GI Surgeries Activity by Digital Education @ CTLM https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj The purpose of this assignment is to create a space where you can share your thoughts with your classmates and your instructor. While many of us are practicing dietitians, it’s good to be exposed to areas that we may not know a lot about, or get a refresher on a topic. By sharing what you learned, or asking about what is not clear is a good way to just exchange information, and remind oneself that there is always more room to grow/learn. If you see a question, that you can answer of your classmates, please do so! Sharing a tidbit about something you have found successful in practice in regards to nutritional management of GI surgeries (i.e. foods to avoid, or food to slow down output, etc.) can always be helpful, and good to add a new “tool” to our “tool kits”. To add your comments for each prompt, click the plus sign (+) below each column. ADD YOUR NAME at the end of your post to get credit for your work. en-us 2021-09-02 16:38:18 UTC 2025-10-12 11:25:54 UTC hello@padlet.com Post Gastrectomy Diet Education https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1852479757 Hello Classmates!   For this assignment, I chose to share a tidbit of practice knowledge that I have found when providing MNT to post-gastrectomy patients.  I have taught the post-gastrectomy diet for more than three decades.  When I teach this diet, I emphasize the importance of eating small frequent meals/snacks including protein-rich foods, avoiding foods high in concentrated sugars, and limiting liquid intake to 4 ounces at mealtimes, consuming additional fluids between meals.   Since, I like to provide my patients with the most up to date information possible, I decided to look for post-gastrectomy diet information from other websites.  One of the best handouts, I came across was one called “Eating After Your Gastrectomy” from Memorial Sloan Kettering Cancer center.  https://www.mskcc.org/cancer-care/patient-education/eating-after-your-gastrectomy.  This handout provides very comprehensive information including recommendations for B12 supplements, lactose intolerance, portion sizes, strategies for dining out, label reading, and six days’ worth of sample menus.   Reviewing this handout made we realize something that I wasn’t including in my MNT – the fact that soluble fibers are beneficial in managing diarrhea.   I realized that prior to this my teaching was focused on the type of carbohydrates that cause dumping syndrome (concentrated sweets) and not on how foods such as bananas, peanut butter, and oatmeal, can help control the diarrhea associated with dumping syndrome, which I now plan to address when I teach this diet.  In the near future, I hope to update my institutions handout to include recommendations I learned from the Memorial Sloan Kettering Cancer center.  
-Karen Brokken RD CNSC 
 
]]> 2021-10-28 22:10:35 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1852479757 https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1859801861 Jill Endres - Are there good guidelines for the nutrition management of uncomplicated colostomies?  Other than liberating salt intake, maintaining hydration, and watching gas-producing foods, do you make any recommendations for these patients beyond those for the general population?  Probiotics?   Sloan Kettering has a nice resource for patients. Diet Guidelines for People With a Colostomy | Memorial Sloan Kettering Cancer Center (mskcc.org)

]]> 2021-11-01 20:27:18 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1859801861 https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1863236297 Hi Jill,
 
