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Lucy Knox - Year 2.5 > 229 - Nutrition > Flashcards

229 - Nutrition Flashcards

1
Q

Who is particularly at risk of malnutrition?

A 
Surgery - gut removal
Poor appetite - missed inpatient meals
Chronic inflammation
Swallowing problems
Disabilities
Mechanical issues
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2
Q

Why are those who are ill more likely to become malnourished?

A

Tissue damage activates mechanisms that increase energy needs

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3
Q

How long can you stay alive nil by mouth?

A 
2 months until death
If compromised (sepsis, surgery) - 1 month
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4
Q

Why does malnutrition cause death?

A

Loss in muscle mass and strength (including cardiac muscle)
Loss of proteins
Reduced immune response (low lymphocytes, low helper:supressor T cell ration, low antibody affinity)
Reduced wound healing
Reduced heat production
Multiple organ failure

+ reduced motility - DVT/PE risk

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5
Q

The acronym WAASP is used in assessment of nutrition, what does it mean?

A

To screen risk - highlight who needs full assesment

W-eight
A-ppetite
A-bility to eat
S-tress factors
P-ressure ulcers
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6
Q

Is serum albumin a measure of nutrition?

A

NO. Shows state of illness.

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7
Q

What nutritional support is available for those with malnutrition / at risk?

A

Eat more
Eat supplements
Artificial support - enteral and paraenteral

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8
Q

What is enteral feeding?

A

Delivery of nutritionally complete food to the GI tract - stomach, duodenum, jejenum.

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9
Q

What are the indications for enteral feeding?

A
  • functioning gut
  • if unable to meet nutritional requirements
  • If sudden, unintentional weightloss >10%
  • If hypermetabolic - sepsis, trauma
  • If anorexia has caused disease
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10
Q

What are the advantages of enteral feeding?

A 
Nutrients effectively mobilised and utilised
Preserves intestinal mucosal structure
Comfortable, simple to give day/night
Independent of appetite.
Inexpensive
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11
Q

What are the side effects of enteral feeding?

A

Can get GO reflux
Not good if poor gastric emptying
Diarrhoea

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12
Q

How is enteral feed given?

A

Short term - NG tube or NJ tube

Longer term - PEG tube

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13
Q

What is a PEG tube?

A

Percutaneous endoscopic gastostomy

  • done via an OGD, push stomach to wall, use selldinger technique to tunnel a tube - use as entry port.
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14
Q

Who might need a PEG tube inserted?

A

Stroke pt
Head and neck malignancy
Neuro problems

Not indicated if unexpected to live for a month

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15
Q

What is TPN?

A

Total parenteral nutrition

- NOT via the GI tract - into a vein

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16
Q

Who might need TPN?

A

inadequate or unsafe oral or enteral intake

Non functioning, inaccesable or perforated gut

17
Q

What is put in TPN?

A

Use standard bags with all in - roll to mix

Energy - estimate BMR
Proetin - calculated as nitrogen requirment, given as vamin (inc. all esential amino acids)
Electrolytes
Micronutrients - vitamins and trace elements (must be added to giving bag)
Fluid

18
Q

How is TPN administered?

A

Via PICC, Hickman line, subcutaneous port…

19
Q

What complications do you get with TPN?

A

Metabolic - fluid overload, electrolyte imbalance, refeeding syndrome, liver issues

Mechanical - line occlusion, thrombosis, wrong placement

Infection - s.aureus

20
Q

How is infection reduced in someone receiving TPN?

A

Can tunnel the central line -> PICC line
Good training
investigate all high temperatures

21
Q

What is refeeding syndrome? Why does it occur?

A

A Potentially fatal complication that occurs when nutritional support is given to a severely malnourished person

When malnourished, catabolic state, breakdown of muscles, low protein, K+, phosphate, Mg, Zn

When refed, anabolic state. Insulin released, this causes cellular uptake of K+, Phosphate, Mg - so what little there was is taken into cells - leaves serum levels too low - causes arrythmias, oeadema, ATP depletion (as phosphate needed), coma, convulsions.

22
Q

When is someone at risk of refeeding syndrome?

A

V low BMI (15% in 3-6 months, little/no intake for >10 days, low baseline

Or multiple less severe factors

or GI disease, alcoholism, malignancy, post-bariatic surgery, anorexia, bizarre diets

23
Q

How can you prevent refeeding syndrome?

A 
Evaluate electrolyte status
Supplement them - don't delay refeeding but supplement early on.
Give vit B
Start with reduced rate of feeding
Monitor often
24
Q

What is Short bowel syndrome?

A

The state of malabsorption and malnutrition that occurs following a massive anatomical or functional loss of the small intestine - usually due to surgical resection.

25
Q

What can cause short bowel syndrome?

A

Newborns - necrotising enterocolitis (ischaimia and necrosis of GI tract, 2-7% of premature babies have it)
- congenital issues - midgut volvulus, jejunoileal astrasia, hirshsprungs

Children/adults: Surgery for intussusception, crohn’s disease, trauma, ischaemia, cancer

26
Q

What is peadiatric small bowel syndrome?

A

Children have the potential that their SI will lengthen after resection, as child is born with 200cm, which grows to 350-800cm normally.

Also, rapid GI growth in weeks 26-38 gestation, so newborns have increased capacity for it to carry on growing

27
Q

What does the duodenum secrete and absorb

A

Secretes - CCK + secretin

Absorbs - Iron, Ca, Mg, Folate

28
Q

What does the jejunum absorb?

A 
Glucose
amino acids
fat
thiamine
Vit C
29
Q

What does the ileum secrete and absorb?

A

Secretes - enteroglucagon

Absorbs - water, electrolytes, bile acids and salts, Vit B12, Vit ADEK (fat soluble), phosphorus, zinc

30
Q

What does the ileocaecal valve do?

A

Slows intestinal transit time

prevents bacteria reflux

31
Q

After a jejunal resection what is affected and what happens?

A

Temporary reduction of most nutrients occurs

The jejenum itself isn’t very good at adaption, but the ileum adapts to fulfil jejenums role - both structurally and functionally.

Increases in length, diameter, villi change. Characterised by epithelial hyperplasia.

Begins within 24-48hrs of ressection.

32
Q

How does ileal adaption after jejunal resection occur?

A

Key genes express mediators

Delivery of enteral food is key, so food stimulates enzyme production (CCK).

GLP-2 induces villus hyperplasia + increased absorption
Prostaglandins involved in intestinal proliferation (? bad if NSAIDS used ??)

Ghrelin levels reduced

33
Q

What happens after ileal resection?

A

Jejenum is very leaky + ileum normally reabsorbs most this liquid, so if ileum is lost then fluid and electrolyte loss occurs. Colon adapts to increase fluid and electrolyte absorption. Colon also increases production of gut hormones (eg. peptide YY)

Ileum also primary site for B12 and bile acids and Vit ADEK are absorbed - so must be replaced otherwise deficient.

34
Q

What happens after the loss of the ileocaecal valve?

A

Small bowel bacterial overgrowth
Can cause dilation and decreased motility in SI
Harder to wear from parenteral nutrition when missing

35
Q

What can happen to gut motility after a big resection?

A

Ileum may have ‘ileal break’ -> slow gastric emptying can delay delivery of food to SI.

This is ? controlled by peptide YY

Lucy Knox - Year 2.5 (15 decks)

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