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Gen surg > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Screening tool for malnutrition

A

Malnutrition Universal Screening Tool(MUST)

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2
Q

Feeding preference if unable to eat sufficient calories

A

Oral nutritional supplements(ONS)

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3
Q

Feeding preference if unable to take sufficient calories orally or dysfunctional swallow

A

Nasogastric tube feeding tube(NGT)

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4
Q

Feeding preference if oesophagus blocked/dysfunctional

A

Gastrostomy feeding(PEG/RIG)

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5
Q

Feeding preference if stomach inaccessible or outflow obstruction

A

Jejunal feeding(jejunostomy)

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6
Q

Feeding preference if jejunum inaccessible or intestinal failure(IF)

A

Parenteral nutrition

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7
Q

SNAP mnemonic for any patients with intestinal failure

A

Sepsis - Infection present must be corrected, otherwise feeding will be largely useless

Nutrition - Once infection is corrected, suitable nutrition should be provided

Anatomy - Define anatomy of GI tract so that surgery can be planned

Procedure - Definitive surgery once any infection eradicated, the patient nourished, and the anatomy defined

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8
Q

What is ERAS

A

Enhanced recovery after surgery:

Reduction in ‘Nil by Mouth’ times

Pre-op carbohydrate loading

Minimally invasive surgery

Minimising the use of drains and nasogastric tubes

Rapid reintroduction of feeding post-operatively

Early mobilisation

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9
Q

Medical management of high output stoma

A

Reduction in hypotonic fluids

Reduction in gut motility with high dose loperamide and codeine

Reduction in secretions with PPIs

Use of WHO solution to reduce sodium losses

Low fibre diet to reduce intraluminal retention of water

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10
Q

What is parenteral feeding

A

IV administration of nutrients

May be supplemental to oral or tube feeding, or it may provide only source of nutrition as total parenteral nutrition(TPN)

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11
Q

Peripheral lines vs central access for parenteral feeding

A

Peripheral lines may be used to deliver short-term nutritional support, but central access is necessary for feeding of more than two weeks’ duration

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12
Q

Optimal method of access for central catheters

A

Ideally tunnelled subclavian vein central lines, inserted using the full aseptic technique

Parenteral nutrition solution is thrombogenic and an irritant to veins

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13
Q

Method of peripheral administration in parenteral nutrition

A

Achieved through peripherally inserted central catheters(PICCs) or standard cannulae, inserted with an aseptic technique

Tolerance to peripheral lines is increased with feeds of low osmolality and neutral pH and the use of soft paediatric cannulae

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14
Q

Which form of imaging can aid in getting access to central veins

A

Ultrasounded-guided venepuncture

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15
Q

Feed preparations for TPN solutions

A

Iso-osmotic lipid emulsions are used to provide an energy-rich solution and reduce irritation of veins

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16
Q

How should parenteral nutrition be introduced

A

Introduced at a low rate and gradually increased

TPN is usually delivered at a continuous flow rate but cyclical regimens may suit longer use

17
Q

Complications of parenteral feeding

A 
Re-feeding syndrome 
Cath related complications 
Infection 
Liver and gallbladder dysfunction 
Hyperglycaemia
18
Q

What is re-feeding syndrome

A

Intracellular electrolyte stores, particularly phosphate, are depleted during starvation despite normal serum conc

Feeding stimulates cellular uptake of electrolytes and can lead to electrolyte disturbances with profound hypophosphataemia

19
Q

Clinical features of re-feeding syndrome

A

Usually develop within 4 days of re-feeding, but are often nonspecific

Later manifestations include rhabdomyolysis, cardiac failure, hypotension, arrhythmias, resp failure, seizures and coma

20
Q

Catheter-related complications of parenteral feeding

A

Immediate complications include haemorrhage, pneumothorax or haemothorax, arrhythmias or cardiac tamponade.

Long-term complications include thrombosis and pulmonary embolism, pleural or pericardial effusion, subacute bacterial endocarditis, chylothorax and venopulmonary fistula.

21
Q

Features of liver and gallbladder dysfunction in parenteral feeding

A

Majority develop mild cholestasis with elevation of transaminases and alkaline phosphatase

Gallstones and gallbladder sludging may also occur

22
Q

NICE advice regarding use of enteral feeding for post-op patients

A

Persons having surgery should not have enteral feeding within 48 hrs after surgery unless they have:

Inadequate or unsafe oral intake; and

a functional, accessible GI tract

23
Q

Features of NG tubes

A

Depend on adequate gastric emptying

Allow use of hypertonic feeds, high feeding rates and bolus feeding into the stomach reservoir

Tubes are simple to insert but are easily displaced

24
Q

Features of NJ tubes

A

Reduce incidence of GORD and are useful in delayed gastric emptying

Post-pyloric placement can be difficult but may be aided by IV prokinetics

25
Q

Indications for PEG tubes

A

Stroke
Motor neurone disease
Parkinson’s disease
Oesophageal cancer

26
Q

Relative contra-indications to PEG tubes

A 
Reflux 
Previous gastric surgery 
Gastric ulceration 
Malignancy 
Gastric outlet obstruction
27
Q

How are PEG tubes inserted

A

Inserted directly through the stomach wall endoscopically or surgically under antibiotic cover

28
Q

Features of pre-digested feeds

A

Contain nitrogen as short peptides or free amino acids and aim to improve nutrient absorption in the presence of pancreatic insufficiency or inflammatory bowel disease

Fibre content of feeds is variable and some are supplemented with vitamin K, which may interact with other meds

29
Q

Complications of NG tube

A

Nasopharyngeal discomfort and later nasal erosions, abscesses and sinusitis

Acute complications such as pharyngeal or oesophageal perforation

30
Q

Complications of PEG or jejunostomy tubes

A

Can lead to complications related to endoscopy plus bowel perforation and abdominal wall or intraperitoneal bleeding

Post-insertion complications include stoma site infections, peritonitis, septicaemia, peristomal leaks, dislodgement and gastrocolic fistula formation

31
Q

Purpose of propping patients up by at least 30 degrees whilst feeding and 30 mins after

A

To minimise the risk of aspiration

Reflux occurs frequently(esp in patients with impaired consciousness, poor gag reflex and when fed in the supine position)

32
Q

GI symptoms of enteral feeding

A 
Abdominal bloating 
Cramps 
Nausea
Diarrhoea 
Constipation
33
Q

Monitoring for enteral feeding

A

Position of nasally inserted tubes, which should be checked before each feed by obtaining tube aspirate of pH < 5.5 on pH paper

Development of erosions

Gastrostomy and jejunostomy stoma sites should be checked for infection

Gen surg (24 decks)

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