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Intro to Clinical Medicine > Nutritional Disorders > Flashcards

Nutritional Disorders Flashcards

1
Q

If a person has sores that wont heal what could be a reason?

A

Diabetes

But ALSO… look at their albumin levels. They may be malnurished

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2
Q

Whats an ACE score?

A

is a tally of different types of abuse, neglect, and other hallmarks of a rough childhood

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3
Q

Who is more likely to experience adverse affects of abuse as children?

A

Six month olds. Infants and toddlers.

3 yearolds and up not as much because they can distract themselves

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4
Q

What are some clinical features you might find on an underweight patient?
3

A
  1. loss of body fat;
  2. dry, loose skin with decreased turgor (bounce back);
  3. thin, dry, dull hair
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5
Q

In industrilaized societies, PEM usually results how?

A

Secondary to other diseases

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6
Q

What is marasmus?

A

Protein-calorie starvation caused by protein and energy deficiency

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7
Q

How long does it take to develop?

A

over weeks or months

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8
Q

What is the etiology for marasmus?

4

A
  1. Lack of food due to lack of access
  2. Physical Disability/prevents one from getting to food
  3. Chronic illness
  4. Prolonged hospitalization
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9
Q

Clinical and Laboratory findings for Marasmus? (pathology)

8

A
  1. History of weight loss
  2. Muscle wasting
  3. Absent subcutaneous fat
  4. Decreased BP, pulse and temperature
  5. Dry, loose skin with loss of turgor
  6. Dry, thin, dull hair
  7. Mild anemia
  8. Mildly reduced serum proteins
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10
Q

What is Kwashiorkor?

A

Severe protein deficiency in the presence of adequate energy.

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11
Q

Etiologies of Kwashiorkor?

3

A
  1. Decreased intake (scarcity as in 3rd world countries, dysphagia, substance abuse, etc.)‏
  2. Increased losses (i.e. malabsorption, diarrhea, glycosuria)‏
  3. Increased requirement (i.e. fever, neoplasms, surgery)
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12
Q

Why do they call kwashiorkers sickness of weening?

A

do well when they get breast milk, no protein after the second baby is around. lots of carbs thats why they still have energy

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13
Q

Clinical and laboratory findings for Kwashiorkers? (pathology)
9

A
  1. Normal fat and muscle
  2. Decreased BP, bradycardia, hypothermia
  3. Edema and hepatomegaly with ascites/acasarca
  4. Lethargy and apathy
  5. Skin develops dry, hyperpigmented, hyperkeratotic lesions face & extremities
  6. Hair is sparse, dry, brittle & yellowish/red
  7. Serum albumin low (often
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14
Q

General pathology from PEM?
4

(protein energy malnutrition)

A
  1. Loss of body weight
  2. Loss of adipose stores
  3. Loss of skeletal muscle mass
  4. Protein mass is lost from the liver, GI tract, kidneys and heart
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15
Q

What organ produces protein?

A

liver

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16
Q

What happens when liver is damaged due to malnutrition?

3

A

Low protein production/depressed levels of circulating proteins
low clearence of toxins
glyconeogensis is reduced leading to hypoglycemia

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17
Q

What labs would we order to evaluate protein status/liver function?

A

Albumin
Bilirubin
Clotting factor

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18
Q

Why would we check liver enzymes?

A

only to check for liver failure not how it is funcitoning

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19
Q

Why do we get the swelling in PEM?

A

decrease in capillary hydrostatic pressure- favor from vascular to interstitial fluid= swelling

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20
Q

What drug will increase liver function tests and make it look like its functioning normally?

A

Statin

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21
Q

What is PEMs actual affact on the liver?

A

doesnt damage the cells they just arent working that well in this scenerio

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22
Q

How is bilirubin cleared from the blood?

A

liver

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23
Q

How does PEM affect muscle mass?

2

A
  1. Both fat stores & muscle are used for fuel

2. Muscle loss results in weakness & lost protein

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24
Q

How does PEM affect cardiac function?

A
  1. Decrease in mass & stroke volume

2. Cardiac output is decreased

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25
Q

How does PEM affect lung function?

4

A
  1. Weakness and atrophy of respiratory muscles
  2. Decrease in vital capacity, tidal volume and minute volume
  3. Mucocilliary clearance is abnormal
  4. Overall decrease breathing capacity
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26
Q

HOw does PEM affect immune function?

5

A

****All components are adversely affected/Is among the most important changes with PEM

  1. Lymphocyte count decreased
  2. T cells are depressed (what do the T cells do? )
  3. Specific antibody responses are depressed
  4. Impaired complement
  5. Neutropenia
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27
Q

What can result from immune deficiency in PEM and why would we want to keep that in mind while doing labs?

