Domain II: Nutrition Care for Individuals and Groups: Medical Nutrition Therapy Flashcards
An ____ is an eroded mucosal lesion
Ulcer
What is the typical treatment for GI ulcers?
-Antacids
-Antibiotics to eradicate Helicobacter pylori bacteria
What are two examples of medications used for treatment of ulcers?
-Cimetidiine
-Ranitidine
Cimetidine and Ranitidine are what drug class?
H2 blockers
H2 blockers like Cimetidine and Ranitidine work by preventing the binding of ____ to its receptor, therefore decreasing acid secretion
Histamine
For someone with an ulcer, diet should be well-balanced and we should recommend avoiding ___-___ ____
Late-night snacking
For someone with an ulcer, we should also recommend avoiding gastric irritants such as…
-Cayenne
-Black pepper
-Large amounts of chili powder
-Avoid excess caffeine and alcohol
A ____ ____ is a protrusion of a portion of the stomach above the diaphragm into the chest
Hiatal hernia
MNT for a hiatal hernia:
-Small, bland feedings
-Avoid late-night snacks
-Caffeine
-Chili powder
-Black pepper
Dumping Syndrome commonly follows a _____ (Billroth I, II)
Gastrectomy
What symptoms does Dumping Syndrome cause when beginning to eat?
-Cramps
-Rapid pulse
-Weakness
-Perspiration
-Dizziness
Dumping Syndrome occurs when rapidly hydrolyzed carbohydrates enter the _____, and excess water is drawn in to achieve osmotic balance
Jejunum
The water in the jejunum causes rapid ____ in the vascular fluid compartment and a decrease in peripheral vascular resistant
Decrease
When this occurs during Dumping Syndrome, ____ ____ drops, and signs of cardiac insufficiency appear
Blood pressure
About 2 hours after signs of cardiac insufficiency occur, the carbohydrates are digested and absorbed rapidly, which causes blood sugar to rise, stimulating an ____ of insulin
Overproduction
The overproduction of insulin leads to blood sugars to fall below fasting, which is known as ____ or ____ ____
Reactive or alimentary hypoglycemia
A Billroth I, or a _______, attaches the remaining stomach to the duodenum
Gastroduodenostomy
A Billroth II, or a _______, attaches the remaining stomach to the jejunum
Gastrojejunostomy
With a Billroth II (gastrojejunostomy), food bypasses the _____
Duodenum
When food bypasses the duodenum, the secretion of ____ and ____ by the duodenum is reduced
Secretin, pancreozymin
Secretin and pancreozymin normally stimulate the ____, so after a Billroth II, there is little pancreatic secretion
Pancreas
Absorption of ____, which is most rapidly absorbed in the duodenum, and ____, which requires acid for absorption, are adversely affected after a Billroth II (gastrojejunostomy)
Calcium; iron
A Vitamin B12 (cobalamin) deficiency (common after gastric surgery) is caused by a lack of ____ ____, or ___ ___ in the loop of the intestine that is being bypassed
Intrinsic factor; bacterial overgrowth
_____ anemia is caused by B12 deficiency
Pernicious
Pernicious anemia is diagnosed using the ____ test, which looks for intrinsic factor levels
Schilling
____ deficiency is also common after gastric surgery and can also be caused by B12 deficiency because it needs B12 to be transported into the cell
Folate
Folate deficiency and low serum iron, which is a cofactor in folate metabolism, can lead to ____ anemia
Megaloblastic
MNT for s/p gastric surgery:
-Small, frequent meals
-Fluids before or after meals (not during) to slow passage
-Restrict hypertonic concentrated sweets
-50-60% complex carbohydrates
-Protein at each meal
-Moderate fat intake
-B12 injections may be needed
-Lactose may be poorly tolerated due to rapid transport
What deficiencies may develop after a complete gastrectomy?
-Iron
-B12
-Folate
-Calcium
-Vitamin D
-B1 (thiamin)
-Copper
____ is delayed gastric emptying
Gastroparesis
Gastroparesis can be caused by…
-Surgery
-Diabetes
-Viral infections
-Obstructions
Moderate to severe ____ can have detrimental effects of gastric nerves, and may lead to gastroparesis
Hyperglycemia
____ are a class of drug that work to increase stomach contractility and treat gastroparesis
Prokinetics
What are two examples of prokinetic drugs used for gastroparesis?
-Erythromycin
-Metoclopramide
MNT for gastroparesis:
-Small, frequent meals
-May need pureed foods
-Avoid high-fiber foods
-Avoid high-fat foods (liquid fat may be better tolerated)
-Avoid caffeine (acidic)
-Avoid mint (acidic)
-Avoid alcohol (acidic)
-Avoid carbonation
A _____ might occur with gastroparesis due to undigested food or medication
Bezoar
Treatment for a bezoar include ____ or ____ therapy
Enzyme or endoscopic
____ ____ is a rare digestive disease caused by either bacterial, viral, or parasitic infection
Tropical sprue
Tropical sprue is a chronic GI disease that cases ____ ____, and may affect the stomach as well
Intestinal lesions
Tropical sprue causes symptoms like…
-Diarrhea
-Malnutrition
Tropical sprue may also cause deficiencies of ____ and ____ due to decreased hydrochloric acid and intrinsic factor
Folate and B12
____ are typically used for medical treatment of tropical sprue
Antibiotics
MNT for tropical sprue:
-High kcal diet
-High protein diet
-IM B12 injections
-Oral folate supplements
Non-tropical sprue is similar in nature to ____ ____ or ____-___ ____
-Celiac disease
-Gluten-induced enteropathy
____ refers to storage proteins (prolamins)
Gluten
What are some examples of prolamins?
