nutrient malabsorption

Question 1

what can cause maldigestion? 3

Answer 1

• chronic pancreatitis,
• CF,
• pancreatic carcinoma

Question 2

what can cause inadequate absorptive surfaces? 3

Answer 2

• intestinal resection
• gastro colic fistula
• jejuno-ileal bypass

Question 3

what can cause a bile salt deficiency? 5

Answer 3

• cirrhosis
• cholestasis
• bacterial overgrowth
• impaired ileal reabsorption
• bile salt binders

Question 4

what can cause lymphatic obstruction? 3

Answer 4

• lymphoma
• whipples disease
• intestinal lymphangiectasia

Question 5

what can cause vascular disease? 3

Answer 5

• constrictive pericarditis
• RSHF
• mesenteric arterial or venous insufficiency

Question 6

what can cause mucosal disease? 5

Answer 6

• infection
• inflammatory diseases
• radiation enteritis
• eosinophilic enteritis
• ulcerative jejunitis

Question 7

describe energy balance in disease? 6

Answer 7

• In the absence of food, glucose is maintained through mobilisation of stores of glycogen and if prolonged, gluconeogenesis and lipolysis
• In disease, inflammatory response= cytokines
• TNFalpha insulin resistance glycolysis
• IL2 glucose metabolism
• IL4 lipid and glucose metabolism
• IL6 lipolysis activity and appetite reduced

Question 8

what does growth hormone do?

Answer 8

helps with recovery

Question 9

what do patients with an acute illness need? 3

Answer 9

• Meet energy demand
• Conserve muscle mass- avoid negative nitrogen balance
• Manage blood glucose

Question 10

what are the feeding issues that patients face? 4

Answer 10

• Poor appetite or inability to eat
• Extended periods of time nil by mouth
• Not a priority
• Unclear roles and responsibility

Question 11

what are the nutrition goals for people with chronic illness? 7

Answer 11

• Start with food- may have long term enteral feeding
• Focus on balanced diet for them
• Diet to increase energy intake
• Diet to maintain blood glucose
• Diet to reduce workload of the kidney
• Diet to reduce inflammation
• Diet to support treatment

Question 12

what should you remember about nutrition in a hospital? 10

Answer 12

• Make food a part of your conversation with the MDT:
• On admission
• At ward rounds
• Planning for discharge
• In GP practise
• Supporting home care
• .
• Consider the body of evidence
• Be wary of nutrition pseudoscience
• Learn to be critical thinkers
• Leave your dietary beliefs at home