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Guidelines
Guidelines for Artificial Nutrition Support
Introduction
One third of hospital patients are affected by
moderate or severe malnutrition. Malnutrition impairs immunity, organ
and muscle function; it results in weak mus-cles that fatigue more
readily, including muscles of respiration and locomotion. Malnourished
patients are withdrawn and apathetic and are less able to co-operate in
their management. The restoration of body tissues occurs much more
slowly than weight loss, especially in ill or septic pa-tients. Studies
have demonstrated in-creased morbidity and mortality in malnourished
patients, and malnutrition is associated with prolonged hospital stay 4.
Conversely nutritional support under these circumstances has resulted in
reduced morbidity, mortality and hospital stay.
Gastroenterologists (physicians and surgeons) are
responsible for the management of patients with intestinal failure, the
placement of percutaneous enteral feeding devices, and they are
increasingly involved in the organisation of nutrition support services
within the hospital. Consequently gastroenterologists must be able to
identify malnourished patients and those at nutritional risk, arrange
appropriate nutritional intervention, supervise and monitor treat-ment
in the hospital, and when indicated in the home.
Examples of patients who need nutritional assessment
include: those with gastrointestinal disease (inflammatory bowel
disease, chronic liver disease, cystic fibrosis, and some
gastrointestinal malignancies), patients with swallowing disorders
(chronic neurological disease and oropharyngeal disorders), and patients
with severe anorexia.
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