-Gliadin (wheat)
-Secalin (rye)
-Hordein (barley)
-Avenin (oats)
Celiac’s have a reaction to_____, which affects the jejunum and ileum (proximal intestine)
Gliadin
Celiac disease can cause…
-Malabsorption (leads to loss of fat-soluble vitamins)
-Macrocytic anemia
-Weight loss
-Diarrhea
-Steatorrhea
-Iron-deficiency anemia
Those with non-tropical sprue, Celiac, or gluten-induced enteropathy need a gluten (gliadin)-free diet which restricts…
-Wheat
-Rye
-Oats (if harvested and milled with wheat)
-Barley
-Buckwheat (may be contaminated)
-Bran
-Graham
-Malt
-Bulgur
-Couscous
-Durum
-Orzo
-Thickening agents
What things are acceptable for a gluten-free diet?
-Corn
-Potato
-Rice
-Soybean
-Tapioca
-Arrowroot
-Carbon bean
-Guar gum
-Flax
-Amaranth
-Millet
-Teff
-Quinoa
Constipation is sometimes due to an ____ colon (weakened muscles)
Atonic
MNT for constipation:
-High-fiber diet
-High fluid
-Exercise
____ is the presence of diverticula, or small sacs that protrude through the intestinal wall due to structural weakness
Diverticulosis
Diverticulosis is related to ____ and lifelong intra-colonic pressures
Constipation
MNT for diverticulosis is a ___-___ diet to increase volume and weight of residue and provide rapid transport
High-fiber
_____ is when diverticula become inflamed as a result of food and residue accumulation and bacterial action
Diverticulitis
MNT for diverticulitis:
-Clear liquids
-Low-residue or elemental
-Gradual return to high fiber
____ provides indigestible bulk and promotes intestinal function
Fiber
Dietary fiber includes non-digestible ___ and ___
Carbohydrates and lignans
Dietary fiber binds _____ and ____ fecal bulk
Water; increases
Dietary fiber is found in things like…
-Legumes
-Wheat bran
-Fruits
-Vegetables
-Whole grains
Oat bran and ____ fiber decrease serum cholesterol by binding bile acids, converting more cholesterol into bile
Soluble
Soluble fibers ____ gastric emptying, absorb water, and form a soft gel in the small intestine
Delay
Soluble fibers slow the passage of food through the GI tract and inhibit the absorption of ____ and _____
Glucose and cholesterol
What are sources of soluble fiber?
-Fruits
-Vegetables
-Legumes
-Oats
-Barley
-Carrots
-Applies
-Citrus fruits
-Strawberries
-Bananas
Adequate intake of fiber for men is ____ g, and for women, it is ____ g per day
38; 25
A high-fiber diet may increase needs for…
-Calcium
-Magnesium
-Phosphorus
-Copper
-Selenium
-Zinc
-Iron
A low-fiber diet may cause _____
Constipation
_____ is inflammation of the stomach
Gastritis
Gastritis may lead to…
-Anorexia
-Nausea
-Vomiting
-Diarrhea
MNT for gastritis:
-Clear liquids
-Advance diet as tolerated
-Avoid gastric irritants
What are two inflammatory bowel diseases?
-Crohn’s Disease
-Ulcerative colitis
Crohn’s Disease is also known as ____ ____
Regional enteritis
Crohn’s Disease affects the ____ ____
Terminal ileum
Crohn’s disease causes symptoms like…
-Weight loss
-Anorexia
-Diarrhea
Crohn’s disease can also cause B12 deficiency, which leads to ____ ____
Megaloblastic anemia
Crohn’s disease can also lead to ___-___ anemia due to blood loss and decreased absorption
Iron-deficiency
Ulcerative colitis is an ulcerative disease of the _____
Colon
Ulcerative colitis begins in the ____
Rectum
Ulcerative colitis causes symptoms like…
-Chronic bloody diarrhea
-Weight loss
-Anorexia
-Electrolyte (Na, K) disturbances
-Dehydration
-Anemia
-Fever
-Negative nitrogen balance
Treatment for IBD includes maintaining fluid and electrolyte balance, sometimes accomplished with ____-____ agents
Anti-diarrheal
One example of an anti-diarrheal is _____
Sulfasalazine
MNT for acute Crohn’s flare-ups:
-Bowel rest
-Parenteral nutrition or minimal residue
For acute Ulcerative Colitis, an ____ diet (EN) may be needed to minimize fecal volume
Elemental
For those with IBD, energy needs should be based on current ____
BMI
For those with IBD, fat only needs to be restricted for those experiencing _____
Steatorrhea
MNT for IBD:
-May need supplementation of water-soluble vitamins, as well as iron and folate
-Assess Calcium, Magnesium, and Zinc
-Watch lactose
-Small, frequent feedings
-High fat may improve energy imbalance
-Protein at each meal
-Chewable MVI
Coconut oil derived ____ ____ is an easy-to-oxidize source of energy and may improve bowel damage
MCT oil
When IBD is in remission or under control, a ___-___ diet should be initiated to stimulate peristalsis
High-fiber
____ ____ ____ causes chronic abdominal discomfort, altered intestinal motility, and bloating
Irritable bowel syndrome
The goals for treating IBS:
-Adequate nutrition intake
-Tailor patterns to specific GI issues
Those with IBS should avoid…
-Gas-forming foods
-Swallowing air during eating
It is recommended that those with IBS should use a ___ ___ to track intake, emotions, environment, and symptoms to determine any trigger foods
Food diary
A ____-____ diet may help eliminate possible sources of discomfort in those with IBS
Low-FODMAP
_____, which contains menthol, a smooth muscle relaxant, may relax the lower esophageal sphincter which can then reduce reflux, cramping, and pain for those with IBS
Peppermint
Lactose intolerance is due to a ____ deficiency
Lactase
Normally, lactase splits lactose into ____ and ____
Glucose and galactose
In the absence of lactase, lactose remains intact, exerting _____ _____
Hyperosmolar pressure
Due to the hyperosmolar pressure caused by lactose, ____ is drawn into the intestine to dilute the load
Water
The excess water drawn into the intestine causes…
-Distention
-Cramps
-Diarrhea
Bacteria then ferment the undigested lactose, releasing ____ ____ gas
Carbon dioxide
Lactose intolerance is detected by a ____ ____ test
Breath hydrogen
The breath hydrogen test works because hydrogen is produced by ____ ____ on lactose, absorbed into the bloodstream, and exhaled in 60-90 minutes
Colonic bacteria
The lactose tolerance is conducted by providing someone with an oral dose of lactose (up to 50 g) after a fast; if intolerant of lactose, blood glucose will rise < ____ mg/dl above fasting (flat curve), if tolerant, blood glucose will be above that much (normal curve)
25
MNT for lactose intolerance:
-Lactose-free
-No animal milk or milk products
-No whey
-Calcium and riboflavin supplements are recommended
-Yogurt and small amounts of aged cheese may be tolerated
What two products are okay in someone with lactose intolerance?
