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Study Notes - Gastroenterology > Malnutrition > Flashcards

Malnutrition Flashcards

1
Q

What is 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

What are disease related causes of malnutrition generally speaking? (4)

A

Decreased intake (decreased appetite, pain when eating, dysphagia)
Increased nutritional requirement (trauma, burns, surgery)
Impaired absorption/ digestion
Increased nutrient loss (stoma, vomiting, diarrhoea)

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3
Q

What are the 4 aspects of the malnutrition cycle?

A

Anorexia + weight loss ->
Complications ->
Illness ->
Hospital ->

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4
Q

Psychosocial causes of malnutrition?

A
  • Inappropriate food provision
  • Lack of assistance
  • Poor eating environment
  • Self neglect
  • Bereavement
  • Inability to access food
  • Deprivation
  • Loneliness
  • Lack of cooking skills or facilities
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5
Q

Adverse effects of malnutrition?

A 
Impaired immune response
Impaired wound healing 
Reduced muscle strength and fatugie
Reduced respiraotry muscle strength
Inactivity, especially in bed bound patients
Water and electrolyte disturbances (leading to a decreased ability to excrete sodium and water)
Impaired thermoregulation
Menstrual irregularities/ amenorrhoea
Impaired psycho-social function
Prolonged hospital stay/ recovery
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6
Q

What scoring tool is used to assess malnutrition

A

The malnutrition universal screening tool (MUST)

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7
Q

What anthropometric measurements can be taken to assess nutrition?

A

o Mid-arm muscle circumference
o Triceps
o Grip strength

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8
Q

What biochemical assessment can assess nutritional status?

A 
Urinary creatinine 
IGF1
Micronutrients
Albumin
Transferrin
Transthyretin (prealbumin)
Retinol binding protein
Vitamin A, C, D and E
Zinc
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9
Q

What type of nutritional support is available (4)

A

Food fortification and dietary counselling
Oral nutrition support e.g. additional snacks/ sip feeds
Enteral tube feedng (delivery of nutritionally complete feed directly into the gut via a tube)
Parenteral nutrition (delivery of nutrients IV)
Or combination

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10
Q

Who needs nutritional support? (5)

A
  • BMI 10% within the last 3–6 months
  • BMI 5% within the last 3–6 months
  • Have eaten or are likely to eat little or nothing for more than 5 days or longer
  • Poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism
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11
Q

What kind oral nutritional supplements are available?

A
  • Ready made drinks (sip feeds)
  • Powders to reconstitute with milk e.g. Build-up, Enshake
  • Puddings e.g. Forticreme
  • Carbohydrate supplements (powder or liquid)
  • Fat supplements e.g. Calogen
  • Fat and protein supplements (powder or liquid) e.g. Pro-Cal
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12
Q

What are the standard indication for oral nutritional supplements?

A 
o	Disease related malnutrition
o	Intractable malabsorption 
o	Per-operative preparation of malnourished patients
o	Dysphagia
o	Proven IBD
o	Post total gastrectomy 
o	SBS
o	Bowel fistulae
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13
Q

Types of enteral tube feeding?

A

• Delivery of a nutritionally complete feed via a tube into the stomach, duodenum or jejunum
o Nasogastric (NG)
o Nasojejunal (NJ)
o Percutaneous endoscopic gastrostomy PEG
o Percutaneous jejunostomy
o Surgical jejunostomy
o Feed is nutritionally complete

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14
Q

Indications for enteral tube feeding?

A 
•	inadequate or unsafe oral intake, and 
•	a functional, accessible gastrointestinal tract
•	‘if the gut works, use it’
o	Unconscious patients
o	Neuromuscular swallowing disorder
o	Upper GI obstruction
o	GI dysfunction
o	Increased nutritional requirements
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15
Q

What is parenteral nutrition?

A

Administration of a nutrient solution via a central or peripheral vein

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16
Q

What are the indications for parenteral feeding?

A

• Healthcare professionals should consider parenteral nutrition in people who are malnourished or at risk of malnutrition and meet either of the following criteria:
o inadequate or unsafe oral and/or enteral nutritional intake
o a non-functional, inaccessible or perforated (leaking) gastrointestinal tract
♣ IBD with severe malabsorption
♣ Radiation enteritis
♣ Short bowel syndrome
♣ Motility disorders

17
Q

What are the indications for parenteral feeding in type 1 intestinal failure?

A 
o	Severe malnutrition pre-op
o	Post-op feeding: ileus/organ failure/5 day rule
o	Intestinal fistulae
o	Multi-organ failure
o	Post chemo mucositis
18
Q

What is refeeding syndrome?

A

A potentially fatal shift 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

19
Q

With what type of feeding is refeeding syndrome less likely to occur?

A

• Less likely to occur with oral feeding as intake usually limited by poor appetite but excessive feeding can easily be administered by PN or EN

20
Q

What are the metabolic features of refeeding syndrome?

A 
o	Hypokalaemia
o	Hypophosphataemia 
o	Hypomagnesaemia
o	Altered glucose metabolism
o	Fluid overload
21
Q

What are the physiological causes of refeeding syndrome?

A 
o	Arrhythmias
o	Altered level of consciousness
o	Seizure
o	Respiratory failure
o	Cardiovascular collapse
o	Death
22
Q

Who is at moderate risk of refeeding syndrome?

A

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

23
Q

Who is at high risk of refeeding syndrome? (4)

A

BMI 15% in last 3-6 months
little or no nutritional intake for > 10 days
Low level of serum potassium, phosphate or magnesium before feed
(either 1 of these or 2 of the same things but slightly less or a history of alcohol or drug abuse)

24
Q

Who is at extremely high risk of refeeding syndrome? (2)

A

BMI 15 days

25
Q

How to prevent refeeding syndrome in moderate risk patients? (3)

A

Introduce feeding at max. of 50% of requirements for 48 hours
Monitor clinical and biochemical parameters
Increase to full if monitoring reveals no problems

Study Notes - Gastroenterology (42 decks)

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