GI/Nutrition Flashcards
Signs/symptoms of cyclic vomiting syndrome
- MC in ages 3-7, equal in both sexes
- Diagnostic criteria: two or more periods of intense nausea and paroxysmal vomiting that last for hours to days in a 6 month period, episodes are stereotypical, episodes are separated by weeks to months with return to baseline between episodes
Treatment of cyclic vomiting syndrome
- Cyproheptadine (antihistamine) for kids 5 or younger
- Amitriptyline for kids 6 and older
- Supplementation with coenzyme Q10 and L-carnitine can be good for prophylaxis
Secondary lactose intolerance cause and diagnosis
- Cause: damage to villi in small intestine following acute gastroenteritis but also with celiac disease, IBD, autoimmune conditions, or chemo
- Symptoms: diarrhea, bloating, pain, gas, nausea
- Diagnosis: elevated stool reducing substances
Presentation of celiac disease in type 1 DM
- Recurrent hypoglycemia
- Can also have lack of weight gain and stomach aches
Vitamin E deficiency symptoms
Ataxia, hyporeflexia, limitation of eye movements, abnormal proprioception, muscle weakness
Neonatal GER gets better at what age
12 months - resolves in 95% of patients
Vitamin A name
Retinol
- Absorbed in terminal ileum, stored in liver
Vitamin E name
Tocopherol (Toke-of-E-rol)
Vitamin K name
Phylloquinone
- Absorbed in jejunum
- Newborns are deficient because insufficient intestinal bacteria
Vitamin B1 name
Thiamine
Vitamin B2 name
Riboflavin
Vitamin B3 name
Niacin
Vitamin B5 name
Pantothenic Acid
Vitamin B6 name
Pyridoxine
Vitamin B9 name
Folate
Vitamin B12 name
Cyanocobalamin
- Binds intrinsic factor, absorbed in terminal ileum, stored in liver
Vitamin C
Ascorbic acid
Most common cause worldwide of blindness in young children
Vitamin A deficiency - can also lead to dryness of the eyes
Vitamin cause of pseudotumor cerebri
Vitamin A toxicity (think of this if a teenager is on isotretinoin for acne)
Vitamin cause of macrocytic anemia, large tongue
- Vitamin B9 (folate) deficiency
- Vegetarians are at risk and if child is on goat’s milk
Vitamin cause of macrocytic anemia and pernicious anemia
- Vitamin B12 (cyanocobalamin) deficiency
- Vegans, parasitic infections, IBD, NEC are risk factors
Vitamin cause of scurvy, bleeding gums, leg tenderness, poor wound healing
Vitamin C deficiency
Vitamin cause of oxalate and cysteine nephrocalcinosis
Vitamin C intoxication
Vitamin cause of hemolytic anemia in preemies
Vitamin E deficiency
Vitamin cause of neuropathies, peripheral edema, thrombocytosis, muscle weakness
Vitamin E deficiency in older children
Vitamin cause of hemorrhagic disease in the newborn
Vitamin K deficiency
Vitamin D2 name
Ergocalciferol (2 Cs)
Vitamin D3 name
Cholecalciferol (3 Cs)
25-hydroxy vitamin D
- Gets hydroxylated in the liver and is the primary storage form
- Only one liver so only one number
- THIS IS THE ONE TO MEASURE ON A TEST!
1,25 hydroxy calciferol
- Formed in the kidney (calcitriol is another name)
- Active form!
