6. Nutrition

Question 1

What does the body require energy for?

Answer 1

• homeostasis
• maintenance of ionic gradients
• transport
• biosynthesis
• heat generation
• locomotion

Question 2

What are vitamins?

Answer 2

Organic compounds that are required in small amounts for maintenance of normal health and metabolic integrity.

Question 3

What are the lipid soluble vitamins?

Answer 3

A, D, E and K

Question 4

What are the sources of Vitamin A?

Answer 4

• liver
• carrots
• kidney
• egg yolk
• butter

Question 5

What are the signs of Vitamin A deficiency?

Answer 5

• night blindness
• xeropthalmia (dry eyes)

Question 6

What are the consequences of Vitamin D deficiency?

Answer 6

Rickets (poor mineralisation of bone, affects children)

Osteomalacia (bone demineralisation, affects adults)

Question 7

What are the sources of Vitamin E?

Answer 7

• olive oil
• meat
• eggs
• leafy vegetables

Question 8

What are the consequences of Vitamin E deficiency?

Answer 8

Rare - serious neurological dysfunction.

Question 9

What are the sources of Vitamin K?

Answer 9

Green vegetables:
- broccoli
- brussel sprouts
- kale
- spinach

Question 10

What are the functions of Vitamin K?

Answer 10

Co-enzyme for FII, FVII, FIX and FX in the clotting cascade.

Question 11

What are the consequences of Vitamin K deficiency?

Answer 11

• impaired clotting
• haemorrhagic disease

Question 12

What are the sources of Vitamin B1 (thiamine)?

Answer 12

• legumes
• brown rice
• cereals made from whole grains

Question 13

What are the consequences of Vitamin B1 deficiency?

Answer 13

• Wernicke-Korsakoff syndrome
• peripheral neuritis

Question 14

What are the sources of Vitamin B9 (folate)?

Answer 14

• leafy vegetables
• liver

Question 15

What are the consequences of Vitamin B9 deficiency?

Answer 15

• macrocytic anaemia
• mouth ulcers

Question 16

What is obesity?

Answer 16

Excess of body fat that is sufficient to affect health adversely (BMI >30kg/m2).

Question 17

What medical complications are associated with obesity?

Answer 17

• T2DM
• hypertension
• coronary artery disease
• cancers
• osteoarthritis

Question 18

What are the goals of weight loss?

Answer 18

5-10% reduction in weight from is associated with clinically worthwhile reduction in comorbidities.

Question 19

What are some potential health benefits from the loss of 10kg from initial body weight in obese patients?

Answer 19

• 25% fall in total mortality
• 50% fall in obesity-related cancer deaths
• 15% fall in HbA1c

Question 20

How can obesity be managed by diet?

Answer 20

Calculate deficit of 600kCal per day

8% of body weight can be lost within 12 months.

Question 21

What is the mechanism of action of Orlistat in obesity?

Answer 21

Inhibits pancreatic and gastric lipases, reducing absorption of dietary fat.

Question 22

What are the side effects of Orlistat?

Answer 22

• liquid stools
• faecal urgency
• oily discharge

Question 23

What are the surgical options to treat obesity?

Answer 23

• laparoscopic gastric banding
• gastric bypass

Question 24

Approximately what proportion of adults aged >65years are undernourished?

Answer 24

10%

Question 25

What screening tool can be used to assess malnutrition risk in patients?

Answer 25

MUST score

Question 26

What are some causes of malnutrition?

Answer 26

- vegans (lack iron or B12) - excessive alcohol - nausea - medication - social isolation - depression - poverty

Question 27

What are the clinical features of malnutrition?

Answer 27

- muscle wasting - concave abdomen - loose rings on fingers - prominent cheek bones

Question 28

What are the indications of artificial nutritional support?

Answer 28

Indicated if oral intake is insufficient to maintain nutrition.

Question 29

What is enteral artificial nutrition support?

Answer 29

Nutrition support via the gut.

Question 30

What is parentral nutrition support?

Answer 30

Intravenous administration of nutrition.

Question 31

a) description b) uses c) advantages d) disadvantages of nasogastric access.

Answer 31

a) fine-boor tube giving pernasal access. b) short-to-medium term intragastric feeding, due to inability to swallow. c) bedside placement without sedation; well tolerated d) risk of malposition; difficult to manage in confused patients

Question 32

a) description b) uses c) advantages d) disadvantages of nasojejunal access.

Answer 32

a) fine-bore tube passed into distal duodenum / proximal jejunum b) inability to swallow complicated by GORD or gastroparesis; gastric outlet obstruction; acute severe pancreatitis c) bedise placement; accurate delivery; d) endoscopy or fluoroscopy for placement; easily displaced

Question 33

a) description b) uses c) advantages d) disadvantages of PEG access.

Answer 33

a) tube passed through abdominal wall into stomach, retained internally by a balloon. b) long-term intragastric feeding; c) difficult to displace; reliable in long-term; d) requires endoscopic placement; peritonitis; bleeding; PEG site infection

Question 34

a) description b) uses c) advantages d) disadvantages of surgical jejunostomy access.

Answer 34

a) feeding tube placed surgically into jejunum b) postoperative feeding c) permits early enteral feeding in post-operative setting d) not ideal for long-term use due to risk of displacement

Question 35

What are the options for parenteral nutritional support/

Answer 35

- PICC line - midline catheter - Hickman catheter

Question 36

What is the role of artificial nutrition in palliative care?

Answer 36

Limited evidence to suggest length and quality of life is improved using artificial nutritional support in palliative care settings. Patients can eat food naturally with accepted risk of aspiration.

Question 37

How can nutritional services be delivered in hospital?

Answer 37

MDT involving clinician, specialist nurse, dietitian and pharmacist within the hospital service. Referral of patients to nutritional team.