Chapter 14-Nutritional Management Of The Surgical Oncology Patient

Question 1

The primary function of the small bowel is

Answer 1

Nutrient absorption

Question 2

The primary function of the first section of the small bowel the duodenum is

Answer 2

Macronutrient absorption utilizing pancreatic and bile secretions

Question 3

What can occur when the second portion of the small bowel, the jejunum is resected or loses portions of the jejunum?

Answer 3

Loss of portions of the jejunum can result in inappropriate secretion of digestive enzymes and accelerate gastric emptying

Question 4

What can occur when a significant resection of the lower jejunum and ileum occurs?

Answer 4

This can reduce Intestinal absorption and may result in short bowel syndrome.

Short bowel syndrome is usually defined as having less than 30% of normal intestinal length or about 200 cm in adults and 75 cm in children

Question 5

Gastric acid in a small bowel stimulates the release of __________ to neutralize the acid thereby protecting the function of pancreatic enzymes and bile acid

Answer 5

Bicarbonate

Question 6

The presence of undigested food in the colon can cause bacteria to ferment and produce lactic acid. What can this cause? And how is this situation managed?

Answer 6

Metabolic acidosis

It is managed with refined carbohydrate restriction, antibiotics and probiotics.

Question 7

What is the primary digestive function of the colon

Answer 7

Fluid resorption and electrolyte absorption

Question 8

Partial and total resections of the colon have an impact on fluid and electrolyte balances. How long does it take the colon to adapt?

Answer 8

At a minimum a temporary impact or it could take 2 years or longer

Question 9

Bacterial overgrowth of the terminal ileum following ileocecal valve resection can reduce_________ absorption and result in the need for supplementation

Answer 9

Vitamin B12

Question 10

Cancer patients with an ileostomy are at increased risk for________ and ______. There is an increased need for _________ and ___________

Answer 10

Dehydration and electrolyte abnormalities

Sodium and water

Question 11

Cancer patients with an ileostomy s.hould consume more water than their ostomy. How much water should they consume?

Answer 11

They should consume at least one more liter of fluid than their ostomy output

Question 12

What is the main function of the pancreas?

Answer 12

Production of bicarbonate and pancreatic enzymes, which are important or macronutrient digestion

Question 13

What is the main role of the liver?

Answer 13

Nutrient metabolism

Question 14

After intestinal surgery, what are the most common side effects?

Answer 14

Nausea, abdominal cramping and diarrhea

Question 15

After intestinal surgery how long should one follow a diet to avoid the side effects after surgery?

Answer 15

Four to six weeks

Question 16

What are the general diet recommendations for the first four to six weeks after intestinal surgery?

Answer 16

1) eat small frequent meals, 5 to 6 per day
2) chew Foods well
3) choose a high-protein food at each meal or snack
4) avoid high fiber foods both insoluble and soluble fiber
NO RAW vegetable, fruits, seeds or whole grains
5) limit foods high in soluble fiber, some white grains, rice , COOKED VEGETABLES ,CAN FRUITS, applesauce and bananas are okay
6) limit TOTAL fiber to less than 20 grams per day
Cereals with 3 grams of fiber or less are okay
Breads pastas and potatoes with 2 grams of fiber are less are okay
Lean tender meat, eggs, low-fat Dairy, non carbonated beverages are ok

Question 17

Enteral tube feeding provided for how many days prior to surgery can reduce morbidity and mortality in malnourished surgical patients by preserving bowel mucosa and modulating the immune response

Answer 17

10 days prior to surgery

Question 18

The benefits of enteral nutrition patients with malnutrition usually outweigh the risks of access related complications situations. Except in these are three situations.

Answer 18

Ascites (excess abdominal fluid)
Peritoneal carcinomatosis
Inoperable bowel obstruction

Question 19

According to Aspen nutrition support is indicated only for more than how many days unless the patient is malnourished

Answer 19

7 to 10 days

Question 20

How soon following major abdominal surgery does the small bowel gain function?

Answer 20

Almost immediately

Question 21

How soon do patients after intestinal resection resume oral intake

Answer 21

6 to 9 days post-operative

Question 22

After operations in GI patients who are severely malnourished and you need prolonged enteral intake where should they be fed?

