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Surgery > Nutrition part 1 > Flashcards

Nutrition part 1 Flashcards

1
Q

Fundamental goals of nutritional support

A

To meet the energy requirement for metabolic processes
To maintain a normal core body temperature
For tissue repair

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2
Q

Subjective global assessment

A

Clinical assessment of need for nutritional support
Presence of low serum albumin
Physical Examination
Weight change or unintentional weight loss

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3
Q

Presence of low serum albumin

A

Less than 3g/dl

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4
Q

Physical examination

A 
Wasting of muscle mass
Loose or flabby skin
Presence of edema or ascites
Glossitis
Skin lesions
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5
Q

Weight loss of > 10% of IBW

A

Mild to moderate malnutrition

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6
Q

Weight loss of > 20% suggest

A

Severe malnutrition

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7
Q

Weight loss of > 30% is

A

Premorbid

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8
Q

Adequate indicator of malnutrition in absence of other causes of hypoalbuminemia

A

Albumin

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9
Q

Long half life of albumin

A

21 days

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10
Q

Albumin suggests adequate nutritional status

A

> 3.5 g/dl

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11
Q

Albumin suggest malnutrition

A
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12
Q

Albumin

A

Visceral proteins

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13
Q

Biochemical indicator of malnutrition

A

Visceral proteins
Rapid turnover proteins
Nitrogen balance

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14
Q

Indicator of the degree of illness rather than strictly nutritional status

A

Rapid turnover of proteins

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15
Q

Rapid turnover of proteins vary with

A

Hepatic metabolic response ( decreased synthesis )

Capillary leak response ( diluted serum levels )

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16
Q

Serum albumin half life

A

14-20 days

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17
Q

Serum pre albumin half life

A

2-4 days

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18
Q

Serum transferrin half life

A

8-10 days

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19
Q

Serum albumin in a stable, hydrated patient

A

Less than 3.5g/dL

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20
Q

Serum prealbumin corresponds to mild depletion

A

10-17

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21
Q

Serum prealbumin corresponds to moderate depeltion

A

5-10 mg/dl

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22
Q

Serum prealbumin corresponds to severe depletion

A

5mg/dl

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23
Q

Serum transferrin of

A

Less than 200mg/Dl

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24
Q

Sensitive indicator of malnutrition

A

Transferrin

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25
Q

How to calculate nitrogen balance?

A

Nitrogen loss minus nitrogen intake

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26
Q

How to calculate nitrogen intake

A

Sum of nitrogen delivered from enteral and parenteral feedings

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27
Q

Nitrogen losses are through

A

Urine
Fistula drainage
Diarrhea

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28
Q

How to estimate 24 hours urinary loss

A

UUN concentration x urine volume

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29
Q

How to calculate nitrogen loss

A

1.2 x 24 hours UUN in g/day plus 2

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30
Q

CHO stores are exhausted after a

A

24 hours fasting

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31
Q

Carbohydrates after 24hours fast

A

Liver glycogen is used first then muscle glycogen

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32
Q

In the first day of starvation, caloric needs are supplied by

A

Fat and protein

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33
Q

Protein is converted to glucose via

A

Hepatic gluconeogenesis

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34
Q

10days of starvation, the brain adapts to use of

A

Fats

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35
Q

The brain cannot use free fatty acids so it relies on

A

Ketoacids produce by liver

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36
Q

Adaptation to ketone usage has a

A

Protein sparing effect

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37
Q

Physiologic stress

Metabolic demand is dramatically incresed

A

Catabolic phase

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38
Q

Physiologic stress

Catabolic phase

A

Rise in the urinary excretion of nitrogen( mas malala sa starvation)
Protein depletion
Increased glucagon, glucocorticoids and catecholamines
Reduction of insulin

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39
Q

Physiologic stress

Shifting of catabolism to anabolism

A

Early anabolic phase

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40
Q

Early anabolic phase

A

Positive nitrogen balance
Weight gain
Muscular strength

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41
Q

Early anabolic phase mechanism

A

Babalik yung total amount ng nitrogen na nawala during catabolic phase, pero mas mabagal nga lang.

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42
Q

Last several days to weeks

A

Early anabolic phase

43
Q

Final period of recovery

A

Late anabolic phase

44
Q

Late anabolic phase last from

A

Several weeks to months

45
Q

Late anabolic phase

A

Adipose stores gradually

Nitrogen balance equilibrates

46
Q

Weight gain is much slower during late anabolic phase than in early due to

A

Higher caloric content of fat

47
Q

Results when individual consumes inadequate kilocalories, protein, etc

A

Primary malnutrition. Walang sakit, wala lang makain, hahaha

48
Q

Occurs when adequate food is infused or consumed

A

Secondary malnutrition, may sakit to kain madaming pagkain. Hahaha

49
Q

Patients who are nutritionally depleted

A

Malabsorption

50
Q

Pt who are unable to take nutrients by GIT

A

Decreased intake

51
Q

More preferred route of nutrition

A

Enteral route over the parenteral route

52
Q

Advantage of enteral route

A

Physiologic
Less cardiac load
Inexpensive
Tolerated

53
Q

Enteral feeding maintains

A

Mucosal integrity
Absorptive function
Normal microbial flora

54
Q

Enteral nutrition

A

Less bacteria and endotoxin release from intestinal lumen to blood stream

55
Q

Enteral access

A

Nasoenteric
Gastrostomy
Jejunostomy

56
Q

Nasoenteric tube feeding

A

Caeinates and whole proteins

57
Q

Gastrostomy tube

A

Blended food

58
Q

Gastrostomy tube

Stamm

A

Sero lined

Temporary

59
Q

Gastrostomy tube

Glassman

A

Mucous lined

Permanent

60
Q

Jejunostomy tube

A

Elemetal diet

61
Q

Jejunostomy tube endoscopic

Permanent

A

Roux en Y

Witzel

62
Q

Nasogastric tube

A

Short term use only
Aspiration risk
Nasopharyngeal trauma
Frequent dislodgement

63
Q

Nasoduodenal/nasojejunal

A

Short term
Lower aspiration risks in jejeunum
Placement challenge (radiograph often necessary )