-Lactate
-Lactalbumin
Treatment for acute diarrhea in infants and children requires aggressive and immediate _____ (replace fluids and electrolytes lost in stool)
Rehydration
For infants and children with acute diarrhea, WHO recommends a ____ ____ solution
Glucose electrolyte
A glucose electrolyte solution is as effective as _____ rehydration and much cheaper and ingredients are easily attainable (reintroduce oral intake within 24 hours)
Parenteral
Chronic nonspecific infantile diarrhea causes no significant _____
Malabsorption
For an infant with chronic nonspecific infantile diarrhea, consider the ratio of ____ to ____ calories as well as the volume of ingested liquids (some are inadvertently put on a low fat diet or consume too many fluids or too many calories)
Fat to carbohydrate
MNT for chronic nonspecific infantile diarrhea:
-Provide 40% of calories from fat
-Limit fluids
-Restrict or dilute fruit juices with high osmolar loads (gapes, apple)
No fruit juice up to age ____, those up to 6 should be limited to 4 ounces per day
1
For adults with diarrhea, remove the cause and replace lost ___ and ____, especially those high in sodium and potassium
Fluid and electrolytes
In order to decrease diarrhea, ___ ___ needs to be decreased
Gastric motility
MNT for reducing gastric motility:
-Avoid clear liquids
-Avoid foods high in lactose, sucrose, and fructose
-Avoid caffeine and alcohol
-Avoid high-fiber foods
Another way to decrease diarrhea is to _____ the consistency of stool
Thicken
MNT for thickening the consistency of stool:
-Banana flakes
-Apple powder
-Pectin sources
If an adult is having diarrhea, it is important to repopulate the GI tract with normal ____
Flora
_____ are food components (pectin, fructose, oats, whole grains) that promote the growth of healthy bacteria
Prebiotics
Prebiotics exist in _____
Fructooligosaccharides
Examples of prebiotic foods:
-Onion
-Garlic
-Banana
-Artichoke
-Asparagus
-Chicory
_____ are sources of bacteria that are used to reestablish bacterial gut flora
Probiotics
Probiotics can be found in ____ dairy foods like yogurt, kefir, and aged cheese
Fermented
Probiotics can also be found in other fermented foods with beneficial live cultures, like…
-Kimchi
-Miso
-Tempeh
-Sauerkraut
If needed, adults with diarrhea can stimulate the GI tract with a diet…
-Low in fiber
-Low in fat
-Lactose-free
Steatorrhea is a consequence of ____
Malabsorption
Normal stool has between 2-5 grams of fat, stool with over ___ g is indicative of malabsorption
7
MNT for steatorrhea:
-High protein
-High complex carbohydrates
-Fat as tolerated
-Vitamins (especially fat-soluble)
-Minerals
-MCT (rapidly hydrolyzed in the GI tract)
The consequences of ____ ____ ____ are associated with significant resections of the small intestine
Short bowel syndrome
Short bowel syndrome can cause things like…
-Malabsorption
-Malnutrition
-Fluid and electrolyte imbalances
-Weight loss
The severity of short bowel syndrome reflects the…
-Length and location of resection
-Age of patient
-Health of remaining tract
The loss of the ____ (especially the distal 1/3), the ___ ____, and the ____ are of particular concerns with short bowel syndrome
Ileum, ileocecal valve, colon
Most digestion takes place in the first ____ cm of the intestine (in the duodenum and upper jejunum); what remains are small amounts of sugar, starches, fiber, and lipids
100
If someone has a jejunal resection, the ____ can adapt and take over the jejunal functions
Ileum
Significant resections of _____ produce major complications
Ileum
The distal ileum is responsible for the absorption of…
-Vitamin B12
-Intrinsic factor
-Bile salts
The ileum normally absorbs a major portion of ____ in the GI tract
Fluid
Patients with ileal resection have above-average needs for ____ to compensate for excessive losses in the stool
Water
Those with ileal resection should drink at least ___ ___ more than their ostomy output daily
1 Liter
If the ileum cannot recycle bile salts, lipids are not emulsified; this leads to malabsorption of ___-___ ____
Fat-soluble vitamins
Malabsorbed fats combine with calcium, zinc, and magnesium, leading to the production of ____, which impairs absorption
Soaps
Ileal resection may also increase colonic absorption of ____, leading to kidney stones
Oxalates
Those with ileal resections have ____ fluid and electrolyte secretions as well as increased colonic motility
Increased
Loss of the colon causes loss of…
-Water
-Electrolytes
-Salvage absorption of carbohydrates and other nutrients
If someone has loss of the colon, provide ___ ___
Chewable vitamins
Someone with short bowel syndrome might initially receive ____ ____ to restore and maintain nutrition status
Parenteral nutrition
In someone with short bowel syndrome, ____ nutrition should be started early to stimulate growth and be increased over time (continuous)
Enteral
It may take ___ or ____ for someone with short bowel syndrome to transition to oral feedings
Weeks, months
MNT for s/p jejunal resection:
-Normal balance of carbohydrates, protein, and fat
-Avoid lactose
-Avoid oxalates
-Avoid large amounts of concentrated sweets
-Vitamin and mineral supplements
MNT for s/p ileal resection:
-Limit fat
-Use MCT (does not require bile salts, needs less intestinal surface area)
-Supplement fat-soluble vitamins, Ca, Mg, Zn
-Parenteral B12 followed by monthly injections if more than 100 cm of terminal ileum is removed
Functions of the liver:
-Stores and releases blood
-Filters toxic elements
-Metabolizes and stores nutrients
-Regulates fluid and electrolyte balance
____ ____ is a list of major enzymes found in organs and tissues; enzyme levels in the blood are elevated when tissue damage causes them to leak into the circulation
Enzyme profile
What are 4 liver function tests?
