GI AND SURGERY MODULE

Objectives Satisfactory Not

Completion Applicable
Review
1.The student will review with the rotation coordinator the normal
functioning of the GI tract.

.The student will discuss with the rotation coordinator the role of nutrition
for GI diseases !including Crohn"s# ulcerative colitis# diverticulitis# peptic
ulcer disease# and malabsorption disorders$. Include in the discussion#
but not limited to# all the following that are applicable%
a. etiology and treatment
a. pathophysiology
b. metabolic&nutritional alterations
c. current medical treatments&trends
'. (iscuss the dietitian"s role as part of the health care team
Assess
). *sing height&weight&labs and other pertinent information the student
will assess the appropriateness of%
a. the +("s order
b. diet
c. energy&protein&nutrient re,uirements
-. The student will obtain diet histories.
./////// !Goal of ' or more$
0. The student will complete nutrition care plans.
.////// !Goal of ' or more$
Educate
1.The student will utili2e the diet history and care plan as well as any
other pertinent educational material to instruct patients and&or family
member on his&her specific dietary regimen.
. ////// !Goal of ' or more$
Document
3. *sing the format appropriate for the site# the student will document all
pertinent information in the medical record.
.////////!Goal of ' or more$
Observe/Optional
4. 5bserve a 67G or NG tube placement.
GI and Surgery Wors!eet
"# De$ine t!e $o%%o&ing surgery re%ated ter's and abbreviations(

S)O8 Small 9owel 5bstruction8 the small intestine may become obstructed from food# fluid# gas# or from
scar tissue post8surgery.
1
Surgery includes: locating and unbloc;ing the bloc;ed area# removing any
damaged sections of the intestine# and if possible# reconnecting the intestine. If a large part is removed
and unable to be reconnected# a colostomy or ileostomy is performed.
1

*U)8 <idney# *reter# 9ladder8 an =8ray that may be performed to assess the abdominal area for causes
of abdominal pain# or to assess the organs and structures of the urinary and&or gastrointestinal !GI$
system.
1

GOO +gastric out%et obstruction, > ?eferring to the complete or incomplete obstruction of the distal
stomach# pylorus or pro=imal duodenum.

5bstruction may occur due to a mass lesion# e=ternal

compression# or as a result of obstruction from acute edema# or chronic scarring and fibrosis. These
factors produce a mechanical barrier to gastric emptying.

S))O +s'a%% bo&e% bacteria% over gro&t!,- A condition in which# an over8proliferation of bacteria e=ist
in the small intestine.
'
Treatment with antibiotics# probiotics# prebiotics# and in some cases# surgical
modification of the blind loop may be utili2ed. A low @5(+A6 diet may be recommended.
'

Liga'ent o$ .riet/- A band of smooth muscle e=tending from the Aunction of the duodenum and AeAunum
to the left crus of the diaphragm and functioning as a suspensory ligament.
1

)ariu' s&a%%o& - The process of getting =8ray pictures of the esophagus or the upper GI tract
!esophagus# stomach# and duodenum$.
)
The patient drin;s a li,uid that contains barium sulfate which
coats and outlines the inner walls of the esophagus and the upper GI tract allowing them be seen on an =8
ray picture.
)

01 drain +0acson-1ratt, - A tube that prevents body fluid from collecting near the site of surgery.
1
The
drain pulls this fluid !by suction$ into a bulb. The bulb can then be emptied and the fluid inside measured.
1

1ancreatic en/y'es- en2ymes secreted by the pancreas during digestion !trypsin# chymotrypsin#
steapsin# amylopsin$
1

2ic'an 3at!eter8 long8term# central venous indwelling catheter with e=ternal port!s$
1

I%eus- type of bowel obstruction resulting when peristalsis stops

1

Steatorr!ea- undigested fat appears in the feces due to the inability to digest or absorb fat# most
commonly occurring in pancreatic disease and malabsorption syndromes.
1

Anasto'osis- a surgical connection between two structures# usually meaning a connection that is
created between tubular structures# such as blood vessels or loops of intestine.
1

Debride'ent - surgical removal of dead# damaged# or infected tissue to promote healing of otherwise
healthy tissue
1

4%uorosco5y- a type of medical imaging that shows a continuous B8ray image on a monitor.
-
An B8ray
beam is passed through the body and the image is transmitted to a monitor so the movement of a body
part or of an instrument or contrast agent !CB8ray dyeD$ through the body can be seen in detail.
-

Osto'y- surgical opening

1

4istu%a- An abnormal passage between two organs or between an organ and the s;in.
1

?eference%
1. National Institute of Eealth. *S National Fibrary of +edicine.+edline 6lus.
http%&&www.nlm.nih.gov&medlineplus&ency&article&GG41.htm. Accessed on Hune # G1).
. Ha;a E# +cEembe +(# ?ambau 6@# Chalya 6F. Gastric outlet obstruction at 9ugando +edical Centre in Northwestern Tan2ania% a prospective
review of 13) cases. BMC Surg. G1':1'%)1. Accessed Hune # 1G).
'. (escher N# <renits;y HS. +edical Nutrition Therapy for lower Gastrointestinal Tract (isorders. In +ahan <F# 7scott8Stump S# ?aymond HF eds.
<rause"s food I the nutrition care process. St. Fouis# +5% 7lseiver and Saunders:G1%01G80)'
). National Institute of Eealth# National Cancer Institute. 9arium Swallow. http%&&www.cancer.gov&dictionaryJcdridK)01-0. Accessed Huly 3# G1).
-. *.S. @ood and (rug Administration. @louroscopy.
http%&&www.fda.gov&radiationemittingproducts&radiationemittingproductsandprocedures&medicalimaging&medical=8rays&ucm11-'-).htm. Accessed
Huly 3# G1).