64
Q

More reliable than NGT

Risks of aspiration pneumonia can be reduced by 35% compared to NGT

A

Small bowel feeding NDT and NJT

65
Q

Nasoenteric tubes disadvantage

A

Clogging
Kinking
Removal
Nasopharyngeal complications

66
Q

If more than 30 days of nasoenteric feeding it will required

A

Percutaneous endoscopic gastrostomy

67
Q

PEG

A 
Skills
Gastric decompression or bolus feeds
Aspiration risks
12-24 months
Higher complication in placement
68
Q

PEG relative contraindications

A 
Ascites
Coagulopathy
Gastric varices
Gastric neoplasm
Lack of a suitable abdominal site
69
Q

Tube size used in PEG and for how long?

A

18F - 28F

12-24 months

70
Q

The only absolute contraindication to feeding jejunostomy is

A

Distal intestinal obstruction

71
Q

Relative contraindications of surgical gastrostomy and jejunostomy

A 
Severe edema of intestinal wall
Radiation enteritis
Inflammatory bowel disease
Ascites
Severe immunideficiency
Bowel ischemia
72
Q

Surgical gastrostomy and jejunostomy

The biggest drawback usually is possible clogging and knotting of the

A

6F catheter

73
Q

Surgical gastrostomy and jejunostomy

Three questions must be considered

A

What is the likelihood that thus patient will be eating in 7-10 days?
Are they malnourished or not?
What is the magnitude of this illness?

74
Q

Patients need for jejunal tube feeding

A

Total gastrectomy

Multiple trauma involving the thorax, pelvis and long bones who undergoes laparotomy

75
Q

Complications of enteral nutrition

A

Abdominal distention and cramps
Impaired respiratory mechanics
Pneumonia intestinalis and small bowel necrosis

76
Q

Common adverse effects of early enteral nutrition

A

Abdominal distention and cramps

77
Q

Result of intolerance to enteral feedings

A

Impaired respiratory mechanics

78
Q

Infrequent but significant problems in patients receiving jejunal tube feedings

A

Pneumatosis intestinalis and small bowel necrosis

79
Q

Risk factor of pneumatosis intestinalis and small bowel necrosis

A

Cardiogenic and circulatory shock
Vasopressor use
Diabetes melitus
COPD

80
Q

Better tolerated by stomach

A

Hyperosmolar solutions

81
Q

Increase osmolality first thevolume

A

Gastric feeding

82
Q

Increase volume first then osmolality

A

Small bowel

83
Q

Precautions to prevent reflux/aspiration

A

30 degree angle
Conscious patient
Stop feeding at 11pm

84
Q

Gastric feeding

Solution used

A

Hypertonic

Isotonic

85
Q

Gastric feeding

Infusion rate

A

Bolus or continous

86
Q

Gastric feeding

Initiation of infusion

A

25-30 ml/hour

87
Q

Gastric feeding

Increments

A

25-30 ml/ hour daily

88
Q

Gastric feeding

Intolerance

A

Vomiting

89
Q

Jejunal feeding

Solution used

A

Isotonic

90
Q

Jejunal feeding

Infusion rate

A

Continous

91
Q

Jejunal feeding

Initiation of infusion

A

25-30ml/hr

92
Q

Jejunal feeding

Increments

A

25-30 ml/hr

93
Q

Jejunal feeding

Intolerance

A

Distention, diarrhea, colic, NGT reflux

94
Q

Tube feedings

Polymeric

A

Isocral

Osmolyte

95
Q

Tube feedings

High caloric density

A

Magnacal

96
Q

Tube feedings

Monomeric

A

Vivonex Ten

97
Q

Tube feedings

Disease specific

A

AminAid,

Hepatic Aid

98
Q

Complications of enteral feeding

A 
Malposition of the catheter
Aspiration
Solute overloading
Perforation
Re feeding syndrome
Small bowel necrosis
Pneumatosis intestinalis
99
Q

Can occur on commencing enteral or parenteral nutrition

A

Refeeding program

100
Q

Reintroducing carbohydrate

A

Increase in insulin levels
Increased uptake of phosphate by the cells
Shift of sodium and water out of the cells

101
Q

Refeeding syndrome

Metabolic effects

A

Hypophosphatemia
Hypokalemia
Hypomagnesimia
Occasionally hypocalcemia

102
Q

Refeeding syndrome

Initial symptoms may be vague but

A 
Rhabdomyolysis
Respiratory failure
Cardiac failure
Dysrhtmias
Coma
Sudden death
103
Q

40 - 60 of hospitalized patients are malnourished to some degree because

A

Inadequate intake
Impaired absorption
Increased requirements

Surgery (7 decks)

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