Chapter 14: Nutrition Management of the Surgical Oncology Patient Flashcards
Ms. Smith is a 65 year old, 60”, 120#, had a surgical resection of her ileum which result in a permanent ileostomy. Initially, her output was 1L per day which has slowed down. Her labs are Na 153, K 5.0, Creat 0.9. She is now ready to discharge and you are to instruct her on her fluid intake? What is the best recommendation given her ostomy?
Consume at least 1L more fluid than ostomy output
Surgical interventions for gastric cancer can result in reduced gastric acid production. What is a predicted issue from reduced gastric acid?
Bacterial and fungal overgrowth resulting in pain when eating - by achlorhydria
Constipation - by dysmotlity s/p resection
Megaloblastic anemia - caused by inability to activate B12
40 yr old female recently had a significant small bowel resection d/t tumor invasion. She now presents to the hospital with metabolic acidosis as a result of undigested food in the colon. What are your recommendations?
Restrict refined CHO (lactose, fructose and alcohol sugars)
Could also add probiotics, several Lactobacillus strains and antibiotics
PT on tube feedings for 2 months secondary to severe anorexia and post-op dysphagia. She has been undergoing SLP therapy 3 days/week and upgraded to mech soft with thin liquids. Appetite has also improved. RD is working on weaning feedings to improve hunger cues. When should nutrition support be discontinued?
Once pt’s oral intake meets 75% of needs and can drink 1000 ml of fluid for 3 days
Reggie has cancer at the GE junction. Will undergo a partial gastrectomy with removal of the lower esophageal sphincter (LES) and resection of the vagus nerve. What side effects should the RD be prepared to discuss with the patient?
Esophageal Dysmotility
Regurgitation
Reflux
Potential need for enteral nutrition support
**Resection of vagus nerve would reduce pt’s ability to experience early satiety
Patients with an ileostomy are at increased risk for dehydration an electrolyte abnormalities and should consume what?
Fluids at least one liter greater than ostomy output
A pt is experiencing reflux of bile from the small bowel into the stomach s/p gastrojujunostomy. What drugs would our recommend to help neutralize the irritating effect of the bile?
Sadly none - there are no drugs that neutralize the irritating effect of the bile in the esophagus
Bacterial overgrowth in the terminal ileum following ileocecal valve resection can reduce absorption of which vitamin and may require supplementation?
Vitamin B12
A loss of intrinsic factor due to proximal gastric resection may result in Vit B12 malabsorption, which may lead to what condition?
Megaloblastic Anemia
A decreased or cessation of the production of gastric acid that may allow bacterial and fungal overgrowth. This can lead to pain when eating and suboptimal intake. What is this condition?
Achlorhydria
A patient presents to your 6 months s/p partial resection of ileum with recent takedown of ileostomy. 20# wt loss since resection. Currently getting FOLFOX. Has following symptoms:
- diarrhea ~20 after eating
- heartburn after consuming milk/fruit/tomato products
- N/some V, usually within 3 days of treatment and then improves
- sensitivity to cold foods
- occasional dizziness about 2 hours after eating
- fatigue
What symptoms above might be associated with her bowel surgery and have potential long term feeding issues once chemo is completed
Reflux Esophagitis
Dumping Syndrome
What recommendations would you give a patient with a new ileostomy following a bowel resection 2 weeks ago?
eat small/frequent meals
chew foods well
8-10 cups of fluid daily to prevent dehydration
avoid high fiber foods (both insoluble and soluble)
low fat foods for ease of digestion
limited high sugar foods to prevent diarrhea
What surgical areas have the most potential for major derangements in nutrition status?
Head and Neck
GI tract
Abd vasculature
These areas also have associated conditions/symptoms that directly cause or predispose to malnutrition
In a malnourished surgical patient, EN for ____ days prior has been found to reduce morbidity and mortality and preserve bowel mucosa and modulating the immune response
10 days
Studies show that preoperative education on expectations and pain management can reduce _______ and ________, and improve _______
reduce anxiety and pain
improve outcomes
How long does it take for the small bowel to adapt after an intestinal resection?
weeks to months
Early initiation of EN postoperatively promotes many physiologic benefits including _____________, _________ and ________, and reduces ________________.
wound healing, gut function and immunity
hospital length of stay
What are the major implications for nutrition regarding surgery to:
Head and Neck
Compromise the ability to chew/swallow
Possible dependence of EN for life
Side effects from treatment like mucositis
What are the major implications for nutrition regarding surgery to:
Peritoneal
Initial present with abd bloating/cramping, N/D/C, anorexia
Due to proximity, its common for GI resections to occur during the debulking surgery, causing disruption to normal GI function
Peritonitis can cause an ileus or impair gut absorption
What are the major implications for nutrition regarding surgery to:
Esophageal
Preop present with swallowing issues/dysphagia
Dumping is common after surgery, as is reflux, dysmotility of the remaining esophagus and gastric dysmotility (secondary to resection of vagus nerve). Damage to this nerve can cause satiety issues, leading to overfeeding and possibly regurgitation.
30% experience stricture(s) after esophagectomy
What are the major implications for nutrition regarding surgery to:
Stomach
Depends on site…
Removal of LES (lower esophageal sphincter) results in acid reflux.
Disruption of the Pyloric function (lower) causes reflux of bile from small bowel into stomach, dumping syndrome
A decrease in gastric acid can lead to uncontrolled bacterial/fungal growth, causing pain. It also impacts intrinsic factor/B12 absorption
Dysmotility causes early satiety, heartburn, dysphagia, aspiration, and pneumonia
What are the major implications for nutrition regarding surgery to:
Small Bowel
Loss of portions of the jejunum can result in inapprorpiate secretion of digestive enzyimes and accelerate gastric emptying.
Significant resection to lower jejunum and ileum reduces absorption, may result in short bowel syndrome (having less than 30% (200 cm)).
If there is high gastric acid, this won’t get neutralized properly, resulting int deactivating enzymes and deconjugates bile acids, leading to maldigestion/malabsorption
Undigested food in colon can cause metabolic acidosis, bacteria overgrowth, sepsis
What are the major implications for nutrition regarding surgery to:
Colon
It may take 2 years or longer for a colon to restructure/adapt after a surgery
resections to the terminal ileum and colon (ileostomy and/or colostomy) have permanent effects.
Bacteria overgrowth can be a concern, causing several problems
decreased transit time is common
What are the major implications for nutrition regarding surgery to:
Pancreatic
impacts to both exocrine and endocrine functions
exocrine - pancreatic enzymes, bicarbonate production
