Alimentary systems 14 - Clinical Malnutrition Flashcards
Define malnutrition
- A state of nutrition in which a deficiency, imbalance or excess of energy, protein and other nutrients causes measurable adverse effects on tissue, body form and function and clinical outcome
What is the annual cost of under nutrition?
19.6 billion
List the causes of malnutrition
- Food insecurity
- Poor social and care environment
- Poor access to healthcare
- Results in inadequate food and disease
List the consequences of malnutrition
- Low energy
- Muscle weakness
- Infertility
- Weakened immune system
- Increased risk of hospital admissions
- Weak bones so increased risk of fall
- Depression
How is malnutrition diagnosed?
- First nutritional screening is carried out by a non-specialist nurse or health care worker
- Then if necessary there is a nutrition assessment by a specialist
- Finally there is diagnosis
What happens in nutrition screening?
- Quick and simple initial asessment of the patient
- Taken at regular intervals
- Assess nutritional status and categorise into risk, for example using the MUST tool (BMI, weight loss score, acute disease affect score)
How is nutritional status assessed?
- Weight
- Percentage weight loss and time period
- BMI
- Handgrip measure, skinfold thickness and muscle circumference
- Dietary recall/food diary
- Albumin and CRP, creatinine and cholesterol
List the types of parenteral nutrition
- Total parental nutrition is directly into the vena cava
- Peripheral parental nutrition is in a peripheral blood vessel
List the types of enteral nutrition
- Nasogastric tube
- Nasoduodenal tube
- Gastrotomy tube
- Jejunostomy tube
When is a nasogastric tube used?
- When feeding is for less than 1 month
- Crohns disease
- Patients are unconscious
- Patients have a functioning gut but cannot swallow
When are gastrostomies and jejunostomies used?
- When the upper GI tract is damaged
- Used for long term enteral feeding
- Inserted endoscopically or radiologically
How is the amount to feed a patient assessed?
- Indirect calorimetry (gold standard) by measuring gas exchange
- In practice administer 25-30kcal/kg
List the complications of enteral feeding
- Nausea and vomiting
- Tube issues
- Diarrhoea
- Constipation
Define parenteral nutrition
The administration of nutrients either centrally or peripherally where the gastrointestinal tract is inaccessible or there is insufficient gastrointestinal function
List the insertion parenteral nutrition complications
- Pneumothorax
- Bleeding
- Misplacement
List the line complications of parenteral nutrition
- Line sepsis
- Thrombosis/phlebitis
- Occlusion
- Dislodgement, fracture or leaking
List the metabolic complications of parenteral nutrition
- Refeeding syndrome
- Hyper/hypoglycaemia
- Electrolyte disturbances
- Liver disease
- Metabolic bone disease
- Gallstones
List the advantages and disadvantages of parenteral feeding
- Advantage is that you can feed patients with no GI function
- Disadvantages include risk of sepsis, expensive, placed in radiology, needs close monitoring
List the advantages and disadvantages of enteral feeding
- Easy access
- Can be placed by nurses
- Risk of aspiration
- Hard to confirm position
- Can cause trauma
Define refeeding syndrome
Metabolic disturbances that occur as a result of reinstitution of nutrition to patients who arestarved or severely malnourished
List the stages of refeeding syndrome
- Malnutrition results in low glucagon, high insulin and high cortisol
- As as result there is gluconeogenesis, glycogenolysis and protein catabolism
- Upon refeeding, there is insuling secretion and as a result increased glucose uptake, phosphorous magnesium and potassium uptake and thiamine use
- As a result there is hypophosphataemia, hypokalaemia, hypomagnesaemia and sodium and water retention
List the consequences of refeeding syndrome
- Low phosphate causes altered myocardial function, arrhythmia, heart failure. Acute ventilatory syndrome, paralysis and confusion
- Low magnesium causes arrhythmia, tachycardia, slow breathing, weakness, confusion, muscle tremors
- Low potassium causes arrhythmias, cardiac arrest, respiratory distress, paralysis, weakness and rhabdomyolysis
Describe the management of refeeding syndrome
- Replace electrolytes
- Vitamin suppliments
- Nutrition support at max of 10kcal/kg/day
What is short bowel syndrome?
- Significant removal of the bowel (due to crohns, cancer, ulcerative collitis) leaving less then 100cm
- Results in dehydration, malnutrition and malabsorption
How is short bowel syndrome managed?
- Provide adequate nutrition for patients
- Ensure adequate water and electrolytes
- Correct and prevent acid base imbalance
List the symptoms of short bowel syndrome
- Abdominal pain
- Diarrhea and steatorrhea
- Fluid depletion
- Weight loss and malnutrition
Describe the metabolism of alcholol
- Ethanal to acetaldehyde via catalase or NAD (increases reactive oxidative species formation)
- Acetaldehyde to acetate
List the physical effects of alcohol
- Wernickes encephalopathy, cerebral atrophy, optic atrophy, peripheral neuropathy
- Hypertension, alcoholic cardiomyophathy, stroke
- Liver cancer, pancreattis, hepatitis
- Renal failure
- Gout
- Impotence, breast cancer
