Nutrition

Question 1

What screening is used for malnutrition?

Answer 1

MalnutritionUniversal Screeing Tool (MUST)

Question 2

What is the hierarchy of feeding?

Answer 2

If unable to eat sufficient calories - Oral nutritional supplements
If unable to take sufficient calories orally or dysfunctional swallow - Nasogastric tube feeding
If oesophagus blocked/dysfunctional - Gastrostomy feeding (PEG/RIG)
If stomach inaccessible or outflow obstruction -Jejunal feeding (jejunostomy)
If jejunum inaccessible or intestinal failure - Parenteral nutrition

Question 3

Patients with intestinal failure need parenteral nutrition - describe.

Answer 3

SNAP
Sepsis - any overwhelming infection present must be corrected otherwise feeding will be useless
Nutrition - once the infection is corrected, suitable nutritional support should be provided
Anatomy - define the anatomy of the GI tract so surgery can be planned
Procedure - definitive surgery once infection eradicated, patient nourished, and anatomy defined

Question 4

What does a low serum albumin reflex?

Answer 4

Chronic inflammation, protein losting enteropathy, proteinuria, hepatic dysfunction
NOT malnutrition

Question 5

Describe the features of Enhanced Recovery After Surgery (ERAS)

Answer 5

Reduction in nil by mouth times (fluids up to 2 hours pre-surgery
Pre-operative carbohydrate loading
Minimally invasive surgery
Minimising the use of drains and NG tubes
Rapid reintroduction of feeding post-operatively
Early mobilisation