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GI Surgery Cheat Sheet (DRAFT) by

Gi surgery MNT dietetic

This is a draft cheat sheet. It is a work in progress and is not finished yet.

NIS

Small bowel resection
Removed: ileum and/or jejunum
↓ B12, ↓ fat-so­luble vitamins, steato­rrhea
Colectomy (L.I)
All or part of the colon; small intestine is usually joined to rectum or stoma formed
↓ Water & electr­olyte absorp­tion. ↓ SCFA produc­tion. Monitor Na⁺, K⁺, Mg²
J Pouch & Procto­col­ectomy
Entire colon & rectum (proct­oco­lec­tomy); ileum is formed into a pouch and joined to anus (J-pouch)
↓ Water and sodium absorp­tion. Monitor electr­olytes & hydration.
R. Hemico­lectomy
Cecum + ascending colon ± part of terminal ileum; joined to transverse colon
If terminal ileum removed: ↓ B12, bile salt reabso­rption → fat malabs­orp­tion. Monitor B12, fat-so­luble vitamins, stool consis­tency
Extended right hemico­lectomy
Right colon + hepatic flexure + proximal transverse colon ± terminal ileum
Monitor B12, vitamin D, hydration, stoma output if present
Transverse colectomy
Transverse colon; joined ascending to descending colon
Hydration if large portion removed. Minor NIS
Left/S­igmoid hemico­lectomy
Descending colon and/or sigmoid colon
Minimal NIS. Monitor C/D
Left hemico­lectomy & Sigmoid Colectomy
Left colon (splenic flexure to sigmoid)
No major NIS. Monitor bowel regularity
Low Anterior Resection
Sigmoid colon + upper rectum; remaining colon rejoined to lower rectum
Risk of Low Anterior Resection Syndrome: urgency, frequency, incont­inence. Monitor bowel control, hydration & bowel regularity
Colorectal anasto­mosis
rejoining of colon or colon to rectum
Monitor bowel function, hydration, diet tolerance. soft, low-re­sidue diet initially
Abdomi­nop­erineal Resection
Sigmoid colon, rectum, anus – permanent colostomy formed
Risk of consti­pation. Monitor Bowel habits, fibre, hydration. Avoid bulky/­hig­h-fibre early post-op
Esopha­gectomy Oesoph­ageal removed. Stomach moved up.
Oesoph­ageal removed. Stomach moved up.
Feeding via jejunum – placed during surgery. - Eg oesoph­ageal surgery. Concerns: Early satiety, dysphagia, weight loss. Small, frequent meals, text-mod.
Gastre­ctomy
remove parts of the stomach (can be partial or entire stomach)
Feeding via jejunum – often placed surgery. ↓ Intrinsic factor → ↓ B12. ↓ iron, calcium, protein digestion. Avoid fluids with meals
Whipple
Removes head of pancreas, duodenum, gallbl­adder, part of bile duct, sometimes part of stomach
Can eat orally. Impacts - Blood glucose regula­tion, fat absorp­tion, delayed gastric emptying, fat-sol defici­encies. ↓ Pancreatic enzymes → steato­rrhea, malabs­orp­tion. Diabetes risk. PERT. Monitor BGL, fat-sol vits

Nut Absorption

Small Bowel Resection

R. Hemico­lectomy

Left/S­igmoid hemico­lectomy

Esopha­gectomy

NIS

Hyperg­lyc­aemia
Metabolism changes
Catabolism of glucose, free fatty acids and amino acids = Protein catabolism (loss of muscle)
Releases: stress hormones, inflam­mation meditators

Strategies

Pre-op ↑ CHO intake. Reduces pre-op thirst, hunger, post-op insulin resist­ance, losses of nitrogen = mainte­nance of lean BM
Going into surgery well nourished.
Post-op: Can safely eat orally after. Most start on fluid & build up. Some EN/PN – depends on surgery site. Nutrition concern if not eating orally after 3 days (unless already malnou­ris­hed).
Consider: planned vs emergency, Stomas? Drains? Further surgery? Treatment plan, cognitive function, fluid status, malnut­rition & refeeding risk, site of surgery & potential nutrie­nts­/organs impacted, is the gut still functi­oning?
 

Colectomy (L.I)

Extended right hemico­lectomy

Left hemico­lectomy & Sigmoid Colectomy

Colorectal anasto­mosis

Gastre­ctomy

Nut Reqs

Major surgeries: NEMO post-op
125-145kJ energy
1.2-1.5g protein
Minor surgeries: acute adult
re-eva­lua­ted­1-2­/week

Gastric emptying before surgery

Why? Reduce the risk of aspiration during surgery
Most hospitals: NBM ~12 hours before surgery (or midnight) - ease & consis­tency
Evidence pre-op: clear fluids up to 2 hours. Solids up to 6 hours before

Time taken for gastric emptying

large balanced meals (with fibre)
6-12 hours
light meal and/or milk
3-5 hours
Fluids
Within 2 hours (clear fluids 90% within 1h)
 

J Pouch & Procto­col­ectomy

Transverse colectomy

Low Anterior Resection

Abdomi­nop­erineal Resection

Whipple (pancr­eat­ico­duo­den­ectomy)

Diet Codes

Clear fluids
Maintains hydration. Minimise colonic residue. ONS: Resource fruit, ensure juice.
Free fluids
Contains milk & dairy products. Most ONS. Incl. soup, yoghurt, custard, ice cream
Low residual diet
<15g fibre/day. Used for: divert­icu­litis, bowel obstru­ctions, IBD flare
Surgical lite diet
Bland/­simple diet. No spices or rich sauce. Low fibre. Often better tolerated for nausea.

Guidelines & References

Weimann et al. ESPEN practical guidel­ines: clinical nutrition in surgery