lecture 11 Flashcards
Indications for surgical interventions
IBD that is refractory to other medical treatment • Abscess not responsive to therapy (antibiotics, bowel rest) • GI obstructions – Masses, bezoars etc. • Malignant masses requiring resection • Acute emergencies – Ulcers – GI bleed – GI perforation – Peritonitis – Necrotic bowe
Lower GI Resections & Nutrition Implications
When removal of portion of GIT occurs:
– Function of portion removed is lost
– Changes in motility, absorption, waste handling
– All can impact nutritional status
• Larger resections –> (usually) larger nutritional implications
Nutritional Care for the Patient Post GI Surgery
• Post-GI surgery nutrition regimen will be dependent on the type of surgery, portion of the GI tract resected • Why? the more is removed the less things will be absorbed
Major Determinants of Fluid Absorption
motility,
luminal osmolarity,
surface area
mucodsal integrity
Colectomies
• Colectomy: procedure to remove all or part of the large intestine
• Types of colectomies
ØTotal colectomy: entire colon
ØPartial / Subtotal colectomy:part
ØHemicolectomy:removal of the right of left portion
ØProctocolectomy: removal of colon and rectum
Nutritional Considerations Post Colon Surgery
No Ostomy
• Patients may or may not experience GI symptoms
– Disruption of gut microbiota, fluid resorption have not normalized/adapted.
• Most common:
–diarhea
–dehydration
• Nutrition therapy: treat the symptom
- maintain hydration, electrolye repletion if large volumes of stool output
consumme easily digested foods w
otherwise normal diet
Ostomies
Ostomy: surgically created opening from the intestine to skin
• Stoma: actual end of the bowel that cen be seen prtruding throught the abdominal wall
• Classified based on location:
– Colostomy
– Jejunostomy
– Ileostomy
Characteristics of Different Types of Ostomies
descending or sigmoid colostomy: normal poo
transverse colostomyL semi-solid poo
Ascending colostomy: liqui
Nutritional Considerations: Colostomies
Usually start functioning 2-5 days post- surgery • No evidence for specialized diet – Smaller portions, 4-6 meals/d – Cook foods well; chew thoroughly • Odor and gas production may be problematic (bacterial fermentation) – List based on anecdotal reports • Ascending colostomy – Hydration could be an issue • Increase fluid consumption
• Ileocecal valve
– Controls rate of movement from small intestine to large intestine (colon)
– Loss (if resected) may result in hastened motility
Liquid or paste-like
Continuous drainage
Contains digestive enzymes
Nutritional Considerations: Ileostomies
Normally start function ~24h post-surgery
• Specialized diets generally not necessary
– ↑ fluid losses à ↑ consumption of fluid
– ↑ Na loss in ileostomy output à liberalize salt consumption
– If output >1L/d, consider oral electrolyte replacement solution (ORS)
• Gas and odours less a concern (vs colostomy)
– Why?
– If gas an issue, avoid activities that increase amount of air swallowed
• Such as:SMOKING, CHEWING GUM, DRINKING THROUGH A STRAW, CARBONATED BEV.
Loose stool/effluent
– Rx foods that can thicken stool
– Gut-slowing medications (i.e. Imodium)
Foods to Thicken Stool and Control Diarrhea Bananas Cheese White bread/toast Cream of rice Cream of w
Ileostomies & Blockages
• Blockage at ileostomy site
– Increased risk first 6-8 weeks post-op
• May be caused by high fibre, difficulty to digest, stringy foods
– i.e. Nuts, popcorn, dried fruits, raw cabbage, corn, celery, carrots, cucumber skin,
coconut, apples with peels, grapes, tough fibrous meats
• Tips to reduce the risk of a blockage
– Chew food well
– Introduce fibrous foods in small amounts, one at a time, gradually increasing
intake
– Consume fluids with meals
GI Fistulas
• An abnormal opening or passage between two internal organs
of from an internal organ to the surface of the body
• Types of fistula, classified by:
1. lOCALIZATION + ANATOMICAL LOCATION
2.Physiology
3Etiology
Internal:
Consists of an abnormal
communication between adjacent
hollow viscera
Enterocutaneous: Consists of an abnormal communication/passage between the GI tract and the surface of the body/skin
GI Fistula Classification Upon Physiology
High output fistulas: >500ml/d
• Moderate output fistulas: 200-500ml/d
• Low output fistulas: <200ml/day
Etiology / types
Spontaneous: (10-25%) : Crohn’s disease
Cancer
Diverticulitis
Radiation enteritis
Surgical (75-90%): Iatrogenic lesion (sutures) Anastomotic failure Abdominal wall dehiscence Mesh rupture Drain puncture
Traumatic: <5% (Diagnostic intervention (puncture) (Traffic) accident Gun shot wound Knife injury