Answer 22

Jujunal feedings are recommended

Question 23

Your patience nutritional support is initiated how long should this support continue

Answer 23

Until patient needs 2/3 or 3/4 of their nutrition and 1000 mL of fluid for 3 consecutive days

Question 24

How quickly should a patient receiving surgery to the small intestine start being fed again?

Answer 24

Even in the absence of peristalsis and dysmotility they can be fed within 24 hours post-operatively

Question 25

In esophageal surgery the resection of the VAGUS NERVE can cause the patient to experience what?

Answer 25

Reduce the ability to experience satiety

Cause early satiety

Question 26

What connects the esophagus to the stomach?

Answer 26

The lower esophageal sphincter

This picture prevents stomach acid and digestive enzymes from refluxing back up into the esophagus

Removal of the Les can promote acid reflux an occurs in 58% of the patients who undergo an esophagectomy

Question 27

What connects the stomach to the duodenum?

Answer 27

The pyloric sphincter

The disruption of the pyloric sphincter, which often occurs with a gastro jejunostomy, results in reflux of bile from the small bowel into the stomach and even into the esophagus

This is difficult to manage because unlike stomach acid there are no drugs to neutralize this

Question 28

Disruption of the pyloric sphincter and gastrojejunostomy may lead to________.

Answer 28

Dumping syndrome

Question 29

____________ refers to a decrease or a stop in the production of gastric acid

Answer 29

Achlorhydria

Question 30

________ may allow bacterial and fungal overgrowth which can cause pain when eating and lead to suboptimal intake

Answer 30

Achlorhydria

Question 31

The acidic environment of the stomach along with the production of _____ assists in the release of the vitamin B12 from food and facilitates the absorption in the in the terminal ileum

Answer 31

Intrinsic factor (IF)

Question 32

What type of surgery can cause the loss of the intrinsic factor

Answer 32

Proximal gastric resection

Question 33

What type of nutritional deficiency can occur as early as one year after a total gastrectomy

Answer 33

A B12 deficiency

Question 34

A protein restriction of 0.8 is recommended for liver disease when what is present?

Answer 34

Mental status change

Question 35

Hypoalbuminemia in the setting of liver disease and or liver surgery can result in malabsorption due to what?

Answer 35

Edema of the bowel wall

Question 36

A patient has had surgery of the small bowel and has had the pyloric valve removed
They are experiencing diarrhea, bloating, nausea and tachycardia immediately or about 30 minutes after meals. What issue could they be experiencing? And what nutrition intervention would you suggest?

Answer 36

EARLY DUMPING SYNDROME- high sugar foods pull more water into the intestine to dilute the sugars, causing dumping

Small frequent meals
Separation of solids and fluids and meals, separate fluids 45 minutes before eating or one hour after eating
Reduction in simple carbohydrates + concentrated fat and high sugar foods
Avoid high fiber foods with 3 grams of fiber or more

Question 37

The patient has had surgery on the small bowel and it has had the pyloric valve removed

Side effects include hypoglycemia, and dizziness at least 90 to 180 minutes after meals. What could be the issue with this patient? And what would be the nutritional intervention you would suggest?

Answer 37

LATE DUMPING SYNDROME
A lot of sugar being released into the bloodstream can cause blood sugar to quickly rise hypoglycemia

Small frequent meals
Separation of solids and fluids and meals 45 minutes before or 1 hour after meals
Reduce simple carbohydrates + concentrated fat and high sugar foods and juices
Avoid high fiber foods with 3 grams of fiber or more
With LATE DUMPING eat protein fat and soluble fiber sources with each meal these may slow the rate that sugar is absorbed into the blood. Do not eat more than three servings of grain, juice or fruit in one meal

Question 38

How long should an anti-dumping diet be followed after a digestive tract surgery?

Answer 38

Usually 6 to 8 weeks

Question 39

What are the general guidelines for following a ANTI-DUMPING DIET whether it be an early dumping syndrome or a late dumping syndrome?

Answer 39

For 6 to 8 weeks the general guidelines include:
Eat six small meals a day
Eat slowly and relax
Don’t mix food and fluid for 45 minutes to an hour
Lie down for 15 minutes after eating
Choose low fiber foods. No raw fruits and vegetables
Protein at each meal and snack
Avoid high sugar foods and fluids
Artificial sweeteners are okay
Limit fruit to half a cup cooked or canned at a meal