GI Nutrition Flashcards
1
Q
Malnutrition
Consequence of what (2)
Results in what (3)
A
inadequate intake of proteins and calories OR deficiencies in the digestion or absorption or proteins
Weight loss, Lethargy, Weakness
2
Q
Good diet has what three components
A
- Sufficient energy in all 3 types
- Amino acids and fatty acids
- Vitamins and minerals
3
Q
Primary malnutrition definition
A
One or all of these components are missing from the diet
4
Q
Secondary malnutrition
A
Although supply is adequate: you are not absorbing, using, or storing nutrients
5
Q
Chronic alcoholism sees deficiencies in what? 4
A
thiamine, pyridoxine, folate, and Vitamin A
6
Q
Malnutrition is determined how?
A
In terms of BMI
7
Q
What is BMI of malnutrition?
A
Less than 16
8
Q
Protein energy malnutrition has what two diseases?
A
Marasmus and Kwashiorkor
9
Q
Somatic protein compartment is where
Affected by what disease
A
Skeletal muscle
Marasmus
10
Q
Visceral protein compartment is where
Affected by what disease
A
Visceral organs like liver
Kwashiorkor
11
Q
Maramus definition
A
<60% of normal weight for sex, height and age
12
Q
Marasmus Effect on growth Albumin levels Extremity change Other changes seen (3)
A
Growth retardation
Normal albumin
Emaciated extremities
Anemia + Vitamin def. + Immune def
13
Q
Kwashiorkor Definition Most common form of PEM in who Why Occurs in what conditions (4) Albumin level and what it signals Two tissues spared from loss Skin change Hair change Liver change
A
Protein deprivation African children Weaned too early and eat carbs mainly 1. Chronic diarrhea 2. Protein losing enteropathies 3. Nephrotic syndrome 4. Burns Low albumin --> Edema Spares fat and muscle Flaky paint appearance Loss of hair color Fatty liver
14
Q
Kwashiorkor vs. Marasmus Mental State Face appearance Fat that remains Edema presence Fatty liver Hair changes Growth failure
A
Mental: K is apathy and M is alert Face: K is moon face and M is wizened Fat: K is subq fat and Marasmus is none Edema: K has it Fatty liver: K has it Hair change: K has it Growth failure: Both
15
Q
How to measure nutritional status of elderly
A
Mini-nutritional assessment
16
Q
Obvious signs of PEM
Fat
Muscle
Edema
A
Fat: Depletion of subq fat in arms, shoulders, chest wall
Muscle: Wasting of quad and delts
Edema: Ankle or sacral edema
17
Q
Cachexia definition
What % of cancer patients
3 most common cancers associated
Mortality is the result of what
A
PEM in patients with AIDS or advanced cancers
50%
with GI, pancreatic, and lung cancers
atrophy of the diaphragm and other respiratory muscles
18
Q
Cachetic agents
A
Tumor necrosis factor alpha Inflammatory cytokines Interleukin-6 Proteolysis-inducing factor (PIF) Lipid-mobilizing factor (LMF)
19
Q
Anorexia definition
A
self-induced starvation
20
Q
Bulemia definition
A
food binging followed by induced vomiting
21
Q
Anorexia nervosa Title Effect on what system prominent Symptoms of this effect 2 Three blood changes
A
Highest death rate of any psychiatric disorder
Endocrine
Amenorrhea, Hypothyroidism, Bone density decreased
Anemia, Lymphopenia, Hypoalbuminemia
22
Q
Which is more common, bulemia or anorexia
Which has better prognosis
Which sex more
A
Bulimia
Bulimia
Women
23
Q
Endocrine change in bulimia
A
Amenorrhea
24
Q
Major complications of bulimia are due to what (2)
A
- Chronic vomiting
2. Chronic use of laxative and diuretics
25
Findings in bulimia (5)
1. Hypokalemia
2. Aspiration
3. Esophageal and cardiac gastro rupture
4. Acid damage to teeth
5. Knuckle bruising (Russell's sign)
26
How many vitamins are needed
Which are fat soluble
What makes fat soluble better
13
DEAK
Store in body better
27
4 vitamins synthesized endogenously
| And from what
Vitamin D: Steroids
Vitamin K and Biotin: Intestinal microflora
Niacin (B3): Tryptophan
28
Vitamin A includes what three types
Retinol
Retinal
Retinoic acid
29
Chemical name of Vitamin A
Retinol
30
Transport and storage form of Vitamin A
Retinol ester
31
Name for all types of Vitamin A
Retinoids
32
Vitamin A animal sources
Liver, fish, eggs, milk, butter
