Presenter Suraj Subedi Roll no. 29 B. V. Sc. & A. H.

, 9th sem
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Care of the surgical patient does not end when the procedure is finished. Postoperative care of surgical patients often determines the ultimate outcome; with critical patients it may determine whether they survive.
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Patients Outcome in relation to 3 different aspects of surgery

Postoperative Manageme nt

Patients Outcome
Preoperative Manageme nt

Surgical procedure
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Postsurgical Management
yNormalization of Homeostasis yControl of Pain yPrevention of Secondary Infection yEarly Recognition of Complications yNutritional Management
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Nutritional Management
Patient Requirement

Feeding Route

Proper Nutrition of Post surgical patients

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Calorie Requirements
y Basal Energy Requirement (BER)
y Animal less than 2 kg body wt.

y Animal more than 2 kg body wt.

y Maintenance Energy Requirements

(MER)

Associated Clinical Problems Cage Rest Postsurgical Stress Trauma or Cancer Sepsis Major Burns

Factor

1.00 1.25 1.25 1.35 1.35 1.5 1.50 1.70 1.70 2.00
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Protein Requirements

Species

Maintenance

Hepatic or Renal failure

Canine

5.0 7.5 g/100 kcal

< 3.0 g/100 kcal

Feline

6.0 9.0 g/100 kcal

< 4.0 g/100 kcal

How the nutrients are provided???

Nutrients

Enteral Nutrition

Parenteral

Normal Voluntary

Hyperalimentation
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Parenteral Nutrition
y Provision of the readily utilized nutrients in their simplest form

that a body can utilize.

y Route is the slow continuous infusion through catheter i/v. y Indicated when intestine cannot adequately absorb nutrients

(severe malabsorption, impaired motility, massive small bowel resection etc.)

y 8.5% amino acids with electrolytes (protein source), 10 to 20%

lipids (fat) and 50% dextrose ( carbohydrate) are generally used. B-complex are added at 1-2 ml per ltr.
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Common Parenteral Infusions

y Hermin T (Alembic) y Aminodrip (Wockhardt) y Aminosteril-N Hepa 8% (Fresenius Kabi) y Intralipid (Fresenius Kabi) y Dextrose 50%

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Complications of Parenteral Nutrition

y Catheter kinking and displacement y Phlebitis y Thrombosis y Sepsis y Hyperglycemia y Hyperlipidemia y Azotemia y Electrolyte imbalance
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Enteral Route of nutrition

y Ideal enteral diet should be well tolerated, readily digested

and absorbed, contain essential nutrients, be readily available, inexpensive, have a long shelf life and easy to use.
y diets should be isotonic (approx. 300 mOsm/L) y Caloric density of approx. 1.0 kcal/ml y Include fiber at 1.0 to 1.5 g/100 kcal and y provide approx 16% of total calories as protein and approx

30% of calories as fat.

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Types of Enteral Diets

A. Monomeric
y y y y

Indicated in patients with Gastrointestinal disorders crystalline amino acids for protein glucose and oligosaccharides as carbohydrate safflower oil as essential fatty acids source indicated for patients with intact digestive and absorptive function contain large molecular weight proteins, carbohydrates and fats.

B. Polymeric
y y

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Some commercial diets

y Polymeric Diets
y Jevity Osmolite HN y Impact y Vital HN y ProMod

y Monomeric Diets
y Vinonex HN
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A homemade diet
For dog and cat
y 1 jar baby food y 1 cooked egg y 15 ml corn oil y 15 ml corn syrup y 100 ml water

Nutrient : 1 kcal/ml

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Enteral Hyperalimentaion
y Designate supplying of the nutrients by methods like
y Nasoesophageal y Pharyngostomy y Esophagostomy y Gastrotomy y Enterostomy

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Nasoesophageal intubation
y Small bore soft polyvinyl and silastic feeding tubes y Well tolerated y Can be left for several days y Can drink and swallow around the tubes avoiding

repeated intubation.
y Liquid diet administered y Cats and Dogs < 15 kg wt. : 5 French X 91 cm

Dogs > 15 kg wt. : 8 French X 91 cm

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Pharyngostomy
y Contraindicated for patients with esophageal disorders

i.e.

esophagitis,

esophageal

stricture,

recent

esophageal surgery, esophageal foreign body removal, neoplasm).

y Larger diameter gen. 20

24 French.

y Placed upto the midesophagus

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Esophagostomy
y Large bore tubes 20

24 French

y Eliminates coughing, laryngospasm, and/or aspiration

occasionally associated with laryngostomy tubes.

y Disadvantage:

need for general anesthesia for tube

placement

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Gastrotomy
y Ease of patience, patients tolerance y Large bore size y Oral feeding can commence normally y Disadvantage:
y Need for specialized instrument y General anesthesia y Waiting for 12

24 hrs before initiating feeding

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Enterostomy
y Celiotomy is required for placement of these tubes y A 5French , 36 inch infant needle used y Highly digestible food materials are supplied

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Rate and Volume of Feeding

y Depends upon the state of patient and capacity of intestine y Normal canine and feline capacity: 80 ml fluid/ kg b. wt. y Anorectic Patients: 30 40 cc fluid/kg b. wt. and gradual

increase over 2-3 days.

y A minimum of 3 feedings daily
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Guidelines for feeding via an Enterostomy tube

y Calculate total requirement y Give of calculated volume during first 24 hrs y Give of calculated vol. during second 24 hrs y Give of calculated volume during third 24 hrs y Give entire calculated volume during fourth 24 hours y Note: a minimum of 4-5 feedings /day needed.
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Complications of enteral hyperalimentation

y Mechanical
y inadvertent tube placement in trachea or peritoneal cavity y gut perforation y regurgitaion in tube y Irritation y infection at exit site y Occlusion y tube removal
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y Gastrointestinal
y Vomiting y Cramping y abdominal distension y diarrhoea

y Metabolic complications
y Hyperglycaemia (major) y Hypophosphatemia y hyperkalemia
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References
y Bojrab, M. J. 1998. Current Techniques in Small Animal Surgery, 4 th

edition, Williams & Wilkins, USA

y Denise, A. E. Parenteral Nutrition. In

http://www.vin.com/proceedings/Proceedings.plx? CID=WSAVA2004&Category=1252&O=Generic Accessed on 24th may, 2011

y Denise , A. E. Home Made Diets In

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA200 4&Category=1252&O=Generic Accessed on 24th may, 2011

y Fossum.,T. W. 1997. Small Animal Surgery. 1st Mosby, USA y Pierson, A. L. Feeding tubes for Cats In www.catinfo.org accessed

on 25th may, 2011

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Thank You
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Questions are highly welcomed

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