Day 1 Flashcards
(144 cards)
1
Q
what is metabolism?
A
the process by which nutrients are converted to cellular energy
2
Q
Describe characteristics of ATP
A
It’s essential for energy utilizing and energy producing fxns of the body. The energy gained from the oxidation of carbs, proteins, fats converts ADP to ATP.
3
Q
What are 4 examples of ATP utilization?
A
Active ion transport, muscle contraction, synthesis of molecules, cell division and growth
4
Q
How many kcal/g are in carbs?
A
4 kcal/g
5
Q
How many kcal/g are in proteins?
A
4 kcal/g
6
Q
How many kcal/g are in fats?
A
9 kcal/g
7
Q
How many kcal/g are in alcohol?
A
7 kcal/g
8
Q
What are the final products of carb digestion?
A
glucose, fructose, galactose
9
Q
Where in the body and in what form is glucose stored?
A
Stored in the liver as glycogen. Excess glucose is stored as triglycerides in adipose tissue and as glycogen in skeletal muscles
10
Q
What is glycogenolysis?
A
The breakdown of glycogen into glucose in the liver and skeletal muscle
11
Q
What is gluconeogenesis?
A
The synthesis of glucose from amino acids, the glycerol portion of fats, and lactate in the liver
12
Q
What stimulates gluconeogenesis?
A
Hypoglycemia and low carb levels stimulate the release of cortisol which mobilizes cells to release proteins that are broken down into amino acids
13
Q
How are fats metabolized?
A
Fats are absorbed into intestinal lymph by chylomicrons and empty into the jxn of the jugular and subclavian veins. The chylomicrons are removed from blood in adipose tissue and liver by lipoprotein lipase. Lipoprotein lipase releases the triglyceride from the chylomicrons where they are broken down into fatty acids and glycerol.
14
Q
What is the fxn of hormone-sensitive triglyceride lipase?
A
Breaks down fat into glucose
15
Q
What activates hormone-sensitive triglyceride lipase?
A
Epi, NE, corticotropin, glucocorticoids, and GH
16
Q
What hormone causes rapid mobilization of fat?
A
Thyroid hormone
17
Q
How are proteins metabolized?
A
Proteins are broken down into amino acids in the GI tract, absorbed into the blood, and enter cells to form new proteins. A few free amino acids remain in the blood as plasma proteins
18
Q
What is the fxn of growth hormone in protein metabolism?
A
increases the synthesis of cellular proteins. decreases glucose release and uses fatty acids for energy
19
Q
What is the fxn of glucocorticoids in protein metabolism?
A
Decrease proteins in tissue
20
Q
What is the fxn of testosterone in protein metabolism?
A
Increases proteins in tissue
21
Q
Define basal metabolic rate?
A
The energy output of the body to perform essential metabolic fxns of the body
22
Q
What factors raise BMR?
A
Skeletal muscle mass, testosterone, growth hormone, fever
23
Q
What factors decrease BMR?
A
hypothroidism, sleep, malnutrition
24
Q
Define BMI.
A
Measurement of body fat based on height and weight ration
25
What are the parameters of BMI?
underweight < 18.5 , optimal 18.5-25, overweight 25.1-30, obese >30
26
What is the formula used to determine BMI?
weight (kg)/ height (m) squared
27
Define recommended daily allowance.
The intake that meet the nutrient need of almost all healthy persons in a specific age and sex group
28
What is the purpose of the RDA's?
To advise people about the level of vitamin and nutrient intake to prevent disease
29
What is included in the daily reference intake?
RDA, the adequate intake, the estimated avg requirement, and the tolerable upper intake level
30
Define malabsorption.
The impaired absorption of nutrients.
31
Define maldigestion.
The impaired digestion of nutrients.
32
What stimulates parietal cells to secrete HCl in the stomach?
Gastrin
33
What cells protect the stomach lining?
Goblet cells (produce mucous)
34
What is the fxn of CCK?
inhibits gastrin which slows emptying from the stomach. stimuluates the release of pancreatic enzymes responsible for nutrient absorption.
