Peri-operative Nutrition Flashcards
Why do malnourished patients make poor surgical candidates?
Surgery causes physiological stress with a resultant of a hyper-metabolic state and catabolic response.
Post-op complications in malnourished patients
Reduced wound healing
Increased infection rates
Skin breakdown
How to screen for malnutrition.
MUST score.
What tools are used to assess nutritional state?
Weight
BMI
Grip strength
Triceps Skin Fold Thickness
Mid Arm Circumference
Explain the hierarchy of feeding
If unable to eat sufficient calories -> Oral nutritional supplements
If unable to meet calorie req orally or dysfunctional swallow -> NGT
If stomach is inaaccesible or outflow obstruction -> Jejunal feeding by jejunostomy
If jejunum is inaccessible or intestinal failure -> Parenteral nutrition
Patients with intestinal failure often need parenteral nutrition.
Mnemonic SNAP for parenteral nutrition.
Sepsis - the infection msut be corrected otherwise feeding will be largely useless
Nutrition - Once infection is corrected suitable nutritional support should be provided
Anatomy - Define the anatomy of the GI tract so that surgery can be planned
Procedure - Definitive surgery once any infection eradicated the patient nourished and anatomy defined.
Does low serum albumin reflect on nutritional state?
No
Low serum albumin reflects on chronic inflammation, protein losing enteropathy, proteinuria, hepatic dysfunction.
Enhanced Recovery After Surgery is used for nutrition.
Explain the basic tenets of ERAS.
Reduction in NBM times
Pre-operative carbohydrate loading
Minimally invasive surgery
Minimising the use of drains and NG tubes
Rapid reintroduction of feeding post-op
Early mobilisation
When should enteral diet be commenced post-op?
Within 24 hours of uncomplicated GI surgery without increased risk of post-op complications
Should you give parenteral nutrition in an Entero-Cutaneous Fistulae?
It shouldn’t be indicated straight away.
The proportion of ECF will heal spontaneously with PN is relatively small.
It is better to do surgical repair.
What does the nutritional management of ECF depend on?
The level of the fistula
A high fistula (jejunal) might need enteral or parenteral nutritino
A low fistula (ileum/colon) can be treated with a low fibre diet.
What is the nutritional support and treatment for High output stoma dependent on?
Length of bowel to stoma.
Nutritional support for a jejunostomy
Nutritional support for a colostomy
Once active disease or infection has been excluded, a reduction in stoma output can be achieved by…
Reduction in hypotonic fluids to 500ml/day
Reduction in gut motility with high dose loeramide and codeine phosphate
Reduction in secretions with high dose PPi twice a day
Use of WHO solution to reduce sodium losses
Low fibre diet to reduce intraluminal retention of water.
