, with meconium ileus as the newborn presentation. Answering in that structure also sets up item three, because the pancreatic insufficiency you describe here is precisely what makes the energy calculation that follows a clinical question rather than an arithmetic exercise.

Item two asks specifically what dietary regimen Miriam follows, so this is an extraction task rather than a recommendation task. Read the case for what the family actually does — the pancreatic enzyme replacement taken with meals and snacks, the high-calorie and high-fat pattern that reverses the usual healthy-eating advice, the fat-soluble vitamin supplementation, added salt, and any supplements or overnight feeding the narrative mentions — and report those, keeping your own suggestions out of the answer entirely. The case's texture is worth using: the weight-gain difficulty from birth, the thirty minutes of physiotherapy before school, and the family's daily routine all explain why the regimen looks the way it does. Keeping recommendations out of this answer matters more than it sounds: the question is testing whether you can read a case for what it reports, and graders notice immediately when a student slides from description into advice.

Item three is arithmetic and the marks are in doing it carefully. Convert first — 62 pounds is about 28.1 kilograms and 51 inches is about 1.30 metres — then apply the given girls' equation with the low-active factor of 1.13, showing the substitution so a checker can follow it. Part b is the conceptual half: knowing CF requires roughly two to four times the usual intake does not tell you where in that range to start, so the initial level comes from nutritional status, growth trajectory, degree of malabsorption, and disease severity, then gets titrated against measured response. Part c wants concrete advice — enzyme timing with every fat-containing meal, energy-dense and fortified foods, high-protein choices, supplements between meals, and salt replacement. Show every step of the substitution, including the unit conversions, because partial credit on a calculation question depends entirely on the working being visible rather than on the final number being right.

Likely learning objectives

Inferred from the brief — check these against your own rubric.

01
Organize item one by organ, tracing each effect back to obstructed exocrine secretions.
02
Extract Miriam's actual regimen from the case rather than recommending one.
03
Convert units correctly and show the EER substitution with the low-active PA factor.
04
Explain that the initial calorie level comes from nutritional status and growth response, not from the multiplier alone.
05
Give concrete patient advice on enzymes, energy density, protein, supplements, and salt.

Assignment instructionsQuoted verbatim

Read the full question

Review every instruction before using the planning guidance that follows.

The text mentions that CF affects all the exocrine functions in the body as well as lung complications, and can lead to death during the adult years. Using the cystic fibrosis foundation website ( www.cff.org (Links to an external site.)Links to an external site. ), list the major effects on the digestive alterations in the pancreas, liver and large intestine in those with CF. 2. Read the following case study and write what the dietary regimen Miriam follows. MIRIAM – A Cystic Fibrosis Case Study My niece, Miriam, was born in April 1996. At 6 pounds 12 ounces, she had difficulty putting weight on after she was born. In fact at one point it dropped to 6 pounds. After a spell in hospital in December 1996, when she was suffering from bronchitis, it was thought that she had asthma but my sister-in-law was already beginning to suspect that Miriam had Cystic Fibrosis. There was no other explanation of the symptoms which Miriam had. Eventually, Miriam was given a “sweat test” and it was confirmed that she had Cystic Fibrosis. Both Tim & Sue are carriers – which is how they unknowingly passed on the faulty CF gene to Miriam. No sooner had Miriam’s CF been diagnosed, shortly before she was one year old, than the medical support swung into action. The family had meetings with all members of the CF team – a doctor, a nurse, a social worker, a physiotherapist and a dietitian. Miriam is now approaching five years old. Before she goes to school in the morning, she has around 30 minutes of inhalers and physiotherapy. With every meal she has to eat a number of “Creons”, mixed in with her food, which help her to digest her food. She has to eat a high fat and high calorie diet. In the evening, she has another 40 minutes of inhalers, physiotherapy and nebulizers. She then has to take a variety of antibiotics, fluoride and vitamins. Not surprisingly, all these medications have side effects – Miriam can be fairly hyperactive, she is always hot, and it takes her a long time to get to sleep each night. Every nine weeks, Miriam is taken to the CF clinic. When Miriam has a particularly bad infection, it is necessary for her to go into hospital to receive a course of intra-venous antibiotics. The threat of infection is an ever-constant danger. To counter the risk of cross-infection, there are individual cubicles in the CF clinic and strict hygiene standards apply. Miriam cannot play or mix with other children with CF. Inevitably all this has a major impact on the family. Every time they go on holiday – however short – all the drugs and equipment need to be taken with them. If they go out for the day, or when they are on holiday, Miriam’s daily routine of physio each morning and evening have to be fitted in – meaning no early starts, and no stopping out late. (adapted from http://people.exeter.ac.uk/ajohnson/miriam.htm) (Links to an external site.)Links to an external site. (Links to an external site.)Links to an external site. 3. Using the information from Chapter 13 and the formula provided below, complete the question a-c. Table: DRIs for Energy for Children (Available at: http://books.nap.edu/openbook.php? record_id=10490&page=107 (Links to an external site.)Links to an external site. ) EER for Girls 9 Through 18 Years EER = 135.3 – (30.8 ´ age [y]) + PA ´ (10.0 ´ weight [kg] + 934 ´ height [m]) + 25 kcal CF affects all the exocrine functions DQ PA = 1.00 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary)* PA = 1.13 if PAL is estimated to be ≥ 1.4 < 1.6 (low active) PA = 1.26 if PAL is estimated to be ≥ 1.6 < 1.9 (active) PA = 1.42 if PAL is estimated to be ≥ 1.9 < 2.5 (very active) a. Calculate the estimated nutritional requirements for a 10-year-old female with cystic fibrosis who weighs 62 pounds and is 51 inches tall and is considered low active. b. The estimated calorie requirement for an individual with cystic fibrosis is two to four times the usual recommendation. How would one know the appropriate calorie level to recommend initially? c. Research the nutrition recommendations for cystic fibrosis ( https://www.cff.org/Living-with-CF/Treatments-and-Therapies/Nutrition (Links to an external site.)Links to an external site. or https://medlineplus.gov/ency/article/002437.htm (Links to an external site.)Links to an external site. ) that can assist an individual with meeting her high calorie and protein requirements. What advice could you provide to a patient? 4. What have you learned about treatment for CF? 5. (Optional, one extra credit point) Read the paper, “ Caregiver Coping, Mental Health and Child Problem Behaviours in Cystic Fibrosis: A Cross-Sectional Study,” review the documentJane Sheehan, Int.J. Behav. Med. (2014) 21:211–220. The thesis of the paper is that the caregiver coping strategies is related to the health of the CF child. a. Complete the table below defining the characteristics noted in the paper of a proactive or adaptive coping strategy and an avoidant or passive coping strategy.

