Role of nutrition in surgery By Dr. Pradnya L. BHMS MD. DHNE Lecturer- dept of Surgery & Homeopathic Therapeutics.

1. ROLE OF
NUTRITION IN
SURGERY

3. In last two decades, there has been an
increasing realization of key role that nutrition
plays in surgery.
The operative results in terms of morbidity and
survival are usually the best when patients are
in good nutritional state, and worst when
malnourished.
Surgical procedures temporarily interfere with
the digestive, absorptive, and assimilative
function of body at a time when nutritional
requirements are more.

4. Types of Nutrition-
1. EN (ENTERAL NUTRITION)
2. TPN (TOTAL PARENTERAL NUTRITION)

5. ENTERAL
NUTRITION-

6. 1. Enteral nutrition refers to any method of
feeding that uses the gastrointestinal (GI) tract
to deliver nutrition and calories. It can include a
normal oral diet, the use of liquid supplements
or delivery by use of a tube (tube feeding).
2. There are many reasons for enteral and
parenteral nutrition including GI disorders such
as bowel obstruction, short bowel syndrome,
Crohn's disease, and ulcerative colitis; as well as
certain cancers or in comatose patients.

7. 1. When patients have problems with eating or
digestion, it is sometimes necessary to
provide nutrition with artificial food, which is
specially formulated to provide the right
balance of fats, proteins, sugars, vitamins and
minerals.
2. These artificial preparations can be delivered
into the gut to be absorbed in the usual way,
which is known as Enteral Nutrition.

8. Indications for the use of EN-
1. Intestinal fistulae
2. Short Bowel Syndrome-a. Messenteric
infarction
b. Internal or External herniation with
strangulation.
c. Major abdominal trauma.
d. IBD- Crohn's Disease.

10. Total
Parenteral Nutrition
(TPN)

11. • Parenteral nutrition refers to the delivery of
calories and nutrients into a vein. This could
be as simple as carbohydrate calories
delivered as simple sugar in an intravenous
solution or all of the required nutrients could
be delivered including carbohydrate, protein,
fat, electrolytes (for example sodium and
potassium), vitamins and trace elements (for
example copper and zinc).

12. If the patients gut cannot be used to absorb
nutrients, then nutrition must be delivered into the
patient’s blood stream, bypassing the gut. Reasons
for this type of feeding include-
1. Intestinal Obstruction, Paralytic ileus.
2. Perforations of the gut where feeding will result
in worsening infections.
3. Where a large part of the gut has been removed
and the patient cannot absorb enough food (short
bowel syndrome)
4. Where parts of the bowel are diseased and not
able to absorb properly (functional short bowel)

13. Parenteral nutrition is slowly pumped into the
blood stream through a drip. As it can be very
irritant to blood vessels, it is normally given into
a large vein near the heart though a central
venous line placed into the upper arm, chest or
neck. Using parenteral nutrition can sometimes
result in serious problems such as blood
infections or an upset in biochemistry.
Therefore, patients need intensive monitoring.

14. Indications for the use of TPN-
1. Alimentary tract obstruction secondary to
neoplasm or stricture of oesophagus, gastric
carcinoma or pyloric obstruction
2. Paralytic ileus
3. Ulcerative colitis/crohns disease/ tuberculous
enteritis)
4. Acute pancreatitis

17. Recovery from any nutritional deficit will follow
on the return of normal feeding.
Any delay in return to normal diet such as may
be imposed by nature of operation e.g.
Oesophagectomy or complications of surgical
procedures(ileus, peritonitis ,intestinal fistulae,
sepsis and shock) can severely aggravate
problems of maintaining nutrition.
Malnutrition causes delay in wound healing and
increases susceptibility to infection.

18. Nutritional intake is low in post operative
patients on IV fluids alone, in those with
dysphagia, anorexia and many of cancer
patients.
Energy output is more in hyper metabolic state
like severe stress, major trauma, pyrexia.

19. • Nutritional support in renal diseases-
1. Partial EN (enteral nutrition) should always
be aimed for in patients with renal failure
that require nutritional support.
2. Patients with renal failure who show marked
metabolic derangements and changes in
nutritional requirements require the use of
specifically adapted nutrient solutions.
3. Patients under HD have a higher risk of
developing malnutrition. Intradialytic PN
(IDPN) should be used if causes of
malnutrition cannot be eliminated and other
interventions fail.

20. 4. IDPN should only be carried out when
modifiable causes of malnutrition are excluded
and enhanced oral (like i.e. additional energy
drinks) or enteral supply is unsuccessful or
cannot be carried out.

21. • Nutritional support in liver diseases-
1. Protein malnutrition is advance feature of
liver disease.
2. Most important nutritional indicator is
hypoalbuminaemia.
3. Objective of nutritional support in liver
failure is to provide adequate calories and
proteins without aggravating hepatic
encephalopathy.

22. 4. An adequate nutritional support is essential in
liver disease to sustain hepatic function and to
promote the hepatic regeneration.
5. In patients of liver disease who unable to
tolerate oral feeding TPN is acceptable means of
providing optimal nutritional support.