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22 Feb 24 Nutrition Flashcards

1
Q

Lactose Intolerance Etiology/RF

A

🧣Congenital /developmental lactase def

🧣Small intestinal infection or inflammation

🥾LI is ppt by inflammatory disorders affecting brush border (Gastro)
Pts mostly have HO recent intestinal illness.
May also be ppt by Celiac Dx and Crohn dx.

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2
Q

Lactose Intolerance CF

A

GI distress after dairy intake
Abd pain
Flatulence /bloating
Watery diarrhea

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3
Q

Dx of Lactose intolerance

A

Resolution of SS on dairy restricted diet

Lactose breath hydrogen test

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4
Q

Ttt of Lactose intolerance

A

Dietary restriction of Lactose
Lactase replacement if dairy ingested

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5
Q

LI pathogenesis

A

PRIMARY :
🛞Acquired , persistent lactase def
🛞Onset usually in early childhood

SECONDARY:
🛞small intestinal epithelial damage due to infection (GASTRO) or Inflammation (Celiac Dx)
🛞 often transient (weeks to months)

👠temporary loss of Lactase a brush border enzyme found within small intestinal mucosa , results in fermentation of unabsorbed lactose by colonic bacteria.

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6
Q

Cause of diarrhea in Lactose Intolerance

A

Colonic Lactose creates an osmotic influx of water into bowel causing diarrhea.
Stools are bulky , malodorous but not bloody or mucoid.

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7
Q

Vitamin B1 thiamine def

A

Beriberi (peripheral neuropathy , heart failure )

Wernicke - korsakoff syndrome

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8
Q

Vitamin B2 def Features

A

Def seen pts with Anorexia Nervosa
Low daily diet (lactose intolerance)
Malabsorptive Syndromes (celiac sprue)

🧣Angular cheilosis (fissures at corners of lips)
🧣 Glossitis (hyperemic tongue)
🧣 Stomatitis. (hyperemic /edematous oropharyngeal MM , sore throat)

🧣Normocytic anemia

🧣Seborrheic dermatitis

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9
Q

Vitamin B6 def

A

Cheilosis , stomatitis , glossitis
Irritability , confusion , depression

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10
Q

Vitamin B9 folic acid def

A

Megaloblastic anemia
Neural tube defects (fetus)

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11
Q

Vitamin B12 def and sources

A

Sources : meat , dairy

Def:
Megaloblastic anemia
Neurologic deficits (confusion , paresthesias , ataxia.

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12
Q

Vitamin C def

A

Sources :
Citrus fruits , strawberries , tomatoes , potatoes , broccoli

Def :
Scurvy (punctate hemorrhage , gigivitis , corkscrew hair )

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13
Q

Chromium def S/S

A

Impaired glucose control in Diabetes

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14
Q

Copper deficiency S/S

A

🧘🏻Brittle hair
🧘🏻Skin depigmentation
🧘🏻Neurologic dysfunction (ataxia , peripheral neuropathy)
🧘🏻Anemia
🧘🏻Osteoporosis

Mimics B12 def

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15
Q

S/s of selenium def

A

Thyroid dysfunction
Cardimyopathy
Immune dysfunction

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16
Q

S/S of Zinc def

A

🚜Alopecia
🚜Pustular skin rash (perioral region and extremities)
🚜Hypogonadism
🚜Impaired wound healing
🚜Impaired Taste
🚜Immune dysfunctio.

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17
Q

Zinc def ETIOLOGY

A

Mostly absorbed in duodenum and jejunum

Def is in cases of malabsorption
Crohn dx
Celiac dx
Bowel resection
Gastric bypass
Poor nutritional intake
Parenteral nutrition

🥾Pts taking parenteral nutrition are at risk of trace mineral def ( Zinc , selenium, copper , chromium ) due to inadequate supplementation of parenteral intake.

🥾Comorbid diarrhea and malabsorption further increases the risk of trace mineral def in pts with PN due to excessive GI losses.

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18
Q

What is vegan diet ?

A

Diet consisting of plant based foods :
Fruits
Vegetables
Legumes
Grains.
No animal derived foods (meat , dairy , egg)

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19
Q

Potential benefits of vegan diet

A

🗻Lower blood glucose and cholesterol

🗻Reduced Risk of cardiovascular dx
(Heart dx and stroke)

20
Q

Nutritional def of vegan diet

A

Common:
Vitamin B12 , Vitamin D , calcium

Possible :
Iron , Zinc

🥾A Well balanced vegan diet supplys all essential Amino acids and protein and folic acid to meet most nutritional needs.

21
Q

Features of pellagra

A

👗Dermatitis : Rash on sun exposed areas rough , hyperpigmented , scaly skin

👗Diarrhea : Abd pain , nausea , loss of appetite

👗Dementia : neuronal degeneration in brain and spinal cord and leads to memory loss.
Affective S/S(depressed mood) , psychosis.

22
Q

Isoniazid associated pellagra

A

Prolonged isoniazid therapy without concomitant use Pyridoxine (vitamin B6)
Which is needed for niacin synthesis interferes with metabolism of TRYTOPHAN (niacin is synthesized endogenously from tryptophan) leads to pellagra.

23
Q

Causes of pellagra

A

Isoniazid

Cause in dev countries : impaired nutrition , alcohol ,chronic illness

Developing countries : use of corn as staple foods.

