Surgical Nutrition

Question 1

What is the motto of surgical nutrition?

Answer 1

“If the gut works, use it”

Question 2

What is the normal adult daily requirement of protein?

Answer 2

1 g/kg/day

Question 3

What is the normal adult daily requirement of calories?

Answer 3

30 kcal/kg/day

Question 4

How is basal energy expenditure changed after a severe head injury?

Answer 4

Increased 1.7 fold

Question 5

How is basal energy expenditure changed after a severe burn?

Answer 5

Increased 2-3 fold

Question 6

What is the calorie content of fat?

Answer 6

9 kcal/g

Question 7

What is the calorie content of protein?

Answer 7

4 kcal/g

Question 8

What is the calorie content of carbohydrate?

Answer 8

4 kcal/g

Question 9

What is the formula for converting nitrogen requirement/loss to protein requirement/loss?

Answer 9

Nitrogen X 6.25 = protein

Question 10

What is RQ?

Answer 10

Respiratory Quotient:

Ratio of CO2 produced to O2 consumed

Question 11

What is the normal RQ?

Answer 11

0.8

Question 12

What can be done to decrease the RQ?

Answer 12

More fat, less carbohydrates

Question 13

What dietary change can be made to decrease CO2 production in a patient in whom CO2 retention is a concern?

Answer 13

Decrease carbohydrate calories and increase fat calories

Question 14

What lab tests are used to monitor nutritional status?

Answer 14

Prealbumin (acute change determination); transferrin; albumin (more chronic determination); total lymphocyte count; anergy; retinol-binding protein

Question 15

Where is iron absorbed?

Answer 15

Duodenum (some in proximal jejunum)

Question 16

Where is vitamin B12 absorbed?

Answer 16

Terminal ileum

Question 17

What are the surgical causes of vitamin B12 deficiency?

Answer 17

Gastrectomy, excision of terminal ileum, blind loop syndrome

Question 18

Where are bile salts absorbed?

Answer 18

Terminal ileum

Question 19

Where are fat-soluble vitamins absorbed?

Answer 19

Terminal ileum

Question 20

Which vitamins are fat-soluble?

Answer 20

K, A, D, E

Question 21

What are the signs of vitamin A deficiency?

Answer 21

Poor wound healing

Question 22

What are the signs of vitamin B12/folate deficiency?

Answer 22

Megaloblastic anemia

Question 23

What are the signs of vitamin C deficiency?

Answer 23

Poor wound healing, bleeding gums

Question 24

What are the signs of vitamin K deficiency?

Answer 24

Decrease in the vitamin K-dependent clotting factors (II, VII, IX, X), bleeding, elevated PT

Question 25

What are the signs of chromium deficiency?

Answer 25

Diabetic state

Question 26

What are the signs of zinc deficiency?

Answer 26

Poor wound healing, alopecia, dermatitis, taste disorder

Question 27

What vitamin increases the PO absorption of iron?

Answer 27

PO vitamin C (ascorbic acid)

Question 28

What vitamin lessens the deleterious effects of steroids on wound healing?

Answer 28

Vitamin A

Question 29

What are the common indications for TPN?

Answer 29

NPO > 7 days; enterocutaneous fistula; short bowel syndrome; prolonged ileus

Question 30

What is TPN?

Answer 30

Total Parenteral Nutrition

Question 31

What is in TPN?

Answer 31

Protein, carbohydrates, lipids, (H2O, electrolytes, minerals, vitamins, +/- insulin, +/- H2 blocker)

Question 32

What percentage of calories in TPN comes from lipids?

Answer 32

20-30%

Question 33

What percentage of calories in TPN comes from protein?

Answer 33

10-20%

Question 34

What percentage of calories in TPN comes from carbohydrates?

Answer 34

50-60%

Question 35

What are the possible complications of TPN?

Answer 35

Line infection, fatty infiltration of the liver, electrolyte or glucose problems, PTX during placement of central line, loss of gut barrier, acalculus cholecystitis, refeeding syndrome, hyperosmolality

Question 36

What are the advantages of enteral feeding?

Answer 36

Keeps gut barrier healthy, thought to lessen translocation of bacteria, not associated with complications of line placement, associated with fewer electrolyte or glucose problems

Question 37

What is the major nutrient of the small bowel?

Answer 37

Glutamine

Question 38

What is refeeding syndrome?

Answer 38

Decreased serum potassium, magnesium, and phosphate after refeeding (via TPN or enterally) a starving patient

Question 39

What is an elemental tube feed?

Answer 39

Very low residue tube feed in which almost all the tube feed is absorbed

Question 40

Where is calcium absorbed?

Answer 40

Duodenum (actively), jejunum (passively)

Question 41

What is the major nutrient of the colon?

Answer 41

Butyrate (and other short-chain fatty acids)

Question 42

What must bind B12 for absorption?

Answer 42

Intrinsic factor from the gastric parietal cells

Question 43

What sedative medication has caloric value?

Answer 43

Propofol delivers 1 kcal/cc in the form of lipid

Question 44

Why may all the insulin placed in a TPN bag not get to the patient?

Answer 44

Insulin will bind to the IV tubing

Question 45

What is the best way to determine the caloric requirements of a patient on the ventilator?

Answer 45

Metabolic chart

Question 46

How can serum bicarbonate be increased in patients on TPN?

Answer 46

Increase acetate (which is metabolized into bicarbonate)

Question 47

What are trophic tube feeds?

Answer 47

Very low rate of tube feeds (usually 10-25 cc/hr), which are thought to deep mucosa alive and healthy

Question 48

When should PO feedings be started after a laparotomy?

Answer 48

Classically after flatus or stool PR (usally POD #3-5)

Question 49

What is the best parameter to check adequacy of nutritional status?

Answer 49

Prealbumin