14. Nutrition and malnutrition Flashcards

1
Q

What are the healthy eating guidelines?

A
  • 5 portions of fruit/vegetables a day
  • Base meals on starch carbohydrates (wholegrain preferable)
  • Have some dairy (lower fat/sugar preferable)
  • Proteins (including 2 portions of fish ever week, one of which should be oily)
  • Choose unsaturated oils
  • 6-8 glasses of fluid a day
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2
Q

How does the reality compare to the recommendations of healthy eating?

A
  • Less than 40% of adults and less than 10% of children consume the recommended 5 a day
  • Saturated fat intake exceeds recommendation (meat and dairy provide 45% of this)
  • > 85% consume higher than recommended free sugars
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3
Q

What is enteral and parenteral feeding?

A
  • Enteral - delivery of nutritious fluid past the upper GI tract, into the stomach/duodenum/jejunum
  • Parenteral - delivery of nutrients via IV catheter, bypassing the GI tract (can take more than 12 hours)
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4
Q

What kind of patient is treated with enteral and parenteral feeding?

A
  • Enteral - temporary upper GI problem e.g. dysphagia or trauma
  • Parenteral - dysfunction of GI tract, unable to digest/absorb/excrete
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5
Q

What are the risks of enteral and parenteral feeding?

A
  • Enteral (low risk) - nausea, vomiting, aspiration

* Parenteral (high risk) - pneumothorax, blood clots, infection, liver failure

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6
Q

What are the technical requirements, effects on GI tract and costs of enteral and parenteral feeding?

A
  • Enteral - basic training, maintains internal structure and function of GIT, cheaper
  • Parenteral - specialist training, atrophy of GIT due to underuse, expensive
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7
Q

What is short bowel syndrome?

A
  • Lack of functional small intestine
  • Characterised by significant removal of the bowel - left with less than 100cm of functional intestinal tract
  • Can be caused by Crohn’s, cancer, ischaemia, ulcerative colitis, irradiation
  • Leads to dehydration, malnutrition
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8
Q

How can short bowel syndrome be managed?

A
  • Provide adequate nutrition
  • Ensure adequate water and electrolytes to maintain homeostasis
  • Correction and prevention of acid base imbalance

• Anastamosis - connection of small intestine to colon - important surgical intervention, can reduce reliance on parenteral nutrition

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9
Q

What is adaptive thermogenesis?

A

Amount of energy needed to keep warm and absorb nutrients

older, loss of muscle, lower energy intake

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10
Q

What is re-feeding syndrome?

A
  • Metabolic disturbances as a result of reinstitution of nutrition to patients who are starved/severely malnourished
  • Arrhythmia, respiratory distress, weakness
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11
Q

How do you managed re-feeding syndrome?

A
  • Daily biochemistry and replace electrolytes
  • Vitamin supplementation for first 10 days of feeding
  • Start low, increase slowly
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12
Q

What is thiamine and what can a deficiency lead to?

A

• Vitamin B1
• Involved in the breakdown of energy molecules e.g. glucose
• Found on the membranes of neurones
• Deficiency: beriberi - lethargy, fatigue, CV, nervous, muscular and GI symtpoms
(could be caused by humans - thiamine of white rice removed by polishing)

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13
Q

What is niacin and what can a deficiency lead to?

A

• Nicotinamide is a derivative
- used to form coenzymes NAD and NADP
• Deficiency: Pellagra

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14
Q

What are the signs of malnutrition?

A
• Weight loss
- loss of subcutaneous fat
- muscle wasting
• Peripheral oedema
• Glossitis
• Hair loss
• Chronic infections
• Poor wound healing
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15
Q

What factors affect the metabolism of alcohol?

A
  • Diet
  • Genetic
  • Gender
  • Body habitus (physique)
  • Race
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16
Q

What negative effects does alcohol have on the body?

A
  • CNS - Wernickes encephalopathy
  • CVS - hypertension
  • GIT - oesophagitis, alcoholic hepatitis, pancreatic cancer etc.
  • Glomerulonephritis, gout, pseudocushings, impotence etc.
17
Q

What effect does alcohol have on immunity?

A
  • Immunosuppression - increased incidence of infectious disease
  • Autoimmunity - liver cirrhosis, renal disease associated with IgA deposition
18
Q

Outline the metabolism of ethanol?

A

• Ethanol => acetaldehyde [alcohol dehydrogenase/catalase/Cytochrome P450-2e1]
• CYP2E1:
- is an inducible enzyme - heavy drinking can still be metabolised effectively
- creates reactive oxygen species - tissue damage, inflammation and stimulation of immune system (fibrosis etc.)
• Acetaldehyde => CO2 + H20 [aldehyde dehydrogenase]
• ALDH - genetic polymorphisms for this gene

19
Q

What is a fatty liver?

A
  • Fat droplets deposited in the liver
  • Can lead to steatohepatitis and abnormal LFTs
  • Reversible if alcohol reduced
20
Q

What is hepatic fibrosis?

A
  • Migrating macrophages
  • Chronic inflammation
  • => hepatic stellate - lay down collagen fibres
21
Q

Describe cirrhosis

A
  • Asymptomatic
  • Irreversible scarring of liver with fibrous bands and regenerative nodules
  • Eventually develops in 20% after 15 years
  • Morbidity common - associated with jaundice, ascites, bleeding etc.
  • Death in most within 10 years
22
Q

How much alcohol is in one unit?

A

8g

23
Q

How do you calculate units of alcohol by volume?

A

(Percentage volume (g of alcohol in 100ml) x 0.789 x volume drunk)/100

24
Q

What are the clinical features of acute alcohol poisoning?

A
  • Ataxia and anasthesia
  • Dysarthria (slurring of words)
  • Nystagmus (involuntary eye twitching)
  • Drowsiness => coma
  • Inhalation of vomit
25
Q

What are the effects of alcohol on the male reproductive system?

A
  • Strong Leydig cell toxin
  • Adverse effect on synthesis and secretion of testosterone
  • Common cause of male impotence
26
Q

What causes a ‘hangover’?

A
  • Dehydration

* Altered osmolarity of endolymphatics

27
Q

What is a serious (blood level) complication of acute alcohol poisoning?

A

Alcohol induced hypoglycaemia