L2: Surgical Nutrition Flashcards
(134 cards)
1
Q
Def of Malnutrition
A
2
Q
Causes of Malnutrition
A
3
Q
Metabolic Response to Starvation
A
4
Q
Mechanism of metabolic response to trauma & sepsis
A
5
Q
Body response to Trauma & Sepsis
A
6
Q
Mechanism of metabolic response to surgery
A
7
Q
triggers for metabolic response to surgery
A
8
Q
Risk factors for metabolic response to surgery
A
9
Q
How to Decrease IR before surgery?
A
10
Q
Evaluation of Malnutrition
A
11
Q
Hx
Evaluation of Malnutrition
A
12
Q
History of poor nutrient intake
Evaluation of Malnutrition
A
13
Q
Significant Loss of body weight (see table)
Evaluation of Malnutrition
A
14
Q
Social & economic conditions may lead to poverty & malnutrition
Evaluation of Malnutrition
A
15
Q
Gastrointestinal symptoms
Evaluation of Malnutrition
A
16
Q
Other chronic medical illnesses
Evaluation of Malnutrition
A
17
Q
Physical Examination
Evaluation of Malnutrition
A
18
Q
general appearence
Evaluation of Malnutrition
A
19
Q
Skin,Nails & Hair
Evaluation of Malnutrition
A
20
Q
Effect of decrease in protein
Evaluation of Malnutrition
A
21
Q
Effect of low iron
Evaluation of Malnutrition
A
22
Q
effect of low vit C
Evaluation of Malnutrition
A
23
Q
effect of low zinc
Evaluation of Malnutrition
A
24
Q
Effect of low Vit A
Evaluation of Malnutrition
A
25
Eyes
**Evaluation of Malnutrition**
26
Effect of anemia
**Evaluation of Malnutrition**
27
effect of low thiamine
**Evaluation of Malnutrition**
28
effect of low vitamin A on eyes
**Evaluation of Malnutrition**
29
Def of **Anthropometry**
30
Anthropometry can assess the level of energy reserves by ......
estimating the amount of subcutaneous adipose stores.
31
However, Anthropometry ....... identify specific nutrient deficiency
cannot
32
Anthropometric assessment
33
Triceps skin fold thickness (mm)
34
Mid arm circumference (cm)
35
Investigations to detect subclinical nutritional deficiencies in surgical patients.
36
To detect subclinical nutritional protein deficiencies in surgical patients:
37
Nitrogen Balance
37
...... protein gained = ..... g nitrogen.
6.25 , 1
38
Equations for Nitrogen balance
39
Serum Albumin
40
Serum albumin level ..... during the acute stress of surgery, sepsis, or other acute inflammatory illness because of ......
- ↓
^^^^^^^
- ↑ circulating extravascular volume.
- TNF-α mediated inhibition of albumin synthesis.
41
Normal albumin level (used as an index of malnutrition) → .......
35g/L = 3.5g/dl (half-life of → 14 to 18 days).
42
Prealbumin (half-life, 3 to 5 days) or transferrin (<200 mg/dL; half-life, 7 days) → .......
ore sensitive indicators of rapid changes in nutritional status.
43
Creatinine excretion
44
Creatinine is a metabolic product of ......
skeletal muscle creatine
45
Creatinine amount is ...... proportional to skeletal muscle mass.
directly
46
...... g creat = .....g of fat free skeletal muscle in the 24-h urine collection (With steady state of day-to-day renal function).
- 1
- 18.5
47
Creatinine Levels & Assessment of surgical Patients
48
Immunological assessment
49
Delayed cutaneous hypersensitivity or anergy → Most commonly tested by delayed reaction to skin recall antigens.
....
50
- It was widely used in early studies of nutritional assessment and is a manifestation of cell-mediated immunity.
- Total Lymphocyte count is often <1000 /μL and may accompany anergy to common skin test antigens.
- Not all malnourished patients are at Immunological risk.