6# De$ine and describe surgica% 5rocedures and nutritiona% i'5%ications(
3!o%edoc!ojejunosto' y > anastomosis of the common bile duct to AeAunum to relieve symptoms of
biliary obstruction and reinstate continuity to bile tract
1

Implications%

Increase protein inta;e

3!o%ecystecto'y 8 surgical removal of the gallbladder# especially if there are multiple stones# stones are
large# or they are calcified.

Implications%

No specific dietary treatments for prevention of cholithiasis

Eigh fiber# low8fat# plant based diet

Avoid fasting and rapid weight loss

If diarrhea persists post8surgery# an antidiarrheal medication and a high fiber diet for
more bul; may be needed
3o%onic j-5ouc!8 creation of a reservoir using a portion of the distal ileum for patients who have had their
colons removed. @olds of the ileum are Aoined together to create a small pouch which is then connected to
the rectum and ileum.
)

Implications%

reduce caffeine

lactose avoidance in lactose8deficient persons

limitation of fructose and sorbitol

ade,uate fluid and electrolyte inta;e

consume small meals fre,uently and chew thoroughly to prevent obstruction

I%eosto'y taedo&n- The final stage of the ileal pouch anal anastomosis !I6AA$ surgery. The temporary
detour for stool through the ileostomy is closed and stool is passed through the ileal pouch made by the
surgeon# then out of the body through the anal opening.

Implications%

small fre,uent meals

low residue diet

ade,uate fluid and electrolyte inta;e

Rou7-en-y 8 Creating a stomach pouch out of a small portion of the stomach and attaching it directly to
the small intestine# bypassing a large part of the stomach and duodenum.
-

Implications%

Fow acid# li,uid diet to progress to solids to prevent dumping syndrome

6rotein focused

(aily multivitamins
E75%oratory %a5aroto'y % surgery to loo; at the organs and structures in the abdominal area
-

I%eosto'y- an opening of the ileum at the abdominal wall !fistula$. +ade when the entire colon# rectum
and anus must be removed.
'

Implications%

Small fre,uent meals

(rin; at least 1F more than ostomy output daily

6atients may have low vitamin C and folate inta;es because of low fresh vegetable and
fruit inta;es# and may re,uire supplementation

5mitting gaseous foods# caffeinated beverages# carbonated beverages# limitation of

fructose and sorbitol# and limitation of lactose if lactase8deficient
3o%osto'y8 surgical establishment of artificial connection between the lumen of the colon and the s;in.
'

The stoma is about the si2e of a ,uarter and is usually located in the right lower part of the abdomen near
the beltline. A pouch is worn over the opening to collect waste# and the patient empties the pouch as
needed.
'

Implications%

avoid gaseous foods

Avoid foods that may cause odor !legumes# onions# garlic# cabbage# eggs# fish# some
medications and some vitamin and mineral supplements$

Small fre,uent meals# chewing food well

.rac!eosto'y 8surgical opening into the trachea
-

Implications%

Suctioning the tracheostomy tube before eating will help prevent coughing while eating.

Increase fluids to prevent buildup of mucus

W!i55%e- 6ancreaticoduodenectomy8 A whipple may be performed if there is cancer&tumor in the
pancreas.
0
The conventional Lhipple involves removal of the head of the pancreas# the duodenum# and
portions of the stomach# gallbladder and bile duct. ?econnection of the remaining stomach# bile duct and
pancreas to the digestive tract is then made to restore flow of ingested contents# digestive en2ymes and
bile. In the pylorus8sparing Lhipple# the section of stomach is not removed during the operation.

Implications%

Clear li,uids for first few days post8surgery# then progression to regular diet

Small fre,uent meals to reduce nausea vomiting and diarrhea

0

1ancreatecto'y- Surgical removal of all or part of the pancreas.
0
Similar to a Lhipple procedure# a
portion of the stomach# duodenum# gallbladder# and local lymph nodes are also removed. The spleen may
also be removed.

Implications%

Small fre,uent meals

Avoid high fat foods

?ecommendation of a multivitamin
0
Eso5!agogastrecto'y- Surgical removal of the esophagus and part of the stomach.
1
The esophagus is
replaced by moving the remaining portion of the stomach upwards# or by replacing it with a section of the
large bowel !colonic reconstruction$

Implications%

Initial feeding via NG tube

6rogression to swallow test

6rogression to H8tube for 181G days until wounds are healed

Eso5!agecto'y- e=cision of all or part of the esophagus
1

Implications%

@lush the tube with water before and after feedings

6rogression from li,uids to soft foods over )83 wee;s recovery

(rin; fluids 'G minutes after eating solid food.

(rin; slowly# ta;ing 'G to 0G minutes to finish a drin;

Small meals

Sit upright when eating

8agoto'y( trunca% and se%ective-
.runca%( Complete severing of the vagus nerve on the distal esophagus.
'
6erformed with a drainage
procedure !such as pyloroplasty$ to allow better gastric emptying of solids. (ecreases acid secretion by
parietal cells in the stomach thereby decreasing their response to gastrin.
Se%ective( (ividing or severing only the vagus nerve branches that affect the pro=imal stomach where
gastric secretions occur# leaving the antrum and pylorus innervated.
Implications%
Spicy foods should be avoided
Small# fre,uent feedings of ice water# followed by li,uids and easily digested solid
foods# until progression to regular diet
Nissen 4undo5%ication8 Complete fundoplication# most commonly laprascopically
-

Implications%

Small and fre,uent meals.

