Total Gastrec tomy

Gastrectomy
Darlene Piper
Darlene Piper
Final C ase Study
Case Study
Illinois StateUniversity
Illinois State University
Unity Point
Unity PointMethodist
Methodist
General Information

 T.H. 52 yom, IBW 185#

 PMH includes COPD, GERD, Esophageal stricture, Cyclic Vomiting
Syndrome, MI
 Total gastrectomy for gastroparesis; acute pancreatitis x 3
 Dates of first admission: September 10-16, Unit 4H
 Dates of second readmission: September 24-30, 2018, Unit 8C
 Dates of third readmission: October 4-11, 2018, Unit 4H
 Dates of fourth admission: October 21, 2018, Unit 4H

 Current Attending Physician: Dr. Salimath

Total Gastrectomy

 Definition: Total removal of the stomach

 Complications:
 Dumping syndrome
 Gastric stasis
 Fat maldigestion and lactose intolerance

 Preformed by Peoria Surgical Group, Dr.

Crawford
First Admit

 9/10-16 Admitted for gastroparesis

 Pt vomited daily since 14
 Total gastrectomy
 Wt stable 226# >3 months
 Pt noted he has gained 52# over several months
 Intervention
 J-tube feedings
 Osmolite 1.2 Goal rate 80 mL/hr – 1,840 mL/d, 2,208 kcals, 102 g pro, 1,508 free H2O
 Pt upset about total gastrectomy
 9/13 Not totally willing to accept full Bariatric/TF Diet education education
 Dc/ed prior to proper education
Second Admit

 9/24-30 Admitted for pancreatitis

 Wt 203# - 10% wt loss x 2 weeks
 J tube changed position and was removed
 Intervention
 9/25 Pt received highlights of Gastric Bypass Diet
 9/28 Pt received full education of diet upon diet advancement from NPO to
clears
 Third Admit
 10/4-11 Pt returned with pancreatitis
 Pt wt 190# – 16% x 1 month • Pt dc/ed 10/11 – patient
 10/5 Given Full Gastric Bypass Diet adamant to go home,
claiming his diet would
improve
Intervention
• 600 cal daily average day on
 Calorie count low fat gastric bypass diet (25-
 Pt had outside food brought in 27%)
 Got pt involved, write down what he was eating • Given detailed information
 Spoke about diet and small meals about nutrient needs and
 Comprehension of what small is was in question vitamin/mineral
 Supplements: split in half
supplementation information
 Chugging and straws • Recommended to see
 Lactose issues outpatient Dietitian.
Fourth Admit

 Pt admitted on 10/20 d/t postop complication, chronic pancreatitis, noncompliance, and pain
 Continued poor appetite, consuming very little at home
 Pt 175# ?stated wt – 22.5% wt loss x 5 weeks
 24 hour recall
Fired previous MD, Dr. Crawford and Dr. Salimath now attending physician
 Pureed/ soft diet
 No carbonation, juices, fat restricted

X ray from 10/20

-Mild acute chronic pancreatitis with small fluid and mild benign distal common bile duct stricture
-ERCP cannot be performed d/t gastrectomy
-Currently no obstruction
-Hepaticojejunostomy
Dietetic Intervention

 Pt does not tolerate pills well d/t esophageal stricture

 Does not like taking hycet, had hallucinations, hosp meds worked better–
need to find proper pain control
 10/22 Full detailed Gastric Bypass Diet education
 Food temperatures
 No appetite
 MD approved Ensure (low carb)
 High protein snacks
Sample menu for pureed/soft with portion sizes, measurement conversion
chart, and picture for reference and comparison of measuring cups. Gave him
1 T and 2T measures
Current

Per MD 6 weeks to 6 months for pancreatitis and fluid to subside

Current amylase and lipase trending down
Continued pain management- Fentyl and Reglan

Current Actual Weight: 185# 18% wt loss x 6 weeks

Continued non compliance with diet
 TF in consideration
 Discontinued Ensure d/t emesis
 Protein powder to mix in food
 Calorie count started today
Hindsight

 Noncompliance patient experience

 Comparison
Questions?
Resources

 Radigan, A.E. (2004). Post-Gastrectomy: Managing the Nutrition Fall-Out,

Practical Gastroenterology, series 18.