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Surgical Nutrition Flashcards

1
Q

What is the motto of surgical nutrition?

A

“If the gut works, use it”

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2
Q

What is the normal adult daily requirement of protein?

A

1 g/kg/day

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3
Q

What is the normal adult daily requirement of calories?

A

30 kcal/kg/day

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4
Q

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

A

Increased 1.7 fold

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5
Q

How is basal energy expenditure changed after a severe burn?

A

Increased 2-3 fold

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6
Q

What is the calorie content of fat?

A

9 kcal/g

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7
Q

What is the calorie content of protein?

A

4 kcal/g

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8
Q

What is the calorie content of carbohydrate?

A

4 kcal/g

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9
Q

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

A

Nitrogen X 6.25 = protein

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10
Q

What is RQ?

A

Respiratory Quotient:

Ratio of CO2 produced to O2 consumed

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11
Q

What is the normal RQ?

A

0.8

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12
Q

What can be done to decrease the RQ?

A

More fat, less carbohydrates

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13
Q

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

A

Decrease carbohydrate calories and increase fat calories

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14
Q

What lab tests are used to monitor nutritional status?

A

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

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15
Q

Where is iron absorbed?

A

Duodenum (some in proximal jejunum)

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16
Q

Where is vitamin B12 absorbed?

A

Terminal ileum

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17
Q

What are the surgical causes of vitamin B12 deficiency?

A

Gastrectomy, excision of terminal ileum, blind loop syndrome

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18
Q

Where are bile salts absorbed?

A

Terminal ileum

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19
Q

Where are fat-soluble vitamins absorbed?

A

Terminal ileum

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20
Q

Which vitamins are fat-soluble?

A

K, A, D, E

21
Q

What are the signs of vitamin A deficiency?

A

Poor wound healing

22
Q

What are the signs of vitamin B12/folate deficiency?

A

Megaloblastic anemia

23
Q

What are the signs of vitamin C deficiency?

A

Poor wound healing, bleeding gums

24
Q

What are the signs of vitamin K deficiency?

A

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

25
Q

What are the signs of chromium deficiency?

A

Diabetic state

26
Q

What are the signs of zinc deficiency?

A

Poor wound healing, alopecia, dermatitis, taste disorder

27
Q

What vitamin increases the PO absorption of iron?

A

PO vitamin C (ascorbic acid)

28
Q

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

A

Vitamin A

29
Q

What are the common indications for TPN?

A

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

30
Q

What is TPN?

A

Total Parenteral Nutrition

31
Q

What is in TPN?

A

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

32
Q

What percentage of calories in TPN comes from lipids?

A

20-30%

33
Q

What percentage of calories in TPN comes from protein?

A

10-20%

34
Q

What percentage of calories in TPN comes from carbohydrates?

A

50-60%

35
Q

What are the possible complications of TPN?

A

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

36
Q

What are the advantages of enteral feeding?

A

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

37
Q

What is the major nutrient of the small bowel?

A

Glutamine

38
Q

What is refeeding syndrome?

A

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

39
Q

What is an elemental tube feed?

A

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

40
Q

Where is calcium absorbed?

A

Duodenum (actively), jejunum (passively)

41
Q

What is the major nutrient of the colon?

A

Butyrate (and other short-chain fatty acids)

42
Q

What must bind B12 for absorption?

A

Intrinsic factor from the gastric parietal cells

43
Q

What sedative medication has caloric value?

A

Propofol delivers 1 kcal/cc in the form of lipid

44
Q

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

A

Insulin will bind to the IV tubing

45
Q

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

A

Metabolic chart

46
Q

How can serum bicarbonate be increased in patients on TPN?

A

Increase acetate (which is metabolized into bicarbonate)

47
Q

What are trophic tube feeds?

A

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

48
Q

When should PO feedings be started after a laparotomy?

A

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

49
Q

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

A

Prealbumin

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