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Flashcards in GI Nutrition Deck (117):
1

Malnutrition
Consequence of what (2)
Results in what (3)

inadequate intake of proteins and calories OR deficiencies in the digestion or absorption or proteins

Weight loss, Lethargy, Weakness

2

Good diet has what three components

1. Sufficient energy in all 3 types
2. Amino acids and fatty acids
3. Vitamins and minerals

3

Primary malnutrition definition

One or all of these components are missing from the diet

4

Secondary malnutrition

Although supply is adequate: you are not absorbing, using, or storing nutrients

5

Chronic alcoholism sees deficiencies in what? 4

thiamine, pyridoxine, folate, and Vitamin A

6

Malnutrition is determined how?

In terms of BMI

7

What is BMI of malnutrition?

Less than 16

8

Protein energy malnutrition has what two diseases?

Marasmus and Kwashiorkor

9

Somatic protein compartment is where
Affected by what disease

Skeletal muscle
Marasmus

10

Visceral protein compartment is where
Affected by what disease

Visceral organs like liver
Kwashiorkor

11

Maramus definition

<60% of normal weight for sex, height and age

12

Marasmus
Effect on growth
Albumin levels
Extremity change
Other changes seen (3)

Growth retardation
Normal albumin
Emaciated extremities
Anemia + Vitamin def. + Immune def

13

Kwashiorkor
Definition
Most common form of PEM in who
Why
Occurs in what conditions (4)
Albumin level and what it signals
Two tissues spared from loss
Skin change
Hair change
Liver change

Protein deprivation
African children
Weaned too early and eat carbs mainly
1. Chronic diarrhea
2. Protein losing enteropathies
3. Nephrotic syndrome
4. Burns
Low albumin --> Edema
Spares fat and muscle
Flaky paint appearance
Loss of hair color
Fatty liver

14

Kwashiorkor vs. Marasmus
Mental State
Face appearance
Fat that remains
Edema presence
Fatty liver
Hair changes
Growth failure

Mental: K is apathy and M is alert
Face: K is moon face and M is wizened
Fat: K is subq fat and Marasmus is none
Edema: K has it
Fatty liver: K has it
Hair change: K has it
Growth failure: Both

15

How to measure nutritional status of elderly

Mini-nutritional assessment

16

Obvious signs of PEM
Fat
Muscle
Edema

Fat: Depletion of subq fat in arms, shoulders, chest wall
Muscle: Wasting of quad and delts
Edema: Ankle or sacral edema

17

Cachexia definition
What % of cancer patients
3 most common cancers associated
Mortality is the result of what

PEM in patients with AIDS or advanced cancers
50%
with GI, pancreatic, and lung cancers
atrophy of the diaphragm and other respiratory muscles

18

Cachetic agents

Tumor necrosis factor alpha
Inflammatory cytokines
Interleukin-6
Proteolysis-inducing factor (PIF)
Lipid-mobilizing factor (LMF)

19

Anorexia definition

self-induced starvation

20

Bulemia definition

food binging followed by induced vomiting

21

Anorexia nervosa
Title
Effect on what system prominent
Symptoms of this effect 2
Three blood changes

Highest death rate of any psychiatric disorder
Endocrine
Amenorrhea, Hypothyroidism, Bone density decreased
Anemia, Lymphopenia, Hypoalbuminemia

22

Which is more common, bulemia or anorexia
Which has better prognosis
Which sex more

Bulimia
Bulimia
Women

23

Endocrine change in bulimia

Amenorrhea

24

Major complications of bulimia are due to what (2)

1. Chronic vomiting
2. Chronic use of laxative and diuretics

25

Findings in bulimia (5)

1. Hypokalemia
2. Aspiration
3. Esophageal and cardiac gastro rupture
4. Acid damage to teeth
5. Knuckle bruising (Russell's sign)

26

How many vitamins are needed
Which are fat soluble
What makes fat soluble better

13
DEAK
Store in body better

27

4 vitamins synthesized endogenously
And from what

Vitamin D: Steroids
Vitamin K and Biotin: Intestinal microflora
Niacin (B3): Tryptophan

28

Vitamin A includes what three types

Retinol
Retinal
Retinoic acid

29

Chemical name of Vitamin A

Retinol

30

Transport and storage form of Vitamin A

Retinol ester

31

Name for all types of Vitamin A

Retinoids

32

Vitamin A animal sources

Liver, fish, eggs, milk, butter

33

Vitamin A vegetable sources
Why is vegetable good
Most important carotenoid

Carrots, squash, spinach
Has carotenoids that can turn to Vit A
Beta-carotene

34

Absorption of Vitamin A requires what? (3)

