Term
Calorie is defined as____ |
|
Definition
| the amount of heat required to raise 1 g of water (1 mL) by 1°C. |
|
|
Term
§Adult male: Water is approximately ___% of lean body mass. |
|
Definition
|
|
Term
| Give examples of simple and complex sugars. |
|
Definition
§Simple (monosaccharide's & disaccharides)
§Complex (oligosaccharides & polysaccharides)
§Monosaccharide's (glucose, fructose, galactose)
§Disaccharides (sucrose & lactose)
|
|
|
Term
Storage forms of energy, i.e., glycogen in animals and starch or cellulose in plants). |
|
Definition
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|
Term
§All carbohydrates provide ___ of energy. |
|
Definition
|
|
Term
Carbohydrate diet is composed of ___. |
|
Definition
| 60% starch, 30% sucrose, & 10% lactose |
|
|
Term
| 3-10 sugars usually connected through glycosidic bonds |
|
Definition
|
|
Term
§Polypeptides are linear chains of amino acids. |
|
Definition
|
|
Term
|
Definition
Carbohydrates - 4kcal/g of energy
Lipids - 9 kcal/g energy
Proteins - 4 kcal/g energy |
|
|
Term
§2nd largest energy source to fat; converted to glucose through gluconeogenesis. |
|
Definition
|
|
Term
_____is the major source of fuel through glycolysis and oxidative phosphorylation (generates ATP, CO2 and water while consuming O2). |
|
Definition
|
|
Term
| each gram of protein provides ___of energy. |
|
Definition
|
|
Term
§Lipids existing as liquids at room temp are called ___and lipids existing as solids at room temp are called ___. |
|
Definition
|
|
Term
§composed of 3 long-chain (4-26 carbons) fatty acids combined with glycerol. |
|
Definition
|
|
Term
___fatty acids contain no double-bonds in the structure whereas as ___fatty acids contain at least one double bond. |
|
Definition
|
|
Term
§___contain both saturated and unsaturated fats. |
|
Definition
|
|
Term
§Each gram of fat contains ___of energy |
|
Definition
|
|
Term
§To prevent essential fatty acid deficiency any nutritional plan must contain ___ and ___. |
|
Definition
| linoleic; a-linolenic acid |
|
|
Term
|
Definition
Electrolytes
Vitamins
Trace elements |
|
|
Term
|
Definition
| An acute, subacute or chronic state of nutrition, in which varying degrees of overnutrition or undernutrition with or without inflammatory activity have led to a change in body composition and diminished function. |
|
|
Term
|
Definition
§Marasmus
§Kwashiorkor
§Mixed
§Obesity |
|
|
Term
§Results from prolonged inadequate intake or utilization of protein and calories.
§Somatic protein and fat wasting occurs, however, visceral protein is preserved.
§Weight loss >10% of usual body weight.
§When severe cell mediated immunity and muscle function are impaired. |
|
Definition
|
|
Term
§Inadequate protein and micronutrient intake.
§Preserved adipose tissue, however, there is depletion of visceral & sometimes somatic protein stores.
§Severe hypoalbuminemia & edema seen in more advanced cases. |
|
Definition
|
|
Term
§Severe protein-calorie malnutrition
§Chronically ill, starved patients under hypermetabolicstress
§Trauma, infection, and burns.
§Reduced visceral and somatic protein & lipid.
§Immunocompromised & compromised wound healing. |
|
Definition
Mixed Marasmus/Kwashiorkor |
|
|
Term
| A comprehensive approach to diagnosing nutrition problems that uses a combination of the following: medical, nutrition, and medication histories; physical examination; anthropometric measurements; and laboratory data |
|
Definition
|
|
Term
In the U.S., JCAHO mandates nutrition screening within the first ___hours of admission to an acute care facility. |
|
Definition
|
|
Term
| Components of a Nutrition History |
|
Definition
Medical history
Chronic illness
Surgical history
Psychosocial history
Socioeconomic status
History of GI problems (N, V, D)
Diet history, including diets for weight gain or loss
Food preferences & intolerances
Medications
Weight history
§Increase or decrease
§Intentional or unintentional
§Time period for weight change
Functional capacity |
|
|
Term
| Nutrition Assessment Goals |
|
Definition
•Identification of the presence of factors associated with an increased risk of developing malnutrition, including disorders resulting from macro- or micronutrient deficiencies, obesity, or impaired metabolism or utilization.
