4 - Nutrition in Medicine

Question 1

Undernutrition

Answer 1

A form of malnutrition resulting from a reduced supply of food or from inability to digest, assimilate and utilise the necessary nutrients

Question 2

Reasons for under nutrition in hospitals

Answer 2

Confusion, treatment, reduced ability to swallow, shit food, shit teeth, difficulty in self-feeding

Question 3

Consequences of undernutrition in the community

Answer 3

Falls
dependency
Infection
Depression

Question 4

Consequences of undernutrition in hospital

Answer 4

Increased length of stay
Increased dependency
Increased mortality

Question 5

Symptoms of under nutrition in catabolic patients

Answer 5

Decreased muscle mass
Decreased visceral proteins
Impaired everything
Multiple organ failure

Question 6

Symptoms of under nutrition in healthy patients

Answer 6

Fatigue, general weakness
Depression
Changes in behaviour
Complete exhaustion

Question 7

Causes for reduced nutritional intake

Answer 7

Anorexia
Dysphagia
Nil by mouth

Question 8

Causes of increased nutritional losses

Answer 8

Malabsorption

Wound exudate/burns

Question 9

Increased nutritional requirements

Answer 9

Inflammation/infection
Pyrexia
Tissue healing
Metabolic effects

Question 10

How to combat malnutrition in hospitals

Answer 10

Use MUST (Malnutrition universal screening tool) 
Bmi, weight loss + acute disease = score --> management guidelines

Question 11

How do you assess nutritional status

Answer 11

Subjective Global Assessment
(SGA)
 History
 Weight and BMI
 Weight changes (consider ascites and oedema)
 Appetite, early satiety, and taste changes
 Diet history and adequacy of intake
 GI symptoms: persistent nausea, vomiting, diarrhoea, or constipation
 Energy and activity levels

Question 12

Clinical investigations for malnutrition

Answer 12

Anthropometrics - Skin thickness (fat), mid upper arm circumference (MUAC)
DEXA
Handgrip dynamometry

Question 13

What is your Total Energy Expenditure made up of

Answer 13

Basal metabolic rate
Thermic effect of food
Physical activity
Stress factors

Question 14

Nitrogen requirements

Answer 14

0.75/kg/day

Question 15

How to measure fluid

Answer 15

Add up non-urinary output (ng tube, stoma, fistula)
insensible loss (sweat) 500ml + 10% for every rise in 1degree c
Allow 1-1.5L urine daily

Question 16

Enteral feeding + when you would use it

Answer 16

Feeding tube gastrostomy

• with reduced consciousness
• unsafe swallow (parkinsons)
• Cystic fibrosis

Question 17

Parenteral feeding + when you’d use it

Answer 17

Feeding via IV

• When intestinal failure - Intestinal obstruction
• Short bowel
• Acute pancreatitis

Question 18

When should you not give parenteral feeding

Answer 18

Before or after major surgery

In pancreatitis

Question 19

Problems with NG tube

Answer 19

Aspiration
Discomfort
Diarrhoea

Question 20

Problems with PEG

Answer 20

Diarrhoea

Infection

Question 21

Problems with PN

Answer 21

Infection
Electrolyte disturbances
Hepatic dysfunction
Hyperglycaemia