@luids Inta;e% M cup with meals# 1 cup w& snac;s

sit upright during and after meals

avoid sugary I sweetened beverages&foods to avoid dumping syndrome

2art'ann9s 1rocedure- ?esection of the rectosigmoid colon with creation of a colostomy
-
Implications% slow diet progression post op after IN tubes&fluids remove
1artia% Gastrecto'y( )i%%rot! I and II-
:
I( the remnant stomach is reattached to the duodenum8 less dumping than 9illroth II.
II( the remnant stomach is reattached to the side of the AeAunum# preserving the duodenal stump allowing
for continual flow of bile and pancreatic en2ymes from the intestines
Implications%
Small# fre,uent feedings of ice water# followed by li,uids and easily digested solid
foods# until progression to regular diet
(aily multivitamins
6rotein focused meals to increase satiety
Avoidance of high fat# acidic# or spicy foods
Intestina% Urinary diversions- *rinary diversion is a surgical procedure that reroutes the normal flow of
urine out of the body when urine flow is bloc;ed.
3
Urosto'y urinary diversion( re,uires an e=ternal pouch !stoma$
3ontinent urinary diversion( the creation of an internal reservoir with a segment of the small or
large intestinesOthat stores urine until it can be drained with or without stoma
I%ea% conduit- !common$ stoma with outlet to release urine from ureters through the
small intestine
Uretoerosto'y-!rare$ ureters are directly connected to the abdominal wall !stoma$
2e5aticojejunosto'y ; direct connection between the hepatic duct and the AeAunum that is used to drain
bile directly from the liver.
-

.ota% < 3o'5%ete Gastrecto'y- removal of the entire stomach and reconnection of the intestine to the
esophagus due to cancer# polyps# or bleeding
-
Implications% Small# fre, meals# Eigh 6?5# nutrient dense snac;s&meals
1uesto& 5rocedure - a lateral side8to8side pancreaticoAeAunostomy that is used for the treatment
of chronic pancreatitis.
4
The pancreas is essentially filleted along its long a=is from the uncinate process
to the tail and connected to a ?ou= en8P loop of AeAunum.
4
LAR +%o&er anterior resection,- part of the rectum containing the tumor is removed without affecting the
anus.
-
The colon is then attached to the remaining part of the rectum so that after the surgery# you will
move your bowels in the usual way.
-
Implications%
low fat# fiber
small# fre,uent meals
1EG- 6ercutaneous 7ndoscopic Gastrostomy8 nonsurgical techni,ue for placing a tube directly into
stomach and through the abdominal wall.
1G
An endoscope is used to guide the tube from the mouth into
the stomach or the AeAunum and then through the abdominal wall.
1G

Implications%

7nteral tube feeding due to inability to swallow food

Commercially prepared formulas are provided for tube feeding
?eference%
1. Nogt (6# Eermann ?7. Choledochoduodenostomy# choledochoAeAunostomy or sphincteroplasty for biliary and pancreatic
disease. Ann Surg.1431:14'!$%1018103
. 7scott8Stump S. Galbladder (isease. In Nutrition and diagnosis8related care. 1
th
ed. 9altimore +(% Fippincott Lilliams I
Lil;ins:G1%-108-13.
'. (escher N# <renits;y HS. +edical Nutrition Therapy for lower Gastrointestinal Tract (isorders. In +ahan <F# 7scott8Stump S#
?aymond HF eds. <rause"s food I the nutrition care process. St. Fouis# +5% 7lseiver and Saunders:G1%01G80)'.
). +ayo Clinic. Tests and 6rocedures. Illeoanal anastomosis !H8pouch$ Surgery. http%&&www.mayoclinic.org&tests8
procedures&ileoanal8anastomosis8surgery&basics&definition&prc8GG1''G0. Accessed Huly 4# G1).
-. National Institute of Eealth. *S National Fibrary of +edicine.+edline 6lus.
http%&&www.nlm.nih.gov&medlineplus&medlineplus.html. Accessed on Hune )# G1).
0. Columbia *niversity (epartment of Surgery. The 6ancreas Center. Treatment of 6ancreatic Cancer% Surgery.
http%&&pancreasmd.org&ed/treatment/wp.html. Accessed Huly 4# G1).
1. The 5hio State *niversity +edical Center. 7sophagogastrectomy.
https%&&patienteducation.osumc.edu&(ocuments&esophagogastrectomy.pdf. Accessed Huly 4# G1).
3. National Institute of (iabeties and (igestive and <idney (iseases. National <idney and *rologic (iseases Information
Clearinghouse. *rinary (iversions. http%&&;idney.nidd;.nih.gov&<*(iseases&pubs&urostomy&inde=.asp=. Accessed Huly 1G# G1).
4. @reed et al. Abdomen after a 6uestow 6rocedure% 6ostoperative CT Appearance# Complications# and 6otential 6itfalls.
?adiology. 1441: G'!'$%14G
1G. ?aymond HF# Ireton8Hones CS. @ood and nutrient delivery%nutrition support methods. . In +ahan <F# 7scott8Stump S#
?aymond HF eds. <rause"s food I the nutrition care process. St. Fouis# +5% 7lseiver and Saunders:G1%'G08').
:# De$ine t!e $o%%o&ing diseases < disorders and discuss nutritiona% i'5%ications(
3ro!n9s Disease and U%cerative 3o%itis
Crohn"s disease and *lcerative Colitis !*C$ are the two maAor forms of inflammatory bowel disease !I9($.
1

Crohn"s (isease is characteri2ed by abscesses# fistulas# fibrosis# submucosal thic;ening# strictures# and
obstruction in varying areas of the GI tract. *nli;e *C# inflammation Cs;ipsD areas of the intestine# leaving
segments of healthy intestine between inflamed areas. +ost cases affect both the ileum and the colon
simultaneously. Conversely# *C affects only the innermost lining of the large intestine and rectum and is more
common in *C than in Crohn"e disease. 9oth Crohn"s and *C can result in diarrhea# fever# weight loss# anemia#
food intolerances# malnutrition# growth failure and e=traintestinal manifestations !arthritic. (ermatologic# and
hepatic$. Lhile malnutrition is a concern for both Crohn"s and *C# it is more of a lifelong concern for patients with
Crohn"s disease. Surgery does not cure Crohn"s disease but it does remove inflamed areas.
1

MN.( 6N may be needed in patients with persistent bowel obstruction# fistulas# and maAor GI resections
that result in S9S where 7N is not possible.
1
6rotein re,uirements may be increased !1.'81.-g&;g&day$# depending
on severity and stage of the disease and restoration re,uirements. +alabsorption# maldigestion# drug8nutrient
interactions# or inade,uate inta;e is common in I9( patients and supplemental vitamins# especially folate# 90# 91#
and minerals and trace elements may be needed. A reduction in dietary fiber !if needed$# small fre,uent meals#
and avoidance of problem foods may also be recommended. Ade,uate hydration is also important as diarrhea
can cause dehydration.
1
I)D-
Inflammatory 9owel (isease !I9($ is characteri2ed by abscesses# fistulas# fibrosis# submucosal thic;ening#
strictures# and obstruction in the GI tract.

