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Gastrectomy (The types (Bariatric/metabolic procedures (Restrictive…
Gastrectomy
What is it?
Removal or partial removal of stomach
The types
Mid gastrectomy
NIS think reduced mech action of stomac
Distal gastrectomy
NIS think dumping symdrome
Proximal gastrectomy
NIS think reflux/heartburn
Total gastrectomy
Oesophagus directly into duodenum/jejunum
Bariatric/metabolic procedures
Roux-en-Y gastric bypass
Vertical gastrectomy with duodenal switch
Restrictive procedures
Gastric adjustable band
Gastric sleeve
Who for?
Ulcers
Cancers
Wt loss
May be in conjuction with chemo/XRT
Nutritional goals
Maintain/improve nutritional status in the postoperative period
Assist to minimise postoperative symptoms
Maintain/improve nutritional status in the preoperative period
Nutritional Mgt
Individual tolerance for food items varies
Manage dumping symdrome
Symptoms of dumping sydrome
Early dumping (<30mins postprandial)
GI symptoms
Diarrhoea
Nausea
Bloating
Borborygmus (GI noise)
Abdo pain
Vasomotor symptoms
Flushing
Palpitations
Perspirations
Tahycardia
Hypotension
Syncope
Late dumping (1-3hrs postprandial)
Hypoglycemia
Palpitations
Perspiration
Hunger
Weakness
Confusion
Syncope
Manage symptoms through:
Avoid high sugar foods/fluids
Postural considerations
Fluids separate from meals
Limit alcohol
Small, frequent meals
15g guar gum/pectin with meals
Slows gastric emptying
Some pts develop lactose intolerance so low lac diet
Monitor for vit/min deficiencies - B12, Fe, Ca