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GI > Malnutrition > Flashcards

Malnutrition Flashcards

1
Q

What is malnutrition?

A

A state of nutrition with a:
- deficiency, excess or imbalance of energy, protein and other nutrients

=> causes adverse effects on tissue, body form and function

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2
Q

What are the possible physiological mechanisms that underlie malnutrition?

A
  • Decreased intake
  • Impaired digestion and/or absorption
  • Increased nutritional requirements
  • Increased nutrient losses
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3
Q

Why may a patient have decreased intake of food?

A
  • poor appetite
  • pain on eating
  • medication side effects
  • dysphagia
  • sore mouth
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4
Q

What can cause decreased digestion/ absroption of food?

A

pathology in:

  • stomach (gastritis)
  • intestine (Coeliac/ Crohn’s)
  • pancreas
  • liver
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5
Q

What can cause the body to have an increased nutritional requirement?

A
  • catabolism infection
  • trauma
  • burns
  • surgery
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6
Q

What can cause increased loss of nutrients from the body?

A
  • vomiting
  • diarrhoea
  • stoma losses
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7
Q

Most patients experiencing malnutrition live in a Nursing Home or Residential Home. TRUE/FALSE?

A

TRUE

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8
Q

What percentage of hospital patients are considered malnourished?

A

30-40%

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9
Q

How can malnutrition lengthen a patients stay in hospital?

A

a chronic condition results in poor food intake
=> patient becomes malnourished and experiences GI dysfunction, poor wound healing and increased risk of infection

=> this makes them not want to eat => worsening food intake and malnutrition

=> their stay in hospital lengthens to break this cycle

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10
Q

What are the potential psychosocial causes of malnutrition?

A
  • Self neglect
  • Deprivation
  • Bereavement/ Loneliness
  • Inability to access food
  • Lack of cooking skills or facilities
  • Poor eating environment
  • Lack of assistance
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11
Q

Describe how starvation affects metabolism, weight and hormones

A
  • metabolic rate decreases
  • weight loss is slow (all from fat stores)
  • hormones show small increase at start (catecholamines/cortisol etc) then fall. Insulin decreases
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12
Q

Describe how injury affects metabolism, weight loss and hormones in the body.

A
  • Metabolic rate increases
  • weight loss is FAST (80% from fat store, remainder protein)
  • Increases in hormones (catecholamines, cortisol, GH) Insulin increased but relative insulin deficiency
  • Salt and water retention occurs
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13
Q

What common effects can malnutrition cause in a patient?

A
  • poor immune response/ wound healing
  • fatigue, weakness and inactivity
  • water and electrolyte disturbances
  • impaired thermoregulation
  • menstrual irregularities
  • psychosocial impairment
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14
Q

Weight loss can be a symptom of a variety of GI diseases. Give some examples.

A
  • Coeliac
  • Crohn’s
  • Cancer (oesopahgeal/gastric/colorectal)
  • intra-abdominal infection
  • impaired GI motility
  • acute liver disease
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15
Q

How is malnutrition screened for/ identified?

A
  • physical appearance very thin
  • recent unplanned weight loss in history
  • loose fitting clothing/jewellery that used to fit
  • risk of under-nutrition from recent illness
  • swallowing difficulty present which could impair persons ability to eat and drink
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16
Q

WHat scoring system is used to assess patients nutritional status and when should this be completed during their hospital stay?

A
  • MUST score
  • all patients must be screened within 1 day of admission
  • Also screened at regular intervals throughout their stay
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17
Q

What physical measurements can be used as part of a nutritional assessment?

A

Anthropometry
=> Mid-arm muscle circumference around Triceps

Grip strength
=> Refer to validated charts

18
Q

What biochemical markers may be used in the assessment of malnutrition?

A
  • Albumin
  • Transferrin
  • Transthyretin (prealbumin) [useful in monitoring response to nutritional support]
  • Retinol binding protein (reflects recent dietary intake)
  • IGF1
  • Micro Nutrients
19
Q

What vitamins and minerals are ALWAYS low in the high risk group for malnutrition?

A
  • Vitamins A, C, D, E

- Zinc

20
Q

What nutritional support options exist for those who are malnourished?

A
  • Food fortification
  • Oral nutrition support – e.g. snacks and/or sip feeds
  • Enteral tube feeding
  • Parenteral nutrition – the delivery of nutrition intravenously
21
Q

Who needs nutritional support?

A
  • BMI <18.5
  • Unintentional weight loss >10% within the last 3–6 months
  • BMI <20 and unintentional weight loss >5% within the last 3–6 months
  • Poor absorptive capacity
  • high nutrient losses
  • increased nutritional needs from catabolism
22
Q

What can be used in food fortification to improve the patients diet?

