Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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
Q

Who assesses the patient if the screening provides a trigger

A

Dietician

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the assessment stage

A

Systematic process of collecting and interpreting information to determine the nature and cause of the nutrient imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What do we assess

A 
Anthropometry 
Biochemistry
Clinical
Dietary
Nutrition requirement
Social + physical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is anthropometry

A

Measurement of the physical properties of the body as different parts of the body are affected by malnutrition differently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What can we look at in terms of anthropometry

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the limitation of using a respirator gas canopy for RMR

A

Predictive estimate- 70% accuracy therefore not perfect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What do we look at in biochemistry

A

Nutrient availability in tissues and fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the limitations of biochemistry

A

Time consuming and expensive

Skewed results due to acute inflammation therefore we dont test until CRP < 10 µg/L

33
Q

What is our clinical assessment

A 
PMH
Alcohol drug use 
Chronic disease
Recent surgery
Recent GI problems 
Change in appetite or diet
34
Q

What is our social + physical assessment

A

Socioeconomic status
Addiction
Living status

35
Q

Who do we consider for nutrition support

A

People who are:
Malnourished
At risk of malnutrition

36
Q

How does someone qualify for being malnourished

A

BMI < 18.5 or
Unintentional weight loss >10% past 3-6 months or
BMI < 20 + unintentional weight loss >5% past 3-6 months

37
Q

How does someone qualify for being at risk of malnutrition

A

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
Q

What is artificial nutrition support

A

Provision of enteral or parental nutrients to prevent or treat malnutrition

39
Q

What types of nutrition support do we have

A

Oral nutritional support
Enteral tube feeding
Parenteral nutrition

40
Q

When do we use oral nutrition support

A

If oral nutrition is safe and possible - may need thickeners or additional support if required e.g. dysphagia

41
Q

When do we use parenteral nutrition

A

If oral nutrition not safe or possible and the Gi tract is not functional or accessible

42
Q

When do we use enteral nutrition

A

If oral nutrition not safe or possible but the Gi tract is functional or accessible

43
Q

Why do we prefer enteral nutrition

A

It uses the gut

44
Q

What is the 1st line approach to EN

A

Nasogastric tube through the nose and into the stomach

45
Q

Why might be an NGT be contraindicated

A

Gastric outlet obstruction

46
Q

What do we use if NGT is contraindicated

A

Feeding tube is placed distal to the stomach e.g. through a NDT or NJT

47
Q

If we require longer term feeding whilst on EN (3+ months) - what should we do

A

Gastrostomy or jejunostomy tube

48
Q

What factors determine the nutritional feed the patient receives

A 
Renal function
Sodium levles
Respiratory function
Immune function
Elemental balance
Peptides
49
Q

What are the types of complications arising form EN

A

Mechanical
Metabolic
GI

50
Q

What are the mechanical complications of EN

A

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
Q

What are the metabolic complications of EN

A

Hyperglycaemia

Deranged electrolytes

52
Q

What are the GI complications of EN

A 
Aspirates 
Nasopharyngeal pain
Laryngeal ulceration
Vomiting 
Diarrhoea
53
Q

What is parenteral nutrition

A

Feeding of nutrients and electrolytes directly into venous blood

54
Q

What are the indications for PN

A

Inadequate or unsafe oral or enteral route

55
Q

What are the main access points for a CVC (central venous catheter)

A

Superior vena cava and right atrium

56
Q

What types of bag does the dietician give

A

Scratch bag or ready made bag - discussed in MDT based on nutrient/electrolyte targets for patient

57
Q

What are the types of complications arising from PN

A

Mechanical
Metabolic
Catheter related infection

58
Q

What are the metabolic complications of PN

A 
Deranged electrolytes 
Hyperglycaemia 
Abnormal liver enzymes
Oedema
Hypertriglyceridaemia
59
Q

What are the mechanical complications of PN

A 
Pneumothorax
Haemothorax
Thrombosis
Cardiac arrhythmias
Catheter occlusion 
Thrombophlebitis 
Extravasation
60
Q

What are the catheter problems with PN

A

Bacteraemia

Septicaemia

61
Q

What are the benefits of nutritional support

A

Decreased non elective hospital readmission

Increases protein and energy intake therefore increases weight

62
Q

What is the most abundant circulating plasma protein in health

A

Albumin

63
Q

How much albumin is produced a day? By what?

A

10-15 grams/day produced by hepatocytes

64
Q

What increases albumin

A

Insulin
Cortisol
Growth hormone

65
Q

What decreases albumin

A

IL-6
TNF

pro-inflammatory cytokines

66
Q

What is a negative acute phase protein e.g. albumin

A

A protein that lowers its levels in an inflammatory state

67
Q

How is albumin reduced in inflammation

A

Increased trans capillary loss of albumin, degradation of albumin and downgrading of its synthesis

68
Q

Can we use albumin as a marker for malnutrition or indicator for nutritional support

A

No - this is because it decreases during a moderate inflammatory response

69
Q

What do we see in obsess trauma patients

A

Hypoalbuminaemia

70
Q

What is refeeding syndrome

A

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
Q

Describe RFS

A

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
Q

What is thiamine

A

Coenzyme in the carbohydrate metabolism; its deficiency may occur upon refeeding in a Vitamin B depleted patient

73
Q

Why do we get oedema from RFS

A

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
Q

What are the consequences of RFS

A

Arrhythmia, tachycardia, congestive heart failure leading to cardiac arrest and possible sudden death

Respiratory depression

Encephalopathy, coma, seizures, rhabdomyolysis

Wernicke’s encephalography

75
Q

Who is at risk of RFS

A

Very little of no food intake for more than 5 days

76
Q

Who is at high risk of RFS

A 
≥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
Q

Who is at extremely high risk of RFS

A

BMI < 14

Negligible intake > 15 days

78
Q

How do we manage RFS

A
  • 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.
© 2024 Bold Learning Solutions. Terms and Conditions