Chapter 24: Surgical Nutrition Flashcards

1
Q

What are the normal daily dietary requirements for adults of thefollowing:

Protein?

Calories?

A

Protein: 1 g/kg/day

Calories: 30 kcal/kg/day

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2
Q

What is the calorie content of the following substances:

Fat?

Protein?

Carbohydrate?

A

Fat:9 kcal/g

Protein:4 kcal/g

Carbohydrate:4 kcal/g

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3
Q

What is the formula for converting nitrogen requirement/loss to protein requirement/loss?

A

Nitrogen × 6.25 = protein

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4
Q

What is RQ?

A

Respiratory Quotient; ratio of CO2 produced to O2 consumed

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5
Q

What is the normal RQ?

A

0.8

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6
Q

What can be done to decrease the RQ?

A

More fat, less carbohydrates

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7
Q

What dietary change can be made to decrease CO2 production in a patient in whom CO2 retention is a concern?

A

Decrease carbohydrate calories and increase calories from fat

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8
Q

What lab tests are used to monitor nutritional status?

A

Blood levels of:

Prealbumin (t½≈2 to 3 days)—acute change determination

Transferrin (t½≈8 to 9 days)

Albumin (t½≈14 to 20 days)—more chronic determination

Total lymphocyte count

Anergy

Retinol-binding protein (t½≈12 hours)

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9
Q

Where is iron absorbed?

A

Duodenum (some in proximal jejunum)

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10
Q

Where is vitamin B12 absorbed?

A

Terminal ileum

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11
Q

What are the surgical causes of vitamin B12 deficiency?

A
  • Gastrectomy
  • excision of terminal ileum
  • blind loop syndrome
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12
Q

Where are bile salts absorbed?

A

Terminal ileum

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13
Q

Where are fat-soluble vitamins absorbed?

A

Terminal ileum

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14
Q

Which vitamins are fat soluble?

A

K,A,D,E (“KADE”)

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15
Q

What are the signs of the following disorder:

Vitamin A deficiency

A

Poor wound healing

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16
Q

What are the signs of the following disorder:

Vitamin B12/folate deficiency

A

Megaloblastic anemia

17
Q

Vitamin C deficiency signs

A

Poor wound healing, bleeding gums

18
Q

Vitamin K deficiency

A

Decrease in vitamin K–dependent clotting factors (II, VII, IX, and X);bleeding; elevated PT

19
Q

Chromium deficiency

A

Diabetic state

20
Q

Zinc deficiency

A

Poor wound healing, alopecia, dermatitis, taste disorder

21
Q

Fatty acid deficiency

A

Dry, flaky skin; alopecia

22
Q

What vitamin increases the PO absorption of iron?

A

PO vitamin C (ascorbic acid)

23
Q

What vitamin lessens the deleterious effects of steroids on wound healing?

A

Vit A

24
Q

What are the common indications for total parenteral nutrition(TPN)?

A
  1. NPO >7 days
  2. Enterocutaneous fistulas
  3. Short bowel syndrome
  4. Prolonged ileus
25
Q

What is the major nutrient of the gut (small bowel)?

A

Glutamine

26
Q

What is “refeeding syndrome”?

A

Decreased serum potassium, magnesium, and phosphate after refeeding (viaTPN or enterally) a starving patient

27
Q

What is an elemental tube feed?

A

Very low residue tube feed in which almost all the tube feed is absorbed

28
Q

Where is calcium absorbed?

A

Duodenum (actively)

Jejunum (passively)

29
Q

What is the major nutrient of the colon?

A

Butyrate (and other short-chain fatty acids)

30
Q

What must bind B12 for absorption?

A

Intrinsic factor from the gastric parietal cells

31
Q

What sedative medication has caloric value?

A

Propofol delivers 1 kcal/cc in the form of lipid!

32
Q

Why may all the insulin placed in a TPN bag not get to the patient?

A

Insulin will bind to the IV tubing

33
Q

How can serum bicarbonate be increased in patients on TPN?

A

Increase acetate (which is metabolized into bicarbonate)

34
Q

What are “trophic” tube feeds?

A

Very low rate of tube feeds (usually 10 to 25 cc/hr), which are thought to keep mucosa alive and healthy

35
Q

What is the best lab to check adequacy of nutritional status?

A

Prealbumin