- 2 kidneys so 2 numberes
- Helps calcium absorption in the gut and releases calcium into the blood from bone
Vitamin cause of hypercalcemia and hyperphosphtamiea
Vitamin D excess
- Sx: nausea, vomiting, weakness, polyuria, polydipsia, elevated BUN, renal failure
Calculation for caloric needs
- 100 kcal/kg (1st 10 kg)
- 50 kcal/kg (next 10 kg)
- 20 kcal/kg (any more kgs)
- 1500 kcal for first 20 kg then 20kca/kg after
Caloric needs for preterm and term infants
100-120 kcal/kg/d
- Reasons for preemies to have increased caloric need: lower fat levels so spend more energy in heat production, organogenesis, developing fat stores
Protein requirements in preterm/term infants
- Preemies: 3.5 g/kg/d
- Term infants: 2-2.5 g/kg/d for the first 6 months
Cause of infant not gaining weight post op after a big GI surgery
Increased urine output due to increased renal solute load (sodium, potassium, chloride, phosphorus)
Recommended amount of iron in formula
12 mg/L
Iron supplementation in babies
- Needed early on in LBW and preemie infants
- Infants who receive more than 50% of their calories from breastmilk need iron supplementation starting around 4 months of age
- Less iron in breast milk but it’s more bioavailable
Milk protein allergy
- Milk protein allergy is IgE mediated and prevents with vomiting , rash, and irritability
- Need elemental formula
FPIES
- Food protein induced enterocolitis syndrome
- Non IgE mediated severe cow milk protein intolerance
- Presents in first 3 months with heme positive stools or hematochezia
- Switch to protein hydrolysate formula or elimination diet if breastfeeding
Scaly dermatitis, alopecia, thrombocytopenia
Essential fatty acid deficiency
Tx: IV lipids with linoleic acid
Infant with eczematous eruptions, alopecia, poor growth/diarrhea, lesions around the mouth and/or perianal area
- Zinc deficiency due to lack of absorption
- Can present when weaned from breastmilk (breast milk contains a protein which facilitates zinc absorption)
- Autosomal recessive
- Rash: acrodermatitis enteropathica (no lichenification as compared to eczema)
Menkes Kinky Hair Syndrome
- X linked disorder
- Low serum copper and low serum ceruloplasmin
- Tissue copper level is high (compared to Wilsons)
- Twisted hairs (pili torti)
Fat differences in preemies vs term babies
- Preemies have decreased amount of bile acids making it harder for them to absorb long chain trigylcerides
- Preemie formula has 50% of total fat from MCTs
- Breast milk has 12% of fat from MCTs
Phosphorus and calcium in preemies
- Calcium and phosphorus are poorly absorbed in their guts so they require large supplementation amounts
- Lack of both can lead to demineralization
- Can have normal serum calcium and phosphorus but will have elevated alkaline phosphatase
Differences in colostrum vs mature milk
- Arachidonic acid, docosahexaenoic acid, and zinc decrease in mature milk
- Vitamin d levels are lower in colostrum
- Colostrum has more protein (a lot of immunoglobulins), carotene (yellow color), less fat, a little less lactose, and less caloric content compared with mature milk
Breast milk vs cow’s milk
- Breast milk has more lactose which makes it sweeter
- Cow’s milk has more phosphorus (too much for infant kidneys to handle) so can cause hypocalcemia
Contraindications to breast milk
- Infants with galactosemia
- Mothers in the US with HIV
- Mom with active HSV lesions on the breast, TB positive (until treated for 2 weeks)
- Moms receiving chemo, flagyl, diastat, amphetamines, cocaine, PCP
Macros differences in milk vs formula
- Breast milk: 70% whey, 30% casein (breast milk is WHEY better), major carb is lactose, human milk fats
- Cow’s milk: 20% whey, 80% casein, major carb is lactose, butter fat
- Milk based cow formula: 20-100% whey, 0-80% casein, major carb is lactose, vegetable oil
- Soy formula: 100% soy, major carb is corn syrup or sucrose, vegetable oil
Breast milk immunity
Lactose derived oligosaccharides inhibit bacterial adhesions to mucosal surfaces
- IgA antibodies
Obesity complications
Depression, avascular necrosis of the hip, diabetes, hypertension, osteoarthritis
Kwashiorkor
- Protein deficiency
- Pot belly, pitting edema, rash, thin/frail hair, pallor, overall thin appearance
Marasmus
- General nutrition deficiency
- Muscle wasting without edema, underweight, hair is normal
Most common complication of NG feeding
- Diarrhea, then reflux
- Most severe complication is vomiting with aspiration
Refeeding syndrome labs
- Muscle weakness, fatigue
- Low phosphorus, low thiamine, elevated glucose (due to low insulin)
- Tx: 50% of targeted kcal/kg/d to start at and then slowly increase
Vitamin B12 anemia cause
- Leads to macrocytic anemia and neurologic changes due to degeneration of posterior and lateral spinal columns
- Intrinsic factor made in gastric parietal cells is needed for absorption of B12 –> autoimmune mediated damage to gastric parietal cells screws this up
Cholestasis definition
Conjugated bilirubin concentration greater than 2 mg/dL or greater than 20% of the total bilirubin level
Differential for neonatal conjugated hyperbilirubinemia
Urinary tract infection, Alagille syndrome, galactosemia, total parenteral nutrition–associated cholestasis, ɑ1-antitrypsin deficiency, medication side effect, biliary atresia
Clinical symptoms of Alagille Syndrome
- Heart defect (PPS)
- Short stature, vertebral anomalies
- Cholestatic liver disease (paucity of bile ducts)
- Prominent forehead, hypertelorism, deep set eyes
- Posterior embryotoxon (opaque ring around the cornea)
Genetics of Alagille Syndrome
Autosomal dominant inheritance pattern with variable penetrance because of mutations primarily in the JAG1 gene