Flashcards in 229 Nutrition Deck (27):
Name 3 consequences of malnutrition
1. Decreased muscle mass
2. Decrease in visceral proteins
3. Impaired immune function
4. Impaired wound healing
Name 3 effects of malnutrition on the immune system
1. Decreased lymphocyte proliferation
2. Decreased helper:suppressor T cell ratio
3. Decreased antibody affinity
4. Cytokine deficiencies
5. Decreased phagocyte killing
6. Reduced Ig response
What type of feeding would a person who's malnourished due to anorexia with a functioning gut require?
What type of feeding would a non-functioning gut require?
How long would a short term PICC line be in situ for (e.g. for severe pancreatitis)?
Name 2 indications for long term TPN
Extreme short bowel
Under how many cm's is extreme short bowel syndrome diagnosed?
Which a.a. has a central role in nitrogen metabolism?
Which a.a. is glutamine the precursor of?
Glutathione (+ nucleotides)
Name 2 complications of TPN
Who is at severe risk of re-feeding syndrome?
Very low BMI
No intake for ~ 10 days
Hx alcohol/drug abuse
What is the feeding treatment protocol for severe malnutrition with risk of re-feeding syndrome?
Reduced rate feeding to 10ml/kg/day and increase to full nutritional demand by 4-7 days
What is the reason for re-feeding syndrome?
Catabolic to anabolic metabolism - i.e. switch from endogenous ketones to exogenous glucose which causes increased insulin secretion
What does the rapid increase of insulin secretion cause in re-feeding syndrome?
Rapid uptake of phosphate, potassium and magnesium + Na and H2O retention.
and THIAMINE DEFICIENCY
What is the outcome of hypophosphataemia and thiamine deficiency in re-feeding syndrome?
What is short bowel syndrome?
Malabsorption disorder caused by the surgical removal of the small intestine, or rarely due to the complete dysfunction of a large segment of bowel
What is the most common cause of short bowel syndrome in newborns?
What is the most common cause of short bowel syndrome in children and adults?
Name 3 outcomes of short bowel syndrome
Why might some patients with short bowel syndrome suffer with clotting abnormalities?
Steatorrhoea leading to malabsorption of Vit K = fat soluble
Why do patients get hypergastrinaemia in short bowel syndrome?
Negative feedback mechanism for inhibiting gastrin secretion removed and so HCl is over produced
What is the cause of diarrhoea in SBS?
Osmotic load generated by malabsorbed carbohydrates - especially simple carbs
What happens to the villi of the ileum after jejunal resection?
They grow in length and diameter
Which hormone is responsible for ileal brake?
What stimulates intestinal proliferation?
Which incretin induces epithelial hyperplasia in ilea adaptation following jejunal resection?