On any given month I typically have 4-5 patients who are s/p ostomy surgery-about ½ of which have had colostomies.   When I counsel them, I emphasize the importance of chewing their food well as it is well known that hard to chew foods can cause blockages of the ostomy At my facility, we have access to the Academy of Nutrition and Dietetics’ (AND) Nutrition Care Manual, and, I noted that about eight months ago, they posted a new handout on colostomy nutrition therapy (prior to that their only ostomy handout posted was for ileostomies).    The AND handout for colostomy makes no mention of the need to increase dietary sodium intake.  I think this is something that is not much of an issue with colostomies, but it is a significant issue for ileostomies.   The handout does recommend a fluid intake of between 8 to 10 cups per day with higher amounts recommended during hot weather.   AND also advises people with ostomies to eat their largest meal in the middle of the day to decrease stool output at night and promote a good night’s sleep and that missing meals causes the intestine to be more active and increase gas and watery stools.   The colostomy patient is advised to try one new food every three days and to keep a journal recording how the food was tolerated.   If the food is bothersome, it recommends avoiding it for 2-3 weeks and then trying it again in smaller amounts.   Regarding vitamin and mineral supplements, it suggests not to use “gummy” supplements as they are not absorbed as well as chewables, suggesting that a daily multivitamin with minerals and a chewable or liquid calcium supplement be taken daily (although the amount of calcium is not specified).   Regarding fiber, the handout says to avoid high fiber foods right after surgery as the bowel is swollen and avoiding fiber will help it heal.    The fiber restricted diet plan should provide no more than 13 grams/day.   Once the bowel is healed, it recommends to gradually introduce high fiber foods into the diet.  Foods that may discolor stools include beets, foods with red dye, asparagus, broccoli and spinach.    Foods that help relieve odor include buttermilk, cranberry juice, yogurt with active cultures, and parsley.    When I counsel patients, I tell them that no two ostomy patients are exactly alike with what they can tolerate and that it is a matter of paying attention to what you are eating and the symptoms you experience after eating.  Hope this is helpful!  - Karen Brokken RD CNSC   
]]> 2021-11-03 01:31:54 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1863236297 Whipple surgery https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1866292677 Hello! I have previously heard of the Whipple surgery and knew it was a very high-risk, extensive procedure involving the pancreas, but I never knew many of the details regarding the surgery itself. I did not realize just how much was removed (parts of stomach, duodenum, jejunum, lymph nodes, head of pancreas, common bile duct, gallbladder). Because of this, it makes sense that one would experience issues such as delayed gastric emptying, dumping syndrome, DM, lactose-intolerance, PEI, and micronutrient malabsorption). -Kelsey Eisner]]> 2021-11-04 02:04:47 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1866292677 I learned a lot from this module! In terms of ostomies, I hadn’t known that there were multiple types of ostomies that could be created; the double barrel technique of creating the ostomy for healing before reattaching the segments to restore normal bowel function is amazing to me; I almost had the impression that ostomies are created with permanence in mind, so I am glad that my impression has now changed! (A last tidbit that I found so interesting is refeeding bile that has drained after a cholecystectomy and that patients can drink it by mixing it with a soda! This is so fascinating to me). -Kinzie Matz https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1866451169 2021-11-04 03:19:14 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1866451169 Short bowel syndrome https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1872015008 I wanted to share a tidbit from my work in infants and children with short bowel syndrome. It's always important to really find out how much and what part of the bowel was removed or how much remains. This is critical since every short bowel syndrome child behaves differently. I found the information on fiber use to be really interesting...and also confusing. From the Part 2 article by Carol Rees Parrish and John K Dibaise, it mentioned the use of fiber to bulk stools to thicken stools and therefore hopefully decrease the number of stools per day. However fiber can also pull fluid away from the body and may decrease absorption of nutrients and water soluble vitamins. We have had good success with adding fibers especially from the use of real food based formulas in improving stools frequency and consistency and have been able to transition patients of amino acid based formulas (after time where their gut has adapted more) to these food-based formulas I believe because of their fiber content. The use of fiber in short bowel patients who still have some of their colon can also provide additional calories as bacteria produce short chain fatty acids while fermenting this fiber. We also always start with the introduction of vegetables over fruits in infants with short bowel syndrome to provide fiber without the added sugars in fruits. --Tracy Solomons ]]> 2021-11-06 21:38:06 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1872015008 https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1872734093 Hi everyone. I'm a bit confused about protein recommendations in patients who have had partial or total gastrectomy and gastric bypass (especially RYGB). As their stomach acid is decreased and transit time affected, how does their body compensate for reduced protein breakdown prior to arriving in the small intestine? I've had multiple patients at my last job who came to me years after having bariatric surgery only to become severely malnourished and unable to tolerate most protein containing foods (despite regularly taking their prescribed vitamins and meeting their protein goal, albeit mainly through supplements by the time they see me). How can we as dietitians work to help reduce the long term risk of malnutrition in these patients? - Kristina Eggener]]> 2021-11-07 13:33:57 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1872734093 Enterocutaneous fistula & ostomy https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1873278210 I wanted to share a bit of information that I had actually learned recently. I started covering our transplant and GI surgery floors in June so I have learned a TON during this time (& also a ton thanks to this class). 

