Nutrition in Surgery pptx - D. Muhanned

بسم الله الرحمن الرحيم

NUTRITION IN SURGERY

Principles of Nutrition

Avoiding of malnutrition is the basic goal in nutrition
therapy as malnutrition increases the morbidity and mortality
of the disease process and prevents or delays the recovery.

Malnutrition increases the chance of sepsis, prevents

wound healing, increases the respiratory complications,
and decreases the efficacy and tolerance to radiotherapy or
chemotherapy.

Whenever possible enteral route of nutrition should be

used .

Overfeeding should be avoided as it leads into hyperglycaemia,

hepatic steatosis, raised BUN, and excess CO2
production.
Immunomodulators like glutamine, arginine and omega 3
fatty acids are also very useful.

Caloric requirement:

Neonatal 100 kcal/kg/day.

Adult 40 kcal/kg/day.

Adult with catabolism 60 kcal/kg/day.

It is given as:
xx Carbohydrates 50%.
xx Fat 30-40%.
xx Protein 10-15%.
Caloric values:
xx Carbohydrate 4 kcal/g.
xx Protein 4 kcal/g.
xx Fat 9 kcal/g.

.
Indications for Nutritional Support
• a-Preoperative nutritional depletion .
b. Postoperative complications: Sepsis, ileus, fistula.

c. Intestinal fistula
d. Pancreatitis, malabsorption, ulcerative colitis, pyloric
stenosis.
e. Anorexia nervosa and intractable vomiting.

f. Trauma—multiple fractures, fasciomaxillary injuries, head and neck injuries.

g. Burns.
h. Malignant disease.
i. Renal and liver failure.
j. Massive bowel resection causing short bowel syndrome.

How to assess the nutritional status:

Clinical parameters:
Body weight.
Body mass index.
Triceps skin fold.
Mid arm circumference.

Laboratory parameters:

Serum albumin.
Lymphocytic count.
Skin hypersensitivity reaction.

NUTRITIONAL SUPPORT
Enteral Nutrition:
Easy.
Safe.
Inexpensive.
Preserves trophic hormones and the mucosal integrity of the gastro- intestinal tract.
Less infectious complications.

Side effects:

Abdominal colic.
Nausea and vomiting.
Reflux and pulmonary complications.
Diarrhoea.
Esophageal irritation and ulceration.

Methods:

Nasogastric tubes.
Nasojejunal tubes.
Gastrosotomy:
Surgical
Percutaneous endoscopy.
Jejunostomy:
Surgical
Percutaneous endoscopy.

Complications of enteral feeding
. Aspiration
. Wound infection and leak
. Diarrhoea due to rapid feeding or hyperosmolarity
. Hyperglycaemia
. Hypokalaemia
. Refeeding syndrome due to severe hypokalaemia and
hypophosphataemia

TPN Indications

. Failure or contraindication for any enteral nutrition
for 7-10
days
. High output abdominal fistulas, duodenal, biliary, pancreatic
fistulas
. Major abdominal surgeries of liver, pancreas, biliary, colonic
. Septicaemia
. Multiple trauma
. Short bowel syndrome
. Severe pancreatitis, bowel ischaemia, peritonitis, ileus
. Massive GI bleeding, unstable haemodynamically
. High-risk of aspiration
. Hyperemesis gravidarum
. Multiorgan failure, head injury, severe burns

Components used in TPN
. Carbohydrates
. Fat and amino acids
. Vitamins and trace elements, electrolytes, minerals

Complications

Technical
a. Air embolism.
b. Pneumothorax.
c. Bleeding.
d. Catheter displacement, sepsis, blockage.
e. Infection, thrombosis.

Biochemical

a. Electrolyte imbalance: Hyponatraemia, hypokalaemia,
hypophosphataemia.
b. Hyperosmolarity.
c. Hyperglycaemia—common.
d. Dehydration.
e. Altered immunological and reticuloendothelial function.
f. Azotaemia.

• Othersa. Dermatitis.b. Anaemia and increased capillary permeability.c. Cholestatic jaundice: It is common.d. Severe hepatic steatosis.e. Metabolic acidosis.f. Candida infection (candidiasis), staphylococcal infection

REFEEDING SYNDROME

xx Refeeding syndrome is occurrence of severe fluid and electrolyte
imbalance in severely malnourished individual while
starting the proper feeding enteral or parenteral nutrition. It
is more common in TPN.
xx It causes hypomagnesaemia, hypocalcaemia and hypophosphataemia
leading into myocardial dysfunction, respiratory
changes, altered liver functions, altered level of consciousness,
convulsions and often death.
xxGradual feeding and correction of magnesium, phosphate
and calcium and other electrolytes is important.
xx Condition is common in chronic starvation, severe anorexia
and alcoholic patients.

Nutrition in Surgery