Surgical Nutrition, C25 P160-164

Question 1

What is the motto of surgical nutrition?

P160

Answer 1

“If the gut works, use it”

Question 2

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

Answer 2

1 g/kg/day

Question 3

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

Answer 3

30 kcal/kg/day

Question 4

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

Answer 4

Increased ≈1.7 x

Question 5

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

Answer 5

Increased ≈2–3 x

Question 6

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

Answer 6

9 kcal/g

Question 7

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

Answer 7

4 kcal/g

Question 8

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

Answer 8

4 kcal/g

Question 9

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

Answer 9

Nitrogen x 6.25 = protein

Question 10

What is RQ?

P161

Answer 10

Respiratory Quotient: ratio of CO(2)

produced to O(2) consumed

Question 11

What is the normal RQ?

P161

Answer 11

0.8

Question 12

What can be done to decrease the RQ?

P161

Answer 12

More fat, less carbohydrates

Question 13

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

Answer 13

Decrease carbohydrate calories and increase calories from fat

Question 14

What lab tests are used to monitor nutritional status?

P161

Answer 14

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)

Question 15

Where is iron absorbed?

P161

Answer 15

Duodenum (some in proximal jejunum)

Question 16

Where is vitamin B12 absorbed?

P162

Answer 16

Terminal ileum

Question 17

What are the surgical causes of vitamin B12 deficiency?

P162

Answer 17

Gastrectomy, excision of terminal ileum, blind loop syndrome

Question 18

Where are bile salts absorbed?

P162

Answer 18

Terminal ileum

Question 19

Where are fat-soluble vitamins absorbed?

P162

Answer 19

Terminal ileum

Question 20

Which vitamins are fat soluble?

P162

Answer 20

K, A, D, E (“KADE”)

Question 21

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

Answer 21

Poor wound healing

Question 22

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

Answer 22

Megaloblastic anemia

Question 23

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

Answer 23

Poor wound healing, bleeding gums

Question 24

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

Answer 24

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

Question 25

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

Answer 25

Diabetic state

Question 26

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

Answer 26

Poor wound healing, alopecia, dermatitis, taste disorder

Question 27

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

Answer 27

Dry, flaky skin; alopecia

Question 28

What vitamin increases the PO absorption of iron? | P162

Answer 28

PO vitamin C (ascorbic acid)

Question 29

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

Answer 29

Vitamin A

Question 30

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

Answer 30

NPO >7 days Enterocutaneous fistulas Short bowel syndrome Prolonged ileus

Question 31

What is TPN? | P163

Answer 31

Total Parenteral Nutrition = IV nutrition

Question 32

What is in TPN? | P163

Answer 32

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

Question 33

How much of each in TPN: Lipids P163

Answer 33

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

Question 34

How much of each in TPN: Protein P163

Answer 34

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

Question 35

How much of each in TPN: Carbohydrates P163

Answer 35

50% to 60% of calories as dextrose

Question 36

What are the possible complications of TPN? | P163

Answer 36

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

Question 37

What are the advantages of enteral feeding? | P163

Answer 37

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

Question 38

What is the major nutrient of the gut (small bowel)? | P163

Answer 38

Glutamine

Question 39

What is “refeeding syndrome”? | P163

Answer 39

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

Question 40

What are the vitamin K–dependent clotting factors? | P163

Answer 40

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

Question 41

What is an elemental tube feed? | P163

Answer 41

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

Question 42

Where is calcium absorbed? | P163

Answer 42

Duodenum (actively) | Jejunum (passively)

Question 43

What is the major nutrient of the colon? | P164

Answer 43

Butyrate (and other short-chain fatty acids)

Question 44

What must bind B12 for absorption? | P164

Answer 44

Intrinsic factor from the gastric parietal cells

Question 45

What sedative medication has caloric value? | P164

Answer 45

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

Question 46

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

Answer 46

Insulin will bind to the IV tubing

Question 47

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

Answer 47

Metabolic chart

Question 48

How can serum bicarbonate be increased in patients on TPN? | P164

Answer 48

Increase acetate (which is metabolized into bicarbonate)

Question 49

What are “trophic” tube feeds? | P164

Answer 49

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

Question 50

When should PO feedings be started after a laparotomy? | P164

Answer 50

Classically after flatus or stool PR | usually postoperative days 3–5

Question 51

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

Answer 51

Prealbumin