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Biochemical Aspects Of GI Disease Flashcards

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1
Q

What methods are used to determine nutritional status?

A

Clinical assessment

Dietary

Anthropometric measurements

Functional

Laboratory based assessments

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2
Q

What is involved in a clinical assessment of nutritional status?

A

What is normal weight for patient

Food intake

Chewing/swallowing

GI symptoms i.e. nausea/vomiting/altered bowel habit

Drugs/alcohol

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3
Q

What methods can be used to assess food intake?

A

Dietary recall

Food diaries

Food weighing

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4
Q

How can muscle mass be assessed?

A

Grip strength

Isometric knee extension

Response to electrical stimulation

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5
Q

What are the 3 components of a functional assessment?

A

Muscle mass

Hepatic secretory proteins (albumin + transferrin)

Immune response in malnourished patients i.e. assess cell mediated immunity

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6
Q

How might patient with malabsorption present?

A

Food appearing the same in bowel as when eaten

Pale bulky stools

Abdominal distention

Vague malaise

Tiredness

Weight loss

Anaemia

Easy bruising + bleeding (vit K def)

Failure to thrive in infants

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7
Q

What are the consequences of malnutrition?

A

Impaired immune response= infection

Decreased respiratory muscle strength= increased risk of chest infection

Impaired wound healing= prolonged recovery

Inactivity= Thromboembolism + pressure sores

Decreased skeletal muscle strength= fatigue and increased risk of falls

Impaired thermoregulation= hypothermia

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8
Q

Which enzymes are involved in carbohydrate digestion?

A

Salivary amylase
Pancreatic amylase
Brush border enzymes (lactase, dextrinase, glucoamylase)

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9
Q

What is the function of amylase?

A

Breaks the alpha-1,4 bond in starch

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10
Q

How are carbohydrates absorbed in the GIT?

A

Secondary active transport with Na+

Facilitated diffusion of some monosaccharides

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11
Q

What are the causes of secondary lactase deficiency?

A

IBD

Chronic alcoholism

Coeliac disease

Tropical sprue

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12
Q

What tests can be done to investigate carbohydrate absorption?

A

Lactose tolerance test= serial glucose measurements after 50g of lactose

Hydrogen breath tests
I.e glucose hydrogen breath test can indicate bacterial overgrowth in upper SI

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13
Q

Why might someone with liver disease have high triglycerides in blood?

A

Absorbed glycerol and short chain fatty acids are transported to liver via the hepatic portal vein meaning if liver not functional there will be poorer absorption

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14
Q

What is fat absorption dependent on?

A

Bile production- which is dependent on liver secretions (bile salts/phospholipids + cholesterol)

Patent bile ducts

Pancreatic enzymes

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15
Q

What enzymes are involved in protein digestion?

A

Pepsin

Pancreatic proteases

Brush border enzymes

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16
Q

Why is it important to assess a patients nitrogen balance?

A

It gives an indication to whether they are metabolising protein correctly which is essential for ensuring a good healing process

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17
Q

What tests are used to assess pancreatic function?

A
  1. Faecal pancreatic elastase-1
    Enzymes produced in pancreas which is resistant to degradation by other enzymes and therefore is present in stool to be measured
  2. Serum immunoreactive trypsin (IRT)
    Used in heel prick test for babies to screen for CF
    Low values= failure of production i.e pancreatic disease
    High values= obstruction
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18
Q

Where are the different vitamins absorbed?

A

SI= A,D,E, C, B

LI= K + B via bacterial metabolism

19
Q

Which proteins are fat-soluble and which are water soluble?

How is the absorption of fat-soluble proteins different from water-soluble ones?

A

Fat-soluble:
A D E. K
Carried by micelles and diffuse into absorptive cells

Water:
C B
Diffusion (active or passive)
I..e B12 binds to intrinsic factor

20
Q

What are the signs of vitamin A deficiency?

A

Night blindness

21
Q

What are the acute and chronic consequences of an excess of vitamin A?

A

Acute:
Raised ICP
Nausea
Vomiting + visual disturbances

Chronic:
Liver/bone damage
Teratogenic

22
Q

Who is more sensitive to vitamin E deficiencies? How does the deficiency present?

A

Premature Infants= haemolytic anaemia + thrombocytopenia

children= spinocerebellar degeneration

23
Q

Who is most at risk of thiamine deficiency? What are the 2 types of thiamine deficiency and how do they present?

