Power point presentation Slides Presented in Lectures at Services institute of Medical Sciences Lahore

1. Nutrition in Surgical Patients
Dr Abdul Basit Qureshi
AP Surgical Unit 1

2. What?
• Carbohydrate
• Lipid
• Protein
• Trace elements
• Vitamins

3. Who?
• Malnourished (>10% lean body mass)
• Incapable of eating (>10 days)

4. Why?
• Risks of malnutrition including infection,
poor healing and higher mortality
• Malnutrition is exacerbated by
physiological stress

5. When?
• Preoperative?
• Early?
• Late?
• ---after initial resuscitation following injury
or surgery

6. How?
• Parenteral
• Enteral
• Total
• Partial

7. Issues
• Metabolic response to injury
• Enteral vs. Parenteral

8. Nutritional Assessment
• Body weight
• Body mass index
• Serum proteins:albumin, prealbumin,
transferrin
• Immune competence: lymphocytes

9. Nutritional Requirements
• 25 cal/kg/day
• carbohydrate ~70%
• Lipid 15-30%
• Protein 1.5-2.0g/kg/day. Not for calories
• Additional 50% to 100% for stress as in
ICU patients

10. Nutritional Goals
• Nitrogen balance
• Preserve or restore visceral protein
• Reduce morbidity
• Reduce mortality
• Reduce hospital stay

11. Enteral Requirements
• Delivery into the GI tract by tube with
minimum risk of aspiration or patient effort
• Delivery of nutrients with minimal need for
digestion
• Control of rate to prevent osmotic diarrhea

12. Advantages of enteral nutrition
• Easier
• GI bacterial translocation
• Cheaper
• Fewer specific complications

13. Conclusions
• Nutrition is a powerful determinate of
patient outcome
• The proper provision of nutrition is a
component of basic patient care
• Nutrition is a precise and potentially very
hazardous form of intervention