Misc Flashcards
B12 deficiency in GI cancers
Serum B12 level < 300 pg/L
Risk is present with the loss of more than 20 cm of the ileum, short bowel, radiation enteritis, NET, cirrhosis, achlorhydria and metformin use
Liver disease limits vitamin B 12 reserves, check methylmalonic acid levels because serum levels may be elevated to liver destruction
Replete with 1000 mcg/d for 4 weeks followed by 500 mcg/d for maintenance of synthetic B12
Somastatin analogue therapy
SSAs are similar to the horomone somastatin which is responsible for the release of other hormones into the body. These reduce the amount of hormones secreted from functional tumors and help stabilize NET tumor growth
Ex- octreotide, lanreotide, pasireotide
Improve diarrhea and flushing, side effects incoude malabsorption, hyperglycemia and hypothyroidism
Best way to predict malnutrition in patients with cirrhosis?
Handgrip strength
Nutrition interventions for HCC
6 small meals with carb rich snack at bedtime
25-40 kcal/kg based on dry wt
1-1.5 g pro/kg, encourage liquid protein sources to replace losses with ascites
Avoid glutamine supplementation because it metabolizes into ammonia and glutamate
Ascites fluid wts;
Mild: 3-5 kg
Moderate: 7-9 kg
Severe: 14-15 kg
NET nutrition
Carcinoid syndrome- flushing and diarrhea with dopamine and tyramine containing foods (aged cheese, alcohol, smoked meats, fermented foods, dairy, unprocessed meats, omega 3 fish, eggs, banana and dark chocolate)
Secretory diarrhea- Enterade and ondansetron could help, imodium won’t
Niacin deficiency: in 45% of pts with NET , not full blown pellagra but brown scaly patches on arms and legs. High pro diet (1.5g/kg) + daily vit + niacinamide (20- 50 mg BID)
Tests to diagnose Pancreatic Exocrine Insufficiency
Coefficient of fat absorption
Fecal chymotrypsin level
Fecal elastase (fecal elastase 1)
Fecal fat excretion
Urinary paraaminobenzoid acid excretion rate
Carbon 13 labeled mixed triglyceride breath test
Vitamin A repletion
Check retinol binding protein and serum retinol
Rebuild with 30,000 IU retinol palmitate once daily for 4 weeks
Maintain with DRI
PN may be needed if unable to stabilize
B12 repletion
Rebuild with 1000 mcg cyanocobalamin IM once monthly and maintain with the same of 1000 mcg of B12 daily orally
What micronutrient can decrease risk of Lung cancer
Dietary intake of fruits and veg containing carotenoids
What micronutrient can increase risk of developing lung cancer
Beta carotene supplements
Obesity is a risk factor for which cancers?
Esophageal, breast, kidney, gallbladder, colon, skin, rectal
Thyroid cancer in women
Foods to avoid on low iodine diet
Dairy Egg yolks Processed meats Seafoods Soy foods Maraschino cherries Seaweed Beans- navy, Lima, kidney, red beans Whey protein Bread with iodate conditioners Milk chocolate Iodized salt
Top 5 new cancer cases in men
- Prostate
- Lung
- Colorectal
- Bladder
- Melanoma
Top 5 new cancer cases women
- Breast
- Lung
- Colorectal
- Uterine
- Thyroid
What percentage of men and women will develop cancer in their lifetime
40% men
38% women
