IF and malnutrition Flashcards
what is ulna length an estimate of
height
what does hand grip dyamometry assess
upper muscle strength
what does mid upper arm circumference reflect
muscle mass and subcutaneous fat
what does tricep skin fold thickness provide
estimate of total body fat
what does waist circumference tell you
predictor of CV risk
what does IF result from
inability to maintain adequate nutrition or fluid status via the intestines
type I
Self-limiting short term postoperative or paralytic ileus
type II
Prolonged, associated with sepsis and metabolic complications. Often related to abdominal surgery with complications
type III
Long term but stable – home parenteral nutrition often indicated
where is type III taken care of
wards to home
what will investigations show
dec albumin, ADEK and zinc
treatment of type I
self limiting - replace fluid and electrolytes
PPIs
in type I IF what do you do if they cant tolerate food or fluid
parenteral nutrition
what do u give to preserve Mg in type I IF
alpha hydroxycholecalciferol
enteral nutrition
Delivery of nutrition into the stomach, duodenum, or jejunum via a tube.
what do you feed patients with in perioperative period
enteral nutrition
enteral nutrition contraindications
- Lower G.I. obstruction
- Prolonged ileus
- Severe vomiting/diarrhoea
- Fistulae
- Intestinal ischaemia
enteral nutrition complications
incorrect insertion
rupture and perforation - bleeding
reflux
GI intolerance or irritation
what is the first choice for enteral nutrition short term feeding
nasogastric
when is Parenteral Nutrition used
when patients cant be fed enterally
what is the tunnelled catheter in parenteral nutrition insertion guided by
US
when is parenteral nutrition used over ET feeding
SBS
non functioning GI tract
motility disorder
IBD with severe malabsorption
dangers of parenteral nutrition
sepsis
SVC thrombosis
line fracture
liver disease
what feeding is given in type II IF
parenteral and possible enteral
how is type III IF treated
HPN
bowel lengthening
intestinal transplantation
what is the long term survival of intestinal transplantation like compared to HPN
lower
SBS
small bowel <200cm
what is SBS an indication for
HPN
what is a small bowel transplantation usually combined with
liver transplantation
what are the indications for small bowel transplantation
last resort - loss of venous access and liver disease
step 1 MUST score
BMI
>20=0, 18.5-20=1, <18.5=2
MUST score step 2
Weight Loss
<5%=0, 5-10%=1, >10%=2
MUST score step 3
Disease
If pt acutely ill and no (or no likely) nutrition >5 days=2
MUST score step 4
risk
0=Low, 1=Medium, ≥2=High
MUST score step 5
management
- Low risk Routine clinical care, repeat screening
- Medium risk Observe, document dietary intake for 3 days
- High risk Treat: refer to dietician, set goals, monitor
Alpha-beta-lipoproteinaemia inheritance
Au R
Alpha-beta-lipoproteinaemia
inability to synthesis chylomicrons - affect the absorption of fat, cholesterol and fat soluble vitamins
Alpha-beta-lipoproteinaemia
treatment
vitamin E
refeeding syndrome
As the body turns to fat and protein metabolism in the starved state, there is a drop in the circulating level of insulin.
The catabolic state also depletes intracellular stores of phosphate, although serum levels remain normal.
When refeeding begins, the insulin levels rise and there is an inc cellular uptake of phosphate.
what develops within 4 days in refeeding syndrome
hypophosphateaemic state
- red and white cell dysfunction, respiratory insufficiency, arrhythmias, cardiogenic shock and sudden death
malnutrition effects - water and electrolyte disturbances
dec ability to excrete Na and water
malnutrition effects - menstrual irregularities and amenorhroea
infertility and osteoperosis