51
Adverse effect of protein or calories depletion
52
Read Dietary assessment tools
53
Assessment of nutritional requirement
54
Estimating Energy Requirement
55
Aim of fluid maintenance
56
Methods of Fluid input
57
Methods of Fluid output
58
Indications of Intravenous fluid replacement solutions
59
Selection of Intravenous fluid replacement solutions
60
Types & Uses of Intravenous fluid replacement solutions
61
Effect of intestinal resection on fluid & nutrient absorption
62
Effect of Jejunal resection
63
result of Jejunal resection
64
Effect of Ileal resection
65
Result of Ileal resection
66
Def of **Short Bowel Syndrome**
67
CP of **Short Bowel Syndrome**
68
Complications of **Short Bowel Syndrome**
69
Recovery of **Short Bowel Syndrome**
70
TTT of **Short Bowel Syndrome** if no normal recovery
71
Types of Nutritional Support
72
Daily Requirements of
- Water
- Calories
- Sodium
- Potassium
73
Total energy need in:
- Unwell Patients
- Stable patients
- Severe illness
74
CHO Req per day
75
Protein Req per day
76
Fat Req per day
77
Effect of **Mixture of glucose and fat in TPN**
78
Effect of Vit B
**Surgical Nutrition**
79
Effect of Vit C
**Surgical Nutrition**
80
Obstructive jaundice & pancreatic duct obstruction → .... in fat soluble vitamins (ADEK)
↓
81
- ↑ intestinal losses → ↓ in Na, K, phosphate.
- ↓ in trace elements (zinc magnesium, Fe) due to inflammatory response → needed for increased utilization of AA and decrease refeeding syndrome
..
82
Indications Of Nutritional Support
83
Advantages of enteral feeds
84
Who Needs Nutritional Support?
85
Algorithm of feeding
86
Methods of Enteral Feeding
87
Indications of N/G tube feeding.
88
Types of **Gastrostomy tube feeding**
89
Types of **Jejunostomy tube feeding**
90
NJT are better than NGT and gastrostomy as NJT
bypass the pylorus so ......
decrease aspiration and also not need for TPN with
91
Types of Tube feeding techniques
92
Installation of Nasogastric tube
93
Indications of Fine bore tube
94
charachters of Fine bore tube
95
Disadvantages of Fine bore tube
96
Installation of Nasojejunal feeding
97
Types of Gastrostomy
98
complications of Gastrostomy
99
Types of Jejunostomy tube
100
Complications of Jejunostomy tube
101
Complications of enteral feeding
102
GIT Complications of enteral feeding
103
Metabolic Complications of **Enteral feeding**
104
Contraindications to Enteral Nutrition
105
Def of **Parentral Nutrition**
106
Indication of **Parentral Nutrition**
107
Compositions of parenteral solutions
108
Types of parenteral Nutrition
109
Characters of Peripheral parenteral nutrition
110
Characters of Total parenteral nutrition
111
Sites for insertion in Parentral Nutrition
112
Advantages of parentral nutrition
113
Characters of Parenteral Amino Acid Solutions
114
Special Parenteral Amino Acid Solutions (Formulas)
115
Designing parenteral nutrition formula
116
Mechanical complications of **Parentral Nutrition**
117
Metabolic complications of **Parentral Nutrition**
118
Infection complications of **Parentral Nutrition**
119
Other complications of **Parentral Nutrition**
120
- In patients with diabetes and those with impaired blood glucose control owing to critical illness → administration of parenteral nutrition should coincide with a variable insulin infusion regimen to avoid hyperglycemia.
- Conversely, insulin dosing should be reduced accordingly when parenteral nutrition is interrupted to avoid hypoglycemia.
..
121
Def of **Refeeding Syndrome**
122
CP of **Refeeding Syndrome**
123
Who are at risk of **Refeeding Syndrome**?
124
Prevention & Therapy of **Refeeding Syndrome**
125
Incidence of **Liver Dysfunction**
**Complications Related to TPN**
126
Types of Diseases in liver dysfunction
**Complications Related to TPN**
127
RF for Liver Dysfunction
**Complications Related to TPN**
128
**Metabolic bone Disease & Vitamin Deficiency**
- **Complications Related to TPN**
129
Cause of **Overfeeding**
**Complications Related to TPN**
130
CP of **Overfeeding**
**Complications Related to TPN**
131
Monitoring
**Complications Related to TPN**
131
Take Home messages
- Surgical Nutrition
132
Doneeeeee
