L2: Surgical Nutrition Flashcards by Ahmed Farag | Brainscape

Q

Def of Malnutrition

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Causes of Malnutrition

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Metabolic Response to Starvation

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Mechanism of metabolic response to trauma & sepsis

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Body response to Trauma & Sepsis

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Mechanism of metabolic response to surgery

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triggers for metabolic response to surgery

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Risk factors for metabolic response to surgery

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How to Decrease IR before surgery?

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Q

Evaluation of Malnutrition

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Q

Hx

Evaluation of Malnutrition

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Q

History of poor nutrient intake

Evaluation of Malnutrition

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Significant Loss of body weight (see table)

Evaluation of Malnutrition

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Q

Social & economic conditions may lead to poverty & malnutrition

Evaluation of Malnutrition

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Gastrointestinal symptoms

Evaluation of Malnutrition

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Other chronic medical illnesses

Evaluation of Malnutrition

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Q

Physical Examination

Evaluation of Malnutrition

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general appearence

Evaluation of Malnutrition

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Q

Skin,Nails & Hair

Evaluation of Malnutrition

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Effect of decrease in protein

Evaluation of Malnutrition

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Q

Effect of low iron

Evaluation of Malnutrition

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effect of low vit C

Evaluation of Malnutrition

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effect of low zinc

Evaluation of Malnutrition

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Q

Effect of low Vit A

Evaluation of Malnutrition

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Eyes

Evaluation of Malnutrition

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Effect of anemia

Evaluation of Malnutrition

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effect of low thiamine

Evaluation of Malnutrition

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Q

effect of low vitamin A on eyes

Evaluation of Malnutrition

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Q

Def of Anthropometry

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Q

Anthropometry can assess the level of energy reserves by ……

A

estimating the amount of subcutaneous adipose stores.

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Q

However, Anthropometry ……. identify specific nutrient deficiency

A

cannot

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Anthropometric assessment

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Triceps skin fold thickness (mm)

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Mid arm circumference (cm)

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Q

Investigations to detect subclinical nutritional deficiencies in surgical patients.

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Q

To detect subclinical nutritional protein deficiencies in surgical patients:

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Q

Nitrogen Balance

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Q

…… protein gained = ….. g nitrogen.

A

6.25 , 1

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Q

Equations for Nitrogen balance

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Q

Serum Albumin

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Q

Serum albumin level ….. during the acute stress of surgery, sepsis, or other acute inflammatory illness because of ……

A

↓

^^^^^^^

↑ circulating extravascular volume.
TNF-α mediated inhibition of albumin synthesis.

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Q

Normal albumin level (used as an index of malnutrition) → …….

A

35g/L = 3.5g/dl (half-life of → 14 to 18 days).

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Q

Prealbumin (half-life, 3 to 5 days) or transferrin (<200 mg/dL; half-life, 7 days) → …….

A

ore sensitive indicators of rapid changes in nutritional status.

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Q

Creatinine excretion

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Creatinine is a metabolic product of ……

A

skeletal muscle creatine

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Q

Creatinine amount is …… proportional to skeletal muscle mass.

A

directly

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Q

…… g creat = …..g of fat free skeletal muscle in the 24-h urine collection (With steady state of day-to-day renal function).

A

1
18.5

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Q

Creatinine Levels & Assessment of surgical Patients

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Q

Immunological assessment

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Q

Delayed cutaneous hypersensitivity or anergy → Most commonly tested by delayed reaction to skin recall antigens.

A

….

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Q

It was widely used in early studies of nutritional assessment and is a manifestation of cell-mediated immunity.
Total Lymphocyte count is often <1000 /μL and may accompany anergy to common skin test antigens.
Not all malnourished patients are at Immunological risk.

