Malnutrition

Question 1

Refeeding syndrome

Answer 1

Complication resulting from rapid reintroduction of feeding following starvation

Causes metabolic imbalances

Question 2

Metabolic imbalances seen in Refeeding syndrome

Answer 2

Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
Abnormal fluid balance

Question 3

What are the complications of refeeding syndrome

Answer 3

Arrhythmias
Respiratory/Cardiac failure
Rhabdomyolysis, weakness, seizure

Question 4

Which patients are at high risk of refeeding syndrome

Answer 4

BMI <18.5
Unintentional weight loss >15% over last 3-6 months
Little nutritional intake >5 days
History of alcoholsm, cancer, insulin therapy, chemotherapy

Question 5

Treatment of refeeding syndrome

Answer 5

Introduce small amounts of food

Additional vitamin supplements - thiamine, vitamin B

Monitor FBCs, UE, PO4, Mg

Question 6

Parenteral feeding (IV) can be done via

Answer 6

PICC line (central catheter via basilic vein)

Central venous catheter (subclavian line)

Question 7

Deficiency of Vitamin D can cause..

Answer 7

Osteomalacia and rickets

Sign = proximal weakness of limbs

Question 8

Deficiency of Vitamin K can cause..

Answer 8

Poor clotting

Sign= bruising, bleeding

Question 9

Deficiency of Vitamin B1/thiamine can cause..

Answer 9

Beri Beri (Wet and dry)

Question 10

Wet Beriberi

Answer 10

Affects CV system

Left-ventricular HF
Leg swelling
Tachycardia
Tachypnoea

Question 11

Dry beriberi

Answer 11

Affects nervous system

Motor and sensory neuropathy of hands and feet

Question 12

B12 deficiency causes

Answer 12

Pernicious anaemia (macrocytic)

Question 13

Deficiency of Niacin can cause..

Answer 13

Pellagra

3Ds =
Dermatitis
Diarrhoea
Dementia

Question 14

Pellagra is common in

Answer 14

Alcoholics

Those on isoniazid (TB)

Question 15

Vitamin C deficiency can cause

Answer 15

Scurvy

Gingivitis
Bleeding

Question 16

Coeliac disease =

Answer 16

Autoimmune condition

Sensitivity to gluten

Question 17

Which genes are associated with coeliac disease

Answer 17

HLA-DQ2 (95%) HLA-DQ8 (80%).

Question 18

Which patients should be screened for Coeliacs?

Answer 18

Autoimmue thyroid disease
Dermatitis herpetiformis
IBS
T1D
First-degree relatives with coeliac disease

Question 19

Main symptoms of coeliacs

Answer 19

Diarrhoea 
Failure to thrive in children
Persistent and unexplained GI symptoms = abdo pain, NandV, cramping
Prolonged fatigue
Unexplained iron deficiency anaemia

Question 20

Coeliacs tends to affect __________ of small intestine

Answer 20

Duodenum

Question 21

Histology of Coeliacs

Answer 21

Villous atrophy (Flat mucosa)
Crypt hyperplasia  Infiltration with lymphocytes

Question 22

Investigation for Coeliacs

Answer 22

TTG Ab (Tissue transglutaminases)

Endomyseal Ab (IgA)

Question 23

Intestinal causes of malabsorption

Answer 23

Coeliac disease

Crohn’s disease

Question 24

Pancreatic causes of malabsorption

Answer 24

chronic pancreatitis
cystic fibrosis - Pancreatic insufficiency
pancreatic cancer

Question 25

Biliary causes of malabsorption

Answer 25

biliary obstruction primary biliary cirrhosis Lack of bile for fat absorption

Question 26

Pancreatic insufficiency =

Answer 26

Inability of exocrine pancreas to secrete digestive enzymes Pancreatic proteases (trypsin and chymotrypsin), amylase, lipase

Question 27

In which conditions do you tend to see pancreatic insufficiency

Answer 27

Chronic pancreatitis | CF

Question 28

Pancreatic insufficiency

Answer 28

Creon (contains enzymes)

Question 29

Pancreatic insufficiency symptoms

Answer 29

Maldigestion, malnutrition and ↓levels of micronutrients, vitamins, lipoproteins Steatorrhea common

Question 30

Pancreatic insufficiency investigations

Answer 30

Faecal pancreatic elastase-1

Question 31

Kwashiorkor

Answer 31

Malnutrition caused by a PROTEIN deficiency Oedema is present subcut fat still present

Question 32

Marasmus

Answer 32

Malnutrition caused by a deficiency of everything Tend to look emaciated (loss of muscle mass, prominent bones)

Question 33

Intrinsic factor is produced by _______ cells in __________ and is needed for ____ absorption

Answer 33

Parietal cells Fundus and body of stomach B12

Question 34

What might cause a decrease in intrinsic factor

Answer 34

Autoimmune condition = pernicious anaemia -> B12 deficiency | Gastrectomy (removing part of stomach that reduces IF production)

Question 35

Reduced B12 absorption =

Answer 35

Can cause neurological problems (numbness and tingling in hands and feet)

Question 36

Vitamin C (ascorbic) deficiency symptoms

Answer 36

SCURVY Gingivitis and bleeding gums