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Surgery > Surgical Metabolism and Nutrition > Flashcards

Surgical Metabolism and Nutrition Flashcards

1
Q

If a patient loses 5% of his weight it one month, is it considered _____ (significant or severe) weight loss

A

Significant

Severe: >5% in 1 month
at 3 months: significant 7.5%; severe >7.5%

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2
Q

____ is an indirect measure of protein stores

A

Mid-arm muscle circumference

Triceps Skinfold Thickness - indirect measure of fat stores

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3
Q

What is the formula in calculating Transferrin level based on the TIBC?

A

Transferrin = (0.8 x TIBC) - 43

Transferrin - transport of iron, half life of 8-10 days, target level 200-300 mg/dL

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4
Q

What is the formula of absolute lymphocyte count?

A

ALC = WBC x % lymphocyte

Target: >2000

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5
Q

What is the caloric requirement and protein requirement for non-stressed patient?

A

25-30kcal/day

0.8 to 1g/kg/day CHON

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6
Q

Feeding tube is indicated in short term access only. What is the cut-off “week”?

A

<6-8 weeks

Long term: if more than 6-8 weeks

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7
Q

A type of enteral formula that contains 2.0 kcal/mL and has intact nutrients

A

fluid restricted

Standard intact nutrient = 1kcal/mL, mostly lactose free, fiber containing, or fiber free

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8
Q

Cite the contraindications for Total Parenteral nutrition

A
  1. Functional GIT
  2. Hemodynamically unstable
  3. Hypovolemic, cardiogenic, or septic shock
  4. Severe pulmonary edema, fluid overload
  5. Anticipated treatment <5 days
  6. Profound metabolic or electrolyte disturbances
  7. Unable to obtain venous access
  8. Prognosis doesn’t warrant aggressive nutritional support
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9
Q

A type or parenteral nutrition support wherein the osmolarity is around 1500-2800 mOs/L, and requires administration into large veins at 2-6L/min, complete nutritional requirements

A

Centra parenteral nutrition

Peripheral parenteral nutrition - <900mOsm/day, low [dextrose], low [amino acid]

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10
Q

____ is a fatal condition where the fluid shifts and electrolytes (presenting as fatigue, lethargy, muscle weakness, fluid overload, cardiac arrhythmia, hemolysis) that may occur in malnourished patients receiving artificial refeeding whether enterally or parenterally

A

Refeeding syndrome

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11
Q

[severity of weight loss: significant/severe]

1 week 1 to 2%

A

significant

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12
Q

[severity of weight loss]

It is considered a severe weight loss in 1 month if you lost ____ %

A

> 5%

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13
Q

[severity of weight loss]

It is considered a severe weight loss in 3 months if you lost ____ %

A

> 7.5%

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14
Q

[severity of weight loss]

It is considered a significant weight loss in 6 month if you lost ____ %

A

10%

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15
Q

[BMI]

what is the BMI AP cut off for overweight

A

23 to 24.9

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16
Q

[BMI]

what is the BMI AP cut off for Obese type 1

A

25 to 29.9

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17
Q

[BMI]

what is the BMI AP cut off for underweight

A

<18.5

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18
Q

[BMI]

what is the BMI AP cut off for normal

A

18.5 to 22.9

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19
Q

transferrin ___ (increases/decreases) in

IDA, anemia of chronic diseases

A

increases

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20
Q

transferrin ___ (increases/decreases) in

hemosiderosis, thalassemia, hemochromatosis

A

decreases

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21
Q

What is the formula in determining transferrin based on TIBC?

A

Transferrim = (0.8 x TIBC) - 43

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22
Q

The estimated protein requirement for non-stressed patient is?

A

0.8 to 1g/kg/day

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23
Q

burn patients need ____ grams of protein per kg per day?

