144. Nutrition Flashcards
List the nutrients absorbed in the: Stomach Duodenum Jejunum Ileum Colon
Stomach: water, EtOH, Cu, I, F, Molybdenum
Duodenum: heavy metals (Ca, Mg, Fe, Cu, Se), P, thiamine, riboflavin, niacin, biotin, folate, Vit ADEK
Jejunum: thiamine, riboflavin, niacin, pantothenate, biotin, folate, B6, Vit C, ADEK, heavy metals, lipids, monosaccharides, AAs, small peptides
Ileum: Vit C/D/K, B12, folate, Mg, Bile salts, acid
Colon: Na, Cl, K, vit K, biotin, SCFAs
EoE
- what is the tx
- how can this cause malnutrition?
Tx: SFED with serial reintroduction (milk, eggs, wheat, soy, nuts, seafood)
Wheat deficiency: GF substitutes not fortified like wheat! (Fe, folate, B vitamins, fiber)
Milk deficiency: miss protein, Ca, P, Vit A/D/B12, riboflavin, pantothenic acid
Celiac Disease
- what is it, and its tx
- what are the 6 nutritional deficiencies seen with these pts?
Autoimmune enteropathy due to gluten (villous blunting, brush border inflammation)
Tx: lifelong GF diet
Complications
1. Fe-Deficiency Anemia (check Fe, ferritin levels)
2. Lactose Intolerance (transient due to brush border inflammation - no lactase - resolves with GF diet)
3. GF Diet: risk of Vit D, B12, folate, Ca, Zn deficiency; more intake of Hg, Arsenic, mycotoxins (in GF foods)
4. Osteopenia/Osteoporosis: monitor with bone mineral density, due to vit D deficiency form villous blunting
5. Folate Deficiency: check serum and supplement
6. B12 deficiency: check serum and supplement
IBD
- what is it, which disease has more nutritional complications
- what nutritional components are at risk?
Malabsorptive condition - deficiencies are common
More pronounced in Crohn’s than UC
Deficiencies in Fe, B6, B12, Vit D/A, Zn
Zinc Deficiency
- what disease is this seen in?
- sx
- sources of zinc
- RF
- typical presentations
- tx
Seen in IBD pts
sx: impaired growth, hypogonadism, dry scaly skin rashes, diarrhea, immune deficiency, hair loss, anorexia
Sources: shellfish, meat, nuts, legumes, dairy
RF: acrodermatitis enteropathica (inborn error of metabolism), eating disorders, malnutrition, malabsorption, GI surgery, diarrhea
Presentations
1. pt with RYGB and poor diet
2. pt with consistent IBD flares/diarrhea
3. pancreatitis pt with procedures (Whipple - lose pancreas/duodenum)
tx: Zn supplementation
Iron Deficiency
- what disease/condition is this seen in?
- Sx
- sources
- RF
Seen in post GI surgery (RYGB, LGS), Celiac Disease
sx: hypochromic microcytic anemia, pica (craving non-food items), kilonychia (spoon-like nails)
Sources: meat, poultry, fish, legumes, tofu, fortified cereal
RF: young children, pregnant/menstruating women, blood loss, malabsorptive disorders/GI surgery, athletes
Vitamin D Deficiency
- fx of vit D
- sx
- sources
Fx: regulate Ca/P metabolism in bone/intestine/kidney, activated by sunlight
Sx: bony abnormalities (kids = Rickett’s; adults = osteomalacia), muscle weakness, pain
higher risk of autoimmune/neurodegenerative disease (parkinson’s MS, IBD)
Sources: fatty fish (salmon, tuna), cod liver oil, Fortified foods (milk), egg yolks
(Vegan ppl need Ca supplementation)
Vitamin A Deficiency
- fx
- sx
- sources
- RF
Fx: in vision (night vision, wide field, depth perception)
Sx: night blindness, conjunctival changes (Bitot spots - keratin buildup and corneal drying), corneal ulceration
Sources: liver, eggs, dairy (or from beta-carotenes - leafy greens, orange/red vegetables)
RF: poverty, malabsorptive disorders
Vitamin A Toxicity
- sx
ELEVATED LFTs
this is why we do not over supplement in pregnancy (higher risk of spontaneous abortion/birth defects)
Vitamin B1 (Thiamin) Deficiency
- three disease variants
- sources
- RF
SHORT HALF LIFE - diseases develop in DAYS
- Wet Beriberi: peripheral PD (edema), high CO, HF/cardiomegaly, neuropathy
- Dry Beriberi: peripheral neuropathy (foot/wrist drop, less reflexes, less sensation of vibration/joint position, paresthesias)
- Wernicke-Korsakoff: ataxia, disordered eye motility, neuropathy, confusion, memory problems (confabulation)
Sources: whole grains, legumes, yeast, pork
RF: alcoholism, eating disorders, poor diet, GI surgery, high metabolic demands (Trauma, Infection) - b/c B1 is cofactor in carb/AA catabolism
Vitamin B2 (Riboflavin) Deficiency
- sx
- sources
- RF
Sx: sore/weakness, Red/Magenta Tongue, angular stomatitis/lip swelling (sores), scaly dermatitis
Sources: fortified cereal, milk, eggs, oily fish, veggies, grains
RF: alcoholism, eating disorders, CF, jaundiced newborns
B3 (Niacin) Deficiency
- sx
- sources
- RF
Pellagra: 4Ds - Diarrhea, Dementia, Dermatitis, Death
Sources: meat, fish, legumes, peanuts (protein sources), cereal/coffee/tea
RF: monotonous diet (only maize), alcoholism, eating disorders, malabsorptive disease, long term isoniazid use
B9 Folate Deficiency
- sx
- sources
- RF
sx: megaloblastic anemia, high risk of NTDs in offspring
sources: fortified cereals, legumes, greens, orange juice
RF: alcoholism, malabsorptive disease, GI surgery, meds use (valproate, MTX, bactrim)
B12 Deficiency
- sx
- sources
- RF
Sx: megaloblastic anemia, glossitis, neuropathy, feet paresthesia, ataxia, memory problems, personality changes
Sources: ANIMAL products, seafood, meat, poultry, dairy
RF: higher age, atrophic gastritis, veganism, GI surgery, use of PPIs/metformin, pernicious anemia
