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CNSC combines > Digestion/Absorption > Flashcards

Digestion/Absorption Flashcards

1
Q

how long is the duodenum

A

350-600 centimeters

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2
Q

how much fluid does the duodenum secrete

A

9 liters (2 liters from PO, 7 liters of gastric fluid)

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3
Q

role of the ileocecal valve

A

Prevents backsplash of colon contents into the jejunum. Closes when there is an increase in colonic pressure

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4
Q

complications of ileocecal valve removal

A

decreased B12 absorption, decreased bile salt reabsorption, rapid GI movement of the small bowel contents into the colon which can cause malabsorption

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5
Q

______ are partially digested in the large bowel then consumed by gut bacteria where it is fermented and made into short chain fatty acids for energy for the colonocytes

A

soluble fiber

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6
Q

short chain fatty acids are derived from which type of fiber

A

soluble fiber

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7
Q

which type of fiber adds bulk to stool to soften it

A

insoluble fiber

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8
Q

conditions that cause gut dysbiosis

A

obesity, diabetes, IBD/IBS, cancer

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9
Q

where are sodium and water absorbed most efficiently

A

colon and ileum

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10
Q

where is fat primarily absorbed

A

duodenum / proximal jejunum

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11
Q

Primary absorption site of iron

A

duodenum

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12
Q

primary absorption site of manganese and folic acid

A

jejunum

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13
Q

Medium Chain Triglycerides are used during fat malabsorption because

A

they don’t have to be formed into micelles, they are water soluble and go right into circulation and don’t require bile salts.

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14
Q

Benefits of short chain fatty acids

A 
inhibit cholesterol formation
improve splanchnic circulation
enhances immunity helper T cells
inhibits pathogen growth
decreases luminal pH
lowers bile solubility
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15
Q

Primary absorption site of vitamin B 12

A

ileum

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16
Q

where are the majority of water, electrolytes and minerals absorbed

A

colon and small bowel

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17
Q

potassium and bicarobonate are secreted into the

A

colon

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18
Q

water follows sodium via this mechanism

A

osmosis

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19
Q

ileal or colonic losses from diarrhea or high output fistulas can lead to

A

hypokalemia, acidemia from loss of bicarbonate

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20
Q

most dietary iron is in the ______ form which is poorly absorbed in the gut

A

Ferric Fe2+

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21
Q

In order for iron to be absorbed, it has to change into the ______ form

A

Ferrous Fe3+

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22
Q

Which vitamin aids in the reduction of the Ferric Form (Fe2) of Iron to the Ferrous form (Fe3) of iron for easier absorption

A

Vitamin C (ascorbic acid)

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23
Q

What can be added to foods to enhance the absorption of iron in non-heme foods

A

Vitamin C

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24
Q

what amino acid provides the main fuel for enterocytes

A

glutamine

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25
Q

the absence of this amino acid can lead to mucosal atrophy

A

glutamine

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26
Q

site of primary protein digestion

A

duodenum

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27
Q

which enzymes digest protein

A

pepsin/pepsinogen when mixed with chyme

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28
Q

what amino acids are most rapidly absorbed

A

branched chain amino acids and essential amino acids

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29
Q

the primary energy source for the GI tract is ________ which has trophic effects and helps with immune function

A

glutamine

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30
Q

there is an increased need for what amino acid in critical illness

A

glutamine

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31
Q

what is the most abundant amino acid

A

glutamine

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32
Q

detriments of inadequate glutamine

A

GI mucosal atrophy, impaired immune function, increased risk for sepsis/bacterial translocation

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33
Q

which amino acids are important for the small intestine

A

glutamine and aspartate

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34
Q

what function do amino acids provide the liver

A

synthesis of plasma proteins: albumin, pre albumin, transferrin, clotting factors (fibrinogen/prothrombin)

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35
Q

The amino acid alanine is used for what in the liver

A

gluconeogenesis

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36
Q

Bile drains into the

A

duodenum

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37
Q

a disturbance of the lymphatic system in which fluid is incorrectly distributed and does NOT respond to diuretics

A

lymphedema

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38
Q

The correct dosage of IV sodium proves ___ to ___ mEq/kg of sodium

A

1-2 mEq/kg

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39
Q

normal serum sodium range

A

135-145

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40
Q

when serum sodium is low, cells are known as ______tonic

A

hypotonic

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41
Q

primary sodium losses occur from

A

NGT suction, fistula drainage, adrenal insufficiency

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42
Q

when there are increased solutes in the blood circulation, water shifts from inside of the cell to outside of the the cell resulting in which type of hyponatremia

A

hypertonic hyponatremia

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43
Q

Primary IV treatment of hypovolemic hyponatremia

A

normal saline

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44
Q

Causes of hypovolemic hyponatremia

A

Third Spacing (SBO, low albumin)
Diarrhea, Vomiting, NGT suction (GI losses)
Diuretics

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45
Q

primary treatment of hypervolemic hyponatremia

A

Water restriction

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46
Q

causes of hypervolemic hyponatremia

A

CHF, Cirrhosis, TURP

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47
Q

primary treatment of isovolemic hyponatremia

A

water restriction

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48
Q

causes of isovolemic hyponatremia

A

too much IVF, water intoxication, diuretics, SIADH, drugs

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49
Q

the hormone released by the pituitary gland that tells your kidney how much water to conserve to maintain blood pressure by concentrating the urine

A

Anti Diuretic Hormone

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50
Q

When your body has high levels of ADH, the kidneys re-absorb too much water. Total body water will increase and becomes hypo-osmolar and sodium decreases which is known as

A

SIADH (symptom on inappropriate diuretic hormone)

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51
Q

Etiologies of SIADH

A

malignant tumors, head trauma, meningitis, schizophrenia meds, post surgical

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52
Q

Treatment for SIADH

A

water restriction , sodium restriction

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53
Q

Acute hypotonic hyponatremia (acute water intoxication)

A

Sodium <125mEq/L causing headache, nausea, confusion. Na <110 mEq/L can cause seizure, coma or death

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54
Q

Sodium Deficit Calculation

A

Normal Na - Current Na x body weight in kg x % body water

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55
Q

Give no more than ___ free water deficit a day or > mEq/day when restricting sodium

A

1/2 of the free water deficit or 6-12 mEq/Day

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56
Q

a condition of cerebral edema (which can be deadly) in which too much sodium is given too much at one time is known as

A

osmotic myelinolysis

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57
Q

Hypertonic saline (3%) is used to treat

A

severe hyponatremia when a patient is confused or obtunded

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58
Q

when giving hypertonic saline, serum Na should be checked how often

A

every 1-2 hours

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59
Q

Don’t correct Na more than ____ to ____ a day

A

6-12 mEq/day

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60
Q

How much sodium would you replete for a 70kg male with a serum sodium of 120mEq/L with headache and confusion

A

126-120 x .6 x 70 kg = 252 mEq sodium

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61
Q

symptoms of hypernatremia

A

lethargy, confusion, twitching , stupor, coma

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62
Q

failure of the central brain to release ADH or failure of the kidneys to respond to ADH is known as

A

Diabetes Insipidus

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63
Q

Symptoms of diabetes insipidus

A

polyuria, polydypsia,hypernatremia , retained sodium

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64
Q

is sodium high or low in diabetes insipidus

A

high

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65
Q

treatment of diabetes insipidus

A

hypotonic fluids 0.2 or 0.45% NaCl, volume restriction, sodium restriction

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66
Q

the major intracellular electrolyte

A

potassium

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67
Q

normal serum range of potassium

A

3.5-5

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68
Q

typical IV dose of potassium ins mEq/kg/day

A

1-2 mEq/kg/day

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69
Q

causes of hyperkalemia

A

acidosis (Hydrogen moves out of the blood to become less acidic and into the cell, so potassium will move out of the cell into the blood), renal failure, traumatic blood draw (false positive), hemolysis, burns, crushing syndrome, NSAIDS, K sparing diuretics, tacrolimus

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70
Q

symptoms of hyperkalemia

A

EKG changes, decreased heart rate, arrthymias, high T waves, wide QRS, heart block, atrial systole, cardiac arrest, muscle cramping/twitching, weakness

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71
Q

What is the first step of potassium correction to stabilize the heart

A

calcium gluconate

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72
Q

What is the second step of potassium correction to shift potassium back into the cell

A

sodium bicarb, 100mL 50% dextrose, 10 units of insulin

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73
Q

Other methods to reduce potassium in hyperkalemia after calcium gluconate and correction of acidosis

A

dc or decrease supplemental potassium, use K sparing diuretics like Lasix, dialysis

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74
Q

symptoms of hypokalemia

A

weakness, lethargy, constipation, arrhythmia, psychosis, post op ileus, flat T waves

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75
Q

causes of hypokalemia

A

diarrhea, high urine output, metabolic alkalosis, increased amounts of insulin, catecholamines, furosemide, thiazide diuretics, sorbitol, refeeding syndrome

