Nutrition

Question 1

When should a patient eat following GI surgery?

Answer 1

Eat if passed flatus/opened bowels - paralytic ileus has passed

Question 2

What are the different forms of enteral nutrition?

Answer 2

• caloric supplements
• nasogastric tube: risk of aspiration when vomiting (narrow bore for nutrition, wide bore for drainage of gastric contents)
• nasojejunal tube: pylorus prevents vomiting
• percutaneous endogastric tube +/- radiologically insertion (push stomach wall out during endoscopy and pass tube to surface)
• jejunostomy

Question 3

Give some examples of complications of enteral nutrition.

Answer 3

• aspiration
• re-feeding syndrome
• tube falling out/not in right place

Question 4

Give some examples of complications of parenteral nutrition.

Answer 4

LINE

• pneumo/haemothorax (central line feeding)
• vascular injury
• sepsis
• thrombosis

FEED

• fluid overload
• electrolyte imbalance
• liver damage
• gut atrophy
• refeeding syndrome

Question 5

What is refeeding syndrome?

Answer 5

Protein deficiency —> give food with high protein content —> fluid shift —> arrhythmias

note: pay close attention to K+, Mg2+, and phosphate (“refeeding bloods”)

Question 6

Describe the indications for a nasogastric tube.

Answer 6

Short-medium duration (<6wks) - nutritonal support
- narrow bore: less discomfort, reduced risk of rhinitis, pharyngitis, or oesophageal erosion

Aspiration of stomach contents e.g. decompression of intestinal obstruction
- wide bore

Question 7

What are the contraindications for a nasogastric tube?

Answer 7

• high risk of aspiration
• gastric stenosis
• GORD
• upper GI stricture
• nasal injury
• base of skull fracture

Question 8

Describe the indications for a nasojejunal tube.

Answer 8

Patients at high risk of pulmonary regurgitation e.g. gastric atrophy, gastroparesis, pancreatitis

Question 9

Describe the indications for a PEG tube.

Answer 9

Long-term feeding

Less reflux and feed aspiration, therefore more appropriate for mobile patients

Question 10

Describe the indications for a double contrast (air) barium enema.

Answer 10

• rectal bleeding (gross or occult)
• poylps or carcinoma (suspected or known)
• IBD (suspected or known)
• patient > 40yrs who can cooperate without assistance

Question 11

Describe the indications for a single contrast barium enema.

Answer 11

• patient < 40yrs with abdo. S&S suggestive of polyps, colitis, or bleeding
• suspected diverticulitis
• limited exam requested to verify or exclude obstruction, volvulus, appendicitis, fistula, etc.
• uncooperative/disabled/old/ill patient unable to tolerate double contrast enema

Question 12

What are the contraindications for a barium enema?

Answer 12

• suspected acute perforation
• acute fulminating colitis
• immediately after biopsy

Question 13

Describe the indications for a water-soluble contrast enema.

Answer 13

• suspected perforation or high risk for intestinal perforation or anastomotic leak
• therapeutic: disimpaction
• differentiate between mechanical obstruction and colonic pseudo-obstruction

Question 14

What are the contraindications for a water-soluble enema?

Answer 14

• risk of pulmonary aspiration during swallowing

- dehydrated infants