Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Junior Clinical Posting > Nutrition in Surgery > Flashcards

Nutrition in Surgery Flashcards

1
Q

What is nutrition and nutrient?

A

Nutrition – The process of utilizing exogenous substances for the production of energy and the synthesis of new tissues.

Nutrient is a substance that is consumed as part of the diet to provide a source of energy, material for growth or their regulation e.g CHO, protein, fat, vitamins & minerals

NUTRITION is an essential component for peri-operative care of surgical patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Resting energy expenditure (REE)

A

the energy expended by a person at rest in a thermoneutral environment.

REE in newborn 55Kcal/kg/day, in adult 20-30Kcal/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the Difference between REE and BMR?

A

REE and BMR usually differs by less than 10% but REE is higher because it include energy expenditure at mental activity and other expenditure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the Basal Requirement?

A

50% - CHO(1g of CHO -4kcal)
35% - Fats(1g of fat -9kcal)
15% - Proteins(1g of protein-4kcal)

These requirements are altered after surgery, trauma or
during infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the daily nuritional requirement?

A

Daily Requirement
Calories:
Adult: 25-35kcal/kg: 2200-2500kcal/day.
Newborn/infants: 90-120kcal/kg/day
Protein 1-1.5g/kg/day
Nitrogen -0.2g/Kg/day
Vitamins:
Vit A – 5000iu wkly
Vit k – 5-10mg wkly
Vit C – 60-80mg/day
Vit B12 – 500mcg wkly
Folic acid 3-6mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the daily requirement for Minerals and Trace elements?

A

Zinc – 5mg/day
Cu – 0.5-2.00mg/day
Mn – 70-150mcg/day
Cr – 40mcg/day
Se – 70-150mcg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the fat solcuble and water soluble vitamins?
Where is Vit. B12 absorbed?
Where is Folic acid absorbed?

A

Fat soluble vitamins –A,D,E,K
Water soluble vitamins –B and C
Vit B12 absorbed in the terminal ileum
Folic acid is absorbed in the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the RISKS ASSOCIATED WITH MALNUTRITION?

A

-impaired wound healing
Impaired immunity
Wound infection
Impaired coagulation
Reduced muscle strength, respiratory function
Post op fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathophysiology of Starvation

A

The energy requirement is increased in catabolic states such as surgery, trauma

Major elective abdominal surgeries or trauma by 10-30%, generalized peritonitis 15-50%, sepsis 50-80% and burns 80-200%

If these requirements are not met by exogenous supplement, they will be provided from endogenous alternative ways to the deterrent of the body

In Starvation- 1st 12hrs previous meal utilized and within 24 hrs body glucose store is depleted. after 24hrs fatty acids and amino acids are being broken down (gluconeogenesis)

Obligate use of glucose (the CNS others; rbc, wbc, fibroblast, proximal convulated tubules)

Brain and nervous tissue requires 120g of glucose /day while other obligatory users require 40g of glucose/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is malnutrition?

A

There is lack of nutrient in appropriate proportions
Important determinant of surgical outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are causes of malnutrition?

A

Decreased intake
Decreased absorption
Increased losses
Increased utilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the causes of malnutrition via decreased intake?

A
  • Anorexia: liver dx, cancer
  • Neurological disorders
  • Brain surgery
  • Head injury
  • Coma
  • Maxillofacial surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the causes of malnutrition via decreased absorption?

A
  • Malabsorption syndrome-biliary or pancreatic dx
  • Massive bowel resection
  • Short bowel syndrome
  • GIT fistula (High output
  • GI obstruction (Oesophageal tumour,
  • Oesophageal stricture, Achalasia Cardia,
  • Gastric tumour, Pyloric stenosis)
  • Ulcerative Colitis, Crohn’s disease
  • GIT anomalies in infants
  • Acute radiation enteritis
  • prolonged ileus after major surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes Hypercatabolic state (increase utilization):

A
  • Major burns
  • Polytrauma patient
  • Sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nutritional Assessment

A
  • Clinical
  • anthropometry
  • Laboratory evaluation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ASSESSMENT OF NUTRITIONAL STATUS: History

A

Weight loss
History to suggest inadequate intake
Lack of food: 24-hr dietary recall
Eating pattern, dietary restrictions
Anorexia: liver disease, sepsis, cancer
History to suggest increased losses
Persistent vomiting
Chronic diarrhoea
Enterocutaneous fistula e.t.c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is Nutritional Status assessed?

A

Physical Examination:
- Skin and fluffy hair/hair loss , loose flabby skin, oedema.
- Pallor, muscle wasting (eg loss of thenar muscle)
- peripheral oedema
- peripheral neuropathy
* CVS; displaced apex beat , haemic murmurs
* Abdomen; stomas, fistula, abdominal masses, hepatomegaly
* Rectal examination; perineal fistula, pale stools
* Nervous system; neuropathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Normal Anthropometric measurement

A
  • weight, Height
  • BMI (19-24.9kg/m2)
  • Skin fold thickness (using skin fold caliper) – M-10mm,F – 13mm
  • Mid upper arm circumference - M ->25cm ,F- >23cm
  • waist –hip ratio –M – <0.94 , F- <0.8
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How to measure organ function?

