Surgical Nutrition, C25 P160-164 Flashcards Preview

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Flashcards in Surgical Nutrition, C25 P160-164 Deck (51)
1

What is the motto of surgical nutrition?
P160

“If the gut works, use it”

2

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

1 g/kg/day

3

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

30 kcal/kg/day

4

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

Increased ≈1.7 x

5

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

Increased ≈2–3 x

6

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

9 kcal/g

7

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

4 kcal/g

8

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

4 kcal/g

9

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

Nitrogen x 6.25 = protein

10

What is RQ?
P161

Respiratory Quotient: ratio of CO(2)
produced to O(2) consumed

11

What is the normal RQ?
P161

0.8

12

What can be done to decrease the RQ?
P161

More fat, less carbohydrates

13

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

Decrease carbohydrate calories and increase calories from fat

14

What lab tests are used to monitor nutritional status?
P161

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)

15

Where is iron absorbed?
P161

Duodenum (some in proximal jejunum)

16

Where is vitamin B12 absorbed?
P162

Terminal ileum

17

What are the surgical causes of vitamin B12 deficiency?
P162

Gastrectomy, excision of terminal ileum, blind loop syndrome

18

Where are bile salts absorbed?
P162

Terminal ileum

19

Where are fat-soluble vitamins absorbed?
P162

Terminal ileum

20

Which vitamins are fat soluble?
P162

K, A, D, E (“KADE”)

21

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

Poor wound healing

22

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

Megaloblastic anemia

23

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

Poor wound healing, bleeding gums

24

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

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

25

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

Diabetic state

26

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

Poor wound healing, alopecia, dermatitis, taste disorder

27

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

Dry, flaky skin; alopecia

28

What vitamin increases the PO absorption of iron?
P162

PO vitamin C (ascorbic acid)

29

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

Vitamin A

30

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

NPO >7 days Enterocutaneous fistulas
Short bowel syndrome
Prolonged ileus

31

What is TPN?
P163

Total Parenteral Nutrition = IV nutrition

32

What is in TPN?
P163

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

33

How much of each in TPN:
Lipids
P163

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

34

How much of each in TPN:
Protein
P163

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

35

How much of each in TPN:
Carbohydrates
P163

50% to 60% of calories as dextrose

36

What are the possible complications of TPN?
P163

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

37

What are the advantages of enteral feeding?
P163

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

38

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

Glutamine

39

What is “refeeding syndrome”?
P163

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

40

What are the vitamin K–dependent clotting factors?
P163

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

41

What is an elemental tube feed?
P163

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

42

Where is calcium absorbed?
P163

Duodenum (actively)
Jejunum (passively)

43

What is the major nutrient of the colon?
P164

Butyrate (and other short-chain fatty acids)

44

What must bind B12 for absorption?
P164

Intrinsic factor from the gastric parietal cells

45

What sedative medication has caloric value?
P164

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

46

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

Insulin will bind to the IV tubing

47

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

Metabolic chart

48

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

Increase acetate (which is metabolized into bicarbonate)

49

What are “trophic” tube feeds?
P164

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

50

When should PO feedings be started after a laparotomy?
P164

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

51

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

Prealbumin