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Flashcards in Week 229 - Nutrition Deck (17)

What indications are there for enteral feeding?

-1st Line in the malnourished
-Unable to meet nutritional requirements with diet
-Unintentional weight loss
-Functioning gut
-Hypermetabolic state
-Anorexia owing to disease state


What indications are there for parenteral feeding?

-Non-functioning, inaccessible or perforated gut
-Gut rest required
-Metabolic stress or anticipated prolonged duration (>3/7)
-Inadequate or unsafe oral/enteral feel


List indications for short-term parenteral feeding

mucositis from chemo
severe pancreatitis; IBD
multi-organ failure; post-op period (abdo)


List indications for long-term parenteral feeding

intestinal atresia; CD; radiation enteritis; motility disorders e.g. scleroderma; extreme short-bowel


Name 3 types of enteral feeding and when you might use each

Supplements - simple lack of certain dietary elements
NG - dysphagia; critically ill; poor voluntary intake
PEG -unable to tolerate; chronic neurological condition; stroke - dysphagia >4wks; head& neck malignancy


Name the 2 types of feed available via NG tube

Elemental (partially broken down / digested - foul smelling and tasting)
Semi-elemental e.g. Modulen


List some advantages of enteral feeding

-Preserves intestinal mucosa
-Comfortable and readily accepted
-Independent of appetite/swallowing ability
-simple to administer day/night
-Nut. effectively mobilised


List 3 complications of enteral feeding

Poor gastric emptying


List 3 complications of parenteral feeding

-line sepsis -thrombophlebitis
-fluid overload -hyperglycaemia
-electrolyte imbalance -re-feeding syndrome
-liver dysfunction -osteoporosis


What is the advantage of a tunnelled central venous catheter?

↓ risk of infection reaching blood


Why is glutamine an important part of enteral/parenteral feeds?

The most abundant amino acid in the body.
Central role in nitrogen metabolism. Most important fuel for: enterocytes, gut mucosa and immune cells


List some risks factors for re-feeding syndrome when introducing supplementary nourishment to someone

Low BMI; little or no intake for >5days; unintentional weight loss >10 over 3-6months; Low K, Mg, PO prior to feeding; Hx of alcohol abuse; use of meds inc insulin, antacids, diuretics or chemo


What 3 things in should you monitor particularly closely in an individual started on TPN?

Catheter site - for infection
LFTs and U&Es


List some absolute contraindications for PEG placement

Contraindication to OGD
Inability to transilluminate


List some relative contraindications for PEG placement

coagulopathy; unlikely to survive >30 days; inflammatory or neoplastic conditions of stomach/abdo wall; gastric varices; morbid obesity; ascites; CAPD


Describe briefly what occurs in re-feeding syndrome

Starvation: body breaks down proteins and fats for energy > insulin levels deplete; phosphate stores deplete
On refeeding: insulin levels increase > cellular phosphate uptake increases > hypophosphataemic state > mostly responsible for features of the syndrome


List some features of refeeding syndrome

- Rhabdomyolysis - ↓ RBCs and WCC function
- Respiratory insufficiency - Arrhythmias
- Cardiogenic shock - Seizures
- Sudden Death