-Alkaline phosphatase (ALP)
-Lactic acid dehydrogenase (LDH)
-Aspartate amino transferase (AST, SGOT)
-Alanine aminotransferase (ALT, SGPT)
Normal range for alkaline phosphatase (ALP) is ____-____ U/L
30-120
Alkaline phosphatase (ALP) is elevated in what conditions?
-Liver disease
-Bone disease
Alkaline phosphatase (ALP) is decreased in what conditions?
-Scurvy
-Malnutrition
Lactic acid dehydrogenase (LDH) is increased in what conditions?
-Hepatitis
-Myocardial infarction
-Muscle malignancies
Aspartate aminotransferase (AST) is increased in ____
Hepatitis
Alanine aminotransferase (ALT) is increased in ___ ___
Liver disease
In liver disease, liver enzymes are _____
Elevated
Acute viral hepatitis can cause symptoms like…
-Inflammation
-Necrosis of liver
-Jaundice
-Anorexia
-Nausea
-Fatigue
-Jaundice
Jaundice occurs when ____ ____ are blocked
Bile ducts
Hepatitis A is contracted through the ____-____ route of transmission (this is the type more directly connected to food)
Fecal-oral
Hepatitis B is ____ transmitted
Sexually
Hepatitis C is contracted through ___-___ contact
Blood-blood
Those with acute viral hepatitis should increase their ____ intake to prevent dehydration
Fluid
Care for acute viral hepatitis varies depending on ____ and ____ ____
Symptoms and nutrition status
Those with acute viral hepatitis should get ___-___% of kcal from carbohydrates in order to replenish liver glycogen and spare protein
50-55
Those with acute viral hepatitis should get ___-___ g of protein per kg for cell regeneration and to provide lipotropic agents to convert fat into lipoprotein for removal from the liver
1-1.2
Those with acute viral hepatitis should have ___ to ____ fat intake if tolerated, but those with steatorrhea should get under ____% of kcals from fat
Moderate to liberal; 30
Those with acute viral hepatitis should have small, frequent meals (____-___) because of anorexia
4-6
____ intake should be encouraged for those with acute viral hepatitis due to its antioxidant content
Coffee
Those with acute viral hepatitis should take a ____ with B complex, C, K, and zinc
Multivitamin
If someone with acute viral hepatitis has fluids retention, they should not exceed ___ grams of sodium per day
2
_____ is damaged liver tissue that is replaced by bands of connective tissue which divide the liver into clumps and reroutes many of the veins and capillaries; blood flow through the liver is disrupted
Cirrhosis
With cirrhosis, a protein deficiency may lead to…
-Ascites
-Fatty liver
-Impaired blood clotting
What is the normal route of blood flow?
-Esophageal
-Veins
-Portal vein
-Liver
-Vena cava
Ascites occurs when blood cannot leave the _____
Liver
With ascites, connective tissue overgrowth blocks blood flow out of the liver into the ___ ___
Vena cava
Since blood flow is backed up, the liver expands (can hold an extra liter of blood); when storage capacity has been exceeded, pressure caused by increased blood volume forces fluid to sweat through the liver into the ____ ____
Peritoneal cavity
The fluid that leaks into the peritoneal cavity is almost pure ____ with a high osmolar load, pulling more fluid in to dilute this load; this leads to ___ and ____ retention
Plasma; sodium and water
Low serum ____ may be due to the dilution factor
Albumin
____ ____ occur when blood can’t enter the liver
Esophageal varices
When blood can’t enter the liver, it causes ____ ____
Portal hypertension
Connective tissue overgrowth causes resistance to blood entering the portal vein; the increased pressure forces blood back into ____ veins that offer less resistance; esophageal, abdominal, and collateral veins enlarge
Collateral
Someone with cirrhosis needs adequate to high protein; they should get ___-___ g/kg or ___ g/kg when in stress
0.8-1.2; 1.5
Someone with cirrhosis needs a high calorie intake of ____-____ kcal/kg estimated dry weight or basal energy expenditure + 20%
25-35
Someone with cirrhosis should have a moderate to low-fat diet, with fat making up ____-____% of calories
25-40
_____ oil might be needed for someone with cirrhosis
MCT
For someone with cirrhosis who is experiencing malabsorption, they should get under ____ g of fat per day
30
____ is the preferred fuel in cirrhosis (should include omega 3)
Fat
For someone with cirrhosis, decrease ___ ____ ____ if steatorrhea develops
Long chain triglycerides
If varices are present, someone should follow a ___-___ diet
Low-fiber
If someone has edema or ascites, someone should follow a ___-____ diet (under 2 g)
Low-sodium
With ____, someone should follow a fluid restriction of 1-1.5 L/day depending on severity as well as a moderate sodium intake
Hyponatremia
What vitamins should be supplemented in someone with cirrhosis?
