Nutrition

Question 1

Reasons hospital patients become malnourished

Answer 1

1. +requirements
2. +losses
3. Decrease intake
4. Missed ooportunity
5. Treatment->NV
6. Enforced starvation
7. Difficulty with feeding
8. Unappetising food

Question 2

Assessment of malnourished

Answer 2

1. History
Weight loss
Reduced intake
Diet change
NVD
2. Examination
Hydration
Skin thickness
Hair rough, wiry, pressure sores
BMI
Grip strength
Edema
temporalis, deltoids, suprascapular 
and infrascapular muscles,  the bellies of biceps and triceps and the interossei of the hands
If tendons palpable, bony shoulder girdle-
loss of 30% total protein stores
3. Investigations
Generally unhelpful
Low albumin
Metabolic stress: +T, +WCC, blood cultures, infection

Question 3

Management of malnutrition in hospital

Answer 3

1. Identify those at risk, ensure meals available when hungry
2. Feed orally when can, consider NGT before IV
3. Need input from dietician
4. Build up feeds gradually
5. Weigh weekly, check BG and electrolytes
6. Treat underlying conditions

Question 4

Indications for TPN

Answer 4

1. Gut obstructed
2. Gut short
3. Gut fistulated
4. Gut inflamed
5. Gut cannot cope
6. When unlikely to improve >7 days

Question 5

Pathophysiology of malnutrition in sepsis and trauma

Answer 5

Sepsis and trauma–>
1. protein stores not preserved and used as gluconeogenic precursors
2. In burns++protein catabolism, ++energy expenditure +free fatty acid oxidation
3. Ongoing protein metabolism >1 month post surgery
Due to +TNFs,
IL-6,8–> also have role in
anorexia, pyrexia, fatigue, fat catabolism

Question 6

Negatives of not providing enteral nutrition

Answer 6

atrophy, -ve barrier function,
bacteria and toxin translocation-
ay lead to SIRS, sepsis and
multiorgan failure.
Also impairs absortion and
then when food represented
cannot digest

Question 7

Risks of enteral nutrition in surgical

Answer 7

Aspiration

Question 8

Complications of TPN

Answer 8

1. Line placement->pneumothorax, hemothorax
2. Infections
3. Hyperglycemia
4. ++Morbidity and mortality
5. Hepatic dysfunction
6. Abnormal electrolytes, vitamine, fatty acids and trace elements

Question 9

Reviewing patient with TPN

Answer 9

1. Review fluid balance twice daily
2. Check weight, fluid balance, urine glucose daily
3. UEC, glucose, FBC daily until stable
4. Do not rush
5. Treat underlying conditions