Fiser ABSITE Ch. 10 Nutrition Flashcards Preview

Surgery > Fiser ABSITE Ch. 10 Nutrition > Flashcards

Flashcards in Fiser ABSITE Ch. 10 Nutrition Deck (87):
1

Caloric need is approximately ___ kcal/kg/day

25

2

kcal/g of fat, protein, oral carbohydrates, dextrose

9, 4, 4, 3.4

3

How many g protein/kg/day is needed and what percentage should be essential amino acids.

1, 20

4

Formula for caloric requirements for burn patient? protein requirements?

25 kcal/kg/day + (30 kcal/day x % burn)
1-1.5 g/kg/day + (3g x % burn)

5

Much of the energy expenditure is used for what?

heat production

6

Basal metabolic rate increases ___% for each degree above 38.0

10

7

What is the name of the equation that calculates basal energy expenditure based on weight, height, age and gender?

Harris-Benedict equation

8

What is central line TPN based and what is its max administration rate?

glucose, 3 g/kg/hr

9

What is peripheral line parenteral nutrition (PPN) based?

fat based

10

What is the fuel for colonocytes?

short chain fatty acids

11

What is the fuel for small bowel enterocytes?

glutamine

12

What is the most common amino acid in the bloodstream and tissue?

glutamine

13

What is the primary fuel for neoplastic cell?

glutamine

14

Approximate half-life of albumin, transferrin, prealbumin

20 days, 10 days, 2 days

15

Normal protein level?

6.0-8.5

16

Name 4 acute indicators of nutritional status

retinal binding protein, prealbumin, transferrin, total lymphocyte count

17

Formulas for ideal body weight Men and Women

Men 106 lb + 6 lb for each inch over 5 ft
Women 100 lb + 5 lb for each inch over 5 ft

18

What is the strong risk factor for morbidity and mortality after surgery?

Low albumin (less than 3.0)

19

What is respiratory quotient?

Ratio of CO2 produced to O2 consumed, measurement of energy expenditure.

20

What does a RQ > 1 mean? Tx?

lipogenesis (overfeeding)

decrease carbohydrates and caloric intake- high carbohydrate intake can lead to CO2 buildup and ventilator problems

21

What does a RQ less than 0.7 mean? Tx?

ketosis and fat oxidation (starving)
increase carbohydrates and caloric intake

22

What is the RQ for pure fat metabolism?
pure protein metabolism?
pure carbohydrate metabolism?

pure fat = 0.7
pure protein = 0.8
pure carbohydrate = 1.0

23

Postoperative Phases
Diuresis phase days __-__
Catabolic phase days __-__ (negative nitrogen balance)
Anabolic phase days __-__ (positive nitrogen balance)

2-5
0-3
3-6

24

Glycogen stores are depleted after __-__ hours of starvation. The body then switches to ___

24-36
fat

25

What proportion is glycogen stores in skeletal muscle and what proportion is in liver?

2/3 in skeletal muscle
1/3 in liver

26

____ stays in muscle after breakdown from glycogen and is utilized.
Skeletal muscle lacks ____ (found only in the liver)

glucose 6 phosphate
glucose 6 phosphatase

27

What is the simplest amino acid precursor for gluconeogenesis and the primary substrate for gluconeogenesis

Alanine

28

What are the only two amino acids to increase during times of stress?

alanine and phenylalanine

29

Late in starvation gluconeogenesis occurs where?

in the kidney

30

Protein-conserving mechanisms do not occur after trauma or surgery secondary to what 2 factors?

catecholamines and cortisol

31

What is the main source of energy in trauma and starvation?

Fat (ketones)

32

Most patients can tolerate a ___% weight loss without major complications.

15

33

How many days can a patient tolerate without eating?
After that, what are 2 options?

7 days
Dobbhoff tube or start TPN

34

What is the main reason to try to feed gut?

avoid bacterial translocation (bacterial overgrowth, increased permeability due to starved enterocytes

35

What is elemental formula?

all protein given in the form of amino acids (given IV, expensive)

36

Consider PEG when regular feeding not possible (eg CVA) or predicted not to occur for >___ weeks

4

37

Brain utilizes ___ with progressive starvation (normally uses glucose)

ketones

38

Name 4 obligate glucose users

peripheral nerves, adrenal medulla, RBCs and WBCs

39

What three things are decreased with refeeding syndrome?

K, Mg, PO4

40

What are the sx of refeeding syndrome?

cardiac dysfunction and fluid shifts

41

How to prevent refeeding syndrome?

starting at a low rate (10-15/kg/day)

42

What is cachexia mediated by?