Bile
Pancreas enzymes
Antioxidant activity

35

Most of Vitamin A is stored where

Liver

36

Vitamin A five funcitons

1. Maintains normal vision
2. Cell growth and differentiation
3. Fat metabolism
4. Host resistance to infections
5. Antioxidant

37

What are the four forms of Vitamin A containing pigmentsin eye

One rhodopsin (rods-light)
Three iodopsins (cones-color)

38

Vitamin A has what effect on mucus

Keeps mucus secreting epithelium orderly, if not there undergoes metaplasia

39

Vitamin A as a treatment (2)

Skin: Severe acne and psoriasis
Treats acute promyelocytic leukemia

40

Vitamin A deficiency in the eye results in (5)

1. Impaired vision
2. Night blindness
3. Dry eyes
4. Squamous metaplasia
5. Immune deficiency

41

Synthetic retinoids have what effects

Synthetics like accutane have teratogenic effects

42

Vitamin D function

Maintain calcium and phosphorus levels

43

3 deficiencies of Vitamin D

1. Osteomalacia (adults)
2. Rickets (kids)
3. Hypocalcemic tetany

44

Major source of endogenous Vitamin D?

Synthesis in the skin to make D3

45

Vitamin D can also come from (2)

1. Deep sea fish
2. Plants (ergosterol)

46

How is 1,25 Vitamin D made?

After sun activation Vitamin D3 binds to D-binding protein and goes to liver to be acted on by 25-OHases and is then acted on by alpha-1 hydroxylase in the kidney to form 1,25

47

3 ways Vitamin D production in kidney is regulated

Hypocalcemia --> Increase PTH --> Increase Vit D
Hypophosphatemia --> Activates alpha-1hydroxylase
Increased 1,25 levels --> Decrease its own synthesis

48

Vitamin D effects on calcium (4)

1. Stimulation of intestinal absorption of Ca
2. Stimulation of calcium reabsorb in Kidney
3. Interact with PTh
4. Mineralization of bone

49

What level constitutes Vitamin D deficiency

less than 20

50

Rickets
Mechanism

Excess of unmineralized matrix causing overgrowth of epiphyseal cartilage

51

Rickets most common when?

First year of life

52

Rickets symptoms

1. Craniotabes (softening of bone)
2. Frontal bossing of head and squared appearance of head
3. Rachitis rosary of ribs
4. Pigeon breast deformity of chest
5. Bowing of legs
6. Lumbar lordosis of spine

53

Osteomalacia is what mechanism

Lack of Vitamin D deranges the normal bone remodeling that occurs throughout life

54

Vitamin D has what effect on cell cycle

Can control apoptosis and differentiation

55

Vitamin E
Most common form
Food source
Acumulates mainly where

Alpha-tocopherol
Everything
Fat deposits the most, but can be anywhere

56

Vitamin E function

an antioxidant

57

Deficiencies of Vitamin E 3

1. Fat absorption
2. Low birth weight
3. Abetalipoproteinemia

58

Main neuro problem of Vit E deficiency

Spinocerebellar degeneration

59

Vitamin E toxicity

Decreases synthesis of coag factors --> Causes hemorrhage

60

Vitamin K is required for what

Production of gamma-carboxyglutamates

61

Gamma-carboxyglutamates have what funciton

Allow clotting factors 2, 7, 9, 10, protein C and protein S to bind to phospholipid surface

62

Vitamin K dependent factors:

2, 7, 9, 10, Protein C, Protein S

63

Deficiency in Vitamin K leads to what

hypoprothrombinemia and a bleeding diathesis

64

Coumadin effect on Vitamin K

Blocks recycling of Vitamin K to decrease clotting factor ability

65

Water soluble proteins have what two advantages

1. Readily absorbed
2. Do not need transport proteins

66

Thiamine Vitamin B1
Source
Function (3)

Refined foods

Synthesis of ATP
Pentose phosphate pathway
Neural membrane conductance

67

Thiamine deficiency 2

1. Chronic alcoholics
2. Pernicious vomiting or diarrhea

68

Syndromes of thiamine deficiency 3

Dry beriberi
Wet beriberi
Wernicke-Korsakoff syndrome

69

Wernicke's encephalopathy entails what? (4)

1. nystamus
2. Ataxia
3. Ophthalmoplegia
4. Deranged mental function

70

Korsakoff psychosis includes what:

Problems with memory

71

Dry beriberi is what?