35
What is the primary fxn of the small intestine?
Absorption of nutrients, water, electrolytes
36
What 3 steps are required for normal nutrient absorption?
luminal processing, absorption into the intestinal mucosa, and transport into the circulation
37
What nutrients use facilitated diffusion?
fructose, riboflavin, vitamin b12
38
What nutrients use active transport?
glucose, galactose, amino acids, ions, folic acid, ascorbic acid, thiamin, bile acids
39
Where are most dietary lipids absorbed?
The proximal 2/3's of the jejunum
40
How does fat hydrolysis begin?
In the stomach with lingual and gastric lipase
41
What lipases are responsible for the majority of lipid hydrolysis?
pancreatic lipase and colipase
42
What is the fxn of secretin?
Enhances pancreatic bicarb secretion and raises the pH to 6.5 (optimal for fat digestion)
43
What is Zollinger-Ellison's syndrome?
A disease that decreases duodenal pH that can selectively inhibit fat absorption
44
What is the fxn of bile salts?
Enhance fat solubilization by creating micelles
45
Define steatorrhea.
fatty stools due to fat malabsorption
46
Describe 3 causes of fat malabsorption.
Impaired production/activity of pancreatic lipase or colipase.
A decrease in the absorptive surface area.
Abnormalities in lymphatic flow
47
What are the two principal polysacchrides of starch?
amylose and amylopectin
48
What enzymes contribute to the digestion of carbs?
salivary amylase, pancreatic amylase, and ptyalin
49
What happens to carbs that aren't digested in the small intestine?
Undergo degradation in the colon, fermentation, formation of fatty acids, CO2, hydrogen and methane
50
What enzymes in the stomach begin protein digestion?
Gastric pepsins (pepsinogen 1 and 2)
51
Define achlorhydric and its clinical significance.
achlorhydric is a condition characterized by lack of HCl that results in a lost ability to control gastric emptying. Patient's can still digest proteins, but aren't able to absorb it since CCK isn't released.
52
Describe how proteins are digested into amino acids in the duodenum.
Enterkinase is released by microvilli which converts trypsinogen to trypsin. Trypsin converts pancreatic proteases into active forms which then digest the proteins.
53
How are amino acids absorbed in duodenum?
By Na+ dependent amino acid co-transporters at the brush border membrane. Energy is indirectly provided by Na+-K+ pump.
54
Name two diseases caused by impaired pancreatic protease secretion/activity.
Chronic pancreatitis and cystic fibrosis
55
Name three conditions that impair protein absorption by the reduction of intestinal absorptive surface.
Gastrectomy, celiac sprue, ulcerative colitis
56
Where are most vitamins and minerals absorbed?
The proximal half of the small intestine.
57
Where is B12 absorbed?
The ileumand distal jejunum
58
Name two conditions that result from decreased B12 absorption.
Macrocytic anemia and peripheral neuropathy.
59
Name the 4 fat soluble vitamins
A,D, E, K
60
Describe how calcium is absorbed.
Gastric acid causes Ca++ salts to go into soln so it can be absorbed along with the active vitamin D. Greatest proportion of calcium is absorbed in the ileum
61
Describe how iron is absorbed.
Occurs mostly in duodenum and upper jejunum. Passes thru brush border into the epithelial cell. Then moves across serosal surface of cell into the blood.
62
What vitamin enhances iron absorption?
Vitamin C
63
Where are water and electrolytes absorbed?
small intestine and colon
64
Describe how water is absorbed.
Passive process that is a fxn of solute absorption
65
What is absorbed in the large intestine?
water, sodium, chloride
66
What is secreted in the large intestine?
bicarb, mucus, fecal bacteria
67
How is sodium absorbed in large intestine?
By the active sodium pumps of epithelial cells have on their basolateral membranes
68
How is chloride absorbed in large intestine?
By exchange with bicarb
69
What is the fxn of goblet cells in the large intestine?
To secrete mucus that helps lubricate and protect the epithelium. Helps bind the dehydrated ingesta to form feces
70
What two processes are attributed to the microbial flora of the large intestine?
