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IPT: GI/Resp > Block 4 > Flashcards

Block 4 Flashcards

1
Q

Which ergogenic aid is banned or limited by athletic organizations?

A

Caffeine

Ephedra

Erythropoietin

GH

Testosterone

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2
Q

Physiologic action of creatine?

A

Osmotically pulls water into muscle cells

Increased creatine/creatine phosphate is a source of ATP replenishment

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3
Q

Uses of erythropoietin?

A

Anemia, reduction of RBC

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4
Q

Physiologic action of erythropoietin?

A

Produced in kidney in response to hypoxia, anemia, or blood loss

Stimulates RBC

Provides CNS stimulation via oxygenation

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5
Q

Erythropoietin AE?

A

Thromboembolism + HTN

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6
Q

Physiologic Action of GH?

A

Secreted by pituitary gland

Direct: increases lean mass and decreases fat mass

Indirect: stimulates IGF-1 to redistribute body fat

Acutely increases w/ exercise

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7
Q

AE of GH?

A

CVD risk, fluid retention, carpal tunnel syndrome, high BG, pain

AE dependent on dose and duration of use

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8
Q

DDI with GH?

A

Corticosteroids, estrogen, diabetes rx

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9
Q

Testosterone uses?

A

Hypogonadism, delayed puberty in males

Cachexia and cancer (due to weight loss and hypogonadal state)

Wound/burn healing

Erythropoietin effects

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10
Q

Physiologic actions of testosterone?

A

Produced by gonads

Regulated by LH

Affects nitrogen balance which aids protein synthesis

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11
Q

Efficacy of testosterone in athletic performance?

A

Limited evidence due to discrepancies in dosing

Must pair with weight training to see muscle strength changes

High doses dont necessarily produce obvious differences compared to low

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12
Q

Testosterone AE?

A

Reproductive

Psychiatric

CV

Dermatologic

Boxed warning of secondary exposure and pulmonary oil embolism

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13
Q

What are the measurements of nutritional status?

A

Growth

Tricep skinfold thickness

Visceral proteins (albumin, etc)

Nitrogen balance

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14
Q

How is growth measured with WHO and CDC?

A

WHO = 0-24 months

CDC = 2yrs +

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15
Q

What is the checklist for growth charts?

A

Age

Gender

Measurement type

Source

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16
Q

Caloric requirements and age?

A

Lower the age, MORE nutrients are needed due LESS reserves and GREATER metabolic rate

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17
Q

Indications of parenteral nutrition?

A

Premature

Unable to meet needs via oral or enteral

Failure to thrive

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18
Q

What are the macronutrients?

A

Carb (dextrose 3.4kcal/g)

Protein (Cysteine is essential to prevent oxidative injury)

Fats (prevents FA deficiency and not to exceed 40% of daily calories)

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19
Q

Who is required to have starter parenteral nutrition?

A

Newborns that are <1500g

Require parenteral support based on diagnosis of gastroschisis, TEF, or CDH

Initiate within few hours of birth

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20
Q

What is specifically in the starter parenteral nutrition?

A

AA (3-3.5g/kg/day): prevent protein catabolism and improve glucose tolerance

Dextrose: maintain normal glucose and potassium

Calcium

Heparin: maintain line patency

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21
Q

Benefits of starter parenteral nutrition?

A

Increased availability/safety

Time and cost effective

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22
Q

Drawbacks to starter parenteral nutrition?

A

Only to those w/:

Electrolyte imbalance

Renal issues

Hyperglycemia

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23
Q

When is breast milk recommended?

A

For first 6 months

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24
Q

What are the stages of human milk?

A

Colostrum = produced in first few days PP

Transitional = days 3-14 PP

Mature = 2 weeks PP

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25
Q

Characteristics of colostrum milk vs transitional/mature?