The two main types of I9( are C( and *C. Though not completely
understood# the cause of I9( may involve a genetic predisposition and an un;nown irritant which activates a
mucosal inflammatory response# resulting in damage to the intestine.
1
+alabsorption and maldigestion of nutrients
and water result from flare ups of the intestinal wall which is the site nutrient metabolism. 9oth Crohn"s and *C
can result in diarrhea# fever# weight loss# anemia# food intolerances# malnutrition# growth failure and e=traintestinal
manifestations !arthritic. (ermatologic# and hepatic$.
1

MN.( Consuming small fre,uent meals# limiting dairy in those who are lactose intolerant# decreasing fiber
according to tolerance level# ade,uate hydration# avoiding problem foods and possible supplementation with a
multivitamin is recommended for these patients.
1

3e%iac Disease
Celiac disease is a digestive disease caused by the inta;e of gluten# that damages the villi of the small intestine
and thus interfering with the absorption of nutrients from food.
'
Celiac disease is genetic and can sometimes
triggered after surgery# pregnancy# childbirth# viral infection# or severe emotional stress. Symptoms vary between
individuals and can affect the digestive system and other parts of the body. Common symptoms include%
abdominal bloating and pain# chronic diarrhea# vomiting# constipation# pale# foul8smelling# or fatty stool# and
weight loss. +ore common in adults are symptoms of une=plained iron8deficiency anemia# fatigue# bone or Aoint
pain# arthritis# and bone loss or osteoporosis. Celiac disease can be diagnosed via# a blood test for high levels of
anti8 tissue transglutaminase antibodies or anti8 endomysium antibodies and&or an intestinal biopsy.
'

MN.( A gluten8 free diet is the only treatment for celiac patients. Gluten containing foods include: barley#
bulgur# durham# farina# graham flour# malt# rye# semolina# spelt# triticale# and wheat.
'

S)S - s!ort bo&e% syndro'e
Short bowel syndrome characteri2ed by poor absorption of nutrients due to reduced length or decreased function
of the bowel after resection.
1

Since the small and large intestines are involved with the digestion and absorption of vitamins# minerals#
macronutrients# and water# the removal of parts of the intestine absorption is affected. +alabsorption is lin;ed to
the area of the intestine that has been removed. ?esectioning of the duodenum can affect absorption of iron#
calcium# and magnesium and cause anemia# osteoporosis# and fractures. ?esectioning of the AeAunum results in
malabsorption of fat# carbohydrates# protein# vitamins# and minerals# which can lead to swelling# poor muscle
coordination# steatorrhea# acidosis# or contribute to osteoporosis. ?esectioning of the ileum# the site of 91
absorption# can cause damage to the brain# nerves# and spinal cords. ?esectioning of the colon affects water and
electrolyte absorption and causes dehydration# irregular heartbeat# muscle wea;ness# headache# and nausea.
1
MN.( Small# fre,uent mini8meals are li;ely more tolerable than large feedings.
1
Tube feeding may be
helpful in ma=imi2ing inta;e or restoring and maintaining nutrient status. An oral diet or enteral nutrition plus the
use of gut8slowing medications should be ma=imi2ed to prevent dependence on 6N. Supplementation with a
multivitamin and mineral supplement may also be needed to meet re,uirements. Ade,uate fluid and electrolytes#
especially sodium# should be provided fre,uently in small amounts.
1

Diverticu%osis < diverticu%itis
(iverticulosis is characteri2ed by sacli;e herniations !diverticula$ in the colonic wall. Increased pressure on the
colonic wall results in the creations of holes that can bulge out and cause pain and discomfort.
1
(iverticulitis is the
inflammation of these diverticula and can include abscess formation# acute perforation# acute bleeding#
obstruction# and sepsis. Fifelong low8fiber# and high inta;e of refined foods leads to the development of
diverticulosis&diverticulitis.1
+NT% A high8fiber diet in combination with ade,uate hydration promotes soft and bul;y stools ma;ing it
easier for individuals to defecate.
1
Increase fiber inta;e gradually because dramatic inta;e may cause bloating
and gas. ?ecommendations for fiber are -g&day for adult women and '3g&day for men. An individual may use a
fiber supplement such as methylcellulose or psyllium fiber if they have difficulty consuming the necessary amount.
Ade,uate fluid inta;e !8'F&day$ is also recommended. A low residue diet or 6N may be necessary during a flare
up# followed by a gradual return to a high8fiber diet. If more than ' flares occur in the span of 1 year# a resection
may be done.
1

1ancreatitis +acute and c!ronic, and 1ancreatic 5seudocyst-
6ancreatitis !inflammation of the pancreas$ is characteri2ed by edema# cellular e=udate# and fat necrosis.
'
Clinical
findings include% abdominal pain and distention# nausea# vomiting# steatorrhea# and in severe cases: hypotension#
oliguria# and dyspnea. Symptoms may worsen with food consumption. 6ancreatic pseudocyst can result from
pancreatitis and is a sac; of pancreatic en2ymes# blood and tissue found in the pancreas.
'
MN.(
Acute(

