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Pathology > GI Nutrition > Flashcards

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

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2
Q

Good diet has what three components

A
  1. Sufficient energy in all 3 types
  2. Amino acids and fatty acids
  3. Vitamins and minerals
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3
Q

Primary malnutrition definition

A

One or all of these components are missing from the diet

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4
Q

Secondary malnutrition

A

Although supply is adequate: you are not absorbing, using, or storing nutrients

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5
Q

Chronic alcoholism sees deficiencies in what? 4

A

thiamine, pyridoxine, folate, and Vitamin A

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6
Q

Malnutrition is determined how?

A

In terms of BMI

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7
Q

What is BMI of malnutrition?

A

Less than 16

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8
Q

Protein energy malnutrition has what two diseases?

A

Marasmus and Kwashiorkor

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9
Q

Somatic protein compartment is where

Affected by what disease

A

Skeletal muscle

Marasmus

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10
Q

Visceral protein compartment is where

Affected by what disease

A

Visceral organs like liver

Kwashiorkor

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11
Q

Maramus definition

A

<60% of normal weight for sex, height and age

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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

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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
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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
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15
Q

How to measure nutritional status of elderly

A

Mini-nutritional assessment

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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

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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

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18
Q

Cachetic agents

A 
Tumor necrosis factor alpha
Inflammatory cytokines
Interleukin-6
Proteolysis-inducing factor (PIF)
Lipid-mobilizing factor (LMF)
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19
Q

Anorexia definition

A

self-induced starvation

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20
Q

Bulemia definition

A

food binging followed by induced vomiting

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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

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22
Q

Which is more common, bulemia or anorexia
Which has better prognosis
Which sex more

A

Bulimia
Bulimia
Women

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23
Q

Endocrine change in bulimia

A

Amenorrhea

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24
Q

Major complications of bulimia are due to what (2)

A
  1. Chronic vomiting

2. Chronic use of laxative and diuretics

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25
Q

Findings in bulimia (5)

A
  1. Hypokalemia
  2. Aspiration
  3. Esophageal and cardiac gastro rupture
  4. Acid damage to teeth
  5. Knuckle bruising (Russell’s sign)
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26
Q

How many vitamins are needed
Which are fat soluble
What makes fat soluble better

A

13
DEAK
Store in body better

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27
Q

4 vitamins synthesized endogenously

And from what

A

Vitamin D: Steroids
Vitamin K and Biotin: Intestinal microflora
Niacin (B3): Tryptophan

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28
Q

Vitamin A includes what three types

A

Retinol
Retinal
Retinoic acid

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29
Q

Chemical name of Vitamin A

A

Retinol

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30
Q

Transport and storage form of Vitamin A

A

Retinol ester

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31
Q

Name for all types of Vitamin A

A

Retinoids

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32
Q

Vitamin A animal sources

A

Liver, fish, eggs, milk, butter

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33
Q

Vitamin A vegetable sources
Why is vegetable good
Most important carotenoid

A

Carrots, squash, spinach
Has carotenoids that can turn to Vit A
Beta-carotene

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34
Q

Absorption of Vitamin A requires what? (3)

A

Bile
Pancreas enzymes
Antioxidant activity

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35
Q

Most of Vitamin A is stored where

A

Liver

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36
Q

Vitamin A five funcitons

A
  1. Maintains normal vision
  2. Cell growth and differentiation
  3. Fat metabolism
  4. Host resistance to infections
  5. Antioxidant
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37
Q

What are the four forms of Vitamin A containing pigmentsin eye

A 
One rhodopsin (rods-light)
Three iodopsins (cones-color)
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38
Q

Vitamin A has what effect on mucus

A

Keeps mucus secreting epithelium orderly, if not there undergoes metaplasia

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39
Q

Vitamin A as a treatment (2)

A

Skin: Severe acne and psoriasis

Treats acute promyelocytic leukemia

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40
Q

Vitamin A deficiency in the eye results in (5)

A
  1. Impaired vision
  2. Night blindness
  3. Dry eyes
  4. Squamous metaplasia
  5. Immune deficiency
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41
Q

Synthetic retinoids have what effects

A

Synthetics like accutane have teratogenic effects

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42
Q

Vitamin D function

A

Maintain calcium and phosphorus levels

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43
Q

3 deficiencies of Vitamin D

A
  1. Osteomalacia (adults)
  2. Rickets (kids)
  3. Hypocalcemic tetany
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44
Q

Major source of endogenous Vitamin D?

A

Synthesis in the skin to make D3

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45
Q

Vitamin D can also come from (2)

A
  1. Deep sea fish

2. Plants (ergosterol)

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46
Q

How is 1,25 Vitamin D made?

A

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

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47
Q

3 ways Vitamin D production in kidney is regulated

A

Hypocalcemia –> Increase PTH –> Increase Vit D
Hypophosphatemia –> Activates alpha-1hydroxylase
Increased 1,25 levels –> Decrease its own synthesis

48
Q

Vitamin D effects on calcium (4)

A
  1. Stimulation of intestinal absorption of Ca
  2. Stimulation of calcium reabsorb in Kidney
  3. Interact with PTh
  4. Mineralization of bone
49
Q

What level constitutes Vitamin D deficiency

A

less than 20

50
Q

Rickets

Mechanism

A

Excess of unmineralized matrix causing overgrowth of epiphyseal cartilage

51
Q

Rickets most common when?

A

First year of life

52
Q

Rickets symptoms

A
  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
Q

Osteomalacia is what mechanism

A

Lack of Vitamin D deranges the normal bone remodeling that occurs throughout life

54
Q

Vitamin D has what effect on cell cycle

A

Can control apoptosis and differentiation

55
Q

Vitamin E
Most common form
Food source
Acumulates mainly where

A

Alpha-tocopherol
Everything
Fat deposits the most, but can be anywhere

56
Q

Vitamin E function

A

an antioxidant

57
Q

Deficiencies of Vitamin E 3

A
  1. Fat absorption
  2. Low birth weight
  3. Abetalipoproteinemia
58
Q

Main neuro problem of Vit E deficiency

A

Spinocerebellar degeneration

59
Q

Vitamin E toxicity

A

Decreases synthesis of coag factors –> Causes hemorrhage

60
Q

Vitamin K is required for what

A

Production of gamma-carboxyglutamates

61
Q

Gamma-carboxyglutamates have what funciton

A

Allow clotting factors 2, 7, 9, 10, protein C and protein S to bind to phospholipid surface

62
Q

Vitamin K dependent factors:

A

2, 7, 9, 10, Protein C, Protein S

63
Q

Deficiency in Vitamin K leads to what

A

hypoprothrombinemia and a bleeding diathesis

64
Q

Coumadin effect on Vitamin K

A

Blocks recycling of Vitamin K to decrease clotting factor ability

65
Q

Water soluble proteins have what two advantages

A
  1. Readily absorbed

2. Do not need transport proteins

66
Q

Thiamine Vitamin B1
Source
Function (3)

A

Refined foods

Synthesis of ATP
Pentose phosphate pathway
Neural membrane conductance

67
Q

Thiamine deficiency 2

A
  1. Chronic alcoholics

2. Pernicious vomiting or diarrhea

68
Q

Syndromes of thiamine deficiency 3

A

Dry beriberi
Wet beriberi
Wernicke-Korsakoff syndrome

69
Q

Wernicke’s encephalopathy entails what? (4)

A
  1. nystamus
  2. Ataxia
  3. Ophthalmoplegia
  4. Deranged mental function
70
Q

Korsakoff psychosis includes what:

A

Problems with memory

71
Q

Dry beriberi is what?

A

Myelin degeneration

72
Q

Wet beriberi is what

A

CV syndrome with vasodilation and heart failure

73
Q

Riboflavin Vitamin B2 is a component of what?

