Medical and surgical gastroenterology Flashcards
List the daily requirements of fat, protein and carbohydrate utilised by the body
The estimated average daily requirement is 2000 calories for women and 2500 for men.
It is recommended this is made up by 55-70% CHO, 30% fat and 15% protein.
The daily requirement of protein is 0.75g/kg. On a 2500 calorie diet, this would equate to 344g of CHO, 83g of fat and 45g of protein.
Knowing a patient’s weight and level of stress. How can you calculate the daily requirements for calories, protein and carbohydrates?
Protein (4kcal/g), CHO (4kcal/g), Fat (9kcal/g) 4.2kJ = 1 kcal
Daily expenditure = BMR x [time in bed + PAR(time at work) + PAR(time at home)]
OR
Daily expenditure = BMR x Stress factor x Activity factor (PAL)
Stress factors: 1.2 for elective surgery, 2.0 for severe burn, 1.5 for wound, infection or trauma. PAL: 1.2 for patient confined to bed, 1.3 for patients out of bed
List the water soluble and fat-soluble vitamins
Vitamins B and C are water soluble.
Vitamins A, D, E and K are fat soluble. (DEAK)
What is the incidence and complications of undernutrition?
Undernutrition may be present in up to 25% of hospital inpatients, due to increased requirements, increased nutritional losses, decreased intake & enforced starvation
Complications include:
- muscle wasting
- depression of immune response
- fatigue
- failure of reproductive function
- poor wound healing
- depression
- loss of libido
- anxiety
- ultimately, death.
Malnutrition of specific nutrients (vitamins) may result in clinical symptoms:
- Vit A (night blindness, xeropthalmia, keratomalacia)
- Vit B1 Thiamin (Beriberi, wernickes encephalopathy)
- Riboflavin (angular stomatitis)
- Vit B3 Niacin (Pellagra)
- Vit B6 (polyneuropathy)
- B12 (Megaloblastic anaemia)
- Folate (Megaloblastic anaemia)
- Vit C (scurvy)
- Vit D (rickets, osteomalacia)
- Vit E (neurological disorders)
- Vit K (coag defects)
List the indications for insertion and removal of a nasogastric tube
Indications:
- To empty stomach e.g. pre-operatively, intestinal obstruction, gastric outlet obstruction, if aspiration risk
- Intra-operatively e.g. to inflate/deflate the stomach
- For irreversible dysphagia e.g. MND
- To feed ill patients
Removal:
- Removal is warranted with recovery, or movement of the tube
- ‘Wean’ the patient by intermittent spigotting before removal, to ensure they can tolerate not having the NG
What are alternatives methods of gastric intubation instead of NG tube
- Gastrostomies placed endoscopically or surgically
- Jejunostomies placed surgically
- Nasoduodenal tubes
- percutaneous enterogastrostomy
- Define obesity
- What it its prevelence in UK?
- What are risk factors for obesity?
- Obesity is defined as:
- Class 1 = BMI 30-35 (moderate)
- Class 2 = BMI 35-40 (severe)
- Class 3 = BMI >40 (very severe/morbid)
- About 20-25% of adults in the UK are obese.
- Risk factors for obesity include:
- increased energy intake
- decreased energy expenditure
- Hypothyroidism
- Cushing’s syndrome
- Corticosteroid treatment
- hypothalamic damage
- being stupid/poor
- giving up smoking
What are clinical and social complications of obesity?
- Metabolic syndrome (diabetes, hypertension and hyperlipidemia)
- Non-alcoholic fatty liver disease & liver cirrhosis
- Restricted ventilation (sleep apnoea)
- Mechanical affects (incontinence, arthritis, varicose veins)
- Increased peripheral steroid conversion in adipose (polycystic ovary syndrome, breast/uterine cancers)
Describe main interventions used in management of obesity
- Lifestyle changes: (exercise, CV risk factors, eating behaviour modification)
- Supervised low calorie diet (600kcal deficit)
- Drugs:
- Orlistat - lipase inhibitor
- Surgery:
- Used if BMI >40 or >35 with obesity related complications
- Prodedures can be restrictive (gastric banding), malabsorptive (bilio-pancreatic diversion) or both (Roux-en-Y bypass)