Recently I had a patient that got into a MVC and had a lot of abdominal surgeries. They ended up developing a high output ECF - normally I do not see these patients because frequently they are on TPN for life depending on where their fistula is and if they can get their output under control. Well, this patient was on TPN for a long time and then was able to come off of it and was put on a oral diet - which meant I would follow her now during her hospitalization. 

I knew nothing really about ECF, the diet or how to aid in controlling output. Through this I learned that if the ECF is in the colon (where hers was) you could actually treat it similarly to if they had an ileostomy! Their body digests the food the same way, but it would come out of their fistula into a pouch (similar to an ileostomy) instead of their rectum and anus. I thought that was very interesting. We educated her on a mix of a SBS and ileostomy diet depending on her symptoms and output from her ECF. Additionally, if their output starts to trend up and there is nothing in their diet that would increase their ECF output (ex: high sugar beverages) you can consider anti-motility agents. It was very cool thing to learn about! If you are interested in this and are able to have access to ASPEN they have a great article on ECF and nutrition.

- Kaitlyn Kivi

]]> 2021-11-07 19:46:33 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1873278210 Reinfusing Bile Output https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1873373161 We recently had a pt that required his bile to be reinfused along with TF. We had never had a pt requiring this process before (at least in the 13 years I've been on staff) so I knew it would be important to provide education and support to the nursing staff. My tidbit of advice is that when your hospital/unit/clinic/etc is faced with a new or unfamiliar process that relates to nutrition, it is important to make sure that you understand the process and then help other involved staff understand so that the pt is getting the care they require. Sometimes it is not enough to just include the information in your notes and in orders. Working with nursing leadership to explain the process and importance of it, touching base with the RNs assigned to the pt, going into the pt's room to see that it's being done and being done properly, reminding folks at rounds and/or huddles, etc. When this pt arrived at our facility I right away spoke with the House Supervisor and RN assigned to pt to make sure they understood the process which consisted of collecting the bile over the course of the shift and then reinfusing it just like you would infuse a water flush via the pump (this required a dual port feeding tube). I checked in with nursing staff daily  (especially if it was a different RN than the previous day) to ask how the pt was doing, how much bile output was being collected, and asking them to describe the process of reinfusing it to me so that I could be certain they understood. We eventually ended up being able to pull the drain on this pt due to output decreasing and they were able to start eating and eventually ate enough to transition off TF. I guess this tidbit isn't directly related to GI surgeries, but is hopefully still helpful!! 
-Ashley Massart]]> 2021-11-07 21:10:37 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1873373161 Whipple surgery and pylorus-sparing procedure https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1875846001 In this module, I was fascinated to learn more about the Whipple procedure as I previously did not fully understand the complexity of the surgery. It’s amazing to me the number of resections and subsequent reconstructions that can be completed in one procedure. I found it interesting that the pylorus-sparing version of the surgery is more commonly done in Europe but not in the United States despite comparable long-term survival rates. As more data becomes available specific to outcomes associated with delayed gastric emptying and other postoperative complications, I’ll be curious to see if the procedure becomes more popular in the United States. -Sarah Luzinski 