TNF-a

43

How much protein contains 1 g of nitrogen?

6.25

44

How much total protein is synthesized in a 70 kg male per day?

250 g/day

45

What organ is responsible for amino acid production and breakdown?

Liver

46

What is produced to get rid of ammonia from amino acid breakdown?

urea

47

The majority of protein breakdown from skeletal muscle is from what two amino acids?

glutamine and alanine

48

What is used to synthesize bile salts?

cholesterol

49

How do medium and short chain fatty acids enter enterocytes?

simple diffusion

50

After micelles and other fatty acids enter enterocytes, what are formed? which enter lymphatics.

chylomicrons

51

What is the difference between medium/short chain fatty acids and long chain fatty acids in how they enter circulation?

medium and short enter portal system
long chain enter lymphatics

52

On liver endothelium, clears chylomicrons and TAGs from the blood, breaking them down to fatty acids and glycerol which are then taken up by hepatocyte

Lipoprotein lipase

53

On liver endothelium; binds short and medium chain fatty acids

Free fatty acid binding protein

54

Most important route of entry for dietary cholesterol; synthesized in the liver

VLDL

55

What is the preferred source of energy for the liver, heart and skeletal muscle?

fatty acids

56

What are unsaturated fatty acids used for?

structural components for cells

57

In fat cells; breaks down TAGs (storage form of fats) to fatty acids and glycerol; released into blood (sensitive to growth hormone, catecholamines, glucocorticoids)

Hormone-sensitive lipase

58

What are the 2 essential fatty acids?

linolenic, linoleic

59

The essential fatty acids are important for immune cells and are needed for ___ synthesis

prostaglandin

60

Omega 3 fatty acids converted into what three important lipids thought to have antioxidant properties?

PGI3, TXA3, LTB5 (all odd; think BAI)

61

Omega 6 fatty acids are converted into what 3 important lipids?

PGE2, TXA2, LTB4 (all even; think BAE)

62

Carbohydrate digestion begins with what enzyme?
Then what other 2?

salivary amylase
then pancreatic amylase and disaccharidases

63

Glucose and galactose are absorbed by what mechanism? Where are they released into?

secondary active transport
portal vein

64

Fructose is absorbed by what mechanism? Where is it released into?

facilitated diffusion
portal vein

65

sucrose = ___ + ___
lactose = ___ + ___
maltose = ___ + ___"

fructose + glucose
galactose + glucose
glucose + glucose

66

Protein digestion begins with what enzyme?
Then what other 3?

stomach pepsin
trypsin, chymotrypsin and carboxypeptidase

67

Trypsinogen released from ___ and activated by ___ released from ___.

pancreas, enterokinase, duodenum

68

What is the mechanism by which protein is aborbed?
Where is it then released and in what form?

amino acids, dipeptides and tripeptides are absorbed by secondary active transport;
released into portal vein as free amino acids

69

May want to limit protein intake in pts with ___ and ___ to avoid ammonia buildup and possible worsening encephalopathy

liver failure and renal failure

70

What are the 3 branched amino acids (w/ mnemonic)?

leucine, isoleucine, valine (LIV)

71

Where are the branched amino acids metabolized?

muscle

72

Name the deficiency associated with hyperglycemia, encephalopathy, neuropathy

chromium

73

Name the deficiency associated with cardiomyopathy, weakness, hair loss

selenium

74

Name the deficiency associated with pancytopenia

copper

75

Name the deficiency associated with hair loss, poor healing, rash

zinc

76

Name the deficiency associated with weakness (failure to wean off ventilator), encephalopathy, decreased phagocytosis

phosphate

77

Name the deficiency associated with Wernicke's encephalopathy, cardiomyopathy, peripheral neuropathy

Thiamine (B1)

78

Name the deficiency associated with sideroblastic anemia, glossitis, peripheral neuropathy

Pyridoxine (B6)

79

Name the deficiency associated with megaloblastic anemia, peripheral neuropathy, beefy tongue

Cobalamin (B12)

80

Name the deficiency associated with megaloblastic anemia, glossitis

Folate

81

Name the deficiency associated with pellagra (diarrhea, dermatitis, dementia)

Niacin

82

Name the deficiency associated with dematitis, hair loss, thrombocytopenia

Essential fatty acids

83

Name the deficiency associated with night blindness

Vitamin A

84

Name the deficiency associated with coagulopathy

Vitamin K

85

Name the deficiency associated with rickets, osteomalacia

Vitamin D

86

Name the deficiency associated with neuropathy

Vitamin E

87

What is the process called by which lactate goes to the liver and is converted back to pyruvate and eventually glucose via gluconeogenesis

Cori cycle