Digestion of carbs not digested in the small intestine and the synthesis of vitamin K and B vitamins.
71
What causes the brown color of feces?
Stercobilin and urobinin produced by bacterial degration of bilirubin.
72
How do you convert lb to kg?
lb x .45
73
how do you convert kg to lb?
kg x 2.2
74
how do you convert in to m?
ins x 2.54
75
how do you convert cm to in?
cm x .39
76
how many calories equal 1 lb?
3500
77
What are inadequate intake causes of weight loss?
cancer, depression, lack of funds, GI problems, chronic illness
78
What are excess requirement causes of weight loss?
cancer, increased metabolic demand, thyroid abnormalities, excessive excercise
79
What are decreased metabolism causes of weight gain?
aging, thyroid abnormalities, menopause, sedentary lifestyle
80
What are fluid retention causes of weight gain?
heart failure, liver failure/cancer, ovarian cancer, ascites
81
What is anhedonia?
Doesn't take pleasure in anything. sign of depression
82
What is cachectic?
looks anorexic, clothes hanging off patient
83
What does NAD stand for?
no acute distress
84
How do you calculate percent body weight lost?
(normal weight-real weight)/normal weight) x100
85
What test indicates presence of ascites?
positive shifting dullness on percussion
86
When is the comprehensive history used?
for admission history and physical exams, new patient intake sessions, and pre-operatively
87
When is the focused or problem-oriented exam used?
Most episodic patient visits
88
What are etiologies of obesity?
genetic factors, environmental, lack of physical activity
89
What is Prader-Willi
rare disorder characterized almond eyes, decreased muscle tone, hypogonadism, truncal obesity
90
What are secondary causes of obesity?
cushings, insulinoma, hypthyroidism, hypothalamic damage, GH deficiency. less than 1% have underlying disease
91
What conclusions were drawn from Framinham study?
obese ppl at age 40 lived 6-7 yrs less, those who were overweight lived about 3 yrs less
92
What are the morbidities associated with obesity?
Type II diabetes, hypertension, dyslipidemia, heart disease, stroke, ostoearthritis, sleep apnea, cancer
93
What are treatment methods for obesity?
decreasing food intake, increase energy expenditure, behavoir modification
94
What are the prescriptions for weight loss?
lorcarserin (belvaq), orlistat (xenical, alli), phentermine (adipex-P)
95
What are indications for surgical therapy of obesity?
be well-informed/motivated, BMI >40, acceptable risk for surgery, have failed previous non-surgical weight loss
96
What are contraindications for surgical therapy?
Untreated depression, drug/alcohol abuse, inability to comply with diet changes, > 65 or <18
97
What are the types of surgical therapy for obesity?
lap band, sleeve gastrectomy, roux-en-y gastric bypass
98
what causes marasmus-like secondary PEM?
COPD, CHF, cancer, AIDS. typically results from chronic diseases
99
what causes kwashiorkor-like secondary PEM?
Burns, trauma, sepsis. primarily in association with hypermetabolic acute illness
100
What is marasmus?
protein-calorie starvation caused by protein and energy deficiency
101
WHat are etiologies of marasmus?
lack of food, physical disability, chronic illness, prolonged hospitalization
102
What is kwashiorkor?
Severe protein deficiency in presence of adequate energy
103
What are etiologies of kwashiorkor?
decreased intake, increased losses, increased requirements
104
What happens as a result of liver dysfxn?
decrease in hepatic synthesis of serum proteins
105
What happens to immune fxn in PEM?
decreased lymphocyte count, T cells are depressed, specific antibody responses are depressed, impaired complement, neutropenia
106
How do you treat PEM?
correct fluid/electrolyte abnormalities, treat underlying etiology of malnutrition, start repletion of protein
107
What happens to morbidity rate with low albumin levels?
higher morbidity
108
What are the 3 phases of metabolic response to critical illness?
Ebb phase, flow phase, anabolic phase
109
What happens during Ebb phase?