5ral and enteral feeding are withheld

Support with IN fluids

If oral nutrition cannot be initiated in -81 days# initiate tube feeding

5nce oral nutrition has started% provide easily digestible low8fat foods.
6rovide 0 small meals throughout the day with ade,uate protein and increased calories.
3!ronic(

6rovide an oral diet as provided in the acute phase

T@ may be used if oral diet is inade,uate or as a way to reduce pain

Supplementation with pancreatic en2ymes along with maintenance of optimal intestinal pE to

facilitate en2yme activation

Supplement fat8soluble vitamins and vitamin 91

+CT oil may relieve steatorrhea and weight gain

E3 $istu%a +enterocutaneous,-
An abnormal passage connecting the intestine and the s;in of the abdomen resulting in the contents of the
stomach&intestine to lea; through the s;in.
1
Farge amounts of fluid and electrolytes can be lost when fistulas of the
intestinal tract occur. +alabsorption and infection can also occur.
1
MN.( 6N# tube feeding# an oral diet# or a combination can be used in these patients.
1
The method used is
dependent upon the location of the fistula# the presence of abscesses or obstructions# the length of functional
bowel# the ability of the patient to manage fistula output and the overall condition of the patient.
1

1rotein %osing entero5at!y
An abnormal loss of protein from the digestive tract or the inability of the digestive tract to absorb
proteins.
1
Any condition that can cause serious inflammation in the intestines can lead to protein losing
enteropathy.
1

MN.( @ocused on curing the condition causing protein losing enteropathy
1
?eference%
1. (escher N# <renits;y HS. +edical Nutrition Therapy for lower Gastrointestinal Tract (isorders. In +ahan <F# 7scott8Stump S#
?aymond HF eds. <rause"s food I the nutrition care process. St. Fouis# +5% 7lseiver and Saunders:G1%01G80)'.
. National Institute of Eealth. *S National Fibrary of +edicine.+edline 6lus.
http%&&www.nlm.nih.gov&medlineplus&medlineplus.html. Accessed on Hune 10# G1).
'. National Institute of (iabeties and (igestive and <idney (iseases. National Institute of Eealth. Celiac (isease Awareness
Campaign. http%&&celiac.nih.gov&materials.asp=. Accessed Huly 1G# G1).
). Easse H+# +atarese F7. +edical Nutrition Therapy for Eepatobiliary and 6ancreatic disorder. . In +ahan <F# 7scott8Stump S#
?aymond HF eds. <rause"s food I the nutrition care process. St. Fouis# +5% 7lseiver and Saunders:G1%0)-801).
=# De$ine t!e $unctions> side e$$ects and 5ossib%e nutrient i'5%ications o$ $o%%o&ing
'eds(
Medication 4unction Side E$$ects Nutrient I'5%ications
Cimetidine
?anitidine
E 9loc;er8 9loc;s action of
histamine on parietal cells#
leading to a decrease in acid
production. *sed to treat
G7?(
Eeadache# diarrhea# di22iness#
drowsiness# breast enlargement#
confusion# e=citement# depression#
nervousness# hallucinations
bland diet# hours pre or post prandial
@e supplement# avoid alcohol
Cipro NT
!via tube$
Antibiotic8 7radicate
Eelicobacter pylori and
prevent or treat infection
after abdominal wounds.
Nausea# vomiting# stomach pain#
heartburn# diarrhea# urgency#
headache# itching# rash# blisters#
tingling# difficulty breathing# rapid
heartbeat# fainting
Eas similar side effects as caffeine# thus
coffee# soda# tea# etc. should be limited.
+ust maintain ade,uate hydration.
Increase fiber and monitor vitamin C and
7.
Colace Fa=ative8 Softens stool by
mi=ing fluid with the stool#
preventing dry and hard
feces.
Stomach cramps# nausea# throat
irritation# s;in rash# difficulty
breathing# fever# vomiting
+ust receive sufficient fluid inta;e to
prevent dehydration. Increase fiber# fruits#
vegetables# and whole grain.
+i= powder with mil;&Auice to mas; bitter
taste I avoid throat irritation
Coumadin Anti8 coagulant8 6revents
blood clots from forming or
growing larger.
Gas# abdominal pain# bloating#
change in taste# chills# hives# rash#
difficulty breathing# fever# infection#
nausea# lac; of energy. Can thin
blood if ta;en with antibiotics.
Avoid foods with too much vitamin <
avoid dar;# leafy greens# garlic# ginger#
ging;o# ginseng# saw palmetto# horse
chestnut
Imodium
Fomotil
Anti8 diarrheal8 Slows rate of
stomach and intestine#
increases density of stools
by decreasing amount of
fluid. *sed for ileostomy to
reduce amount of stool.
(i22iness# tiredness# rash# dry mouth#
nausea# vomiting# constipation# and
abdominal pain.
Increase fluids and electrolytes# avoid
alcohol
5ctreotide&
Sandostatin
Anti8 secretory8 Slows gastric
emptying by inhibiting
release of insulin I gut
hormones. This eases
discomfort# reduces intestinal
fluid# helps with diarrhea.
Nausea# vomiting# diarrhea#
abdominal pain# bloating# flatulence
low fat diet may reduce GI side effects#
possible fat soluble vitamin due to
malabsorption
5mepra8
2ole
6roton 6ump Inhibitor8
(ecreases the amount of
acid made in stomach.
Constipation# gas# nausea# vomiting#
headache# rash# hives# itching#
swelling# difficulty breathing# irregular
heartbeat# di22iness# diarrhea#
Ta;e 'G80G mins ac with acidic Auice or
sprin;led over 1Tbs applesauce followed
with E5. Ca supplement due to reduced
absorption# avoid St. Hohns Lart or
stomach pain# fever ging;o biloba
6rednisone
&
Solu8
medrol
Anti8 inflammatory8 Control
inflammation in intestine in
I9( patients by suppressing
immune system activity.
Eigh blood pressure# increased ris; of
infection# weight gain# acne# mood
swings# high blood sugar# wea;ened
bones# insomnia.
Increase calcium and vitamin ( inta;e to
prevent osteoporosis
6ropofol Given as a sedative to
patients undergoing
endoscopic procedures.
hypotension# bradycardia# agitation#
decrease in pulmonary function
low fat diet and avoid alcohol
Questran&
Cholestyra
mine
9ile acid& salt resin8 9inds
e=cess bile salts# which
worsen S9S. ?educes bile8
salt diarrhea after a small
resection.
belching# nausea# vomiting#
dyspepsia# constipation# drowsiness#
headache
Ta;e before meals with water# non C5
beverage# broth# or pureed fruit 8 N7N7?
dry. Fow fat I chol diet# increase fluids
and fiber. If ta;en long term# fat sol
vitamin I folate suppl.
?eglan&
metoclopra
mide
6ro;inetic agent8 Stimulates
the GI tract w&o stimulating
gastric# biliary# or pancreatic
secretions. *sed to empty
intestines during certain med
proced.
(rowsiness# e=cessive tiredness#
wea;ness# headache# di22iness#
restlessness# diarrhea# urinary
incontinence# flushing# depression#
fever# swelling# vision problems
avoid alcohol# can interfere with (+
patients I insulin re,uirements 8 monitor
Seno;ot S
Seno;ot
7nema8 ?eleases C5 in
the colon# pushing against
the intestinal wall and
causing contractions. This
initiates peristalsis and help
move stool mass along.
?ectal bleeding# blistering# burning#
itching# pain# s;in irritation
+ust receive sufficient fluid inta;e to
prevent dehydration. Increase fiber# fruits#
vegetables# and whole grain.
Glutamine *sed for S9S to ma=imi2e
absorption and protects the
lining of the GI tract.

