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PATHOLOGY > nutrition > Flashcards

nutrition Flashcards

1
Q

what are the fat sol vits

A

A D E K

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2
Q

are you more likely to be deficient or in excess of fat sol vits

A

stored in adipose tissue – so uncommon to be deficient in these
More likely in excess

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3
Q

what is vit A

A

retinol

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4
Q

excess and def in vit A - and test

A

E:
* exfoliation
* hepatitis

D
* colour blindness

serology - only do if had bariatric surgery and present with blindness

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5
Q

what is vit D

A

cholecalciferol

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6
Q

excess and def in vit D - and test

A

E
* hypercalcaemia

D
* osteomalacia/rickets

serum

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7
Q

what is vit E

A

tocopherol

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8
Q

excess and def in vit E - and test

A

D
* anaemia
* neuropathy
* ?malignancy
* IHD

serum - but not done
very rare

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9
Q

what is vit K

A

phytomenadione

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10
Q

def in vit K - and test

A

defective clotting

PTT or INR
can replace with tablet/injection

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11
Q

What are the water sol vits

A

B1

B2

B6

B12
C
folaite
niacin

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12
Q

what is B1

A

thiamine

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13
Q

what is B2

A

riboflavin

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14
Q

what is B6

A

pyridoxine

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15
Q

what is B12

A

cobalamin

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16
Q

def of B1 and test

A

beri-beri
neuropathy
wernicke syndrome

test - RBC transketolase

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17
Q

what is beri-beri

A

2 types

  • wet: where get CVD, oedema, HF.
  • Dry : neuro problems, some may have Wernicke syndrome
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18
Q

features of wernicke syndrome

A

confused,
ataxia,
oculomotor dysfunction

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19
Q

def of B2 and test

A

glossitis

test - RBC glutathione reductase

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20
Q

def and excess of B6 and test

A

D
* dermatitis
* anaemia

E - neuropathy

test - RBC AST activation

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21
Q

def of B12 and test

A

pernicious anaemia

test - B12 serum - do if:
* other autoimmune
* macrocytic anaemia

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22
Q

what is vit V

A

ascorbate

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23
Q

def and excess of vit C and test

A

D - scurvy

E - renal stones

test - plasma - rarely done

24
Q

def and test for folate

A
  • megaloblastic anaemia
  • neural tube defect

Test - RBC folate

25
Q

def of niacin

A

pellagra

present with:
* dementia
* diarrhoea
* dermatitis
* death

26
Q

def and excess and tests of iron

A

Haemochromatosis ie high iron – iron deposition in:
testes -> primary hypogonadism, low libido,

high ferritin

27
Q

iodine def and test

A

goitre
hypothyroid

Test - TFTs

28
Q

zinc def

A

dermatitis

29
Q

copper def and excess

A

D - anaemia

E - wilson’s : copper in eye, brian and liver

test - Cu, caeroplasmin

30
Q

def and excess of fluride

A

D - dental caries

E - flourosis (staining of teeth)

31
Q

what makes up energy expenditure

A

resting energy expenditure (REE) - metabolic rate - fixed
can change diet and exercise - if change either then the REE can change
* reduce food and increase exercise - REE changes = harder to lose wht
* better wht loss to reduce calorie than increase exercise

exercise

thermogenesis

faclultative t

32
Q

ideal diet

A
33
Q

summarise energy homeostasis

A

White adipose tissue is the majority of adipose tissue in body – largest endocrine gland in body

Direct link to hypothalamus.

After eating:
* satiety levels increase,
* energy expenditure increase due to insulin

PYY made from small intestine – satiety hormone – increase after eating

Adiponectin production from adipose tissue
* is lower in obese -> insulin resistance

Leptin is anti-hunger hormone

Ghrelin – hunger hormone

34
Q

normal body weight composition

A

98% O2, C, H, Na, Ca
60-70% H2O, 10-35% fat, 10-15% protein, 3-5% minerals

Fat content is what changes between individuals – measure by looking at waist circumference, or fat expenditure from biceps

35
Q

BMI definition of obesity

A

25-30 kg/m2 overweight
>30 kg/m2 obese
>40 kg/m2 morbidly obese

36
Q

problem with BMI and what is a better measurement

A

muscle can increase BMI

Ethnic variations – south Asian, have lower cut offs than Caucasian

South Asian = more risk of dm or CVD – adipose tissue is central – at risk of CVD because of visceral adiposity

So waist circumference is more accurate

If have**BMI >40 – then have a lot of adiposity at front – difficult to measure waist circumference – so BMI is better **

37
Q

consequence of bad BMI

A

Mortality dependant on BMI
U shaped – mortality if >25BMI, if less than 20 BMI – mortality rate alsoincrases
Risk of onchology problems
Smoker = low wht and risk of lung cancer
High BMI risk – CVD

38
Q

obesity co-morbidities

A

psych morbidity
chest disease
malignancy - bowel, breast, endometrial, prostate
diabetes and metabolic syndrome
gynae disease
* PCOS
* infertility
* risk to fetus
* high risk pregnancy
* fetus may become obese later in life
rheum disease
CVS disease

39
Q

protein intake

A

84gm men,
64gm women

40
Q

different types of amino acid

A

Indispensable (e.g. leucine)
* we cannot make in body
* if don’t get from the diet -> protein deficient

“conditionally” indispensable (e.g. Cysteine)
* need at certain points in life eg childhood/pregnancy
* deficiencies can happen, but if have in diet then it is unlikely for deficiency to occur

Dispensable (e.g. alanine)
* body can make

41
Q

assessments for protein

A

Nitrogen excretion and balance
Tracer techniques

Don’t use these assessments on clinical basis – just look at muscle bulk to assess status

42
Q

what are the types of lipid

A

Polyunsaturated fatty acid (PUFA) include essential fatty acids (EFA)

Dietary fat determines LDL-C
* **saturated fat increases [chol] **because of the higher LDL (marker of CVD)
* PUFA reduces total [chol] because of lower LDL

high [HDL] associated reduced IHD risk
* HDL is higher in women and some alcohol
* HDL is lower in obesity

want non-HDL level less than 4 as marker of cardiovascular risk.

Can now do cholesterol levels non-fasting as HDL and LDL are not effected

43
Q

metabolism of fat

A

Fat in diet made up of triglycerides – glycerol and fatty acids

Intestine will reabsorb in a form of monoglycerides

Pancreatic lipase break down fatty acids by hydroxylation

Through intestine have build up as fatty acids – then go around the body and stored as adipose

44
Q

what does the structure of the fatty acids mean in terms of disease

A

**Saturated are bad **
Monosaturated are better
And polyunsaturated are the best

Sat have no carbon double bonds
Monosat – have one carbon bond
Polyunsat and have many

trans - saturated are worse than cis - and are a marker of CVD

45
Q

summarise carb intake

A

40-80% total energy intake
Polymerisation into sugars, oligosaccharides and polysaccharides
80 % should be complex = polyunsaturated = starch/wholemeal
20 % simple

fibre - not absorbed, but used to bulk stool - if not much fibre = constipation

46
Q

what conditions are nutrients linked to

A

Cardiovascular disease
Obesity
Alcoholism
T2DM
Pregnancy
Most malignancy
Many GI conditions

47
Q

what is metabolic syndrome

A

have a multitude of conditions - risk of all obesity related conditions

48
Q

endocrine causes of obesity

A

Hypothyroid
Cushings syndrome – excess cortisol – get rapid onset wht gain, rather than in obesity where there is wht gain through yrs
Acromegaly
Pit disease – absence GH

49
Q

approach to obesity

A

Exclude endocrine cause
Exclude complications of obesity
Educate
Diet and exercise
Medical therapy (Orlistat, GLP-1 agonist)
Surgical therapy

50
Q

what is orlistat

A

inhibit absorption of fat
prevents breakdown of fatty acid in intestine
can lose 5% of wht

51
Q

use of GLP-1 agonist

A

gut hormone that can make us more full.
We can replace by an injection
lose 8-10% wht

52
Q

benefit of wht loss

A

helps all of:
* Psychological benefit
* PCOS
* Oesophagitis
* CVD
* Osteoarthritis
* Liver function
* Pregnancy
* reduce mortality
* BP
* HbA1c
* DM
* LDL
* HDL

53
Q

what are the different types of bariatric surgery

A

Adjustable band
* silicone ring above top of stomach,
* ring attached to port in adipose tissue –
* put fluid into ring to make it tigher or take it away make looser.
* Band can erode into mucosa – emergency and may need a reoperation

sleeve gastrectomy

gastric bypass
* Reduce stomach size
* 1st part of duodenum is bypassed (150cm)
* Most of stomach is bypassed
* And 2nd part of intestine goes into pouch
* Metabolic operation – direct treatment of t2dm – can go into remission – don’t need to take meds for a long time

54
Q

health benefits of bariatric surgery

A
  • Resolution/improvement of T2DM
  • Resolution/improvement of hypertension
  • Improved lipid profile
  • Resulting in overall reduction in cardiac risk
  • Resolution of obstructive sleep apnoea
  • Resolution of PCOS and improved fertility
  • Reduced cancer related deaths
  • Regression of non-alcoholic fatty liver disease
  • Reduced mortality
55
Q

what is the duodenal-jejunal sleeve

A

Silicone ring – food goes in, inserted with endoscope
Food not mixed with bile salts

People with dm get better

But cant stay in >1yr – so more of an interim treatment

56
Q

what is marasmus and sx

A

Low calorie intake of carb, protein and lipids:

  • Shrivelled
  • Growth retarded
  • Severe muscle wasting
  • No s/c fat
57
Q

what is kwashiokor

A

Lack only of protein – still have carbs and lipids

More common at times of famine
Protein go down more than carb and lipid in times of famine

  • Oedematous
  • Scaling/ulcerated
  • Lethargic
  • Large liver, s/c fat
  • Protein deficient

PATHOLOGY (94 decks)

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