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GASTROENTEROLOGY SCE > Nutrition > Flashcards

Nutrition Flashcards

1
Q

When should we further investigate IDA

A

All post menopausal women and men over 50years

Perform TTG, OGD, colonoscopy

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2
Q

In pre-menopausal women identified as IDA what test should be performed next

A

TTG

DO FURTHER IX IF STRONG FH OR SYMPTOMATIC

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3
Q

Pellagra is a deficiency of what

A

Niacin (vitamin B3)

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4
Q

Symptoms of pellagra

A

4Ds

Dementia
Dermatitis
Diarrhoea
Death

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5
Q

Pellagra is classically cause by niacin deficiency, by what other mechanisms can we develop pellagra and so which syndrome may the patient have

A

Reduced TRYPTOPHAN - this is linked to carcinoid syndrome as the precursor tryptophan is used to make serotonin instead of niacin

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6
Q

What an thiamine (B1) deficiency lead to…

A
  1. Beri-beri - wet = heart failure, dry = neurological symptoms
  2. Wernickes-korsakoffs
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7
Q

Vitamin B2 is also known as

A

Riboflavin

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8
Q

Deficiency of riboflavin (B2) causes what symptoms?

A

Dermatitis
Geographic tongue
Stomatitis

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9
Q

Describe how folic acid becomes biologically active

A

Folic acid is found in green veg and animal products in the polyglutamate form. It is cleaves to the monoglutamate form in the jejunum where it is absorbed and transformed to form the active tetrahydrofolic acid needed for DNA synthesis

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10
Q

Causes of folate deficiency

A 
MTX
Trimethoprim
Malabsorption
SIBO
CD
ETOH excess
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11
Q

First line management in obese patient coming for surgical options

A

Lifestyle - exercise, diet, behavioural interventions

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12
Q

If obese patient has failed lifestyle measures for >3 months in weight loss aims, what treatment can be offered next

A

Orlistat

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13
Q

How does orlistat work

A

Lipase inhibitor

Prevents conversion of dietary fat to its absorbable form

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14
Q

When should anti-obesity surgery be considered

A

Failure of non-surgical measures - no clinical weight loss over 6/12

BMI>40

BMI >35 and significant comorbidity that would likely benefit from surgery

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15
Q

Vitamin B6 is also called

A

Pyridoxine

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16
Q

Symptoms of pyridoxine (B6) deficiency

A

Seizures

Peripheral neuritis

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17
Q

Levels of these are high/low/normal in an anorexic patient:

  1. FSH
  2. LH
  3. GH
  4. Albumin
  5. Cortisol
A
  1. Low
  2. Low
  3. High
  4. Normal
  5. High
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18
Q

Describe the mechanism of B12 absorption

A

B12 liberated from protein binding by acid in stomach

B12 binds to R-factors

In duodenum B12 is release from R-factors by pancreatic protease allowing it to be bound to IF

Then absorbed in TI

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19
Q

Which drugs can cause low B12

A

Metformin

Nitrous oxide

PPI

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20
Q

A patient is defined as malnourished if…

A
  1. BMI <18.5

Unintentional weight loss >10% in last 3-6/12

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21
Q

Daily total energy requirement in unwell patient or those at risk of re-feeding are…

A

25-35kcal/kg/day

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22
Q

Daily nitrogen requirement in unwell patient or those at risk of re-feeding are…

A

0.23-0.24g/kg/day

23
Q

Daily total protein requirement in unwell patient or those at risk of re-feeding are…

A

0.8-1.5g/kg/day

24
Q

Daily total water requirement in unwell patient or those at risk of re-feeding are…

A

30-35ml/kg/day

25
Q

Describe basic physiology in re-feeding syndrome

A

When starved intracellular minerals are depleted. When start eating get relative fly Seima with increased insulin which stimulates fat/protein/glycogen synthesis which all requires electrolytes (including PO4)

26
Q

Gastroparesis happens in what proportion of pt with T1DM

A

25-55%

27
Q

Gastroparesis happens in what proportion of pt with T2DM

A

30%

28
Q

What is the gold standard test to evaluate gastroparesis?

