Chapter 18: Gastric & esophageal Flashcards
T/F: Squamous cell esophageal cancer is found within the upper 2/3 of the esophagus
True
Adenocarcinoma is the lower 1/3
How is cancer at the GE junction treated?
Like esophageal cancer
______ esophageal cancer is most common in the world and amongst black people in the US
Squamous
Treatment of esophageal & gastric cancers are based on ____________
Resectability
What are the 3 options to create a new esophagus?
Stomach
Small intestine
Large intestine
Is HPV associated more with squamous cell or adenocarcinomas of the esophagus?
Squamous
Adenocarcinoma is mostly obesity & GERD
When does esophagitis typically occur during concurrent chemoRT for esophageal cancer
weeks 3-6
What are 5 MNT tips for esophageal stent?
- Liquids for a couple of days and then very soft/moist foods
- Chewing thoroughly
- Cabonated beverage if food doesn’t pass
- Sitting upright for 30-60 minutes after eating
- Small bites
T/F: Malnutrition has been reported in >75% esophageal cancer patients and toxicities are especially prevalent w/ sarcopenic obesity
True
_______ is the most common symptom of esophageal cancer
Dysphagia
Formula recommendations for j tube feedings post-esophagectomy
Standard. Energy-dense can also be trialed and typically well tolerated
T/F: ERAS is traditionally recommended post-esophagectomy
FALSE
Really the only cancer it’s not recommended with d/t risk for anastomosis leak and aspiration risk . This is the traditional approach but some newer studies are demonstrating safety/benefit
How long should you remain upright post-op esophagectomy before going to bed?
2-3 hours
The removal of ________ during esophagectomy is often the cause of reflux
lower esophageal sphincter
Why do strictures sometime form post-esophagectomy?
Anastomotic complications (leaks & strictures)
In advanced cases of esophageal cancer, post-surgical malabsorptive may be an issue. There is some evidence that _____________ may provide benefit
PERT
4 signs of dumping syndrome
- Bloating
- Abdominal cramping
- Nausea
- Diarrhea
Differences in early versus late dumping syndrome
Early - 10-30 minutes post-prandial. Nausea, vomiting, abdominal cramping, bloating, diarrhea. 75% of cases.
Late - hunger, perspiration, difficulty concentrating
(low BG signs). 1-3 hours post-prandial. 25% cases
7 tips for dumping syndrome
- Limit concentrated sweets
- Avoid lactose foods if needed
- Avoid fried & greasy foods
- Eat foods w/ protein & complex carbs, soluble fiber
- Separate liquids from meals by 30 minutes before or afte
- Eat 5-6 small meals/day
- Chew food until liquified
Gastric cancer is the most prevalent in _________ (country)
Korea (salty foods)
Gastrointestinal stromal cancers (GISTs) occur in the stomach but the most common type of gastric cancer is ___________
Adenocarcinoma
Gastric adenocarcinomas are typically described as ______ or _______, but could have mixed features of both
Intestinal
Diffuse
Define linitis plastica
Rigid/thick stomach wall possibly d/t infiltration by diffuse adenocarcinomas
What is the difference between intestinal and diffuse adenocarinomas of the stomach?
Intestinal - well-differentiated
Diffuse - poorly differentiated
_______ infection is a risk factor for gastric cancer
H. pylori
What are the 3 options for surgical options for stomach cancer
- Distal subtotal gastrectomy - if lesion is not at the cardia/fundus. Billroth one or billroth 2.
- Proximal subtotal gastrectomy (if the cardia is involved). Just cut off the top.
- Total gastrectomy (if it involves the stomach diffiusely or arises int he body and extends to within 6 cm of the cardia
Billroth 1 and billroth 2 are two different types of partial gastrectomy reconstruction techniques - describe the difference
Billroth 1 = distal, removes pylorous and the stomach gets re-attached to the duodenum
(not altered much)
Billroth 2 = also for distal. sparates the duodenum, removes the lower stomach, and reattaches it to the jejunum
What is involved in a total gastrectomy?
The stomach is removed. The esophagus is attached to the jejunum while the duodenum is moved to form a loop and get bile salts/pancreatic enzymes
T/F: Larger remnant stomach post-gastrectomy can reduce symptoms
True
Recommendation for early feeding/ERAS post-gastrecomy
Positive benefit, should be offered food and drink from post-op day 1
Is EN or PN recommended s/p gastrectomy
EN, usually j tube
Role of immunonutrition formulas in gastrectomy patients?
May reduce hospital LOS, postop infections, anastomatic leaks
Palliative care for non-surgical gastric cancer patients may include _______ or ________
Gastric dilation or gastroduodenal stent
Adjuvant chemotherapy for _______ months or more has been identified as the single independent risk factor for postoperative gastric loss of muscle mass
6
7 potential side effects post gastrectomy
- small gastric remnant AKA early satiety syndrome
- Gastric stasis
- Dumping syndrome
- Postvagotomy diarrhea
- Bile reflux gastritis
- Bone disease
- Fat malabsorption
What is gastric stasis? Symptoms and MNT
Hypomobility of the remnant stomach. Nausea, fullness, symptom relief w/ vomiting.
Prokinetic agents
Small volume, frequent meals
Liquids instead of solids or pureed foods
Low fat/low fiber
*may need to remove the remnant stomach and do total gastrectomy
Octreotide or ________ (DM med) may help to control dumping syndrome
Acarbose
What is post vagotomy diarrhea and how is it managed?
Explosive, episodic diarrhea unrelated to oral intake.
Watchful waiting, may improve after months. Try to insitgate problematic foods. Anti-diarrheals and fiber supplementation
What are 3 common nutrient deficiencies post-gastrectomy
Vitamin B12 (no intrinsic factor), Folate (malabsorptioN), Iron deficiency
*think anemias
What is Bile reflux gastritis?
Typically after Billroth 2 gastrecotmy. Burning epigastric pain and nausea/vomiting that does not relieve the pain. Vomit often contains bile
Cholestyramine may help to get rid of some of the bile acid. Not much to do diet-wise. Probably need surgery to correct
