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Surgery final (Sabiston) > 5 - Metabolism in surgical patients > Flashcards

5 - Metabolism in surgical patients Flashcards

1
Q

What is the water percentage in an adult men/women?

A

60%

50

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2
Q

Describe which physical examination features can assist evaluating a patient’s hydration status? 6

A 
mental status
skin turgor
sunken eyes
capillary  filling
tachycardia/BP
urine output
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3
Q

Which lab values can assist evaluating a patient’s hydration status? 3

A

BUN/Cr > 10
elevated hematocrit
metabolic acidosis

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4
Q

How much liquid is exerted in daily feces?

A

250 ml

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5
Q

How much liquid is exerted in daily urine?

A

800-1500 ml

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6
Q

How much liquid is exerted in daily insensible loss

(Breathing/skin, heat, mechanical ventilation)?

A

1500 ml

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7
Q 
Describe the daily requirement for the following:
water-
Na-
K-
Cl-
glucose-
protein-
A 
water- 2500 ml
Na- 5-10g
K- 40-80 mEq/kg
Cl- 1.5 mEq/kg
glucose- 100
protein- 0.8 g/kg
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8
Q

What is the TBW (total body water) in an adult?

A

2.5 L

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9
Q

Which solution will you use for GI secretion loss?

A

RL

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10
Q

Which solution will you use for stomach secretion loss?

A

half standard + 20 KCL

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11
Q

Which solution will you use for pancreatic secretion loss?

A

RL

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12
Q

What is the maintenance fluid for an adult during surgery? 3

A

first 10 kg- 4cc/kg
second 10 kg- 2cc/kg
extra weight- 1cc/kg

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13
Q

What is the maintenance fluids for a 50 kg adult?

A

40 + 20 + 30 = 90 cc

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14
Q

When calculating maintenance fluids for an adult- use the following formula:

A

60 cc + (weight-20)

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15
Q

Which crystalloid solutions do you know? 2

A

ringer lactate (Hartman)
Normal saline
hypertonic saline

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16
Q

What are the characteristics of ringer lactate? 4

A
  • hypotonic
  • pH 6.5
  • ECF like electrolytes (Na/K/Ca) and HCO3
  • used for volume balance
17
Q

What are the characteristics of normal saline? 5

A
  • isotonic
  • lower pH than Hartman’s (can cause metabolic acidosis in large volumes)
  • contains K
  • higher electrolytes (Na/Cl/) level than Hartman’s
  • used for renal failure, metabolic alkalosis, brain edema
18
Q

What are the characteristics of hypertonic saline? 2

A

hyperosmotic

allows fast volume retur

19
Q

Which keloid solutions do you know? 2

A

natural (albumin/PPF)

synthetic (HES-starch dextrose)

20
Q

What are the indications for keloid solutions? 3

A

quick volume correction
severe catabolic state (burn)
hypoalbuminemia

21
Q

Describe 5 disadvantages of keloid solution: 5

A 
coagulation disorder
anaphylactic reaction
GFR decrease
pulmonary edema 
osmotic diuresis
22
Q

Which patients should receive 5% glucose solution? 3

A

infants
premature babies
elders

23
Q

What are the disadvantages of 5% glucose solution? 4

A

inotropic hyperglycemia and reduced wound healing
it can become hypotonic
osmotic urination
neurological symptoms in cerebral ischemia patients

24
Q

Surgical patients with nutritional deficiency are more likely to suffer from: 5

A 
delayed wound healing
catabolism
decreased function
slower recovery
increased post-op mortality/morbidity
25
Q

What are the criteria for starting with nutritional support to a surgical patient? 5

A
  • malnutrition/chronic disease
  • involuntary weight loss (>10% in 6 months or 5% a month)
  • expected blood loss of > 500 ml during surgery
    FTT (in infants)
  • katabolic disease (burn/sepsis/trauma/pancreatitis)
26
Q

What are the characteristics of a malnutrition patient?

A

BMI < 18.5
albumin < 3g%
transferrin < 200 mg%

27
Q

What are the indications for enteral feeding? 1 + 3

A

inability to eat in the following 7 days
+

> 1 meter of intestine+functioning ileocecal valve+airway

28
Q

What are the C/I for enteral feeding post op? 7

A 
refractory vomiting/diarrhea
bowel obstruction/gastroparesis/paralytic ileus
bowel ischemia
high output, entero-cutaneouse fistula
peritonitis
active GIB
hemodynamic instability
29
Q

NGT (nasogastric tube) is used when feeding < __ weeks.

A

4

30
Q

When feeding for longer than _ weeks, use __ or __.

A

gastrostomy

jejunotomy

31
Q

What are the indications for parenteral feeding?

A 
C/I for enteral feeding
dysfunctional intestine  
bowel rest (e.g. post severe pancreatitis)
32
Q

Describe the two methods for parenteral feeding:
1-
2-

A

peripheral vein, <1-2 weeks , <850 mOsmol/L

central vein, >1-2 weeks , >850 mOsmol/L

33
Q

What are the disadvantages of parenteral feeding? 5

A
  • mechanical (pneumothorax emboli, thrombosis, bleeding)
  • infections (sepsis, endocarditis, bacteria migration)
  • metabolic (hypertriglyceridemia, hyperglycemia)
  • acalculous cholestasis
  • re-feeding syndrome (in malnutrition/alcoholic)
34
Q

What happens in re feeding syndrome?

A

fast shift of P/K/Mg form plasma to cells when feeding malnourished/ alcohol abusers patients

35
Q

What are the clinical signs of re-feeding syndrome? 4

A

neuromuscular
rhabdomyolysis
respiratory failure/arrhythmia/ renal failure
pancytopenia

36
Q

Name 5 of the neuromuscular signs that can be seen in re-feeding syndrome:

A 
lethargy
disorientation
dysphagia
ocular muscle weakness
ataxia/seizures

Surgery final (Sabiston) (54 decks)

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