Clinical nutrition : malnutrition in intestinal disease.

Dr Andrew Tomkins lectures on malnutrition in patients with gastrointestinal disease which, after surgery, frequently leads to impaired wound healing and a susceptibility to infection. Other effects of malnutrition can lead to an imbalance of electrolytes and trace-elements as well as anaemia, but the main problem is often protein-energy malnutrition resulting from an inadequate intake of calories. Tomkins shows how the severity of malnutrition can be assessed and how severe malnutrition should be managed by intensive prevention measures in at-risk cases and an elemental diet or parenteral nutrition in already established cases. 5 segments.

Dr Andrew Tomkins lectures on malnutrition. He shows how it is common among patients with gastrointestinal disease and can lead to impaired wound healing and a susceptibility to infection. Other effects of malnutrition can lead to an imbalance of electrolytes and trace-elements as well as anaemia, but the main problem is often protein-energy malnutrition. This results from either an inadequate availability or volitional intake of calories. Tomkins shows how the severity of malnutrition can be assessed and how severe malnutrition should be managed by intensive prevention measures in at-risk cases and an elemental diet or parenteral nutrition in already established cases.

London : University of London Audio-Visual Centre, 1977.

1 encoded moving image (28.47 min.) : sound, black and white.

00:28:47

University of London

Unrestricted

CC-BY-NC

Creative Commons Attribution-Non-Commercial 2.0 UK: England & Wales

In English

Presented by Dr Andrew Tomkins, Department of Human Nutrition, London School of Hygiene and Tropical Medicine. Made for British Postgraduate Medical Federation. Made by University of London Audio-Visual Centre.

This video is one of around 310 titles, originally broadcast on Channel 7 of the ILEA closed-circuit television network, given to Wellcome Trust from the University of London Audio-Visual Centre shortly after it closed in the late 1980s. Although some of these programmes might now seem rather out-dated, they probably represent the largest and most diversified body of medical video produced in any British university at this time, and give a comprehensive and fascinating view of the state of medical and surgical research and practice in the 1970s and 1980s, thus constituting a contemporary medical-historical archive of great interest. The lectures mostly take place in a small and intimate studio setting and are often face-to-face. The lecturers use a wide variety of resources to illustrate their points, including film clips, slides, graphs, animated diagrams, charts and tables as well as 3-dimensional models and display boards with movable pieces. Some of the lecturers are telegenic while some are clearly less comfortable about being recorded; all are experts in their field and show great enthusiasm to share both the latest research and the historical context of their specialist areas.

Segment 1 Tomkins speaks to camera and describes how common malnutrition can be in patients with severe gastrointestinal disease. He begins by looking at a table which lists the physiological changes that occur during malnutrition, then a further table listing the kinds of intestinal disease that might lead to nutritional disorders; he separates these into three types: protein-energy malnutrition, anaemia and electrolyte / trace element deficiencies. He begins with protein-energy malnutrition and describes how whole body protein should best be measured. Time start: 00:00:00:00 Time end: 00:06:39:00 Length: 00:06:39:00

Segment 2 To show how malnutrition in intestinal disease affects growth, Tomkins shows graphs detailing the physiological development of a young man with Crohn's disease; his malnutrition meant that he had hardly grown between the ages of 11 and 17. Tomkins goes on to show how a patient might develop malnutrition. He shows an illustration detailing normal food absorption levels and then explains the various reasons that these levels may not be met in a person with an intestinal disease. He emphasises the importance of a trained dietician in helping to control the malnutrition. Time start: 00:06:39:00 Time end: 00:12:22:00 Length: 00:05:43:00

Segment 3 Tomkins shows a graph comparing amino acid and nitrogen absorption in normal and ill patients. He returns to the case discussed earlier of the young man with Crohn's diesase - in addition to his malnutrition due to lack of intestinal absorption, he was also not given enough calories to help his body fight off the fever and infection he suffered following surgery. He describes other ways in which the body, when unwell, needs more calories than normal in order to avoid malnutrition. Time start: 00:12:22:00 Time end: 00:18:08:00 Length: 00:05:46:00

Segment 4 Tomkins shows a graph detailing levels of protein loss from abnormal excretions which occur during intestinal disease - much larger quantities than normal of protein are found in faecal samples. Tomkins goes on to discuss a patient with stagnant loop syndrome. He describes the diagnosis of the condition, and focuses particularly on the high levels of albumin secretion in the patient, leading to malnutrition. Time start: 00:18:08:00 Time end: 00:22:43:00 Length: 00:04:35:00

Segment 5 Tomkins concludes the lecture by considering the management of nutrition in patients with gastrointestinal disease. He believes it is essential to diagnose and treat prophylactically, particularly in post-operative periods. He advocates the use of elemental diet and shows a diagram detailing the recovery rates of patients put on an elemental diet following gastrointestinal surgery compared with those who were not. Tomkins believes that the mortality rate of those suffering from intestinal disease could be avoided if malnutrition were diagnosed and treated more efficiently. Time start: 00:22:43:00 Time end: 00:28:47:09 Length: 00:06:04:09