DIET IN SURGERY
Good nutrition prior to and following surgery ensures fewer post-operative complications, better wound healing, short convalescence and lower mortality. chronic diseases increase the nutritional requirements.
Malnutrition can lead to weight loss, poor wound healing, decreased intestinal motility, anaemia, oedema or dehydration and the presence of ulcers. The circulating blood volume and the concentration of the serum proteins, haemoglobin and electrolytes may be reduced.
Following surgery or injury the need for nutrients is greatly increased as a result of loss of blood, plasma, or pus from the wound surface, haemorrhagefrom the gastrointestinal or pulmonary tract, vomiting and fever. During immobilization, loss of some nutrients such as protein is accelerated.
A fairly simple operation often involves moderate deficiency in food intake for a few days following the operation /surgery. Some nutrients may be supplied by parenteral fluids, but the full needs of the body usually are not met by that means alone.
Adequate oral intake is often delayed for a considerable period following cardiac or gastrointestinal surgery. Metabolic losses are great and alternative methods of nutritional support needed.
The objectives in the dietary management of surgical conditions are:
1. To improve the pre-operative nutrition whenever the operation is not of an emergency nature.
2. To maintain correct nutrition after operation or injury as far as possible and
3. To avoid harm from injudicious choice of foods.
REQUIRED NUTRIENTS
(1) PROTEIN: A satisfactory state of protein nutrition ensures
a. Rapid wound healing
b. Increases resistance to infection
c. Exerts a protective action upon the liver against the toxic effects of anaesthesia and
d. Reduces the possibility of oedema at the site of the wound .
The presence of oedema is a hindrance to wound healing and in operations on the gastrointestinal tract, may reduce motility thus leading to distension.
When protein is depleted in post-operative condition complications are increased. Protein catabolism is increased for several days immediately following surgery or injury , patients are characteristically in negative nitrogen balance even though the protein intake may be appreciable. The degree of negative balance can be reduced at higher intakes of protein and calories.
The level of protein to be used in pre-operative and post-operative diets depends on the previous state of nutrition, the nature of the operation and the extent of the post-operative losses. Intake of 1.0 to 1.5g per kilogram or about 100g of protein are necessary as a rule.
(2) ENERGY: Without sufficient caloric intake tissue proteins cannot be synthesized. Excess metabolism of body fat may lead to acidosis, whereas depletion of the liver glucose may increase the likelihood of damage to the liver with 2500 to 3000 kcal patients make progress.
Obesity delays healing. Whenever possible, it should be corrected. Rapid weight loss results in loss of lean body mass and should be avoided.
(3) MINERALS: Phosphorus and potassium are lost in proportion to the breakdown of body tissue. In addition derangements of sodium and chloride metabolism may occur subsequent to vomiting, diarrhoea, perspiration, drainage, anorexia and dieresis or renal failure.
Iron-deficiency anaemia occurs in association with mal-absorption or excessive blood loss. Diet alone is ineffective in correction of anaemia, but a liberal intake of protein and ascorbic acid, together with administration of iron salt is of value in convalescence. Transfusions are usually required to overcome severe reduction in haemoglobin level.
(4) FLUIDS: The fluid balance maybe upset prior to and following surgery owing to failure to ingest normal quantities of fluids and to increased losses from vomiting ,exudates , haemorrhage , diuresis and fever. A patient should not be operated in a state of dehydration since the subsequent dangers of acidosis are great. When dehydration exists prior to operation, parenteral fluids are administered, if the patient is unable to ingest sufficient liquid by mouth.
(5) VITAMINS: Ascorbic acid (vitamin C) is especially important for wound healing and should be provided in increased amounts prior to and following the surgery. Vitamin k is of concern to the surgeon since the failure to synthesize vitamin k in the small intestine, the inability to absorb it or the defect in conversion to prothrombin is likely to result in bleeding. Haemorrhage is especially likely to occur in patients who have diseases of the liver.