A

People after bariatric surgery or gastric balloons
I.e. due to not being able to eat and the associated vomiting
Alcoholics

Dry:
Peripheral neuropathy
Muscle weakness
Fatigue

Wet
Oedema
HF

AND wenrickes encephalopathy (unsteady on feet and present as dementia)

24
Q

How can you assess for thiamine deficiency? What extra measure needs to be taken?

A

Can directly measure thiamin in blood BUT need to protect from sun light

25
Q

What type of vitamin is generally non-toxic in excess and why?

A

Water-soluble vitamins due to being able to easily excrete any excess via the kidney

26
Q

What are the signs of riboflavin deficiency?

A 
Angular stomatitis 
Oily scaly skin rashes 
Eye sensitive to light 
Anaemia 
Birth defects (CHD + limb defects)
27
Q

When is nicotinamide deficiency most likely to occur? How is it treated?

A

Alcoholism + long term diarrhoea

Replacement

28
Q

How does vitamin B6 deficiency present?

A 
Seborrhoeic dermatitis 
Atrophic glossitis 
Confusion 
Neuropathy 
Sideroblastic anaemia
29
Q

Why is it important to measure B12 and folate in diabetic patients?

A

Metformin can lead to deficiencies in these vitamins

30
Q

Why is zinc important and what can cause deficiencies?

A

Essential component of enzymes

Inadequate intake or increase loss via diarrhoea

31
Q

What is the main cause of copper deficiency? What is easiest way to assess for copper deficiency?

A

Poor parenteral nutrition

Measure caeruloplasmin i.e. plasma protein carrier

32
Q

What are the methods of supplementing nutrition?

A

Food supplements

Enteral i.e. via gut

Parenteral i.e. IV

33
Q

What types of food enrichment can be given to patient to help improve nutrition?

A

Fortified puddings
Fortified supplements
Modular supplements
Nutritionally complete supplements

34
Q

Why is it important to delivery nutrients to the gut via enteral feeding?

A

Stimulate gut hormones
Help maintain gut integrity
Nutrients are absorbed into portal circulation
More physiological than TPN

35
Q

What are the indications for enteral nutrition?

A

Disturbed swallowing
Upper GI obstruction i.e. stricture
Inability to eat
GI disease i.e. pancreatic insufficiency
High requirements after burns + trauma
Loss of appetite i.e. anorexia + cardiac cachexia + cancer
Transition from parental nutrition

36
Q

What are the different methods of enteral feeds?

A 
NG
Orogastric 
Gastronomy 
Oesophagostomy 
Nasoduodenal 
Jejunostomy
37
Q

What is total parenteral nutrition (TPN) ?

A

Line directly into circulation (vein) meaning GIT and liver are bypassed

38
Q

When is TPN indicated?

A

Lack of functioning GIT i.e. bowel cancer/severe IBD

Oral or enteral route unable to provide adequate nutrition

GIT needs to be rested i.e. gastroschisis prolonged diarrhoea/high output fistula/anastomosis

39
Q

What is re-feeding syndrome and who is at risk of developing it?

A

Metabolic disturbances due to reinstitution of nutrition to patients which results in disturbances in potassium, magnesium and phosphorus

Patients with anorexia 
Patients with chronic alcoholism 
Oncology patients 
Postoperative patients 
Elderly 
Uncontrolled DM 
Patients with chronic malnutrition 
Long term users of antacids 
Long term users of diuretics
40
Q

What are the signs of re-feeding syndrome?

A 
Delirium 
Epilepsy 
Wenricke’s encephalopathy 
Cardiac arrhythmias 
Anaemia 
Hypokalaemia/magnesaemia/phosphataemia 
Hyperglycaemia 
Diarrhoea 
Peripheral oedema 
Paraesthesia 
Weakness 
Fasciculations
41
Q

What are medically induced causes of malnutrition?

A

Gastric sleeve

Roux en Y gastric bypass

42
Q

IBD can be a cause of malnutrition and deficiencies. How is IBD investigated?

A

Faecal calprotectin
Marker of WC count in the bowel and can help to differentiate between IBS and IBD

Stool culture done to detect whether bacterial infection present

43
Q

What test is used to screen for bowel cancer?

A

Faecal immunohistochemical test (FIT)

Used to detect and quantify the amount of blood in stool sample by using antibodies which specifically recognise human Hb

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