]]> 2021-11-08 17:35:58 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1875846001 What I found most interesting was that there is really no difference in outcomes when considering EN verses PN post a whipple. They always stress if the bowel works to use it but it appears that it may not be the case in these patients. I remember working with a MD that performed several Whipples and shake and bakes and I had a discussion with him requesting he place a J-tube for enteral nutrition verses starting PN right away. He agreed to do it but now I know why he was hesitant. https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1876027932 Brandee Grenda]]> 2021-11-08 18:42:08 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1876027932 It is recommended to look for pill absorption with those that have an ileostomy. Why wouldn't you automatically change medication form to liquid or crushed to prevent possible absorption issues? https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1876056417 Brandee Grenda]]> 2021-11-08 18:53:02 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1876056417 I don't work with these patients often but the few times I have, I remember thinking the output patients have with an ileostomy is not consistent between patients. My best advice - each patient is different and some may experience output <1L and others >2L so be open minded and prepared for all volumes along with recommendations for each patient- B.Grenda. https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1876108556 2021-11-08 19:13:16 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1876108556 https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1876259296 Hi everyone! I don't work with bariatric surgery patients often. Prior to this module, I did not know that roux en y gastric bypass alters hunger hormones. I recently had a patient with a history of lap band then sleeve then RNY that is being evaluated to be a kidney donor who's currently taking phentermine for an appetite suppressant. On brief review, there's some studies showing appetite suppressants helping prevent weight regain post RNY. I'd love to hear if anyone has experience with this! --Ashley Peña Elsbernd]]> 2021-11-08 20:15:47 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1876259296 Hi everyone! What an interesting module. I have no experience in working with bariatric surgery population, so I knew things here and there such as liquid diet pre-op, separating liquids and solids post-op and taking multiple vitamins/minerals daily d/t decreased absorption, BUT I had no idea that protein shakes are required in the first year after surgery! It makes sense to choose whey protein powder as it is best absorbed with is absorption rate ~10g per hour and to break this up into multiple meals/snacks vs taking it all at once to maximize absorption (this method is also utilized for athletes!). Any type of bariatric surgery requires commitment. -Agnes Kim https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1876343130 2021-11-08 20:55:56 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1876343130 Ostomy Output https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1877046542 Hello everyone, the question I have is the following. For patients with high ileostomy output, besides the diet modifications what else can you recommend to improve output. Can psyllium fiber (Metamucil) be helpful to bulk up the stool and decrease output? I once had a patient with 4-5 L output and diet modifications were not enough to help improve. Thank you!!

Samantha Sanchez]]> 2021-11-09 03:02:59 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1877046542 https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1877245660 I didn't know there was a process for patients to go through prior to and after surgery. Such as meeting with the multidisciplinary team and also taking pre-op nutrition classes. I also learned about the four pre-op nutrition classes and thought that was interesting and can see how those classes can set patients to be successful post-op. Another topic I learned were the pre-op and post-op diets and the amount of time it takes to progress to solids. Enjoyed this topic very much! 

-Naomi]]> 2021-11-09 04:46:03 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1877245660 Fistulas https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1879596043 Hi everyone!

I work in a small hospital but we do have our fair share of GI surgeries. That being said, I was surprised to learn that GI fistulas can spontaneously close without surgical intervention. In fact, the rate of spontaneous closure among patients is ~20%. That is fascinating to me! I am constantly amazed at the ways our bodies work for us

-Rachel Comstock]]> 2021-11-09 22:14:38 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1879596043 SBS and Gattex annaleealthouse https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1879762804 Hi there, 

Throughout my time in clinical practice, I have seen a lot of patients with short bowel syndrome. The biggest issues with SBS is malabsorption and dehydration. Something that I like to recommend is a medicine called Gattex which works to stimulate the growth of small intestinal villi. This increases absorption and could potentially keep patients from readmitting from dehydration and from malnutrition/weight loss that can occur from SBS. 
-Annalee Althouse]]> 2021-11-10 00:16:37 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1879762804 Bariatric surgery https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880043012 I found the presentation on bariatric surgery interesting; it was helpful to hear about how the UW health program operates. One thing I learned was that one of the complications of a RNY is strictures. This typically occurs 3-6 weeks after surgery and occurs because the scars shrink and become too tight. It appears this complication is relatively rare; however, it is important to be aware of all potential complications prior to considering surgery. Other complications of a RNY include pouch leaks and bowel obstructions. -Ellen Magnuson ]]> 2021-11-10 02:17:56 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880043012 MNT for delayed gastric emptying? https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880045122 I have a question in regard to nutritional management of delayed gastric emptying that commonly occurs in patients who underwent a whipple. I saw in the lecture that chewing gum is considered safe and may help accelerate gastric emptying. This confused me and I wonder how this works. I would think that chewing gum would cause more air to be swallowed, creating gas and abdominal discomfort. -Ellen Magnuson]]> 2021-11-10 02:18:53 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880045122 Bariatric surgery https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880047027 I have had some experience working with patients who intend to enter the bariatric surgery program, but their insurance requires 6 months of nutritional counseling. It was clear that some of these patients were only seeing a dietitian because their insurance required it, and they weren’t motivated to make behavior changes. These patients were ultimately not appropriate for surgery, because it requires a lot of behavior changes. I also noticed that a lot of patients had disordered eating patterns, such as emotional eating or binge eating. One thing I have learned is that these eating patterns need to be properly addressed before considering surgery, and therapists who specialize in eating disorders can be helpful with this. -Ellen Magnuson]]> 2021-11-10 02:19:43 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880047027 https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880095523 Hi everyone, 
 I am a little confused regarding SBS patients and oxalate intake. Should all patients be avoiding intake of high oxalate foods or just patients who experience issues with fat malabsorption? 

-Rachel Comstock

]]> 2021-11-10 02:39:44 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880095523 Gallbladder https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880149604 Many of the topics you have brought up are things I learned with the readings and videos as well. So I tried to pick something different:
I was enlightened to find out how severe gallstones can be and that around 10,000 people die each year from them. It is no surprise that most of those deaths come from the development of pancreatitis.
I guess I didn't realize how serious gallbladder surgery could be. I know it is a very common procedure. 
Lastly, I didn't realize how much of a lack of scientific evidence there is for diet recommendations after gallbladder surgery.
-Kelly Petersen]]> 2021-11-10 03:02:01 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880149604 Ostomy Tips https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880158921 For my ostomy patients with high outputs, I have found that reinforcing soluble fiber intake (rather than just recommending to increase fiber) tends to be more helpful. This is something that was mentioned in our lecture but also something I have seen improve high outputs in a clinical setting. I usually share this handout with patients, encouraging them to choose foods higher in soluble fiber. This handout was actually shared with me by our wound/ostomy RN, who also noticed an improvement in output with many patients we had educated on soluble fiber.

soluble-fibre.pdf (carleton.ca)

-Rachel C]]> 2021-11-10 03:06:27 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880158921 In terms of the protein shakes, I know that whey isolate is the best protein to use, but are there other guidelines for what should go into the shake? Should it just be water and the powder? Are there other things to keep in mind when choosing the whey protein isolate in terms of additives (especially sugar and alternative sweeteners)? Thanks! -Rebecca Boenig https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880412435 2021-11-10 05:30:44 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880412435 Whipple: Procedure and Nutrition Implications https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880415860 I learned many things regarding GI surgeries from the resources in this module. The Whipple procedure was particularly new to me, and I will also include some of the associated nutrition implications. A pancreaticoduodenectomy is called a Whipple surgery, which includes the removal of the following: the distal half of the stomach, the duodenum, proximal jejunum, regional lymph nodes, the head of the pancreas, the common bile duct, and the gallbladder. I was initially quite surprised at how many anatomical structures need to be removed in this procedure, and it is evident that there would be significant changes in GI function going forward. Many steps are then taken in the reconstructing of the remaining organs and glands. The pancreas is attached to the jejunum. Attaching the hepatic duct to the jejunum allows for digestive enzymes and bile to be able to flow into the GI tract. Finally, the stomach is attached directly to the jejunum. 

There are several GI-related nutrition implications, that include the following: Delayed gastric emptying can be treated with promotility agents, laxatives, and an epidural with fluid balance to promote GI transit. Low-fat, low-fiber, and liquid foods are recommended. Dumping Syndrome may occur due to undigested gastric contents that are dumped into the small bowel too quickly, which can cause further GI side effects such as nausea and abdominal cramping. Nutrition interventions include smaller, more frequent meals, avoiding fluids with meals, avoiding foods with added sugars, and laying down after eating to slow the transit of food from the stomach to the remaining intestines. Diabetes mellitus becomes a higher risk since part of the pancreas (which produces insulin) is removed in this procedure. It is important to regularly monitor blood glucose levels, and to administer insulin when necessary. Lactose intolerance may occur in the short-term, as the lactase enzyme may become insufficient during and briefly after the surgery. Pancreatic exocrine insufficiency occurs in about 1 in 4 patients, which can cause frequent fatty, frothy, loose stools due to malabsorption. PERT enzymes of 500-2500 PERT units/kg/meal may be needed to provide enough digestive enzymes at meals. Micronutrient malabsorption is common with several nutrients, including calcium, zinc, fat, iron, and fat-soluble vitamins. Close monitoring and appropriate supplementation should be provided. 

Reference:
Schmotzer T. GI Surgeries: Whipple/Pancreatectomy. University of Wisconsin – Madison. 2019. Retrieved on November 5, 2021.

-Nicole Tellock

]]> 2021-11-10 05:32:55 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880415860 Ostomies https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880447258 I learned about the different kinds of ostomies, like the double barrel ostomy, loop ileostomy, and the different shapes that the intestine can be left in for an ileal pouch (S, W, J). I didn't realize before how many different kinds of ostomies there were!
-Libbi C]]> 2021-11-10 05:55:30 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880447258 Corn? https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880453855 In the ostomy lecture, she specifically mentions avoiding corn on the cob with an ostomy. Is this corn on the cob specifically or just corn in general, and if just corn on the cob, why? If corn in general, then should they also avoid green peas? Also, can you explain why skipping meals causes gas? I feel like I've experienced this myself when I go a long time without eating, I get very bloated and sometimes get really bad stomach pain! 
-Libbi C]]> 2021-11-10 05:59:54 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880453855 Ostomies https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880464769 I don't have a ton of practice experience with ostomies yet, especially in the peds population. I specifically remember one patient during my internship who was getting an ileostomy to cure her UC symptoms and she was just so happy to be getting this procedure because she was finally going to be able to eat without experience pain and discomfort. She was nervous but so excited.  She had a LOT of questions about what she could and couldn't eat. It was a lot for her to take in so it was important to go slow, answer her questions as best I could, and validate her concerns. Fortunately, we had a handout that covered most of what she needed to know, but I feel much more prepared to answer these questions after this module.
-Libbi C]]> 2021-11-10 06:07:33 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1880464769 Surgeries https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1881857023 I learned in the lecture about Roux-en-y's that patients who are on insulin before surgery most of the time can leave the hospital after surgery completely off insulin. I also learned in the lecture about J, S, and W pouches, they use a barium enema to confirm there are no leaks in the pouch before reconnecting the tissue. In addition to that, I didn't think about the fact that the pouch tissue now has to learn how to function in a new way once it is reconnected.
-Miranda Miller ]]> 2021-11-10 16:44:06 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1881857023 Ileostomies https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1882609217 When reading the material for this module I was fascinated by the fact that Low FODMAP diets are also recommended for patients who have had ileostomy to help prevent diarrhea.  I knew there was research into Low FODMAP diets and their beneficial use in patient’s with IBS and/or IBD but not so much post ileostomies.  I know many times in the hospital we like to recommend low fiber or low residue diets for patients with ileostomies but never have I heard of Low FODMAP diet used for this purpose before.  According to the article, “ Fiber and Ileostomies: Does it Help or Hurt?” low FODMAPs are found to increase thickness of waste products thereby aiding in helping to prevent dehydration.  Changing of liquid medications containing sugar alcohols is also beneficial in prevention of dehydration in these patients.   Low FODMAP diets are also generally lower in fiber.  

Jennifer M. Ephraim 

]]> 2021-11-10 23:06:43 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1882609217 Ostomies https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1895521928 I am quite unfamiliar with ostomies as I haven't had much clinical exposure, so the presentation by Tracy gave a great introduction. However, I am wondering if ostomies are a reversible procedure. If so, is there a certain time frame? Complications? Recovery? MNT after the reverse procedure?

-Jessica Hansen]]> 2021-11-17 00:56:58 UTC https://padlet.com/digital_edu_ctlm/h3g5a1b59bsaxngj/wish/1895521928