229 Nutrition

Question 1

Name 3 consequences of malnutrition

5 listed

Answer 1

1. Decreased muscle mass
2. Decrease in visceral proteins
3. Impaired immune function
4. Impaired wound healing
5. MOF

Question 2

Name 3 effects of malnutrition on the immune system

6 listed

Answer 2

1. Decreased lymphocyte proliferation
2. Decreased helper:suppressor T cell ratio
3. Decreased antibody affinity
4. Cytokine deficiencies
5. Decreased phagocyte killing
6. Reduced Ig response

Question 3

What type of feeding would a person who’s malnourished due to anorexia with a functioning gut require?

Answer 3

Enteral feeling

Question 4

What type of feeding would a non-functioning gut require?

Answer 4

Parenteral

Question 5

How long would a short term PICC line be in situ for (e.g. for severe pancreatitis)?

Answer 5

2 weeks

Question 6

Name 2 indications for long term TPN

4 listed

Answer 6

Intestinal atresia
Crohn’s
Radiation enteritis
Extreme short bowel

Question 7

Under how many cm’s is extreme short bowel syndrome diagnosed?

Answer 7

200cm

Question 8

Which a.a. has a central role in nitrogen metabolism?

Answer 8

Glutamine

Question 9

Which a.a. is glutamine the precursor of?

Answer 9

Glutathione (+ nucleotides)

Question 10

Name 2 complications of TPN

4 listed

Answer 10

Line sepsis
Thrombophlebitis
Hyperglycaemia
Re-feeding syndrome

Question 11

Who is at severe risk of re-feeding syndrome?

Answer 11

Very low BMI
No intake for ~ 10 days
Hx alcohol/drug abuse

Question 12

What is the feeding treatment protocol for severe malnutrition with risk of re-feeding syndrome?

Answer 12

Reduced rate feeding to 10ml/kg/day and increase to full nutritional demand by 4-7 days

Question 13

What is the reason for re-feeding syndrome?

Answer 13

Catabolic to anabolic metabolism - i.e. switch from endogenous ketones to exogenous glucose which causes increased insulin secretion

Question 14

What does the rapid increase of insulin secretion cause in re-feeding syndrome?

Answer 14

Rapid uptake of phosphate, potassium and magnesium + Na and H2O retention.
HYPOPHOSPHATAEMIA
and THIAMINE DEFICIENCY

Question 15

What is the outcome of hypophosphataemia and thiamine deficiency in re-feeding syndrome?

Answer 15

Tissue hypoxia
Cardiac dysrhythmia
Thrombocytopaeinia
Confusion

Question 16

What is short bowel syndrome?

Answer 16

Malabsorption disorder caused by the surgical removal of the small intestine, or rarely due to the complete dysfunction of a large segment of bowel

Question 17

What is the most common cause of short bowel syndrome in newborns?

Answer 17

necrotising enterocolitis

Question 18

What is the most common cause of short bowel syndrome in children and adults?

Answer 18

Crohn’s

Question 19

Name 3 outcomes of short bowel syndrome

6 listed

Answer 19

Malabsorption
Malnutrition
Diarrhoea
Electrolyte imbalance
Steatorrhoea
Hypergastrinaemia

Question 20

Why might some patients with short bowel syndrome suffer with clotting abnormalities?

Answer 20

Steatorrhoea leading to malabsorption of Vit K = fat soluble

Question 21

Why do patients get hypergastrinaemia in short bowel syndrome?

Answer 21

Negative feedback mechanism for inhibiting gastrin secretion removed and so HCl is over produced

Question 22

What is the cause of diarrhoea in SBS?

Answer 22

Osmotic load generated by malabsorbed carbohydrates - especially simple carbs

Question 23

What happens to the villi of the ileum after jejunal resection?

Answer 23

They grow in length and diameter

Question 24

Which hormone is responsible for ileal brake?

Answer 24

Peptide YY

Question 25

What stimulates intestinal proliferation?

Answer 25

Prostaglandins

Question 26

Which incretin induces epithelial hyperplasia in ilea adaptation following jejunal resection?

Answer 26

GLP-2

Question 27

What is the outcome of the loss of ileocaecal valve in SBS?

Answer 27

Small bowel bacterial overgrowth