Nutritional Management of the Surgical Patient

ISBN-13: 9781119809098 / Miękka / 2023

Phillips

Spis treści

Contributors xvSection 1 Introduction 1Chapter 1 Introduction 3Section 2 Before and During Surgery 5Chapter 2 Nutrition Screening and Assessment 7Sara SmithOverview of Body Composition 8Nutrition-Related Syndromes 8Nutrition Screening 8Nutrition Assessment 12References 14Chapter 3 Nutritional Considerations Prior to Surgery 17Oonagh GriffinMalnutrition and Sarcopenia 18Incidence 18Impact of Malnutrition and Sarcopenia on Surgical Outcomes 19Malnutrition 19Sarcopenia and Sarcopenic Obesity 19Pre-operative Nutritional Treatment Strategies 20Carbohydrate Loading 20Liver Shrinkage Diets 20Priorities For Future Research 21References 21Chapter 4 Prehabilitation Programmes and Their Impact on Surgical Outcomes 25Helen McNamaraA Brief History of Prehabilitation 25Defining Prehabilitation 26Stratified Care and Prehabilitation 26Enhanced Recovery After Surgery and Prehabilitation 27Holistic and Person-Centred Approaches To Prehabilitation 27Psychological Preparation 28Prehabilitation to Support Behaviour Change 28Frameworks for Prehabilitation 28Prime Prehabilitation for Surgery at The Royal Surrey Hospital Foundation Trust 28Interventions of Prime Prehabilitation 29Group Programmes 29One-to-One Consultations 29Home Exercise Programmes 29Friends and Family 29Nutritional Support 29Peer Support 30Prime Outcome Data 30Conclusion 30References 31Chapter 5 Enhanced Recovery after Surgery 33Neil Bibby, Rebekah Lord, and Ashleigh MaskeEarly Oral Feeding 35Nutritional Support and Oral Nutrition Supplements 36Enteral Nutrition 36Immuno-nutrition 37References 40Chapter 6 Surgical Terminology and Pre-operative Considerations: A Guide for Non-Surgeons 42Rajiv LahiriSurgical Descriptors 42Key Suffixes in Surgical Terminology 42Terms to Explain Positioning 43Pre-operative Considerations 43Prehabilitation 46Assessing Surgical Risk 46Emergency Patients 46High-Risk Patients 47Intra-operative Risk Assessment 47Post-operative Complications 48Fistula 48Collections 48Anastomotic Leak 48Chyle Leak 49Conclusion 49Acknowledgements 49References 49Chapter 7 Operating on the Malnourished Patient 51Katy O'Rourke and Chris JonesAnaemia 51Electrolyte Abnormalities 53Sodium 53Potassium 55Calcium 55Magnesium 56Phosphate 56Refeeding Syndrome 57Hyperglycaemia 60Impact of Body Habitus on Anaesthesia 61Obesity 61Consequences of Obesity during Anaesthesia 61The Underweight Patient 61Consequences of Malnutrition during Anaesthesia 61References 64Section 3 Impact of Surgery 67Chapter 8 Nutritional Management of the Surgical Patient in Critical Care 69Nárbhla Donnelly and Anne LanganMetabolic Response to Stress 70Feeding The Post-operative Surgical Patient in Critical Care 70Enteral Nutrition 71Parenteral Nutrition 72Feeding While Receiving Inotrope and Vasopressor Support 72Nutritional Targets 73Determining Energy Targets 73Protein Targets 74Areas for Future Research/Questions Unanswered 75Acknowledgements 79References 79Chapter 9 Nutritional Management of Patients Undergoing Head and Neck Cancer Surgery 83Cathy SkeaHead and Neck Cancers 83Laryngeal Cancer 84Hypopharyngeal Cancer 85Oropharyngeal Cancer 85Oral Cavity Cancer 85General Nutritional Implications Following Surgical Intervention 85Surgical Procedures 86Glossectomy 86Total Laryngectomy 86Pharyngo-Laryngo-Oesophagectomy 86Methods of Post-operative Nutritional Support 87Early Oral Feeding 87Enteral Feeding 87Route of Delivery 87Choice of Formulae 87Parenteral Nutrition 87Post-operative Complications and their Nutritional Management 88Fistulae/Wound Breakdown 88Dysphagia Due to Delayed Wound Healing Resulting in Dysphagia 88Pseudo-epiglottis 88Nasal Regurgitation/Gastro-oesophageal Reflux 88Chylous Fistula (Chyle Leak) 89Long-Term Management of Oesophageal Strictures 89References 95Chapter 10 Cardiothoracic Surgery and Nutrition 97Rupal Patel and Ann-Marie NixonOverview of Surgical Procedures 97Cardiac 97Cardiopulmonary