Gastrointestinal Upper and Lower (Part 2) Fall 2024 PDF

10/30/24 Gastrointestinal Upper and Lower (Part 2) LEC TU RE 10 C LINIC AL NU TRITIO N ASSESSMENT AND INTERV ENTIO N FAL L 2024 1 1 Esophageal Surgery v Esophagecto...

10/30/24 Gastrointestinal Upper and Lower (Part 2) LEC TU RE 10 C LINIC AL NU TRITIO N ASSESSMENT AND INTERV ENTIO N FAL L 2024 1 1 Esophageal Surgery v Esophagectomy o Esophageal cancer primary indication o Requires conduit to transport food § from oropharynx to remainder of GI tract o Gastric pull-up v Patients often present with o Dysphagia o Decreased appetite o Weight loss o Treatment side effects v Placement of enteral feeding tube pre-operatively or intra-operatively often indicated due to challenges to maintain adequate intake 2 2 1  10/30/24 Esophagectomy 3 3 Esophagectomy v Pre-operative MNT o May require textural modification with dysphagia or odynophagia o May benefit from addition of oral nutrition supplements, or smoothies o Tube feeding may be indicated § Persistent inadequate intake, ongoing weight loss § Inability to swallow § Assumes lower GI tract remains functional; otherwise PN v Post-operative MNT o J-tube often placed intra-operatively § Tube feed often indicated until adequate oral intake achieved § Continuous à cyclic § Gradually taper tube feeds as oral intake improves o Diet progression: clear liquids à purees à soft solids à regular diet 4 4 2  10/30/24 Esophagectomy v Post-operative MNT o Small frequent meals, ~6 times per day o Moist tender items, once advanced to soft solids o Sauces and gravies to moisten food o Eat slowly and chew food very well o Limit liquids with meals to