A

Low quantity production

Rich in antibodies

Higher in PROTEIN + FAT SOLUBLE VITAMINS than mature milk

Lower in FAT + ENERGY than mature milk

Easier to digest (higher whey/casein ratio)

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26
Q

Amino acid-based formula i indication?

A

For infants with severe cow’s milk allergy or

several food allergy

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27
Q

Increased medium-chain

triglycerides formula indication?

A

For infants with liver disease and short bowel
syndrome

Bypass lymphatic system

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28
Q

Decreased potassium,

calcium, and phosphorus formula indication?

A

For infants with renal dysfunction or

cardiovascular disease

29
Q

Soy protein formula indication?

A

Vegetarian-based diet

High aluminum, not recommended in preterm neonates due to osteopenia

30
Q

Who gets Vit. D supplementation?

A

Exclusively breastfed babies

Exclusively formula-fed babies consuming less than 32oz of formula/day

**Give 400IU / day

31
Q

When do you give Vit. D supplements and why?

A

Few days after birth unless weaned to 32ox Vit. D formula/whole milk

Absorbs calcium and phosphorus to prevent rickets

32
Q

When are solid foods introduced?

A

Between 4 and 6 months

33
Q

What are the first kinds of foods they should have?

A

Zinc/iron-fortified infant cereal or meat

Nonheme iron-rich foods (prunes, lentils, kidney/white beans)

34
Q

Why should they have solid foods at this time?

A

Full Term neonates deplete iron stores by 4-6 months

Breast milk has lower iron and adequate amount of zinc until 6 months of age

35
Q

What does AAP say about allergenic foods?

A

Early introduction between 4-6 months of age may actually decrease risk of food allergy

36
Q

What does the LEAP study tell us about peanuts?

A

Early intro to peanuts was preventive for infants at “high risk for peanut allergy”

37
Q

LEAP and recommendations w/ and w/o eczema?

A

No eczema/allergies = introduce normally

Mild/moderate eczema = introduce at 6 months of age (doesnt require evaluation)

Severe eczema or EGG allergy = depends on IgE test

Negative = introduce at 4-6 months

Positive = DONT introduce

38
Q

What is “Failure to Thrive”?

A

Weight for age or height less than 5th percentile

Decreased growth velocity; weight falls by 2 percentile lines in 6 months

39
Q

What causes someone to fail to thrive?

A

Inadequate caloric intake, nutrient absorption, and increased metabolism

40
Q

How do you treat someone with failure to thrive?

A

Investigate etiology of medical, diet, and social history

Gradual reinitiation of enteral nutrition

41
Q

What are the risk factors to fail to thrive?

A

Medical conditions (low weight, premature, developmental delay and GERD)

Psychosocial (poverty, poor techniques, unusual diet)

42
Q

Increased intestinal absorption of iron is called..

A

Hemochromatosis

43
Q

Increased intestinal absorption of copper is called..

A

Wilson’s disease

44
Q

What is steatorrhea?

A

An increase in stool fat excretion to > 7% of dietary

fat intake

45
Q

What is stool osmotic gap?

A

Comparison of [Na+] and [K+] in liquid stool with the

osmolality of the stool

46
Q

Osmotic vs secondary diarrhea?

A

Osmotic gap:

Osmotic diarrhea = >50; suggest diminished absorption of one or more dietary nutrients

Secondary diarrhea = <25; Suggests luminal (e.g., E. Coli enterotoxin) or circulating (e.g., vasoactive intestinal peptide) secretagogue

47
Q

How many carbons are in long, medium, and short chain FA?

A

Long >12

Short <8

48
Q

Assimilation of lipids require what?

A

Digestive, absorptive, and postabsorptive phase

or intraluminal, mucosal, and delivery phase

49
Q

How are carbs absorbed?

A

Small intestines in the form of monosaccharides

50
Q

What is lactose malabsorption?