1st 24 hrs, fever, increased CO2 consumption, vasoconstriction
110
What happens during flow phase?
last remainder of acute illness, marked hypercatabolism, negative nitrogen balance and shift to utilization of fat
111
What happens during anabolic phase?
begins onset of recovery, characterized by normalization of VS, improved appetite and diuresis
112
What is inflammatory bowel disease?
inability to maintain ideal body weight with chrohn's disease and ulcerative colitis.
113
what is anthropometry?
measures triceps skinfold and upper arm muscle circumference
114
what is the cause of lactose intolerance?
intestinal lactase levels start to fall about the age of 5 years
115
what are secondary causes of lactose intolerance?
bacterial overgrowth, infectious enteritis, mucosal injury (IBD)
116
How do you determine if a patient is at nutritional risk?
the eyeball test, CBC (anemia), serum albumin < 3.4, cholesterol < 160, critically ill patients
117
How do you determine need for nutritional support?
bowel not functioning, prolonged hypercatabolic states, prolonged bowel rest required, severe protein-calorie malnutrition
118
What is enteral nutrition
tube feeds, can start within 48 hrs
119
What is parenteral nutrition
IV nutrition thru central line
120
What are contraindications for enteral nutrition?
bowel obstruction, hemodynamically unstable, upper GI bleeding, GI ischemia, GI fistula
121
what are indications for enteral nutrition
oral intake insufficient to meet nutritional needs
122
what are complications of enteral feedings?
diarrhea, inadquate gastric emptying, aspiration, dehydration, electrolyte abnormalities
123
what are indications for parenteral nutrition?
inability to absorb adequate nutrients via the GI tract
124
what are contraindications parenteral nutrition?
fxning GI tract, lack of venous access
125
Describe total parental nutrition.
Delivered thru central venous catheter in subclavian, internal jugular, femoral or PICC line.
126
What does TPN contain?
dextrose, amino acids, electrolytes, vitamins, minerals, trace elements
127
What factors are needed to determine TPN prescription?
weight, caloric needs, protein requirements
128
What do you start with for caloric intake?
start with 18 kcal/day and gradually increase to 25-30kcal/day
129
What type of patient needs the most protein?
burn patients, up to 2 g/kg/day
130
What are TPN complications?
infections, metabolic derangements, refeeding syndrome, hepatic dysfxn
131
What could happen if you abruptly stopped TPN?
severe hypoglycemia
132
What is refeeding syndrome?
abrupt decrease in K/Mg/P from pancreatic stimulation and insulin secretion
133
What are the goals of nutritional therapy for type II diabetes?
lower A1C, BP control, Cholesterol control (ABCs)
134
What are the key components for nutrition prescription for type II diabetics?
caloric intake, weight loss, consistency in carb intake, nutritional consent, timing of meals/snacks
135
What are the short and long term goals of weight loss in type II diabetes?
4-6 weeks: 3-6 lbs
| long term 10-20lbs
136
What are goals of nutritional therapy for type I diabetes?
carb counting and adjusting insulin using a ratio of carbs to insulin
137
What is the DASH diet?
dietary approach to stop hypertension, 4-5 servings fruit/veggies, 2-3 servings of dairy, low fat, limit red meat to 2x weekly
138
What is nutritional therapy for hyperlipidemia?
increase fruits, veggies, low saturated fat, increased fiber, limit intake of cholesterol < 200mg
139
What are top 5 foods to lower cholesterol?
oatmeal/oat bran (fiber), fish, nuts, olive oil, foods with added plant sterols that block absorption of cholesterol (yogurt, OJ)
140
What is nutritional therapy for chronic kidney disease?
sodium restriction, protein restriction, low potassium intake, low phosphate intake
141
Why do you decrease sodium for chronic kidney disease?
sodium can build up and contribute to fluid retention and hypertension
142
Why do you restrict protein for chronic kidney disease?
protein waste products are not processed properly
143
Why do you restrict K levels for chronic kidney disease?
K levels increase and can lead to arrhythmias
144
Why do you restrict P levels for chronic kidney disease?
P levels increase and can cause Ca to leach from the bones and lead to osteoporosis and hypercalcemia
