Alimentary systems 14 - Clinical Malnutrition Flashcards Preview

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Flashcards in Alimentary systems 14 - Clinical Malnutrition Deck (28)
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1
Q

Define malnutrition

A
  • A state of nutrition in which a deficiency, imbalance or excess of energy, protein and other nutrients causes measurable adverse effects on tissue, body form and function and clinical outcome
2
Q

What is the annual cost of under nutrition?

A

19.6 billion

3
Q

List the causes of malnutrition

A
  • Food insecurity
  • Poor social and care environment
  • Poor access to healthcare
  • Results in inadequate food and disease
4
Q

List the consequences of malnutrition

A
  • Low energy
  • Muscle weakness
  • Infertility
  • Weakened immune system
  • Increased risk of hospital admissions
  • Weak bones so increased risk of fall
  • Depression
5
Q

How is malnutrition diagnosed?

A
  • First nutritional screening is carried out by a non-specialist nurse or health care worker
  • Then if necessary there is a nutrition assessment by a specialist
  • Finally there is diagnosis
6
Q

What happens in nutrition screening?

A
  • Quick and simple initial asessment of the patient
  • Taken at regular intervals
  • Assess nutritional status and categorise into risk, for example using the MUST tool (BMI, weight loss score, acute disease affect score)
7
Q

How is nutritional status assessed?

A
  • Weight
  • Percentage weight loss and time period
  • BMI
  • Handgrip measure, skinfold thickness and muscle circumference
  • Dietary recall/food diary
  • Albumin and CRP, creatinine and cholesterol
8
Q

List the types of parenteral nutrition

A
  • Total parental nutrition is directly into the vena cava

- Peripheral parental nutrition is in a peripheral blood vessel

9
Q

List the types of enteral nutrition

A
  • Nasogastric tube
  • Nasoduodenal tube
  • Gastrotomy tube
  • Jejunostomy tube
10
Q

When is a nasogastric tube used?

A
  • When feeding is for less than 1 month
  • Crohns disease
  • Patients are unconscious
  • Patients have a functioning gut but cannot swallow
11
Q

When are gastrostomies and jejunostomies used?

A
  • When the upper GI tract is damaged
  • Used for long term enteral feeding
  • Inserted endoscopically or radiologically
12
Q

How is the amount to feed a patient assessed?

A
  • Indirect calorimetry (gold standard) by measuring gas exchange
  • In practice administer 25-30kcal/kg
13
Q

List the complications of enteral feeding

A
  • Nausea and vomiting
  • Tube issues
  • Diarrhoea
  • Constipation
14
Q

Define parenteral nutrition

A

The administration of nutrients either centrally or peripherally where the gastrointestinal tract is inaccessible or there is insufficient gastrointestinal function

15
Q

List the insertion parenteral nutrition complications

A
  • Pneumothorax
  • Bleeding
  • Misplacement
16
Q

List the line complications of parenteral nutrition

A
  • Line sepsis
  • Thrombosis/phlebitis
  • Occlusion
  • Dislodgement, fracture or leaking
17
Q

List the metabolic complications of parenteral nutrition

A
  • Refeeding syndrome
  • Hyper/hypoglycaemia
  • Electrolyte disturbances
  • Liver disease
  • Metabolic bone disease
  • Gallstones
18
Q

List the advantages and disadvantages of parenteral feeding

A
  • Advantage is that you can feed patients with no GI function
  • Disadvantages include risk of sepsis, expensive, placed in radiology, needs close monitoring
19
Q

List the advantages and disadvantages of enteral feeding

A
  • Easy access
  • Can be placed by nurses
  • Risk of aspiration
  • Hard to confirm position
  • Can cause trauma
20
Q

Define refeeding syndrome

A

Metabolic disturbances that occur as a result of reinstitution of nutrition to patients who arestarved or severely malnourished

21
Q

List the stages of refeeding syndrome

A
  • Malnutrition results in low glucagon, high insulin and high cortisol
  • As as result there is gluconeogenesis, glycogenolysis and protein catabolism
  • Upon refeeding, there is insuling secretion and as a result increased glucose uptake, phosphorous magnesium and potassium uptake and thiamine use
  • As a result there is hypophosphataemia, hypokalaemia, hypomagnesaemia and sodium and water retention
22
Q

List the consequences of refeeding syndrome

A
  • Low phosphate causes altered myocardial function, arrhythmia, heart failure. Acute ventilatory syndrome, paralysis and confusion
  • Low magnesium causes arrhythmia, tachycardia, slow breathing, weakness, confusion, muscle tremors
  • Low potassium causes arrhythmias, cardiac arrest, respiratory distress, paralysis, weakness and rhabdomyolysis
23
Q

Describe the management of refeeding syndrome

A
  • Replace electrolytes
  • Vitamin suppliments
  • Nutrition support at max of 10kcal/kg/day
24
Q

What is short bowel syndrome?

A
  • Significant removal of the bowel (due to crohns, cancer, ulcerative collitis) leaving less then 100cm
  • Results in dehydration, malnutrition and malabsorption
25
Q

How is short bowel syndrome managed?

A
  • Provide adequate nutrition for patients
  • Ensure adequate water and electrolytes
  • Correct and prevent acid base imbalance
26
Q

List the symptoms of short bowel syndrome

A
  • Abdominal pain
  • Diarrhea and steatorrhea
  • Fluid depletion
  • Weight loss and malnutrition
27
Q

Describe the metabolism of alcholol

A
  • Ethanal to acetaldehyde via catalase or NAD (increases reactive oxidative species formation)
  • Acetaldehyde to acetate
28
Q

List the physical effects of alcohol

A
  • Wernickes encephalopathy, cerebral atrophy, optic atrophy, peripheral neuropathy
  • Hypertension, alcoholic cardiomyophathy, stroke
  • Liver cancer, pancreattis, hepatitis
  • Renal failure
  • Gout
  • Impotence, breast cancer