Week 229 - Nutrition

Question 1

What indications are there for enteral feeding?

Answer 1

• 1st Line in the malnourished
• Unable to meet nutritional requirements with diet
• Unintentional weight loss
• Functioning gut
• Hypermetabolic state
• Anorexia owing to disease state

Question 2

What indications are there for parenteral feeding?

Answer 2

• Non-functioning, inaccessible or perforated gut
• Gut rest required
• Metabolic stress or anticipated prolonged duration (>3/7)
• Inadequate or unsafe oral/enteral feel

Question 3

List indications for short-term parenteral feeding

Answer 3

mucositis from chemo
severe pancreatitis; IBD
multi-organ failure; post-op period (abdo)

Question 4

List indications for long-term parenteral feeding

Answer 4

intestinal atresia; CD; radiation enteritis; motility disorders e.g. scleroderma; extreme short-bowel

Question 5

Name 3 types of enteral feeding and when you might use each

Answer 5

Supplements - simple lack of certain dietary elements
NG - dysphagia; critically ill; poor voluntary intake
PEG -unable to tolerate; chronic neurological condition; stroke - dysphagia >4wks; head& neck malignancy

Question 6

Name the 2 types of feed available via NG tube

Answer 6

Elemental (partially broken down / digested - foul smelling and tasting)
Semi-elemental e.g. Modulen

Question 7

List some advantages of enteral feeding

Answer 7

• Preserves intestinal mucosa
• Comfortable and readily accepted
• Independent of appetite/swallowing ability
• simple to administer day/night
• inexpensive
• Nut. effectively mobilised

Question 8

List 3 complications of enteral feeding

Answer 8

GORD
Poor gastric emptying
Diarrhoea

Question 9

List 3 complications of parenteral feeding

Answer 9

• line sepsis -thrombophlebitis
• fluid overload -hyperglycaemia
• electrolyte imbalance -re-feeding syndrome
• liver dysfunction -osteoporosis

Question 10

What is the advantage of a tunnelled central venous catheter?

Answer 10

↓ risk of infection reaching blood

Question 11

Why is glutamine an important part of enteral/parenteral feeds?

Answer 11

The most abundant amino acid in the body.

Central role in nitrogen metabolism. Most important fuel for: enterocytes, gut mucosa and immune cells

Question 12

List some risks factors for re-feeding syndrome when introducing supplementary nourishment to someone

Answer 12

Low BMI; little or no intake for >5days; unintentional weight loss >10 over 3-6months; Low K, Mg, PO prior to feeding; Hx of alcohol abuse; use of meds inc insulin, antacids, diuretics or chemo

Question 13

What 3 things in should you monitor particularly closely in an individual started on TPN?

Answer 13

Catheter site - for infection

LFTs and U&Es

Question 14

List some absolute contraindications for PEG placement

Answer 14

Contraindication to OGD

Inability to transilluminate

Question 15

List some relative contraindications for PEG placement

Answer 15

coagulopathy; unlikely to survive >30 days; inflammatory or neoplastic conditions of stomach/abdo wall; gastric varices; morbid obesity; ascites; CAPD

Question 16

Describe briefly what occurs in re-feeding syndrome

Answer 16

Starvation: body breaks down proteins and fats for energy > insulin levels deplete; phosphate stores deplete
On refeeding: insulin levels increase > cellular phosphate uptake increases > hypophosphataemic state > mostly responsible for features of the syndrome

Question 17

List some features of refeeding syndrome

Answer 17

• Rhabdomyolysis - ↓ RBCs and WCC function
• Respiratory insufficiency - Arrhythmias
• Cardiogenic shock - Seizures
• Sudden Death