GI/Nutrition Flashcards
List 2 indications that paediatricians should consider recommending probiotics for.
- Prevent antibiotic-associated diarrhea
- Shorten duration of acute infectious viral diarrhea
- Prevent necrotizing enterocolitis
- Decrease symptoms of colic (decreased daily crying time)
- Decrease some symptoms of IBS
Identify 2 functions of the colonic bacteria
- Contribute to the gut’s barrier function (↑mucin secretion, ↓gut permeability, modulate immune function)
- Metabolize malabsorbed carbohydrates into SCFAs = fuel for enterocytes
- Acidify colonic content
- ↑water absorption
Name the vitamin absorption, function, deficiency and toxicities.
Vitamin A, D, E, K, B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pyridoxine), B7 (biotin), B9 (folic acid), B12 (cyanocobalamin), C
Vitamin
Absorption
Function
Deficiency
Toxicity
Serum measure
Vitamin A
(retinol/ B-carotene)
Small bowel
Vision
Epithelium
Night blind
Keratomalacia
Bitot spots
Xerophthalmia
Hepatotoxicity
Hyperlipidemia
Alopecia
Ataxia
Cheilitis
HA/ IIH
Retinol
Retinol binding protein
Vitamin D
(cholecalciferol)
Small bowel
Skin
Regulate
Ca and PO4
Rickets
Hypocalcemia
HypoPO4
Hypercalcemia
Worsened milk-alkali syndrome
25-OH vit D
PTH
Vitamin E
Small bowel
Cell membrane antioxidant
Prolonged INR
abN bone dev
Coagulopathy
Hemorrhage
Alpha-tocopherol
Vitamin K
(phytonadione)
Small bowel
Activates clotting factors
Prolonged INR
Hemolysis
INR (for factors 2, 7, 9, 10)
Vitamin B1
(thiamine)
Jejunum
ATP synthesis
Pyruvate dehydrogenase cofactor
Refeeding and alcoholism
Wernicke enceph
Dry beriberi (dilated cardiomyopathy, Korsakoff psychosis)
none
Erythrocyte transketolase activity
Vitamin B2
(riboflavin)
Small bowel
Macronutrient metabolism
Iron absorption
Angular stomatitis
Cheilosis
Glossitis
Seb dermatitis
none
Erythrocyte glutathione reductase activity
Vitamin B3
(niacin)
Stomach
Small bowel
Precursor of NAD+/NADP+
DNA repair
Hormone synth
Pellagra (dermatitis, diarrhea, dementia, death)
Vasodilation
Pruritis
Myopathy
Headache
Urine niacin-methylated metabolites
Vitamin B6
(pyridoxine)
Jejunum
Hb synth
Nerve cell fxn
Glucose hemostasis
Dermatitis
Glossitis
Seizures
Anemia
Ataxia
Sensory neuropathy
Pyridoxal phosphate
Vitamin B7
(biotin)
Small bowel
Coenzyme
Dermatitis
Alopecia
Ataxia
Seizures
None
Biotin level
Vitamin B9
(folic acid)
Small bowel
DNA synth/repair
RBC prod
Neural tube formation
Neural tube defects
Anemia
Growth delay
Diarrhea
weakness
Rare
Folate level
Vitamin B12
(cyanocobalamin)
TI
Needs intrinsic factor
Hb synthesis
Macro anemia
Weakness
Paresthesia
(risk pernicious anemia if crohns, gastritis, bariatric surgery, TI Surg)
None
B12 levels
Methylmalonic acid
Homocysteine
Vitamin C
(ascorbic acid)
Ileum
Collagen synth
(wound healing)
Scurvy (anemia, gingival bleeding, perifollicular hemorrhage, poor wound healing)
Rare
(avoid supp if renal failure, iron overload, warfarin)
Ascorbic acid
What are causes of Protein Losing Enteropathy?
What are the symptoms?
How to diagnose?
- PLE = Abnormal protein loss from GI tract
- Causes:
- Abnormal protein leakage across the gut
- Ie. mucosal erosion, gut inflammation
- Decreased protein uptake by lymphatic system
- Ie. Post-Fontan
- Lymphatic obstruction
- Ie. Intestinal lymphangiectasia
- Metabolic
- Ex. congenital disorders of glycosylation
- Abnormal protein leakage across the gut
- Causes:
- Symptoms:
- Diarrhea: fat and/or carbohydrate malabsorption
- Edema: dependent, extremity, facial
- Pleural or pericardial effusion
- Diagnosis:
- Labs
- Low serum proteins (albumin, A1AT, ceruloplasmin, transferrin)
- Malabsorption of fat-soluble vitamins (ADEK)
- Hypogammaglobulinemia (IgA, IgG, IgM)
- Lymphocytopenia
- Normal UA (no urine protein loss)
- Normal liver function (ie. not low production b/c liver disease)
- Diagnostic:
- 24hr collection = elevated stool a1-antitrypsin or fecal calprotectin
- Small bowel contrast study
- “Stacked coins”—thickened or edematous folds
- Endoscopy for mucosal inflammation
- Labs
