CP22 - Nutritional Support

Question 1

what are some of the consquences of RTA on the body

Answer 1

decreased circulating volume, RBC, WBC, cardiac output/BP, organ perfusion, energy substrate delivery to cells and tissues

Question 2

what is shock

Answer 2

Interruption to the supply of substrates to the cell
-Oxygen, glucose, water, lipids, amino acids, micronutrients

Interruption to the removal of metabolites from the cell
-CO2 , water, free radicals, toxic metabolites

Question 3

what are the 3 stages of recovery from trauma

Answer 3

phase 1 clinical shock, phase 2 hypercatabolic state, phase 3 recovery (anabolic state)

Question 4

what is secreted in phase 1 - clinical shock

Answer 4

Cytokines, Catecholamines and cortisol secreted - primary aim - stop bleeding and prevent infection

Question 5

when will phase 2 - catabolic state develop

Answer 5

approx. 2 days after injury

Question 6

what is the main aim for phase 2 catabolic state

Answer 6

avoid sepsis, provide adequate nutrition

Question 7

what is sepsis

Answer 7

infection of blood

Question 8

when will phase 3 occur

Answer 8

approx 3-8 dyas after uncomplicated surgery (May not occur for weeks after severe trauma and sepsis)

Question 9

what is a risk in phase 3 -anabolic state

Answer 9

refeeding syndrome risk

Question 10

what are some of the effects of trauma on biochemistry

Answer 10

-ve nitrogen balance (skeletal muscle breakdown to release more a.acid), glycolysis (skeletal energy reserve depleted), lipolysis (adipose tissue breakdown to release fatty acid)

Question 11

what response will injury cause

Answer 11

inflammation & systemic capillary leak

Question 12

what is the endocrine effect of cytokines

Answer 12

cytokine mediate secretion of catabolic hormone which then increase - acth (increase cortisol), glucagon, catecholamines

cytokines cause inhibiton of anabolic hormones - GH, insulin

Question 13

what happens to glucose stores in injury

Answer 13

interrupted and relies on glucogen which has only 24 hrs supply and brain can not use glucogen as energy but only ketone

this will cause muscle breakdown to give proteins which can be converted into glucose

fat is broken down to release ketone for the brain

Question 14

what happen to protein turn over after injury

Answer 14

excess proteolysis results in life-threatening damage to essetial structure and secreted protein (tramua - primary stimulation for protein breakdown is cytokine secretion from activated macrophages

Question 15

what indicates a poor prognosis following prognosis

Answer 15

failure of blood lactate to return to normal

Question 16

what are some of the consequences of malnutrition

Answer 16

-Negative Nitrogen balance
-Muscle wasting
-Widespread cellular dysfunction
-Associated with
infection
(poor wound healing
changes in drug metabolism
prolonged hospitalisation
increased mortality)

Question 17

what is refeeding syndrome

Answer 17

it is hypokalameia, hypomagnesaemia, hypophosphataemia, thiamine deficiency, salt and water retention -oedema due to feeding casuing body to switch to anabolic state and so cause of glucose etc

Question 18

how does cystic fibrosis cause malnutrition?

Answer 18

Failure to maintain hydration of macromolecules in the lumen of the ducts of the lungs, pancreas, intestine, liver and vas deferens causes secretions to precipitate and cause obstruction, digestive enzyme deficients ie malnutrition ( can cause increase risk of infection and persistent inflammatory state)