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Study Notes - Gastroenterology > Malnutrition > Flashcards

Flashcards in Malnutrition Deck (25):
1

What is 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 (body shape, size and composition), function and clinical outcome

2

What are disease related causes of malnutrition generally speaking? (4)

Decreased intake (decreased appetite, pain when eating, dysphagia)
Increased nutritional requirement (trauma, burns, surgery)
Impaired absorption/ digestion
Increased nutrient loss (stoma, vomiting, diarrhoea)

3

What are the 4 aspects of the malnutrition cycle?

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

4

Psychosocial causes of malnutrition?

• Inappropriate food provision
• Lack of assistance
• Poor eating environment
• Self neglect
• Bereavement
• Inability to access food
• Deprivation
• Loneliness
• Lack of cooking skills or facilities

5

Adverse effects of malnutrition?

Impaired immune response
Impaired wound healing
Reduced muscle strength and fatugie
Reduced respiraotry muscle strength
Inactivity, especially in bed bound patients
Water and electrolyte disturbances (leading to a decreased ability to excrete sodium and water)
Impaired thermoregulation
Menstrual irregularities/ amenorrhoea
Impaired psycho-social function
Prolonged hospital stay/ recovery

6

What scoring tool is used to assess malnutrition

The malnutrition universal screening tool (MUST)

7

What anthropometric measurements can be taken to assess nutrition?

o Mid-arm muscle circumference
o Triceps
o Grip strength

8

What biochemical assessment can assess nutritional status?

Urinary creatinine
IGF1
Micronutrients
Albumin
Transferrin
Transthyretin (prealbumin)
Retinol binding protein
Vitamin A, C, D and E
Zinc

9

What type of nutritional support is available (4)

Food fortification and dietary counselling
Oral nutrition support e.g. additional snacks/ sip feeds
Enteral tube feedng (delivery of nutritionally complete feed directly into the gut via a tube)
Parenteral nutrition (delivery of nutrients IV)
Or combination

10

Who needs nutritional support? (5)

• 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 nutritional needs from causes such as catabolism

11

What kind oral nutritional supplements are available?

• Ready made drinks (sip feeds)
• Powders to reconstitute with milk e.g. Build-up, Enshake
• Puddings e.g. Forticreme
• Carbohydrate supplements (powder or liquid)
• Fat supplements e.g. Calogen
• Fat and protein supplements (powder or liquid) e.g. Pro-Cal

12

What are the standard indication for oral nutritional supplements?

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

13

Types of enteral tube feeding?

• Delivery of a nutritionally complete feed via a tube into the stomach, duodenum or jejunum
o Nasogastric (NG)
o Nasojejunal (NJ)
o Percutaneous endoscopic gastrostomy PEG
o Percutaneous jejunostomy
o Surgical jejunostomy
o Feed is nutritionally complete

14

Indications for enteral tube feeding?

• inadequate or unsafe oral intake, and
• a functional, accessible gastrointestinal tract
• ‘if the gut works, use it’
o Unconscious patients
o Neuromuscular swallowing disorder
o Upper GI obstruction
o GI dysfunction
o Increased nutritional requirements

15

What is parenteral nutrition?

Administration of a nutrient solution via a central or peripheral vein

16

What are the indications for parenteral feeding?

• Healthcare professionals should consider parenteral nutrition in people who are malnourished or at risk of malnutrition and meet either of the following criteria:
o inadequate or unsafe oral and/or enteral nutritional intake
o a non-functional, inaccessible or perforated (leaking) gastrointestinal tract
♣ IBD with severe malabsorption
♣ Radiation enteritis
♣ Short bowel syndrome
♣ Motility disorders

17

What are the indications for parenteral feeding in type 1 intestinal failure?

o Severe malnutrition pre-op
o Post-op feeding: ileus/organ failure/5 day rule
o Intestinal fistulae
o Multi-organ failure
o Post chemo mucositis

18

What is refeeding syndrome?

A potentially fatal shift in fluids and electrolytes and disturbances in organ function and metabolic regulation that may result from rapid initiation of re feeding after a period of under nutrition

19

With what type of feeding is refeeding syndrome less likely to occur?

• Less likely to occur with oral feeding as intake usually limited by poor appetite but excessive feeding can easily be administered by PN or EN

20

What are the metabolic features of refeeding syndrome?

o Hypokalaemia
o Hypophosphataemia
o Hypomagnesaemia
o Altered glucose metabolism
o Fluid overload

21

What are the physiological causes of refeeding syndrome?

o Arrhythmias
o Altered level of consciousness
o Seizure
o Respiratory failure
o Cardiovascular collapse
o Death

22

Who is at moderate risk of refeeding syndrome?

Patients who have had little or no nutritional intake for > 5 days

23

Who is at high risk of refeeding syndrome? (4)

BMI 15% in last 3-6 months
little or no nutritional intake for > 10 days
Low level of serum potassium, phosphate or magnesium before feed
(either 1 of these or 2 of the same things but slightly less or a history of alcohol or drug abuse)

24

Who is at extremely high risk of refeeding syndrome? (2)

BMI 15 days

25

How to prevent refeeding syndrome in moderate risk patients? (3)

Introduce feeding at max. of 50% of requirements for 48 hours
Monitor clinical and biochemical parameters
Increase to full if monitoring reveals no problems