Nutrition Flashcards
Stem1: A critically burnt ill patient is in ITU and requires nutrition. In this station you will be asked the physiology of nutrition and its clinical application.
Stem1: A critically burnt ill patient is in ITU and requires nutrition. In this
station you will be asked the physiology of nutrition and its clinical
application.
- Given these 2 X-rays:
Q1: Compare the findings in both X-rays.
“This is an AP chest radiograph of an adult male/female. The
chest x-ray view is adequate and the NG tube cannot be seen
bisecting the carina and is above the midline to the level of the
diaphragm. The tip of the nasogastric tube is also not visible
below the diaphragm. I can confirm that this tube is not in a safe
position to commence feeding”
……………………
“This is an AP chest radiograph of an adult male/female. The
chest x-ray view is adequate and the NG tube can be seen
bisecting the carina and remaining in the midline to the level of
the diaphragm. The tip of the nasogastric tube is visible below the
diaphragm and is at least 10cm beyond the gastro-oesophageal
junction. I can confirm that this tube is in a safe position to
commence feeding”
Q2: How to confirm that NGT is in place?
By radiological confirmation Xray
and By detection of Ph from aspirate
Q3. If you check the PH of the aspirate & it’s 5.5, what to do ?
I will not use NGT for feeding as it’s not in the stomach
Stem 2. A 55-ycar-old man with long standing Crohn’s discase admitted with abdominal pain and vomiting for 5 days, his weight was 52kg before his recent illness , abdomen was mildly tender, distended and tympanic on percussion. Ileocecal resection with 1ry anastomosis done , but he was taken to OR 4 days later with anastomotic leak for with laparotomy & ileostomy done.
Given this X-ray.
Q4. What’re the findings? Diagnosis?
Xray of Abd and Pelvis it’s spine in position
Dilatation of intestine with stack of coins most propably
Small bowel obstruction
Q5. What could be the cause for IO in this patient?
Most propably Crohns’s causing strictures
Q6. What arc the feeding options to used for this patient?
TPN due to anastomotic leak
Q8. What are the disadvantages of using only glucose as energy source in post-op patient?
Pt is already has high glucose from stress, more glucose will convert to fat and cause fatty liver and affect liver function.
other is glucose oxidation will release a lot of CO2 leading to Resp. Failure and increase vent. Requirement
Q9. Other than glucose, what are the constituents of TPN providing significant energy source?
Fat particles
Q7. What are components of TPN?
CHO – Lipid – PTN – water – essential FA – Minerals
Q10. Indication of’TPN?
Head trauma , Fracture mandible and loss of function of bowel, high output fistula and acute pancreatitis. And burn pts
Q11. Indication of enteral feeding?
Pt is malnourished, mild pancreatitis, sepsis pt and fistula.
Q12: Why enteral feeding is preferred over TPN?
Give access directly to GI which keep mucosa integrity, Cheaper, rapid, less complicated
Q13. What is the cause of mucosal atrophy?
Due to deficiency in glutamine
Inflammation , Infection , autoimmune dis, Chronic alcohol and medications
Q14. Whal is the results of mucosal atrophy?
Bacterial translocation
Q15. Complications of TPN ?
Line-related:
- Infection, sepsis
- Thrombophlebitis
- Thrombosis
- Pneumothorax
- Hemothorax
Feed-related:
- Fluid overload
- Electrolyte imbalance
- Hyperchloremic metabolic acidosis
- Hyperlipidemia
- Hyperammonemia
- Essential fatty acid deficiency
- Hypo/hyperglycemia
- Excess CO2 production (ventilatory problems)
- Re-feeding syndrome
- Gut atrophy and bacterial translocation