A

2.5

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24
Q

[Phase of surgical metabolism]

decreased in total body energy; urinary nitrogen excretion

“reconstruction”

(+) efforts to protect homeostasis

Shock + hypoperfusion

A

EBB phase

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25
Q

[Phase of surgical metabolism]

“after operation phase” + “recovery from operation phase”

A

flow phase

26
Q

[Phase of surgical metabolism]

decreased BMR
decreased Temperature
Decreased O2 consumption

A

Ebb phase

27
Q

[Phase of surgical metabolism]

“after operation phase’

compensating response to initial trauma and volume replacement

A

catabolic phase

28
Q

[Phase of surgical metabolism]

Increased BMR
Increased Temperature
Increased O2 consumption

A

catabolic flow phase

29
Q

[Phase of surgical metabolism]

repair - conserve blood and energy reserves

A

ebb phase

30
Q

[Phase of surgical metabolism]

replacement of lost tissue
positive nitrogen balance

A

anabolic

31
Q

{Energy source]

Short term fasting

A

lipids

32
Q

[Energy source]

prolonged fasting

A

ketone bodies

33
Q

[energy source]

After suregery

A

lipids

34
Q

[Enteral formula]

used in patients with normal or near normal GI function

1 kcal/mL

A

Standard intact nutrients

35
Q

[Enteral formula]

used in patients with severely impaired GI absorption

predigested
low-fat content OR high Medium chain TG

A

elemental

36
Q

[Enteral formula]

Intact nutrients

2 kcalmL

A

Fluid restricted

37
Q

[Enteral formula]

low PO4, low K
Intact nutrients

A

Renal

38
Q

[Enteral feeding access]

short term use
aspiration risks

A

NGT

39
Q

[Enteral formula]

short term use
lower aspiration risk

A

Nasoduodenal

nasojejunal

40
Q

[Enteral formula]

can last 12 to 24 months

A

PEG

41
Q

[Type of PN support]

High osmolarity
Provides complete nutrition
needs large veins with high blood flow

A

CPN or TPN

42
Q

What is the usual osmolarity range for Total PNN?

A

1500 to 2800 mOm/L

43
Q

[Type of PN support]

Osmolarity <900
lower [dextrose] and [amino acids]

A

PPN

44
Q

What are the indication for parenteral nutrition?

A
  1. Inability to absorb adequate nutrients via the GIT
  2. Complete bowel obstruction or intestinal pseuroobstruction
  3. Severe catabolism within 5 to 7 days
  4. Inability to obtain enteral access
45
Q

What are the contraindications for PN

A
  1. Functional GIT
  2. Hemodynamically unstable
  3. Anticipated treatment <5 days in the absence of severe malnutrition
  4. Profound metabolic or electrolyte disturbances
  5. Unable to obtain previous venous access
46
Q

[complications of parenteral nutrition]

vitamin deficiency

A

Vitamin K

47
Q

[complications of parenteral nutrition]

dry, scaly dermatitis and loss of hair

A

Essential FA deficiency

48
Q

[complications of parenteral nutrition]

Trace mineral deficiency

A

Zinc
Copper
Chromium

49
Q

[complications of parenteral nutrition]

diffuse eczematoid rash at intertiginous areas

A

zinc

50
Q

[complications of parenteral nutrition]

associated with glucose intolerance

A

chromium

51
Q

[complications of parenteral nutrition]

associated with microcytic anemia

A

copper

52
Q

What are the electrolyte disturbances in metabolic syndrome?

A
  1. Hypokalemia
  2. Hypomagnesemia
  3. Hypophosphatemia
53
Q

What are the vitamin deficiency in metabolic syndrome?

A

thiamine deficiency

54
Q

The electrolyte abnormalities in refeeding syndrome is due the increased uptake of what electrolytes and vitamins?

A
  1. Glucose
  2. Thiamine
  3. K, Mg, PO4
55
Q

[guess the electrolyte abnormality]

Nausea, vomiting, weakness, confusion,

HYPOTENSION

A

Hypermagnesemia

Again, magkakafriends ang K, Mg, Ca

56
Q

[guess the electrolyte abnormality]

Nausea, vomiting, weakness, confusion,

HYPERTENSION + Polydipsia

A

Hypercalcemia

Again, magkakafriends ang K, Mg, Ca

57
Q

[guess the electrolyte abnormality]

ileus and constipation

A

HYPOkalemia

58
Q

[guess the electrolyte abnormality]

hyperreflexia
seizures
tetany
muscle tremors

A

HYPO magnesemia

Again, magkakafriends ang K, Mg, Ca

59
Q

[guess the electrolyte abnormality]

hyporeflexia
paresthesia
seizures

A

HYPOcalcemia

Again, magkakafriends ang K, Mg, Ca

60
Q

how will you prepare a GI solution?

A

1 ampule D50 + 5 to 10 units regular insulin + Bicarbonate 1 ampule

Surgery (19 decks)

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