?# )rie$%y describe t!e anato'y o$ t!e GI tract +'out! to anus, and discuss
en/y'es invo%ved in 5rocess o$ digestion#
Mout!( Chewing reduces the si2e of food particles which mi= with ptyalin !salivary amylase$ en2yme which
hydroly2es CE5 into de=trin"s and prepares the food for swallowing.
Eso5!agus( Transports food and li,uid from the mouth and pharyn= to the stomach
Sto'ac!( @ood is mi=ed with pepsin which hydroly2es peptide bonds to produce polypeptides and amino acids.
Gastric lipase brea;s down fat to produce free fatty acids.
1ancreas( The pancreas secretes en2ymes and hormones involved in digestion including%
Cholesterol esterase8 hydroly2es cholesterol to form esters of cholesterol and fatty acids
Alpha8amylase8 hydroly2es starch to form de=trin"s and maltose
Trypsin and chymotrypsin8 hydroly2es peptide bonds to form polypeptides
7sterase and Carbo=ypeptidase8 hydroly2es peptide bonds to form amino acids
?ibonuclease and deo=yribonuclease8 Eydroly2es ?NA and (NA to form mononucleotides
S'a%% intestine( The first 1GGcm of the small intestine is where the maAority of digestion and absorption of food
occurs via en2ymes from the brush border.
6eptidases% Eydroly2es polypeptides into amino acids.
<inase% Activates trypsin to hydroly2e proteins in polypeptides.
Sucrase% Eydroly2es sucrose to form glucose and fructose
(e=trinase and maltase% Eydroly2es de=trin or maltose to form glucose
Factase% Eydroly2es lactose to form glucose and galactose
Nucleotidases% Eydroly2es nucleic acids to form nucleotides
Nucleosidase and phosphorylase% Eydroly2es nucleosides to form purines# pyrimidines# and
pentose phosphate.

