Preoperative_Nutrition_Brainscape

Question 1

Why are malnourished patients poor surgical candidates?

Answer 1

They have reduced nutritional reserves, increasing the risk of complications like poor wound healing, infection, and skin breakdown.

Question 2

What is the MUST score used for?

Answer 2

It is a screening tool used to assess the risk of malnutrition in patients.

Question 3

What physical signs might indicate malnutrition during bedside observation?

Answer 3

Muscle wasting, loose skin, and clothes no longer fitting.

Question 4

What are key tools used by dietitians to assess nutritional status?

Answer 4

Weight, BMI, Grip Strength, Triceps Skin Fold Thickness, and Mid Arm Circumference.

Question 5

What is the BMI range for a normal nutritional state?

Answer 5

18.5-24.9 kg/m².

Question 6

What is the preferred route for nutritional support?

Answer 6

Enteral nutrition via the oral route.

Question 7

What is the hierarchy of feeding methods when oral intake is insufficient?

Answer 7

1. Oral Nutritional Supplements (ONS)
2. Nasogastric Tube Feeding (NGT)
3. Gastrostomy Feeding (PEG/RIG)
4. Jejunal Feeding (Jejunostomy)
5. Parenteral Nutrition.

Question 8

What does PEG/RIG stand for?

Answer 8

Percutaneous Endoscopic Gastrostomy / Radiologically Inserted Gastrostomy.

Question 9

In which case should surgery not be delayed for nutritional improvement?

Answer 9

Active Crohn’s disease, as improving nutritional state is unlikely during active disease.

Question 10

What does the mnemonic SNAP stand for in intestinal failure?

Answer 10

Sepsis, Nutrition, Anatomy, Procedure.

Question 11

Why is sepsis correction crucial before providing nutritional support in intestinal failure?

Answer 11

Because feeding is ineffective in the presence of overwhelming infection.

Question 12

What are the key components of Enhanced Recovery After Surgery (ERAS)?

Answer 12

1. Reduced ‘Nil By Mouth’ times
2. Pre-operative carbohydrate loading
3. Minimally invasive surgery
4. Minimising drains and NG tubes
5. Early post-operative feeding
6. Early mobilisation.

Question 13

Why is early post-operative feeding beneficial?

Answer 13

It reduces post-operative complications and promotes recovery.

Question 14

What is the strategy for nutritional support in entero-cutaneous fistulae (ECF)?

Answer 14

Support nutrition prior to surgical repair, with enteral or parenteral nutrition based on fistula level.

Question 15

When should parenteral nutrition be considered for high-output stomas?

Answer 15

1. Jejunostomy with <100 cm from DJ flexure
2. Colostomy with <50 cm from DJ flexure.

Question 16

What medical management strategies can reduce stoma output?

Answer 16

1. Reduce hypotonic fluids to 500 ml/day
2. High-dose loperamide and codeine phosphate
3. High-dose proton pump inhibitors (PPI)
4. WHO solution to reduce sodium losses
5. Low-fiber diet.

Question 17

What role does a low-fiber diet play in high-output stoma management?

Answer 17

It reduces intraluminal water retention, decreasing stoma output.

Question 18

What is the first-line drug therapy to reduce gut motility in high-output stoma?

Answer 18

High-dose loperamide and codeine phosphate.