1 / 26

Providing Nutrition Support after Bariatric Surgery

Providing Nutrition Support after Bariatric Surgery. Presented by: Aja Stokes 12/19/14. Outline of Presentation. Overview of nutrition support Overview of different bariatric surgeries Need for nutrition support after bariatric surgery Medical complications of weight loss procedures.

shawna
Download Presentation

Providing Nutrition Support after Bariatric Surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Providing Nutrition Support after Bariatric Surgery Presented by: Aja Stokes 12/19/14

  2. Outline of Presentation • Overview of nutrition support • Overview of different bariatric surgeries • Need for nutrition support after bariatric surgery • Medical complications of weight loss procedures • Nutritional complications after bariatric procedures • Estimating nutrition needs for the obese bariatric patient • Indicators to assess nutrition support tolerance • Conclusion

  3. Nutrition Support • Nutrition support therapy is needed when patients are unable to eat or take adequate nutrition by mouth, or have GI complications that inhibit the use of the intestinal tract for feeding over an extended amount of time

  4. Nutrition Support cont’d Enteral Nutrition Parenteral Nutrition • EN involves nutrition therapy via nasogastric tube, orogastric tube, gastrostomy, nasoduodenal or nasoenteric, or jejunostomy • PN involves nutrient admixture administered via an IV into the blood with a catheter placed in a vein

  5. Bariatric Surgery • Bariatric procedures promote weight loss through restriction and/or malabsorption • Approved for individuals whose BMI >/= 40 • BMI between 35-40 if accompanied by at least one severe obesity-related comorbidity (i.e., HLD, DM, HTN) • Benefits from surgery include: reduced mortality, increased DM remission, improved beta-cell function, and improved pulmonary function

  6. Bariatric Surgeries cont’d • Roux-en-Y-gastric bypass (RYGB) • Surgeon creates a small gastric pouch with the capacity of 20-30mL from the proximal and attaches it to the roux limb of the jejunum

  7. Bariatric Surgeries cont’d • Laproscopic adjustable gastric band (LAGB) • An adjustable silicone ring fits around the gastric cardia to create a 30mL pouch

  8. Bariatric Surgeries cont’d • Vertical Sleeve gastrectomy • Cutting the antrum of the stomach 2-6 cm away from the pylorus and forming a tubular pouch • Stomach capacity is reduced by about 80 percent through the removal of the fundus and body

  9. Bariatric Surgeries cont’d • Vertical banded gastroplasty • A gastric pouch is created by stapling a vertical line in the upper part of the stomach and placing a band of about 1 cm in diameter at the bottom of the pouch to create a restricted outlet

  10. Bariatric Surgeries cont’d • Biliopancreatic diversion (BPD) • The stomach is horizontally resected into a 200-250mL pouch • The pouch is anastomosed to the jejunum with a long roux limb and a short common limb

  11. Bariatric Surgeries cont’d • Biliopancreatic diversion with duodenal switch (BPD-DS) • The stomach is resected vertically to preserve the pylorus and about 3 cm of the proximal duodenum

  12. Bariatric Surgeries cont’d • Jejunoileal bypass (JIB) • Anastomosis of the jejunum and the ileum resulting in a small area of small bowel for digestion and absorption

  13. Need for Nutrition Therapy after Bariatric Surgery • Indications for EN: • During first 7 days of admission (in well-nourished patients) • Must have functional gastrointestinal tract and ability to safely insert an enteral feeding tube • Enterocutaneous fistula where the enteral feeding tube can be inserted distal to the fistula • Inadequate oral intake to meet metabolic demands (i.e., trauma, burn, or other critically-ill patients) • Significant malnutrition

  14. Need for Nutrition Therapy after Bariatric Surgery cont’d • Indications for PN: • Inability to take oral or enteral nutrition for >7-10 days (5-7 days in ICU setting) • Entercutaneous fistula where the enteral feeding tube can not be inserted distal to the fistula • Ileus • Intestinal obstruction • Intractable vomiting • Intractable diarrhea • Severe gastrointestinal bleeding • Severe malabsorption • Severe malnutrition with inability to obtain enteral access • Contraindication to enteral nutrition • Poor tolerance to enteral nutrition

  15. Medical Complications EN Nutrition Complications • Abdominal bloating • Aspiration • Constipation • Dehydration • Diarrhea • Electrolyte disturbances • Feeding tube clog • High gastric residuals • Hyperglycemia • Infection around tube insertion site • Vitamin and mineral deficiency

  16. Medical Complications cont’d PN Nutrition Complications • Catheter-related blood stream infection • Dehydration • Electrolyte disturbances • Essential fatty acid deficiency • Hyperglycemia • Hypoglycemia • Intestinal atrophy • Metabolic bone disease • Parenteral nutrition-associated liver disease • Volume overload • Vitamin and/or trace element deficiencies or excess

  17. Medical Complications cont’d RYGB LAGB • Gastric remnant distention • Anastomotic leak • Anastomotic stenosis • Marginal ulcer • Hernia • Cholelithiasis • Dumping syndrome • Lowest risk for morbidity, readmission, and reoperation or intervention • Band slippage • Erosion • Esophageal dilatation • Obstruction • Mechanical issues with the hardware

  18. Medical Complications cont’d Vertical Sleeve Gastrectomy BPD/BPD-DS • Gastric bleeding • Gastric stenosis • Gastric leak and reflux • Cirrhosis • Malabsorption • Malnutrition • Nephrolithiasis

  19. Nutritional Complications • Nutrition-related complications occur in about 30% of patients

  20. Estimating Nutrition Needs • Calculating energy needs • Hypocaloric feeding • 11 to 14 kcals/kg ABW • 22 to 25 kcals/kg IBW

  21. Estimating Nutrition Needs cont’d • Calculating protein needs • 2.0g/kg IBW if BMI= 30 to 39.9 • 2.5g/kg IBW if BMI >/= 40 • Calculating fluid needs • No recommendations provided by SCCM/A.S.P.E.N. • Minimum requirement is generally 1.5 L/day

  22. Indicators to assess nutrition support tolerance • Lab measures • Fasting glucose • CRP • Prealbumin • Electrolytes • Nitrogen balance • Weight Trends • Gastric residuals • Adequate wound healing • Functional status

  23. Conclusion • EN and PN are not often used in the bariatric surgery patient • In general, • Protein intake between 2-2.5g/kg (depending on BMI) • Wound healing • Builds muscle • Maintain lean body mass • Muscle burns calories • May help prevent hair loss • Fights infection • Daily supplementation (MVI, iron, B12, calcium, vitamin D)

  24. Conclusion cont’d • Nutrition intervention should be individualized for patients who have undergone bariatric surgery not only in consideration of obesity, but also due to altered gastrointestinal anatomy • RD should work with surgical team to create a nutrition plan to stabilize the patients nutrition status

  25. References Fujioka, K., DiBaise, J. K., and Martindale, R. G. (2011). “Nutrition and Metabolic After Bariatric Surgery and Their Treatment.” Journal of Parenteral and Enteral Nutrition; 35, 52S-59S Kerner, Jennifer. (2014). “Nutrition Support After Bariatric Surgery.” Support Line: A Publication of Dietitians in Nutrition Support; 36(3), 9-21 Mogensen, Kris M. (2010). “Nutrition Support Therapy for the Bariatric Patient.” Weight Management Matters; 7(3), 8-16

More Related