Podcast
Questions and Answers
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?
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?
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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?
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What is the purpose of bioimpedance analysis in nutritional assessment?
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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?
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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?
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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?
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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?
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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?
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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?
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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.
