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Surgery > Fiser ABSITE Ch. 10 Nutrition > Flashcards

Fiser ABSITE Ch. 10 Nutrition Flashcards

1
Q

Caloric need is approximately ___ kcal/kg/day

A

25

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2
Q

kcal/g of fat, protein, oral carbohydrates, dextrose

A

9, 4, 4, 3.4

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3
Q

How many g protein/kg/day is needed and what percentage should be essential amino acids.

A

1, 20

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4
Q

Formula for caloric requirements for burn patient? protein requirements?

A

25 kcal/kg/day + (30 kcal/day x % burn)

1-1.5 g/kg/day + (3g x % burn)

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5
Q

Much of the energy expenditure is used for what?

A

heat production

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6
Q

Basal metabolic rate increases ___% for each degree above 38.0

A

10

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7
Q

What is the name of the equation that calculates basal energy expenditure based on weight, height, age and gender?

A

Harris-Benedict equation

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8
Q

What is central line TPN based and what is its max administration rate?

A

glucose, 3 g/kg/hr

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9
Q

What is peripheral line parenteral nutrition (PPN) based?

A

fat based

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10
Q

What is the fuel for colonocytes?

A

short chain fatty acids

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11
Q

What is the fuel for small bowel enterocytes?

A

glutamine

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12
Q

What is the most common amino acid in the bloodstream and tissue?

A

glutamine

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13
Q

What is the primary fuel for neoplastic cell?

A

glutamine

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14
Q

Approximate half-life of albumin, transferrin, prealbumin

A

20 days, 10 days, 2 days

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15
Q

Normal protein level?

A

6.0-8.5

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16
Q

Name 4 acute indicators of nutritional status

A

retinal binding protein, prealbumin, transferrin, total lymphocyte count

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17
Q

Formulas for ideal body weight Men and Women

A

Men 106 lb + 6 lb for each inch over 5 ft

Women 100 lb + 5 lb for each inch over 5 ft

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18
Q

What is the strong risk factor for morbidity and mortality after surgery?

A

Low albumin (less than 3.0)

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19
Q

What is respiratory quotient?

A

Ratio of CO2 produced to O2 consumed, measurement of energy expenditure.

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20
Q

What does a RQ > 1 mean? Tx?

A

lipogenesis (overfeeding)

decrease carbohydrates and caloric intake- high carbohydrate intake can lead to CO2 buildup and ventilator problems

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21
Q

What does a RQ less than 0.7 mean? Tx?

A

ketosis and fat oxidation (starving)

increase carbohydrates and caloric intake

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22
Q

What is the RQ for pure fat metabolism?
pure protein metabolism?
pure carbohydrate metabolism?

A

pure fat = 0.7
pure protein = 0.8
pure carbohydrate = 1.0

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23
Q

Postoperative Phases
Diuresis phase days __-__
Catabolic phase days __-__ (negative nitrogen balance)
Anabolic phase days __-__ (positive nitrogen balance)

A

2-5
0-3
3-6

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24
Q

Glycogen stores are depleted after __-__ hours of starvation. The body then switches to ___

A

24-36

fat

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25
Q

What proportion is glycogen stores in skeletal muscle and what proportion is in liver?

A

2/3 in skeletal muscle

1/3 in liver

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26
Q

____ stays in muscle after breakdown from glycogen and is utilized.
Skeletal muscle lacks ____ (found only in the liver)

A

glucose 6 phosphate

glucose 6 phosphatase

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27
Q

What is the simplest amino acid precursor for gluconeogenesis and the primary substrate for gluconeogenesis

A

Alanine

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28
Q

What are the only two amino acids to increase during times of stress?

A

alanine and phenylalanine

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29
Q

Late in starvation gluconeogenesis occurs where?

A

in the kidney

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30
Q

Protein-conserving mechanisms do not occur after trauma or surgery secondary to what 2 factors?

A

catecholamines and cortisol

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31
Q

What is the main source of energy in trauma and starvation?

A

Fat (ketones)

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32
Q

Most patients can tolerate a ___% weight loss without major complications.

A

15

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33
Q

How many days can a patient tolerate without eating?

After that, what are 2 options?

A

7 days

Dobbhoff tube or start TPN

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34
Q

What is the main reason to try to feed gut?

A

avoid bacterial translocation (bacterial overgrowth, increased permeability due to starved enterocytes

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35
Q

What is elemental formula?

A

all protein given in the form of amino acids (given IV, expensive)

36
Q

Consider PEG when regular feeding not possible (eg CVA) or predicted not to occur for >___ weeks

A

4

37
Q

Brain utilizes ___ with progressive starvation (normally uses glucose)

A

ketones

38
Q

Name 4 obligate glucose users

A

peripheral nerves, adrenal medulla, RBCs and WBCs

39
Q

What three things are decreased with refeeding syndrome?

A

K, Mg, PO4

40
Q

What are the sx of refeeding syndrome?

A

cardiac dysfunction and fluid shifts

41
Q

How to prevent refeeding syndrome?

A

starting at a low rate (10-15/kg/day)

42
Q

What is cachexia mediated by?

A

TNF-a

43
Q

How much protein contains 1 g of nitrogen?

