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