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76
Q

IV forms of potassium

A

potassium chloride, potassium acetate, potassium phosphorous

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77
Q

what type of potassium is preferred in acidosis

A

potassium acetate

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78
Q

potassium takes ___ hours to normalize

A

2 hours

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79
Q

Avoid providing IV potassium with ______ as glucose/insulin will increase forcing potassium into the cell and worsen hypokalemia

A

dextrose

80
Q

you must correct ______ to correct potassium

A

magnesium

81
Q

normal serum mangesium

A

1.8-2.8

82
Q

magnesium is primarily absorbed in the

A

jejunum/ileum

83
Q

magnesium is primarily excreted by the

A

kidneys

84
Q

symptoms of hypomagnesemia

A

low potassium, tetany, decreased insulin sensitivity, arrhythmias

85
Q

causes of hypomagnesemia

A

refeeding syndrome, decreased intake/absorption, prolonged magnesium free PN, alcoholism, ileostomy, short bowel syndrome, loop diuretics, DKA

86
Q

what route of magnesium replacement is preferred

A

IV, oral can cause GI upset

87
Q

max infusion rate of magnesium

A

1 gram per hour (less in renal failure)

88
Q

replace magnesium with ____ in order to decrease risk of cardiac arrhythmias

A

potassium

89
Q

causes of hypermagnesemia

A

chronic kidney disease and high magnesium intake/provision in EN/PN

90
Q

symptoms of hypermagnesemia

A

nausea, diaphoresis, flushing/heat flash, bradycardia, hypotension

91
Q

IV treatment for hypermagnesemia

A

calcium chloride or calcium gluconate

92
Q

medication treatment for hypermagnesemia

A

loop diuretics

93
Q

normal calcium range

A

8.6-10.2

94
Q

what hormones control calcium

A

parathyroid hormone, vitamin D and calcitonin

95
Q

the release of PTH is signaled by low _____ to increase _________, __________ and _________

A

calcium ; bone resorption, renal conservation, absorption in the gut

96
Q

Vitamin D increases calcium by

A

increasing gut absorption of calcium

97
Q

Calcitonin is signaled by ________ calcium to ______ osteoclast function

A

high calcium to decrease osteoclast formation to stop releasing calcium

98
Q

Ionized Calcium normal range

A

1.2-1.3 mmol/L

99
Q

what is the most accurate way to measure serum calcium

A

ionized calcium

100
Q

ionized calcium is not affected by _____-

A

albumin

101
Q

Calcium correction for hypoalbuminemia

A

4- serum albumin x .8 + serum calcium

102
Q

etiologies of hypocalcemia

A

low albumin, decreased vitamin D activity, hyperphosphatemia, decreased PTH, hypomagnesemia, citrate anticoagulation in CRRT, thyroidectomy, sepsis, rhabdomyolysis, blood transfusion, bisphosphonates, furosemide, calcitonin, phenytoin

103
Q

symptoms of hypocalcemia

A

decreased blood pressure, decreased myocardial contraction, decreased QT prolongation, extremity parenthesis, cramps, tetany

104
Q

preferred IV fluid to correct hypocalcemia

A

calcium gluconate or calcium chloride

105
Q

provide ____ to aid in calcium correction

A

magnesium

106
Q

oral forms of calcium repletion

A

calcium acetate, vitamin D supplements, calcium citrate, calcium carbonate (tums)

107
Q

causes of hypercalcemia

A

cancer, hyperparathyroidism, high vitamin D or A intake, chronic intake of milk, antacids or calcium supplements, lithium, TB, thiazide diuretics

108
Q

symptoms of hypercalcemia

A

fatigue, nausea, vomiting, constipation, anorexia, cardiac arrhythmia, bradycardia

109
Q

treatment of mild hypercalcemia

A

hydration and ambulation

110
Q

treatment of hypercalcemia in setting of malignancy

A

bisphosphonates

111
Q

treatment of severe hypocalcemia

A

lasix, hemodialysis, 1,000-1,500 mg elemental calcium, IV calcium chloride or calcium gluconate

112
Q

normal range of phosphorous

A

2.7-4.5

113
Q

functions of phosphorous

A

makes up bone, pH balance, makes up ATP, carbohydrate metabolism, part of 2.3-diphosphoglycerate on RBCs, muscle function, myocardial function and all cell function

114
Q

regulation of phosphorous

A

intestinal absorption, renal excretion, hormone regulation, bone resorption (deposition)

