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Surgical Nutrition - Coggle Diagram

- - - - CT - not in clinical but in research
  - - - 10% - immune suppression
      - 15-20% impaired wound healing
      - => 30% pressure ulcers, pneumonia, no wound healing
  - - - Predicted Impatient length of stay
      - ↑ Major complications
      - Overall complications
      - Mortality
- - - - 1g: 4Kcal
    - - 1g: 9Kcal (boday can only utilize so much IV fat)
    - - 1g:4kcal
  - - - Access
        
        PEG / PEJ
        
        Indx
        
        Permenant solution
        
        No access
        
        NG / NJ
      - Mechanism
        
        Bolus fed
        
        Feeding pump
      - Advantages
        
        Physiological
        Maintains gut integrity
        Prevents gut status
        May prevent streee ulceration
        
        Compared to PN, EN:
        Superior metabolic handling of nutritions
        Less infectious complications
        Cheaper
    - - TPN
        
        Constitiuents
        
        Access
        
        PICC line / Central Line
      - Indications
        
        Intra-abdominal sepsis
        
        Intestinal fistulae (crohn's)
        
        Multi trauma involving GIT
        
        Severe acute pancreatitis +/- complications
        
        PRolonged paralytic ileus
        
        Severe IBD
        
        Gut ischaemia, prolonged ileus, gut failure as part o MOF
        
        GI high output fistula or obstruction distal to feeding tube
        
        Inaccessible GIT
        
        Extensive reduction of absorptive surgace (SBS - combine with EN)
        
        Intractable vomiting
      - Complications
        
        Technical : Line Insertion
        
        Pneumothorax
        
        Bleed
        
        Infectious complications
        
        Staph epidermis mainly
        
        Nutritional / metabolic complications
        
        Overfeeding
        
        Undernutrition
        
        Fluid status abnormality
        
        Electrolyte disturbances
        
        Hyperglycaemia
        
        Hypertiglycerideaemia
        
        Refeeding synndrome
        
        Symptoms
        
        Tachycardia
        
        Tachypnoea
        
        Peripheral odemea
        
        Hepatic distrubances
        Raised enzymes
        Cholestasis
        Steatosis
        Peri-portal lymphocyte infiltreation
        
        Mechanical complications
      - Indications for Short Term PN
        
        unfinished