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LC Gastroenterology Week 2 > 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

lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat.

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2
Q

Is malnutrition a major clinical and public health problem in the UK?

A

YES

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3
Q

What percentage of hospital admissions are identified as malnourished?

A

30-40%

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4
Q

In what type of setting are people likely to be malnourished? (kinda)

A

Care home

Hospitals

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5
Q

What is malnutrition , simple terms?

A

An under of over nutrition where there is a nutrient imbalance

Mostly in clinical setting malnutrition will refer to under nutrition and is usually cause by disease of illness - DRM

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6
Q

What can short and long term malnutrition lead to?

A

Short term - adaptive

Long term - harmful

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7
Q

Describe the malnutrition cycle?

A

Hospital
Anorexia + weight loss
Complications
Illness…

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8
Q

What can the impact of malnutrition be on the body?

A

GI dysfunction
Infection
Poor wound healing - which can further decrease food intake

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9
Q

Describe how acute and chronic conditions link together in malnutrition?

A

They can both interact to exacerbate malnutrition and increase the length of hospital stay

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10
Q

Describe some acute malnutrition events?

A 
Sepsis, pneumonia etc
Fever
Surgery
Trauma
Radiotherapy
Chemotherapy
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11
Q

Describe some chronic malnutrition events?

A 
Anorexia
Asthenia, depression
Dysphagia
Malabsorption, fistula, diarrhoea
Infection (TB, HIV etc)
Immobility
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12
Q

Describe some disease related causes of malnutrition?

A

Decreased intake - poor appetite, pain on eating, dysphasia

Impaired digestion and/or absorption - problems with stomach, intestine, pancreas, liver

Increased nutritional requirements - trauma, catabolism infection, surgery

Increased nutrient losses - vomiting, diarrhoea, stoma losses

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13
Q

What are some Psychosocial causes of malnutrition?

A 
Self neglect 
Bereavement 
Inability to access food
Deprivation 
Lack of cooking skills/facilities 
Poor eating environment
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14
Q

Describe the effects of starvation?

A

Decreased metabolic rate
Slow weight loss, almost all from fat stores
Decrease nitrogen
Insulin decreased
Early small increase in HG, cortisol etc, then slow fall
Initial water and sodium loss, then late retention

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15
Q

Describe the effects of injury?

A

Increased metabolic rate
Rapid weight loss, from fat stores and protein
Increased nitrogen
Increase in hormones, insulin increased but relative insulin deficiency
Water and sodium retention

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16
Q

What are the effects of malnutrition

A

Increased risk of infection - due to impaired immune response

impaired wound healing

Reduced muscle strength
Fatigue
Reduced resp muscle strength - increased risk of check infection, difficult to wean from ventilator

Inactivity, bed bound - increased pressure sores and thromboembolism

Decreased ability to excrete sodium and water

Hypothermia

Infertility and osteoporosis

Depression, self neglect - impaired psycho-social function

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17
Q

Describe some of the differentials of weight loss as a symptom in GI disease?

A 
Crohns 
Impaired gastric motility 
Acute liver disease 
Colorectal cancer 
Oesophageal cancer 
Gastric cancer 
Coeliac disease 
Intra abdominal infection
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18
Q

Describe the consequences of malnutrition simply?

A 
Impaired immune function
Delayed Healing
Pressure sores
Immobility
Muscle weakness
Cardio-respiratory weakness

Psychosocial effects
Length of stay
Hospital costs
Prolonged recovery

19
Q

What is the screening tool used to identify adults who are malnourished?

A

MUST

20
Q

Describe the 5 MUST steps?

A

Measure height and weight and get a BMI

Note percentage of unplanned weight loss

Establish acute disease effect

Add scores from 1,2 and 3 to obtain overall malnutrition

Use the management guidelines to develop care plan

21
Q

What are some ‘investigations’ and things you can measure to asses the nutritional state of a patient? (CHECK)

A

Mid arm muscle circumference
Triceps
Grip strength

22
Q

Describe the Biochemical assessment of nutritional status - Albumin?

A

Can be used as a non-specific marker of illness

Constitutes for around 50% of total protein in plasma

23
Q

Biochemical assessment of nutritional status - what things can you assess?

A 
Albumin 
Transferrin 
Transthyretin 
Retinol binding protein 
Urinary creatinine 
IGF1 (insulin like growth factor)
Micronutrients
24
Q

What might transthretin be useful in monitoring?