Good nutrition prior to and following surgery ensures fewer post-operative complications, better wound healing, short convalescence and lower mortality. chronic diseases increase the nutritional requirements.
Malnutrition can lead to weight loss, poor wound healing, decreased intestinal motility, anaemia, oedema or dehydration and the presence of ulcers. The circulating blood volume and the concentration of the serum proteins, haemoglobin and electrolytes may be reduced.
Following surgery or injury the need for nutrients is greatly increased as a result of loss of blood, plasma, or pus from the wound surface, haemorrhagefrom the gastrointestinal or pulmonary tract, vomiting and fever. During immobilization, loss of some nutrients such as protein is accelerated.
A fairly simple operation often involves moderate deficiency in food intake for a few days following the operation /surgery. Some nutrients may be supplied by parenteral fluids, but the full needs of the body usually are not met by that means alone.
Adequate oral intake is often delayed for a considerable period following cardiac or gastrointestinal surgery. Metabolic losses are great and alternative methods of nutritional support needed.
The objectives in the dietary management of surgical conditions are:
1. To improve the pre-operative nutrition whenever the operation is not of an emergency nature.
2. To maintain correct nutrition after operation or injury as far as possible and
3. To avoid harm from injudicious choice of foods.
REQUIRED NUTRIENTS
(1) PROTEIN: A satisfactory state of protein nutrition ensures
a. Rapid wound healing
b. Increases resistance to infection
c. Exerts a protective action upon the liver against the toxic effects of anaesthesia and
d. Reduces the possibility of oedema at the site of the wound .
The presence of oedema is a hindrance to wound healing and in operations on the gastrointestinal tract, may reduce motility thus leading to distension.
When protein is depleted in post-operative condition complications are increased. Protein catabolism is increased for several days immediately following surgery or injury , patients are characteristically in negative nitrogen balance even though the protein intake may be appreciable. The degree of negative balance can be reduced at higher intakes of protein and calories.
The level of protein to be used in pre-operative and post-operative diets depends on the previous state of nutrition, the nature of the operation and the extent of the post-operative losses. Intake of 1.0 to 1.5g per kilogram or about 100g of protein are necessary as a rule.
(2) ENERGY: Without sufficient caloric intake tissue proteins cannot be synthesized. Excess metabolism of body fat may lead to acidosis, whereas depletion of the liver glucose may increase the likelihood of damage to the liver with 2500 to 3000 kcal patients make progress.
Obesity delays healing. Whenever possible, it should be corrected. Rapid weight loss results in loss of lean body mass and should be avoided.
(3) MINERALS: Phosphorus and potassium are lost in proportion to the breakdown of body tissue. In addition derangements of sodium and chloride metabolism may occur subsequent to vomiting, diarrhoea, perspiration, drainage, anorexia and dieresis or renal failure.
Iron-deficiency anaemia occurs in association with mal-absorption or excessive blood loss. Diet alone is ineffective in correction of anaemia, but a liberal intake of protein and ascorbic acid, together with administration of iron salt is of value in convalescence. Transfusions are usually required to overcome severe reduction in haemoglobin level.
(4) FLUIDS: The fluid balance maybe upset prior to and following surgery owing to failure to ingest normal quantities of fluids and to increased losses from vomiting ,exudates , haemorrhage , diuresis and fever. A patient should not be operated in a state of dehydration since the subsequent dangers of acidosis are great. When dehydration exists prior to operation, parenteral fluids are administered, if the patient is unable to ingest sufficient liquid by mouth.
(5) VITAMINS: Ascorbic acid (vitamin C) is especially important for wound healing and should be provided in increased amounts prior to and following the surgery. Vitamin k is of concern to the surgeon since the failure to synthesize vitamin k in the small intestine, the inability to absorb it or the defect in conversion to prothrombin is likely to result in bleeding. Haemorrhage is especially likely to occur in patients who have diseases of the liver.
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