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M104 T1 > M104 T1 L1 > Flashcards

M104 T1 L1 Flashcards

1
Q

What types of patients does the majority of malnutrition cases occur in?

A

GI disease / cancer
liver disease
surgery patients

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2
Q

Which GI malignancies is malnutrition common in? (COP.Gary)

A

colorectal
oesophageal
pancreatic
gastric

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3
Q

Which surgery types is malnutrition common in? (Good GIrls CAN ; MArry Very Strongly)

A

general surgery
GI surgery
cancer surgery
major vascular surgery

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4
Q

What are the causes of malnutrition?

A

Inadequate intake of nutrients
Impaired nutrient digestion and processing in the digestive tract
Excess losses of nutrients
Altered requirements for nutrients

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5
Q

Which organs, when they dysfunction, will result in the excessive loss of nutrients?

A 
(SIP.Liver)
stomach
intestine
pancreas 
liver
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6
Q

How does the excessive loss of nutrients occur?

A 
Vomiting
NG tube drainage
Diarrhoea
Surgical drains
Fistulae
Stomas
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7
Q

What is a consequence of altered nutrient requirements in the body?

A

there are increased metabolic demands

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8
Q

What different health issues cause increased metabolic demands? (BICIB.Wounds)

A 
brain injury
cancer 
inflammation
burns
wounds
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9
Q

What are the two types of simple starvation mechanisms?

A

uncomplicated EARLY fasting

uncomplicated fasting

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10
Q

What happens in the body during uncomplicated early fasting?

A

peripheral protein is broken down into amacs to maintain gluconeogenesis
glycogen stored in liver is used to support the CNS
fat is used to make FAs and glycerol

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11
Q

What are the mechanisms by which uncomplicated fasting occurs?

A

less peripheral protein is broken down, so less gluconeogenesis occurs
providing for the brain and the periphery now occurs via ketogenesis which sources its substrate from fatty acids and glycerol
Therefore, the amount of glucose that is circulating to feed the periphery and brain is in large part substituted by ketone bodies

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12
Q

What part of the body is affected by stress starvation in particular?

A

the peripheral muscle

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13
Q

What happens to ischaemic or inflammatory tissue during stress starvation?

A

it will produce lactate
this will undergo gluconeogenesis
more glucose will be produced

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14
Q

What two processes occur during stress starvation?

A

ketogenesis (by fat and glycerol)

gluconeogenesis (ischaemic tissue)

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15
Q

What happens to the metabolic rate in simple starvation vs stress starvation?

A

simple - low

stress - high

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16
Q

What happens to muscle protein breakdown in simple starvation vs stress starvation?

A

simple - high

stress - very high

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17
Q

What happens to protein synthesis in simple starvation vs stress starvation?

A

simple - low

stress - high

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18
Q

What happens to plasma albumin levels in simple starvation vs stress starvation?

A

simple - neutral

stress - very low

19
Q

What happens to nitrogen balance in simple starvation vs stress starvation?

A

simple - low

stress - very low

20
Q

What happens to ketone bodies in simple starvation vs stress starvation?

A

simple - very high

stress - high

21
Q

What happens to gluconeogenesis in simple starvation vs stress starvation?

A

simple - high

stress - very high

22
Q

What happens to blood glucose in simple starvation vs stress starvation?

A

simple - low

stress - high

23
Q

What happens to insulin plasma concentration in simple starvation vs stress starvation?

A

simple - high

stress - high

24
Q

What happens to insulin resistance in simple starvation vs stress starvation?

A

simple - very high

stress - very high

25
Q

What happens to salt and water retention in simple starvation vs stress starvation?

A

simple - high

stress - very high

26
Q

What is the effect of malnutrition in healthy people by day 5?

A

decreased skeletal muscle mass

decreased skeletal muscle function

27
Q

What is the effect of losing at least 18% of body mass?

A

physiological disturbance

28
Q

How is cardiac output affected by malnutrition?

A

45% reduction

29
Q

What processes does malnutrition affect that results in decreased ventilation function?

A

respiratory contractility
diaphragmatic contractility
diaphragmatic muscle mass
respiratory muscle mass

30
Q

What percentage of weight loss is fatal?

A

approx 40%

31
Q

How does malnutrition affect the liver?

A

impaired liver function

necrosis in the liver

32
Q

How does malnutrition affect mental heatlh?

A

depression

apathy

33
Q

How does malnutrition affect immune function?

A

impaired gut immunity
decreased immunity
imparied wound healing

34
Q

How does malnutrition affect the body?

A 
decreased ventilation function
imparied gut integrity
reduced cardiac output
imparied renal function
reduced strength
hypothermia
reduced gut function
35
Q

Why do malnutrition patients cost the NHS so much each year?

A

they attend their GP surgery more often
they are admitted to hospital more frequently
they tend to stay in hospital longer
they succumb to infections more easily
they are often discharged to long-term care
they die

36
Q

How do hospitals cause malnutrition?

A

Inadequate / unpalatable / unsuitable food
Can’t reach food / can’t feed themselves
Altered taste / poor appetite due to being in hospital
nil by mouth

37
Q

What are the medical causes for inadequate intake?

A 
a poor diet (choose the wrong things from the diet charts)
a poor appetite
anorexia
taste disturbances
'Nil by mouth'
Pain
Nausea 
Dysphagia
Depression
Physical disability and inability to feed self
Unconsciousness (coma)
38
Q

How might nil by mouth make malnutrition worse in hospitals?

A

Starved for Ix
And then again if the Ix gets cancelled
Starved before and after surgery

39
Q

What are the environmental causes for inadequate intake?

A

Inadequate food quality
Inadequate food availability
No protected meal times
Inadequate training and knowledge of medical and nursing staff

40
Q

What are the categories of causes for inadequate intake?

A

medical

environmental

41
Q

When might have the quality of food be inadequate?

A

meals unpalatable
food poor in nutrients
served of improper temperature

42
Q

When might have the food availability be inadequate?

A

if it is outside the reach of elderly or physically incapacitated patients

43
Q

What is being done to reduce malnutrition exacerbation in clinical environments (mainly hospitals)?

A

MUST screening rolled-out nationwide
Yearly MUST-screening (allows hospitals to show they are screening patients for malnutrition)
Educating staff (improved timing / help at meals, mouth care etc)
Protected meal times
Volunteers helping at meal times
Improving recording food and fluid intake
Dedicated Nutrition support teams and dietitians

M104 T1 (15 decks)

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