33
Vitamin A vegetable sources
Why is vegetable good
Most important carotenoid
Carrots, squash, spinach
Has carotenoids that can turn to Vit A
Beta-carotene
34
Absorption of Vitamin A requires what? (3)
Bile
Pancreas enzymes
Antioxidant activity
35
Most of Vitamin A is stored where
Liver
36
Vitamin A five funcitons
1. Maintains normal vision
2. Cell growth and differentiation
3. Fat metabolism
4. Host resistance to infections
5. Antioxidant
37
What are the four forms of Vitamin A containing pigmentsin eye
```
One rhodopsin (rods-light)
Three iodopsins (cones-color)
```
38
Vitamin A has what effect on mucus
Keeps mucus secreting epithelium orderly, if not there undergoes metaplasia
39
Vitamin A as a treatment (2)
Skin: Severe acne and psoriasis
| Treats acute promyelocytic leukemia
40
Vitamin A deficiency in the eye results in (5)
1. Impaired vision
2. Night blindness
3. Dry eyes
4. Squamous metaplasia
5. Immune deficiency
41
Synthetic retinoids have what effects
Synthetics like accutane have teratogenic effects
42
Vitamin D function
Maintain calcium and phosphorus levels
43
3 deficiencies of Vitamin D
1. Osteomalacia (adults)
2. Rickets (kids)
3. Hypocalcemic tetany
44
Major source of endogenous Vitamin D?
Synthesis in the skin to make D3
45
Vitamin D can also come from (2)
1. Deep sea fish
| 2. Plants (ergosterol)
46
How is 1,25 Vitamin D made?
After sun activation Vitamin D3 binds to D-binding protein and goes to liver to be acted on by 25-OHases and is then acted on by alpha-1 hydroxylase in the kidney to form 1,25
47
3 ways Vitamin D production in kidney is regulated
Hypocalcemia --> Increase PTH --> Increase Vit D
Hypophosphatemia --> Activates alpha-1hydroxylase
Increased 1,25 levels --> Decrease its own synthesis
48
Vitamin D effects on calcium (4)
1. Stimulation of intestinal absorption of Ca
2. Stimulation of calcium reabsorb in Kidney
3. Interact with PTh
4. Mineralization of bone
49
What level constitutes Vitamin D deficiency
less than 20
50
Rickets
| Mechanism
Excess of unmineralized matrix causing overgrowth of epiphyseal cartilage
51
Rickets most common when?
First year of life
52
Rickets symptoms
1. Craniotabes (softening of bone)
2. Frontal bossing of head and squared appearance of head
3. Rachitis rosary of ribs
4. Pigeon breast deformity of chest
5. Bowing of legs
6. Lumbar lordosis of spine
53
Osteomalacia is what mechanism
Lack of Vitamin D deranges the normal bone remodeling that occurs throughout life
54
Vitamin D has what effect on cell cycle
Can control apoptosis and differentiation
55
Vitamin E
Most common form
Food source
Acumulates mainly where
Alpha-tocopherol
Everything
Fat deposits the most, but can be anywhere
56
Vitamin E function
an antioxidant
57
Deficiencies of Vitamin E 3
1. Fat absorption
2. Low birth weight
3. Abetalipoproteinemia
58
Main neuro problem of Vit E deficiency
Spinocerebellar degeneration
59
Vitamin E toxicity
Decreases synthesis of coag factors --> Causes hemorrhage
60
Vitamin K is required for what
Production of gamma-carboxyglutamates
61
Gamma-carboxyglutamates have what funciton
Allow clotting factors 2, 7, 9, 10, protein C and protein S to bind to phospholipid surface
62
Vitamin K dependent factors:
2, 7, 9, 10, Protein C, Protein S
63
Deficiency in Vitamin K leads to what
hypoprothrombinemia and a bleeding diathesis
64
Coumadin effect on Vitamin K
Blocks recycling of Vitamin K to decrease clotting factor ability
65
Water soluble proteins have what two advantages
1. Readily absorbed
| 2. Do not need transport proteins
66
Thiamine Vitamin B1
Source
Function (3)
Refined foods
Synthesis of ATP
Pentose phosphate pathway
Neural membrane conductance
67
Thiamine deficiency 2
1. Chronic alcoholics
| 2. Pernicious vomiting or diarrhea
68
Syndromes of thiamine deficiency 3
Dry beriberi
Wet beriberi
Wernicke-Korsakoff syndrome
69
Wernicke's encephalopathy entails what? (4)
1. nystamus
2. Ataxia
3. Ophthalmoplegia
4. Deranged mental function
70
Korsakoff psychosis includes what:
Problems with memory
71
Dry beriberi is what?
