Nutrition - 229

Question 1

State 5 consequences of malnutrition on the body and how this could increase mortality

Answer 1

1) Decreased muscle mass -> cardiac failure
2) Decreased visceral proteins -> respiratory failure
3) Impaired immunity -> infection
4) Impaired wound healing -> pressure sores, wound breakdown
5) Multiple organ failure!

Question 2

Name 3 methods of nutritional support

Answer 2

Eating more
Food supplements
Artificial support, e.g. parenteral & enteral feeding

Question 3

What is enteral feeding?

Answer 3

It delivers nutritionally complete food straight into the stomach, duodenum or jejunum.

Question 4

Name one requirement before you can feed someone enterally

Answer 4

They must have a functioning gut

Question 5

Name 3 indications for enteral feeding

Answer 5

Unable to meet caloric requirements with normal food,

unintentional weight loss of >10% within 3/12, hypermetabolic state

Question 6

Name 3 advantages of enteral feeding

Answer 6

1) Nutrients used more effectively
2) Preserves intestinal mucosal structure
3) Prevents biliary sludge
4) Comfortable
5) Independent of swallowing problems/appetite

Question 7

What is parenteral feeding?

Answer 7

Intravenous feeding, either centrally or peripherally

Question 8

Name 2 indications for parenteral feeding

Answer 8

Non-functioning gut

Gut rest required (e.g. post op)

Question 9

Name some complications of parenteral feeding

Answer 9

Line sepsis, thrombophlebitis, fluid overload, hyperglycaemia, re-feeding syndrome

Question 10

What is the most abundant free amino acid in the body? What is it important for?

Answer 10

Glutamine

Nitrogen metabolism, enterocytes, gut mucosa, immune cells, acid-base balance

Question 11

What proteins/vitamins/minerals deplete during starvation?

Answer 11

Protein, K, P, Mg, Zn, Thiamine

Question 12

Phosphate and magnesium levels both deplete during starvation - what is the relevance of this?

Answer 12

They are needed for ATP production

Question 13

What is thiamine used for?

Answer 13

Carbohydrate metabolism

Question 14

Refeeding leads to what kind of movement?

Answer 14

Intracellular

Question 15

What transports glucose, K, Mg, and P into cells during refeeding syndrome? What does this lead to?

Answer 15

Insulin.

Oedema

Question 16

What do you monitor daily in someone who you think is at risk of refeeding syndrome?

Answer 16

Na, K, urea, creatinine, Mg, P.

Question 17

What is the most common cause of short bowel syndrome?

Answer 17

Surgical removal

Question 18

In newborns, what is one of the most common causes of surgical removal of bowel resulting in SBS?

Answer 18

Nectrotizing enterocolitis -> ischaemia and necrosis of the GI tract.

Question 19

What happens immediately following jejunal resection? How is this then fixed?

Answer 19

Temporary decrease in nutrient absorption. Functional adaptation takes place and the ileum adapts to increase absorption

Question 20

What hormone is an important regulator of intestinal epithelial differentiation?

Answer 20

Thyroid hormone

Question 21

What happens to the ileum following jejunal resection?

Answer 21

The villi increase in length, diameter and function -? epithelial hyperplasia.

Question 22

What is essential for stimulating ileal adaptation?

Answer 22

The delivery of nutrients enterally

Question 23

Are ghrelin levels high or low in patients with SBS?

Answer 23

Low

Question 24

The administration of what aa enterally increases ileal adaptation? (following jejunal resection)

Answer 24

Sulphur amino acids

Question 25

What protein stimulates villus hyperplasia in the ileum within 4 days of jejunal resection?

Answer 25

GLP-2

Question 26

Ileal resection will result in deficiency of what?

Answer 26

B12 and imparied absorption of A,D,E and K

Question 27

What is the ileal brake thought to be triggered by? And what is thought to control it?

Answer 27

Triggered by fats, controlled by peptide YY