A

6.25

44
Q

How much total protein is synthesized in a 70 kg male per day?

A

250 g/day

45
Q

What organ is responsible for amino acid production and breakdown?

A

Liver

46
Q

What is produced to get rid of ammonia from amino acid breakdown?

A

urea

47
Q

The majority of protein breakdown from skeletal muscle is from what two amino acids?

A

glutamine and alanine

48
Q

What is used to synthesize bile salts?

A

cholesterol

49
Q

How do medium and short chain fatty acids enter enterocytes?

A

simple diffusion

50
Q

After micelles and other fatty acids enter enterocytes, what are formed? which enter lymphatics.

A

chylomicrons

51
Q

What is the difference between medium/short chain fatty acids and long chain fatty acids in how they enter circulation?

A

medium and short enter portal system

long chain enter lymphatics

52
Q

On liver endothelium, clears chylomicrons and TAGs from the blood, breaking them down to fatty acids and glycerol which are then taken up by hepatocyte

A

Lipoprotein lipase

53
Q

On liver endothelium; binds short and medium chain fatty acids

A

Free fatty acid binding protein

54
Q

Most important route of entry for dietary cholesterol; synthesized in the liver

A

VLDL

55
Q

What is the preferred source of energy for the liver, heart and skeletal muscle?

A

fatty acids

56
Q

What are unsaturated fatty acids used for?

A

structural components for cells

57
Q

In fat cells; breaks down TAGs (storage form of fats) to fatty acids and glycerol; released into blood (sensitive to growth hormone, catecholamines, glucocorticoids)

A

Hormone-sensitive lipase

58
Q

What are the 2 essential fatty acids?

A

linolenic, linoleic

59
Q

The essential fatty acids are important for immune cells and are needed for ___ synthesis

A

prostaglandin

60
Q

Omega 3 fatty acids converted into what three important lipids thought to have antioxidant properties?

A

PGI3, TXA3, LTB5 (all odd; think BAI)

61
Q

Omega 6 fatty acids are converted into what 3 important lipids?

A

PGE2, TXA2, LTB4 (all even; think BAE)

62
Q

Carbohydrate digestion begins with what enzyme?

Then what other 2?

A

salivary amylase

then pancreatic amylase and disaccharidases

63
Q

Glucose and galactose are absorbed by what mechanism? Where are they released into?

A

secondary active transport

portal vein

64
Q

Fructose is absorbed by what mechanism? Where is it released into?

A

facilitated diffusion

portal vein

65
Q 
sucrose = \_\_\_ + \_\_\_
lactose = \_\_\_ + \_\_\_
maltose = \_\_\_ + \_\_\_"
A

fructose + glucose
galactose + glucose
glucose + glucose

66
Q

Protein digestion begins with what enzyme?

Then what other 3?

A

stomach pepsin

trypsin, chymotrypsin and carboxypeptidase

67
Q

Trypsinogen released from ___ and activated by ___ released from ___.

A

pancreas, enterokinase, duodenum

68
Q

What is the mechanism by which protein is aborbed?

Where is it then released and in what form?

A

amino acids, dipeptides and tripeptides are absorbed by secondary active transport;
released into portal vein as free amino acids

69
Q

May want to limit protein intake in pts with ___ and ___ to avoid ammonia buildup and possible worsening encephalopathy

A

liver failure and renal failure

70
Q

What are the 3 branched amino acids (w/ mnemonic)?

A

leucine, isoleucine, valine (LIV)

71
Q

Where are the branched amino acids metabolized?

A

muscle

72
Q

Name the deficiency associated with hyperglycemia, encephalopathy, neuropathy

A

chromium

73
Q

Name the deficiency associated with cardiomyopathy, weakness, hair loss

A

selenium

74
Q

Name the deficiency associated with pancytopenia

A

copper

75
Q

Name the deficiency associated with hair loss, poor healing, rash

A

zinc

76
Q

Name the deficiency associated with weakness (failure to wean off ventilator), encephalopathy, decreased phagocytosis

A

phosphate

77
Q

Name the deficiency associated with Wernicke’s encephalopathy, cardiomyopathy, peripheral neuropathy

A

Thiamine (B1)

78
Q

Name the deficiency associated with sideroblastic anemia, glossitis, peripheral neuropathy

A

Pyridoxine (B6)

79
Q

Name the deficiency associated with megaloblastic anemia, peripheral neuropathy, beefy tongue

A

Cobalamin (B12)

80
Q

Name the deficiency associated with megaloblastic anemia, glossitis

A

Folate

81
Q

Name the deficiency associated with pellagra (diarrhea, dermatitis, dementia)

A

Niacin

82
Q

Name the deficiency associated with dematitis, hair loss, thrombocytopenia

A

Essential fatty acids

83
Q

Name the deficiency associated with night blindness

A

Vitamin A

84
Q

Name the deficiency associated with coagulopathy

A

Vitamin K

85
Q

Name the deficiency associated with rickets, osteomalacia

A

Vitamin D

86
Q

Name the deficiency associated with neuropathy

A

Vitamin E

87
Q

What is the process called by which lactate goes to the liver and is converted back to pyruvate and eventually glucose via gluconeogenesis

A

Cori cycle

Surgery (33 decks)

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