General Surgery
Surgical Nutrition
MBBS surgery notes on surgical nutrition: nutritional assessment, enteral and parenteral feeding and refeeding syndrome, mapped to NMC codes SU12.1 to SU12.3.
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Surgical Nutrition
MBBS surgery notes on surgical nutrition: nutritional assessment, enteral and parenteral feeding and refeeding syndrome, mapped to NMC codes SU12.1 to SU12.3.
This chapter addresses the nutritional care of the surgical patient. It covers the assessment of malnutrition, calculation of energy and protein needs, the choice between enteral and parenteral feeding, and the dangers of refeeding.
High-yield: Surgical Nutrition
- Malnutrition is common in surgical patients and independently increases wound complications, infection and mortality.
- Nutritional status is assessed by history of weight loss, body mass index, physical examination and markers such as serum albumin.
- A basal adult needs roughly 25 to 30 kcal/kg per day, rising with the catabolic stress of major surgery, sepsis and burns.
- Protein needs are about 1 to 1.5 g/kg per day, higher in the catabolic surgical patient to limit muscle loss.
- When the gut works, enteral nutrition is preferred as it maintains gut integrity, is cheaper and has fewer complications than parenteral.
- Enteral routes include oral supplements, nasogastric and nasojejunal tubes, and gastrostomy or jejunostomy for longer-term feeding.
- Parenteral nutrition is reserved for a non-functioning or inaccessible gut, such as high output fistula, short bowel or prolonged ileus.
- Total parenteral nutrition is usually given through a central line because of its high osmolarity.
- Central line complications of parenteral nutrition include catheter sepsis, thrombosis and pneumothorax at insertion.
- Metabolic complications of parenteral nutrition include hyperglycaemia, deranged electrolytes and deranged liver function.
- Refeeding syndrome occurs when a starved patient is fed too fast, causing dangerous falls in phosphate, potassium and magnesium.
- Refeeding syndrome is prevented by starting feeding slowly, correcting electrolytes and giving thiamine before feeding.
- Trace elements and vitamins, including zinc and vitamin C, are essential for wound healing and are supplemented in prolonged feeding.
- Immunonutrition with agents such as glutamine and arginine is used in selected major surgical patients.
- Early enteral feeding within enhanced recovery pathways speeds return of gut function and shortens hospital stay.
Enteral versus parenteral nutrition
- **Enteral:** Preferred when the gut works; maintains mucosal integrity, cheaper and safer. Oral, nasogastric, nasojejunal, gastrostomy or jejunostomy.
- **Parenteral:** For a non-functioning or inaccessible gut such as short bowel or high output fistula; usually via a central line.
- **Energy target:** About 25 to 30 kcal/kg per day, raised for catabolic stress.
- **Refeeding risk:** Feeding a starved patient too fast drops phosphate, potassium and magnesium; start slow and give thiamine.
NMC competencies in this chapter
- **SU12.1:** Assessment of nutritional status in surgery
- **SU12.2:** Enteral and parenteral nutrition support
- **SU12.3:** Complications of nutritional support including refeeding syndrome
Frequently Asked Questions
When is enteral nutrition preferred over parenteral?
Whenever the gut works, enteral feeding is preferred because it maintains gut mucosal integrity, is cheaper and carries fewer infective and metabolic complications than parenteral nutrition.
When is parenteral nutrition indicated?
When the gut cannot be used or accessed, such as in short bowel syndrome, high output enterocutaneous fistula, prolonged ileus or severe malabsorption.
What is refeeding syndrome?
A dangerous shift of electrolytes when a starved patient is fed too quickly, causing falls in phosphate, potassium and magnesium; it is prevented by slow feeding, electrolyte correction and thiamine.
How much protein does a surgical patient need?
About 1 to 1.5 g/kg per day, at the higher end in catabolic states after major surgery, sepsis or burns to limit muscle breakdown and support healing.
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