115
Q

causes of phosphorous shifts

A

carbohydrate/insulin, catecholamines and alkalosis

116
Q

symptoms of hypophosphorous

A

ataxia, confusion, paresthesia, hemolysis, refeeding syndrome

117
Q

etiologies of low phosphorous

A

alcoholism, critical illness, respiratory or metabolic acidosis, DKA treatment 2/2 insulin, high CHO in TPN especially if malnourished

118
Q

treatment of mild hypophosphorous

A

K Phos, Phos NaK

119
Q

treatment of symptomatic hypo phosphorous

A

IV K phos or IV Na Phos

120
Q

____mmol of phos = 4.4 mEq potassium

A

3

121
Q

causes of hyperphosphatemia

A

CKD, ESRD, trauma, hemolysis, rhabdomyolysis, respiratory metabolic acidosis, high dose phos containing enemas

122
Q

If a patient has excessive vomiting with bile they will have low

A

sodium and chloride

123
Q

gastric juice contains ____ to ___ mEq/L of chloride

A

120-160 mEq chloride

124
Q

bile contains ______ to ______ of sodium

A

120-170 mEq/L

125
Q

diarrhea contains _____ to _____ mEq/L of potassium

A

10-60

126
Q

if a patient has excessive diarrhea, they will be low in

A

potassium and sodium (and zinc!)

127
Q

if a patient has large volumes of NGT suction what could you expect in regards to electrolyte/acid base balance

A

decreased chloride, decreased sodium and metabolic alkalosis

128
Q

composition of lactated ringers

A

130 mEq sodium, 4 mEq potassium, 3 mEq calcium, 109 meQ chloride, 28 meQ bicarb will transform into acetate, lactate , 280 osmoles

129
Q

which IV fluid is compositionally comparable to the jejunum

A

lactated ringers

130
Q

composition of normal saline

A

154 mEq sodium 154 mEq chloride , 308 milliosmoles

131
Q

composition of D5W

A

Dextrose 5% per liter, water, 250 mOsm

132
Q

which IV fluid has the lowest osmolarity

A

D5W

133
Q

D5W + 0.45 NaCl

A

Dextrose, Water, 77 mEq sodium 77 mEq chloride, 405 milliosmoles

134
Q

which IVF has the highest osmolarity

A

D5W with 1/2 normal saline (0.45NaCl) with Potassium

135
Q

where are 90-95% of bile salts re absorbed

A

terminal ileum

136
Q

water and sodium are most efficiently absorbed here

A

ileum and colon

137
Q

catabolism of this macronutrient is most common in stress starvation

A

Fat (lypolysis)

138
Q

the gallbladder is stimulated by

A

cholecystekinin

139
Q

high insulin levels suppresses this form of metabolism

A

lipolysis (insulin increase indicates fed state)

140
Q

which enzyme starts the digestive process of carbs in the mouth

A

salivary amylase

141
Q

homeostasis of copper is driven by

A

excretion

142
Q

the majority of copper is absorbed by the

A

duodenum

143
Q

phytates, zinc, iron and large vitamin C doses interfere with ___ absorption

A

copper

144
Q

copper is excreted via

A

bile

145
Q

oxidation/reduction reactions, electron transfer, manganese oxidation glucose metabolism, and oxidation of ferrous to ferric form of iron are roles of

A

copper

146
Q

Copper deficiency inhibits ______ absorption

A

iron

147
Q

deficiency of copper causes _____ deficiency

A

iron deficiency anemia

148
Q

Iron needs to be reduced to the ferric state so it can bind to transferrin on the red blood cell. This is inhibited by ____ deficiency leading to iron deficiency anemia

A

copper

149
Q

copper deficiency causes _____ ____ anemia (type of RBC)

A

microcytic , hypochromic

150
Q

populations at risk for copper deficiency

A

bariatric surgery, intestinal surgery, diarrhea, malabsorptive disorders

151
Q

excessive copper can be secondary to _____ excretion leading to oxidative damage

A

impaired gallbladder (biliary)

152
Q

Wilson’s disease is caused by excess ______ in the liver, typically causing liver cirrhosis

A

copper

153
Q

hypopigmentation of the hair, Kayser Fleisher rings in the eyes, hypochromic microcytic anemia are symptoms of ____ deficiency

A

copper

154
Q

an overdose in zinc causes ______ deficiency

A

copper

155
Q

_____ medications decrease copper absorption

A

acid reducers as copper digestion relies on HCL From the stomach

156
Q

Copper deficiency is common in ______ disease and requires supplementation when anemic