-B complex
-Vitamin C
-Zinc
-Magnesium
-Monitor need for vitamin A and D
____ is involved in the conversion of ammonia to urea; in someone with cirrhosis, there is increased loss in urine
Zinc
What is the progression of alcoholic liver disease?
- Hepatic steatosis
- Alcoholic hepatitis
- Cirrhosis
Alcoholic liver disease is liver injury due to alcohol and the ____ derangements it causes
Metabolic
Alcohol is converted into _____ and excess _____ which disrupts liver metabolism
Acetaldehyde; hydrogen
With alcoholic liver disease, hydrogen replaces ___ as fuel in the Kreb’s Cycle, so fat accumulates in the liver which then leads to fatty liver and increases triglyceride levels
Fat
The shift in the NADH/NAD ratio with alcoholic liver disease inhibits ___-___ of fatty acids and promotes triglyceride synthesis
Beta-oxidation
In what ways does alcohol/alcoholic liver disease cause malnutrition?
-Alcohol replaces food in the diet
-Alcohol causes inflammation of the GI tract and interferes with absorption of B12, vitamin C, folic acid
-Interferes with vitamin activation
-Increases need for B vitamins in order to metabolize alcohol
-Increases needs for magnesium (excreted after alcohol consumption)
-Malnutrition increases alcohol’s destructive effects
You must supplement ____ and ____ ____ for someone with alcoholic liver disease
Thiamin; folic acid
____ and ____ deficiencies in alcoholic liver disease are most responsible for malabsorption
Protein and folate
A thiamin deficiency with alcoholic liver disease causes ____-____ ____
Wernicke-Korsakoff Syndrome
With hepatic failure (ESLD), liver function is decreased to ____% or less
25
With hepatic failure (ESLD), the liver cannot convert ____ into urea, so it accumulates
Ammonia
Symptoms of hepatic failure include…
-Apathy
-Drowsiness
-Confusion
-Coma
Coma caused by hepatic failure is called ____ ____ ____
Portal systemic encephalopathy
____, or involuntary jerking motions, is a sign of impending coma in someone with ESLD
Asterixis
Someone with hepatic failure (non-comatose) should have moderate to high protein diet, up to ____-____ g/kg as tolerated
1-1.5
If someone with ESLD should have _____ protein intake if they have protein-sensitive hepatic encephalopathy
Modest
Someone with end-stage liver disease should get ___-___ kcal/kg
30-35
Someone with ESLD should get ___-___% of their kcal from fat, with MCT if needed
30-35
Someone with ESLD should have a ___ ___ diet if they have ascites and should also get vitamin/mineral supplementation as needed
Low sodium
The altered neurotransmitter theory says that with ESLD, ____ are decreased (they are used for energy), and _____ are increased because the damaged liver is unable to clear them
Branched-chain amino acids (BCAAs); (Aromatic amino acids) AAA
Adding ____ to the diet of someone with end-stage liver disease will add calories and protein, but may not reduce symptoms; they are used when standard treatment is not working and when the patient does not tolerate standard protein
BCAAs
Standard treatment for end-stage liver disease is _____, which is a hyperosmolar laxative that removes nitrogen, along with _____, which is an antibiotic that destroys bacterial flora that produce ammonia
Lactulose; Neomycin
Non-alcoholic fatty liver disease causes _____, or fat build-up in the liver that is not related to alcohol consumption
Steatosis
Non-alcoholic fatty liver disease is most common in what populations?
-BMI 35 or over
-Type 2 diabetics
-Those with metabolic syndrome
Non-alcoholic fatty liver disease can be managed with _____ changes
Lifestyle
What lifestyle changes can be used to treat non-alcoholic fatty liver disease?
-Weight loss (7-10% of starting weight; no rapid weight loss because greater flux of fatty acids to the liver may worsen inflammation and accelerate disease progression)
-Healthful eating (Mediterranean diet, moderate alcohol, avoid sugar-sweetened beverages, coffee may help due to antioxidants)
-Physical activity (150 minutes of moderate-intensity aerobic activity, plus two strength training sessions each week)
_____ is inflammation of the gallbladder
Cholecystitis
Cholecystitis can be caused by an infection, which causes excess water to be absorbed, causing _____ to precipitate out
Cholesterol
When cholesterol precipitates out, ____ can form
Gallstones
Another term for gallstones is _____
Cholelithiasis
Treatment for cholecystitis includes a ____-____ diet
Low-fat
Someone with acute cholecystitis should get ____-___ grams of fat per day
30-45
Someone with chronic cholecystitis should get ____-_____% of kcals from fat
25-30
A ____ is a surgical removal of the gallbladder
Cholecystectomy
After a cholecystectomy, ____ is secreted from the liver directly into the intestine
Bile
MNT for s/p cholecystectomy:
-Limit fat intake for several months to allow the liver to compensate
-Slowly increase fiber to help normalize bowel movement
Pancreatitis causes…
-Inflammation with edema
-Cellular exudate
-Fat necrosis
Pancreatitis may be due to a blockage or reflux of the ____ ____
Ductal system
Pancreatitis causes premature activation of enzymes within the pancreas, leading to _____
Autodigestion
Acute pancreatitis causes a hypermetabolic and hyperdynamic state, leading to increased ____ ____ ____
Basal metabolic rate
MNT for acute pancreatitis:
-Put pancreas at rest by withholding all feedings
-Maintain hydration (IV)
-Progress as tolerated to easily digested foods with low-fat content
-Elemental (pre-digested) enteral nutrition into the jejunum may be tolerated
Chronic pancreatitis causes recurrent attacks of ____ ____ of long duration
Epigastric pain
Someone with chronic pancreatitis should get ____ ____ _____ _____ which is taken orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase
Pancreatic enzyme replacement therapy (PERT)
MCT oil can be used in someone with chronic pancreatitis because they do not require ____ ____ for digestion (can add it to mixed dishes, jams, jellies, etc)
Pancreatic lipase
To promote weight gain in someone with chronic pancreatitis, give maximum level of ____ tolerated without an increase in steatorrhea or pain
Fat
If someone with chronic pancreatitis is malabsorbing fat-soluble vitamins, give them in ___-___ form
Water soluble
Parenteral ____ may be provided to someone with chronic pancreatitis because pancreatic protease (which is low in pancreatitis) splits off the vitamin from the carrier
B12
In someone with chronic pancreatitis, pancreatic ____ secretion may be defective so an antiacid may be given to increase the efficiency of PERT
Bicarbonate
In severe, prolonged cases of chronic pancreatitis, ____ ____ may be needed
Parenteral nutrition
What can be done to avoid pain with chronic pancreatitis?