•Determination of risk of malnutrition-associated complications.
•Establishment of estimated nutrition needs.
•Establishment of baseline nutrition status with parameters against which to measure nutrition therapy outcomes. |
|
|
Term
| Ideal body weight for children |
|
Definition
[(height in cm)2 X 1.65]/1000 |
|
|
Term
§Usual body weight (UBW)
Change in weight over time |
|
Definition
–[(ABW/UBW) X 100]
§Rapid unintentional weight loss (i.e., 5% of UBW in 1 month or 10% in 6 months) |
|
|
Term
| 5 Physical Exam & Anthropometricshysical Exam & Anthropometrics |
|
Definition
•Muscle & fat wasting often noticed in the temporal area
•Loss of fat & muscle in the shoulders
•Loss of SC fat in the interosseous & palmar areas of the hands
•Triceps skin-fold thickness using a nutrition calipers
•Mid-muscle circumference = Midarm circumference – triceps skin-fold thickness. |
|
|
Term
albumin, transferrin, prealbumin (transthyretin), total lymphocyte count.
- which is increased in kidney dysfunction
- Which of these have the lowest half-life?
- which has highest half-life
- which is increased in volume depletion, anabolic steroids, insulin, infection
- which is increased in iron deficiency, pregnancy, hypoxia, blood loss or by esterogens?
- which is increased in volume depletion
- what are their values?
- what are their functions?
|
|
Definition
- kidney function = prealbumin (transthyretin)
- lowest half-life = prealbumin
- highest half life = total lymphocyte count
- increased in volume depletion, anabolic steroids, insulin, infection = albumin
- increased in iron deficiency, pregnancy, hypoxia, blood loss or by esterogens = transferrin
- which is increased in volume depletion = total lymphocyte count
- albumin (-5 g/dL), transferrin (250-300 mg/dL), prealbumin (15-40 mg/dL), T lymophocyte count = >1500/ mm3
- Albumin (Maintains plasma oncotic pressure; transports small molecules); Prealbumin (Binds T3 and to a lesser extent T4, carrier for retinol-binding protein)
|
|
|
Term
| What is RQ? Which RQ corresponds with: underfed? Overfed? What is goal RQ? |
|
Definition
RQ = moles CO2 produced per mole O2 consumed; net substrate utilization CHO, fat, protein
Goal RQ = 0.85
RQ <0.7 = underfed
RQ >1 = overfed |
|
|
Term
| Limitations to Indirect Calorimetry |
|
Definition
- Not all institutions have metabolic carts.
- Calibration errors are common
- Overestimates REE for patients with hyperventilation, metabolic acidosis, overfeeding, and air leaks in the system.
- Underestimates REE with hypoventilation, metabolic alkalosis, underfeeding, and gluconeogenesis.
- Indirect calorimetry should be considered in obese patients, metabolically stressed, mechanically ventilated, continuous sedatives, HD, HIV.
|
|
|
Term
| What type of patient needs the most protein requirement? The least? |
|
Definition
Most = burn ptns (>50% BSA)
Least = severe hepative failure |
|
|
Term
| function of 24-hour urine urea nitrogen (UUN) collection |
|
Definition
to monitor protein adequacy
§Measures 85-90% of total nitrogen excretion from the body
§Other losses: skin, fecal, and respiratory nitrogen losses |
|
|
Term
| 1g nitrogen = ___g protein |
|
Definition
6.25 g protein = 1 g nitrogen |
|
|
Term
| What is goal nitrogen balance? What is the equation? |
|
Definition
Goal is positive N2 balance (+3 to +5 g/day)
Nitrogen IN = Protein IN (g/day)/6.25
Nitrogen OUT (g/day) = [UUN X 1.2] + 1
Nitrogen Balance = (N2 IN) – (N2 OUT) |
|
|
Term
Adequate intake for a-linolenic acid is ____for men and ___ for women while for linoleic acid is ___ for men and ____ for women.
