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Bloc E - GI & Metabolism > Jan30 M2-Bioenergetics > Flashcards

Jan30 M2-Bioenergetics Flashcards

1
Q

TBW, ECF and ICF % of body weight

A

60%
ECF 20%
ICF 40%

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2
Q

what determines the volume of a compartment and how water diffuses between them

A
  1. number of osmotically active particles

2. intravascular hydrostatic pressure

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3
Q

osmole def

A

osmotically active particle, so a particle that can’t cross a water permeable membrane

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4
Q

5 naturally-occuring molecules that freely and passively penetrale cell membranes (so are not osmotically active)

A

water, O2, CO2, urea, ETOH

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5
Q

IC and EC protein concentration

A

200g per L IC

70g per L EC

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6
Q

low conc ions and high conc ions in the cell

A

low: Na and Cl
high: K, Mg, PO4

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7
Q

serum def

A

sample of blood without the blood cells and precipitated coagulation factors

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8
Q

typical % blood cells in the blood + blood volume and plasma volume of 70 kg indiv

A

blood is 40% blood cells

70kg indiv.: 5L blood, 3L plasma

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9
Q

volume ratio between IV and IS compartments + reason

A

IS 3-4 times size of IV bc of balance of hydrostatic and colloid P

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10
Q

speed of osms equilibration ECF-ICF vs ECF-IV

A

ECF-IV very fast because IS is 0 P compartment (capacitor) to buffer fluctuations IV
ECF-ICF takes hours

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11
Q

dehydration def

A

ECF hypertonicity and loss of ICF water

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12
Q

main 2 reactions to dehydration and why

A
  • thirst (pituitary senses ECF osmolarity)

- reduction in urinary free water excretion

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13
Q

common causes of dehydration

A

lack of water, lack of water + meds increasing urine water loss, neuro prob: no thirst, big loss of water, other diseases (nephro bloc)

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14
Q

volume depletion def and cause

A

ECF volume depletion. loss of iso-osmolar electrolytes and water from ECF (diarrhea, vomiting, etc.)

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15
Q

how to check for volume depletion

A
  • absence of JVP, veins of lower arms and hands not filled with blood
  • HR, BP and how these change with position change
  • skin pinch= it’s not elastic
  • dry mouth
  • urine output
  • dry diaper
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16
Q

where volume is lost in volume depletion

A

in both ISF and IVF (and more in ISF), except if trauma, splenic rupture or acute hemorrhage)

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17
Q

shock and pre-shock def

A

shock: more than 50% IV volume loss

pre-shock: more 15% IV volume loss

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18
Q

pre-shock charact.

A

very low BP, very high HR, veins collapsed, urine output is 0, patient feels terrible

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19
Q

Third space disease

A

ECF (or whole blood if hemorrhage) spills deep within the body (picture of hypovolemia but no indication of issing ECF, like hemorrhage or diarrhea)

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20
Q

best way to detect ECF volume expansion (and best way for ECF volume depletion too)

A

monitor patient’s body weight over time

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21
Q

signs of ECF excess

A

edema (skin, lower extremities)

severe and everywhere is anasarca

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22
Q

most common condition leading to an excess (beyond tolerable) IV expansion

A

right heart failure (pulm edema, high venous P, edema)

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23
Q

potential spaces and name of edema in there

A

pleural space, pericardial cavity, joint space, abdomen (ascites). these are called effusions

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24
Q

severe toxic-inflammatory states (severe injury or infection): effect on water balance

A

increase capillary wall permeability to HMW proteins

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25
Q

transudate def

A

effusion with normal IS fluid and low protein (high outward hydrostat P, negative IS tissue pressure, low plasma oncotic P)

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26
Q

exudate def

A

protein-rich, cell-rich, outpouring of inflammatory fluid at infection or damage site

