Disorders of Nutrition and Metabolism in Clinical Surgery

This guidebook for the general surgeon and his or her team is focused on patient care and is based on an understanding of the fundamentals of nutrition and metabolism within the context of high standards of surgical care. The text also examines advances in molecular biology.

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This text is based mainly on studies of patients from surgical wards studied in the University Department of Surgery at Auckland Hospital. More than 600 surgical patients covering most of the commonly encountered metabolic problems have been entered in various protocols and studies over the past 10 years. Not discussed here are those problems and diseases of which the authors have no personal experience. In particular, burns have not been covered, nor have the special nutritional and metabolic problems of children. The book is organized into four parts and covers those areas which are everyday occurrences in busy surgical clinics. The first part of the book deals with fundamental principles underlying metabolic care, the compositional and physiological changes that occur in normal convalescence after major surgery and then some of the more difficult problems encountered in metabolic care in the perioperative period. A fairly formal account of water and salt and acid base therapy is then given. The second part of the book is a comprehensive account of nutritional care.
Modern ideas of the classification of adult protein energy malnutrition and new discoveries of the effect of nutritional therapy in treating it are then covered. Practical aspects of nutritional assessment are explained as are the therapeutic modes of enteral and partenteral feeding. This section finishes with four case management problems, a learning technique used most successfully by Dr. George Blackburn of Boston. The next section of the book, Part three, covers the particular nutritional and metabolic problems encountered in the practice of the surgeon who deals with complex problems of the alimentary tract. Finally the book finishes with an insight for the general surgeon into serious surgical illness, including in particular those patients with organ failure. This is not meant to be a comprehensive account of intensive care.
It is specifically designed for those members of general surgical teams who find this area somewhat confusing and baffling and this section is aimed to introduce them to the terminology used in critical care, the type of treatments given and the role that they may be expected to play if they are working in a team situation with critical care specialists alongside. This section is not designed for those who are experts in critical care and manage this side of patient care entirely themselves. There has been no attempt to cover the extensive literature on the subject but an up-to-date and representative bibliography is provided which will enable the reader to explore certain topics in more depth.