3.1 Malnutrition
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- Created by: amyloucook3
- Created on: 18-10-19 15:16
Superior abdominal boundary
diaphragm, under cover of thoracic cage extending to 4th ics
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Inferior abdominal boundary
pelvic inlet
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Anterolateral abdominal boundary
musculo-aponeurotic abdominal wall, helps protect viscera
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Posterior abdominal boundary
lumbar vertebrae, deep back muscles
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Linea alba
diploid process and pubic synthesis, skin groove, white fibrous struture
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Umbilicus
landmark for dermatome T10, L3-L4
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Rectus Abdominous
either side of linea alba , strap muscle, has tendinous intersections
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Linea semilunaris
lateral
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Inguinal groove
skin folds that overlies inguinal ligament
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Right Hypochondriac Viscera
Pylorus of stomach, part of right lobe of liver, gall bladder, right kidney
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Epigastric Viscera
Liver, stomach, duodenum, pancreas
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Left hypochondriac Viscera
Stomach, left kidney
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Right Lumbar Viscera
Ascending colon
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Umbilical Viscera
small intestines
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Left Lumbar Viscera
Descending colon
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Right Inguinal Viscera
Caecum, appendix
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Hypogastric (Pubic/suprapubic) viscera
Sigmoid colon
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Left inguinal viscera
descending colon
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Superior to umbilicus lymphatic drainage
axillary lymph nodes
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Inferior to umbilicus lymphatics drainage
superficial inguinal lymph nodes
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T7-T9 dermatomes
supply skin superior to umbilicus
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T10 Dermatome
Umbilicus
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T11-T12 Dermatome
Iliohypogastric (L1) and Ilioinguinal (L1) supply skin below umbilicus
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L1 dermatome
suprapubic region
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Peritonitis
inflammation of peritoneum, arises from bacterial infection or chemical irritation. May give rise to excess fluid that accumulates (ascites)
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Mesentery
double fold of peritoneum, contains neuromuscular structures, attaches thine together
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greater omentum
attaches greater curvature of stomach and 1st part of duodenum to transverse colon. Made up of gsatrophrenic, gastrosplenic and gastrocolic ligament
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Lesser omentum
attaches lesser curvature to liver, has free edge (omental foramen), contains portal triad
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function of abdominal wall
Support anterolateral wall, Protect viscera from injury, Compress viscera to maintain or increase abdominal pressure (i.e. coughing, burping, yelling, Produce force for defaecation, micturition, vomiting, parturition, Anterior & lateral flexion
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Rectus Sheath
Made of aponeurosis of the transversus abdominals, internal and extremal oblique
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Rectus sheath contains...
rectus abdominis and pyramidalis mm, Anastomosing sup and inf epigastric aa & vv, Lymphatic vessels, Distal portions of the ant rami of spinal nerves T7-T12
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Foregut Derivtives
Oesophagous, stomach, duodenum (superior and 1/2 descending part), liver and extra hepatic biliary system, pancreas
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Foregut derivative blood supply
Coeliac Trunk
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Midgut Derivatives
duodenum (descending distal and the rest), jejunum, ileum, caecum, appendix, ascending colon, proximal 2/3 of transverse colon
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Midgut derivatives blood supply
Superior mesenteric artery
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Hindgut derivatives
distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum, upper part of anal canal
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Hindgut derivative blood supply
Inferior mesenteric artery
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Duodenum Formation
Terminal foregut & proximal midgut, C-shaped form as stomach rotates, Retro-peritoneal, As stomach rotated the duodenum takes the form of a C-shape
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Atresia
Complete absence of a lumen Needs surgery
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Stenosis
Narrowing of the lumen
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90˚counterclockwise rotation only - left sided colon
Large intestine on left hand side, Can see on x ray
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Reversed rotation of intestinal loop (90˚ clockwise)
Duodenum is anterior to transverse colon and SMA, Can compromise blood supply to midgut derivatives
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anterior abdominal wall defect
Intra-abdominal contents (intestines and/or organs) herniate through abdominal wall
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Nutrition
The provision of nourishment to cells, tissues, organs, systems and the body as a whole.
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Nutrient Turnover
metabolic substrates continually been utilised and replaced, allows for rapid adjustment in changes to metabolic state when there is synthesis or loss
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Nutrient flux
through a metabolic pathway is measure of activity of pathway, not necessarily related to size of metabolic pool
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Metabolic pools - Functional
direct involvement in body function(s)
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Metabolic pool- storage
provides buffering effect - can be made into functional pool when needed
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Metabolic Pool - Precursor
provide the substrate for nutrient/metabolite synthesis
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glycemic index (GI)
allows comparison of blood glucose responses to ingestion of CHOs from different foods relative to pure glucose (GI=100)
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Low GI foods
(<55): e.g. Muesli, legumes, oats, fructose, apples (38)
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High GI Foods
(>70): e.g. white bread (73), instant mashed potatoes (85), linked with T2D
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Recommendations of CHO
~50% of dietary energy, >5% from free sugars
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Vitamins
organic substances required in small amounts for normal metabolism, but can't be synthesised
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Water soluble vitamins
B and C
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Fat Soluble Vitamins
A, D, E, K
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Water Soluble- Intermediary Metabolism
Thiamin, Nicotinic acid, Riboflavin, Pantothenic acid
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Water Soluble vitamins - antioxidants
Vitamin and E
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Water soluble - Anaemia preventing
B12 and folate
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Positive energy balance
development of obesity, growth, pregnancy, recovery from depletion
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Negative energy balance
wasting disease, anorexia, starvation, voluntary weight loss
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Basal or resting metabolic rate (BMR)
accounts for 60-70% of total energy expenditure, heart and respiratory account for 10% of BMR, protein turnover 25%
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Energy expenditure of physical activity (EEA)
accounts for 25%- 30% of energy expenditure
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Diet induced thermogenesis (DIT)
Increased in metabolic rate after a meal, accounts for ~10% of energy expenditure
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Nutrient stores
energy intake - energy expenditure
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E.A.R
estimate average requirement, if all have the same 1/2 under and 1/2 overfed
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R.N.I
reference nutrient intake, meets or exceeds needs of 97.5% of group
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Recommended dietary composition
CHO ~ 50% (<5% free sugar), 30g fibre, Fat <35%, Protein ~15-20%
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PAL
overall physical activity level, ratio of total energy expenditure to BMR
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Factors affecting energy requirements
resting metabolism (size, growth, age, food), physical activity
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to estimate energy requirements
predict basal energy expenditure, multiply by activity factor, may increase in illness and trauma
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Women's estimates energy requirements
RMR = 13.1 x weight + 558
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Men's estimated energy requirements
RMR= 16 x weight + 545
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Adults protein R.N.I
0.8g Protein/kg/day (1 egg = 6-7g)
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Health
complete state of physical, mental and social wellbeing and not nearly the absence of disease of infirmity
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wellbeing
how we feel in ourselves, includes quality of life, good physical and mental health and being part of communities
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demographic transition
as societies become industrialised death rate falls due improvement in sanitation and healthcare. Birth rate initially stay high, later social changes and contraception decrease birth rate, which leads to ageing population
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epidemiological transition
as society develops, infectious diseases and malnutrition decline, but non-commutable chronic diseases rise, shift in mortality from young to high
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Primary prevention
actions to prevent the occurrence of problem. e.g. education, immunisation, lifestyle
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secondary prevention
actions to detect and treat occurrence if problem before systems develop, e.g. screening
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Tertiary Prevention
action to limit disability once symptoms have developed, e.g. rehabilitation
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Targeted High Risk Strategy
for someone who is at risk, greater capacity for individual benefit, better compliance, low population level impact
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Population (Universal) Strategy
encourage whole population to eat healthy diet, shifts while population risk small amount, individuals who directly change behaviour who might nor benefit directly
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Risk Factors for CVD
obesity (weight around waist worse), diabetes, diet, smoking, ack of physical exercise
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Dietary requirements for CVD
decrease salt intake (>6g), Mediterranean diet, increase fibre, exercise
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DASH Diet
Dietary approaches to stop hypertension, high in fruit and veg and NSP, low fat diary produce and reduced red meat, increase K, Ca, Mg and fibre, reduce Na
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Hypercholesterolaemia
small increase in LDL-C, increased risk of atheroma
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Saturated Trans Fats
increase LDL-C levels, associated with increased CV Risk
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soluble NSPs
decrease in LDL-C, bind bile salts and prevent reuptake, reduced risk of CVD
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Phytosterols (Stanols)
plant derived, inhibit absorption of cholesterol (and uptake)
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Obesity
abnormal or excessive body fat accumulation to extent that health may be impaired
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BMI for obesity
>30%
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TOFI - thin outside fit inside
o Could look lean but could have lots of visceral fat, could be lots of subcutaneous fat and less visceral fat o Visceral fat increases the risk for diabetes, CVD and some cancers
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MUST (Malnutrition Universal Screening Tool)
Main questions: • Have you unintentionally lost weight recently? • Have you been eating less than usual? • What is your normal weight? • How tall are you?
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Other cards in this set
Card 2
Front
pelvic inlet
Back
Inferior abdominal boundary
Card 3
Front
musculo-aponeurotic abdominal wall, helps protect viscera
Back
Card 4
Front
lumbar vertebrae, deep back muscles
Back
Card 5
Front
diploid process and pubic synthesis, skin groove, white fibrous struture
Back
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