-Avoid large meals with fatty foods
-Avoid alcohol
Cystic fibrosis is a disease of ____ glands
Exocrine
Cystic fibrosis causes secretion of thick ____ that obstructs glands and ducts
Mucous
Cystic fibrosis causes ____ ____ deficiency
Pancreatic enzyme
Those with cystic fibrosis also have high perspiration _____ levels
Electrolyte
Cystic fibrosis can also cause _____ because it affects the transport of chloride across the cell membrane
Malabsorption
For those with CF, use age-appropriate ____ to assess height and weight
BMI
Those with CF may require ____ ___ ___ ____ at meals and snacks
Pancreatic enzyme replacement therapy
Diet for someone with CF should be…
-High protein
-High calorie
-Unrestricted in fat
-Liberal in salt
If someone with CF is growing normally and steatorrhea is controlled, provide calories to cover the ____ for age and sex
RDA
If someone with CF is failing to grow, use BEE x ____ ____ plus disease coefficients
Activity factor
Patients with CF who fail to grow may need ____-___% of normal energy needs
110-200
For those with CF, protein should make up ____-___% of calories because they experience malabsorption due to pancreatic deficiency
15-20
For someone with CF, carbohydrates should make up ___-___% of total calories
45-55
Those with CF need liberal fat intake to compensate for high energy needs; fat should make up ___-___% of total kcal
35-40
Those with CF require a high sodium intake; they need an additional ___-___ g/day in hot weather or with heavy perspiration
2-4
Those with CF should receive age-appropriate doses of ___-___ vitamins and minerals
Water-soluble
What supplements should be provided to someone with CF?
-Zinc
-Water soluble form of fat-soluble vitamins (A and E)
____ blood pressure is the greatest pressure and measures during the contraction; ____ is the least pressure and measures during relaxation
Systolic, diastolic
Hypertension may be ____ (essential), or ____ (due to another disease)
Primary, secondary
Hypertension is classified in stages based on risk of developing ____ ____ ____
Coronary artery disease
Normal blood pressure:
<120/80 mm Hg
Elevated blood pressure:
Systolic between 120-129 AND diastolic under 80
Stage 1 hypertension:
Systolic between 130-139 OR diastolic between 80-89
Stage 2 hypertension:
Systolic at least 140 OR diastolic at least 90
____ is a major factor in the cause and treatment of hypertension
Obesity
Thiazide diuretics may be used to treat hypertension; a common adverse effect is _____
Hypokalemia
What are the four modifiable risk factors in primary prevention and treatment of hypertension?
-Overweight
-High salt intake
-Alcohol consumption
-Physical inactivity
For the management of hypertension, salt restriction of under ____ mg/day should is recommended
2300
The DASH diet recommends…
-Whole grains
-Fruits
-Vegetables
-Low-fat dairy
-Poultry
-Fish
-Moderate sodium
-Limit alcohol
-Decrease sweets
-Calcium-rich foods to meet DRI
The _____ diet can also be used for the management of hypertension
Mediterranean
The Mediterranean diet is high in ___ ____ ____ and ____ fats
Alpha-linolenic acid (omega 3); monounsaturated
What are some types of fats that the Mediterranean diet promotes (high omega 3)?
-Olive oil
-Canola oil
-Soybean oil
-Walnuts
-Almonds
-Pecans
-Peanuts
-Pistachios
What else does the Mediterranean diet promote?
-Fish, poultry, and eggs rather than beef
-Breads
-Fruits and vegetables in abundance
-Beans and legumes
-Yogurt
-Cheese
-Moderate consumption of wine with meals
____, which is an antioxidant in the skin of red grapes, may help lower blood pressure
Reservatrol
What factors increase the risk of atherosclerosis?
-Hypertension
-Obesity
-Smoking
-Elevated blood lipids
-Heredity
Coronary artery disease causes hard, ____ arteries from plaque buildup
Narrow
____ is a deficiency of blood due to obstruction
Ischemia
_____ is the loss of elasticity of blood vessel walls
Arteriosclerosis
A ____ ____ is due to a reduction of coronary blood flow to the myocardium due to a blood clot blocking a narrowed coronary artery
Myocardial infarction
_____ ____ is another term for chest pain
Angina pectoris
____ is a medication that can be given for blood clots
Heparin (blood thinner)
Dyslipidemia describes both…
-High triglycerides
-Low HDL
____ are a type of lipoprotein synthesized in the intestine from dietary fat
Chylomicrons
Chylomicrons transport dietary triglyceride from the gut to the ____
Adipose
Chylomicrons are the ____ density lipoproteins and have the smallest amount of protein
Lowest
VLDL (pre-beta) transport ____ ____ from the liver to the adipose
Endogenous triglycerides
LDL (beta) transports ____ from the diet and liver to all cells
Cholesterol
Small dense LDL (LDL-C) is associated with increased risk; it is _____ to diet
Responsive
Larger buoyant LDL is ____ associated with an increased risk
Not
HDL (alpha) does reverse cholesterol transport; it moves cholesterol from the ____ to the ____ for excretion
Cells; liver
IDL (between pre-beta and beta) is an LDL precursor and causes ____ of other lipoproteins
Catabolism
____ ____ is diagnosed based on having 3 or more risk factors; diagnosis is linked to insulin resistance, which often increases risk for coronary events
Metabolic syndrome
What are the risk factors that the diagnosis of metabolic syndrome is made upon?
