Gastrointestinal Assessment Part 2

Gastrointestinal Upper and Lower Assessment (Part 2)

• This lecture covers clinical nutrition assessment and intervention for gastrointestinal issues.
• Focuses on esophageal surgery and gastric surgery.

Esophageal Surgery

• Esophagectomy: Primarily performed for esophageal cancer.
• Purpose: To create a conduit for food transportation from the throat to the remainder of the GI tract.
• Method: May involve gastric pull-up.
• Common Presentations: Dysphagia, decreased appetite, weight loss, and treatment side effects.
• Pre-operative Management: Often involves placement of an enteral feeding tube before or during surgery to maintain adequate nutritional intake.
• Pre-operative Nutritional Management (MNT): May require modifications to texture/consistency for dysphagia or odynophagia. Additional oral nutrition supplements or smoothies could help. Tube feeding may be necessary.
• Post-operative Nutritional Management(MNT): Small, frequent meals (~6 times per day), moist items as tolerated, sauces to moisten food, eat slowly, limit liquids with meals, energy dense supplements, avoidance of concentrated sweets in some cases. Small frequent meals may still be a necessary component after the ability to transition to a normal diet is achieved.

Gastric Surgery

• Subtotal Gastrectomy: Removal of a portion of the stomach.
• Total Gastrectomy: Removal of the entire stomach.
• Reasons for Removal: Certain malignancies (affecting the middle/upper stomach).
• Reconstruction Methods: Gastroduodenostomy (Billroth I), Gastrojejunostomy (Billroth II), Roux-en-Y configuration (gastrojejunostomy).

Gastric Anatomy

• Diagrams are present of the stomach, illustrating the fundus, cardia, body, pylorus, and antrum.

Gastric Surgery Complications-Related Nutrition

• Vagotomy: Impairs motor function of the stomach and may lead to gastric stasis and impaired gastric emptying.
• Total Gastrectomy: Associated risks include early satiety, nausea/vomiting, weight loss, and inadequate bile acids and pancreatic enzymes in the initial post-op period.
• Subtotal Gastrectomy with Vagotomy: Associated risks include early satiety and delayed gastric emptying.
• Impaired Nutrient Absorption: Potential for reduced nutrient absorption and malnutrition.

Dumping Syndrome

• Description: Common complication after gastric surgery.
• Causes: Rapid emptying of hypertonic contents into the small intestine.
• Stages: Early (within 10-30 minutes post-prandially) and late (1-3 hours post-prandially). Symptoms frequently vary, but generally include diarrhea, abdominal pain, cramping, bloating, nausea, vomiting, dizziness, hypotension, tachycardia, weakness, headache, and flushing.

Gastrectomy MNT

• Emphasis: Small frequent meals, avoid simple carbohydrates and sweets, and focus on complex carbohydrates, and include protein-rich foods.
• Additional Notes: Limit liquids with meals, allow adequate time between liquids and solids, and consume soft, bland foods immediately following the surgery.

Bariatric Surgery

• Types: Roux-en-Y gastric bypass (RYGB) and Biliopancreatic diversion (BPD).

Bariatric Surgery MNT

• Diet Progression: Starts with sugar-free, decaffeinated clear liquids, gradually progresses to full liquids, then purees, and finally, soft/regular foods, and this is often done in stages due to patient needs.

Bariatric Surgery MNT – Supplements and Deficiencies

• Emphasis: Protein supplements, vitamin/mineral supplements, and additional supplements as needed or per facility protocol during the initial stages following surgery are essential .
• Deficiencies: Thiamine, Vitamin B12, Folate, Iron, Zinc, Calcium, and Copper are frequently monitored.

Bowel Resection

• Type: Duodenal Resection, Jejunal Resection, Ileal Resestion, Colon Resection, and others.
• Purpose: The reason for the resection is important for nutritional care and management.
• Complications: Include nutrient malabsorption and deficiencies, and complications due to the extent of the surgical procedure.

Bowel Resection- MNT

• Focus: Monitoring nutrient deficiencies and providing high quality nutritional support to maintain overall health

Enhanced Recovery After Surgery (ERAS)

• Focus: Minimizing time in the hospital.
• Strategies: includes measures like early carbohydrate loading, early hydration, and early re-introduction of nutrition.

Intestinal Ostomy

• Types: Ileostomy, and Colostomy
• Key points and concerns: Type and location of ostomy, and specific nutritional considerations are crucial.
• Considerations: The amount and type of ostomy output, the adequacy of nutrition, and the potential for electrolyte imbalance.

Short Bowel Syndrome

• Causes: Results from extensive intestinal resection.
• Consequences: Problems range from dehydration, electrolyte imbalance, to the lack of nutrient absorption, along with reduced gut microbiome, and increased frequency of medical complications.
• Management Strategy: Optimize nutritional intake and prevent/treat related complications.

This quiz focuses on clinical nutrition assessments and interventions related to gastrointestinal issues, specifically esophageal and gastric surgeries. It covers critical topics like esophagectomy, pre-operative management, and post-operative nutritional care for patients. Test your knowledge on the nutritional challenges faced during these surgical procedures.