Peri-op nutrition Flashcards
1
Q
Hierarchy of feeding methods
A
- If unable to eat sufficient calories - oral nutritional supplements
- If unable to take sufficient calories orally or dysfunctional swallow - NG tube
- If oesophagus blocked/dysfunctional - Gastrostomy feeding (PEG or RIG)
- If stomach inacessable or outflow obstructed - Jejunal feeding (jejuonostomy)
- If jejunum inacessable or intestinal failire - paraenteral nutrition
2
Q
How to manage patients with intestinal failure who need surgery?
A
SNAP
* Sepsis - correct overwhelming infection otherwise feeding will be useless
* Nutrition - eg paraenteral
* Anatomy - plan surgery anatomically
* P - procedure, definitive surgery
3
Q
Low serum albumin and nutrition
A
- Low albumin does not reflect nutritional state
- It is associated with poorer surgical outcomes though
- Treat underlying cause of low albumin, don’t just feed the patient
4
Q
What was part of ERAS change - enhanced recovery after surgery?
A
- Reduction in NBM times - can have clear fluids up to 2hrs prior
- Pre-operative carbohydrate loading
- Minimally invasive surgery
- Minimising use of drains and NG tubes
- Rapid reintroducing feeding post op
- Early mobilisation
5
Q
How early can patients eat post surgery?
A
- Most can safely tolerate within 24hrs if uncomplicated GI surgery
6
Q
Nutritional management of entero-cutaneous fistula
A
- Dependent on level
- Jejunal/high fistula may need support with enteral/paraenteral nutrition
- Low (ileum/colon) can be treated with low fibre diet
- Then surgery
7
Q
Management high ouput stoma
A
- Manage disease/infection causing
- Reduce hypotonic fluids - to 500ml/day
- Reduce gut motility with loperamide and codeine
- Reduce secretions with high dose PPIs
- WHO solution to reduce sodium losses - oral rehydration therapy
- Low fibre diet - reduce intraliminal retention of water
8
Q
When does high output stoma need para-enteral nutrition?
A
If jejunostomy is <100cm from DJ flexure
If colostomy is <50cm from DJ flexure
9
Q
A