A

The response to nutritional support over the initial assessment

25
Q

What would retinol binding protein be useful in assessing?

A

Reflects recent dietary intake rather than overall nutritional status.

Levels increase in ^GFR and alcoholisms and decreased by chronic liver disorders and vitamin A and zinc deficiency

26
Q

What is IGF1 good in assessing?

A

IT is reduced in acute and chronic malnutrition and increases with repletion.

Levels reduced in liver disease and renal failure.

27
Q

What are the ABCDE’s of measuring malnutrition?

A

anthropometry, biochemistry, clinical condition and dietary intake as well as economic/psychosocial issues

28
Q

What substances have been found to be lower in high risk groups?

A

Vitamins A, C, D and E, Albumin and Zinc

29
Q

What type of nutritional support can you give?

A

Food and dietary counselling
Oral nutrition support (additional snack, sip feeds)
Enteral tube feeding
Parenteral nutrition

30
Q

Who needs nutritional support? (BMI, weight loss)

A

BMI < 18.5
Unintentional weight loss of >10% in last 3-6months

BMI <20 and unintentional weight loss of >%% in last 3-6 months

Have not eaten for or are likely to eat nothing for more than 5 days

Poor abortive capacity and/or high nutrition losses and/or increased nutritional needs from causes such at catabolism

31
Q

What is Catabolism?

A

Catabolism is the set of metabolic pathways that breaks down molecules into smaller units that are either oxidized to release energy, or used in other anabolic reactions.

32
Q

Describe some oral nutritional supplements?

A 
Ready made drinks (sip feeds)
Powders to reconstitute with milk 
Puddings 
Carb supplements 
Fat supplements 
Fat and protein supplements
33
Q

What might be the indications to give oral supplements? (check)

A 
Disease related malnutrition
Intractable malabsorption
Per-operative preparation of malnourished patients
Dysphagia
Proven IBD
Post total gastrectomy
SBS
Bowel fistulae
34
Q

What is enteral tube feeding?

A

Delivery of a nutritionally complete feed via a tube into the stomach, duodenum or jejunum

35
Q

Give some examples of enteral tube feeding?

A 
Nasogastric (NG)
Nasojejunal (NJ)
Percutaneous endoscopic gastrostomy PEG
Percutaneous jejunostomy
Surgical jejunostomy
36
Q

What are the indications for enteral tube feeding?

A

Inadequate or unsafe oral intake
Need a functional or accessible GI tract

if the gut works, use it’
Unconscious patients
Neuromuscular swallowing disorder
Upper GI obstruction
GI dysfunction
Increased nutritional requirements
37
Q

What are some contra-indications for enteral tube feeding?

A 
Lower gastrointestinal obstruction
Prolonged intestinal ileus
Severe diarrhoea or vomiting
High enterocutaneous fistula
Intestinal ischaemia
38
Q

Describe some complications that may occur with enteral tube feeding?

A 
Damage on insertion 
Discomfort, strictures when its in 
Tube falls out
Tube displaced and bronchial administration of feed 
Aspiration 
Metabolic issues
39
Q

When might you give parenteral nutrition?

A

When there is inadequate or unsafe oral and enteral intake

When there is a non functional GI tract or perforated GI tract (Leaking)

40
Q

Name some conditions where you might give parental nutrition?

A

IBD - with severe malabsorption
SBS
Motility disorders

41
Q

What must you be careful about when giving someone food/nutrition after not having it for a while?

A

Referring syndrome, can easily overfeed with Enteral etc

Fatal shifts in fluids and electrolytes and disturbances in organ function

42
Q

What are some metabolic and physiological features of referring syndrome?

A 
Metabolic
Hypokalaemia
Hypophosphataemia
Hypomagnesaemia
Altered glucose metabolism
Fluid overload
Physiological
Arrhythmias
Altered level of consciousness
Seizure
Respiratory failure
Cardiovascular collapse
Death
43
Q

Who is at risk of referring syndrome?

A

Mod risk - patients who have had no/little nutritional for >5days
High risk - patients with low BMI, unintentional weight loss etc
Extremely high risk - BMI <14 or pretty much no intake for >15days

44
Q

Roughly how do you manage someone at moderate risk of referring syndrome?

A

Introduce nutritional support at 50% for 48 horus
Monitor closely
Increase nutrition if biochemistry all okay

LC Gastroenterology Week 2 (6 decks)

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