Myelin degeneration

72

Wet beriberi is what

CV syndrome with vasodilation and heart failure

73

Riboflavin Vitamin B2 is a component of what?

FMN and FAD in redox reactions

74

Riboflavin source

Meat, dairy products, veggies

75

Deficiency of Riboflavin is what

Ariboflavinosis: Cheilosis, glossitis, inflammation

76

Niacin Vitamin B3 is component of what
Food source
Synthesized from what in body

NAD and NAP
Grains and legumes
Tryptophan

77

Niacin deficiency common patients

Alcoholics
IC'd

78

3D's of niacin deficiency known as pellagra

Dermatitis
Dementia
DIarrhea

79

Two other pellagra symptoms

Scarlet tongue
Casal's necklace

80

Niacin use in therapy

Used in hypercholesterolemia to lower LDL

81

Pyridoxine Vitamin B6 function
Deficiency causes (3)
Deficiency results in (1)

Metabolism of AA's and glycolipids
Drugs that work as agonists, Alcoholics, Pregnant
Increased plasma homocysteine

82

Vitamin B12 function (3)

Nucleic acid synthesis
Needed for normal folate metabolism
Maintenance of myelinization of spinal cord tracts

83

Deficiency of Vitamin B 12 result (2)

1. Megaloblastic anemia
2. Degeneration of posterolateral spinal cord tracts

84

Vitamin C made endogenously?
Deficiency state called
Manifests how (2)

No
Scurvy
Bone disease and hemorrhages

85

Vitamin C function (3)

In redox reactions
Hydroxylation of collagen
Regenerates antioxidant form of Vitamin E

86

Deficiency in two patient types

Alcoholics
Elderly
Dialysis

87

Scurvy symptoms

1. Bleeding from gums and joints and skin
2. Scorbutic bone with outward projection of ribs
3. Scorbutic rosary


88

First clinical sign of Vitamin C deficiency

Perifolicular petechiae

89

Toxicity of Vitamin C effect

Kidney stones

90

Folate function
Found in what

Nucleic acid synthesis
Wheat, legumes, veggies

91

Deficiency of folate results in what (4)

Megaloblastic anemia
Neural tube defects
Increased homocysteine
Increase risk for colon cancer

92

Zinc deficiency

Rash called acrodermatitis enteropathica

93

Iron deficiency

Hypochromic microcytic anemia

94

Iodine deficiency (2)

Goiter + Hypothyroidism

95

Copper deficiency

Muscle and neuro deficits

96

Fluoride deficiency

Dental caries

97

Selenium deficiency

Myopathy: Keshan disease

98

Obesity definition

Excess adiposity and excess body weight

99

Obesity associated with what: 4

Type 2 diabetes
Dyslipidemias, CV disease
HTN
Cancer

100

Normal BMI:

18.5 to 25

101

Overweight BMI:

25-30

102

Obese BMI

>30

103

Central/visceral obesity
Severity

Fat accumulates in trunk and abdominal cavity
Much higher risk for disease

104

3 neurohumoral mechanisms for energy balance

Peripheral/Afferent
Arcuate nucleus in hypothalamus
Efferent system

105

Peripheral/Afferent has what components (4)

1. Leptin: fat cells
2. Ghrelin: Stomach
3. Peptide YY: Ileum and colon
4. Insulin: pancreas

106

Leptin has what effect

Gives you sense of fat stores

107

Humans with loss of leptin gene have what

Early onset severe obesity

108

Leptin stimulates what

physical activity and heat production

109

Number of adipocytes effect?

Higher the number, higher risk of obesity

110

Ghrelin has what effect
Levels before meal
Levels after meal

Increases food intake
Rise before
Lower after

111

PYY levels during fasting
PYY levels after eating

Low during fasting
High after

112

Situations of decreased PYY

Gastric bypass
Prader-Willi

113

High BMI and cancer association in women?

Adenocarcinoma of esophagus
THyroid, colon, kidney cancers

114

High BMI and cancer associationin women

Adenocarcinoma of esophagus
Endometrial, gall bladder, and kidney cancers

115

Aflatoxin effect on cancer

Works with Hep B to cause hepatocellular carcinoma

116

Nitrosamines generate what cancer

Gastric carcinoma

117

High fat + low colon causes what cancer

Colon