A

cant mount an immune response so WBC wont go way up in elderly malnurished patients. Wont know if they have an infection or not and cant tell from WBC

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28
Q

Effects of PEM on GI tract?

A
  1. gastric motility slows
  2. gastric acid secretion decreases
  3. total small bowel mass decreases because of mucosal atrophy and loss of villi
  4. bacterial overgrowth can occur
  5. pancreas atrophy,
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29
Q

What will mucosal atrophy and loss of villi affect?

A

no absorption

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30
Q

How does PEM affect bone mineralization?

A

with loss of calcium intake, calcium is taken from the bones

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31
Q

What are some symptoms that will result in a loss of calcium deficiency?
4

A
  1. no bone development,
  2. loss of menstration,
  3. heart is dangerous(not firing)
  4. Takes it from the bones -osteporotic?
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32
Q

What else going on in the GI tract is going to affect the calcium?

A

not absorbing it, couldnt take in calcium if you gave it to them

33
Q

How does PEM affect the menstrual cycle?

2

A
  1. low levels of circulating estrogen &
  2. low levels of gonadotropins

lead to irregular or absent menses & infertility (hypothalamus regulates it/recognizes its not a good time to have a baby)

34
Q

How does PEM affect testicular function?

A

testosterone levels decrease leading to decreased sperm production & possible testicular atrophy

35
Q

How does PEM affect wound healing?

A 
adversely affected in several ways; 1. neovascularization, 
2. collagen synthesis, 
3. fibroblast proliferation & 
4. wound remodelling 
are all delayed
  1. local edema and
  2. micronutrient deficiencies also have an effect
36
Q

Etiologies of PEM (especially in the U.S.?)

11

A
  1. Anorexia
  2. Nausea
  3. Dysphagia
  4. Pain
  5. GI obstruction
  6. Poor dentition
  7. Poverty
  8. Old age
  9. Social Isolation
  10. Substance Abuse
  11. Depression
37
Q

What drug gets the most credit for causing C.Diff in hospitals and what do you treat the C.Diff with?

A

Malabsorption (C.Diff -clindamycin most credit for causing C-diff, treat with vanco)

38
Q

What could be causes of increased nutrient losses leading to PEM is hospitilized patients?
7

A
  1. Malabsorption
  2. Diarrhea
  3. Bleeding
  4. Nephrosis
  5. Fistula draining
  6. Glycosuria
  7. Protein losing enteropathy (loss of protein in the GI tract)
    - presents with edema
    - Fontans disease
39
Q

In what situations would we need increased nutrient requirements for patients(cause of PEM)?

A
  1. Fever
  2. Burns
  3. Trauma
  4. Surgery
  5. Trauma
    6 .Infection
  6. Neoplasms
  7. Medications
    Need more energy, lose more protein
40
Q

Treatment for Protein Energy Malnutrition

3

A
  1. First goal to correct fluid & electrolyte abnormalities
  2. Then start repletion adult-0.8 g protein per kg a day increase to 1.0-1.5 g protein/kg
  3. Treat underlying etiology of malnutrition
41
Q

What could mistakes with refeeding cause?

A

any sodium, carbs could cause heart failure

42
Q

What does sedimentation rate test for?

A

indicates inflammation

43
Q

What does ABG test for ?

A

pH

44
Q

How often would we check weight?

A

3 times per week

45
Q

How often would we check CBCs on malnutrition due to infection?

A

at least weekly while the patient is still febrile

46
Q

What percent of patients are undernourished when they enter the hospital?

A

40%

47
Q

What percent of patients become malnurished while they enter the hospital?

A

40-70%

48
Q

What test directly correlates with morbidity?

A

Albumin levels

49
Q

What are the three phases of metabolic response to critical illness?

A

Ebb phase
Flow phase
Anabolic phase

50
Q

Describe the Ebb phase?

5

A

1st 12-24 hours

  1. Fever
  2. Increased CO2 consumption
  3. Vasoconstriction
  4. shut down metabolism because we need it to heal
  5. BP cardiac output will drop
51
Q

The changes that occur in the Ebb phase are due to what?

5

A 
activation of the Sympathetic Nervous System and Adrenal-Pituitary axis
SPECIFICALLY:
Rise in 
1. epinephrine
2. norepinephrine
3. GH
4. cortisol
5. other corticosteroids
52
Q

Describe the Flow phase?

5

A
  1. lasts remainder of acute illness
  2. Marked by hypercatabolism, mediated by catecholamines
  3. Results in negative nitrogen balance and shift to utilization of fat as the major fuel source.
  4. Increase cardiac out put and pressure metabolic output increases
  5. 80% of this comes from fat
53
Q

Why do surgeons look at the foley after someone has had surgery?