Bypass 98Coronary Artery Bypass Grafting 98Valve Replacement Surgery 98Aortic Surgeries 98Thoracic Surgery 98Cardiothoracic Transplant 99Nutritional Implications 99Cardiac Surgery 99Fluid Management 99Thoracic Surgery 100Cardiothoracic Transplant 100Body Composition and Weight Management 100Food Safety 100Complications 100Gut Ischaemia 100Vocal Cord Palsy 101Chylothorax 101Parenteral Nutrition 102Octreotide 102Monitoring 102Surgical and Radiological Interventions 102Long-Term Management 102Cardioprotective Diet and Weight 102Cardiac Rehabilitation 102Long-Term Post-Transplant Complications 103Hypertension, Dyslipidaemia, and Diabetes 103Chronic Kidney Disease 104Osteoporosis and Vitamin D 104Further Research 107References 108Chapter 11 Nutritional Management of the Surgical Patient: Oesophago-gastric Surgery 110Charles Rayner and Fiona HuddyCommon Operations and Their Anatomy 111Oesophagectomy 111Gastrectomy - Total or Subtotal 112Nutritional Optimisation and Prehabilitation 112Post-operative Nutrition Support 113Dietary Reintroduction 114Nutritional Management of Early Complications 114Anastomotic Leak 114Chyle Leak 115Post-operative Ileus 115Adjuvant Oncological Treatments 115Nutritional Management of Late Complications 115Poor Oral Intake and Anorexia 115Dysphagia Due to Anastomotic Stricture 116Dumping Syndrome 116Malabsorptive Syndromes 117Pancreatic Exocrine Insufficiency 117Small Intestinal Bacterial Overgrowth 117Bile Acid Malabsorption 117Micronutrient Deficiencies 117References 120Chapter 12 Endoscopic Procedures and Their Implications for Nutrition 123John S. LeedsEndoscopic Procedures 124Endoscopic Retrograde Cholangiopancreatography 124Endoscopic Ultrasound 124Cyst Drainage and Necrosectomy 125Biliary Access and Drainage 125Facilitation of Endoscopy in Patients with Surgically Altered Anatomy 126Endoscopic Ultrasound-Guided Gastroenterostomy 126Oesophageal Stent 126Endoscopic Insertion of Feeding Tubes 126Duodenal Stent 127Complications 127Managing Duodenal Perforation 128Long-Term Management 128References 130Chapter 13 Pancreatitis 132Mary E. PhillipsTypes Of Pancreatitis 132Acute Pancreatitis 132Chronic Pancreatitis 133Acute on Chronic Pancreatitis 133Surgical Procedures for Acute Pancreatitis 133Drainage of Collections/Necrosectomy 133Embolisation 134Laparoscopic Cholecystectomy 134Other Surgical Procedures 134Surgical Procedures for Chronic Pancreatitis 134Nutritional Management of Acute Pancreatitis 134Timing of Nutritional Intervention 134Route of Feeding 134Formulation of Enteral Feed 135Probiotics 135Oral Diet 135Pancreatic Exocrine Insufficiency 135Diabetes 136Lifestyle Advice 136Nutritional Management of Chronic Pancreatitis 136Nutritional Assessment 136Oral Diet 137Tube Feeding 137Pancreatic Exocrine Insufficiency 137Diabetes 137Lifestyle Advice and Long-Term Follow-Up 137References 138Chapter 14 Pancreatic Resection 141Alessandro Parente, Sarah Powell-Brett, and Keith J. RobertsOverview of Surgical Procedures 141Pancreatico-duodenectomy 142Distal Pancreatectomy 142Total Pancreatectomy 142Central Pancreatectomy 142Drainage Procedures 143Impact of Pancreatic Resection on Nutrition 143Pre-operative Malnutrition and Pancreatic Exocrine Insufficiency 143Post-operative Pancreatic Exocrine Insufficiency 143Consequences of Pancreatic Exocrine Insufficiency and Malnutrition Following Pancreatic Resection 144Other Nutritional Considerations 145Common Post-operative Complications and Their Nutritional Management 145Post-Pancreatectomy Haemorrhage 145Delayed Gastric Emptying 145Post-operative Pancreatic Fistula 145Bile Leak 146Chyle Leak 146Long-Term Management 146Diabetes after Pancreatic Surgery 146Pancreatic Enzyme Replacement Therapy 146References 149Chapter 15 Liver Resection 153Nabeel Merali and Adam FramptonLiver Physiology and Anatomy 153Pre-operative Care 154Embolisation 154Pre-operative Nutrition 154Surgery 155Indications for Surgery 155Contraindications to Surgery 155Operative Description 155Post-operative Care 