A

(disaccharide present in milk - glucose and
galactose): The only clinically important disorder of carbohydrate absorption

Caused by deficiency of lactase

Primary - genetically decreased or absence of lactase

Secondary - abnormalities in both structure
and function of other brush border enzymes and transport processes (e.g., celiac disease)

51
Q

What nutrients are absorbed specifically in the proximal small intestines?

A

Calcium, iron, and folic acid

Cobalamin and bile acid is in the ileum

52
Q

Environmental, immunologic, and genetic factors of celiac disease?

A

Unknown etiology

Environmental = Associated w/ gliadin (component of gluten)

Immunologic = IgA, antiendomysial, anti-tTG AB

Genetic = High amongst whites, low in everyone else

53
Q

Sx, diagnosis, Tx of celiac disease?

A

Sx = diarrhea and steatorrhea

Diagnosis = small intestine biopsy + looks at response of condition (thru Sx and histologic changes)

Tx = restrict gluten

54
Q

Etiology and Sx of tropical sprue?

A

Etiology: Unknown

Consensus: May be caused by one or more infectious agents (e.g., K. pneumoniae, E. cloacae, and E. coli)

Sx = CHRONIC diarrhea, steatorrhea, deficiency in cobalamin and folate

55
Q

Diagnosis and Tx of tropical sprue?

A

Diagnosis = Small-intestinal biopsy residing or has recently lived in a tropical country

Tx = tetracycline + folic acid

56
Q

What is short-bowel syndrome and the Sx?

A

Resection of various lengths of the small intestine or, on rare occasions, are congenital

Sx = Diarrhea, steatorrhea, enteric hyperoxaluria, gastric
hypersecretion of acid

57
Q

Tx of short-bowel syndrome?

A

If the colon is in situ, the initial diet should be low in fat and high in carbohydrate

Cholestyramine and calcium for hyperoxaluria

PPI

58
Q

Etiology and Sx of bacterial overgrowth syndrome?

A

Anatomic or functional stasis or to a communication between the relatively sterile small intestine and the colon with its bacteria

Sx = Diarrhea, steatorrhea, and macrocytic anemia (due to cobalamin)

59
Q

Diagnosis and Tx of bacterial overgrowth syndrome?

A

Diagnosis = Low cobalamin and high folate, increased levels of aerobic and/or anaerobic colonic-type
bacteria in a jejunal aspirate obtained by intubation

Tx = Surgically corrected, if not then use broad spectrum Abx

60
Q

Etiology and Sx of Whipple’s Disease?

A

Etiology = Tropheryma whipplei, gram-positive bacillus

Sx = Diarrhea, steatorrhea, weight loss, arthralgia, and CNS/cardiac problems

61
Q

Diagnosis and Tx of Whipple’s Disease?

A

Diagnosis = tissue biopsy

Tx = ceftriaxone or merrem for 2 wks then Bactrim (or chloramphenicol) BID for a year

62
Q

Malnutrition/Starvation stage of refeeding syndrome?

A

Liver glycogen depleted and reduced insulin

fat and protein catabolism

energy source changes from fats to ketones

muscle catabolism to death

63
Q

Nutrition replacement stage of refeeding syndrome?

A

Primary source of nutrition = carbs

64
Q

Refeeding syndrome issues?

A

Hypo = phos, mag, potassium

Hyper = sodium

Thiamine deficiency

65
Q

Baseline labs for refeeding syndrome?

A

BMP with phosphorus and magnesium

Baseline weight

66
Q

What should you start before and during refeeding?

A

Before = Thiamine for 3-5 days + multivitamin

During = Electrolytes orally/enterally for mild/moderate conditions. IV for severe

67
Q

What is the refeeding regimen?

A

Start at 50% calorie intake unless its for high risk patients (anorexia) then its 25%

68
Q

Monitoring parameters in refeeding syndrome?

A

I/O

Weight (1kg/week in adults)

Daily BMP with phosphorous and magnesium for at
least 7 days (then 3 times in following week) during
refeeding period

IPT: GI/Resp (4 decks)

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