A

To see if their body is starting to flow again. Kidneys are a good indicator of body function

54
Q

Describe the Anabolic phase?

3

A
  1. begins onset of recovery
  2. Characterized by normalization of Vital signs
  3. Improved appetite and diuresis
55
Q

What are the two types of inflammatory bowel disease?

A

Chrohns and Ulcerative colitis

56
Q

What is Chrohns characterized by?

A
  1. Autoimmune- can be all throughout the body but sometimes only in certain areas.
  2. These areas become inflamed and dont absorb well
57
Q

What can we do to treat Chrohns?

A

B12 injections

58
Q

What is ulcerative colitis characterized by?

4

A
  1. earlier onset than Chrohns
  2. lots of inflammation that affects the rectum and colon
  3. inflammation leads to problems with absorption
  4. lots of bleeding and high risk for colon cancer
59
Q

What could cause a decreased nutrient intake with these IBDs?
7

A
  1. Altered taste secondary to Zinc Deficit
  2. Medications
  3. Anorexia
  4. Early satiety
  5. Association of food with diarrhea and/or pain
  6. Concomitant lactose intolerance
  7. Malabsorbtion
60
Q

What happens when Chrohns is active?

A

Resting Energy Expenditure (REE) increases

61
Q

How do we lose protein in IBD?

3

A
  1. Capillary leak of proteins through inflamed tissue
  2. Results in decreased concentration of plasma proteins in bloodstream
  3. Cellular proteins continue to get broken down to “feed the pool”
62
Q

How would we diagnose IBD?

2

A
  1. Measure weight, height, percent weight lost and Body mass index (BMI)‏
  2. Anthropometry uses measurements of the triceps skinfold (measures subcutaneous fat) and upper arm muscle circ. (measures muscle area)‏
63
Q

What would we count to detect inadequate intake and nutrition deficiencies?
3

A
  1. Use 3-5 day cal counts & diet history
  2. Labs to monitor nutrient history
  3. Calculate estimated caloric intake requirements
64
Q

How would we calculate caloric intake requirements?

How much protein is required?

A

Base on ideal body weight + “catch up growth”

2.4g – 3g/kg per day of protein

65
Q

For an underweight moderately active person how many cal/kg do they need a day?

A

35

66
Q

How do we find how many calories an underweight patients needs per day?

A

35 times ideal body weight

67
Q

How do we find how many grams of protein an underweight patient needs a day?

A

Actual body weight times 2.4 (or 3g)

68
Q

What could be causes of weight loss in cancer patients?

5

A
  1. Mucositis (painful ulcerations..?)
  2. Loss of appetite
  3. Inability to ingest or absorb adequate calories
  4. In catabolic state because of neoplasm
  5. Treatments (such as surgery) can worsen problem
69
Q

How does nutritional support and malignancy associated weight loss usually interact?

A

The routine use of nutritional support in those with advanced, incurable CA is associated with a higher risk of treatment-related complications

70
Q

Which cancer patients can benefit from caloric supplementation?
5

A
  1. Those who are malnourished or at risk of becoming so during treatment.
    - ensure
  2. Those who have potentially curable disease or look forward to a long disease-free period after cancer treatment.
  3. Those who are undergoing major visceral surgery
  4. Prophylactically during hematopoetic cell transplantation
  5. During therapy for head & neck cancers.
71
Q

Who are the most lactose intolerant people?

4

A

Asians
African Americans
Native Americans
Caucasians

72
Q

What are some symptoms associated with lactose intolerance?

2

A
  1. Increased or osmotic stool

2. Loss of fluid with lactose deficiency

73
Q

By what age are intestinal lactase levels starting to fall?

A

5

74
Q

Secondary causes of lactose intolerance include?

3

A

Bacterial overgrowth
Infectious enteritis
Mucosal injury (i.e. IBD)‏

75
Q

Symptoms of lactose deficiency?

5

A
  1. abdominal pain,
  2. bloating,
  3. flatulence,
  4. diarrhea, and
  5. In adolescents: vomiting
76
Q

Treament for lactose deficiency?

2

A
  1. reduce dietary lactose intake, 2. take enzyme substitute
77
Q

To maintain Ca and Vit D levels what should we supplement our diet with if we are lactose deficient?
2

A
  1. Calcium carbonate

2. absorb more taking 500mg 3x a day (if achlorhydria CA+ citrate should be used)

78
Q

Whats the first sign for someone getting parkinsons or alzheimers?

A

no sense of smell

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