Surgical nutrition

Question 0

What are the calorie contents of the main metabolites?

Answer 0

Fats: 9kcal/ g
Protein: 4kcal/g
Carbohydrate: 4kcal/g

Question 1

What are the daily nutritional requirements in health?

Answer 1

25 kcal/ kg
100g glucose
0.15g nitrogen/ kg
0.8g protein/ kg

Question 2

How much recent weight loss if considered to be risky for surgery?

Answer 2

> 10% of original body weight

Question 3

What are the indications for parenteral nutrition?

Answer 3

1. neurological disease (coma, intracranial surgery, CNS trauma)
2. maxillofacial or neck trauma
3. malfunctioning GIT (fistula, Crohn’sm massive small bowel resection, upper GI disease)
4. hypercatabolic state {-ve nitrogen balance} (fever >38, severe polytrauma, extensive burns)

Question 4

What are the complications for parenteral feeding?

Answer 4

Same as central line +
increased glucose and risk of HHS
hypokalaemia, hyperchloride, risk of acidosis 
low magnesium and phosphate 
low essential fatty acids 
increased urea 
jaundice

Question 5

What is refeeding syndrome?

Answer 5

low potassium, magnesium, phosphate in a patient who is being re fed after a period of starvation

Question 6

When should enteric feeding start after laparotomy?

Answer 6

Once the patient has passed flatus

Question 7

What ate the fat soluble vitamins and where are they absorbed?

Answer 7

Vits A, D, E and K

in the terminal ileum

Question 8

Which water soluble vitamin is absorbed in the terminal ileum?

Answer 8

Vit B12 - dependent on intrinsic factor produced by the parietal cells i the stomach

Question 9

Describe the clinical features of Vitamin A deficiency

Answer 9

night blindness, xerosis of the conjunctiva and cornea
xerophthalmia and keratomalacia
keratinisation of the lung, GI tract and urinary tract epithelia
increased susceptibility to infections
follicular hyperkeratosis of the skin

Question 10

Describe the clinical features of Vitamin B deficiency

Answer 10

Vit B1 (thiamine)
Irritability, poor memory, sleep disturbances, chest pain, anorexia, abdominal pain, and constipation 
CVS symptoms (wet Beri Beri)

Vit B6 (pyridoxine)
Dermatosis, glossitis, cheilosis, peripheral neuropathy and lymphopenia 

Vit B12 (cobalamin)
Megalobalstic anaemia, peripheral neuropathy

Question 11

Describe the clinical features of Vitamin C deficiency

Answer 11

Scurvy

Bleeding gums, poor wound healing

Question 12

Describe the clinical features of vitamin D deficiency

Answer 12

Osteomalacia or rickets

Bowing of the long bones, short stature in children, and flattening of the pelvic bones

Question 13

Which vitamin increases Fe absorption

Answer 13

Vitamin C

Question 14

Which mineral is important in wound healing?

Answer 14

Zinc