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Biochemical Aspects Of GI Disease Flashcards

(43 cards)

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1
Q

What methods are used to determine nutritional status?

A

Clinical assessment

Dietary

Anthropometric measurements

Functional

Laboratory based assessments

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2
Q

What is involved in a clinical assessment of nutritional status?

A

What is normal weight for patient

Food intake

Chewing/swallowing

GI symptoms i.e. nausea/vomiting/altered bowel habit

Drugs/alcohol

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3
Q

What methods can be used to assess food intake?

A

Dietary recall

Food diaries

Food weighing

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4
Q

How can muscle mass be assessed?

A

Grip strength

Isometric knee extension

Response to electrical stimulation

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5
Q

What are the 3 components of a functional assessment?

A

Muscle mass

Hepatic secretory proteins (albumin + transferrin)

Immune response in malnourished patients i.e. assess cell mediated immunity

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6
Q

How might patient with malabsorption present?

A

Food appearing the same in bowel as when eaten

Pale bulky stools

Abdominal distention

Vague malaise

Tiredness

Weight loss

Anaemia

Easy bruising + bleeding (vit K def)

Failure to thrive in infants

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7
Q

What are the consequences of malnutrition?

A

Impaired immune response= infection

Decreased respiratory muscle strength= increased risk of chest infection

Impaired wound healing= prolonged recovery

Inactivity= Thromboembolism + pressure sores

Decreased skeletal muscle strength= fatigue and increased risk of falls

Impaired thermoregulation= hypothermia

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8
Q

Which enzymes are involved in carbohydrate digestion?

A

Salivary amylase
Pancreatic amylase
Brush border enzymes (lactase, dextrinase, glucoamylase)

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9
Q

What is the function of amylase?

A

Breaks the alpha-1,4 bond in starch

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10
Q

How are carbohydrates absorbed in the GIT?

A

Secondary active transport with Na+

Facilitated diffusion of some monosaccharides

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11
Q

What are the causes of secondary lactase deficiency?

A

IBD

Chronic alcoholism

Coeliac disease

Tropical sprue

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12
Q

What tests can be done to investigate carbohydrate absorption?

A

Lactose tolerance test= serial glucose measurements after 50g of lactose

Hydrogen breath tests
I.e glucose hydrogen breath test can indicate bacterial overgrowth in upper SI

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13
Q

Why might someone with liver disease have high triglycerides in blood?

A

Absorbed glycerol and short chain fatty acids are transported to liver via the hepatic portal vein meaning if liver not functional there will be poorer absorption

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14
Q

What is fat absorption dependent on?

A

Bile production- which is dependent on liver secretions (bile salts/phospholipids + cholesterol)

Patent bile ducts

Pancreatic enzymes

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15
Q

What enzymes are involved in protein digestion?

A

Pepsin

Pancreatic proteases

Brush border enzymes

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16
Q

Why is it important to assess a patients nitrogen balance?

A

It gives an indication to whether they are metabolising protein correctly which is essential for ensuring a good healing process

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17
Q

What tests are used to assess pancreatic function?

A
  1. Faecal pancreatic elastase-1
    Enzymes produced in pancreas which is resistant to degradation by other enzymes and therefore is present in stool to be measured
  2. Serum immunoreactive trypsin (IRT)
    Used in heel prick test for babies to screen for CF
    Low values= failure of production i.e pancreatic disease
    High values= obstruction
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18
Q

Where are the different vitamins absorbed?

Study These Flashcards
A

SI= A,D,E, C, B

LI= K + B via bacterial metabolism

19
Q

Which proteins are fat-soluble and which are water soluble?

How is the absorption of fat-soluble proteins different from water-soluble ones?

Study These Flashcards
A

Fat-soluble:
A D E. K
Carried by micelles and diffuse into absorptive cells

Water:
C B
Diffusion (active or passive)
I..e B12 binds to intrinsic factor

20
Q

What are the signs of vitamin A deficiency?

Study These Flashcards
A

Night blindness

21
Q

What are the acute and chronic consequences of an excess of vitamin A?

Study These Flashcards
A

Acute:
Raised ICP
Nausea
Vomiting + visual disturbances

Chronic:
Liver/bone damage
Teratogenic

22
Q

Who is more sensitive to vitamin E deficiencies? How does the deficiency present?

