M104 T1 L1 Flashcards
What types of patients does the majority of malnutrition cases occur in?
GI disease / cancer
liver disease
surgery patients
Which GI malignancies is malnutrition common in? (COP.Gary)
colorectal
oesophageal
pancreatic
gastric
Which surgery types is malnutrition common in? (Good GIrls CAN ; MArry Very Strongly)
general surgery
GI surgery
cancer surgery
major vascular surgery
What are the causes of malnutrition?
Inadequate intake of nutrients
Impaired nutrient digestion and processing in the digestive tract
Excess losses of nutrients
Altered requirements for nutrients
Which organs, when they dysfunction, will result in the excessive loss of nutrients?
(SIP.Liver) stomach intestine pancreas liver
How does the excessive loss of nutrients occur?
Vomiting NG tube drainage Diarrhoea Surgical drains Fistulae Stomas
What is a consequence of altered nutrient requirements in the body?
there are increased metabolic demands
What different health issues cause increased metabolic demands? (BICIB.Wounds)
brain injury cancer inflammation burns wounds
What are the two types of simple starvation mechanisms?
uncomplicated EARLY fasting
uncomplicated fasting
What happens in the body during uncomplicated early fasting?
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
What are the mechanisms by which uncomplicated fasting occurs?
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
What part of the body is affected by stress starvation in particular?
the peripheral muscle
What happens to ischaemic or inflammatory tissue during stress starvation?
it will produce lactate
this will undergo gluconeogenesis
more glucose will be produced
What two processes occur during stress starvation?
ketogenesis (by fat and glycerol)
gluconeogenesis (ischaemic tissue)
What happens to the metabolic rate in simple starvation vs stress starvation?
simple - low
stress - high
What happens to muscle protein breakdown in simple starvation vs stress starvation?
simple - high
stress - very high
What happens to protein synthesis in simple starvation vs stress starvation?
simple - low
stress - high
What happens to plasma albumin levels in simple starvation vs stress starvation?
simple - neutral
stress - very low
What happens to nitrogen balance in simple starvation vs stress starvation?
simple - low
stress - very low
What happens to ketone bodies in simple starvation vs stress starvation?
simple - very high
stress - high
What happens to gluconeogenesis in simple starvation vs stress starvation?
simple - high
stress - very high
What happens to blood glucose in simple starvation vs stress starvation?
simple - low
stress - high
What happens to insulin plasma concentration in simple starvation vs stress starvation?
simple - high
stress - high
What happens to insulin resistance in simple starvation vs stress starvation?
simple - very high
stress - very high
What happens to salt and water retention in simple starvation vs stress starvation?
simple - high
stress - very high
What is the effect of malnutrition in healthy people by day 5?
decreased skeletal muscle mass
decreased skeletal muscle function
What is the effect of losing at least 18% of body mass?
physiological disturbance
How is cardiac output affected by malnutrition?
45% reduction
What processes does malnutrition affect that results in decreased ventilation function?
respiratory contractility
diaphragmatic contractility
diaphragmatic muscle mass
respiratory muscle mass
What percentage of weight loss is fatal?
approx 40%
How does malnutrition affect the liver?
impaired liver function
necrosis in the liver
How does malnutrition affect mental heatlh?
depression
apathy
How does malnutrition affect immune function?
impaired gut immunity
decreased immunity
imparied wound healing
How does malnutrition affect the body?
decreased ventilation function imparied gut integrity reduced cardiac output imparied renal function reduced strength hypothermia reduced gut function
Why do malnutrition patients cost the NHS so much each year?
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
How do hospitals cause malnutrition?
Inadequate / unpalatable / unsuitable food
Can’t reach food / can’t feed themselves
Altered taste / poor appetite due to being in hospital
nil by mouth
What are the medical causes for inadequate intake?
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)
How might nil by mouth make malnutrition worse in hospitals?
Starved for Ix
And then again if the Ix gets cancelled
Starved before and after surgery
What are the environmental causes for inadequate intake?
Inadequate food quality
Inadequate food availability
No protected meal times
Inadequate training and knowledge of medical and nursing staff
What are the categories of causes for inadequate intake?
medical
environmental
When might have the quality of food be inadequate?
meals unpalatable
food poor in nutrients
served of improper temperature
When might have the food availability be inadequate?
if it is outside the reach of elderly or physically incapacitated patients
What is being done to reduce malnutrition exacerbation in clinical environments (mainly hospitals)?
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