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27
Q

important modifiable determinant of ECF volume

A

dietary sodium consumption

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28
Q

4 anatomic compartments and %

A

fat 20%
BCM 50%
ECF 20%
Structural tissues 10%

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29
Q

body cell mass def

A

metabolically active non-fat tissues

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30
Q

structural tissues def

A

skeleton and associated CT

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31
Q

technique to determine fat to total body weight and principle

A

densitometry.
100% fat body would have density of 0.900
0% fat body would have density of 1.100

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32
Q

fat content vs visible tissue

A

fat content with body composition technique is pure fat

fat seen on physical exam is adipose tissue (85% fat)

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33
Q

what is stored in adipose tissue

A

triglycerides

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34
Q

to lose 1kg of pure fat, how much adipose tissue must be lost

A

1.18kg (1/0.85) bc only 85% adipose tissue is pure fat so need more than 1kg of adipose tissue

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35
Q

2 ways to check body fat content clinically

A

BMI and physical exam

36
Q

BMI formula

A

weight (in kg)/height (m)2

37
Q

BMI range for normal body fat

A

18-25. below 18, fat low. over 25, fat high

38
Q

problem with BMI over 30

A

increased health risk, and increases with higher BMI over 30

39
Q

adipocytes vs BCM metabolic activity

A

adipocytes: very low
BCM: account for most of REE

40
Q

what makes up the BCM

A

80% skeletal muscle

15% liver kidney spleen intestines lungs heart etc

41
Q

severity of BCM losses

A

10% loss = lose strength/derangements
25% loss = severe disability
45% loss = very dangerous, can’t live

42
Q

easiest/fastest way to assess BCM clinically

A

examine patient’s muscles

43
Q

ways changes in BCM can be calculated

A

-determining rate of protein intake and rate of a.a being catabolized and their N being excreted

44
Q

values to know in calculating the BCM change (3)

A
  • N makes up 16% of protein weight (1g N lost = 6.25g protein lost)
  • 1g protein lost = 5g weight lost bc 4g water coming with it
45
Q

if one is losing 15g N/day, what’s the calculation for finding daily BCM loss

A

15N/day x 6.25g prot/g of N x 5g mass/g prot = 469 g BCM

46
Q

time scale of changes in adult skeletal mass and def of skeleton mass

A

bones and CT

adult skeletal mass lost over months/years

47
Q

homeostasis def

A

rate of gain and loss of all body constituents are in dynamic regulated balance

48
Q

essential nutrient def

A

nutrient essential for health

49
Q

nonessential nutrient def

A

not required for health because 1) another nutrient can do the same fct OR 2) body can synthesize it from another nutrient

50
Q

4 nutrient classes

A

lipids, carbs, proteins, ethanol

51
Q

3 levels of organization of metabolic fcts

A

cellular, whole body, external work done

52
Q

energy units and their definition (unit of our interest)

A

kcals. heat energy needed to make 1L of water raise its temp by 1 degree

53
Q

where exactly energy from food is stored

A

high-energy phosphate bonds (synthesis of ATP from AMP and ADP)

54
Q

body ATP content and how much times it takes to burn it

A

45g. all burned in 1 min so complete ATP turnover takes 60s

55
Q

during supra-maximal exercise, what does the body do to adapt to the failling intracellular ATP

A

activates a reg pathway that accelerates a lot the anaeorobic glycolysis

56
Q

Pasteur effect def

A

accelerated glycolysis in anaerobic conditions

57
Q

why lactic acid made during exercise

A

anaerobic glycolysis makes NADH. if O2 lacking, can’t make it NAD+ so the highly reduced environment (NADH) makes pyruvic acid become lactic acid

58
Q

how lactic acid turned back into pyruvic acid

A

when O2 back, NADH oxidized to NAD. less reduced environment so can make pyruvic acid from lactic acid