3o%on> Rectu'> Anus( The colon does not secrete en2ymes for digestion
?eference%
9eyer 6F. Inta;e% (igestion# Absorption#Transport# and 7=retion of Nutrients. . In +ahan <F# 7scott8Stump S# ?aymond HF eds.
<rause"s food I the nutrition care process. St. Fouis# +5% 7lseiver and Saunders:G1%813.
@# Diagra' t!e sites o$ absor5tion o$ 'acro and 'icronutrients and $%uid#
Sto'ac!( In the stomach# only alcohol is absorbed
S'a%% intestine% +ost absorption ta;es place in the small intestine via brush border en2ymes. In the duodenum%
iron# calcium# magnesium# and 2inc are absorbed. In the HeAunum# carbohydrates !glucose# galactose# fructose$#
protein !amino acids# dipeptides# tripeptides$# water soluble vitamins !vitamin C# thiamin# riboflavin# pyrido=ine#
folic acid$# fat soluble vitamins !vitamins A# (# 7# <$# fat# and cholesterol are absorbed. @inally# in the ileum#
vitamin 91 and bile acids !which help in the absorption of fat soluble vitamins$ are absorbed.
3o%on<Large intestine( Almost all of the macronutrients# minerals# vitamins and trace elements# and fluid are
absorbed before reaching the colon. Eere# most of the remaining fluid is absorbed and the colon also absorbs
electrolytes and small amounts of remaining nutrients.
Anus( defecation
?eference%
9eyer 6F. Inta;e% (igestion# Absorption#Transport# and 7=retion of Nutrients. . In +ahan <F# 7scott8Stump S# ?aymond HF eds.
<rause"s food I the nutrition care process. St. Fouis# +5% 7lseiver and Saunders:G1%813.
A# Discuss t!e ro%e o$ 'acro and 'icronutrients $or &ound !ea%ing#
5verall nutrition status !proper amounts of protein# carbohydrate# fats# vitamins# I minerals$ is important for
ensuring wound healing. There is an increase in energy needs of -8'-;cal&;g depending on stage of wound.
@luid needs increase !'GmF&;g body weight# or 1mF&;cal$ to maintain blood flow to wounded tissue. 6rotein needs
also increase in order for repair and maintenance of collagen and other structural components.
?ecommendations are 1.81.-g&;g body weight depending on stage of wound and ;idney function. Ade,uate fat
inta;e !R'G;cals$ is needed to provide sufficient energy to the wound and to provide the substrate for the many
roles of fat by8products# including the components of free fatty acid on wound inflammation and wound cell
proliferation. Supplementation of fat soluble vitamins A# C# and 7 is important to promote healing. Sinc
supplementation is also encouraged if patients are not receiving 1-8-mg&day.
?eferences%
1. @riedrich F. Nutrition and Lound Eealing% @rom the <itchen to the 6harmacy. Dietary Managers Association. Available
at% http%&&www.anfponline.org&7vents&11Annual/handouts&lfriedrich/nutritionLoundEealing.pdf. Accessed +arch 1# G1).
Lild T# ?ahbarnia A# <ellner +# Sobot;a F# 7berlein T. 9asics in nutrition and wound healing. Nutrition. G1G:0!4$%308300.Acessed
+arch '# G1)
(emling ?E. Nutrition# anabolism# and the wound healing process% an overview. Eplasty. GG4:4%e4. Accessed +arch '# G1)
B# W!at is t!e i'5ortance o$ t!e i%eoceca% va%ve in t!e $unctioning o$ t!e GI tractC
The ileocecal valve functions to limit the amount of intestinal material that is passed bac; and forth from the small
intestine to the colon. Lhen the valve is damaged or is not functioning# significant amounts of fluid and substrate
can enter into the colon and increase chances of microbial overgrowth in the small intestine.
?eference%
9eyer 6F. Inta;e% (igestion# Absorption#Transport# and 7=retion of Nutrients. . In +ahan <F# 7scott8Stump S# ?aymond HF eds.
<rause"s food I the nutrition care process. St. Fouis# +5% 7lseiver and Saunders:G1%813.
D# De$ine du'5ing syndro'e and nutritiona% i'5%ications# Out%ine diet
reco''endations to 5revent < treat du'5ing syndro'e#
(umping syndrome is when e=cessive ,uantities of hypertonic foods and li,uids are released into the pro=imal
small intestine before digestion ta;es place.
1
It occurs as a result of surgical procedures that allow large amounts
of li,uid or solid to enter the small intestine in concentrated form. 7arly dumping syndrome occurs 1G to 'G
minutes after a meal and results from rapid movement of fluid into the stomach followed by a sudden addition of
large amounts of food from the stomach. Fate dumping syndrome occurs to ' hours after a meal and results
from rapid movement of sugar into the intestine# raising the body"s blood glucose and causing the pancreas to
increase insulin release. The increased insulin release results in hypoglycemia !low blood sugar$.
1
Symptoms
include% severe abdominal pains or cramping !due to the distention of the small intestine$# nausea# vomiting#
di22iness# fatigue# e=cessive sweating# and some may e=perience fainting.

Recco'endations(
6

Small# fre,uent meals
Fess solid and more crushed foods
Fimit fluid inta;e during meals
Inta;e fewer simple sugars
Increase comple= carbohydrate inta;e
Increase fiber inta;e !to slow transit time$
Fying down immediately after meals
Increasing the amount of fat in the diet
Factose8free foods if lactose8intolerant
?eference%
National Institute of Eealth. National (igestive (iseases Information Clearinghouse !N((IC$. (umping Syndrome.
http%&&digestive.nidd;.nih.gov&ddiseases&pubs&dumping syndrome&inde=.asp=http%&&digestive.nidd;.nih.gov&ddiseases&pubs&dumping8
syndrome&inde=.asp=. Accessed Huly 1G#G1).

(escher N# <renits;y HS. +edical Nutrition Therapy for upper Gastrointestinal Tract (isorders. In +ahan <F# 7scott8Stump S#
?aymond HF eds. <rause"s food I the nutrition care process. St. Fouis# +5% 7lseiver and Saunders:G1%-480G4.
"E# Discuss $at 'a%absor5tion> $eca% $at test +Fua%itative and Fuantitative,> and ro%e
o$ M3. oi%# De$ine diarr!ea#
@at malabsorption occurs when there is not enough healthy absorptive area# insufficient production of bile acids or
pancreatic en2ymes to properly absorb fat or other nutrients in the small intestine.
1
@at malabsorption results in
e=cess fat remaining in the stool or steatorrhea. Common symptoms of steatorrhea include diarrhea and stomach
cramps. (iarrhea is characteri2ed by abnormally fre,uent evacuation of semisolid or fluid fecal matter# usually
e=ceeding 'GGml from the bowel. (iarrhea is accompanied by an e=cessive loss of fluid and electrolytes.
1

The fecal fat test measures the amount of fat in the stool# and thereby helps to estimate the percentage of dietary
fat that does not get absorbed in the body.

In other words it helps to determine how well the liver# gallbladder#

pancreas# and intestines are wor;ing.
Gua%itative > A ,ualitative fecal fat test is conducted by ta;ing a suspension of stool placed on a glass slide#
treating it with a special stain# and then e=amining it under the microscope to detect the presence of fat droplets.
Guantitative- If the ,ualitative fecal fat test is negative# then a 18hour ,uantitative fecal fat test is ordered. This
better evaluates fat digestion and absorption because% 1$ The person being tested is re,uired to ingest a
moderately high amount of fat per day before and during sample collection so that their absorption ability can be
Cchallenged# $ @at is not e=creted at a constant rate in the stool therefore# the combination and mi=ing of the stool
within a 18hour collection period gives a more accurate picture of average absorption and e=cretion than a single
sample.

