SURGICAL NUTRITION Saraical mnutrition > Exteral Fareeteral : Aldvartages of enteral over porerteral « : Trp rielogical » cheap ~ Frevents cholestasis Mesntoins potency of tntestinal microvilli Favenls translocation of got boclenia voRUAMN jeoI6ung ee ENTERAL NUTRITION 00:08 12 + Enteral mufrifion Mouth E NT tube 7b tube (NB tube causes aspiration) Feeding gastrortomy, | jejurorfomy FEEDING GASTROSTOMY LITAMM, WITZEL and PEG} 00: Oy: 1G Some gprttroctomy Stab incition made in cToroch : Feni-dyain leakage - wort « Wtzel’ anethed : A tunnel is created “For Tube placement before piercing Gtomach wall Lette’ peri-drain leakege TE [Tercatantous Evdoscopic ostrorfomy J» Tobe placed faking entorcepe Light ar reference Hos path method and pul method Pisedvortage © Move chances of PES aspiration Compared fo Jguretory Padvartage Phypolegical | Version 1.2 / Marrow 3.0/ 201920 . Complications of entero] nutrition ; MC: Osmotic diow hota Tule veloted © Block or migition of tube Aspiration + Fayenteral nufnntion : Nutrition via Iv-route + Tedtcationt High output fecal firtla [> 200 ce output fay bre) ~ Preutte episodes of Tsp ~ Tritial prose of acule severe pancreatitis - TFrelorged porolytic slew (>12.b) ~ Short bowel syrdrome Short bowel syndrome No aneaningful obsorption Adults = 210 cm tmall intestine im absence of iltorcaecal jurdlion (fc) Zloocm small intestine im presence of CF Children’ Bianchi «long tudieal spliting of bouel + end to [ end anastomosis» T absorption Srer [Seriol Transverse Enteroplasty} Linear cutter fired alternatively on bowel Bowel is 2g ag, food absorption T MODES OF PARENTERAL NUTRITION 00 IS ee Control line MC> Subclovian vein > Peripheral lime » ah father + Ret of the fluid feuiremend met by one|De Version 1.2 / Marrow 3.0 / 2019.+ TPN colutions Usually, Go-es fs carbohydrates wast fats 8 WS-r0f* profeine, ecretial elemertr , vitaminr; ee Depending on carbohydrate Compost tion. | C High ocmelay Tr T venous thromboris risk , f Co, Rar) o . " g Lows ormoler TPN” Prefered in pulmonery compromsie reipirafory then COMPLICATIONS OF TPN 00°19: 32 g | Cental line rebated complicctione * Preamathorax , orchythonias air embolim, 3 | Vlockode , migration. , thrombosis , MC: CRBS! [Grheter related ood stream infection) | Catheter induced repr] Catheter related sepru MC organism : Staphylococcus epidermidis Complications die to feeding regime = MC overall Hypergiycerna Metabolic derangements ; Cholertacir ; Refeeding cyrdrome , efe REFEEDING SYNDROME 90: 22: 34 Chronically malnourished patient given (orge qyuortitier of TPN causes Fefeeding syrdrome Cattobohe phase sing Topidly converted fo Arabolic phose causes; th metemio. , Hypephosphatemia , Hypekalemia + Fluid overload] — ‘sfereg per li Leads to orchugthonios and Grgufive heart failure RELATED PEARLS Version 1.2/ Marrow 3.0 / 2019