Surgical_Nutrition-1

Surgical_Nutrition-1 - Surgical Nutrition Vic V.Vernenkar,...

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Unformatted text preview: Surgical Nutrition Vic V.Vernenkar, D.O. St. Barnabas Hospital Dept. of Surgery Impact on Outcome ♦ For well nourished or mildly malnourished general surgery patients, peri-operative nutritional support did not improve outcome and actually was associated with increased septic complications after surgery both pulmonary and intra-abdominal. ♦ For severely malnourished patients before a major surgical procedure, peri-operative nutritional support reduced postoperative complications (wound complications, wound failure, prolonged hospital stay, ICU days, use of hospital resources) by about 10%, without significant increase in infectious complications. Who will need it? ♦ Well nourished and mildly malnourished patients who cannot take oral food for more than one week post operatively to avoid prolonged starvation. ♦ Severely malnourished patients undergoing general surgery procedures. ♦ All critically ill patients (Sepsis patients, Multiple Injury patients Burn patients, etc). ♦ Patients whom you predict cannot use their gut for prolonged period of time (Short gut syndrome, EC fistula, etc). When to Start? ♦ Preoperatively in severely malnourished patient undergoing a major surgical operation. ♦ Immediately postoperatively in severely malnourished patients. ♦ Immediately after major trauma, sepsis, major burns. ♦ Normal or mildly malnourished patient who is unable to eat on his own by 7 days after surgery. Metabolism ♦ Nutritional implications in surgical diseases are numerous and include anorexia, sodium and fluid retention, accelerated gluconeogenesis, hyperglycemia, insulin resistance, and lipid intolerance. ♦ In reviewing body nutrient metabolism, one must consider body energy stores . Metabolism ♦ Triglyceride storage in the typical male consists of 140,000 calories. ♦ Muscle contains 24,000 calories as protein, 2000 calories as glycogen, 3000 calories as triglyceride. ♦ Liver contains 300 cal as glucose in glycogen form, 500 cal as triglyceride. ♦ Unstressed starvation uses adipose stores. Metabolism (unstressed) ♦ During the first 48-72 hrs increased use of fat stores, and most tissues except RBCs, WBCs, and renal medulla oxidize lipid stores. ♦ Brain has an obligate glucose requirement, over 3-5 days uses fatty acids for energy. Assessment of Nutritional Status ♦ Weight loss is a significant indicator ♦ More than 10% unintentional loss in 6 month period. ♦ 5% loss in 1 month. ♦ Anorexia, persistent nausea, vomiting, diarrhea, malaise. ♦ Loss of subcutaneous fat, muscle wasting, edema, ascites. Evaluation of Nutritional Status (Difficult) ♦ Weight loss ♦ Serum markers – Albumin level T1/2 = 21 d – Transferrin T1/2 = 8 d – Prealbumin level T1/2 = 2-3 d ♦ Immune competence (delayed hypersensitivity reaction, total lymphocyte count) Assessment ♦ Signs of specific nutritional deficiencies....
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Surgical_Nutrition-1 - Surgical Nutrition Vic V.Vernenkar,...

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