Clinical evaluation

Clinical evaluation

Clinical assessment of nutritional status should begin by consideration of any important symptoms that may suggest malnutrition. Upper abdominal symptoms such as nausea and vomiting, early satiety , dysphagia, reflux or bloating as well as lower gastrointestinal symptoms of diarrhoea or constipation can all indicate inadequate nutritional intake or absorption. A thorough assessment of the past medical history and comorbidities is also essential in assessing nutritional status, as conditions such as cancer, gastrointestinal pathologies (e.g. inflammatory bowel disease and liver disease) and neurological conditions (e.g. stroke , Parkinson’s disease and dementia) can all contribute to a ff ect nutritional status. Nutrient absorption can be impaired by conditions directly a ff ecting the bowel such as short bowel syndrome, high-output stoma and enterocutaneous fistulae, and also by disorders more proximally in the gastrointestinal tract such as pancreatic insu ffi ciency , in which absorption is impaired because of a lack of pancreatic enzyme secretion into the bowel. These conditions and the appropriate management are dealt with in the relevant chapters in this book. James Parkinson , 1755–1824, general practitioner of Shoreditch, London, UK, published The total daily calorie intake of an individual can be estimated via a diary of their food and fluid intake, taking into account the quality of the food or fluid consumed. For patients who are unwell, this needs to take into account any di ff erences in current food and fluid consumption compared with their 2 typical intake when well. Their caloric intake can be assessed against their calculated energy requirements, estimated with the calculation of 25–35 /uni00A0 kcal/kg lean body weight and taking into account any metabolic stresses and activity level. Patients whose caloric intake falls short of their caloric requirements or who are anticipated to eat little or nothing for over 5 continuous days in the near future (e.g. owing to upcoming abdominal surgery) are likely to requir e nutritional support. The Malnutrition Universal Screening Tool (MUST), developed by the British Association for Parenteral and Enteral Nutrition (BAPEN), is a rapid screening tool that can be used in both hospitals and the community , and takes into account a combination of the above factors to identify those individuals a t risk of malnutrition ( Figure 25.2 ). Patients who are found to be likely to be malnourished require referral to a dietician or nutritional support team, with regular reviews to ensure sus - tained improvement in nutritional status. - Clinical evaluation

Clinical assessment of nutritional status should begin by consideration of any important symptoms that may suggest malnutrition. Upper abdominal symptoms such as nausea and vomiting, early satiety , dysphagia, reflux or bloating as well as lower gastrointestinal symptoms of diarrhoea or constipation can all indicate inadequate nutritional intake or absorption. A thorough assessment of the past medical history and comorbidities is also essential in assessing nutritional status, as conditions such as cancer, gastrointestinal pathologies (e.g. inflammatory bowel disease and liver disease) and neurological conditions (e.g. stroke , Parkinson’s disease and dementia) can all contribute to a ff ect nutritional status. Nutrient absorption can be impaired by conditions directly a ff ecting the bowel such as short bowel syndrome, high-output stoma and enterocutaneous fistulae, and also by disorders more proximally in the gastrointestinal tract such as pancreatic insu ffi ciency , in which absorption is impaired because of a lack of pancreatic enzyme secretion into the bowel. These conditions and the appropriate management are dealt with in the relevant chapters in this book. James Parkinson , 1755–1824, general practitioner of Shoreditch, London, UK, published The total daily calorie intake of an individual can be estimated via a diary of their food and fluid intake, taking into account the quality of the food or fluid consumed. For patients who are unwell, this needs to take into account any di ff erences in current food and fluid consumption compared with their 2 typical intake when well. Their caloric intake can be assessed against their calculated energy requirements, estimated with the calculation of 25–35 /uni00A0 kcal/kg lean body weight and taking into account any metabolic stresses and activity level. Patients whose caloric intake falls short of their caloric requirements or who are anticipated to eat little or nothing for over 5 continuous days in the near future (e.g. owing to upcoming abdominal surgery) are likely to requir e nutritional support. The Malnutrition Universal Screening Tool (MUST), developed by the British Association for Parenteral and Enteral Nutrition (BAPEN), is a rapid screening tool that can be used in both hospitals and the community , and takes into account a combination of the above factors to identify those individuals a t risk of malnutrition ( Figure 25.2 ). Patients who are found to be likely to be malnourished require referral to a dietician or nutritional support team, with regular reviews to ensure sus - tained improvement in nutritional status. - Clinical evaluation

Clinical assessment of nutritional status should begin by consideration of any important symptoms that may suggest malnutrition. Upper abdominal symptoms such as nausea and vomiting, early satiety , dysphagia, reflux or bloating as well as lower gastrointestinal symptoms of diarrhoea or constipation can all indicate inadequate nutritional intake or absorption. A thorough assessment of the past medical history and comorbidities is also essential in assessing nutritional status, as conditions such as cancer, gastrointestinal pathologies (e.g. inflammatory bowel disease and liver disease) and neurological conditions (e.g. stroke , Parkinson’s disease and dementia) can all contribute to a ff ect nutritional status. Nutrient absorption can be impaired by conditions directly a ff ecting the bowel such as short bowel syndrome, high-output stoma and enterocutaneous fistulae, and also by disorders more proximally in the gastrointestinal tract such as pancreatic insu ffi ciency , in which absorption is impaired because of a lack of pancreatic enzyme secretion into the bowel. These conditions and the appropriate management are dealt with in the relevant chapters in this book. James Parkinson , 1755–1824, general practitioner of Shoreditch, London, UK, published The total daily calorie intake of an individual can be estimated via a diary of their food and fluid intake, taking into account the quality of the food or fluid consumed. For patients who are unwell, this needs to take into account any di ff erences in current food and fluid consumption compared with their 2 typical intake when well. Their caloric intake can be assessed against their calculated energy requirements, estimated with the calculation of 25–35 /uni00A0 kcal/kg lean body weight and taking into account any metabolic stresses and activity level. Patients whose caloric intake falls short of their caloric requirements or who are anticipated to eat little or nothing for over 5 continuous days in the near future (e.g. owing to upcoming abdominal surgery) are likely to requir e nutritional support. The Malnutrition Universal Screening Tool (MUST), developed by the British Association for Parenteral and Enteral Nutrition (BAPEN), is a rapid screening tool that can be used in both hospitals and the community , and takes into account a combination of the above factors to identify those individuals a t risk of malnutrition ( Figure 25.2 ). Patients who are found to be likely to be malnourished require referral to a dietician or nutritional support team, with regular reviews to ensure sus - tained improvement in nutritional status. -