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GastroIntestinal (GI) > Malnutrition > Flashcards

Flashcards in Malnutrition Deck (36):
1

What is the definition of malnutrition?

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

2

What are the disease related causes of malnutrition?

Decreased intake
Impaired digestion and/or absorption
Increased nutritional requirements
Increased nutrient losses

3

What is Malnutrition?

Deficit of:
Energy
Protein
Vitamins
Decreased intake
Impaired absorption

4

What is the malnutrition cycle?

Anorexia + Weight loss ->
Complications ->
Illness ->
Hospital

5

What can a chronic status of malnutrition case?

Anorexia
Asthenia, depression
Dysphagia
Malabsorption, fistula, diarrhoea
Infection (TB, HIV etc)
Immobility

6

What can an acute event of malnutrition cause?

Sepsis
Pneumonia
Fever

caused by: Surgery, radiotherapy, chemotherapy

7

What physiological effects does Malnutrition have?

Increase Infection Rate
Decrease wound healing
Physical weakness
Hypermetabolism
Inflammatory response
Insulin resistance

8

What is the effect of starvation on the metabolic rate?

Decreased Metabolic rate

9

What is the effect of Injury on the Metabolic rate?

Increased metabolic rate

10

What type of weight loss is associated with starvation?

Slow weight loss almost all from fat stoes

11

What types of weight loss is associated with injury?

Rapid loss 80% from fat stores, remained from protein

12

What are the effects of starvation on hormones and electrolytes?

Decrease in nitrogen losses
Small increases in catecholamines, cortisol, GH, then slow fall. Insulin decreased
Initial loss of water and sodium, with late retention

13

What are the effects of injury on hormones and electrolytes?

Increased Nitrogen
Increases in catecholamines, cortisol, GH. Insulin increased but relative insulin deficiency
Retention of water and sodium due to serum albumen.

14

Effects of Malnutrition?

Impaired immune response
Impaired wound healing
Reduced muscle strength and fatigue
Water and electrolyte disturbances
Impaired thermoregulation
Menstrual irregularities
Impaired Psyco-social function

15

What is weight loss a symptom of in GI disease?

Impaired GI motility
Acute liver disease
Coeliac disease
Crohn's disease
Colorectal cancer
Gastric cancer
Oesophageal cancer
Intra-adbominal infection

16

What is the MUST score?

It is a score that is used to detect malnourished adults

17

What biochemical assessments are used for nutritional status?

Albumen - as it is 50% of total protein plasma
Transferrin - The synthesis of this is reduced in protein restriction
Transthyetin (Prealbumin) - Reflects recent diety intake over nutritional status
Urinary creatinine - renal function
IGF1 (Growth factor) - reduced in malnutrition
Micronutrients -

18

What biochemical measures in the older community should be used to test for malnutrition?

Vitamin A
Vitmain C
Vitamin D
Vitamin E
Zinc
Albumin

19

Who do you offer nutritional support for?

People with a MUST score of 2

20

What are the components of the MUST tool and suggests a patient should have nutritional support?

BMI 10% within the last 3–6 months
BMI 5% within the last 3–6 months
Have eaten or are likely to eat little or nothing for more than 5 days or longer
Poor absorptive capacity and/or high nutrient losses and/or increased

21

What are the different types of nutrition support?

Food fortification and counselling
Oral nutrient support
Enteral tube feeding
Parenteral nutrition

22

When would you prescribe oral nutritional supplements?

Disease related malnutrition
Intractable malabsorption
Per-operative preparation of malnourished patients
Dysphagia
Proven IBD
Post total gastrectomy
SBS
Bowel fistulae

23

How does enteral tube feeding work?

Delivery of a nutritionally complete feed via a tube into the stomach, duodenum or jejunum

24

What are the different types of Enteral tubes?

Nasogastric (NG)
Nasojejunal (NJ)
Percutaneous endoscopic gastrostomy PEG
Percutaneous jejunostomy
Surgical jejunostomy

25

When would you use Enteral feeding tubes?

"If the gut works, use it"

Unconscious patients
Neuromuscular swallowing disorder
Upper GI obstruction
GI dysfunction
Increased nutritional requirements

26

What are the cmplications of using an enteral tube feeder?

Lower gastrointestinal obstruction
Prolonged intestinal ileus
Severe diarrhoea or vomiting
High enterocutaneous fistula
Intestinal ischaemia
Oesophagitis
Aspiration
Refedding syndrome
Hyperglycaemia

27

What is parenteral nutrition?

Parenteral nutrition (PN) is feeding a person intravenously, bypassing the usual process of eating and digestion

28

When would you consider Parenteral nutrition?

Inadequate oral or enteral nutation
Leaking in the GI track

29

What conditions would you use parenteral nutrition for?

IBD with severe malabsorption
Radiation enteritis
Short bowel syndrome
Motility disorders
Type 1 intestinal failure
Intestinal fistulae
Multi-organ failure

30

What is referring syndrome?

Fatal shift in fluids and electrolytes which causes disturbances in organ function.
Results from a rapid invitation of re-feeding after a period of under nutrition Happens if you give a quick administration of glucose via tube feeding or parenteral feeding

31

What are the events that leads to referring syndrome?

1. Starvation and malnuteation
2. Leads to Glycogenolysis, gluconeogenesis and protein catabolsim
3. Leads to nutrient depletion with salt and water intolerance
4. Refeeding switches the body to anabolism
5. Insulin secretion
6. Protein and glycogen synthesis
7. Refeeding syndrome

32

What are the metabolic signs of refeeding syndrome?

Hypokalaemia Hypomagnesaemia Hypophosphataemia Thiamin deficiency Salt and water retention - oedema

33

What are the physiological symptoms of referring syndrome?

Arrhythmias
Seizure
Respiratory failure
Cardiovascular collapse
Death

34

What tests do you run for high risk parents for rereeding syndrome?

PO4,
Mg2+
K+
Ca+

35

How many kcal per day would you administer for a high risk patient of refeeding syndrome?

10 kcl/kg/day

36

How many kcal per day would you administer for a extremely high risk patient of refeeding syndrome?

5 kcl/kg/day