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Neo Board Review > Nutrition and GI > Flashcards

Nutrition and GI Flashcards

1
Q

Pepsinogen produced and stimulated by?

A

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

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2
Q

Stomach acid produced by?

A

Parietal cells

Stimulated by vagus nerve, histamine, gastrin

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3
Q

Gastrin stimulated by?

A

Presence of food and stimulates enzyme pepsin and gastic acid secretion

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4
Q

Chymotrypsinogen and trypsinogen conversion

A

To chymotrypsin and trypsin by enterokinase in the intestinal mucosa

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5
Q

Glucoamylase

A

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

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6
Q

Disaccharidases maturation levels

A

Maltase, isomaltase, sucrase at adult levels by 28 weeks

Lactase not until 36 weeks

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7
Q

Role of CCK

A

Hormone that triggers release of pancreatic juice and bile

Decreases gastrin secretion

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8
Q

Secretin role

A

Hormone that stimulates pancreas to release bicarbonate which slows gastric emptying

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9
Q

GIP

A

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

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10
Q

Motilin role

A

Hormone that increases gastric emptying

Erythromycin is a motilin agonist

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11
Q

Benefits of early enteral feeding

A

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

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12
Q

Common diagnoses with pancreatic insufficiency

A

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

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13
Q

Conjugated hyperbilirubinemia ddx

A

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)

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14
Q

Colostrum whey to casein ratio

A

80 (whey) : 20 (casein)

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15
Q

Mature milk whey to casein ratio

A

55:45

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16
Q

Predominantly casein formulas whey to casein ratio

A

20:80

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17
Q

Predominantly whey formulas whey to casein ratio

A

80:20 or 60:40

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18
Q

Preterm formulas whey to casein ratio

A

Greater protein content and whey >casein

Enfamil preterm formula 80 whey : 20 casein

19
Q

AA that are glucose precursors

A

Alanine
Glutamate
Aspartate

20
Q

Essential AA

A 
Branched (valine, leucine, isoleucine)
Histidine
Lysine
Methionine
Phenylalanine
Threonine
Tryptophan
21
Q

Percentage of total kilocalories protein should account for in parenteral nutrition

A

7-15%

1g protein = 1g AA = 0.16g nitrogen

22
Q

Protein starting dose for PN

A

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

23
Q

Enteral protein goal

A
  1. 5-4.5g/kg/day

3. 2-4.1 per 100kcal

24
Q

Essential FA

A

Linoleic acid

Alpha linolenic acid

25
Q

Essential fatty acids deficiency

A

Scaly dermatitis, alopecia, thrombocytopenia, susceptibility to bacterial infections, FTT

Prevention 0.5-1g/kg/day IL

26
Q

Diagnosis of essential FA deficiency

A

Increased triene:tetraene ratio (>0.2)

Also called the Holman index

27
Q

Kcal fat should provide in daily calories

A

30-50%

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

28
Q

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

A

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

29
Q

%kcal glucose should provide

A

35-45% of total kcal

30
Q

GIR

A

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

mg/kg/min

31
Q

Vitamin E deficiency

A

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

32
Q

Vitamin K deficiency

A

Required for carboxylation of prothrombin to thrombin

Hemorrhagic disease of the newborn

33
Q

Vitamin A deficiency

A

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

34
Q

Vitamin B1 deficiency

A 
Thiamine 
Beriberi (fatigue, irritability, constipation, cardiac failure)
A/c maple syrup urine disease and pyruvate dehydrogenase complex deficiency
35
Q

Vitamin B2 deficiency

A

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

36
Q

Vitamin B6 deficiency

A

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

37
Q

Biotin deficiency

A

Alopecia, dermatitis, scaling, seborrhea

38
Q

Zinc deficiency

A

Acrodermatitis enteropathica

FTT, alopecia, diarrhea, dermatitis

39
Q

Calcium to phosphorous ratio in TPN

A

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

40
Q

PN cholestasis TPN adjustments

A

Decrease manganese and copper

Increase zinc

41
Q

Renal insufficiency PN adjustments

A

Decrease chromium and selenium

42
Q

PN cholestasis and lipids

A

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

43
Q

Nitrogen balance calculation

A

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)

44
Q

Calorie calculations

A

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

Neo Board Review (12 decks)

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