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140 Cards in this Set
- Front
- Back
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what's the problem w/ being sick?
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when you're sick you can't eat, but you have increased energy and nutrient needs
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does eating while sick make a difference?
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you get better faster when you have good nutrition during illness
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how can you supplement nutrition in sick patient?
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enterally (gut)
or parenterally (IV) |
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what can the bod pod do?
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close it and it measures your energy expenditure
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what are a person's nutritional needs?
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fluid
calories protein fat carbs vitamins electrolytes minerals |
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how much fluid does an adult need?
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1.5 L/m2/day
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how much fluid does a kid need?
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100 cc/kg/day for 1st 10 kg
55 cc/kg/day for 10-20 kg 25 cc/kg/day more for weight above 20 kg |
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when are kid's nutrient needs increased?
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high losses
fever present increased metabolism |
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when might a kid need more fluid?
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throwing up
diarrhea |
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when might a kid need more nutrition?
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if have fever, need 10% more fluid and energy
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what are nutrient requirements if hyperthyroidism?
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need more calories b/c burn lots of energy
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when do patients have excessive losses of fluid?
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salivary diversion
NG suction: lose HCl + K + Na diarrhea |
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when are ppl not at fluid homeostasis?
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inadequate intake
excessive losses abnormal absorption |
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why do patients have abnormal absorption?
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short gut
abnormal small bowel mucosa colectomy |
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why do you need more fluid w/ abnormal small bowel mucosa?
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no villi
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why do you need more fluid if colectomy?
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b/c colon absorbs fluid and colon is gone :(
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what are the energy needs in calories for a normal adult?
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40 kcal/kg/day
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what are the energy needs in calories for a normal infant?
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120 kcal/kg/day
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when are energy needs increased in ppl?
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malabsorption (of carbs, protein, fat)
increased utilization |
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how much energy in cal from carbs?
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4 kcal/g
~40% energy intake |
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what is energy you get from protein?
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4 kcal/g
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how much protein do kids need?
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2-3 g/kg/day needed in kids
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how much energy do you get from fat?
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10 kcal/g
~40% of calories |
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how are carbs dissolved?
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mouth: salivary amylase
SI lumen: pancreatic amylase SI brush border: lactase, sucrase hepatic carb metab |
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what are the SI brush border transporters?
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-Na/glucose co-transporter : SGLT1
-fructose transporter |
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what is energy you get from protein?
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4 kcal/g
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how much protein do kids need?
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2-3 g/kg/day needed in kids
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how much energy do you get from fat?
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10 kcal/g
~40% of calories |
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how are carbs dissolved?
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mouth: salivary amylase
SI lumen: pancreatic amylase SI brush border: lactase, sucrase SI brush border transporters |
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what are the SI brush border transporters?
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-Na/glucose co-transporter : SGLT1
-fructose transporter |
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how is glucose transported out of cell? goes where?
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GLUT-2
goes into interstitium, into capillaries |
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describe hepatic carb metab:
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most glucose --> muscle
-breakdown products return for gluconeogenesis -glycogen synthesis for storage -fructose metab in liver -galactose metab in liber |
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how much protein does adult take in?
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70 g protein/day
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what's protein turnover in body?
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250 g/day
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what's protein synthesis?
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50g muscle
25 g liver |
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what are protein losses?
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10 g by intestine
80 g by urinary system |
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describe protein absorption:
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stomach: HCl + pepsin
pancreatic enzymes brush border peptidases brush border aa/peptide transporters cellular peptidases BL membrane transport out of cell aa deamination and oxidation |
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how is protein broken down in stomach?
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hydrolysis by HCl
proteolysis by pepsin |
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how do pancreatic enzymes break down protein?
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break specific bonds
40% aa 60% peptides |
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what aa/peptide transporters in brush border?
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Na-dependent
Na-independent multiple transporters w/ overlapping sp |
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where does glutamine concentrate?
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enterocytes
-makes epithelium thicker and stronger |
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what happens to aa in liver?
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undergo deamination and oxidation
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what happens to branched chain aa?
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metabolized in muscle
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what happens to byproducts of aa metabolism?
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aspartate
alanine -can be used for gluconeogenesis |
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what are imp proteins made from aa in liver?
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albumin
coagulation factors |
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what happens to NH3 left over from protein breakdown?
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detoxified in liver: urea cycle
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why do you need albumin?
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-colloid oncotic pressure in blood
-keeps fluid in blood -ppl w/ low albumin are edematous |
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what happens to ppl born w/o a bile duct?
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block bile flow --> become cirrhotic
hard liver -big spleen b/c portal vein blood can't get into liver -malnourished |
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describe urine if born w/ no bile duct? poop?
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dark b/c has high conjugated bilirubin that liver can't excrete into bile b/c no bile ducts
-white poop |
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is fat soluble in water?
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no
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what are some of the fats in our diet?