-Elevated blood pressure (130 or more systolic, and/or 85 or more diastolic)
-Elevated triglycerides 150 or more
-Fasting serum glucose 100 or more
-Waist measurement 40 inches or more in men or 35 inches or more in women
-Low HDL under 40 in men or under 50 in women
Optimal LDL level is under ____
100
Optimal total cholesterol level is under ____
200
Low HDL cholesterol for men is under ____ and for women it is under ____
40; 50
HDL cholesterol is high if it is ____ or above
60
High ____ levels are independent risk factors for CHD
Homocysteine
Normal triglyceride level is under ____
150
The ___ ___ diet is for the prevention and treatment of cardiovascular disease
Heart Healthy
The heart-healthy diet provides under ___% of total calories from saturated fat
7
The heart-healthy diet provides under ____ mg of cholesterol
200
The heart-healthy diet provides no more than ____ g of sodium
2
The heart-healthy diet promotes:
-Whole grains
-Fruits
-Vegetables
-Low-fat or fat-free dairy
-Unsaturated fats
The heart healthy diet promotes ___-___ g of fiber intake per day, with ___-___ g of soluble fiber
20-30; 5-10
The adult treatment panel (ATP IV) does not focus on specific target levels for LDL, but defines _____ for whom lowering LDL would be most beneficial
Groups
The adult treatment panel recommends a heart-healthy diet and statin therapy for…
-Patients who have atherosclerotic cardiovascular disease
-Patients with LDL of 190 or higher
-Patients with type 2 diabetes who are between 40 and 75 years of age
-Patients with an estimated 10-year risk of cardiovascular disease of 7.5% or higher who are between 40 and 75 years old
____ ____ is when a weakened heart fails to maintain adequate output, resulting in diminished blood flow so fluid is held in tissues (edema); causes dyspnea
Heart failure
With heart failure, there is reduced blood flow to the kidneys which causes secretion of hormones that hold in sodium and fluid, leading to ___ ___
Weight gain
____ is a medication used in heart failure to increase the strength of the heart contraction
Digitalis
Someone with heart failure should limit sodium intake to ___-___ g/day (DASH diet)
2-3
Those with heart failure should also limit fluid intake to ___-___ L/day
1-2
Those with heart failure should get ____-____ g/kg ABW of protein per day for both normally nourished and malnourished patients
1.1-1.4
Energy needs for heart failure is calculated by multiplying _____ by an activity factor
RMR
Activity factor for a sedentary patient with heart failure:
1-<1.4
Activity factor for a low-active patient with heart failure:
1.4-<1.6
Activity factor for an active patient with heart failure:
1.6-<1.9
Activity factor for a very active patient with heart failure:
1.9-<2.5
Use indirect calorimetry to determine RMR; if that is not available, estimate RMR at ____ kcal/kg for normally nourished or ____ kcal/kg for malnourished
22; 24
In someone with heart failure, evaluate ____ status (can be lost with loop diuretics; if low, pyruvate cannot be converted into acetyl CoA for energy, so the heart muscle becomes deprived
Thiamin
What should be supplemented in someone with heart failure?
-DRI for folate and magnesium
-MVI with B12
Those with heart failure should be encouraged to do regular ____ ____
Physical activity
____ ____ is unintended weight loss caused by blood that is backed up into the liver and intestines, causing nausea and decreased appetite
Cardiac cachexia
____ and ____ supplementation may help with cardiac cachexia
Arginine and glutamine
What is the MNT for cardiac cachexia?
-Low saturated fat
-Low cholesterol
-Low trans fat
-<2 g sodium
-High calorie
The _____ is a tuft of capillaries held closely by Bowman’s Capsule; it produces ultrafiltrate which then passes through the tubules
Glomerulus
Bowman’s capsule blocks the passage of ____ ____ ____ and large molecules like protein
Red blood cells
The proximal convoluted tubule is the site of major ____ ____
Nutrient reabsorption
The Loop of Henle maintains ____ and ____ balance
Water and sodium
The distal tubule is responsible for maintaining ____-___ balance
Acid-base
What are the 4 renal functions?
-Filtration
-Absorption
-Excretion
-Secretion
The kidneys make sure red blood cells and protein stay in the blood, all else filters through the ____
Tubules
The kidneys absorb ____% of glucose and amino acids, as well as ___% of water, sodium, and potassium
100; 85
The kidneys excrete…
-Wastes
-Urea
-Excess ketones
What types of things do the kidneys secrete?