+CT !medium chain triglyceride$ oil is ta;en as a medication in tablespoon amounts.
'
It is given to patients with
fat malabsorption to add to caloric inta;e and serve as a vehicle for lipid soluble nutrients. +CT oil provides
around 1cals&gram# replacing the 4cals&gram lost due to malabsorption of fat. 9ecause +CT"s are rapidly
o=idi2ed# rendering many ;etone bodies# they supply a ,uic; source of energy. +CT oil does not re,uire bile for
emulsification# and can be better tolerated.
'
?eference%
1. (escher N# <renits;y HS. +edical Nutrition Therapy for lower Gastrointestinal Tract (isorders. In +ahan <F# 7scott8Stump S#
?aymond HF eds. <rause"s food I the nutrition care process. St. Fouis# +5% 7lseiver and Saunders:G1%01G80)'
. National Institute of Eealth. *S National Fibrary of +edicine.+edline 6lus.
http%&&www.nlm.nih.gov&medlineplus&medlineplus.html. Accessed on Hune )# G1).
'. 9ach AC# 9abayan N<. +edium8chain triglycerides% an update. Am J Clin Nutr.143:'0!-$%4-G840.
""# W!at is intrinsic $actor and &!at GI 5rocedures !ave an e$$ect on its ro%eC
Intrinsic factor is a glycoprotein found in the gastric Auices that helps the intestines to absorb 91 from the diet. I@ is
secreted by the parietal cells of the stomach. (uring digestion# stomach acids release vitamin 91 from food and
I@ binds to the vitamin 91 allowing it to be absorbed at a specific segment of the small intestine. Lithout and
ade,uate amount of I@# vitamin 91 absorption is decreased and the body is unable to produce enough normal red
blood cells# leading to anemia. Individuals who undergo bariatric surgery are at increased ris; for developing
pernicious anemia !unsuccessful absorption of vitamin 91$. 9ariatric surgery# and other gastrectomy procedures#
can half I@ production.
?eference%
Fab Test 5nline. http%&&labtestsonline.org&. Accessed on Hune )# G1)
"6# 3o'5are and contrast t!e Gastric La5)and> Gastric S%eeve and Gastric )y5ass
Surgeries# )e sure to inc%ude 'edica% di$$erences> vita'in<'inera% concerns>
MN.> side e$$ects> etc# )e t!oroug!#
Type 6rocedure

vit&min
1#'
Supplement
1#'
Side
1#'
effects&complications
Fap9an
d
A band is placed around the upper part of the
stomach to create a small pouch to hold food.
The band limits the amount of food that can be
eaten by ma;ing the individual feel full after
eating small amounts of food. The band can be
adAusted by the surgeon to allow for faster
passage of food or slower passage through the
digestive system.
folate# Nit
91#
thiamine
!91$# bone
loss
1 multivitamin
per day# 1 daily
Ca supplement
dumping syndrome# pressure or
fullness# nausea# vomiting
anastomosis lea;age# pneumonia#
pulmonary embolism# band slippage#
band erosion
Gastric
Sleeve
6art of the stomach is removed and a new#
tube8shaped stomach# or Csleeve#D is made. A
more radical procedure than gastric band that
is irreversible and cannot be adAusted. It wor;s
by reducing stomach si2e and restricting the
amount of food able to be eaten at a time.
Nit 91# Ca
citrate&
bone loss#
iron#
thiamine
!91$
multivitamins
per day# 1 daily
calcium
supplement
dumping syndrome# pressure or
fullness# nausea# vomiting#
Gastric
9ypass
A cut is made across the top of stomach and
the intestines are rerouted to bypass significant
digestion. A walnut8si2ed !1 o2.$ pouch is sewn
to small intestine# directly going from stomach
to small intestine to digest. This procedure is
e=tremely difficult to reverse and cannot be
adAusted.
iron# calcium
citrate# Nit (#
Nit 91#
folate#
thiamine
!91$
Nit. 91
intramuscular or
sublingual
supplement#
multivit per day#
1 daily Ca
supplement
dumping syndrome# pressure or
fullness# nausea# vomiting
+NT%
'

5ver several days progress from clear to full li,uids. 7nteral feeding with a high protein inta;e will
help to promote healing. 6rovide at least 1GGG;cal&day. 6rotein should be 1.-8.G g&;g&day.
Add semisolid or pureed foods in small amount until weight loss is achieved. Initial gastric
capacity is around 'G80GmF with progression up to -GmF. Three small meals and two snac;s is
best tolerated.
Aim for -G grams protein&day !female$# 1G grams protein&day !male$ per day if possible. 1' gm
protein or more# and 1G gm sugar or less per serving to prevent dumping syndrome Eigh protein
and low8fat foods are best for maintaining lean body mass during weight loss.
Carbohydrate inta;e should be less than 'Gg&meal and a minimum of 1'Gg&day to meet
recommendations.
Chew foods slowly# consume li,uids 'G minutes before or after a meal# not during meals. Avoid
overeating and sit upright while eating and after meals.
Avoid alcoholic beverages# soft drin;s# straws# high8fat foods# and high8carbohydrate foods.
Sip )380) o2&day of li,uid !especially water$ to avoid dehydration.
A daily multivitamin to meet micronutrient re,uirements# and a monthly 91 inAection may be
recommended.
Avoid obstructive foods !popcorn# celery# nuts# seeds# etc.$.
Avoid sugar alcohols to avoid gas# diarrhea# and cramping
CNewD stomachs can only handle 18 o2. food per meal# up to 1 cup when 1 year post op
?eference%
1. Aills F# 9lan;enship H# 9uffington C# @urtado +# 6arrott H. AS+9S Allied Eealth Nutritional Guidelines for the Surgical Leight
Foss 6atient. Surg Obes Relat Dis. GG3:)!- Suppl$%S1'81G3.
. The Fap band System website. Available at http%&&www.lapband.com&compare8lapband. Accessed Huly 1G# G1).
'. 7scott8Stump S. Galbladder (isease. In Nutrition and diagnosis8related care. 1
th
ed. 9altimore +(% Fippincott Lilliams I
Lil;ins:G1%31)831-.