Study These Flashcards
A

Premature Infants= haemolytic anaemia + thrombocytopenia

children= spinocerebellar degeneration

23
Q

Who is most at risk of thiamine deficiency? What are the 2 types of thiamine deficiency and how do they present?

Study These Flashcards
A

People after bariatric surgery or gastric balloons
I.e. due to not being able to eat and the associated vomiting
Alcoholics

Dry:
Peripheral neuropathy
Muscle weakness
Fatigue

Wet
Oedema
HF

AND wenrickes encephalopathy (unsteady on feet and present as dementia)

24
Q

How can you assess for thiamine deficiency? What extra measure needs to be taken?

Study These Flashcards
A

Can directly measure thiamin in blood BUT need to protect from sun light

25
What type of vitamin is generally non-toxic in excess and why?
Water-soluble vitamins due to being able to easily excrete any excess via the kidney
26
What are the signs of riboflavin deficiency?
``` Angular stomatitis Oily scaly skin rashes Eye sensitive to light Anaemia Birth defects (CHD + limb defects) ```
27
When is nicotinamide deficiency most likely to occur? How is it treated?
Alcoholism + long term diarrhoea Replacement
28
How does vitamin B6 deficiency present?
``` Seborrhoeic dermatitis Atrophic glossitis Confusion Neuropathy Sideroblastic anaemia ```
29
Why is it important to measure B12 and folate in diabetic patients?
Metformin can lead to deficiencies in these vitamins
30
Why is zinc important and what can cause deficiencies?
Essential component of enzymes Inadequate intake or increase loss via diarrhoea
31
What is the main cause of copper deficiency? What is easiest way to assess for copper deficiency?
Poor parenteral nutrition Measure caeruloplasmin i.e. plasma protein carrier
32
What are the methods of supplementing nutrition?
Food supplements Enteral i.e. via gut Parenteral i.e. IV
33
What types of food enrichment can be given to patient to help improve nutrition?
Fortified puddings Fortified supplements Modular supplements Nutritionally complete supplements
34
Why is it important to delivery nutrients to the gut via enteral feeding?
Stimulate gut hormones Help maintain gut integrity Nutrients are absorbed into portal circulation More physiological than TPN
35
What are the indications for enteral nutrition?
Disturbed swallowing Upper GI obstruction i.e. stricture Inability to eat GI disease i.e. pancreatic insufficiency High requirements after burns + trauma Loss of appetite i.e. anorexia + cardiac cachexia + cancer Transition from parental nutrition
36
What are the different methods of enteral feeds?
``` NG Orogastric Gastronomy Oesophagostomy Nasoduodenal Jejunostomy ```
37
What is total parenteral nutrition (TPN) ?
Line directly into circulation (vein) meaning GIT and liver are bypassed
38
When is TPN indicated?
Lack of functioning GIT i.e. bowel cancer/severe IBD Oral or enteral route unable to provide adequate nutrition GIT needs to be rested i.e. gastroschisis prolonged diarrhoea/high output fistula/anastomosis
39
What is re-feeding syndrome and who is at risk of developing it?
Metabolic disturbances due to reinstitution of nutrition to patients which results in disturbances in potassium, magnesium and phosphorus ``` Patients with anorexia Patients with chronic alcoholism Oncology patients Postoperative patients Elderly Uncontrolled DM Patients with chronic malnutrition Long term users of antacids Long term users of diuretics ```
40
What are the signs of re-feeding syndrome?
``` Delirium Epilepsy Wenricke’s encephalopathy Cardiac arrhythmias Anaemia Hypokalaemia/magnesaemia/phosphataemia Hyperglycaemia Diarrhoea Peripheral oedema Paraesthesia Weakness Fasciculations ```
41
What are medically induced causes of malnutrition?
Gastric sleeve Roux en Y gastric bypass
42
IBD can be a cause of malnutrition and deficiencies. How is IBD investigated?
Faecal calprotectin Marker of WC count in the bowel and can help to differentiate between IBS and IBD Stool culture done to detect whether bacterial infection present
43
What test is used to screen for bowel cancer?
Faecal immunohistochemical test (FIT) Used to detect and quantify the amount of blood in stool sample by using antibodies which specifically recognise human Hb

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