Surgical Nutrition, C25 P160-164 Flashcards
What is the motto of surgical nutrition?
P160
“If the gut works, use it”
What are the normal daily dietary requirements for adults of the following:
Protein
P160
1 g/kg/day
What are the normal daily dietary requirements for adults of the following:
Calories
P160
30 kcal/kg/day
By how much is basal energy expenditure (BEE) increased or decreased in the following cases:
Severe head injury
P161
Increased ≈1.7 x
By how much is basal energy expenditure (BEE) increased or decreased in the following cases:
Severe burns
P161
Increased ≈2–3 x
What are the calorie contents of the following substances:
Fat
P161
9 kcal/g
What are the calorie contents of the following substances:
Protein
P161
4 kcal/g
What are the calorie contents of the following substances:
Carbohydrate
P161
4 kcal/g
What is the formula for converting nitrogen
requirement/loss to protein requirement/loss?
P161
Nitrogen x 6.25 = protein
What is RQ?
P161
Respiratory Quotient: ratio of CO(2)
produced to O(2) consumed
What is the normal RQ?
P161
0.8
What can be done to decrease the RQ?
P161
More fat, less carbohydrates
What dietary change can be made to decrease CO(2) production in a patient in whom CO(2) retention is a concern?
P161
Decrease carbohydrate calories and increase calories from fat
What lab tests are used to monitor nutritional status?
P161
Blood levels of:
- Prealbumin (t1/22–3 days)—acute change determination
- Transferrin (t1/28–9 days)
- Albumin (t1/214–20 days)—more chronic determination
- Total lymphocyte count
- Anergy
- Retinol-binding protein (t1/212 hours)
Where is iron absorbed?
P161
Duodenum (some in proximal jejunum)
Where is vitamin B12 absorbed?
P162
Terminal ileum
What are the surgical causes of vitamin B12 deficiency?
P162
Gastrectomy, excision of terminal ileum, blind loop syndrome
Where are bile salts absorbed?
P162
Terminal ileum
Where are fat-soluble vitamins absorbed?
P162
Terminal ileum
Which vitamins are fat soluble?
P162
K, A, D, E (“KADE”)
What are the signs of the following disorders:
Vitamin A deficiency
P162
Poor wound healing
What are the signs of the following disorders:
Vitamin B12/folate deficiency
P162
Megaloblastic anemia
What are the signs of the following disorders:
Vitamin C deficiency
P162
Poor wound healing, bleeding gums
What are the signs of the following disorders:
Vitamin K deficiency
P162
↓ in the vitamin K–dependent clotting
factors (II, VII, IX, and X); bleeding;
elevated PT
What are the signs of the following disorders:
Chromium deficiency
P162
Diabetic state
What are the signs of the following disorders:
Zinc deficiency
P162
Poor wound healing, alopecia, dermatitis, taste disorder
What are the signs of the following disorders:
Fatty acid deficiency
P162
Dry, flaky skin; alopecia
What vitamin increases the PO absorption of iron?
P162
PO vitamin C (ascorbic acid)
What vitamin lessens the deleterious effects of
steroids on wound healing?
P162
Vitamin A
What are the common indications for total
parenteral nutrition (TPN)?
P162
NPO >7 days Enterocutaneous fistulas
Short bowel syndrome
Prolonged ileus
What is TPN?
P163
Total Parenteral Nutrition = IV nutrition
What is in TPN?
P163
Protein Carbohydrates Lipids (H(2)O, electrolytes, minerals/vitamins, ± insulin, ± H(2) blocker)
How much of each in TPN:
Lipids
P163
20% to 30% of calories (lipid from soybeans, etc.)
How much of each in TPN:
Protein
P163
1.7 g/kg/day (10%–20% of calories) as amino acids
How much of each in TPN:
Carbohydrates
P163
50% to 60% of calories as dextrose
What are the possible complications of TPN?
P163
Line infection, fatty infiltration of the liver, electrolyte/glucose problems, pneumothorax during placement of central line, loss of gut barrier, acalculus cholecystitis, refeeding syndrome, hyperosmolality
What are the advantages of enteral feeding?
P163
Keeps gut barrier healthy, thought to lessen translocation of bacteria, not associated with complications of line placement, associated with fewer electrolyte/glucose problems
What is the major nutrient of the gut (small bowel)?
P163
Glutamine
What is “refeeding syndrome”?
P163
Decreased serum potassium, magnesium, and phosphate after refeeding (via TPN or enterally) a starving patient
What are the vitamin K–dependent clotting factors?
P163
2, 7, 9, 10 (Think: 2 + 7 = 9, and then 10)
What is an elemental tube feed?
P163
Very low residue tube feed in which almost all the tube feed is absorbed
Where is calcium absorbed?
P163
Duodenum (actively)
Jejunum (passively)
What is the major nutrient of the colon?
P164
Butyrate (and other short-chain fatty acids)
What must bind B12 for absorption?
P164
Intrinsic factor from the gastric parietal cells
What sedative medication has caloric value?
P164
Propofol delivers 1 kcal/cc in the form of lipid!
Why may all the insulin placed in a TPN bag not get to the patient?
P164
Insulin will bind to the IV tubing
What is the best way to determine the caloric requirements of a patient on the ventilator?
P164
Metabolic chart
How can serum bicarbonate be increased in patients on TPN?
P164
Increase acetate (which is metabolized into bicarbonate)
What are “trophic” tube feeds?
P164
Very low rate of tube feeds (usually 10–25 cc/hr), which are thought to keep mucosa alive and healthy
When should PO feedings be started after a laparotomy?
P164
Classically after flatus or stool PR
usually postoperative days 3–5
What is the best parameter to check adequacy of nutritional status?
P164
Prealbumin
