24 Feb Nutrition Flashcards

Question

Manifestations of folate def

Answer 1

☑️Megaloblastic anemia ☑️Low / normal Ret count : inability to increase RBC production to respond to anemia ☑️Pancytopenia : if severe def ☑️Hyperhomocysteinemia : decreased matabolism of homocysteine No neurologic manifestations Normal methylmalonic acid (high in b12)

Answer 2

Maternal Iron def Prematurity Early introduction of cows milk before age 12mo

Answer 3

Iron and vitamin D Iron unti 1 yr esp in premature babies. B12 for exclusively breasfed infants whose mothers are vegan

Answer 4

🔘Positive hydrogen breath test (Indicating impaired absorption and bacterial carb metabolism) 🔘Positive stool test for reducing substances 🔘Low stool pH 🔘Increased stool osmotic Gap High osmotic gap >125 mOsm/kg due to umetabolized lactose and organic acids. Osmotic Gap 290-(2xstool Na + stool K) Is >75 in all forms of osmotic diarrhea. 🔘No steatorrhea

Answer 5

Enteral nutrition initiating within <-48hrs Via NG or orogastric tube If risk of aspiration tube is advanced to postpyloric duodenum. Normal Bowel sounds or evidence of bowel function(passing flatus or stool) not req for EN. TPN used only if contraindication to EN(eg intestinal discontinuity, prolonged ileus ) as it carries risk of infection. Dextrose solutions lack protein and cannot also maintain gut integrity.

Answer 6

🔘Prevent malnourishment and improve outcomes. 🔘Reduced infections (pneumonia) 🔘Maintain gut integrity and decreased bacterial translocation 🔘Prevent atrophy of gut and mucosa associated lymphoid tissue 🔘dec Mortality

Answer 7

☑️Given within 24hrs in burn patients. (Delay if pt is hemodynamically unstable as gut perfusion in inadequte ) ☑️Start at low rate (trackle feeding) progressively inc as the patient tolerates. ☑️Burns patients have increased protein catabolism with moderate to severe burns , high protein , high calorie formulas are used

Answer 8

✔️Metabolic alkalosis ✔️Hypokalemia ✔️Positive stool screen for Diphenolic (bisacodyl) or polyethylene ✔️Colonoscopy showd melanosis coli Histo shows pigment in Macrophages of lamina Propria

Answer 9

Bypasses stomach by creating small gastric pouch, Gastrojejunal anastomosis and jejunojejunal anastomosis Weight loss is due to small gastric pouch And induced malabsorption as nutrients can only be absorbed in common limb.

Answer 10

Happens in first year after surgery due to local tissue ischemia and Ulceration. Progressive narrowing of GJ anastomosis that leads to obstruction of gastric pouch outflow. Progressive S/S : Nausea, post prandial vomiting, GERD , dysphagia to the point of not tolerating liquids. Dx : EGD to visualize GJ anastomosis during which balloon dilation is performed to open the narrowing If balloon dilation fails … surgical revision is done.

Answer 11

Reintroduction of Nutrition in pts with chronic malnourishment. Dec Phosphate Dec Mg Dec K LFT abnormalities Muscle weakness Arrhythmia CCF Rhabdomyolysis Paresthesia seizure

Answer 12

🔻Starvation results in dec PO4 , although serum levels remain Normal due to Transcellular shifts. 🔻Reintroduction if Carbs(tube feeding) causes increased Insulin secretion 🔻Insulin stimulates uptake of electrolytes PO4, K , Mg and inc PO4 utilization during glycolysis. 🔻This causes phosphate utilization And massive fluid and electrolyte shifts.

Answer 13

RUQ pain Recurrent Fever leukocytosis Abd SS : pain vomit SOB , hiccups , Rt sided effusion After laproscopic appendectomy. Dx : CT scan abd Ttt: Drainage and IV AB

Answer 14

Laparoscopy (more than laparotomy )

Answer 15

🔳 subacute fever and Abd pain/flank pain that may radiate to groin or hip 🔳 anorexia weight loss 🔳 abd pain with hip extension (psoas sign)

Answer 16

🟤CT scan abd and pelvis 🟤Leukocytosis , elevated inf markers 🟤Blood and abscess cultures

Answer 17

Drainage BS AB

Answer 18

Psoas abscess

Answer 19

HIV IV drug abuse Diabetes crohn dx Either occurs from hematologic seeding from a distant infection or from direct extension of intraabd infection (diverticulitis , vertebral OM)