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Nutrition and stuff
GI Clin Med exam I don't know
| Question | Answer |
|---|---|
| When are intermittent or bolus feedings given? | Only with gastric feedigns (NG or PEG) |
| PEG TUBE | Percutaneous endoscopic gastoscopy |
| Why are most oral supplements lactose free? | Intermittent lactose intolerance is frequently seen |
| Will Std tube feedings corrent electrolyte embalance? | No, just nl nutrition. Given mild-mod GI stress |
| What is a low residue diet? | Those foods that slow or don't speed up intestinal emptying time (usually used post op or weining off perienteral diet) |
| High Protein & calorie tube feeding indications | Hypermetabolic states: septic, ^protein requirements |
| Elemental/hydrolyzed products indictaions | Malabsorptive/maldigestive dz's,(pancreatitis, Crohn's) Bowel rest |
| Monitoring parameters for tube feeding | I/O's, wt, tolerance, fluid/electyrolytes, |
| Complications of tube feeding | Aspiration Pneumonia, Diarrhea, Intake (too much/too little), Fluids (may exceed TF plan) |
| Parenteral Nutrition Options | PN, TPN, PPN (nutrition directly into blood) |
| Use and route of TPN | Through central vein, (subclavian or SVC) |
| PPN administration | through traditional IV lines, higher vol needed, meets moderate protein and energy needs. SHORT TERM. |
| What must be consulted prior to TPN start? | Both nutrition and pharmacy |
| TPN Tips | Central regimens should be initiated at no greater than 55cc/hr, advance w/ time, Tapering to avoid rebound hypoglycemia, lipid emulsion-administered continuously |
| How do we adjust for fluid needs when pt in on TPN? | Add NS or dextrose seprately, don't mess with the actual TPN bag (expensve) |
| Goals for PN | Meet pt's nutritional needs, avoid complications, get pt onto oral/enteral feeds ASAP |
| Medical Nutrition Therapy Assessment | PES, problem, etiology, signs and sxs |
| Similar to reg diet, low fiber/residue, common for trasition from liquid to general | Soft Diet (surgical soft) |
| Post op, for N/V/D, bowel prep procedures, bowel rest | CL diet, anything clear at RT, poop calorie intake |
| Clear liquid, cooked ceral milk, yogurt, ice-cream, For wired jaw, mouth pain, oral surgery | Full Liquid Diet, CI in lactose intolerance |
| Large amounts of folic acid (>1000mcg/day) | Can mask vit B12 defienciey |
| Neomycin effect on Vit K | Dereases Vit K absorbtion |
| Nitrogen Balance | +: Usually during growth (want + with burns or severe sickneses/dehydration) 0: nl people -: usually with burns, malnurished (want maybe w/ pregnancy) |
| Vit A toxicity | w/supplements, dry skin, cheilosis, glossitis, alopecia, amenorrheah etc |
| PAA's and PAH's | PAA: polycyclic aromatic amines, polycyclic aromatic hydrocarbons (RF for cancers) |
| GERD GOals | Reduce Pain, Reflux, Acidity |
| Tips for PUD and Gastritis nutrition | soft and bland, sm, frequent feedings, add intake n-3 and n-6 FA's, |
| Anemia d/t PUD | -Iron def. d/t antacid & H2 blockers, B-12 d/t chronic gastritis |
| Gastric Cancer MNT | -high protein,calorie, liquid or solids as tolerated |
| Post Gastrectomy dumping syndrome MNT | -high protein, fiber, low simple sugars, avoid liquids after meals, B12, iron supplements |
| Cholecystits/lithiasis diet | Low Fat (regular recommendations 25-30% daily intake |
| Pancreatitis Diet | NPO w/ IV fluids->CL->Low fat, enzyme replacement if steatorrhea preasent, jejunum feeding |
| Moderate to high protein support, ^calorie, mod. fat, oral OTC vit/mineral supplement | Hepatitis diet |
| Vit B5 | panthoeenic acid |
| Biotin | Vit B7 |
| Folic acid | B9 |
| Vitamin Supplementation in therapeutic doses for alcoholics | Thiamine, folic acid, B-12, Vit K |
| High calorie, proein, low Na+, fluid restritions, mechanical soft | Cirrhosis diet |
| Contributing factors to ammonia production | (Hepatic encephalopathy): diet protein, catabolism, bacteria, sloughed GI cells, and blood in GI tract, hypoxia, hypovolemia, hypokalemia |
| ALT > AST | viral hepatitis |
| AST > ALT | Alcoholic hepatitis |
| Decreased AST | Beri-beri (Vit B6 defiency) |
| Increased bilirubin | Hepatic damage, biliary obstruction, hemolysis, fasting |
| Increased CA19-9 | GI cancers: pancrease, stomach, liver, CRC, also sometimes in pancreatitis |
| Decreased Alk phos | Malnutrition, excess vit D, pernicious anemia, Wilsion's dz, hypothyroidism, zinc defiency |
| Risks for HCC | Hepatocellular carcinoma: w/ Hep B at risk for cirrhosis |
| Dx Chronic Hepatitis | >6m, CT, liver biopsy, Inury graded inflammation 1-3, fibrosis graded 1-4 4=cirrhosis |
| Sxs Chronic Hepatitis | palmer erythema, spider angioma, scleral icterus, jaundice, muscle wasting, |
| Tx Chronic Hepatitis | PegInterferon alone or w/Ribaviron AND necleoside/nucleotide analogs. Tx if at risk of cirrhosis |
| Prvention of Viral Hep P | HB IgG for exposed individuals, test ag all pregnant women, VACCINATION |
| Dx Autoimmune Hepatitis | Eliminate other causes, IgG >2x Order SPEP: ANA and SMA positive markers, |
| Tx AIH | Prevent progression to cirrohis |
| Mutation in ATP7B gene | Wilsion's Dz |
| Copper deposition: Kaysar-Fleishcer rings (eyes), hematomeagly, tremor, ataxia | Wilson's Dz |
| Asterixis | Flapping hand with hepatic encephalopathy, chronic hepatitis |
| Decrease in Albumin | Malnutrition, alcoholic cirrohsis, IBD, collegen vascular dz, hyperthyroidism |
| Lynch HNPCC syndrome | Hereditary nonpolyposis colorectal cancer (familial risk) |
| CEA levels | Monitoring levels w/ CRC, not used for detection |
| Secondary causes of NAFLD | Polycystic ovary syndrome, Drugs, Toxins, Nutrutional (rapid wt loss, TPN) |
| NASH tx | slow, gradual wt loss, exercise, dec. cholesterol, maintain nl glucose, avoid ETOH |
| Tool to determine if steroids are useful for tx for hepatitis | Maddrey's Discrimant: MD >32 |
| End stage liver dz determination | MELD Score |
Created by:
becker15
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