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surgery nutrition

1. Good day. This is a special online class for IMD 22-B.

2. Surgical Nutrition Fitzgerald Arancel, MD, FPCS, FPSGS Faculty – Department of Surgery College of Medicine Davao Medical School Foundation

3. Teaching and Learning Objectives : To determine the following: Rationale for providing nutrition for the surgical patient Energy expenditure of the surgical patient Energy & non-energy sources for metabolism Dietary management & nutritional support Source: Schwartz’s Principles of Surgery, 10 th or 11 th Ed. Philippine Textbook of Surgery

4. Nutrition N ūtrix = to nurse; Nūtrīre = to suckle Nourish = to provide with substances necessary to sustain life & promote growth of living organisms Process by which a living organism assimilates food & using it for growth & replacement of tissues It is all about FOOD

5. Rationale of nutritional support for the surgical patient To meet increased energy requirements for Basal metabolic processes Maintenance of core temperature Tissue repair To provide adequate substrates for protein synthesis in order to minimize protein breakdown To reduce mortality & morbidity following surgical stress & trauma

6. Energy expenditure: Non-stressed adult Basal metabolism Physical activity Specific dynamic action (thermic effect) of food Surgical patient Basal metabolism Physical activity ( ↓) Specific dynamic action (thermic effect) of food Stress of injury & surgery ( ↑↑↑)

7. Energy sources for metabolism 3 main sources Carbohydrates (CHO) = 4 kcal/g = 60% TCR* Proteins (CHN) = 4 kcal/g = 20% TCR Fats (CHOH) = 9 kcal/g = 20% TCR (Alcohol) = 7 kcal/g** *Total Caloric Requirement ** An energy source BUT not part of the diet

8. Dietary management 1. How much food should be given? 2. What kind of food should be given? 3. How will this food be given?

9. 1. How much food should be given? Determine: Energy requirements/day? Basal Energy Expenditure (BEE) Estimated Energy Expenditure (EEE) How much CHO, CHN, CHOH?

10. Energy needs/day For a resting, non-stressed adult BEE (in Kcal/day) Male = 66 +13.8(w) + 5(h) - 6.8(a) Females = 655 + 9.6(w) + 1.8(h) – 4.7(a) For a stressed adult EEE (in Kcal/day) Non-ventilated pts = 629 – 11(a) + 25(w) – 609(o) Ventilated pts = 1,925 – 10(a) + 292(t) + 5(w) + 281(s) + 851(b) a = age in years, w = weight in kg, h = height in cm o = obesity, t = trauma, b = burns (present = 1, absent = 0) s = sex (male = 1, female = 0)

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12. How much food should be given? 40 y/o, 70 kg patient: C = 244 grams P = 82 grams F = 36 grams

13. 2. What kind of food shall be given? 3. How will this food be given?

14. Determine: Can the gut be used safely? YES? NPO? Oral feeding? Enteral feeding? NO? NPO? Parenteral nutrition?

15. Gut cannot be used safely Total Parenteral Nutrition (TPN) Provide necessary nutritional elements directly into the blood Must be given by intravenous (IV) infusion into a central vein

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17. Nutritional Support: Decision Algorithm

18. ASSIGNMENT: Instructions: You will COMPUTE for YOUR BEE as a non-stressed adult. From your computed BEE determine YOUR required CHO, CHN & CHOH in grams (rounded off) per day. Use one page only. Turn-in your assignment on-line on or before 8:00 pm today, Monday, 02 August 2021 in Dr. F. Arancel’s TG Account.