In carcinoid syndrome : depletion of tryptophan

In Hartnup dx : congenital disorder of tryptophan absorption

24
Q

Vitamin C def pathogenesis

A

🥇insufficient dietary intake (lack of citrus fruits /vegetables)
🐦Chronic Alcohol /substance use , severe malnutrition (Anorexia , restricted diet)
🐦 gastric bypass surgery
🐦 refugee camps (limited access)

🥇 impaired collagen production

25
CF of Vitamin C def
🗻cutaneous Coiled hair , perifollicular hemm Petechiae , ecchymosis Impaired wound healing 🗻 mucosal: gingivitis with bleeding 🗻 Musculoskeletal : (periosteal hemorrhage) : arthralgia , limp 🗻 constitutional: malaise, depression , vasomotor instability
26
Labs findings of vitamin C def
Anemia(normocytic normochromic) Normal platelet count and coagulation studies
27
Ttt of scurvy
Oral/injectable vitamin C (improvement in days to weeks) Toxicity: (Abd pain , diarrhea ) with excess supplementation.
28
GI features of celiac dx
🧘🏻Diarrhea +_ steatorrhea , Weight loss 🧘🏻Abd pain 🧘🏻Flatulence / Bloating 🧘🏻Late CF : Ulcerative jejunitis , enteropathy- associated T cell lymphoma.
29
Mucocutaneous CF of celiac dx
🚜Dermatitis herpetiformis 🚜Atrophic Glossitis (smooth red tongue with burning pain) Caused by vitamin def and even antibodies given that it manifests early in the dx.
30
Endocrine CF of celiac dx
Vitamin D def Sec Hyperparathyroidism
31
Bone disorders related to celiac dx
Osteomalacia /osteoporosis (adults) Rickets (children)
32
Hematologic Features if Celiac dx
Iron def anemia
33
Neuropsych features if celiac dx
Peripheral neuropathy Depression/anxiety 🥾length dependent axonal polyneuropathy (progressive paresthesia and sensory loss in a distal, symmetric stocking and glove distribution )
34
Celiac dx etiology
Autoimmune dx triggered by Gluten ingestion. An immune response to Gliadin causing inflammation in small intestines resulting in atrophy of villi leading to malabsorption. Malabsorptive features : Fe def Vit D def Otherss Atrophic glossitis Microcytic anemia GI s/s (bloating , diarrhea) Autoantibody mediated S/S: Peripheral neuropathy Neuropsych features Atrophic glossitis (These features manifest early hence thought to be due to antibodies)
35
Paeditric celiac dx RF
🧣First degree relative with celiac 🧣Down syndrome 🧣Autoimmune dx (type 1 DM, autoimmune thyroiditis) High degree of suspicion in paeds as main presenting sign of celiac mayb GROWTH delay (wt loss, poor linear velocity). Growth delay can occur in absense of diarrhea present in 2/3rd of pts. Other GI S/S (bloating , abd discomfort) are often non specific when present. Microcytic anemia
36
Extraintestinal CF of celiac Dx (paeds)
👗General: Failure to thrive/weight loss, short stature , delayed puberty/menarche 👗Oral: Enamel hypoplasia , atrophic glossitis 👗Dermatologic : Dermatitis herpetiformis 👗Hematologic : Iron def anemia (malabsorption) 👗Neuropsych : PN , mood disorder (anxiety , depression ) 👗Musculoskeletal : Arthritis , osteomalacia /Rickets (due to vitamin D def)
37
Dx of celiac dx
🐦Inc Tissue Transglutaminase IgA antibody 🐦Proximal intestinal Biopsy (villous atrophy, crypt hyperplasia , intraepithelial lympphocytosis)
38
Ttt of celiac dx
Gluten free diet DAPSONE for dermatitis herpetiformis.
39
Features of malabsorption in Celiac dx
🛞General: Bulky , foul smelling , floating stools 🛞Fat and protein: Loss of muscle mass , loss of subcut fat , fatigue 🛞Iron: Pallor (anemia) , fatigue 🛞Calcium and vit D. : Bone pain (osteomalacia) , fracture (osteoporosis) 🛞Vitamin K : Easy bruising 🛞Vitamin A : Hyperkeratosis
40
Antibody negative celiac dx
Many pts with biopsy confirmed celiac dx will have negative results on IgA antibody (igA endomyseal and igA TG Ab) testing due to associated concurrent selective IgA deficiency which is common in celiac. If IgA serology is negative but suspicion of celiac is high , TOTAL IgA should be measured (or IgG serology should be done)
41
D-Xylose test for malabsorption
D xylose is a monosaccharide absorbed in small intestine without degradation by pancreatic or brush border enzymes. It is subsequently excreted in urine. Pts with small intestinal mucosal dx will have impaired absorption of D xylose. Eg celiac. Pts with malabsorption due to enzyme def will have normal absorption of Dxylose. Crohn dx involves distal ileum. D xylose is absorbed by proximal small bowel to doesnt affect D xylose test.
42
What is a FP X xylose test (low urinary D xylose level despite normal mucosal absorption) . ?
Delayed gastric emptying. Impaired Glomerular filtration SIBO : Bacteria ferment D xylose before it is absorbed.
43
Dx of celiac dx
Antibody levels (inc tissue TG IgA antibody levels ) Duodenal biopsy : Villous atrophy Crypt hyperplasia
44
CF of scurvy
CF arise in 3 months of diet deficient on vit C Pay attention to scenario with HO alcohol use , Gingival bleed , gingival recession, ecchymosis (poor wound healing). Dx : plasma /lymphocyte vitamin C levels.
45
Pellagra associated conditions
🥇Alcoholism 🥇Anorexia Nervosa 🥇Malabsorptive dx (crohn dx) 🥇Dietary niacin def

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