Myelin degeneration
72
Wet beriberi is what
CV syndrome with vasodilation and heart failure
73
Riboflavin Vitamin B2 is a component of what?
FMN and FAD in redox reactions
74
Riboflavin source
Meat, dairy products, veggies
75
Deficiency of Riboflavin is what
Ariboflavinosis: Cheilosis, glossitis, inflammation
76
Niacin Vitamin B3 is component of what
Food source
Synthesized from what in body
NAD and NAP
Grains and legumes
Tryptophan
77
Niacin deficiency common patients
Alcoholics
| IC'd
78
3D's of niacin deficiency known as pellagra
Dermatitis
Dementia
DIarrhea
79
Two other pellagra symptoms
Scarlet tongue
| Casal's necklace
80
Niacin use in therapy
Used in hypercholesterolemia to lower LDL
81
```
Pyridoxine Vitamin B6 function
Deficiency causes (3)
Deficiency results in (1)
```
Metabolism of AA's and glycolipids
Drugs that work as agonists, Alcoholics, Pregnant
Increased plasma homocysteine
82
Vitamin B12 function (3)
Nucleic acid synthesis
Needed for normal folate metabolism
Maintenance of myelinization of spinal cord tracts
83
Deficiency of Vitamin B 12 result (2)
1. Megaloblastic anemia
| 2. Degeneration of posterolateral spinal cord tracts
84
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Vitamin C made endogenously?
Deficiency state called
Manifests how (2)
```
No
Scurvy
Bone disease and hemorrhages
85
Vitamin C function (3)
In redox reactions
Hydroxylation of collagen
Regenerates antioxidant form of Vitamin E
86
Deficiency in two patient types
Alcoholics
Elderly
Dialysis
87
Scurvy symptoms
1. Bleeding from gums and joints and skin
2. Scorbutic bone with outward projection of ribs
3. Scorbutic rosary
88
First clinical sign of Vitamin C deficiency
Perifolicular petechiae
89
Toxicity of Vitamin C effect
Kidney stones
90
Folate function
| Found in what
Nucleic acid synthesis
| Wheat, legumes, veggies
91
Deficiency of folate results in what (4)
Megaloblastic anemia
Neural tube defects
Increased homocysteine
Increase risk for colon cancer
92
Zinc deficiency
Rash called acrodermatitis enteropathica
93
Iron deficiency
Hypochromic microcytic anemia
94
Iodine deficiency (2)
Goiter + Hypothyroidism
95
Copper deficiency
Muscle and neuro deficits
96
Fluoride deficiency
Dental caries
97
Selenium deficiency
Myopathy: Keshan disease
98
Obesity definition
Excess adiposity and excess body weight
99
Obesity associated with what: 4
Type 2 diabetes
Dyslipidemias, CV disease
HTN
Cancer
100
Normal BMI:
18.5 to 25
101
Overweight BMI:
25-30
102
Obese BMI
>30
103
Central/visceral obesity
| Severity
Fat accumulates in trunk and abdominal cavity
| Much higher risk for disease
104
3 neurohumoral mechanisms for energy balance
Peripheral/Afferent
Arcuate nucleus in hypothalamus
Efferent system
105
Peripheral/Afferent has what components (4)
1. Leptin: fat cells
2. Ghrelin: Stomach
3. Peptide YY: Ileum and colon
4. Insulin: pancreas
106
Leptin has what effect
Gives you sense of fat stores
107
Humans with loss of leptin gene have what
Early onset severe obesity
108
Leptin stimulates what
physical activity and heat production
109
Number of adipocytes effect?
Higher the number, higher risk of obesity
110
Ghrelin has what effect
Levels before meal
Levels after meal
Increases food intake
Rise before
Lower after
111
PYY levels during fasting
| PYY levels after eating
Low during fasting
| High after
112
Situations of decreased PYY
Gastric bypass
| Prader-Willi
113
High BMI and cancer association in women?
Adenocarcinoma of esophagus
| THyroid, colon, kidney cancers
114
High BMI and cancer associationin women
Adenocarcinoma of esophagus
| Endometrial, gall bladder, and kidney cancers
115
Aflatoxin effect on cancer
Works with Hep B to cause hepatocellular carcinoma
116
Nitrosamines generate what cancer
Gastric carcinoma
117
High fat + low colon causes what cancer
Colon
