Podcast
Questions and Answers
What is the primary function of arginine and glutamine in the human body?
What is the primary function of arginine and glutamine in the human body?
Which of the following is NOT a function of lipids in the human body?
Which of the following is NOT a function of lipids in the human body?
What is the primary benefit of omega-3 fatty acids in the perioperative period?
What is the primary benefit of omega-3 fatty acids in the perioperative period?
What is the primary purpose of assessing a patient's nutritional status?
What is the primary purpose of assessing a patient's nutritional status?
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What is the significance of a patient's weight loss history in nutritional assessment?
What is the significance of a patient's weight loss history in nutritional assessment?
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What is the primary role of vitamin C in postoperative recovery?
What is the primary role of vitamin C in postoperative recovery?
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What is the purpose of bioimpedance analysis in nutritional assessment?
What is the purpose of bioimpedance analysis in nutritional assessment?
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Which of the following medications can affect nutrient requirements?
Which of the following medications can affect nutrient requirements?
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What is the primary benefit of enteral formulations containing omega-3 fatty acids and arginine?
What is the primary benefit of enteral formulations containing omega-3 fatty acids and arginine?
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What is the significance of zinc in wound healing?
What is the significance of zinc in wound healing?
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What is the primary source of energy for the brain, RBC, retina, and renal medulla during acute starvation?
What is the primary source of energy for the brain, RBC, retina, and renal medulla during acute starvation?
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What is the result of elevated insulin counteracted by concurrent elevated levels of catecholamines, glucagon, and cortisol during the flow phase of the metabolic response to injury?
What is the result of elevated insulin counteracted by concurrent elevated levels of catecholamines, glucagon, and cortisol during the flow phase of the metabolic response to injury?
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What is the primary function of carbohydrates in the body?
What is the primary function of carbohydrates in the body?
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What is the characteristic of glutamine that makes it a conditionally essential amino acid?
What is the characteristic of glutamine that makes it a conditionally essential amino acid?
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What is the result of prolonged starvation on the body's energy metabolism?
What is the result of prolonged starvation on the body's energy metabolism?
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What is the association between albumin levels and patient outcomes in protein malnutrition?
What is the association between albumin levels and patient outcomes in protein malnutrition?
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What is the primary function of proteins in the body?
What is the primary function of proteins in the body?
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What is the characteristic of arginine that makes it important for maintaining vascular tone?
What is the characteristic of arginine that makes it important for maintaining vascular tone?
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Study Notes
Starvation
- Acute starvation: energy supplied via glycogen stores in liver and muscle (first 12-72 hours)
- Proteolysis (alanine and glutamine) and hepatic gluconeogenesis occur during acute starvation
- Brain, RBC, retina, and renal medulla require glucose for energy
Prolonged Starvation
- Body shifts to lipolysis for protein sparing
- Free fatty acids converted to ketones, potentially leading to acidosis/toxic conditions
Metabolic Response to Injury – Ebb and Flow
Ebb
- Starts immediately after injury, lasts hours to days
- Hypometabolism and tissue hypoperfusion occur
- Increased sympathetic activity and hypothalamic pituitary axis output
- Catecholamines (e.g., norepinephrine) are released to compensate
- Increases cardiac contractility, heart rate, and vasoconstriction
Flow
- Period 3-10 days after injury; catabolic state
- Hypermetabolism and tissue hyperperfusion for healing
- Elevated insulin counteracted by concurrent elevated levels of catecholamines, glucagon, and cortisol
- Results in net loss of proteins (negative nitrogen balance)
- Stress hyperglycemia due to accelerated gluconeogenesis and insulin resistance
Protein Malnutrition
- Marasmus: deficiency in all macronutrients (proteins, carbohydrates, fats)
- Kwashiorkor: deficiency in proteins
- Albumin < 2.5 associated with increased mortality, length of hospitalization, healthcare costs, and rate of readmission
Macronutrients – Carbohydrates
- Function: energy and digestion
- Brain and RBC require glucose for energy
- Limited stores as glycogen, excess converted to fats
- Supplied via gluconeogenesis during hypermetabolic states
- Daily intake: 120g/day
Macronutrients – Proteins
- Function: building blocks – repair/build tissues
- Also functions in immunity, enzymes, transport, hormones, fluid balance, and energy
- All protein in body is functional, not considered storage of energy
- Types: Essential, Non-essential, & Conditionally Essential
- Daily intake: 1.5-2 g/kg/day
Important Amino Acids
- Glutamine:
- Most abundant amino acid (50% of free amino acid pool)
- Primary fuel source for small intestine enterocytes
- Conditionally essential during illness
- Arginine:
- Functions in tissue metabolism, growth, repair
- Substrate for nitric oxide (NO) production
- Important for maintaining vascular tone, coagulation cascade, immunity, etc.
Macronutrients – Lipids
- Functions: energy -active and stored, insulation & organ protection, structure – hormones, cell membranes, nerve tissues, absorption – Vitamins ADEK, phytochemicals
- Types: Essential (Linoleic & Alpha-Linolenic), Non-essential, Saturated (bad), & Unsaturated (mono & polyunsaturated)
- Daily intake: 10-30% of total daily caloric load (2-4% essential)
Micronutrients
- Vitamins, electrolytes, minerals, metals
- Prebiotics: indigestible fiber, feeds gut microbiome
- Probiotics: live, good bacteria, yogurt & cheese
- Water
Nutritional Assessment
- Assessment through history, physical exam, labs, bioimpedance, indirect calorimetry, anthropometric measurements, predictive formulas
- Detailed history and physical exam remains a primary nutritional assessment tool
- Patients should be screened for risk factors and comorbidities, considering the magnitude of proposed surgical procedure
Assessment – History
- Screen for weight changes
- Unexplained weight loss > 5% in one month or 10% in 6 months associated with increased postoperative complications
- Medications: many have nutritionally related side effects or increased nutrient requirements
- Past medical/surgical history
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Description
This quiz covers various aspects of surgical nutrition, including starvation, energy requirements, nutrient assessment, and nutritional therapy options.
