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Gastro > Malnutrition > Flashcards

Malnutrition Flashcards

1
Q

Define malnutrition

A

A state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue, body form (body shape, size and composition), function and clinical outcome

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2
Q

Name some effects of disease related causes of malnutrition

A

Decreased intake
impaired digestion / absorption
Increased nutritional requirements
Increased nutrient losses

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3
Q

How many hospital admissions are identified as malnourished?

A

30-40%

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4
Q

What happens to the majority of patients who are treated for malnutition

A

They improve their nutritional status

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5
Q

Name some economic consequences of malnutrition in the over 65s

A

More hospital admissions
Longer length of stay
more GP visits
More OP visits

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6
Q

What is the main difference between short term and long term malnutrition?

A

Short term is adaptive and they usually return to normal

Long term is a gradual decline and harmful

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7
Q

Describe the malnutrition cycle

A

Anorexia and weight loss result in complications, contributing to illness which results in a hospital admission

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8
Q

What do chronic conditions often result in

A

Poor food intake leading to malnutrition

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9
Q

What is an effect of malnutrition in the GI system

A

Dysfunction - increased infection rate, decreased wound healing and physical weakness. These all result in a poor food intake

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10
Q

Describe some acute events which can lead to poor food intake

A

Sepsis, pneumonia, fever, surgery, trauma, radiotherapy, chemotherapy

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11
Q

Name some psychosocial causes of malnutrition

A 
Inappropriate food provision
self neglect
lack of assistance 
bereavement
inability to access food
poor eating environment 
deprivation
loneliness
lack of cooking skills/ facilities
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12
Q

What happens to the metabolic rate in starvation

A

Reduced

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13
Q

What happens to the weight in starvation

A

slow loss, almost all from fat stores

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14
Q

What happens to the water and sodium in starvation

A

Initial loss but then late retention

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15
Q

What happens to the metabolic rate in injury

A

Increased

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16
Q

What happens to the weight in injury

A

Rapid loss 80% from fat stores, remainder from protein

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17
Q

What happens to water and sodium

A

Retained

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18
Q

Name some adverse effects of malnutrition

A 
Impaired immune responses
Impaired wound healing 
reduced muscle strength and fatigue 
reduced respiratory  muscle strength
inacrtivity, especially in bed bound patient 
water and electrolyte disturbances 
impaired thermoregulation 
menstrual irregularities. amenorrhoea
impaired psycho-social function
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19
Q

What can weight loss be an indicator for?

A 
Impaired GI motility
Acute liver disease
Intra- abdominal infection
acute liver disease 
coeliac disease
oesophageal cancer
gastric cancer 
colorectal cancer 
crohn's disease
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20
Q

Name some consequences of malnutrition

A 
Impaired immune function
Delayed healing 
pressure sores
Immobility
Muscle weakness
Cardio-respiratory weakness
Psychosocial effects
Length of stay 
Hospital costs
Prolonged recovery
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21
Q

When do we screen for risk of under nutrition?

A

On admission and at regular intervals thereafter

22
Q

What screening tool do we use in Tayside?

A

MUST (Malnutrition Universal Screening Tool)

23
Q

What is the usefulness of albumin in nutritional assessment?

A

Constitutes around 50% of total protein in plasma

Low levels therefore could indicate malnutrition although this can be affected by various other factors

24
Q

Generally speaking, what is the trend in biochemical assessment of nutritional status

A

Most tests are reduced or poor in malnourished individuals

25
Q

What type of person requires nutritional support?

A

BMI <10% within the last 3-6 months
No nutritional intake for 5 days
Poor absorptive capacity or high nutrient losses

26
Q

Name some types of nutrition support

A

Food fortification and dietery counselling
Oral nutrition support (additional snacks)
Enternal tube feeding (PEG)
Parenteral nutrition (IV)

27
Q

Name some oral nutritional supplements

A

Ready made drinks (sip feeds)
Powders to reconstitue with milk (Build up, ensure)
Pudding with forticreme

28
Q

Name some fat supplements

A

Calogen

29
Q

Proc-Cal is used for what?

A

Fat and protein supplements

30
Q

What does ETF stand for

A

Enteral Tube feeding

31
Q

How does ETF work

A

Delivers nutritional complete feed via a tube into the stomach (NG, NJ, PEG)
The feed is nutritionally complete

32
Q

What are the indications for ETF

A

Inadequate or unsafe oral intake (SALT)

A functional, accessible GI tract

33
Q

What are some contra-indications for ETF

A 
Lower GI obstruction
Prolonged intestinal ileus
Severe diarrhoea or vomiting
High enterocutaneous fistula
Intestinal ischaemia
34
Q

What are some complications of ETF

A 
Nasal damage
Tube falls ut
Oesophagitis 
Aspiration
Nausea
Hyperglycaemia 
Fluid overload
Electrolyte disturbance
35
Q

What is parenteral Nutrition

A

The administration of nutrient solutions via a central or peripheral vein

36
Q

What are the problems with Parenteral nutrition

A

Expensive
Complications are life threatening
Needs specialist skills
Psycho-social disturbance

37
Q

What is the main indicator for parenteral nutrition?

A

A non-functional, inaccessible or perforated (leaking) GI tract

38
Q

What are some reasons for a perforated GI tract?

A

IBD with severe malabsorption
Radiation enteritis
Short bowel syndrome
Motility disorders

39
Q

How do you estimate energy requirements

A

calculate basal metabolic rate
May need to add factor to account for increased requirements caused by metabolic stress of disease
Add factors for activity and thermomgenesis
May add/ subtract energy to allow weight gain/ loss

40
Q

What is refeeding syndrome?

A

Potentially fatal shifts in fluids and electrolytes and disturbances in organ function and metabolic regulation that may result from rapid initiation of re feeding after a period of under nutrition

41
Q

How can excessive feeding be administered?

A

By PN or EN

42
Q

What are some of the metabolic features of refeeding syndrome?

A 
Hypokalaemia
Hypophosphataemia
Hypomagnesaemia
Altered glucose metabolism
Fluid overload
43
Q

What are some of the physiological features of refeeding syndrome?

A 
Arrhythmias
Altered level of consciousness
Seizure
Respiratory failure 
Cardiovascular collapse
Death
44
Q

Who is at moderate risk of refeeding syndrome?

A

Patients who have had little or no nutritional intake for >5days

45
Q

Who is at extremely high risk of refeeding syndrome?

A

BMI 15days

46
Q

What is the prevention and management of refeeding syndrome in moderate risk patients?

A

Introduce a nutrition support at a maximum of 50% of requirement for the first 48hours
Monitor clinical and biochemical parameters
Increase nutrition support to meet full requirements if monitoring reveals no problems

47
Q

What 4 things do we need to check in high risk refeeding syndrome patients?

A

PO4, Mg2+, K+ and Ca2+

48
Q

What rate of feed do we start high risk patients on?

A

10kcal/kg/day

49
Q

What is the rate of feed that we start extremely high risk patients on?

A

5kcal/kg/day

50
Q

What can with-holding nutrition be perceived as?

A

Neglect

Gastro (67 decks)

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