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JazGI > Dietary issues > Flashcards

Dietary issues Flashcards

1
Q

Physical exercise and fibre decrease the risk of ___ cancer

A

colorectal cancers`

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2
Q

vegetables and fruits decrease the risk of ____(3) cancers

A

mouth-larynx
oesophagus
stomach

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3
Q

red and processed meat increases the risk of ___ cancer

A

colorectal

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4
Q

salt increases the risk of ____ cancer

A

stomach

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5
Q

alcohol increases the risk of _____(4) cancers

A

mouth-larynx
oesophagus
liver
colorectal

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6
Q

increased body fatness increases the risk of ___ (3) cnacers

A

oesophagus
gall bladder
colorectal

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7
Q

Neural centre for monitoring body weight =

A

hypothalamus

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8
Q

lesioning ventromedial hypothalamus =>

A

obesity

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9
Q

leisioning lateral hypothalamus =>

A

Lateral = Leanness

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10
Q

Feeling of fullness =

A

satiation

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11
Q

length of time from 1 meal until the next

A

satiety

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12
Q

CCK is secreted from ______ in the ___
release is proportional to intake of __+__
causes afferents to be sent to ___ and get satiation

A

I / enteroendocrine cells in duodenum and jejunum
lipids and protein
NTS -> hindbrain stimulated

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13
Q

mucosal L cells in GI tract release this rapidly post-meal =>
stimulates the ___

A

PYY3-36
decreases gastric motility, emptying and food intake (satiety signal)
hypothalamus

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14
Q

GLP-1 is released from ___ due to ingestion
It causes __
stimulates ___

A

L cells
decreased gastric emptying and intake of food
NTS andhypothalamus

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15
Q

Satiety signal released from oxyntic cells of small intestine post-meal =

A

OXM - oxyntomodulin

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16
Q

Obestatin is a ___ signal released from ____ which may antagonise ghrelin

A

satiety

stomach/small intestine cells

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17
Q

Satiety+satiation signals =

A 
CCK
PYY3-36
GLP-1
Oxyntomodulin
Obestatin
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18
Q

Hunger signal =

A

ghrelin

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19
Q

Ghrelin is released from ___
it __ before meals and ___ after
___ fat utilisation
__+__ increase ghrelin

A

oxyntic cells in the stomach
increases before and decreases after meals
decreases fat utilisation
hypoglycaemia and fasting

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20
Q

`++_ stim. hypothalamus to increase food intake in adiposity -ve feedback

A

glutamate, GABA, opioids

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21
Q

__ stim hypothalamus to decrease food intake in adiposity -ve feedback

A

monoamines

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22
Q

Hormones whose levels are proportional to fat stores

they tell hypothalamus to __+_

A

leptin and insulin

decrease intake and increase energy expediture

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23
Q

If have a lack of ___ or ___ receptors then have an unrestrained appetite => obesity
are also __,__+__

A

leptin

hyperglycaemic, hyperinsulinaemic and insulin resistant

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24
Q

Roles of leptin = (6)

A 
food intake/expenditure/fat deposition
peripheral glucose homeostasis/insulin sensitivity
maintainenc of immune and reprod. system
angio+tumouri-genesis
bone formation
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25
Q

There are lots of insulin receptor in the ___ in the brain

A

hypothalamus

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26
Q

Adiponectin goes to the ___ and ___ food intake

A

hyothalamus

decreases

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27
Q

food reward has a role in ___ pathways in the brain

same pathway areas that are affected by ___

A

dopamine

substance abuse

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28
Q

Orlistat (Xenical/Alli) is for:
mechanism=
side effects:

A

diet-induced obesity
inhibits pancreatic lipas to less tri absorption
cramping, vomiting and need ADEK supplements

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29
Q

Diet induced obesity => ___ resistance

due to ___/___

A

leptin
defective transport of leptin to brain
altered signal transduction after leptin receptors

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30
Q

malnutrition definition

A

deficiency, excess or imbalance of E, protein + other nutrients => measurable adverse effects

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31
Q

diagnosis of malnutrition is by

A

anthropometry eg. MUAC, BMI, grip strength

biochem: low albumin, transferrin, vitamin and urinary creatinine

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32
Q

factors for needing nutritional support

A

BMI less than 18.5
more than 10% unintentional wt loss in 3-6 months
BMI less than 20 with more than 5% unintentional wt loss in 3-6 months
eaten/will eat little or nothing for more than or equal to 5days
decreased absorptive capacity/increased nutritional needs

33
Q

enteral tubes are not given if patient has:

A

lower GI obstrction, prolonged intestinal ileus
severe d/v
high enterocutaneous fistula
intestinal ischaemia

34
Q

Refeeding syndrome =

A

fatal shifts in fluids and electrolytes and organ + metabolic regulation dysfunction
due to rapid start of refeeding after period of undernutrition
more common in enteral/parenteral feeding

35
Q

Refeeding syndrome pathology:
increased protein and glycogen synthesis uses up (5)
this causes

A

glucose, K+, thiamin, Mg2+, PO4-
hypokalaemia/magnesaemia/phosphataemia
thiamin deficiency
salt and H2O retention

36
Q

refeeding syndrome can cause

A

arrhythmias

altered consciousness, seizures, respiratory failure, CV collapse

37
Q

prevent refeeding syndrome by:

A

start on 50% of required and increase feeding
monitor electrolytes
adjust fluids
supplement vitamins

