Nutrition And Surgery

Question 1

What is ERAS?

Answer 1

Enhanced recovery after surgery.

Question 2

Name 3 main acute phase responses of surgery on nutrition? (3)

Answer 2

1. Hyper-metabolism
2. Protein catabolism
3. Insulin resistance - hyperglycemia

All of which have an influence on macronutrients and

Question 3

Rearrange the following according to the highest energy expenditure:
Skeletal trauma, sepsis, starvation, major burns, elective operation.

Answer 3

Major burns 
Sepsis peritonitis 
Skeletal trauma
Elective operation 
Starvation

Question 4

Name 4 factors that influence metabolic rate

Answer 4

• BMR (Basal metabollic rate)- 70%
  
  • Thermogenesis- 10%
  • Physical work- 20-30%
  • Post injury (Injury/illness itself or effects of treatment)

Question 5

How many KJ is enough for one hour?

Answer 5

475 KJ

Question 6

What is RME?

Answer 6

Rapid metabolic expenditure.

Question 7

Explain the concept of RME

Answer 7

Rapid metabolic expenditure.

- Energy expended in activities necessary to sustain normal body functions homeostasis

Question 8

Name 4 complications that can be attributed to a los of lean body mass (loss of muscle and fat):

Answer 8

Impaired immunity and increased infection.
Decreased healing, infection.
Too weak to sit, pressure ulcers, pneumonia, no healing
Death- usually by pneumonia

Question 9

Which patients are at risk for PEM (Protein-energy malnutrition)?

Answer 9

Excessive alcohol intake
Age: under 18yr and older than 65
Homeless patients, with limited access to food
High metabolic response (catabolic illness and high stress response)
Catabolic drug users (corticosteroids, immunosuppressants)
Protracted vomiting (Bulimia, chemotherapy, AIDS etc)

Question 10

Why is nutritional support important in surgery?

Answer 10

Nutritional support is positively associated with a successful recovery
The mechanism of response includes: improving the nutritional status:
- Increased caloric intake
- Reinforced immune response: GALT (immunemodulating agents)

Question 11

Give 4 supporting facts that perioperative nutritional support positively affects outcome:

Answer 11

1. Reduced prevalence of complications
2. Reduced mortality
3. Cost effective
4. Shorter LOS

Question 12

In order to achieve enhanced recovery after surgery, which 5 practices must be set in place preoperatively:

Answer 12

Omission of nasogastric tube 
Stop smoking 
Fluid and oral carbohydrates load 
Preoperative counseling 
Fasting limited to 3 hours 
No bowel preparation

Question 13

In order to achieve enhanced recovery after surgery, which 5 practices must be set in place postoperatively:

Answer 13

Remove nasogastric tube immediately 
Avoid any post operative drains
Initiation of fluid and carbohydrate diet 
Aggressive mobilization therapy 
Epidural analgesia
Prevent nausea and vomiting

Question 14

In order to achieve enhanced recovery after surgery, which 5 practices must be set in place perioperatively:

Answer 14

Maintain normothermia
Avoid drains
Pain management
Avoid fluid and food overload

Question 15

Incomplete

Answer 15

Incomplete