The Surgical clinics of North America
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Surgery in geriatric patients is accompanied by increases in morbidity and mortality, increases in functional abnormalities and poor outcomes, and increases in severe malnutrition, compared with surgery of similar magnitude in nongeriatric patients. Hospitalized elderly patients are at significant risk of presenting with, or developing, protein-energy and other nutrient deficiencies. However, nutritional assessment of older geriatric patients, 65 to 100 years of age, is a challenging task because of lack of adequate age-specific reference data in this diverse and heterogeneous population. Dietary counseling and conscientious, aggressive nutritional support are required for optimal metabolic and surgical care of this age group.
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Surg. Clin. North Am. · Aug 2011
ReviewNutritional support of the obese and critically ill obese patient.
With the dramatic increase in the prevalence of obesity worldwide and in the United States, it is virtually certain that clinicians will be caring for bariatric and obese nonbariatric patients in increasing numbers. This patient population presents several difficulties from the medical and surgical management perspectives. In particular, nutrition of the bariatric patient and critically ill obese patient is challenging. A clear understanding of the nutritional assessment and unique management strategies available for the bariatric and the critically ill obese patient is essential to provide them with the safest and most effective care.
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Surg. Clin. North Am. · Jun 2011
ReviewAdjuvant nutrition management of patients with liver failure, including transplant.
This article reviews nutrition support in patients with liver disease, including those who are undergoing surgery or liver transplant. The topics covered include the multifactorial etiology of malnutrition, nutritional assessment, and nutritional therapy. Recommendations for use of both enteral and parenteral nutrition are given in patients with alcoholic hepatitis, cirrhosis, and acute liver failure and in patients undergoing surgery or liver transplant.
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The hypermetabolic response to severe burn injury is characterized by hyperdynamic circulation and profound metabolic, physiologic, catabolic, and immune system derangements. Failure to satisfy overwhelming energy and protein requirements after, and during, severe burn injury results in multiorgan dysfunction, increased susceptibility to infection, and death. Attenuation of the hypermetabolic response by various pharmacologic modalities is emerging as an essential component of the management of patients with severe burn injury. This review focuses on the more recent advances in therapeutic strategies to attenuate the hypermetabolic response and its postburn-associated insulin resistance.
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This article deals with the nutritional needs of pediatric patients. It begins by discussing the caloric requirements of different pediatric patients and moves on to a breakdown of the specific nutrients required. It then progresses to a detailed description of the enteral and parenteral modalities for delivery of nutrition to pediatric patients. The article concludes with a discussion of specific problems and disorders encountered in pediatric surgical patients.