Helping patients after intestinal surgery

When we talk of the intestines, we involve the small and large intestines. The two smooth muscles of the body are vital for the final part of digestion and play key role in absorption as well as other multiple bodily functions. Indications of surgery could be mechanical, functional or infectious. Obstruction, tumefaction and inflammatory bowel diseases of the bowels are major surgical indications.When a part of the bowel is affected, it is always removed surgically. This creates health damage in so many aspects but our most important focus now is to understand how we can help the patient return to normal life after such a big surgical intervention.For example, in case of severe ulcerative colitis, the colon is often removed and the ileum as the terminal part of the small intestine often attached to the anus. Removal of the colon (large intestines) will automatically affect the nutritional status of the patient. In this case, you also expect the surface area for absorption of nutrients to be minimised and this in most cases leads to malnutrition-related complications. There is loss of weight due to malnutrition after loss of key nutrients whose absorption largely depends on the surface of the colon. Malnutrition and nutrients deficiency is the major cause of problems that arise after surgery. Additionally, there is often inadequate intake of food and fluids due to the loss of appetite as a result of nausea and abdominal pain. Also, inflammation as a result of surgery makes the body lose a high quantity of proteins through bleeding and sometimes diarrhoea. SolutionImmediately after surgery, the patient is always restricted to receive nutrition and hydration intravenously. After a few days, medical experts will examine the progress of his condition and advise the patient to start a liquid diet. This regimen helps compensate vitamins and minerals lost during and after surgery.Minerals such as potassium and sodium are usually monitored to make sure there is immediate and adequate compensation in the body. Other minerals to monitor are calcium, iron, zinc, magnesium and folates. Fluid therapy is usually followed by a diet of soft foods such as purified fresh fruits and vegetables. Also recommended are high content protein foods such as soft eggs, yoghurt and ground meat to compensate for the lost proteins. When a patient tolerates solid foods, he can advance to a diet that temporarily limits fibre consumption as the repaired part of the bowel or intestine recover from surgery. After two-three weeks, a low-residue diet may be recommended to reduce the frequency of stools accumulation as the healing process continues.However, nutritional needs are specific to the individual and differ with the type of disease affected, age and body mass index. This is why hospitals need to employ qualified nutritionists to provide care for patients based on their needs. Feeding surgery patients calls for high expertise and knowledge. It involves diverse clinical knowledge and comprehensive nutritional understanding.Some surgical indications or complaints calls for particular understanding for the body requirements. For example calorie and proteins need are similar for patients with ulcerative colitis and that of Crohn’s disease. They are both inflammatory bowel diseases whose needs increase during inflammation and immediately after surgery to restore losses. Dr Joseph Kamugisha is a resident oncologist in Jerusalem, Israel