Surgical Nutrition Flashcards

1
Q

What are the causes of malnutrition?

A
  • starvation
  • > social: poverty, neglected elderly
  • > dysphagia: carcinoma of esophagus
  • > loss of appetite: depression, malignancy, chronic toxemia
  • > repeated vomiting: intestinal obstruction
  • > malabsorption: short bowel syndrome (presence of ileocecal valve is v. imp)
  • catabolism
  • > major burn: >20%
  • > major trauma
  • > severe sepsis
  • > major surgery
  • > acute pancreatitis
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2
Q

How does malnutrition affect surgical patients?

A
  • impaired wound healing -> burst abdomen
  • depressed immunity
  • reduced tolerance to chemotherapy & radiotherapy
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3
Q

How should a surgical patient’s nutritional status be assessed?

A
  • body weight
  • mid-arm circumference
  • triceps skin fold thickness
  • serum albumin
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4
Q

how is nutritional support given?

A

1- oral intake
2- enteral feeding
3- parenteral feeding

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5
Q

Which route of feeding is the easiest & safest, and least expensive route?

A

Oral intake -> natural route

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6
Q

when should enteral feeding be used?

A
  • unconscious patients
  • facial & oral trauma or burns
  • dysphagia
  • operations on esophagus
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7
Q

What are the types of tubes used in case of enteral feeding?

A
  • Nasogastric tube
  • Gastrostomy tube -> milk, juice, blenderized foods
  • Jejunostomy tube -> 15cm away from the ligament of Treitz using special commercial enteral formula
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8
Q

What are the complications of enteral feeding?

A
  • malposition & blockage of tube
  • gastroesophageal reflux, nausea & vomiting
  • feeding intolerance
  • fistulae formation or leakage
  • over or under nutrition
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9
Q

When is parenteral feeding indicated?

A

short term access in case of

  • massive bowel resection (short bowel)
  • radiation enteritis (functional short bowel)
  • high output intestinal fistula (<500cc conserve)
  • prolonged ileus
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10
Q

What are the routes of administration in parenteral feeding?

A
  • central venous catheter -> for hyperosmolar solutions

- peripheral catheter -> isotonic lipid preparations

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11
Q

What are the complications of parenteral feeding?

A

NUTRITIONAL

  • over or underfeeding
  • electrolyte disturbances
  • hypo or hyperglycemia

CVC

  • misplacement
  • hemothorax or pneumothorax
  • injury to adjacent nerves of arteries
  • venous thrombosis (due to catheter)
  • sepsis (catheter related)
  • air embolism

GUT MUCOSAL ATROPHY
DETERIORATION OF LIVER FUNCTION TESTS

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12
Q

What is the cause of refeeding syndrome?

A

severe electrolyte & fluid imbalance in severely malnourished patients while starting the proper feeding

  • more common in TPN
  • common in chronic starvation, severe anorexia, & alcoholic patients
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13
Q

What does refeeding syndrome lead to?

A
  • causes hypomagnesaemia, hypocalcemia & hypophosphataemia
  • myocardial dysfunction
  • respiratory changes
  • altered liver functions
  • altered level of consciousness
  • convulsions
  • death
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14
Q

what causes disruption in nitrogen balance?

A

1g protein = 6.25g nitrogen
POSITIVE NITROGEN BALANCE (intake > urinary output) -> anabolic state
NEGATIVE NITROGEN BALANCE (urinary output > intake) -> catabolic state

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15
Q

imp physiological facts

A
  • carbs & proteins = 4Kcal/g
  • fats = 9Kcal/g
  • glucose if the only source of energy for the brain, RBC & adrenal medulla
  • excess calories are stored as fat
  • proteins are used to build muscle & help in synthesis of enzymes & some hormones
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