59
Q

lactic acidosis def

A

accum of lactic acid in tissues and blood in anaerobic conditions

60
Q

VO2 max

A

maximum rate of O2 uptake with increased lactin acid conc

61
Q

energy balance: excess input vs excess output

A

input > output = store TGs in adipose tissue

output > input = take TGs from adipose tissue and oxidize them

62
Q

positive vs negative energy balance and how to measure it

A

negative = output more than intput on long term. (losing weight)
compare weight at diff moments to see how balance is (neutral, positive, negative)

63
Q

direct calorimetry def

A

technique of measuring body’s rate of heat production to measure its rate of fuel oxidation

64
Q

heat combustion of the various fuels (TGs, carbs, proteins, ethanol)

A

TGs= 9kcal per g
carbs= 4
prots=4
ethanol=7

65
Q

indirect calorimetry

A

get rate of fuel oxidation of the body from rate of O2 uptake (rather than from rate of heat prod as in direct calorimetry)

66
Q

heat production and O2 consumption conversion rate and units

A

heat production (in kcal per min) = 4.8 x O2 consumption (L per min)

67
Q

3 determinants of energy flow in the body

A
  • REE or BMR
  • thermic effect of food (heat from food metabolic processing)
  • energy expended for activities (external work)
68
Q

external work (3rd determinant of E flow) definition and diff from internal work

A
  • conversion of chemical energy or our body into other form of energy (mechanical for ex)
  • internal work in our body all converted to heat
69
Q

other determinants of energy flow in disease

A

stuff that increases body’s metabolic rate (tissue damage, infection, inflammation, emotions)

70
Q

REE or RMR or BMR % of daily total energy expenditure and what can change its value

A

2/3

variabilities in value come from differences in BCM composition

71
Q

how to estimate one’s BMR (or REE)

A

1 kcal/kg/hour in men

0.95 kcal/kg/hour in women

72
Q

why can’t use HB (Harris-Benedict) equations of REE estimation for obese people

A

bc equations limited to normal body composition.

otherwise, overestimate their REE because in reality, their fat isn’t as metab active as the rest

73
Q

thermic effect of food in numbers

A

8% of food caloric content is spent in energy to process this food

74
Q

2 major types of physical activity

A
  1. formal exercise

2. nonexercise activity thermogenesis (NEAT)

75
Q

METs definition

A

unit of energy expenditure expressed in kcal per min (or kcal per day)

76
Q

when to use METs unit

A

for ex, if know someone is using 3 kcal per min (light yard work, carrying groceries), would say they are using 3 METs

77
Q

how to calculate TEE (total energy expenditure) (daily)

A

1.5 x REE

78
Q

what can change body weight in short vs long term

A

short term: fluid intake changes, urinary excretion, sweating, evaporation
long term: BCM or adipose tissue changes

79
Q

things that increase BCM and things that decrease it

A

increase BCM: exercise (more muscle mass)

decrease BCM: inactivitiy (muscle atrophy), starvation, cachexia, sarcopenia (loss muscle mass with age)

80
Q

things that increase fat mass and things that decrease it

A

positive energy balance increases it

negative energy balance decreases it

81
Q

how hypothalamus maintains fix body temp

A

signals to adjust rate of heat production (fuel oxidation, muscle activity) and heat loss (shivering, muscular activity) + feeling of hot or cold

82
Q

how higher temperature is achieved (ex in fever)

A

oxidizing fuel at faster rate and generating heat faster than normal

83
Q

2 determinants of body temperature

A

rate of heat generation (fuel oxidation) and rate of heat dissipation

84
Q

what influences rate of heat dissipation

A

patient’s surface area, thermal insulation (skin, fat, clothing, ..), ambiant room temp, capacity to perspire

85
Q

important mechanism for heat elimination and when is it blocked

A

water evaporation bc consumes heat. blocked in anticholinergics that inhibit perspiration

86
Q

how BMR changes with body temp

A

1.1 fold increase with every rise of 1C

87
Q

BMR of person with 40C fever and with usual BMR of 2000

A

2000 x 1.1 x 1.1 x 1.1

Bloc E - GI & Metabolism (58 decks)

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