Module - Clinical Biochemistry Nutrition (SLS141)

STP

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.

Work-based 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.

Work-based Competencies


Learning outcome Title Knowledge
1 1,2,3,4,6

Perform the analyses to laboratory standard operating procedures:

  • tests of malabsorption
  • exocrine pancreatic function tests
  • amylase/lipase.
  • The investigation of:
    • malabsorption
    • inflammatory bowel disease
    • exocrine pancreatic function
    • acute pancreatitis
    • chronic pancreatitis.
  • The assessment and management of patients undergoing:
    • protein energy balance assessment
    • receiving enteral nutrition
    • receiving parenteral nutrition
    • GI obstruction
    • peptic ulceration
    • coeliac disease
    • pernicious anaemia
    • GI bleeding.
  • The specialist biochemical tests (e.g. calprotectin, faecal elastase) and other diagnostic modalities used in the investigation of the above disorders.
2 1,4

Perform the analyses to laboratory standard operating procedures:

  • haematinics (B12, folate)
  • iron
  • ferritin
  • transferrin saturation (iron-binding capacity).
  • The investigation and management of patients with:
    • anaemia (including pernicious anaemia)
    • haemochromatosis.
  • The other diagnostic modalities used in the investigation of the above disorders:
    • haemochromatosis genetics
    • haematological investigations
    • cellular pathology investigations (liver biopsy analysis).
3 1,4

Perform the analyses to laboratory standard operating procedures:

  • porphobilinogen (PBG)
  • porphyrin screen (qualitative)
  • porphyrins (quantitative).
  • The investigation and management of patients with:
    •  porphyria
  • Other diagnostic modalities used in the investigation and confirmation of the diagnosis of porphyria:
    • molecular testing
    • quantitative analysis and identification of porphyrin and porphyrin precursors.
4 1,5

Perform at least three of the following analyses (following observation of analysis performed by practitioner):

  • caeruloplasmin
  • copper
  • zinc
  • manganese
  • selenium
  • lead
  • aluminium
  • mercury.
  • The analytical techniques, their applications and limitations:
    • immunoturbidmetric methods for protein analysis
    • inductively coupled plasma mass spectrometry
    • atomic absorption
    • trace metal deficiencies
    • trace metal toxicities.
5 1,5

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.
  • Vitamin deficiency.
  • Vitamin toxicity.
  • Analytical techniques used to measure vitamins, their applications and limitations.
6 1,2,3,4,5

Identify cases that require urgent intervention and offer clinical advice on the follow-up and/or further management of the patient.

  • Time-critical and grossly abnormal results requiring urgent clinical interventions for the disorders in this module.
7 7

Interpret biochemical data in light of the clinical details.

  • Correct use of data in relation to the full range of investigations specified in this module.
8 7

Draft written reports on patients.

Requirement for reports, including sources of information, appropriate use of patient records, reference materials and current national/international guidelines.

Work-based assessment


Complete 2 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS 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
OCE 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