A
  • use of cheese/ full fat milk in everyday diet to increase energy/ protein content without increasing overall amount of food consumed
  • adding powdered nutritional supplements to food
  • fortifying foods to increase calorie/protein intake
23
Q

What issues do patients find interfere with their eating habits the most when admitted on a hospital ward?

A
  • Presentation of food/drink
  • Difficulty swallowing
  • Unpleasant smells on the ward
  • Treatment/ scans at mealtimes
  • Lack of privacy
  • Hospital crockery or cutlery
24
Q

How can we help patients to want the food they are given on the ward?

A
  • arrange protected mealtimes where they shouldn’t be disturbed
  • Ensure food is within reach of patients
  • Offer tea/coffee/refreshments
  • Provide assistance/encouragement to patients
  • Avoid routine administration of drugs/blood pressure/documentation etc during meal time
  • Offer condiments
25
Q

What is a coloured meal tray used to indicate on the wards?

A
  • patient requires physical assistance with eating and drinking
  • Cognitive impairment
  • Swallowing difficulties
  • Learning Disability
    => allows more support to be given to these patients
26
Q

What oral nutritional supplements can be given to patients?

A
  • Ready made drinks
  • Powders to reconstitute with milk e.g. Ensure Shake
  • 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
27
Q

Patients should only be given oral nutritional supplements if they fall under the ACBS indications. What conditions come under this heading?

A
  • Disease related malnutrition
  • Intractable malabsorption
  • Per-operative preparation of malnourished patients
  • Dysphagia
  • Proven IBD
  • Post total gastrectomy
  • Bowel fistulae
28
Q

HOw can enteral tube feeding be delivered?

A
  • Nasogastric (NG)
  • Nasojejunal (NJ)
  • Percutaneous endoscopic gastrostomy PEG
  • Percutaneous jejunostomy
  • Surgical jejunostomy
29
Q

What are the indications for enteral tube feeding?

A
  • inadequate or unsafe oral intake, and
  • ‘if the gut works, use it’
  • Unconscious patients
  • Neuromuscular swallowing disorder
  • Upper GI obstruction
  • Increased nutritional requirements
30
Q

What are the main CONTRAindications to enteral tube feeding?

A
  • Lower GI obstruction
  • Prolonged intestinal ileus
  • Severe diarrhoea or vomiting
  • High enterocutaneous fistula
  • Intestinal ischaemia
31
Q

When and how can complications arise with enteral tube feeding?

A

Insertion - nasal damage, pharyngeal pouch
Post insertion trauma - erosion, fistulae, stricture
Displacement - in bronchi
Reflux - oesophagitis/ aspiration
GI intolerance - bloating, pain, diarrhoea
metabolic - refeeding syndrome

32
Q

What is parenteral nutrition?

A
  • administration of nutrient solutions via a central or peripheral vein
33
Q

What should a parenteral feeding regimen take into account?

A
  • Energy/ protein/ electrolyte/ mineral and fibre needs
  • Activity levels
  • Underlying condition e.g. catabolism, pyrexia
  • GI tolerance, metabolic instability and risk of refeeding syndrome
  • Likely duration of nutrition support
34
Q

What is refeeding syndrome?

A
  • fatal shifts in fluids and electrolytes

=> disturbances in organ function and metabolic regulation

35
Q

Refeeding syndrome is less likely to occur with oral feeding. TRUE/FALSE?

A

TRUE

36
Q

What metabolic disturbances are commonly seen in refeeding syndrome?

A 
Hypokalaemia (K+)
Hypophosphataemia (PO4)
Hypomagnesaemia (Mg2+)
Altered glucose metabolism
Fluid overload
37
Q

What physical symptoms present with refeeding syndrome?

A
  • Arrhythmias
  • Altered level of consciousness
  • Seizure
  • Respiratory failure
  • Cardiovascular collapse
  • Death
38
Q

What patients are at moderate risk of refeeding syndrome?

A

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

39
Q

What patients are at high risk of refeeding syndrome?

A

ONE of:

  • BMI <16
  • not eaten for 10 days
  • low electrolyte levels before feed

OR TWO of:

  • BMI <18
  • no intake for 5 days or more
  • Hx of alcohol or drug abuse
40
Q

HOw is refeeding syndrome prevented in moderate risk patients?

A
  • Introduce feed at 50% of requirements for first 48 hrs
  • Monitor clinical and biochemical parameters
  • Increase nutrition support to meet full requirements if monitoring reveals no problems
41
Q

How is refeeding syndrome prevented/managed in high risk patients?

A
  • Check electrolytes (PO4, Mg2+, K+ and Ca2)
  • Before and during first 10 days of feeding, give:
  • thiamine, Vit B, multi vitamin and mineral supplement
  • Start feeding at 5-10 kcal/kg/day
  • Slowly increase over 4-7 days
  • Monitor PO4, Mg2+, K+ and Ca2+ for first 2 weeks and amend supplementation as appropriate `

GI (33 decks)

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