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Malnutrition

Definition
  • A state resulting from lack of intake or uptake of nutrition, leading to altered body composition and diminished function.
Types
  • Protein-energy malnutrition: Marasmus (chronic energy deficiency) and kwashiorkor (protein deficiency with energy excess).
  • Specific nutrient deficiencies: Vitamins, minerals, trace elements.
Causes (Gastroenterological)
  • Chronic liver diseases (cirrhosis, hepatitis).
  • Malabsorptive conditions (Coeliac disease, Crohn’s disease, chronic pancreatitis).
  • Gastrointestinal malignancies.
  • Gastrointestinal fistulas.
  • Short bowel syndrome (post-surgical).
  • Chronic alcoholism.
  • Inflammatory bowel disease.
  • Chronic gastrointestinal infections (e.g., giardiasis).
Clinical Features
  • Weight loss and wasting.
  • Muscle atrophy.
  • Edema (especially in kwashiorkor).
  • Anaemia.
  • Weakness and fatigue.
  • Depression and apathy.
  • Specific deficiency signs (e.g., glossitis in B vitamin deficiency).
Investigations
  • Blood tests: Full blood count, electrolytes, liver and renal function, vitamin levels, albumin, prealbumin.
  • Dual-energy X-ray absorptiometry (DEXA) scan: To assess bone density.
  • Endoscopy and colonoscopy if malabsorptive conditions are suspected.
  • Stool tests for malabsorption (faecal fat).
  • Imaging: Abdominal ultrasound, CT, or MRI.
Management
  • Dietary interventions: Tailored to individual needs, fortified foods, oral nutritional supplements.
  • Enteral nutrition: Nasogastric or nasoenteric feeding for those who cannot consume sufficient nutrients orally but have a functioning GI tract.
  • Parenteral nutrition: For patients with non-functioning or inaccessible GI tract.
  • Treating underlying cause (e.g., gluten-free diet for coeliac disease).
Complications
  • Immunodeficiency leading to infections.
  • Osteoporosis and fractures.
  • Organ dysfunction (e.g., cardiac, respiratory, renal).
  • Wound healing impairment.
  • Mental changes, including irritability and depression.

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