A
  • handgrip dynamometry
  • test of respiratory function
20
Q

Investigations to measure nutriotional status

A
  • Full Blood Count-reduced Hb, reduced total lymphocytes count(<1500/mm3)
  • Mantoux test (anergy)
21
Q

Normal Serum Protein Concentration

A
  • Albumin(g/dl) - < 35g/L (t1/2 -14-21 days),assess nutrition over previous 21 days
  • Transferrin (mg/dl)- t1/2 – 7days
  • Thyroxin-binding pre-albumin-t1/2 -3-5days
  • Retinol-binding protein – assess nutritional status over 12hrs
22
Q

What are the INDICATIONS FOR NUTRITION SUPPORT IN MALNUTRITION?

A
  • Resent unintentional loss of weight more than 15%.
  • Unable to eat for ˃5days (e.g. post abdominal surgery)
  • Significant deficit in hand dynamometry
  • Serum albumin less than 3g/dl.
  • Serum transferrin less than 200mg/dl.
  • Skin anergy.
23
Q

What are Protein Requirements for surgery?

A

Number of non-protein (kcal) given should be a ratio of nitrogen intake 150 - 200kcal:1nitrogen.
1g nitrogen = 6.25g protein.
* Malnourished (not stressed)
1-2g protein/kg/day.
* Postop – no organ failure
1.2-1.5g/kg/day.
* Severely catabolic – no organ failure
1.5-2g/kg/day.

24
Q

What are the various routes of administration

A
  • Enteral
  • Parenteral
25
Q

What is Enteral feeding?

A

Refers to delivery of nutrients into GIT. Best and preferred route if no contraindication to its use

26
Q

What are the advantages Enteral feeding?

A
  • Less expensive , readily available
  • Physiologically superior to TPN, portal circulation is not by-passed
  • Stimulation of intestinal motility
  • Secretion of IgA
  • Maintains integrity of GI mucosa(has trophic effects)
27
Q

What are the disadvantages Enteral feeding?

A
  • Aspiration of feeds
  • GIT motility may change suddenly
  • Prolonged infusion of nutrients may lead to overgrowth of bacteria
  • Diarrhoea may be troublesome particularly at the early stages
28
Q

What are the routes for enteral feeding?

A

Oral intake, feeding tubes, Oral/Sip feeding -natural route

29
Q

What are the types of tube-feeding?

A

Naso-enteric (gastric, duodenal, jejunal).
Oro-enteric (gastric, duodenal, jejunal).
Gastrotomy,jejunostomy

30
Q

What are the types of feed given via Enteral Route?

A
  1. Polymeric
    Blenderised
    Modular diet
  2. Monomeric
    Partially hydrolysed
    Elemental diet
31
Q

Types of diet

A

BLENDERIZED DIET
- suitable for patients with normal gut,
- Px in whom there is an obstructive lesion in head and neck/oesophagus that interferes with feeding
It is made from whole protein (with nitrogen content g/L) and complex starch

MODULAR DIET
Prepared by dieticians based on targeted total kcal

ELEMENTAL DIET
pre-digested feeds containing amino acids (and polypeptides), TGs and simple sugars. Thus, absorbed easily

SPECIAL PURPOSE (DISEASE SPECIFIC) DIET
- Consists of a modular supplementation diet designed to meet the patient’s physiological requirements in the particular disease state such as RENAL, HEPATIC

32
Q

What are Options for Tube feeding schedules?

A
  • Continuous
  • Intermittent
33
Q

What are some complications of enteric feeding related to feeding regimen?

A
  • intolerance
  • hyperglycemia
  • Enteric infection
34
Q

What are some complications of enteric feeding related to feeding tube?

A
  • Malposition
  • Dislodgement/migration
  • Aspiration
  • Peritonitis
  • Fistula formation
  • Tube fracture/blockage
35
Q

What are types of enteral feeding options in patients with oesophageal disease, impaired gastric function and recent surgery of the upper GI?

A
  • Gastrostomy
  • Stamm
  • Janeway
  • PEG
  • Jejunostomy
  • Witzel
  • Needle jejunostomy
    Rectal: (rectal infusion)
    Not commonly used
36
Q

What is Total Parenteral Nutrition (TPN)?

A

Is defined as provision of all nutritional requirements by means of intravenous routes and without the use of GI tracts

37
Q

What is Parenteral Nutrition and when is it indicated?

A

Refers to the provision of part or whole of the patient’s nutritional requirement through the non-enteral route

Indicated in patients who require nutritional support but who cannot meet their nutritional needs through enteral route or in whom enteral feeding is contraindicated or not tolerated

38
Q

What is Hyperalimentation?

A

is the intravenous delivery of nutrients to a malnourished patient or patient in hyper catabolic state in amount as high as 2.5 times his basal requirements in healthy state

39
Q

What are the techniques of infusion?

A

Peripheral and central vein

40
Q

Peripheral vein

A

isotonic solution, fats
Short period less than 2 wks
Change site every 48hrs

41
Q

Central vein

A
  • via IJV or subclavian vein
  • hyperosmolar/prolong nutrition
42
Q
A
43
Q
A
  • Infusion protocol/monitoring
    TPN-team
    Daily clinical exam
    Daily blood glucose, urinalysis, electrolytes
    Weekly LFT, serum Ca, FBC, clotting studies, plasma protein
    Serum B12, FA, Fe, lactate, trace element every 10-14 days.
44
Q

What are the categories of Complications in parenteral Nutrition?

A
  • technical
  • metabolic
  • septic
45
Q
A
45
Q
A
46
Q

What are the septic complications of parenteral nutrition?

A
  1. Catheter-related sepsis
  2. Infection at skin site.
  3. Subclavian vein thrombosis

Junior Clinical Posting (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions