GI Tests, Procedures, and Nutrition Assessment

Flashcards generated from lecture notes on GI diagnostic tests, endoscopies, and clinical nutrition screening and assessment.

Anatomical scope of an upper endoscopy (esophagogastroduodenoscopy)

Visual examination of the upper gastrointestinal tract lining, encompassing the esophagus, stomach, and duodenum (the first portion of the small intestine).

Upper endoscopy procedure duration and patient positioning

Typically requires $10$ to $20\,\text{minutes}$ to complete, with the patient positioned lying on their left side.

Transnasal endoscopy

An alternative upper GI diagnostic procedure that passes an ultra-thin scope roughly the size of a drinking straw through the nose rather than the mouth.

Clinical indications for ordering an upper endoscopy

Unexplained upper abdominal discomfort, gastroesophageal reflux disease (GERD), persistent nausea and vomiting, upper GI bleeding, difficulty swallowing (dysphagia or strictures), abnormal imaging findings, foreign body retrieval, and tracking polyps, tumors, or ulcers.

Specific conditions diagnosed via tissue biopsy during an upper GI endoscopy

Gastrointestinal malignancies (cancer), celiac disease, and gastritis.

Stomach anatomical regions visualized during an upper endoscopy

The cardia, fundus, body, cardial notch, angular incisure, pyloric antrum, pyloric canal, and pylorus.

Anatomical scope of capsule endoscopy

Direct visualization of the middle portion of the gastrointestinal tract, specifically all three segments of the small intestine: the duodenum, jejunum, and ileum.

Technical mechanism of capsule endoscopy

The patient swallows a pill-sized capsule containing a light source and video camera; as it passes naturally through the small bowel, it captures images and wirelessly transmits them to a recording device worn on the body.

Synonymous terms for capsule endoscopy

Capsule enteroscopy and wireless capsule endoscopy.

Primary diagnostic purpose and indications for enteroscopy

Direct examination of the small intestine to evaluate conditions such as abnormal abdominal X-rays, small intestinal tumors, unexplained diarrhea, and unexplained gastrointestinal bleeding.

Potential rare complications of enteroscopy

Excessive bleeding at the biopsy site, bowel perforation (a hole in the intestine), biopsy site infection resulting in bacteremia, and vomiting with subsequent pulmonary aspiration.

Anatomical structures evaluated during endoscopic retrograde cholangiopancreatography (ERCP)

The biliary ducts (bile drainage routes from the liver), pancreatic duct (drainage channel from the pancreas), and the gallbladder.

Major duodenal papilla

The common anatomical opening located in the duodenum through which drainage ducts from the liver and pancreas empty into the small intestine.

Radiographic imaging protocol during an ERCP

A catheter is advanced through an endoscope into the major duodenal papilla, contrast material (dye) is injected into the pancreatic or biliary ducts, and fluoroscopic X-rays are taken.

Primary indications for colonoscopy

Investigating blood in the stool, unexplained abdominal pain, chronic diarrhea, persistent changes in bowel habits, or abnormal findings on colonic X-rays or CT scans.

Duration and full anatomical scope of a colonoscopy

Takes $15$ to $60\,\text{minutes}$ and examines the complete large bowel (colon), including the cecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anus.

Anatomical focus, duration, and anesthesia requirements of flexible sigmoidoscopy

Examines the rectum and lower (sigmoid) colon; takes approximately $20\,\text{minutes}$ and typically does not require anesthesia.

Procedural steps and air insufflation during flexible sigmoidoscopy

Air is inflated into the bowel to expand the intestinal wall for clearer viewing; the scope is guided to the transverse colon before being slowly withdrawn while re-examining the mucosal lining.

Gastrointestinal motility and function diagnostic tests

Esophageal motility study, gastric emptying study, and anorectal motility study.

Disease-specific diagnostic tests for gastrointestinal disorders

Liver disease panels, H. pylori testing, fecal calprotectin (for bowel inflammation), and celiac disease serological markers.

Irritable Bowel Syndrome (IBS) diagnostic classification

Classified as a 'diagnosis of exclusion' because diagnosis is established based on negative test results after ruling out organic or structural GI diseases.

ASPEN official definition for the goal of nutrition screening

To identify patients who are malnourished or at risk to become malnourished.

Definition and role of palliative nutrition therapy

Non-intensive nutrition therapy aimed at maintaining comfort, symptom relief, and quality of life rather than aggressive nutritional restoration or repletion.

Clinical findings of Hiram Studley's 1936 surgical outcome study

Demonstrated a direct link between pre-operative weight loss and surgical mortality in peptic ulcer patients: weight loss $< 20\%$ resulted in $3.5\%$ mortality, whereas weight loss $\ge 20\%$ resulted in $33.3\%$ mortality.

Iatrogenic malnutrition

Hospital-induced malnutrition coined by Butterworth ($1976$) caused by clinical oversights such as unrecorded heights/weights, prolonged simple IV fluids, unnecessary NPO status, poor interprofessional communication, delayed nutrition support, and unaddressed elevated metabolic demands.

Blackburn and Bistrian (1977) diagnostic thresholds for severe Kwashiorkor-like malnutrition

Serum albumin $< 2.1\,\text{g/dL}$, serum transferrin $< 100\,\text{mg/dL}$, total lymphocyte count $< 800\,\text{cells/mm}^3$, and delayed hypersensitivity skin test reactivity $< 5\,\text{mm}$.

Core clinical domains assessed during routine nutrition screening

Weight loss (timeframe, amount, percentage), food intake changes (appetite, digestion, food availability), physical activity/mobility alterations, psychological factors (stress, depression, acute disease), and physical metrics (BMI, weight, age).

Malnutrition Screening Tool (MST) characteristics and scoring interpretation

Validated for all adult settings regardless of age or medical history; evaluates unintentional weight loss and poor appetite; a score of $2$ or higher indicates that the patient is 'AT RISK' for malnutrition.

Mini Nutritional Assessment (MNA) target population and score ranges

Designed for adults age $65\,\text{years}$ and older; out of $14\,\text{points}$, scores $12-14$ reflect normal nutritional status, $8-11$ reflect risk of malnutrition, and $0-7$ indicate malnutrition.

Five fundamental domains of a comprehensive Nutrition Assessment

1. Food/Nutrition-Related History, 2. Anthropometric Measurements, 3. Nutrition-Focused Physical Findings, 4. Medical/Surgical Client History, and 5. Biochemical Data, Medical Tests, and Procedures.

Common outpatient dietary intake collection methodology

A $24\text{-hour}$ diet recall.

Clinical rationale for direct physical measurement during anthropometric evaluation

Patients frequently misreport their actual height and weight, making direct measurement essential for accurate assessment, diagnosis, and tracking of weight history.

Anatomical sites examined during a Nutrition-Focused Physical Exam (NFPE) for muscle and fat loss

Upper body: clavicles, shoulders, scapula, deltoids, ribs, and hands. Lower body: quadriceps, calves (gastrocnemius), and feet/ankles (also evaluated for edema).

NFPE physical inspection signs linked to specific micronutrient deficiencies

Night blindness indicates Vitamin A deficiency; petechiae indicate Vitamin C deficiency; glossitis indicates B-vitamin or iron deficiencies; severe/chronic diarrhea increases the risk of zinc deficiency.

Etiology-based adult malnutrition classifications (2010/2012 Consensus)

1. Starvation-Related Malnutrition: no inflammation present (e.g., pure chronic starvation, anorexia nervosa). 2. Chronic Disease-Related Malnutrition: mild to moderate inflammation present (e.g., organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity). 3. Acute Disease- or Injury-Related Malnutrition: marked acute inflammatory response present (e.g., major infection, severe burns, trauma, closed head injury).

Global Leadership Initiative on Malnutrition (GLIM) core principles and guiding international societies

Led by ASPEN, ESPEN, FELANPE, and PENSA ($2018$) to create a simple, universal diagnostic framework usable across high- and low-resource settings without requiring specialized nutrition training.

Required combination of criteria to establish a GLIM malnutrition diagnosis

At least $1$ Phenotypic criterion AND at least $1$ Etiologic criterion.

Phenotypic and Etiologic criteria components in the GLIM framework

Phenotypic criteria ($3$): non-volitional weight loss, low BMI, and reduced muscle mass. Etiologic criteria ($2$): reduced food intake/assimilation, and disease burden/inflammatory activity.

Criterion used to determine malnutrition severity grading under GLIM guidelines

Grading severity (Moderate vs. Severe) is based entirely on the severity of the Phenotypic criteria.

GLIM Phenotypic thresholds for Moderate vs. Severe Malnutrition grading

Weight loss: Moderate = $5-10\%$ in $6\,\text{months}$ or $10-20\%$ beyond $6\,\text{months}$; Severe = $> 10\%$ in $6\,\text{months}$ or $> 20\%$ beyond $6\,\text{months}$. Low BMI: Moderate = $< 20$ if age $< 70\,\text{years}$ or $< 22$ if age $\ge 70\,\text{years}$; Severe = $< 18.5$ if age $< 70\,\text{years}$ or $< 20$ if age $\ge 70\,\text{years}$.

Comparative distinction between GLIM and AAIM malnutrition criteria regarding BMI

GLIM includes specific age-stratified low BMI threshold cutoffs ($< 20$ or $< 18.5$ for age $< 70$; $< 22$ or $< 20$ for age $\ge 70$), whereas AAIM criteria do not incorporate low BMI cutoffs.

AAIM weight loss criteria for Moderate vs. Severe Malnutrition

Moderate: $2\%$ in $1\,\text{week}$, $5\%$ in $1\,\text{month}$, $7.5\%$ in $3\,\text{months}$, $10\%$ in $6\,\text{months}$, or $20\%$ in $1\,\text{year}$. Severe: $> 2\%$ in $1\,\text{week}$, $> 5\%$ in $1\,\text{month}$, $> 7.5\%$ in $3\,\text{months}$, $> 10\%$ in $6\,\text{months}$, or $> 20\%$ in $1\,\text{year}$.

Sequential steps in the ASPEN Adult and Pediatric Nutrition Care Pathway

Admission Screening -> Malnutrition Suspected (Yes/No) -> Nutrition Assessment -> Determine Severity -> Document -> Intervention -> Implement -> Evaluate -> Revise.

Objective functional physical metric used to document malnutrition severity

Grip strength measurement.

Recommended baseline caloric, protein, and fluid requirements for adults

Energy: $27$ to $30\,\text{kcal/kg}$ (non-acute baseline). Protein: $1.0-1.2\,\text{g/kg/day}$ for maintenance; $1.2-1.5\,\text{g/kg/day}$ up to $2.0\,\text{g/kg/day}$ for repletion/critical illness ($15-20\%$ of total calories). Fluids: $30-35\,\text{mL/kg/day}$ (approximately $3\,\text{L/day}$).

Administration limits for IV lipid emulsions (ILE) and dextrose in acute care

IV Lipid Emulsion (ILE): maximum $1.0$ to $1.5\,\text{g/kg/day}$ ($\sim 20-30\%$ of total calories). Dextrose infusion rate: maximum $5$ to $7\,\text{mg/kg/min}$ in acute/critical care.

Golden rule and Nutrition Support Toolbox for feeding route decision-making

'If the gut works, use it!' The Nutrition Support Toolbox consists of oral diet, oral supplements, enteral nutrition (EN), parenteral nutrition (PN), and combination therapies (at least $16$ possible combinations).

Stepwise escalation sequence for selecting optimal nutrition feeding routes

Oral Diet (Regular -> Modified -> Supplements) -> Enteral Nutrition (Gastric -> Small Bowel) -> Parenteral Nutrition.

Mifflin-St Jeor predictive equations for Resting Metabolic Rate (RMR)

Males: $\text{RMR (kcal/day)} = 10(\text{wt}) + 6.25(\text{ht}) - 5(\text{age}) + 5$. Females: $\text{RMR (kcal/day)} = 10(\text{wt}) + 6.25(\text{ht}) - 5(\text{age}) - 161$ (where weight is in kg, height in cm, age in years).

Activity factor multipliers applied to RMR to calculate Daily Energy Expenditure

Sedentary: $\text{RMR} \times 1.1$; Moderate: $\text{RMR} \times 1.2-1.3$; Active: $\text{RMR} \times 1.4-1.5$.

Ireton-Jones (1992) energy expenditure equations for hospitalized patients

Ventilator-dependent: $IJEE_v = 1925 - 10(A) + 5(W) + 281(G) + 292(T) + 851(B)$. Spontaneously breathing: $IJEE_s = 629 - 11(A) + 25(W) - 609(O)$ (where $A$=age in yrs, $W$=actual wt in kg, $G$=gender [male=1, female=0], $T$=trauma [1/0], $B$=burn [1/0], $O$=obesity [1/0]). No additional activity/injury factors are added.

Penn State (2004) energy prediction equation for ventilator-dependent patients

$\text{Kcal/day} = \text{MSJ}(0.96) + T_{\max}(167) + VE(31) - 6212$ (where $\text{MSJ}$ is Mifflin-St Jeor RMR, $T_{\max}$ is maximum body temperature in °C over past $24\,\text{hours}$, and $VE$ is minute ventilation in L/min).

Gold standard method for measuring resting energy expenditure according to ASPEN and ESPEN

Indirect Calorimetry (IC).

Abbreviated Weir Equation used in indirect calorimetry

$\text{REE (kcal/day)} = [3.941(VO_2) + 1.106(VCO_2)] \times 1.44$ (where $VO_2$ is oxygen consumption in mL/min and $VCO_2$ is carbon dioxide production in mL/min).

Respiratory Quotient (RQ) formula and clinical utility

Formula: $RQ = \frac{VCO_2}{VO_2}$. Used to assess energy substrate utilization (carbohydrate, protein, fat) and verify measurement accuracy during indirect calorimetry testing.

Standardized patient preparation requirements for accurate Indirect Calorimetry testing

The patient must be awake, resting in a supine position, at least $2\,\text{hours}$ after a meal (unless receiving continuous nutrition support), and at least $60\,\text{minutes}$ following strenuous physical activity or therapy.

Clinical conditions and technical limitations that invalidate Indirect Calorimetry results

High-frequency mechanical ventilation, chest tubes with air leaks, high inspired oxygen fraction ($FiO_2 > 60\%$), incompetent or missing tracheostomy cuffs, inconsistent inspired oxygen delivery, and unskilled operator technique.