Gastroenterology

Question 1

Daily requirements of fat, protein, carbohydrate

Answer 1

Fat: 30% (9kcal/g)
Carbohydrate: 57% (4kcal/g)
Protein: 13% (4kcal/g)

Question 2

Basic energy requirement & extra energy requirement calculations

Answer 2

BER = 1.3kcal/kg/h
EER = 8.5kcal/kg/h of exercise

Question 3

Malnutrition presentation

Answer 3

Weight loss, reduced intake, nausea/vomiting, diarrhoea

Dehydration, muscle atrophy, no fat between skin-folds, pressure sores, wiry hair

Question 4

Anthropomorphic measurements

Answer 4

BMI = (kg/height(m))2 : doesn’t take muscular mass into account
Waist circumference >88cm (F), >102cm (M) = abdominal obesity
Waist/hip circumference >1 (M), >0.6 (F) = abdominal obesity
DEXA: give % body fat estimation

Question 5

Fat soluble vitamins

Answer 5

A, D, E, K

Question 6

Water soluble vitamins

Answer 6

B, C

Question 7

Consequences of vitamin A deficiency/excess

Answer 7

Deficiency: xeropthalmia: abnormal dryness of the conjunctiva and cornea of the eye, with inflammation and ridge formation
Night blindness
Excess: liver damage, teratogenic

Question 8

Consequences of vitamin B1 (thiamine) deficiency

Answer 8

Beri-beri disease: polyneuropathy

Werkicke-Korsakoff syndrome

Question 9

Consequences of vitamin B3 (niacin) deficiency

Answer 9

Pellagra: dermatitis, diarrhoea, dementia

Question 10

Consequences of vitamin C deficiency

Answer 10

Scurvy: gingivitis & bleeding

Question 11

Consequences of vitamin D deficiency/excess

Answer 11

Rickets, osteomalacia

Excess: hypercalcaemia

Question 12

Indications for NG tube insertion

Answer 12

Stomach emptying: pre-operatively, intestinal obstruction, gastric outlet obstruction, aspiration risk
Intra-operatively: inflate/deflate the stomach
Irreversible dysphagia: motor neurone disease
To feed ill patients

Question 13

Alternatives to NG tubes

Answer 13

Gastrostomy: endoscopic or surgical placement
Jejunostomy: surgical
Nasoduodenal tubes

Question 14

Prevalence and causes of undernutrition in hospital

Answer 14

25% hospital inpatients

Increased requirements, increased nutritional losses, decreased intake, enforced starvation

Question 15

Prevalence of obesity

Answer 15

26% of adults in the UK are obese
Class I = BMI 30-35 (moderate)
Class II = BMI 35-40 (severe)
Class III = BMI >40 (morbid)

Question 16

Complications of obesity

Answer 16

Metabolic syndrome: DM, HTN, hyperlipidaemia
Non-alcoholic fatty liver disease & liver cirrhosis
Restricted ventilation: chronic respiratory acidosis secondary to obesity hypoventilation
Mechanical effects: incontinence, arthritis, varicose veins
Increased peripheral steroid conversion in adipose: PCOS, breast/uterine