After a long experience with persistent peptic ulcer disease that involved more and more gastric tissue, John and his physician decided that surgery was needed. John then entered the hospital for a total gastrectomy. John weathered the surgery well and received some initial nutrition support from an elemental formula fed through a tube that the surgeon had placed into his jejunum. After a few days, the tube was removed. Over the next 2-week period, John was gradually able to tolerate a soft diet in small oral feedings. He soon recovered enough to go home, and he gradually felt his strength returning. He was relieved to be free of his former ulcer pain, and he began to resume more and more of his usual activities, including eating a regular diet of increasing volume and variety.
However, as time went by, John began having more discomfort after meals. He felt a cramping sensation, an increased heartbeat, and then a wave of weakness with sweating and dizziness. John would often become nauseated and have diarrhea. As his anxiety increased, he began to eat less and less, and his weight began to drop. He was soon in a state of general malnutrition.John finally returned to seek medical help. The physician and the clinical dietitian outlined necessary changes in his eating habits, and a specialized food plan was developed for him. John followed the new diet plan faithfully because he had felt so ill. To his surprise, he soon found that his previous symptoms after eating had almost completely disappeared. His weight gradually returned to normal, and his state of nutrition markedly improved. John found that he always fared better if he would nibble on food items throughout the day rather than consume large meals as he used to do.
1. What were John’s nutrition needs immediately after surgery and for the next 2 weeks?
2. Why did his feedings need to be resumed cautiously?
3. Why is emphasis given to postsurgical protein sources? How should this nutrient be provided?
4. After John recovered from surgery and resumed eating, why did he become ill? Describe why his symptoms developed.