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sterols
triglycerides phospholipids (main part of cell membranes) |
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what hydrolyzes fat in stomach?
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gastric lipase
grinding emulsifies it |
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how does small bowel handle fat absorption?
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-pancreatic lipase digests triglycerides
-colipase protects lipase from bile salts -cholesterol esterase needs bile salts to work -phospholipase needs bile salts to work |
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where are bile salts made?
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liver
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what do bile salts do?
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solubilize fats into micelles
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what do bile salts do?
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-solubilize fats into micelles
-help fatty acids cross unstirred aqueous layer into enterocyte |
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what types of fats don't depend on micelles to cross unstirred layer?
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short chain fatty acids
medium chain fatty acids |
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what happens when fats get in enterocyte?
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-reesterified : monoglyceride + 2 fatty acid CoA
-chylomicrons form and are exocytosed |
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how do chylomicrons leave enterocyte?
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-chylomicrons exit via lacteals, lymphatics to ultimately join systemic circulation
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what needs ApoB?
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chylomicrons
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where are bile salts made?
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liver
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where are lipoproteins (VLDL, HDL) made?
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liver
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where are lipoproteins (chylomicrons, HDL) made?
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intestine
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what is purpose of lipoproteins?
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transport fats
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how do you get rid of chylomicron remnants, LDL, HDL?
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liver has receptors for disposal
-feeds back negatively on cholesterol synthesis |
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what makes most of the body's cholesterol, Triglycerides, phospholipase?
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liver
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what esterifies cholesterol in plasma?
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LCAT
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what makes LCAT?
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liver
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how does liver cope w/ starvation?
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makes ketone bodies out of fat
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what's fiber made of?
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-parts of plant cell wall
-plant storage polysaccharides |
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what parts of plant cell walls are in fiber?
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cellulose: linear glucose polymer
non-cellulose polysaccharides lignins- aromatic |
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what are the plant storage polysaccs in fiber?
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pectin
gum mucilage |
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what are exs of soluble fiber?
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beans
fruits oats |
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what are exs of insoluble fiber?
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whole grain prods
veggies |
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how much fiber do westerners eat in comparison to the world?
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western: 20 g/d
developing: 100 g/d |
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what are dietary fiber properties?
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gives food texture
holds water affects motility is viscous adsorbs bile salts digested by colon bac (soluble fiber) |
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how does dietary fiber give food texture?
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more chewing, feel fuller
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how does dietary fiber hold water?
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softer, bulkier stool
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how does dietary fiber affect motility?
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increases transit thru gut
decreases gastric emptying |
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how is dietary fiber viscous?
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slows digestion
diffusion of enzyme |
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what happens when dietary fiber adsorbs bile salts?
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affects fat metab:
lose some of bile salts and don't absorb fat as well |
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how is Na excreted from digestive tract?
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in stomach, parts of gut
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how is Na absorbed in digestive tract?
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-Small bowel Na/glucose cotransport; other cotransports
-Absorption of Na in colon |
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how is K treated in digestive tract?
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-Na/K pump powers enterocyte gradients
-H/K pump in stomach absorbs K -Colon excretes K in response to aldosterone |
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how is Ca treated in digestive tract?
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Absorbed in gut, depends on Vitamin D
Can be lost with malabsorbed fats (makes soaps) |
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how is Fe treated in intestine?
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-Absorbed in proximal intestine
-Can be lost if GI bleeding is taking place |
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how do we get Vitamin D?
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synthesized from cholesterol in the skin or absorbed in the intestine
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how is Vitamin D altered?
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Vitamin D is 25-hydroxylated in the liver
25-OH Vitamin D is 1-hydroxylated in the kidney in the presence of PTH (responds to Ca levels) |
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what happens to 1, 25 OH Vitamin D?
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binds to a cytoplasmic receptor, activating nuclear transcription of the brush border Ca transporter, the intracellular transporter calbindin, and the Ca-dependent ATPase at the BL membrane
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how do you get rickets?
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vitamin D deficiency
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how is iron absorbed?
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absorbed in the duodenum by binding to an enterocyte receptor DMT-1
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what happens to iron if cell doesn't need it?
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bound to ferritin
Fe lost when cell sloughs off Fe transported out of cell by ferroportin |
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what inhibit ferroportin?
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hepcidin
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what happens to Fe if needed?
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circulated bound to transferrin
transferrin binds receptor on target cells and is endocytosed |
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when can't hepcidin inhibit ferroportin?
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hemochromatosis
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what happens in hemochromatosis?
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Fe stores in liver/other organs because HFE gene product inhibits hepcidin activity, allowing ferroportin to transport excess Fe into body
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what are the fat soluble vitamins?
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A, D, E, K
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how do you get A, D, E, K into your body?
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able to absorb fat
-depends on pancreas for lipase, cholesterase -depends on bowel depends on liver |
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how much vitamin D do healthy adults need daily?
