Nutrition Management for Patient with Extended Beta Total Gastrectomy with Roux-en-Y Eosophago-jejunostomy with Possible Nutritional Complications of Post-gastrectomy.

24 Jun 2019 10:50 11:00
Aisyah Nabilah Abd Latif Presenter

Aisyah Nabilah AL1, Noor Izati R1, Norashikin R2
1. UiTM 2. Department of Dietetic and Food Service, Hospital Sungai Buloh, Selangor

Assessment: Mr. S, 70-year-old Indian male, referred for poorly differentiated adenocarcinoma of stomach. Patient had undergone operation for extended beta total gastrectomy with Roux-en-Y eosophago-jejunostomy. Patients BMI was 23.9 kg/m2 (underweight for elderly) with height and weight of 1.65m and 65kg. Haemoglobin and red blood cell levels were below normal range while CRP level was above normal range. Patient had 1 liter restriction of fluid (ROF) and was on intermittent pump feeding via nasojejunum. Upon review, patient was given Nutren Diabetes Liquid 40ml/H, 2x/day. The feeding was withheld due to blood transfusion, reflecting his low intake which was 242 kcal energy and 10.8 g protein.

Diagnosis: Inadequate enteral nutrition infusion related to schedule for infusion interrupted as evidenced by inadequate enteral nutrition volume (242 kcal) compared to estimated requirement (1950 kcal).

Intervention: To provide adequate protein and energy intake, thus, 30 kcal energy/kg current body weight/day and 1.3 g protein/kg current body weight/day were prescribed. Since patient had ROF, feeding was changed to Novasource Renal and increased accordingly

Monitoring and Evaluation: Patient tolerated pump feeding well, and was later able to tolerate soft diet together with Novasource Renal as ONS, which planned to help achieve the adequate requirement. The patient was also educated on a post-gastrectomy diet prior to oral feeding to avoid dumping syndrome. The patient was then discharged with ONS to ensure the adequacy of intake, T. Folic Acid 5 mg OD and IM Cyanocobalamin 1mg for every 3 months for first 2 years to prevent anaemia, with further planning for adjuvant chemotherapy. Discussion: Post-gastrectomy may cause nutritional complications such as Dumping Syndrome, anaemia, and weight loss. Dietary management is the key therapy to these complications. Therefore, proper education about dietary modification and supplementation are crucial. Learning Points: Compliance to post-gastrectomy dietary prescription is crucial to prevent possible complications that may arise

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