38
Q

easy bruising is a sign of which vitamin deficiency

A

C/K

39
Q

___ is an autorecessive form of impaired zinc uptake
need ___
signs =

A

acrodermatitis enteropathica
supplements
alopecia
perioral and acral rash

40
Q

glossitis and angular stomatitis are signs of which deficiency

A

vitamin B/iron

41
Q

Koilonychia is a sign of __ deficiency or __ problems

A

iron

thyroid

42
Q

Baseline investigations for malabsorption =

A

FBC, coagulation, LFTs, albumin, Ca2+/Mg2+, stool culture
=>
endoscopy, barium imaging, CT, MRI

43
Q

Calcium is absorbed from the gut by __ and ___

A

passively - paracellularly - whole length of small intestine

actively (mainly) - transcellularly - due to low concn in lumen

44
Q

active transport of Ca2+ is regulated by ___+_

A

calcitriol - hormonally active product of vit D3

PTH (increases calcitriol)

45
Q

apical channel involved in Ca2+ absorption in the gut and its expression is increased by ___

A

TRPV6

calcitriol

46
Q

in the enterocytes Ca2+ is bound to ___ and so decreases free Ca2+ and maintains driving force for Ca2+ absorption

A

calbindin D

47
Q

2 basolateral membranes involved in Ca2+ absorption =

A

Ca2+ATPase/PMCA1 (increased expression caused by calcitriol)

Na/Ca exchanger/NCX

48
Q

Females or males absorb more iron

A

females

49
Q

form of iron that is absorbable

A

ferrous (Fe2+)

50
Q

form of iron that is ingested and is converted to ___ by ___

A

ferric (Fe3+) by HCl and vitamin C is converted to ferrous (Fe2+)

51
Q

apical membrane transported for gut Fe2+ absorption
coupled to ___
and reduced by __ eg. __

A

DMT1
H+ transport
HFE mutations eg. hereditary haemochromatosis

52
Q

apical membrane transporter that absorbs Hb

A

Hb carrier protein 1 - Hb oxidase transports Hb in and then is changed to Fe2+

53
Q

enzyme that changes iron to stored state (___) =

A

apoferratin converts ferrous to ferritin

54
Q

Basolateral membrane transporter of iron in gut

negatively regulated by ___ from ___ when Fe levels are high = major control of absorption

A

feroportin
hepcidin hormone
liver

55
Q

cobalamin=

A

vitamin B12

56
Q

When B12 is ingested salivary glands secrete ___ and it binds to B12 when ___ releases B12 from protein it was bound to. Parietal cells release ___
___ digest ___ to release B12 which then binds to ___
and is absorbed in terminal ileum by ___

A 
salivary = haptocorin
HCl releases
Parietal = intrinsic factor
Pancreatic proteases digest haptocorin
binds to intrinsic factor
endocytosis
57
Q

Water soluble vitamins =

A

Vitamin B (not 12)
Vit C
Vit H

58
Q

Vitamin H =

A

biotin

59
Q

ascorbate =

A

vit C

60
Q

folate =

Na independant/dependant absorption

A

Vitamin B9

independant

61
Q

Vitamin H and C are Na independant/independant absorption

A

Na dependant

62
Q

fat soluble vitamins need __+__ for asorption

They are incorporated into___

A

bile salts and intaact intestinal mucosa

mixed micelles > passive transport in enterocytes > chylomicrons/VLDL>lymphatics

63
Q

Guidelines for alcohol consumption

A

no more than 14 units per week

ideally spread over 3 or more days

64
Q

Wernicke-Korsakoff syndrome is due to a lack of ___ caused by __

A

Vitamin B1 - thiamine

alcoholism

65
Q

Alcohol is broken down in the liver by __+__

A

cytochrome p450 2E1

alcohol dehydrogenase

66
Q

___ grades cirrhosis and is based on ascites, encephalopathy, PT, bilirubin and albumin

A

Childs A/B/C

67
Q

MELD score grades cirrhosis based on ++_

A

INR, bilirubin, creatinine

68
Q

In alcoholic hepatitis AST:ALT ratio =
AST =
bilirubin =

A

AST: ALT is more than 1.5
AST less than 500
bilirubin more than 80

69
Q

__+_ Alcoholic hepatitis scores are used for prognostic scoring

A

Maddrey’s and Glasgow

70
Q

Limit of alcohol to pass for drink driving

A

50mg

71
Q

How to calculate alcohol units in a drink =

A

(volume(ml)xAlcohol%) / 1000

72
Q

Globus sensation =

A

feeling of something stuck in throat

73
Q

Malingering =

A

make up illness for own gain eg. benefits/drugs

74
Q

factitious disease =

A

only want to occupy “sick” role - not for personal gain

75
Q

Diagnosis of typical anorexia nervosa

A

significant self-induced wt. loss / failure to gain wt in a child
BMI less than 17.5
Skinny ideal
Endocrine abnormalities

76
Q

Restricting type of anorexia nervosa =

A

not binge eating/purging type

77
Q

No endocrine abnormalities are seen in patients with ___ nervosa

A

bulimia

78
Q

Anorexia and bulimia nervos are more common in F/M and by how much?

A

F 10:1

79
Q

Anorexia/bulimia nervosa patients are made inpatients if:

A

suicide risk
more than 5yrs of condition
co-morbidity - depression, extreme social isolation

JazGI (26 decks)

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