156Post-operative Nutritional Support 156Post-operative Complications 156Ascites 156Ileus 156Haemorrhage 157Bile Leak 157Bile Reinfusion 157Liver Failure 157Small-for-Size Syndrome 158Conclusion 158References 160Chapter 16 Nutritional Management of the Urological Surgical Patient 162Gregory J. Nason, Wissam Abou Chedid, Matthew J.A. Perry, and Krishna PatilOverview Of Surgical Procedure 162Enhanced Recovery after Surgery and Prehabilitation 163Impact On Nutrition 164Pre-operative Nutritional Support 164Post-operative Nutrition 165Common Post-operative Complications and Their Nutritional Management 165Ileus 165Metabolic Acidosis 165Areas for Future Research 166References 166Chapter 17 Colorectal Surgery 169Mary E. Phillips and Jeremy R. HuddyPresentation and Aetiology 169Colorectal Cancer 170Inflammatory Bowel Disease 170Other Colorectal Conditions 173Small Bowel Conditions 173Surgical Procedures 174Nutritional Management in the Peri-operative Setting 174Stoma Management 174High-Output Stoma 175Low-Residue Diet 175Ileus 175Short Bowel Syndrome 175Long-Term Complications 176Kidney Stones 176Bile Acid Malabsorption 176Low Anterior Resection Syndrome 176Pouchitis 176Conclusion 176References 176Chapter 18 Nutritional Management of Gynaecological Cancer Patients 178Thanuya Mahendran, Maria Ashworth, Mary E. Phillips, and Jayanta ChatterjeeDietary Contribution to Gynaecological Malignancies 178Pre-operative Malnutrition 179Pre-operative Nutritional Support 179Immuno-nutrition 180Overview Of Surgical Procedures 181Endometrial Cancer 181Cervical Cancer 181Ovarian Cancer 181Primary Debulking Surgery 181Interval Debulking Surgery 181Primary or Interval Debulking Surgery with Bowel Resection and Stoma Formation 182Bowel Obstruction and Palliative Resection 182Post-operative Complications and Impact on Nutrition 182Chyle Leak 183Short Bowel Syndrome 183Conclusion 183References 184Chapter 19 Major Trauma and Surgery 187Jennifer Wetherden and Evanna LeavyPhysiological Response to Injury 188Routes of Nutrition 188Nutritional Requirements 189Overview of Trauma Injuries and Surgeries 189Patient and Injury Characteristics 189Types of Injury 189Types of Surgery 190Abdominal Trauma 190Maxillofacial Trauma 191Chest Trauma and Thoracic Surgery 191Orthopaedic Surgery 191Common Post-operative Complications and Their Nutritional Management 192Paralytic Ileus 192Nutritional Losses 192Long-Term Nutritional Barriers and Complications 192Impaired Mobility 192Weight Management 193Micronutrients and Wound Healing 193Areas For Future Research 193References 196Section 4 Consequences of Surgery 199Chapter 20 Bowel Obstruction and Dysfunction in Benign and Malignant Disease 201Lindsey Allan and Naomi WestranParalytic Ileus 201Diagnosis and Incidence 201Causes and Risk Factors 202Management 203Bowel Obstruction 203Causes and Incidence 203Diagnosis 204Surgical Management 204Nutritional Management 204Areas for Future Research 206References 206Chapter 21 Intestinal Failure and Rehabilitation 210Alison CulkinManagement 211Sepsis 211Nutrition Assessment 211Nutrition Support 212Fluid and Electrolytes 213Parenteral Nutrition 213Enteral Nutrition 213Oral Nutrition 214Anatomy 215Surgical Management 215Prehabilitation 215Long-TermNutritional Consequences 215Renal Issues 215Intestinal Failure-Associated Liver Disease 216Micronutrient Deficiencies 216Areas for Future Research 216References 218Chapter 22 Nutritional Biochemistry in the Post-operative Patient 220Callum LivingstoneTrace Elements 221Zinc (Zn) 221Copper (Cu) 225Selenium (Se) 226Manganese (Mn) 226Iron (Fe) 227Vitamins 227Thiamine (Vitamin B1) 231Vitamin B12 (Cyanocobalamin) 231Folate 231Vitamin A 232Vitamin D 232Vitamin E 233Conclusion 234References 235Section 5 Consolidate Your Learning 239Chapter 23 Test Yourself 241Index 245

O autorze

Mary E. Phillips, OStJ BSc (Hons), RD DipADP is an Advanced Clinical Practitioner and Senior Specialist Dietitian in Hepato-Pancreatico-Biliary Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK.