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Gastrointestinal RT > Malnutrition + Overnutrition > Flashcards

Malnutrition + Overnutrition Flashcards

1
Q

what are the 4 disease related caused of malnutrition?

A

decreased intake
impaired digestion/absorption
increased nutritional requirements
increased nutrient losses

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2
Q

what common symptoms of disease cause increased nutrient losses?

A

vomiting and diarrhoea

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3
Q

what are the 9 main psychosocial causes of malnutrition?

A 
inapproptiate food provision
lack of assistance
poor eating environment
lack of cooking skills/facilities
self neglect
bereavement
inability to access food
deprivation
loneliness
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4
Q

what are the 9 major adverse effects of malnutrition?

A 
impaired immune responses
impaired wound healing
reduced muscle strength and fatigue
cardio-resoiratory weakness
immobility
water and electrolyte disturbances
impaired thermoregulation
menstrual irregularities
psycho-social effects
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5
Q

weight loss is a symptoms for what major 8 GI diseases?

A 
coeliacs diseasse
crohns disease
colorectal cancer
gastric cancer
oesophageal cancer
intra abdominal infection
impaired GI motility
acute liver disease
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6
Q

what is the aim of the MUST score?

A

a screening tool to identify adults who are malnourished or at risk of malnourisment

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7
Q

when must patients be nutritonally screened using MUST?

A

within 1 day of admission

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8
Q

what is Step 1 of MUST?

A

BMI score
above 20 = 0
18.5-20 = 1
below 18. 5 = 2

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9
Q

what is Step 2 of MUST?

A 
weight loss score
(unexplained weight loss in past 3-6 months)
less than 5 percent = 0
5- 10 percent = 1
greater than 10 percent = 2
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10
Q

what is Step 3 of MUST?

A

if patient is acutely ill AND likely to be no nutritional intake for >5days = 2 points

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11
Q

what is Step 4?

A

add scores from step 1, 2 and 3 to calculate overall risk of malnutrition
0 = low risk
1 = medium risk
2+ = high risk

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12
Q

how do you calculate BMI?

A

mass (kg)/

height^2(m)

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13
Q

what is the 4 step pyramid of nutritional support?

A

food
oral nutritional supplements
enteral nutrition
parenteral nutrition

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14
Q

what is refeeding syndrome?

A

occurs when previously malnourished are fed with high carbohydate loads
this causes a rapid decline in electrolytes and an increase in extracellular volume which results in organ dysfunction

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15
Q

why is there an increase in extracellular volume (oedema) in patients with refeeding syndrome?

A

due to salt and water retentsion

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16
Q

what are the main metabolic features of refeeding syndrome?

A 
hypokalaemia
hypophosphataemia
hypomagnesaemia
altered glucose metabolism
fluid overload
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17
Q

what are the physiological features of refeeding syndrome?

A 
arrhythmias
altered level of consciousness
seizures
respiratory failure
cardiovascular collapse
death
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18
Q

how do you prevent refeeding syndrome in moderate risk patients?

A

introduce nutritional support at a maximum of 50% of requirements for first 8 hours, increase nutritional support after 48 hours if monitoring reveals no problems

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19
Q

what must you do to prevent refeeding syndrome in high risk patients?

A

rehydrate carefully and supplement potassium, magnesium, phosphate, calcium, thiamine and vit B
start feeding at 5-10kcal/kg/day

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20
Q

what are the BMI categories?

A 
below 18.5 = underweight
18.5- 24.9 = normal
25- 29.9 = overweight
30- 39.9 = obese
40+ = morbidly obese
21
Q

what are the 9 main consequences of obesity?

A 
diabetes
heart disease
NAFLD
repiratory disease
stroke
osteoarthriris
some cancers (uterus, breast, prostate, colon)
gallbladder disease
dementia
22
Q

what s the effect that long-term obesity has on brain-reprogramming?

A

brain becomes to view extra weight as normal and dieting as a threat to body survival
(so defends new weight by switching on compensatory mechanisms to maintain energy expenditure)

23
Q

what part of the hypothalamus seems to be associated with decreased energy expenditure?
(ie causes obesity)

A

lateral hypothalamus

24
Q

what part of the hypothalamus seems to be associated with increased energy expenditure?
(ie causes leaness)

A

ventromedial hypothalamus

25
Q

what are the 3 basic concepts which underlie the control of energy intake and body weight?

A
  1. satiety signalling (short term)
  2. adiposity negative feedback signalling (long term)
  3. food reward
26
Q

what is satiation?

A

sensation of fullness generated during a meal

27
Q

what is satiety?

A

period of time between termination of one meal and the initiation of the next

28
Q

what type of feedback occurs when satiation signals increase during meal to limit meal size?

A

negative feedback

29
Q

what are 5 gut satiation signals?

A 
cholecystokinin (CCK)
peptide YY (PYY)
glucagon-like peptide (GLP-1)
oxyntomodulin (OXM)
obestatin
30
Q

what is ghrelin?

A

a gut hunger signal secreted from oxyntic cells in stomach

31
Q

when do levels of ghrelin increase?

A

before meals

32
Q

when are levels of ghrelin raised?

A

fasting

hypoglycaemia

33
Q

what 2 hormones report fat status to the brain?

A

leptin

insulin

34
Q

where is leptin made and released from?

A

fat cells

35
Q

where is insulin made and released from?

A

b-cells in pancreas

36
Q

what happens to the levels of leptin and insulin as fat storage increases?

A

hormone levels in the blood increase

37
Q

what is the response of the brain to increased insulin and leptin?

A

eat less and increase energy burn

38
Q

in the obese state what happens to leptin and insulin control mechanisms for reporting fat status?

A

they malfunction

39
Q

how are peripheral actions different to central actions of insulin?

A

insulin peripherally cause build up of fat/glycogen etc (anabolic)
insulin in the brain causes break down of fat (catabolic)

40
Q

why doesnt the high levels of leptin (that accompany high levels of fat storage) in obese people cause catbolism of fat?

A

severe leptin resistance present in most ovese individuals

41
Q

what is the main drug for treatment of obesity?

A

orlistat

42
Q

what is the function of orlistat?

A

inhibits pancreatic lipase to decrease lipid absorption

43
Q

what are the side effects of orlistat?

A

cramping
severe diarrhoea
vitamin deficiency (need to take vitamin supplements)

44
Q

why isn’t orlistat efective over long term?

A

rebound weight

45
Q

what is liraglutide?

A

a glucagon-like-peptide 1 receptor agonist

46
Q

compare dosing of liraglutide for type 2 diabetes to dosing for weight loss?

A

higher doses used for weight loss than diabetes

47
Q

how is liraglutide administered?

A

injections

48
Q

what is the most effect therapy for obesity?

A

bariatric surgery

Gastrointestinal RT (15 decks)

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