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800-1000 iu/day
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how much vitamin D do fat malabsorbing kids need daily?
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8000-12,000 iu/day
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how can you get vitamin A?
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Ingested as carotene, cleaved and reesterified
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how can you get Vitamin D, E?
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Digested by cholesterol esterase, enter micelles
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how can you get Vitamin K?
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actively transported
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what happens if you have a Vitamin A deficiency?
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night blindness
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outcome of Vitamin E deficiency?
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neuro probs
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outcome of Vitamin K deficiency?
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coagulopathy
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where are water soluble vitamins absorbed?
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small bowel
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how do you get B1 (thiamine)?
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-At low luminal concentrations, by active, carrier-mediated process; at high luminal concentrations by passive diffusion
-Carbohydrate metabolism |
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how do you get B6 (pyridoxine)?
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-By passive diffusion in small intestine
-Amino acid and carbohydrate metabolism |
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how do you get B12?
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-depends on IF from stomach and ileal receptors for reabsorption
-Normal cell division; bone marrow, intestinal mucosa, and nervous system function |
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how do you get Vitamin C? func?
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active or passive transport by ileum
-Coenzyme or cofactor in many oxidative processes |
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how do you get folate?
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folate active/carrier-mediated transport duodenum and jejunum
-By Na+-dependent facilitated transport -Nucleic acid biosynthesis, maturation of red blood cells, promotion of growth |
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how is biotin absorbed? func?
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-At low luminal concentrations, by Na+-dependent active transport; at high luminal concentrations, by simple diffusion
-Coenzyme for carboxylase, transcarboxylase, and decarboxylase enzymes, metabolism of lipids, glucose, and amino acids |
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how is B2 absorbed? func?
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-Active transport in proximal small intestine
-Metabolism |
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how is niacin absorbed? func?
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-At low luminal concentrations, by Na+-dependent, carrier-mediated, facilitated transport
-Component of coenzymes NAD(H) and NADP(H); metabolism of carbohydrates, fats, and proteins; synthesis of fatty acid and steroid |
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what disease causes Vitamin A deficiency?
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-disease w/ poor bile flow (liver)
-cystic fibrosis |
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what disease causes Vitamin B12 deficiency?
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-ileal resection
-atrophic gastritis -pancreatic enzymes |
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what causes Fe deficiency?
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poor intake
loss of blood missing transporters |
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what causes fat deficiency?
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pancreatic insufficiency
inadequate bile salts |
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what causes vitamin D deficiency?
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pancreatic insufficiency
inadequate bile salts no Vitamin D receptor no liver no kidney |
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what causes protein calorie malnutrition?
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bad gut
no pancreas bile salt deficiency |
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what do you give patient w/ bad kidney?
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1, 25 OH. .. but give carefully b/c if give too much, become hypercalcemic
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what do you give patient w/ bad liver?
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25' - OH
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if low Ca, what happens to PTH?
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PTH high
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if make patient Vitamin D toxic and high Ca2+, what happens?
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low PTH.. no hydroxylation in kidney
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who don't you give cow's milk based infant formula to? (lactose, bovine protein, complex animal fat)
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don't give if:
-lactose intolerant -milk protein allergy fat:-biliary obstruction, CF |
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who don't you give soy infant formula to? (corn syrup-glucose, soy protein, complex plant fat)
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don't give if :
soy- CF complex plant fat: liver, CF patient |
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why is elemental infant formula good choice for diseased babies?
(corn syrup-glucose, casein-hydrolysate, medium chain fats) |
corn syrup - good even if lactose intol
casein- protein predigested, can use even if pancreatic insufficiency medium chain fats- good for poor bile flow and pancreatic insufficiency |
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what ppl do you give a low protein diet to?
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chronic renal failure
urea cycle defects tyrosinemia |
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what can tyrosinemia lead to?
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early liver failure
high liver cancer rates |
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who do you give ketogenic diet to?
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intractable seizures
-on lots of anti-seizure meds and still seize.. little protein, almost no carbs, lots of fats |
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who do you give low- fat diet (medium chain) to?
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chylothorax
intestinal lymphangiectasia |
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what's chylothorax?
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have surgery and thoracic duct disrupted
-lymphatic fluids fit in chest |
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who do you give cornstarch to? why?
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glycogen storage disease
-slowly breaks down into glucose, which maintains glucose levels |
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what's glycogen storage disease?
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hypoglycemic b/c can't do glycogenolysis
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what levels are high in ppl w/ tyrosinemia?
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succinylacetone --> liver failure
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what can help w/ tyrosinemia?
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-liver transplants b/c get new liver w/ liver enzymes
-give NTBC --> liver failure vanished |
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what main things can lead to malabsorption of fat and fat soluble vitamins?
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poor bile flow
pancreatic insufficiency |
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how are most energy requirements met?
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by carb and fat ingestion
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where is Fe and Ca absorption regulated?
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small bowel
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