A

FMN and FAD in redox reactions

74
Q

Riboflavin source

A

Meat, dairy products, veggies

75
Q

Deficiency of Riboflavin is what

A

Ariboflavinosis: Cheilosis, glossitis, inflammation

76
Q

Niacin Vitamin B3 is component of what
Food source
Synthesized from what in body

A

NAD and NAP
Grains and legumes
Tryptophan

77
Q

Niacin deficiency common patients

A

Alcoholics

IC’d

78
Q

3D’s of niacin deficiency known as pellagra

A

Dermatitis
Dementia
DIarrhea

79
Q

Two other pellagra symptoms

A

Scarlet tongue

Casal’s necklace

80
Q

Niacin use in therapy

A

Used in hypercholesterolemia to lower LDL

81
Q 
Pyridoxine Vitamin B6 function
Deficiency causes (3)
Deficiency results in (1)
A

Metabolism of AA’s and glycolipids
Drugs that work as agonists, Alcoholics, Pregnant
Increased plasma homocysteine

82
Q

Vitamin B12 function (3)

A

Nucleic acid synthesis
Needed for normal folate metabolism
Maintenance of myelinization of spinal cord tracts

83
Q

Deficiency of Vitamin B 12 result (2)

A
  1. Megaloblastic anemia

2. Degeneration of posterolateral spinal cord tracts

84
Q 
Vitamin C made endogenously?
Deficiency state called
Manifests how (2)
A

No
Scurvy
Bone disease and hemorrhages

85
Q

Vitamin C function (3)

A

In redox reactions
Hydroxylation of collagen
Regenerates antioxidant form of Vitamin E

86
Q

Deficiency in two patient types

A

Alcoholics
Elderly
Dialysis

87
Q

Scurvy symptoms

A
  1. Bleeding from gums and joints and skin
  2. Scorbutic bone with outward projection of ribs
  3. Scorbutic rosary
88
Q

First clinical sign of Vitamin C deficiency

A

Perifolicular petechiae

89
Q

Toxicity of Vitamin C effect

A

Kidney stones

90
Q

Folate function

Found in what

A

Nucleic acid synthesis

Wheat, legumes, veggies

91
Q

Deficiency of folate results in what (4)

A

Megaloblastic anemia
Neural tube defects
Increased homocysteine
Increase risk for colon cancer

92
Q

Zinc deficiency

A

Rash called acrodermatitis enteropathica

93
Q

Iron deficiency

A

Hypochromic microcytic anemia

94
Q

Iodine deficiency (2)

A

Goiter + Hypothyroidism

95
Q

Copper deficiency

A

Muscle and neuro deficits

96
Q

Fluoride deficiency

A

Dental caries

97
Q

Selenium deficiency

A

Myopathy: Keshan disease

98
Q

Obesity definition

A

Excess adiposity and excess body weight

99
Q

Obesity associated with what: 4

A

Type 2 diabetes
Dyslipidemias, CV disease
HTN
Cancer

100
Q

Normal BMI:

A

18.5 to 25

101
Q

Overweight BMI:

102
Q

Obese BMI

103
Q

Central/visceral obesity

Severity

A

Fat accumulates in trunk and abdominal cavity

Much higher risk for disease

104
Q

3 neurohumoral mechanisms for energy balance

A

Peripheral/Afferent
Arcuate nucleus in hypothalamus
Efferent system

105
Q

Peripheral/Afferent has what components (4)

A
  1. Leptin: fat cells
  2. Ghrelin: Stomach
  3. Peptide YY: Ileum and colon
  4. Insulin: pancreas
106
Q

Leptin has what effect

A

Gives you sense of fat stores

107
Q

Humans with loss of leptin gene have what

A

Early onset severe obesity

108
Q

Leptin stimulates what

A

physical activity and heat production

109
Q

Number of adipocytes effect?

A

Higher the number, higher risk of obesity

110
Q

Ghrelin has what effect
Levels before meal
Levels after meal

A

Increases food intake
Rise before
Lower after

111
Q

PYY levels during fasting

PYY levels after eating

A

Low during fasting

High after

112
Q

Situations of decreased PYY

A

Gastric bypass

Prader-Willi

113
Q

High BMI and cancer association in women?

A

Adenocarcinoma of esophagus

THyroid, colon, kidney cancers

114
Q

High BMI and cancer associationin women

A

Adenocarcinoma of esophagus

Endometrial, gall bladder, and kidney cancers

115
Q

Aflatoxin effect on cancer

A

Works with Hep B to cause hepatocellular carcinoma

116
Q

Nitrosamines generate what cancer

A

Gastric carcinoma

117
Q

High fat + low colon causes what cancer

Pathology (36 decks)

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