Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BRS YEAR 2 > Gastro - Malnutrition > Flashcards

Gastro - Malnutrition Flashcards

1
Q

What is the definition of malnutrition

A

A state resulting from a lack of uptake or intake of nutrition leading to altered body composition and body cell mass, leading to diminished physical and mental function and impaired clinical outcome from disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What ages does malnutrition affect

A

Most commonly affects younger and older patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What gender does malnutrition affect more

A

Females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What wards does malnutrition affect more

A

Geriatrics

Oncology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What conditions malnutrition occur more in

A

Gastrointestinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risk factors for malnutrition

A
  • 65+ (especially if hospitalised)
  • Long term condition e.g. diabetes, CKD
  • Chronic progressive condition e.g. cancer, dementia
  • Alcohol/drug abuse
  • Gastrointestinal disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How many patients are malnourished upon admission

A

1 in 3 - it often goes unnoticed and under diagnosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What things may lead to malnutrition in hospital

A 
Disease related anorexia
Metabolic response to illness
Repeated NBM status
Excess nutritional losses
Polypharmacy 
Co-morbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does disease related anorexia cause malnutrition

A

Loss of appetite due to pathophysiological changes to the central system regulating feeding behaviour that occurs in the presence of the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the metabolic response to stress with regards to malnutrition

A

Muscle is broken down to amino acids for gluconeogenesis and protein synthesis for the immune response and tissue repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How else may illness cause malnutrition

A

Increased demand for energy, protein and micronutrients leads to loss of body mass/protein. In extreme cases, loss of tissue causes a threat to survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why are patients with a history of malnutrition more at risk

A

These patients have less caloric reserve.

E.g. A 74kg man has a reserve of around 192,000 Kcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do hospital meals affect malnutrition

A

40% of food is left uneaten therefore patients don’t receive appropriate proteins or calories. This is because of:

  • GI symptoms
  • Depression/low mood
  • Lack of motivation
  • Inflexible meal times
  • Patients think low appetite when ill is normal
  • Inactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the impact of malnutrition with regards to operation fitness

A

Patients having an operation for a perforated duodenal ulcer had 10x higher mortality if they had lost more than 20% bodyweight pre-op compared to those who had lost less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

why do the malnourished perform worse in operations

A

Patients are unable to mobilise adequate amounts of endogenous nitrogen in response to stress therefore experience greater morbidity and mortality compared to those who can generate a catabolic response to stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the mortality of malnutrition

A

Direct cause of 66 hospital deaths

Contributes to 285 hospital deaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What increases with malnutrition

A 
Mortality
Septic/post surgical complications
Length of hospital stay 
Pressure sores
Re-admission
Dependency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What decreases with malnutrition

A

Wound healing
Response to treatment
Rehabilitation potential
Quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the cost of malnutrition

A

19.6 billion per year from the NHS - malnourished patient is 3x more expensive to treat - going up due to ageing population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What tool do we use to diagnose malnutrition in the acute setting

A

Malnutrition Universal Screening Tool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Give an overview of the MUST

A

Commonly used in the UK
Rapid, simple
Based on BMI, unplanned weight loss and acute presence of disease to generate low, medium or high risk, and immediate guidance for these groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the steps of diagnosing malnutrition

A

Screen
Assess
Diagnose

Plan
Implement
Monitor
Evaluate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

By when do we have to screen a patient

A

Within 6 weeks of admission and then weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the limits of the screening with MUST

