229 Nutrition Flashcards Preview

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Flashcards in 229 Nutrition Deck (27):
1

Name 3 consequences of malnutrition
(5 listed)

1. Decreased muscle mass
2. Decrease in visceral proteins
3. Impaired immune function
4. Impaired wound healing
5. MOF

2

Name 3 effects of malnutrition on the immune system
(6 listed)

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

3

What type of feeding would a person who's malnourished due to anorexia with a functioning gut require?

Enteral feeling

4

What type of feeding would a non-functioning gut require?

Parenteral

5

How long would a short term PICC line be in situ for (e.g. for severe pancreatitis)?

2 weeks

6

Name 2 indications for long term TPN
(4 listed)

Intestinal atresia
Crohn's
Radiation enteritis
Extreme short bowel

7

Under how many cm's is extreme short bowel syndrome diagnosed?

200cm

8

Which a.a. has a central role in nitrogen metabolism?

Glutamine

9

Which a.a. is glutamine the precursor of?

Glutathione (+ nucleotides)

10

Name 2 complications of TPN
(4 listed)

Line sepsis
Thrombophlebitis
Hyperglycaemia
Re-feeding syndrome

11

Who is at severe risk of re-feeding syndrome?

Very low BMI
No intake for ~ 10 days
Hx alcohol/drug abuse

12

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

13

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

14

What does the rapid increase of insulin secretion cause in re-feeding syndrome?

Rapid uptake of phosphate, potassium and magnesium + Na and H2O retention.
HYPOPHOSPHATAEMIA
and THIAMINE DEFICIENCY

15

What is the outcome of hypophosphataemia and thiamine deficiency in re-feeding syndrome?

Tissue hypoxia
Cardiac dysrhythmia
Thrombocytopaeinia
Confusion

16

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

17

What is the most common cause of short bowel syndrome in newborns?

necrotising enterocolitis

18

What is the most common cause of short bowel syndrome in children and adults?

Crohn's

19

Name 3 outcomes of short bowel syndrome
(6 listed)

Malabsorption
Malnutrition
Diarrhoea
Electrolyte imbalance
Steatorrhoea
Hypergastrinaemia

20

Why might some patients with short bowel syndrome suffer with clotting abnormalities?

Steatorrhoea leading to malabsorption of Vit K = fat soluble

21

Why do patients get hypergastrinaemia in short bowel syndrome?

Negative feedback mechanism for inhibiting gastrin secretion removed and so HCl is over produced

22

What is the cause of diarrhoea in SBS?

Osmotic load generated by malabsorbed carbohydrates - especially simple carbs

23

What happens to the villi of the ileum after jejunal resection?

They grow in length and diameter

24

Which hormone is responsible for ileal brake?

Peptide YY

25

What stimulates intestinal proliferation?

Prostaglandins

26

Which incretin induces epithelial hyperplasia in ilea adaptation following jejunal resection?

GLP-2

27

What is the outcome of the loss of ileocaecal valve in SBS?

Small bowel bacterial overgrowth