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Surgical Recall > Surgical Nutrition, C25 P160-164 > Flashcards

Surgical Nutrition, C25 P160-164 Flashcards

1
Q

What is the motto of surgical nutrition?

P160

A

“If the gut works, use it”

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2
Q

What are the normal daily dietary requirements for adults of the following:
Protein
P160

A

1 g/kg/day

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3
Q

What are the normal daily dietary requirements for adults of the following:
Calories
P160

A

30 kcal/kg/day

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4
Q

By how much is basal energy expenditure (BEE) increased or decreased in the following cases:
Severe head injury
P161

A

Increased ≈1.7 x

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5
Q

By how much is basal energy expenditure (BEE) increased or decreased in the following cases:
Severe burns
P161

A

Increased ≈2–3 x

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6
Q

What are the calorie contents of the following substances:
Fat
P161

A

9 kcal/g

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7
Q

What are the calorie contents of the following substances:
Protein
P161

A

4 kcal/g

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8
Q

What are the calorie contents of the following substances:
Carbohydrate
P161

A

4 kcal/g

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9
Q

What is the formula for converting nitrogen
requirement/loss to protein requirement/loss?
P161

A

Nitrogen x 6.25 = protein

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10
Q

What is RQ?

P161

A

Respiratory Quotient: ratio of CO(2)

produced to O(2) consumed

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11
Q

What is the normal RQ?

P161

A

0.8

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12
Q

What can be done to decrease the RQ?

P161

A

More fat, less carbohydrates

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13
Q

What dietary change can be made to decrease CO(2) production in a patient in whom CO(2) retention is a concern?
P161

A

Decrease carbohydrate calories and increase calories from fat

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14
Q

What lab tests are used to monitor nutritional status?

P161

A

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)
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15
Q

Where is iron absorbed?

P161

A

Duodenum (some in proximal jejunum)

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16
Q

Where is vitamin B12 absorbed?

P162

A

Terminal ileum

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17
Q

What are the surgical causes of vitamin B12 deficiency?

P162

A

Gastrectomy, excision of terminal ileum, blind loop syndrome

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18
Q

Where are bile salts absorbed?

P162

A

Terminal ileum

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19
Q

Where are fat-soluble vitamins absorbed?

P162

A

Terminal ileum

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20
Q

Which vitamins are fat soluble?

P162

A

K, A, D, E (“KADE”)

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21
Q

What are the signs of the following disorders:
Vitamin A deficiency
P162

A

Poor wound healing

22
Q

What are the signs of the following disorders:
Vitamin B12/folate deficiency
P162

A

Megaloblastic anemia

23
Q

What are the signs of the following disorders:
Vitamin C deficiency
P162

A

Poor wound healing, bleeding gums

24
Q

What are the signs of the following disorders:
Vitamin K deficiency
P162

A

↓ in the vitamin K–dependent clotting
factors (II, VII, IX, and X); bleeding;
elevated PT

25
Q

What are the signs of the following disorders:
Chromium deficiency
P162

A

Diabetic state

26
Q

What are the signs of the following disorders:
Zinc deficiency
P162

A

Poor wound healing, alopecia, dermatitis, taste disorder

27
Q

What are the signs of the following disorders:
Fatty acid deficiency
P162

A

Dry, flaky skin; alopecia

28
Q

What vitamin increases the PO absorption of iron?

P162

A

PO vitamin C (ascorbic acid)

29
Q

What vitamin lessens the deleterious effects of
steroids on wound healing?
P162

A

Vitamin A

30
Q

What are the common indications for total
parenteral nutrition (TPN)?
P162

A

NPO >7 days Enterocutaneous fistulas
Short bowel syndrome
Prolonged ileus

31
Q

What is TPN?

P163

A

Total Parenteral Nutrition = IV nutrition

32
Q

What is in TPN?

P163

A 
Protein
Carbohydrates
Lipids
(H(2)O, electrolytes, minerals/vitamins,
 ± insulin,  ± H(2) blocker)
33
Q

How much of each in TPN:
Lipids
P163

A

20% to 30% of calories (lipid from soybeans, etc.)

34
Q

How much of each in TPN:
Protein
P163

A

1.7 g/kg/day (10%–20% of calories) as amino acids

35
Q

How much of each in TPN:
Carbohydrates
P163

A

50% to 60% of calories as dextrose

36
Q

What are the possible complications of TPN?

P163

A

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

37
Q

What are the advantages of enteral feeding?

P163

A

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

38
Q

What is the major nutrient of the gut (small bowel)?

P163

A

Glutamine

39
Q

What is “refeeding syndrome”?

P163

A

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

40
Q

What are the vitamin K–dependent clotting factors?

P163

A

2, 7, 9, 10 (Think: 2 + 7 = 9, and then 10)

41
Q

What is an elemental tube feed?

P163

A

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

42
Q

Where is calcium absorbed?

P163

A

Duodenum (actively)

Jejunum (passively)

43
Q

What is the major nutrient of the colon?

P164

A

Butyrate (and other short-chain fatty acids)

44
Q

What must bind B12 for absorption?

P164

A

Intrinsic factor from the gastric parietal cells

45
Q

What sedative medication has caloric value?

P164

A

Propofol delivers 1 kcal/cc in the form of lipid!

46
Q

Why may all the insulin placed in a TPN bag not get to the patient?
P164

A

Insulin will bind to the IV tubing

47
Q

What is the best way to determine the caloric requirements of a patient on the ventilator?
P164

A

Metabolic chart

48
Q

How can serum bicarbonate be increased in patients on TPN?

P164

A

Increase acetate (which is metabolized into bicarbonate)

49
Q

What are “trophic” tube feeds?

P164

A

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

50
Q

When should PO feedings be started after a laparotomy?

P164

A

Classically after flatus or stool PR

usually postoperative days 3–5

51
Q

What is the best parameter to check adequacy of nutritional status?
P164

A

Prealbumin

Surgical Recall (33 decks)

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