Ch 37 Surgical Alteration of the GI Tract Flashcards
As result of transection of vagus nerve during gastrectomy along w/ increased osmolarity of intestinal contents, patients may experience what?
Watery diarrhea in which an antimotility agent such as loperamide may be helpful
Management of an ECF includes what?
Resuscitation, source control, wound care, and nutrition support
Initially most patients with ECF should be kept NPO and PN may be considered
• For ileostomies, output should be less than waht per 24 hours?
< 1 L per 24 hours
What are some dietary/nutrition considerations for a patient s/p esophagogastrecomy?
Requires patients to limit themselves to softer foods and eat smaller, more frequent meals; many patients will experience inadequate nutrition and require simultaneous jejunostomy tube placement at the time of esophagogastrectomy for prolonged EN
What is the role of immonutrition in elective GI surgery?
Immunonutrition in patients undergoing elective GI surgeries may decrease complications and use is recommended by some surgical societies to improve post op outcomes
Management of delayed gastric emptying after Whipple includes what?
Prokinetic agents together w/ dietary changes (small meals and avoidance of foods that cause constipation or abd pain)
Gastrotomies are mostly done using _____ technique whereas jejunostomies are often done using the _____ technique
Stamm; Witzel
Stammed tubes allow for easier replacement at bedside, and Witzeled tubes allow for greater freedom of movement of the target organ (stomach, jejunum) which can prevent rotation around a fixed point and subsequent obstruction and ischemia
Stamm approach can result in ischemia around gastrostomy/jejunostomy b/c of mucosal compression by intervisceral portion of the tube; Witzel approach can result in visceral narrowing, leading to stenosis or obstruction
Which vitamin deficiencies are common in gastrectomy surgery?
B12, C, and D (due to lack of gastric tissue)
Deficiencies may result in delayed wound healing, anemia, and osteopenia/osteoporosis
what is the treatment for high output ostomies in hemodynamically stable patients?
Fiber supplementation to thicken output and antimotility agents such as loperamide (Immodium) or diphenoxylate/atropine (Lomotil) to decrease GI transit time and increase water absorption
What is considered a high output fistula?
> 500 mL/day
Which deficiencies are common in patients with gastric resections?
B12, folate, iron deficiency is common in patients w/ gastric resections; baseline and periodic monitoring of anemia related lab data are important.
Surgery in form of a total proctocolectomy (removal of entire colon and rectum) offers UC patients what?
Definitive treatment
Inability to achieve good seal around ostomy pouch can result in skin irritation and breakdown. Why is this?
Because of high concentration of active digestive enzymes and acidic pH of ileal contents
More common w/ ileostomies than colostomies
What is the difference between a Chylorhorax and Chylous Ascites?
Chylothorax is presence of chyle (composed of lymphatic fluids and chylomicrons) within pleural space
Chylous ascites is presence of chyle w/in peritoneal cavity
What is the key anatomical difference between a Low Anterior Resection and Abdominoperineal Resection?
Most significant difference between the 2 lies in preservation of anal sphincter complex with LAR with preservation of continence
True or false–a jejunosotmy tube can be used for decompression?
False; Jejunostomy tubes allow for direct feeding of small bowel, but are not used for decompression
What is the role of EN in a surgically “open” abdomen?
EN has been found to be safe and potentially reduce time to definitive abd closure, enterocutaneous fistula rates, and infectious complications
EN can be delivered within the first 24-48 hours following resuscitation through either nasoenteric access or surgically placed access points
What is an enterocutaneous fistula?
Defined as communications between any 2 epithelial surfaces and described with the higher-pressure component listed first
For patients w/ colotis or proctitis after colon resection and proximal diversion of fecal stream, what represents an effective first line treatment?
SCFA enemas
Stomas of small bowel and colonic variety can be constructed in which two variations?
End vs Loop
End ostomy provides complete GI content diversion at level of abd wall w/ no downstream intestinal or colonic continuity or flow
Loop ostomy maintains continuity of GI tract from stomach to anus and diverts most, but not all, GI contents from flowing downstream
Patients with tumors in head of pancreas undergo what type of procedure?
A pancreaticoduodenectomy, referred to as a Whipple procedure; involves resection of head of pancreas, duodenum, and part of the stomach
What should NOT be used to break down a gastric beazor?
Meat tenderizer that contains papain.
Cellulase and cola have been effectively used to help break down the bezoar. Treatment with papain should be avoided because it breaks down normal tissue and is associated with peptic ulcer disease, esophagitis and gastritis. Surgery can also be used.