Turn the brief into deliverables

01
Digestive effects in pancreas, liver, and large intestine, sourced from the CF Foundation.
02
Miriam's dietary regimen as described in the case.
03
The EER calculation with working, the initial-level reasoning, and practical patient advice.
04
A reflection on CF treatment, plus the optional coping-strategy table.

How should the calculation and advice be handled?

Three organs, one mechanism

Trace obstructed exocrine secretions into pancreatic enzyme insufficiency and malabsorption, hepatobiliary obstruction and its progression, and large-bowel obstruction syndromes.

Miriam's regimen, as described

Extract the enzymes with meals, high-calorie high-fat pattern, fat-soluble vitamins, added salt, and any supplementation the case reports, using the case's own details.

The EER calculation

Convert 62 pounds and 51 inches to metric, substitute into the girls' equation with PA = 1.13, and show the arithmetic; then explain how the starting calorie level is actually chosen and titrated.

Advice, treatment, and coping

Give practical high-calorie and high-protein strategies with enzyme timing and salt, reflect on what CF treatment involves, and complete the optional coping table from the paper.

Where are the CF and nutrition sources?

Recommended databases

NCBI Bookshelf / StatPearls
MedlinePlus
Cystic Fibrosis Foundation

Search sequence

1.
Use the CF Foundation material the assignment names for the organ-by-organ digestive effects.
2.
Re-read the Miriam case and list only what the family actually does.
3.
Check the CF nutrition guidance for the enzyme, energy, protein, and salt advice in part c.
4.
Do the conversions and substitution carefully, then write the reflection and optional table.

Reference shortlist

These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.

Nothing here is cleared for citation until you have read it.

01
Cystic Fibrosis
StatPearls, NCBI Bookshelf · 2023
The pathophysiology spine — defective chloride transport and its organ-by-organ consequences in pancreas, hepatobiliary system, and intestine.
02
Cystic Fibrosis
MedlinePlus, U.S. National Library of Medicine · 2024
The clinical and treatment overview supporting the regimen extraction and the treatment reflection in item four.
03
Cystic fibrosis - nutritional considerations
MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine · 2024
The nutrition source the assignment itself names — enzyme replacement, high-calorie and high-protein strategies, vitamins, and salt — for part c's patient advice.

Review before submission

Common mistakes

Writing a general CF overview instead of answering organ by organ.
Recommending a diet in item two when the question asks what Miriam actually follows.
Using pounds and inches directly in a formula that requires kilograms and metres.
Applying the wrong PA factor — low active is 1.13, not the sedentary or active value.
Answering part b with the two-to-four-times multiplier, which is the premise rather than the answer.
Filling the optional coping table with generic definitions instead of the paper's own characteristics.

Submission checklist

Pancreas, liver, and large intestine each addressed with mechanism.
Miriam's regimen reported from the case, without added recommendations.
Units converted; EER substitution shown; PA = 1.13 used.
Initial calorie level explained via status, malabsorption, and growth response.
Patient advice concrete on enzymes, energy density, protein, and salt.
Treatment reflection included; optional table drawn from the named paper.

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