Surgical Nutrition

Question 1

What are the causes of malnutrition?

Answer 1

• starvation
• > social: poverty, neglected elderly
• > dysphagia: carcinoma of esophagus
• > loss of appetite: depression, malignancy, chronic toxemia
• > repeated vomiting: intestinal obstruction
• > malabsorption: short bowel syndrome (presence of ileocecal valve is v. imp)
• catabolism
• > major burn: >20%
• > major trauma
• > severe sepsis
• > major surgery
• > acute pancreatitis

Question 2

How does malnutrition affect surgical patients?

Answer 2

• impaired wound healing -> burst abdomen
• depressed immunity
• reduced tolerance to chemotherapy & radiotherapy

Question 3

How should a surgical patient’s nutritional status be assessed?

Answer 3

• body weight
• mid-arm circumference
• triceps skin fold thickness
• serum albumin

Question 4

how is nutritional support given?

Answer 4

1- oral intake
2- enteral feeding
3- parenteral feeding

Question 5

Which route of feeding is the easiest & safest, and least expensive route?

Answer 5

Oral intake -> natural route

Question 6

when should enteral feeding be used?

Answer 6

• unconscious patients
• facial & oral trauma or burns
• dysphagia
• operations on esophagus

Question 7

What are the types of tubes used in case of enteral feeding?

Answer 7

• Nasogastric tube
• Gastrostomy tube -> milk, juice, blenderized foods
• Jejunostomy tube -> 15cm away from the ligament of Treitz using special commercial enteral formula

Question 8

What are the complications of enteral feeding?

Answer 8

• malposition & blockage of tube
• gastroesophageal reflux, nausea & vomiting
• feeding intolerance
• fistulae formation or leakage
• over or under nutrition

Question 9

When is parenteral feeding indicated?

Answer 9

short term access in case of

• massive bowel resection (short bowel)
• radiation enteritis (functional short bowel)
• high output intestinal fistula (<500cc conserve)
• prolonged ileus

Question 10

What are the routes of administration in parenteral feeding?

Answer 10

• central venous catheter -> for hyperosmolar solutions

- peripheral catheter -> isotonic lipid preparations

Question 11

What are the complications of parenteral feeding?

Answer 11

NUTRITIONAL

• over or underfeeding
• electrolyte disturbances
• hypo or hyperglycemia

CVC

• misplacement
• hemothorax or pneumothorax
• injury to adjacent nerves of arteries
• venous thrombosis (due to catheter)
• sepsis (catheter related)
• air embolism

GUT MUCOSAL ATROPHY
DETERIORATION OF LIVER FUNCTION TESTS

Question 12

What is the cause of refeeding syndrome?

Answer 12

severe electrolyte & fluid imbalance in severely malnourished patients while starting the proper feeding

• more common in TPN
• common in chronic starvation, severe anorexia, & alcoholic patients

Question 13

What does refeeding syndrome lead to?

Answer 13

• causes hypomagnesaemia, hypocalcemia & hypophosphataemia
• myocardial dysfunction
• respiratory changes
• altered liver functions
• altered level of consciousness
• convulsions
• death

Question 14

what causes disruption in nitrogen balance?

Answer 14

1g protein = 6.25g nitrogen
POSITIVE NITROGEN BALANCE (intake > urinary output) -> anabolic state
NEGATIVE NITROGEN BALANCE (urinary output > intake) -> catabolic state

Question 15

imp physiological facts

Answer 15

• carbs & proteins = 4Kcal/g
• fats = 9Kcal/g
• glucose if the only source of energy for the brain, RBC & adrenal medulla
• excess calories are stored as fat
• proteins are used to build muscle & help in synthesis of enzymes & some hormones