Nutrition

Question 1

Surgical patients are typically NPO. This causes them to be in a catabolic state. How does this manifest clinically (1) and Biochemically (3)

Answer 1

Clinically:
Skeletal muscle weakness + wasting

Biochemically:
Impaired albumin production
Impaired wound healing + collagen deposition
Reduced immunity (reduced neutrophil and lymphocyte functioning)

Question 2

What is the best biochemical (1) and clinical (1) test to asses nutrition?

Answer 2

Biochemical: Pre-albumin (rarely used)
Clinical: BMI

Question 3

What is the best assessment of muscle wasting clinically?

Answer 3

Grip strength

Question 4

List 5 types of nutritional support that can be given to malnourished patients

Answer 4

Oral
NG tube
NJ tube
PEG tube
PEJ tube
TPN

Question 5

NG is typically used over NJ tubes. In what scenarios are NJ tubes used? (2/3)

Answer 5

Used if severe vomiting, gastric resection, gastric outlet obstruction

Question 6

What are alternate names used for PEG and PEJ tubes?
When are each used?

If these tubes cannot be used what is the escalation?

Answer 6

PEG = Gastrostomy used in patients with functioning GIT but cannot swallow/anorexic

PEJ = Jejunostomy used to bypass the stomach in case of ulcers

TPN

Question 7

TPN is injected into the _____vein or ______ vein via the ________ line

Answer 7

TPN is injected into the Subclavian vein or Internal Jugular vein via the Hickmann line

Question 8

TPN is typically used when NG and NJ tubes are not possible and only administered in the ICU. What supplementation do these patients require weekly?

Answer 8

Mg, Cu, Zn, manganese, PO4

Question 9

TPN is injected into the Subclavian vein or Internal Jugular vein via the Hickmann line. What are the risks of inserting a central venous catheter?

Answer 9

Haemorrhage/Haematoma
Line superinfection
Line obstruction/kinking
Misplacement/damage to nearby structures leading to pneumothorax, air embolism, carotid artery dissection, cardiac dysarrhythmia

Question 10

What are the complications of providing nutrition to a patient via TPN

Answer 10

Hyperosmolarity
Reduced glycaemic control
Liver dysfunction -> Cholestasis/pancreatic atrophy
Fluid overload

Question 11

How is PEJ performed?

Answer 11

To perform a PEJ, you need to perform a PEG first

So for PEG: Endoscopic insertion with stomach insufflation (done in. every endoscopy btw). A small incision is then made in the abdominal wall and the PEG tube is inserted into the stomach under endoscopic guidance

To convert it into PEJ, a jejunal extension is inserted through the PEG tube and advanced into the pylorus and then into the jejunum

So what we have here is that theyre both in the same location as it is the same incision.

Question 12

What is the difference between a PEG tube and a gastrostomy? Are they the same thing?

What is the difference between a PEJ tube and a jejunostomy? Are they the same thing?

How can you tell the difference between a gastrostomy and a jejunostomy from the outside (or PEG/PEJ)

Answer 12

A gastrostomy tube is surgically inserted (laparoscopically/open) into the stomach while a PEG tube (in the name) is placed endoscopically. In both cases they have the same function which is feeding directly into the stomach

The same rationale is applied to jejunostomy vs PEJ

All of these are located in the same place and look the exact same visually. Medical records or imaging (X-ray) is needed confirm the type!!