-Hormones that control blood pressure
-Blood components
-Ions that maintain acid-base balance
Vasopressin, also known as ____ ____, is secreted from the hypothalamus and stored in the pituitary gland
Antidiuretic hormone
Vasopressin (ADH) exerts a ____ effect and elevates blood pressure
Pressor
Vasopressin (ADH) increases ____ ____ from the distal and collecting tubules
Water resorption
The syndrome of inappropriate antidiuretic hormone causes (too much vasopressin) causes ______ caused by hemodilution
Hyponatremia
Hyponatremia is treated with a ____ ____
Fluid restriction
Renin is a hormone that causes ____ and elevates blood pressure
Vasoconstriction
Renin stimulates ____ to increase sodium absorption and return blood pressure to normal
Aldosterone
Erythropoietin is a hormone produced by the kidney; it stimulates the bone marrow to produce ___ ___ ___
Red blood cells
In renal disease, someone has decreased ____ and ____ ____
GFR; creatinine clearance
In renal disease, someone has increased serum ____ and ___
Creatinine and BUN
A BUN: Creatinine ratio of over ___indicates a “pre-renal state” in which BUN reabsorption is increased due to acute kidney damage (may be reversible and may not require dialysis)
20:1
A BUN: Creatinine ratio of under ____ suggested reduced BUN reabsorption due to renal damage (may need dialysis)
10:1
Renal ___ ____ describes solutes excreted in 1 L urine; daily fixed load of 600 mOsm
Solute load
Renal solute load mainly measures ___ (60%) and electrolytes (____)
Nitrogen; sodium
Manifestations of renal disease:
-Anemia due to decreased production of erythropoietin
-Upset in blood pressure
-Decreased activation of vitamin D
The kidneys produce the active form of vitamin D which promotes efficient absorption of ____ by the gut
Calcium
Renal ____ can be prevented by drinking 1.5-2 L of fluid in order to dilute the urine
Calculi
Calcium oxalate stones can be prevented with…
-Adequate calcium intake (RDA from dairy or supplements with meals) to bind oxalates
-Low oxalate diet (40-50 mg)
Founds high in oxalates:
-Dark leafy greens
-Chocolate
-Strawberries
-Nuts
-Beets
-Tea
More calcium oxalate stones are seen in patients with diets that are low in ____
Calcium
Minerals that are not oxidized in metabolism leave an ____ (residue) in the urine
Ash
To prevent acidic kidney stones, create an alkaline ash by increasing cations like calcium, sodium, potassium, and magnesium by adding to the diet things like…
-Vegetables
-Fruits
-Brown sugar
-Molasses
To prevent alkaline stones, create an acidic ash by increasing anions like chloride, phosphorus, and sulfur by adding into the diet things like…
-Meat
-Fish
-Fowl
-Eggs
-Shellfish
-Cheese
-Corn
-Oats
-Rye
___ ____ ____ is a sudden shutdown of the kidney with previously adequate capacity; causes decreased GFR and inadequate pre-renal perfusion
Acute kidney injury
Acute kidney injury can result from…
-Burns
-Accidents
-Obstructions
-Severe dehydration
Symptoms of acute kidney injury:
-Oliguria (<500 ml urine)
-Azotemia (increased urea in blood)
With acute kidney injury, at first we should provide…
IV glucose, lipids, protein
Someone with an AKI should get ___-___ g/kg of protein if they are non-catabolic without dialysis as GFR returns to normal
1-1.3
Someone with an AKI should get ___-___ g/kg of protein if they are catabolic and/or if dialysis is initiated
1.2-1.5
Those with AKI should get ____-____ kcals/kg or BEE x ___-___ during hypermetabolic conditions
25-40; 1.2-1.3
Energy expenditure ____ as kidney function declines
Increases
Those with AKI should have a low-sodium diet of no more than ___-___g; must replace loses during diuretic phase
2-3
Those with AKI should get ___-___ mg/kg phosphorus; they made need phosphorus binders
8-15
Those with AKI should get ___-___ grams of potassium based on output, serum potassium, and dialysis
2-3
For someone with AKI, replace fluid output from the previous day plus ____ ml
500
Nephrotic syndrome is also known as ____
Nephrosis
With nephrotic syndrome, there is increased ____ and decreased ____ of VLDL
Synthesis; clearance
Nephrotic syndrome is caused by a defect in the capillary basement membrane of the glomerulus which permits the escape of large amounts of ____ into the filtrate moving through the tubules
Protein
Nephrotic syndrome causes…
-Albuminuria
-Edema
-Malnutrition
-Hyperlipidemia
Those with nephrotic syndrome should get ___-___ g/kg of protein with 50% from high-biological value protein
0.8-1
In someone with nephrotic syndrome, excess protein will be catabolized to ____ and excreted
Urea
Those with nephrotic syndrome should get under ____% of total kcal from fat (low saturated fat)
30
Those with nephrotic syndrome should get no more than ____ mg of cholesterol
200
Someone with nephrotic syndrome should get ____ kcal/kg per day
35
Someone with nephrotic syndrome should have a modest sodium restriction of ___-___ g/day, depending on hypertension and edema
2-3
Those with nephrotic syndrome should get ___-___ g/day of calcium, and supplement with vitamin D as well
1-1.5 (1000-1500 mg)
Those with nephrotic syndrome might need ____ restriction if they have edema
Fluid
People with nephrotic syndrome may have abnormalities in what vitamins/minerals, related to protein loss?
-Iron
-Copper
-Zinc
-Calcium
Chronic kidney disease causes…
-Anemia
-Weakness
-Weight loss
-Nausea
-Vomiting
Anemia with CKD is due to deficient production of the hormone ____ by the kidney
Erythropoietin
What types of diets are recommended for those with CKD?
-Mediterranean diet
-DASH diet
-High fruit and vegetable intake
Those with CKD should get ___-___ kcal/kg per day
25-35
Those with CKD should get under ____ mg of sodium per day
2300
For CKD stages 3-5, we should recommend ___-___ g/protein per kg or 0.28-0.43 g/kg with keto acid to meet goal
0.55-0.6
In those with CKD, adjust ____ intake to maintain normal serum levels
Phosphorus
Those with CKD should get ___-___ mg of total elemental calcium per day
800-1000
____ is generally not restricted in CKD unless serum level is elevated and urine output is under 1 L/day
Potassium
____ is generally unrestricted for CKD stages 1-4
Fluid
What types of supplements should be considered in those with CKD?
-Folate
-B12
-B complex
-Vitamin C
-Vitamin D
The long-term goal of chronic renal failure is to prevent ____
Malnutrition
Those on hemodialysis should get ___-___ g/kg SBW of protein per day
1-1.2
