L2: Surgical Nutrition Flashcards
Def of Malnutrition
Causes of Malnutrition
Metabolic Response to Starvation
Mechanism of metabolic response to trauma & sepsis
Body response to Trauma & Sepsis
Mechanism of metabolic response to surgery
triggers for metabolic response to surgery
Risk factors for metabolic response to surgery
How to Decrease IR before surgery?
Evaluation of Malnutrition
Hx
Evaluation of Malnutrition
History of poor nutrient intake
Evaluation of Malnutrition
Significant Loss of body weight (see table)
Evaluation of Malnutrition
Social & economic conditions may lead to poverty & malnutrition
Evaluation of Malnutrition
Gastrointestinal symptoms
Evaluation of Malnutrition
Other chronic medical illnesses
Evaluation of Malnutrition
Physical Examination
Evaluation of Malnutrition
general appearence
Evaluation of Malnutrition
Skin,Nails & Hair
Evaluation of Malnutrition
Effect of decrease in protein
Evaluation of Malnutrition
Effect of low iron
Evaluation of Malnutrition
effect of low vit C
Evaluation of Malnutrition
effect of low zinc
Evaluation of Malnutrition
Effect of low Vit A
Evaluation of Malnutrition
Eyes
Evaluation of Malnutrition
Effect of anemia
Evaluation of Malnutrition
effect of low thiamine
Evaluation of Malnutrition
effect of low vitamin A on eyes
Evaluation of Malnutrition
Def of Anthropometry
Anthropometry can assess the level of energy reserves by ……
estimating the amount of subcutaneous adipose stores.
However, Anthropometry ……. identify specific nutrient deficiency
cannot
Anthropometric assessment
Triceps skin fold thickness (mm)
Mid arm circumference (cm)
Investigations to detect subclinical nutritional deficiencies in surgical patients.
To detect subclinical nutritional protein deficiencies in surgical patients:
Nitrogen Balance
…… protein gained = ….. g nitrogen.
6.25 , 1
Equations for Nitrogen balance
Serum Albumin
Serum albumin level ….. during the acute stress of surgery, sepsis, or other acute inflammatory illness because of ……
- ↓
^^^^^^^
- ↑ circulating extravascular volume.
- TNF-α mediated inhibition of albumin synthesis.
Normal albumin level (used as an index of malnutrition) → …….
35g/L = 3.5g/dl (half-life of → 14 to 18 days).
Prealbumin (half-life, 3 to 5 days) or transferrin (<200 mg/dL; half-life, 7 days) → …….
ore sensitive indicators of rapid changes in nutritional status.
Creatinine excretion
Creatinine is a metabolic product of ……
skeletal muscle creatine
Creatinine amount is …… proportional to skeletal muscle mass.
directly
…… g creat = …..g of fat free skeletal muscle in the 24-h urine collection (With steady state of day-to-day renal function).
- 1
- 18.5
Creatinine Levels & Assessment of surgical Patients
Immunological assessment
Delayed cutaneous hypersensitivity or anergy → Most commonly tested by delayed reaction to skin recall antigens.
….
- 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.
Adverse effect of protein or calories depletion
Read Dietary assessment tools
Assessment of nutritional requirement
Estimating Energy Requirement
Aim of fluid maintenance
Methods of Fluid input
Methods of Fluid output
Indications of Intravenous fluid replacement solutions
Selection of Intravenous fluid replacement solutions
Types & Uses of Intravenous fluid replacement solutions
Effect of intestinal resection on fluid & nutrient absorption
Effect of Jejunal resection
result of Jejunal resection
Effect of Ileal resection
Result of Ileal resection
Def of Short Bowel Syndrome
CP of Short Bowel Syndrome
Complications of Short Bowel Syndrome
Recovery of Short Bowel Syndrome
TTT of Short Bowel Syndrome if no normal recovery
Types of Nutritional Support
Daily Requirements of
- Water
- Calories
- Sodium
- Potassium
Total energy need in:
- Unwell Patients
- Stable patients
- Severe illness
CHO Req per day
Protein Req per day
Fat Req per day
Effect of Mixture of glucose and fat in TPN
Effect of Vit B
Surgical Nutrition
Effect of Vit C
Surgical Nutrition
Obstructive jaundice & pancreatic duct obstruction → …. in fat soluble vitamins (ADEK)
↓
- ↑ 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
..
Indications Of Nutritional Support
Advantages of enteral feeds
Who Needs Nutritional Support?
Algorithm of feeding
Methods of Enteral Feeding
Indications of N/G tube feeding.
Types of Gastrostomy tube feeding
Types of Jejunostomy tube feeding
NJT are better than NGT and gastrostomy as NJT
bypass the pylorus so ……
decrease aspiration and also not need for TPN with
Types of Tube feeding techniques
Installation of Nasogastric tube
Indications of Fine bore tube
charachters of Fine bore tube
Disadvantages of Fine bore tube
Installation of Nasojejunal feeding
Types of Gastrostomy
complications of Gastrostomy
Types of Jejunostomy tube
Complications of Jejunostomy tube
Complications of enteral feeding
GIT Complications of enteral feeding
Metabolic Complications of Enteral feeding
Contraindications to Enteral Nutrition
Def of Parentral Nutrition
Indication of Parentral Nutrition
Compositions of parenteral solutions
Types of parenteral Nutrition
Characters of Peripheral parenteral nutrition
Characters of Total parenteral nutrition
Sites for insertion in Parentral Nutrition
Advantages of parentral nutrition
Characters of Parenteral Amino Acid Solutions
Special Parenteral Amino Acid Solutions (Formulas)
Designing parenteral nutrition formula
Mechanical complications of Parentral Nutrition
Metabolic complications of Parentral Nutrition
Infection complications of Parentral Nutrition
Other complications of Parentral Nutrition
- 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.
..
Def of Refeeding Syndrome
CP of Refeeding Syndrome
Who are at risk of Refeeding Syndrome?
Prevention & Therapy of Refeeding Syndrome
Incidence of Liver Dysfunction
Complications Related to TPN
Types of Diseases in liver dysfunction
Complications Related to TPN
RF for Liver Dysfunction
Complications Related to TPN
Metabolic bone Disease & Vitamin Deficiency
- Complications Related to TPN
Cause of Overfeeding
Complications Related to TPN
CP of Overfeeding
Complications Related to TPN
Monitoring
Complications Related to TPN
Take Home messages
- Surgical Nutrition
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