Surgery - Nutrition
Introduction Oral nutritional support: Giving out foodstuffs that have been enriched or supplements. Enteral nutrition: Oral nutritional supplements and tube feeding via oral, nasal, or percutaneous methods are supplied through the gastrointestinal system. Parenteral nutrition refers to the intravenous administration of liquids, electrolytes, and nutrients. Epidemiology About 40% of patients are admitted with malnutrition. History Loss of weight, decreased appetite, signs of a related disease, or consequences. Examining the body and looking for evidence of cachexia. Weight, BMI, midarm circumference, and triceps skin-fold thickness are examples of anthropometric measures. Pathogenesis The first source of glucose is the breakdown of glycogen in the liver. Hepatic gluconeogenesis (using amino acids from protein breakdown and glycerol from fatty acids) takes place after 24 hours. Glycerol and free fatty acids are released during lipolysis and are converted to ketones by the liver. Investigational studies nutritional screening and evaluation upon admission, albumin, calcium, magnesium, PO4, zinc, and SGA (subjective global assessment). Management should be overseen and managed by a multidisciplinary team that includes a medical team, SALT, and a dietician. Indications Oral nutritional support: indications Individuals who are considered malnourished or at risk due to low body mass index (BMI <18.5 kg/m2, unintentional weight loss >10% in the preceding 3-6 months, or a BMI <20 and unintentional weight loss >5% in the preceding 3-6 months) are included. Enteral: sedation (in the intensive care unit), dysphagia, upper gastrointestinal blockage (tumor, stricture). Nasojejunal: pancreatitis (improves mortality in severe cases and reduces infective consequences), limited stomach motility, restriction of the stomach outflow, patients at risk of aspiration. Parenteral: In cases such as small bowel syndrome, high fistula, persistent ileus, or obstruction where the gastrointestinal tract is not available or functioning. Contraindications Enteral: Absent peristalsis, bowel obstruction, terminal illness (unless the patient requests it). Parenteral: Renal and hepatic insufficiency, egg and soy allergy, exercise caution. Feeds: Enteric formulas may be supplement-only or fully nutritionally replete. Standard formulas include entire proteins, lipids (long-chain triglycerides) with or without fiber, and macro- and micronutrients. Other types of formulae include those that are tailored to a particular disease, immune-modulating, low- or high-energy, peptide-based, free amino acid (elemental), high-lipid, and highly monounsaturated fatty acid formulations. Enteral feeding routes: feeding with a tube through a nasogastric, orogastric, nasojejunal, percutaneous endoscopic gastrostomy (PEG), PEG with jejunal extension, surgical jejunostomy, or radiologically inserted gastrostomy (RIG). Parenteral Feeding (TPN): usually administered by central venous access, while it can also be designed for delivery via other routes. While using TPN, keeping an eye on: & Every day: glucose, Mg2+, Ca2+, PO4, LFT, U&E, Every week: iron and triglyceride studies. Vitamins A and E, zinc, copper, manganese, and selenium levels every month. Complications The following symptoms of malnutrition include impaired wound healing, immunological dysfunction, weakness of the muscles, "susceptibility to infection, pressure sores, hospital stay, readmission rates, and mortality." Enteral nutrition: Biochemical factors include fatty liver, poor renal function, and refeeding syndrome, a potentially catastrophic metabolic shift that occurs when patients with depleted body reserves of minerals like K, Mg, and PO4 are given a carbohydrate source. Mechanical symptoms: nausea, vomiting, diarrhea, and stomach discomfort. Parenteral nourishment: Related to lines: thrombosis, sepsis. Metabolic acidosis, fatty liver and disordered LFTs, hyperglycemia, bacterial translocation, acute cholecystitis (bile stasis), and refeeding syndrome are all associated to feeding. Prognosis Comparatively speaking, those who are malnourished experience 2-3 times as many difficulties.
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