Clinical Biochemistry Nutrition

Module details

Title

Clinical Biochemistry Nutrition

Type

Specialist

Module code

SLS141

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with the knowledge and understanding of normal nutrition and clinical disorders associated with malnutrition, malabsorption and obesity. Trainees will understand the normal biochemistry of haem synthesis, haematinics and contribute to the investigation of anaemia. They will be able to describe the role of trace elements and vitamins and clinical conditions associated with deficiency or excess. They will be able to assess energy balance and understand enteral and parenteral nutrition. They will appreciate the importance of clinical and biochemical parameters in diagnosing and managing nutritional disorders. In the work-based module they will be expected to apply this knowledge as they learn to perform assays to assess nutritional status using a range of methods and gain experience of the interpretation of results in a range of clinical conditions.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1,2,3,4,6	Competency Perform the analyses to laboratory standard operating procedures: tests of malabsorption exocrine pancreatic function tests amylase/lipase.	Action View
# 2	Learning outcome 1,4	Competency Perform the analyses to laboratory standard operating procedures: haematinics (B12, folate) iron ferritin transferrin saturation (iron-binding capacity).	Action View
# 3	Learning outcome 1,4	Competency Perform the analyses to laboratory standard operating procedures: porphobilinogen (PBG) porphyrin screen (qualitative) porphyrins (quantitative).	Action View
# 4	Learning outcome 1,5	Competency Perform at least three of the following analyses (following observation of analysis performed by practitioner): caeruloplasmin copper zinc manganese selenium lead aluminium mercury.	Action View
# 5	Learning outcome 1,5	Competency Perform at least two of the following analyses (following observation of analysis performed by practitioner): vitamin A vitamin E vitamin B1 vitamin B2 vitamin B6.	Action View
# 6	Learning outcome 1,2,3,4,5	Competency Identify cases that require urgent intervention and offer clinical advice on the follow-up and/or further management of the patient.	Action View
# 7	Learning outcome 7	Competency Interpret biochemical data in light of the clinical details.	Action View
# 8	Learning outcome 7	Competency Draft written reports on patients.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform a quantitative analysis of PBG and interpret results	DOPS
Interpret an external quality assurance report for haematinics porphyrins	DOPS
Identify samples which require routine referral to an external laboratory for analysis	DOPS
Perform tests of exocrine pancreatic function	DOPS
Perform laboratory tests for malabsorption	DOPS
Prepare an internal QC sample for a haematinics assay perform assay and interpret results including reference to haematological results	DOPS
Identify, refer and report samples which require urgent analysis at an external laboratory	DOPS
Perform a porphrin screen qualitative	DOPS
Perform porphyrin analysis quantitative	DOPS
Perform laboratory tests for the investigation of haemochromatosis	DOPS
Perform trace element analysis	DOPS
Perform vitamin analyses	DOPS
Explain to a patient the sample collection requirements for investigation of porphyria	OCE
Discuss the laboratory aspects of investigation of nutritional deficiencies with healthcare professionals	OCE

Learning outcomes

1. Perform the range of laboratory and point-of-care techniques used in the workplace to investigate nutritional disorders.
2. Perform the clinical and laboratory investigation and analysis and management of nutritional status.
3. Perform the clinical and laboratory investigation and analysis and management of digestion, absorption and pancreatic function.
4. Perform the clinical and laboratory investigation and analysis and management of disorders of iron metabolism and haem synthesis.
5. Perform laboratory techniques used in the workplace to investigate trace element and vitamin status.
6. Work in partnership with other clinical specialisms in the investigation and analysis of nutritional disorders.
7. Interpret and report on the results of clinical and laboratory investigation of nutrition in the correct clinical context.

Learning outcomes

1. Explain the need for macro- and micronutrients for normal health, growth, repair and reproduction.
2. Discuss the role of clinical biochemistry in the assessment of nutritional status (including that of patients requiring enteral and parenteral feeding).
3. Describe the design, operation and performance of biochemical techniques used to assess digestion and absorption.
4. Describe the design, operation and performance of biochemical techniques used in the assessment of pancreatic function and the detection of pancreatic disease.
5. Discuss the need to select appropriate sample and method for the estimation of trace elements and vitamins (including direct and indirect methods).
6. Discuss the role of clinical biochemistry in the assessment of trace element and vitamin status in health and disease.
7. Describe the design, operation and performance of biochemical techniques used for the analysis of samples for trace elements and vitamins.
8. Discuss the partnership of biochemical nutrition to other clinical specialisms in the investigation of nutritional disorders and patient care.

Indicative content

• Gastrointestinal disorders: physiology and biochemistry of digestion and absorption; maldigestion and malabsorption; pancreatitis (acute and chronic); coeliac disease; inflammatory bowel disease; anaemias; peptic ulcer disease; pyloric obstruction; carcinoid syndrome
• Gastrointestinal function testing: amylase; iron, ferritin, vitamin B12 and folate; calprotectin and lactoferrin, elastase; urea breath testing; gut hormones
• Protein energy balance and malnutrition; markers of nutritional status; assessment of nutritional status in elective, acute and chronic conditions, burns, multiple injury and sepsis; principles and practical nutritional support (enteral, parenteral)
• Trace elements in health and disease
• Methods of measurement of trace elements in biological samples; atomic absorption/emission; inductively coupled plasma mass spectrometry (ICP-MS)
• Vitamins in health and disease; syndromes of vitamin deficiency and excess
• Methods of measuring vitamins in biological samples
• Porphyrin metabolism, porphyrin measurement, systematic investigation of the porphyrias

Activities

• Participate in nutrition team ward rounds and appreciate the multidisciplinary approach to investigation and management of disorders of nutrition in terms of both the patient experience and service delivery.
• Attend outpatient clinics that have a formal dietetic input (e.g. obesity, diabetic, anaemia) to appreciate the nutritional investigation and management of these patients. Discuss and review your experiences of at least two patients.
• Attend a clinic that manages porphyria patients. Reflect and report on the role of such specialist clinics in the diagnosis, treatment and management of patients.
• Observe a urea breath test – reflect and discuss on the use, effectiveness and potential outcomes of this test and other tests that may be appropriate depending on results.