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DU PA Surg Nutr
Duke PA Surgical Nutrition
| Question | Answer |
|---|---|
| High prevalence of __ deficits in hospitalized patients | nutritional |
| __ % of hospitalized patients suffer from some degree of malnutrition (depending on disease and population) | 15 - 50 |
| Loss of weight, appetite, muscle atrophy, and weakness in someone not trying to lose weight, usu. signifies an underlying disease | Cachexia |
| acute visceral protein depletion (chronic protein intake insufficiency), usually affects young childrenedema, pigmentation, pot belly | Kwashiorkor |
| Simple starvation (chronic caloric intake insufficiency)loss of lean body mass, fat, and visceral proteins | Marasmus |
| 40% in liver (rapidly depleted) | Glycogen stores |
| 60% in muscle | Glycogen stores |
| Obligatory gluconeogenesisProtein catabolismIncreased nitrogen lossUnresponsive to glucose administrationMagnitude of loss proportional to injury | Adrenergic/Corticoid phase of Stressed Starvation (Surgery, Trauma) |
| __ common finding with deficiencies in niacin, thiamine, vitamin B6, vitamin B12 | peripheral neuropathy |
| Represents the critical cellular mass necessary for cellular structure as well as function | lean body mass |
| Represents 40% of total body weight | lean body mass |
| Depletion is severe insult and defines patient morbidity and mortality | lean body mass |
| 60% skeletal muscle | lean body cell mass |
| 20% red blood cells and connective tissue | lean body cell mass |
| 20% cell mass | lean body cell mass |
| Utilized for clinical determination of total body fat and skeletal muscle storeSimple, inexpensive, non-invasive technique | Anthropometric measures |
| __% of the total body protein is contained in skeletal muscle | 60 |
| this is major site of protein catabolism during starvation and/or illnes | skeletal muscle |
| Most widely used biochemical marker of muscle mass | 24-hr urine creatinine |
| Creatinine is degradation product of creatine,__ | an energy storage compound located in skeletal muscle |
| Maintains plasma oncotic pressure and is a carrier for enzymes, drugs, hormones, etc. | Serum albumin |
| Serum albumin | Serum albumin |
| Carrier for ironLimited use because level fluctuates with iron stores | Serum transferrin |
| Carrier for thyroxine and retinol-binding proteinSensitive to acute changes in nutrient intake | Serum prealbumin |
| Resting energy expenditure calculated by using the __ equation | Harris-Benedict |
| Nitrogen Balance | N intake - N loss |
| Nitrogen Balance (N intake - N loss):If positive (goal +2 to +4), net state of __ | anabolism |
| Nitrogen Balance (N intake - N loss): If negative, net state of __ | catabolism |
| Nitrogen Intake (enteral and parenteral)(1 gm N/__ g Protein | 6.25 |
| Estimates severity of lean body mass catabolism and quantifies severity of metabolic stress | Catabolic Index (CI): |
| In general, adults will require nutritional support if NPO for greater than __ days | 7 |
| if the gut works | use it |
| contraindications to enteral nutrition | gastroparesis, intestinal obstruction, ileus, high-output fistula, short bowel syndrome |
| Used for conscious patients; preferred for short-term feeding (< 30 days) | Nasoenteric Tube Feeding |
| Nasogastric: adequate gastric emptying require; maintain gastric residuals < __% of total infusion over prior 4 hours | 50 |
| Nasoenteric Tube Feeding:used in patients with high aspiration risk (neurological impairment; poor gastric motility) | Nasointestinal |
| tube feeds cause | diarrhea |
| in a patient with tube feeding and diarrhea check for __ before changing anything else | C. dif |
| Involves continuous infusion of hyperosmolar solution containing carbohydrates, proteins, fats, and other necessary nutrients through an indwelling catheter inserted into the superior vena cava | Total Parenteral Alimentation/Nutrition (TPN) |
| Any patient who will not have functioning GI tract for __ days should be considered for TPN | 5-7 |
| Principal indication for __ are found in seriously ill patients suffering from malnutrition, sepsis, or surgical or accidental trauma when use of the GI tract for feedings is not possible | parenteral alimentation |
| 1. Intravenous vitamin preparations should be added 2. Vitamin K and folate should be administered once a week 3. Vitamin B12 is given once a month intramuscularly | Parenteral Alimentation |
| May present as dry, scaly dermatitis and loss of hair - Syndrome may be prevented by periodic infusion of a fat emulsion equal to 4 - 5% of total calories | Essential Fatty Acid Deficiency |
| - Most frequent trace mineral deficiency is __, which presents as an eczematoid rash developing both diffusely and at intertriginous areas | zinc |
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bwyche
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