A

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Q

Adverse effect of protein or calories depletion

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Q

Read Dietary assessment tools

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Q

Assessment of nutritional requirement

A

Q

Estimating Energy Requirement

A

Q

Aim of fluid maintenance

A

Q

Methods of Fluid input

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Methods of Fluid output

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Q

Indications of Intravenous fluid replacement solutions

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Selection of Intravenous fluid replacement solutions

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Types & Uses of Intravenous fluid replacement solutions

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Q

Effect of intestinal resection on fluid & nutrient absorption

A

Q

Effect of Jejunal resection

A

Q

result of Jejunal resection

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Effect of Ileal resection

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Q

Result of Ileal resection

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Q

Def of Short Bowel Syndrome

A

Q

CP of Short Bowel Syndrome

A

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Complications of Short Bowel Syndrome

A

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Recovery of Short Bowel Syndrome

A

Q

TTT of Short Bowel Syndrome if no normal recovery

A

Q

Types of Nutritional Support

A

Q

Daily Requirements of

Water
Calories
Sodium
Potassium

A

Q

Total energy need in:

Unwell Patients
Stable patients
Severe illness

A

Q

CHO Req per day

A

Q

Protein Req per day

A

Q

Fat Req per day

A

Q

Effect of Mixture of glucose and fat in TPN

A

Q

Effect of Vit B

Surgical Nutrition

A

Q

Effect of Vit C

Surgical Nutrition

A

Q

Obstructive jaundice & pancreatic duct obstruction → …. in fat soluble vitamins (ADEK)

A

↓

Q

↑ intestinal losses → ↓ in Na, K, phosphate.
↓ in trace elements (zinc magnesium, Fe) due to inflammatory response → needed for increased utilization of AA and decrease refeeding syndrome

A

..

Q

Indications Of Nutritional Support

A

Q

Advantages of enteral feeds

A

Q

Who Needs Nutritional Support?

A

Q

Algorithm of feeding

A

Q

Methods of Enteral Feeding

A

Q

Indications of N/G tube feeding.

A

Q

Types of Gastrostomy tube feeding

A

Q

Types of Jejunostomy tube feeding

A

Q

NJT are better than NGT and gastrostomy as NJT
bypass the pylorus so ……

A

decrease aspiration and also not need for TPN with

Q

Types of Tube feeding techniques

A

Q

Installation of Nasogastric tube

A

Q

Indications of Fine bore tube

A

Q

charachters of Fine bore tube

A

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Disadvantages of Fine bore tube

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Installation of Nasojejunal feeding

A

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Types of Gastrostomy

A

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complications of Gastrostomy

A

Q

Types of Jejunostomy tube

A

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Complications of Jejunostomy tube

A

Q

Complications of enteral feeding

A

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GIT Complications of enteral feeding

A

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Metabolic Complications of Enteral feeding

A

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Contraindications to Enteral Nutrition

A

Q

Def of Parentral Nutrition

A

Q

Indication of Parentral Nutrition

A

Q

Compositions of parenteral solutions

A

Q

Types of parenteral Nutrition

A

Q

Characters of Peripheral parenteral nutrition

A

Q

Characters of Total parenteral nutrition

A

Q

Sites for insertion in Parentral Nutrition

A

Q

Advantages of parentral nutrition

A

Q

Characters of Parenteral Amino Acid Solutions

A

Q

Special Parenteral Amino Acid Solutions (Formulas)

A

Q

Designing parenteral nutrition formula

A

Q

Mechanical complications of Parentral Nutrition

A

Q

Metabolic complications of Parentral Nutrition

A

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Infection complications of Parentral Nutrition

A

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Other complications of Parentral Nutrition

A

Q

In patients with diabetes and those with impaired blood glucose control owing to critical illness → administration of parenteral nutrition should coincide with a variable insulin infusion regimen to avoid hyperglycemia.
Conversely, insulin dosing should be reduced accordingly when parenteral nutrition is interrupted to avoid hypoglycemia.

A

..

Q

Def of Refeeding Syndrome

A

Q

CP of Refeeding Syndrome

A

Q

Who are at risk of Refeeding Syndrome?

A

Q

Prevention & Therapy of Refeeding Syndrome

A

Q

Incidence of Liver Dysfunction

Complications Related to TPN

A

Q

Types of Diseases in liver dysfunction

Complications Related to TPN

A

Q

RF for Liver Dysfunction

Complications Related to TPN

A

Q

Metabolic bone Disease & Vitamin Deficiency

Complications Related to TPN

A

Q

Cause of Overfeeding

Complications Related to TPN

A

Q

CP of Overfeeding

Complications Related to TPN

A

Q

Monitoring

Complications Related to TPN

A

Q

Take Home messages

Surgical Nutrition

A

Q

Doneeeeee

A