Nutritional Considerations for surgical patients

Question 1

who should get immunonutrition

Answer 1

All pts anticipating major elective surgery regardless of nutritional status

• immunonutrition are nutrition drinks supplemented with arginine, omega-3 fatty acids, nucleotides

Question 2

what are indications/contraindications for enterel feeding/tube feeding?

Answer 2

Indications

• functioning GI tract
• mechanical ventilation
• unable to eat adequately, maintain wt

Contraindications

• ileus
• major GI bleed
• hemodynamically unstable, high pressor needs

Question 3

• placed surgically, endoscopic, fluroscopic and radiologic
• 14-28 french in size
• PEG, PEJ, surgical G tube, J tube, G/J tube
• contraindications- ascites, peritonitis

Answer 3

Long term tubes- enterostomy

Question 4

Location of tip of feeding tube

• Possibly less risk of aspiration
• continuous and cycle feeds via pump
• max rate/flush about 150ml

Answer 4

post pyloric

Question 5

Location of the tip of feeding tube

bolus feeds- syringe
intermittent-gravity feeds
no pump needed for either

Answer 5

Gastric

Question 6

• Metabolic alterations that occur during nutrition repletion in malnourished
• low phosphate, potassium, magnesium
• thiamin deficiency
• sodium retention/fluid overload
• correct electrolytes before starting feeds
• start and advance feeds slowly monitoring labs
• start 100mg of thiamine x 5-7 days IV/orally

Answer 6

Refeeding syndrome

Question 7

• removes diseaseed part of esophagus
• stomach is attached to remaining part

Answer 7

Tranhiatal esophagectomy

Question 8

• j tube at time of surgery
• leak study
• diet progression varies according to surgeon after leak study
• HOB > 30 all times, sitting up with eating and 30 minutes after
• small amounts of liquids with meals no muscles

Answer 8

Esophagectomy

Question 9

complications of whipple

Answer 9

• delayed gastric emptying- 60% of pts, lasts 4-6 weeks
• dumping/diarrhea
• fat malabsorption. Enzymes 500-2500 units/kg/meal

Question 10

• 15-30ml pouch created
• restrictive and malabsorptive wt loss
• generally lose 50-75% of excess wt
• RD review diet pre-op high protein, small portions common deficiences- Iron, B12, Ca, Vit d

Answer 10

Roux-en Y gastric bypass

Question 11

• No randomized trials on nutritional mangament
• drastic restriction in enteral intake of fat, especially long chain triglycerides
• this slows down-length of time ranges from 1-24 weeks
• adequate protein- chyle contains significant amounts of protein

Answer 11

chyle leak nutritional management

Question 12

Nutritional issues of chyle leak can lead to?

Answer 12

essential fatty acid deficiency

• may occur within 1-3 weeks of fat free diet
• dx: triene to tetraene ration of > 0.4 &/or physical signs
• IV fat may be required, does not increase output

Fat soluable vitamins

• carried by lymphatic system
• water soluable forms of vitamins A, D, E and K may be better utilized

Question 13

why would you have a low fiber diet right after ostomy surgery?

Answer 13

• surgery causes the bowel to swell-avoid obstruction
• most pts. limited diet pre-op add new foods slowly
• gas from fiber can be mistaken for surgical pain

Question 14

what are basic ostomy diet concepts?

Answer 14

• drink plenty of fluid- lose more water
• avoid skipping meals- excessive gas
• chew foods well- avoid obstruction
• avoid seeds, nuts, popcorn, corn on the cob- avoid blockage
• watch for pill absorption
• talk about gas