A

Misses malnourishment in those with over hydration such as oedema or ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Who assesses the patient if the screening provides a trigger
Dietician
26
What is the assessment stage
Systematic process of collecting and interpreting information to determine the nature and cause of the nutrient imbalance
27
What do we assess
``` Anthropometry Biochemistry Clinical Dietary Nutrition requirement Social + physical ```
28
What is anthropometry
Measurement of the physical properties of the body as different parts of the body are affected by malnutrition differently
29
What can we look at in terms of anthropometry
Recent loss of weight (BMI only used if very low ad varies a lot) Mid upper arm circumference + tricep skin fold test CT Hang grip strength
30
What is the limitation of using a respirator gas canopy for RMR
Predictive estimate- 70% accuracy therefore not perfect
31
What do we look at in biochemistry
Nutrient availability in tissues and fluid
32
What are the limitations of biochemistry
Time consuming and expensive | Skewed results due to acute inflammation therefore we dont test until CRP < 10 µg/L
33
What is our clinical assessment
``` PMH Alcohol drug use Chronic disease Recent surgery Recent GI problems Change in appetite or diet ```
34
What is our social + physical assessment
Socioeconomic status Addiction Living status
35
Who do we consider for nutrition support
People who are: Malnourished At risk of malnutrition
36
How does someone qualify for being malnourished
BMI < 18.5 or Unintentional weight loss >10% past 3-6 months or BMI < 20 + unintentional weight loss >5% past 3-6 months
37
How does someone qualify for being at risk of malnutrition
Have eaten little or nothing for >5 days and/or are likely to carry on for the next 5+ days or Have poor absorptive capacity and/or have high nutrient losses and/or have increased nutritional needs from causes such as catabolism
38
What is artificial nutrition support
Provision of enteral or parental nutrients to prevent or treat malnutrition
39
What types of nutrition support do we have
Oral nutritional support Enteral tube feeding Parenteral nutrition
40
When do we use oral nutrition support
If oral nutrition is safe and possible - may need thickeners or additional support if required e.g. dysphagia
41
When do we use parenteral nutrition
If oral nutrition not safe or possible and the Gi tract is not functional or accessible
42
When do we use enteral nutrition
If oral nutrition not safe or possible but the Gi tract is functional or accessible
43
Why do we prefer enteral nutrition
It uses the gut
44
What is the 1st line approach to EN
Nasogastric tube through the nose and into the stomach
45
Why might be an NGT be contraindicated
Gastric outlet obstruction
46
What do we use if NGT is contraindicated
Feeding tube is placed distal to the stomach e.g. through a NDT or NJT
47
If we require longer term feeding whilst on EN (3+ months) - what should we do
Gastrostomy or jejunostomy tube
48
What factors determine the nutritional feed the patient receives
``` Renal function Sodium levles Respiratory function Immune function Elemental balance Peptides ```
49
What are the types of complications arising form EN
Mechanical Metabolic GI
50
What are the mechanical complications of EN
Misplaced NGT can be a cause of death - when it is placed, we need an aspirate of a pH less than 5.5 due to HCl - if it is greater then we need a CXR. Blockage Buried bumper
51
What are the metabolic complications of EN
Hyperglycaemia | Deranged electrolytes
52
What are the GI complications of EN
``` Aspirates Nasopharyngeal pain Laryngeal ulceration Vomiting Diarrhoea ```
53
What is parenteral nutrition
Feeding of nutrients and electrolytes directly into venous blood
54
What are the indications for PN
Inadequate or unsafe oral or enteral route
55
What are the main access points for a CVC (central venous catheter)
Superior vena cava and right atrium
56
What types of bag does the dietician give
Scratch bag or ready made bag - discussed in MDT based on nutrient/electrolyte targets for patient
57
What are the types of complications arising from PN
Mechanical Metabolic Catheter related infection
58
What are the metabolic complications of PN
``` Deranged electrolytes Hyperglycaemia Abnormal liver enzymes Oedema Hypertriglyceridaemia ```
59
What are the mechanical complications of PN
``` Pneumothorax Haemothorax Thrombosis Cardiac arrhythmias Catheter occlusion Thrombophlebitis Extravasation ```
60
What are the catheter problems with PN
Bacteraemia | Septicaemia
61
What are the benefits of nutritional support
Decreased non elective hospital readmission | Increases protein and energy intake therefore increases weight
62
What is the most abundant circulating plasma protein in health
Albumin
63
How much albumin is produced a day? By what?
10-15 grams/day produced by hepatocytes
64
What increases albumin
Insulin Cortisol Growth hormone
65
What decreases albumin
IL-6 TNF pro-inflammatory cytokines
66
What is a negative acute phase protein e.g. albumin
A protein that lowers its levels in an inflammatory state
67
How is albumin reduced in inflammation
Increased trans capillary loss of albumin, degradation of albumin and downgrading of its synthesis
68
Can we use albumin as a marker for malnutrition or indicator for nutritional support
No - this is because it decreases during a moderate inflammatory response
69
What do we see in obsess trauma patients
Hypoalbuminaemia
70
What is refeeding syndrome
A group of biochemical shifts and clinical symptoms that can occur in the malnourished or starved individual on the reintroduction of oral, enteral or parenteral nutrition
71
Describe RFS
In starvation, we have a loss of insulin secretion, increased glucagon therefore gylcogenolysis, gluconeogenesis and protein catabolism in the liver. We have a depletion of protein, fats, minerals, electrolytes and vitamins. We eventually get ketogenesis too. The micronutrients in cells are used up but not replaced, as well as the cells trying to maintain serum levels of these micronutrients. As a result, the cells become deficient of them. Once the body is fed, there is a spike in insulin, so glucose is taken up into cells, and there is the stimulation of anabolic pathways. However, we cannot replace the micronutrients as quick as we use them in these anabolic pathways - this results in severe deficiency inside and outside the cell.
72
What is thiamine
Coenzyme in the carbohydrate metabolism; its deficiency may occur upon refeeding in a Vitamin B depleted patient
73
Why do we get oedema from RFS
When we have a spike on insulin it stimulates the kidneys not to excrete sodium and therefore water. This causes fluid overload and thus oedema
74
What are the consequences of RFS
Arrhythmia, tachycardia, congestive heart failure leading to cardiac arrest and possible sudden death Respiratory depression Encephalopathy, coma, seizures, rhabdomyolysis Wernicke's encephalography
75
Who is at risk of RFS
Very little of no food intake for more than 5 days
76
Who is at high risk of RFS
``` ≥1 of the following: BMI < 16 kg/m2 Unintentional weight loss > 15 % 3 – 6 /12 Very little / no nutrition > 10 days Low K+, Mg2+, PO4 prior to feeding ``` Or ≥ 2 of the following: BMI < 18.5 kg/m2 Unintentional weight loss > 10 % 3 – 6 / 12 Very little / no nutrition > 5 days PMHx alcohol abuse or drugs (insulin, chemotherapy, antacids, diuretics)
77
Who is at extremely high risk of RFS
BMI < 14 | Negligible intake > 15 days
78
How do we manage RFS
- Start: 10-20 kcal/kg - carbs should be providing 40-50% of the energy - Micronutrients from onset of feeding - Correct and monitor electrolytes daily - Administer thiamine from onset of feeding - Monitor fluid shifts and miniseries risk of fluid/sodium overload.

BRS YEAR 2 (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions