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% Document Info
\author{Michellephillips02}
\pdfinfo{
  /Title (gi-surgery.pdf)
  /Creator (Cheatography)
  /Author (Michellephillips02)
  /Subject (GI Surgery Cheat Sheet)
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{GI Surgery Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Michellephillips02} via \textcolor{DarkBackground}{\uline{cheatography.com/214485/cs/46722/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Michellephillips02 \\
  \uline{cheatography.com/michellephillips02} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 11th July, 2025.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{1.55618 cm} x{1.51041 cm} x{1.51041 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{NIS}}  \tn
% Row 0
\SetRowColor{LightBackground}
Small bowel resection & Removed: ileum and/or jejunum & ↓ B12, ↓ fat-soluble vitamins, steatorrhea \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
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⁺, Mg$^{\textrm{2}}$ \tn 
% Row Count 11 (+ 7)
% Row 2
\SetRowColor{LightBackground}
J Pouch \& \seqsplit{Proctocolectomy} & Entire colon \& rectum \seqsplit{(proctocolectomy);} ileum is formed into a pouch and joined to anus (J-pouch) & ↓ Water and sodium absorption. Monitor electrolytes \& hydration. \tn 
% Row Count 19 (+ 8)
% Row 3
\SetRowColor{white}
R. \seqsplit{Hemicolectomy} & Cecum + ascending colon ± part of terminal ileum; joined to transverse colon & If terminal ileum removed: ↓ B12, bile salt reabsorption → fat \seqsplit{malabsorption}. Monitor B12, fat-soluble vitamins, stool consistency \tn 
% Row Count 30 (+ 11)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.55618 cm} x{1.51041 cm} x{1.51041 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{NIS (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
Extended right \seqsplit{hemicolectomy} & Right colon + hepatic flexure + proximal transverse colon ± terminal ileum & Monitor B12, vitamin D, hydration, stoma output if present \tn 
% Row Count 6 (+ 6)
% Row 5
\SetRowColor{white}
Transverse colectomy & Transverse colon; joined ascending to descending colon & Hydration if large portion removed. Minor NIS \tn 
% Row Count 11 (+ 5)
% Row 6
\SetRowColor{LightBackground}
Left/Sigmoid \seqsplit{hemicolectomy} & Descending colon and/or sigmoid colon & Minimal NIS. Monitor C/D \tn 
% Row Count 14 (+ 3)
% Row 7
\SetRowColor{white}
Left \seqsplit{hemicolectomy} \& Sigmoid Colectomy & Left colon (splenic flexure to sigmoid) & No major NIS. Monitor bowel regularity \tn 
% Row Count 18 (+ 4)
% Row 8
\SetRowColor{LightBackground}
Low Anterior Resection & Sigmoid colon + upper rectum; remaining colon rejoined to lower rectum & Risk of Low Anterior Resection Syndrome: urgency, frequency, \seqsplit{incontinence.} Monitor bowel control, hydration \& bowel regularity \tn 
% Row Count 28 (+ 10)
% Row 9
\SetRowColor{white}
Colorectal anastomosis & rejoining of colon or colon to rectum & Monitor bowel function, hydration, diet tolerance. soft, low-residue diet initially \tn 
% Row Count 35 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

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\begin{tabularx}{5.377cm}{x{1.55618 cm} x{1.51041 cm} x{1.51041 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{NIS (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
\seqsplit{Abdominoperineal} Resection & Sigmoid colon, rectum, anus – permanent colostomy formed & Risk of \seqsplit{constipation.} Monitor Bowel habits, fibre, hydration. Avoid \seqsplit{bulky/high-fibre} early post-op \tn 
% Row Count 8 (+ 8)
% Row 11
\SetRowColor{white}
\seqsplit{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. \tn 
% Row Count 20 (+ 12)
% Row 12
\SetRowColor{LightBackground}
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 \tn 
% Row Count 31 (+ 11)
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\par\addvspace{1.3em}

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\begin{tabularx}{5.377cm}{x{1.55618 cm} x{1.51041 cm} x{1.51041 cm} }
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\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{NIS (cont)}}  \tn
% Row 13
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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 \seqsplit{deficiencies.} ↓ Pancreatic enzymes → steatorrhea, \seqsplit{malabsorption}. Diabetes risk. PERT. Monitor BGL, fat-sol vits \tn 
% Row Count 17 (+ 17)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Nut Absorption}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751859369_Nut absoption (GI).png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Small Bowel Resection}}  \tn
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\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{R. Hemicolectomy}}  \tn
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\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Left/Sigmoid hemicolectomy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751854026_Left Sigmoid hemicolectomy.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Esophagectomy}}  \tn
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\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{NIS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Hyperglycaemia} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Metabolism changes} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Catabolism of glucose, free fatty acids and amino acids = Protein catabolism (loss of muscle)} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Releases: stress hormones, inflammation meditators} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Strategies}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pre-op}} ↑ CHO intake. Reduces pre-op thirst, hunger, post-op insulin resistance, losses of nitrogen = maintenance of lean BM} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Going into surgery well nourished.} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{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).} \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{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?} \tn 
% Row Count 13 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Colectomy (L.I)}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751853745_Picture3.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Extended right hemicolectomy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751853944_Extended right hemicolectomy.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Left hemicolectomy \& Sigmoid Colectomy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751854103_Left hemicolectomy & Sigmoid Colectomy.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Colorectal anastomosis}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751854393_Colorectal anastomosis.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Gastrectomy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751854435_Gastrectomy.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Nut Reqs}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Major surgeries: NEMO post-op} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{125-145kJ energy} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{1.2-1.5g protein} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Minor surgeries: acute adult} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{re-evaluated1-2/week} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Gastric emptying before surgery}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Why? Reduce the risk of aspiration during surgery}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Most hospitals: NBM \textasciitilde{}12 hours before surgery (or midnight) - ease \& consistency} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Evidence pre-op: clear fluids up to 2 hours. Solids up to 6 hours before} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.23965 cm} x{2.73735 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Time taken for gastric emptying}}  \tn
% Row 0
\SetRowColor{LightBackground}
large balanced meals (with fibre) & 6-12 hours \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
light meal and/or milk & 3-5 hours \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Fluids & Within 2 hours (clear fluids 90\% within 1h) \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{J Pouch \& Proctocolectomy}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751853840_ileoanal-anastomosis-j-pouch-surgery-procedure-purpose-indications-recovery-results-cost-price-kharch-in-hindi.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Transverse colectomy}}  \tn
\SetRowColor{LightBackground}
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\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Low Anterior Resection}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751854155_Low Anterior Resection.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Abdominoperineal Resection}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751854323_Abdominoperineal Resection.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Whipple \seqsplit{(pancreaticoduodenectomy)}}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751854480_Whipple (pancreaticoduodenectomy).png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Diet Codes}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Clear fluids}} & Maintains hydration. Minimise colonic residue. ONS: Resource fruit, ensure juice. \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
{\bf{Free fluids}} & Contains milk \& dairy products. Most ONS. Incl. soup, yoghurt, custard, ice cream \tn 
% Row Count 8 (+ 4)
% Row 2
\SetRowColor{LightBackground}
{\bf{Low residual diet}} & \textless{}15g fibre/day. Used for: diverticulitis, bowel obstructions, IBD flare \tn 
% Row Count 11 (+ 3)
% Row 3
\SetRowColor{white}
{\bf{Surgical lite diet}} & Bland/simple diet. No spices or rich sauce. Low fibre. Often better tolerated for nausea. \tn 
% Row Count 15 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Guidelines \& References}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Weimann et al. ESPEN practical guidelines: clinical nutrition in surgery} \tn 
% Row Count 2 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}