Nutrition and GI

Question 1

Pepsinogen produced and stimulated by?

Answer 1

Pepsinogen —> pepsin by acid
Produced by chief cells
Stimulated by vagus nerve, histamine, gastrin
Intragastric protein digestion doesnt occur for first 5-8 days because of high stomach pH

Question 2

Stomach acid produced by?

Answer 2

Parietal cells

Stimulated by vagus nerve, histamine, gastrin

Question 3

Gastrin stimulated by?

Answer 3

Presence of food and stimulates enzyme pepsin and gastic acid secretion

Question 4

Chymotrypsinogen and trypsinogen conversion

Answer 4

To chymotrypsin and trypsin by enterokinase in the intestinal mucosa

Question 5

Glucoamylase

Answer 5

Carb digestion
Intestinal brush border enzyme
Removes glucose from end of starch

Question 6

Disaccharidases maturation levels

Answer 6

Maltase, isomaltase, sucrase at adult levels by 28 weeks

Lactase not until 36 weeks

Question 7

Role of CCK

Answer 7

Hormone that triggers release of pancreatic juice and bile

Decreases gastrin secretion

Question 8

Secretin role

Answer 8

Hormone that stimulates pancreas to release bicarbonate which slows gastric emptying

Question 9

GIP

Answer 9

Gastrin inhibitory peptide
Hormone that is stimulated by protein and fat
Slows gastric emptying
Decreases gastrin

Question 10

Motilin role

Answer 10

Hormone that increases gastric emptying

Erythromycin is a motilin agonist

Question 11

Benefits of early enteral feeding

Answer 11

^intestinal BF
^gut barrier defense (earlier intestinal closure)
^enzyme maturation
^motility
Earlier attainment of full enteral feedings

Question 12

Common diagnoses with pancreatic insufficiency

Answer 12

Schwachman-Diamond syndrome: pancreatic insufficiency, BM dysfunction (neutropenia), short stature, normal bicarb secretion

CF: increased Cl in sweat (>50meq/L) but sweat test not reliable until >2kg

Question 13

Conjugated hyperbilirubinemia ddx

Answer 13

Infectious (viral, toxo, syphilis, tb, listeriosis)
Toxin mediated (sepsis, drugs, PN)
Metabolic (galactosemia, GSD, tyrosinemia, A1AT deficiency, hypopit, hypothyroid, CF, Zellweger)
Genetic (Turner, T21)
Vascular (vascular anomalies, Budd chiari)
Neonatal leukemia, HLH, lupus
Intrahepatic duct disease (neonatal idiopathic hepatitis, Alagille)
Extrahepatic duct obstruction (biliary atresia, sclerosing cholangitis, bile duct stenosis, choledochal cyst, bile plug syndrome)

Question 14

Colostrum whey to casein ratio

Answer 14

80 (whey) : 20 (casein)

Question 15

Mature milk whey to casein ratio

Answer 15

55:45

Question 16

Predominantly casein formulas whey to casein ratio

Answer 16

20:80

Question 17

Predominantly whey formulas whey to casein ratio

Answer 17

80:20 or 60:40

Question 18

Preterm formulas whey to casein ratio

Answer 18

Greater protein content and whey >casein

Enfamil preterm formula 80 whey : 20 casein

Question 19

AA that are glucose precursors

Answer 19

Alanine
Glutamate
Aspartate

Question 20

Essential AA

Answer 20

Branched (valine, leucine, isoleucine)
Histidine
Lysine
Methionine
Phenylalanine
Threonine
Tryptophan

Question 21

Percentage of total kilocalories protein should account for in parenteral nutrition

Answer 21

7-15%

1g protein = 1g AA = 0.16g nitrogen

Question 22

Protein starting dose for PN

Answer 22

1.5-3g/kg with daily increments to max of 4g/kg

Question 23

Enteral protein goal

Answer 23

3. 5-4.5g/kg/day

3. 2-4.1 per 100kcal

Question 24

Essential FA

Answer 24

Linoleic acid

Alpha linolenic acid

Question 25

Essential fatty acids deficiency

Answer 25

Scaly dermatitis, alopecia, thrombocytopenia, susceptibility to bacterial infections, FTT Prevention 0.5-1g/kg/day IL

Question 26

Diagnosis of essential FA deficiency

Answer 26

Increased triene:tetraene ratio (>0.2) | Also called the Holman index

Question 27

Kcal fat should provide in daily calories

Answer 27

30-50% | 20% lipid solution: 1mL is 20% fat and fat has 9kcal/g so 1mL has 1.8kcal

Question 28

How much glucose should be provided per gram of protein and why?

Answer 28

6g of glucose per g of protein for positive nitrogen balance

Question 29

%kcal glucose should provide

Answer 29

35-45% of total kcal

Question 30

GIR

Answer 30

(%dextrose x TF) / 144 (Rate x %dextrose) / (weight x 6) (g dextrose x 1000) / wt / 1440 mg/kg/min

Question 31

Vitamin E deficiency

Answer 31

Alpha tocopherol Thrombocytopenia, anemia, reticulocytosis, acanthocytosis, neurologic deficits Increased sensitivity to hemolysis

Question 32

Vitamin K deficiency

Answer 32

Required for carboxylation of prothrombin to thrombin | Hemorrhagic disease of the newborn

Question 33

Vitamin A deficiency

Answer 33

Retinol Important in pulmonary epithelia growth Photophobia, conjunctivitis, abn bone and teeth, scaling, FTT

Question 34

Vitamin B1 deficiency

Answer 34

``` Thiamine Beriberi (fatigue, irritability, constipation, cardiac failure) A/c maple syrup urine disease and pyruvate dehydrogenase complex deficiency ```

Question 35

Vitamin B2 deficiency

Answer 35

Riboflavin FTT, photophobia, blurry vision, dermatitis, mucositis A/c glutaric aciduria type 1

Question 36

Vitamin B6 deficiency

Answer 36

Pyridoxine Dermatitis, mucositis, anemia, seizures A/c homocystinuria

Question 37

Biotin deficiency

Answer 37

Alopecia, dermatitis, scaling, seborrhea

Question 38

Zinc deficiency

Answer 38

Acrodermatitis enteropathica | FTT, alopecia, diarrhea, dermatitis

Question 39

Calcium to phosphorous ratio in TPN

Answer 39

Ca:P 1.3:1 to 1.7:1 <1:1 are not recommended

Question 40

PN cholestasis TPN adjustments

Answer 40

Decrease manganese and copper | Increase zinc

Question 41

Renal insufficiency PN adjustments

Answer 41

Decrease chromium and selenium

Question 42

PN cholestasis and lipids

Answer 42

IL can decrease to 1gkd Smof for high risk of developing PN cholestasis Onegaven for reversing established PN cholestasis

Question 43

Nitrogen balance calculation

Answer 43

Balance = intake - lost Nitrogen intake = protein intake (g/d) x 0.16 (because each gram of protein is 16% nitrogen) Nitrogen lost = urine [urea] + estimated stool losses (4g)

Question 44

Calorie calculations

Answer 44

Dextrose: %dextrose x mkd x 3.4 Protein: gkd x 4kc/g Fat: gkd x 10kc/g Or for fat: [(ml/d) x 2kc/ml] / wt