A

Gastric scintigraphy

Measure residual content at 4 hours. More than 10% left is abnormal

29
Q

Gold standard test for SIBO

A

Duodenal aspirate - >10 to the 5

30
Q

Causes SIBO

A

Excess bacteria entering small bowel - atrophic gastritis, PPI use, gastro jejunostomy, gastrectomy, enteral fistulae

Delayed small bowel clearance - pseudo-obstruction, scleroderma, strictures, autonomic neuropathy

Reduced host defences - old age, chronic pancreatitis, immunodeficiency, HIV

31
Q

What is the risk of malignant change at the anastomoses in patients who have had gastrectomy?

A

3% over 15 years

32
Q

What proportion of patients have dumping syndrome after a roux-en-Y gastric bypass?

A

50-70%

33
Q

Describe symptoms of early dumping

A

Ab pain
Bloating
Diarrhoea

Vasomotor symptoms - headache, flushing, fatigue, hypotension

34
Q

What is early dumping syndrome caused by?

A

Rapid influx of hyperosmolar contents into the duodenum which causes fluid shifts INTO the lumen and luminal distension

35
Q

After eating, when do the symptoms of early dumping syndrome occur

A

30-60minutes after

36
Q

Cause of late dumping syndrome

A

Reactive hypoglycaemia, confirm by OGTT after overnight fast

37
Q

When do symptoms of late dumping syndrome occur after eating?

A

1-3 hours after eating

38
Q

Manage to of dumping syndrome

A

Dietary manipulation - eat small and often, high protein diet, avoid simple sugars, avoid drinking liquid after eating.

Lie supine for 30mins after eating helps delay gastric emptying

Medical - octreotide

39
Q

Describe CT findings of autoimmune pancreatitis

A

Diffuse enlargement of pancreas (sausage shape) with loss of definition of pancreatic cleft. Pancreatic duct abnormality

40
Q

Blood test to investigate autoimmune pancreatitis

A

IgG4

41
Q

Histology finding in autoimmune pancreatitis

A

Lymphoplasmocytic infiltrate

42
Q

Treatment of autoimmune pancreatitis

A

Steroids

43
Q

In patients with jejunostomy and high aroma output, what measures can be taken to reduce atoms output

A
  1. Reduce intake of oral hypotonic fluid
  2. Glucose-saline solution
  3. PPI, loperamide, octreotide
44
Q

Why do patients with jejunostomy get renal stones

A

Increased oxalate absorption from colon as more oxalate unbound to calcium and more oxalate bound to free fatty acids (do worse if have fat malabsorption)

45
Q

Signs of a buried bumper

A 
Difficult to push PEG
difficult to rotate PEG
Hard to flush 
Slowly obstructed
Leakage around site
46
Q

Preventing buried number

A

Ensure 1cm between external fixator and skin

Push in and rotate PEG weekly

47
Q

Signs of zinc deficiency

A

Rash (Peri-oral), alopecia, taste impairment

An now added to all TPN

48
Q

Selenium deficiency associated with?

A

Congestive cardiomyopathy due to myocardial necrosis

Hypothyroidism

49
Q

Alcoholic drinks without gluten

A 
Cider
All SPIRITS
champagne
Port
Wine
50
Q

Why is glucose-saline solution used in short bowel

A

Maximises Na absorption via co-transporter.

If have too much hypotonic fluid it causes net Na loss into gut and therefore increased water excretion by the short gut

51
Q

Describe the MUST scoring system

A

SCORE 0 = BMI >20, weight loss <5% in last 6/12

SCORE 1 = BMI 18.5-20, weight loss 5-10% in last 6/22

Score 2 = BMI <18.5, weight loss >10% in last 6/12

Acutely Ill patients with no suspected nutritional intake in 5/7 = 2 points

52
Q

Best way to screen for malnutrition in patients with ascites and muscle wasting

A

Subjective global assessment (SGA)

53
Q

Signs of zinc deficiency

A 
Skin lesions
Night blind
Confusion
HE
altered taste
Altered wound healing

GASTROENTEROLOGY SCE (11 decks)

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