Malnutrition Flashcards
What is Kwashiorkar malnutrition?
Predominantly protein malnutrition
What is marasmus malnutrition?
Calorie intake deficiency
What is cachexia?
Metabolic disorder where a person unintentionally loses weight
Symptoms: muscle atrophy, fatigue, weakness, loss of appetite
Normally cancer, AIDS, coeliac disease, COPD and TB
What is pellagra and what are the symptoms?
Vit B3 (niacin) deficiency
- Diarrhoea
- Dementia
- Dermatitis
- Death
What would vit K deficiency present as?
lack of production of coagulation factors II,VII, IXand X.
Presents as easy bruising
What are the ways to assess malnutrition in the hospital?
Quantified measurement calculated from BMI, mid-arm circumference indicating muscle mass and
the skin-fold thickness to measure body fat. The measurement score is called the Malnutrition
Universal Screening Tool and aims to be completed within 24 hours of hospital admission and also inlcludes unexplained weight loss experiences in past 3-6 months.
Management of malnutrition in the hospital:
1) general advice, social services
2) nausea: anti-emetics
4) dysphagia: find underlying cause, pureed food and high calorie drinks
5) enteral: oral supplements or via NG/NJ tube. Needs a functioning GI tract. Usually a nasogastric tube but enterostomy used if more than 4-6 weeks.
Contra-indication is any facial or nasal trauma
6) Parenteral feeding: IV nutrients -
Peripheral lines used for short-term and central line sif more than 2 weeks
Common clinical features of malabsorption
- Chronic diarrhoea
- Weight loss
- Steatorrhoea
- Vitmain and iron deficiencies
- Central and peripheral oedema
Why is their malabsorption with coeliac disease?
The inflammatory response results in shortening of the villi lining the small intestine;
villous atrophy. Therefore, absorption of vitamins and nutrients in the small bowel is markedly
impaired. Iron deficient anaemia is the most common blood disorder caused by coeliac disease.
Why is their malabsorption with crohn’s disease?
Damage to the terminal ileum lining
Cobblestone ulcers, muscular hypertrophy and formation of granulomas which affect absorption
Vitamin B12 malabsorption
Megaloblastic anaemia most common
What lipids are needed in the body?
- Triglycerides - most plentiful in body and provides twice as much energy as carb or protein. Can be saturated, mono/polyunsaturated
- Essential Fatty acids - body cant produce these
- Phospholipids - cell membranes due to amphipathic properties
- Steroids - cholesterol, bile salts, adrenal and sex hormones
- Eicosanoids - lipids from arachdonic acid - prostaglandins and leukotrienes
- Lipoprotein - carry cholesterol and triglycerides around the body
What is the difference between trace elements and minerals?
Trace elements present in small quantities (<5g) where minerals are >5g
Minerals: calcium, phosphorus, potassium, sulpher, Na, Cl, Mg, Fe, I
Trace elements: Cu, Co, Zn, Fluoride, manganese
Examples or water-soluble and fat-soluble vitamins:
What are Vitamins C E and beta-carotene?
Fat-soluble - Vit A D E K
Dependent on bile salts and absorbed in small intestine with lipids
Water soluble - Vit B1 B2 B6 B12 C. folate and niacin
Absorbed along with water in GI tract
Vitamins C, E and Beta-carotene act as antioxidants and inactivate oxygen free radicals that would damage DNA
Vit A deficiency causes:
Retinol deficiency causes Night blindness
Vit D (Cholecalciferol) deficiency causes:
Osteomalacia/ rickets
Proximal weakness of limbs
Vit E (Tocopherol) deficiency causes:
Haemolytic anaemia - jaundice
Neuropathy
Vit K (Phytomenadione) deficiency causes:
Bruising - defective clotting
Vit B1 (Thiamine) deficiency causes:
Beri Beri:
Wet Beri beri - oedema, high output left ventricular failure
Dry Beri beri - motor/sensory neuropathy
Vit B2 (Riboflavin) deficiency causes:
Sore tongue and mouth
Vit B6 (Pyridoxine) deficiency causes:
Dermatitis/ Anaemia
Skin rash affecting eye/nose and sore tongue
Vit B12 (Cobalamin) deficiency causes:
Pernicious anaemia
Tiredness, fatigue, pale conjunctivae
Vit C (Ascorbate) deficiency causes:
Scurvy
Bent/coiled hair, bruising, gingivitis
Folate deficiency causes:
Megaloblastic anaemia
Vit B3 (Niacin) deficiency causes:
Pellagra
Dermatitis, dementia, diarrhoea, fatigue, insomnia, glossitis, hallucinations, psychosis
what is basal energy expenditure?
At rest the energy required for metabolism
Varies with age and sex
What is malnutrition?
BMI
Causes of malabsorption:
Structural
Intra-luminal
Mucosal
Outside
Causes of malabsorption:
Coeliac disease Pancreatic enzymes lacking BIle lacking Bacterial overgrowth - hydrogen breath test IBD HIV Addison's, endocrine Ischaemia
Complications of a peg (enterostomy)
Peritonitis
Infection
Diarrhoea
Bloating
Refeeding syndrome
Electrolyte and fluid imbalances - hypotension, cardiac failure,
Hypophosphatemia
Thiamine deficiency
Hypokalaemia
Hypomagnesmia
Abnormal glucose and lipid metabolism
Do an ECG as there is a chance of arresting
Coeliac disease increases the risk of developing which malignancy?
Enteropathy associated T cell lymphoma
What screening tool is used for malnutrition?
MUST (Malnutrition universal screen tool)
Done on admission to hospital
Takes into account BMI, recent weight change and presence of acute disease
Coeliac disease is associated with deficiencies of what?
Iron, folate and Vit B12 deficiency