A

Celiac disease

157
Q

Copper overload occurs with

A

parenteral nutrition 2/2 limited gall bladder stimulation for excretion

158
Q

manganese is excreted by the

A

bile

159
Q

this mineral is involved in the make up of metalloenzymes, arginase and pyruvate carboxylase

A

manganese

160
Q

populations at risk for manganese toxicity

A

long term TPN

161
Q

irritability, hallucinations, ataxia, and hepatic damage, Parkinson’s like symptoms, altered gait are all sings/symptoms of _____ toxicity

A

manganese

162
Q

the content of this mineral in food depends on soil levels

A

selenium

163
Q

thyroid alterations can occur in long term PN with out _____ supplementation

A

selenium

164
Q

hair/nail loss, peripheral neuropathy, tooth decay and fatigue can be symptoms of ___ toxicity

A

selenium

165
Q

selenium deficiency also concurs with ____ deficiency limiting thyroid function

A

iodine

166
Q

this micronutrient is taken up by the thyroid to synthesize thyroid hormones

A

iodinne

167
Q

what is the metabolically active form of thyroid hormone

A

T3

168
Q

goiters are symptoms of ___ deficiency

A

iodine

169
Q

increased TSH and depressed thyroid activity are results of ____ deficiency

A

iodine

170
Q

iodine isn’t available in PN formulations. The alternative method to provide iodine in long term PN patients is

A

antiseptic preparations on the skin

171
Q

this micronutrient is essential for glucose and lipid metabolism by mobilizing insulin

A

chromium

172
Q

hyperglycemia is a symptom of ____ deficiency (trace mineral)

A

chormium

173
Q

fluoride is primarily absorbed in the

A

stomach

174
Q

functions of fluoride include

A

bone mineralization, hardening of tooth enamel, protects calcified tissues from demineralization, inhibits dental carries

175
Q

teeth mottling, nausea/vomiting/diarrhea are all symptoms of ____ toxicity

A

fluoride

176
Q

absorption of molybdenum occurs in

A

the stomach

177
Q

molybedenum are excreted via the

A

kidneys

178
Q

ultra trace elements (lead, lithium, nickel, tin etc) are elements needed in less than _____ mg /day and have no ____ or _____ determined

A

RDA or AI’s

179
Q

now that vitamin K is added to the PN MVI, take caution with patients on this medication

A

Coumadin/Warfarin (monitor INR)

180
Q

Parenteral trace elements

A

selenium, copper, manganese

181
Q

in the setting of parenteral MVI/Trace element shortages, what is recommended

A

prioritize the most vulnerable

182
Q

a patient with mental status changes (dementia) , dermatitis and diarrhea may have this deficiency

A

niacin deficiency (Pellagra)

183
Q

manganese toxicity is common in long term PN because its route of excretion is

A

the gallbladder/bile

184
Q

_____ toxicity occurs with cholestasis (a long term complication of PN)

A

manganese

185
Q

extrapyramidal symptoms such as Parkinson’s like symptoms, muscle ridgitiy and tremors, and altered gait are symptoms of ____ toxicity

A

manganese

186
Q

the most common micronutrient toxicity in long term PN regardless of liver function is

A

hypermanganese

187
Q

if a patient exhibits cholestasis, limit these elements by providing ___ and ___ free trace elements in long term PN patients

A

manganese, copper

188
Q

supplementation of this element may help reduce hyperglycemia

A

chromium

189
Q

patients with significant GI losses including diarrhea are at risk for deficiency of this element

A

zinc

190
Q

in wounds, high ostomy output and excessive diarrhea supplement with this element

A

zinc

191
Q

serum zinc is not a reliable marker of zinc status because

A

it is bound to albumin which is widely available in the body

192
Q

zinc and copper will not compete for absorption in

A

IV doses in PN

193
Q

Case: A patient who is PN dependent with a daily output of 3L from his ileostomy, has recently increased BUN/Creatinine ration and a serum sodium of 131 mEq/L is at risk for what deficiencies. The increased BUN/Cr ratio is likely 2/2 ______. Hyponatremia is likely 2/2 ____ losses when fluid replacement doesn’t contain adequate NA. ______ supplementation is recommended to prevent deficiency as there is likely high losses from the ileostomy drainage

A

water, sodium,zinc
dehydration
GI losses
Zinc

194
Q

headaches and Parkinson’s like activity (extrapyramidal symptoms) are a result of ____ toxicity

A

manganese (sometimes zinc)

195
Q

if a patient with short bowel syndrome who has required PN for 2 years presents with dysgeusia, diarrhea and alopecia, they most likely are deficient in

A

zinc

CNSC combines (9 decks)

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