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Year 3 perioperative management > Nutrition > Flashcards

Flashcards in Nutrition Deck (19)
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1
Q

Indications for parenteral nutrition

A
  • Prolonged obstruction or ileus (>7d)
  • High output fistula
  • Short bowel syndrome
  • Severe Crohn’s
  • Severe malnutrition
  • Severe pancreatitis
  • Unable to swallow: e.g. oesophageal Ca
2
Q

Nutrition screening

A

MUST - malnutrition universal screening tool

3
Q

MUST

A

Low risk - 0 - monitor weekly
Medium risk - 1 - monitor 3 days
High risk - 2 + - refer to dietician

Takes into account:

  • BMI
  • Unplanned weight loss
  • Current intake
4
Q

When to refer to a dietician

A
NBM for 3+ days 
Pressure ulcer grade 2+ 
Pt request 
Haemodialysis 
TPN
5
Q

Refeeding syndrome

A

Decreased carb intake → catabolic state with less insulin, fat and protein
catabolism and depletion of intracellular phosphate

  • Refeeding → increased insulin in response to carbs and increases cellular PO4 uptake.
  • Hypophosphataemia
  • Rhabdomyolysis
  • Respiratory insufficiency
  • Arrhythmias
  • Shock
  • Seizures

• Enzymes are down regulated so ammonia not sufficiently metabolised causing toxicity

6
Q

Physiological stress effect

A

Hyper-metabolic state and catabolic response

7
Q

Assessment

A

All patients admitted to hospital should be screened for malnutrition and have their nutritional state assessed - MUST

8
Q

Nasogastric tube feeding (NGT)

A

If unable to take sufficient calories orally or dysfunctional swallow

9
Q

Gastrostomy feeding

A

If oesophagus blocked/dysfunctional

10
Q

Jejunal feeding (jejunostomy)

A

If stomach inaccessible or outflow obstruction

11
Q

Parenteral nutrition

A

If jejunum inaccessible or intestinal failure (IF)

12
Q

Should surgery be delayed to optimise nutrition first

A

No

13
Q

SNAP

A

Sepsis – Overwhelming infection present must be corrected otherwise feeding will be largely useless

Nutrition – Once the infection is corrected, suitable nutritional support should be provided

Anatomy – Define the anatomy of the GI tract so that surgery can be planned

Procedure – Definitive surgery SN&A

14
Q

Correcting albumin

A

Treat underlying cause not simply feeding patient more protein

15
Q

Enhanced Recovery After Surgery

A
  • Reduction in ‘Nil By Mouth’ times (clear fluids up to 2 hours pre-surgery)
  • Pre-operative carbohydrate loading
  • Minimally invasive surgery
  • Minimising the use of drains and nasogastric tubes
  • Rapid reintroduction of feeding post-operatively
  • Early mobilisation
16
Q

Entero-Cutaneous Fistulae

A

High fistula (jejunal) - may need support with enteral or parenteral nutrition

Low fistulae (ileum/colon) - low fibre diet

17
Q

High Output Stoma treatment factors

A

Distance From DJ Flexure to Jejunostomy

Distance From DJ Flexure to Colostomy

18
Q

How to reduce stoma output if infection and active disease is excluded (5)

A
  1. Reduction in hypotonic fluids to 500ml/day
  2. Reduction in gut motility with high dose loperamide and codeine phosphate
  3. Reduction in secretions with high dose PPI bd
  4. Use of WHO solution to reduce sodium losses
  5. Low fibre diet to reduce intraluminal retention of water
19
Q

Where possible, which of the following feeding routes should be used to optimise a patient’s nutritional status pre-operatively?

A

Oral feeding