Should represent no more than ___% of calories |
|
Definition
1.6 g/day = men
1.1 g/day = women
14-17 g/day = men
11-12 g/day = women
10-35% |
|
|
Term
| What Are Risk Factors for Malnutrition? |
|
Definition
•NPO x5 days
•History of alcohol consumption
•Depression
•Low prealbumin
•Recent surgery
Typical risk factors for malnutrition include:
1) low body weight at least 20% less than IBW
2) involuntary weight loss > 10% in 6 months or > 5-7.5% in 1 month
3) impaired ability to ingest or absorb food adequately; impaired ability includes NPO > 10 days, ETOH/substance abuse, increased metabolic needs, protracted nutrient loss, malabsorption |
|
|
Term
•Salivary gland is controlled by ____. |
|
Definition
| autonomous nervous system |
|
|
Term
•Each Salivary gland receives ___ and __ innervations |
|
Definition
|
|
Term
| results in secretion of small volume of viscous saliva containing high enzyme concentrations. The reduced volume produces sensation of a dry mouth |
|
Definition
| Sympathetic stimulation of salivary gland |
|
|
Term
| Function of mucuos cells. |
|
Definition
}Mucous cellslocated at the
gastric pit secrete mucus. This mucus protects the epithelia from the strongly acidic gastric acid. Insufficient production of mucus will cause ulcers. |
|
|
Term
}Parietal (oxyntic) cells
secrete ___ and ____ |
|
Definition
| hydrochloric acid (HCl) and intrinsic factor. |
|
|
Term
| Chief cellssecrete ____which is produced throughout the stomach and in the Brunner's glands of the duodenum |
|
Definition
| pepsinogen (precursor of the pepsin) |
|
|
Term
}Enteroendocrine cellssecrete ___. ____ located at the bottom of the gastric glands secrete ____. |
|
Definition
hormones;
G cells; gastrin |
|
|
Term
}There are interspersed enteroendocrine cells that ___(A cells) and ____(D cells).. |
|
Definition
| glucagon (A cells); somatostatin (D cells) |
|
|
Term
}____ is secreted for fat digestion. |
|
Definition
|
|
Term
Acid secretion depends on ___and ___ |
|
Definition
| Carbonic anhydrase and chloride/bicarbonate exchange. |
|
|
Term
| One billion parietal cells produce about ___/day of HCl |
|
Definition
|
|
Term
| 4 functions of HCl made by parietal cells |
|
Definition
-Lowers the pH of gastric juice
-kills microorganisms
-breaks down cell walls and connective tissues in food
-activates chief cells - pepsinogen |
|
|
Term
Parietal cell's acid secretion is inhibited by ___ and ___ |
|
Definition
•Somatostatin
•Prostaglandins (mainly PGE2) |
|
|
Term
| What are Enterochromaffin-like cells (ECL cells) and where are they located? |
|
Definition
}The mucosa of the fundus contains a large number of ECL cells which after gastrin stimulation (through blood) release histamine, an important stimulator of acid production.
|
|
|
Term
¢The passage of food takes about
¢___ hours to reach the cecum
¢___ hrs from cecum to rectum |
|
Definition
|
|
Term
| ____ ml of chyme enters the large intestine per day, but less than ____ ml water is lost in feces |
|
Definition
|
|
Term
| What is the final pH of the 1.5 L/day HCl produced by the one billion parietal cells in the stomach? |
|
Definition
|
|
Term
| Example of neural stimulation for secretion |
|
Definition
|
|
Term
| Example of chemical stimulation for secretion |
|
Definition
|
|
Term
| Example of nutrient stimulation for secretion |
|
Definition
•epithelial cells of GI tract |
|
|
Term
| Give the 4 types of stimulus for GI hormone secretion and their examples |
|
Definition
•Neural stimulation – thought, sight
•Chemical stimulation – taste, odor
•Nutrient stimulation -- epithelial cells of GI tract
•Mechanical stimulation |
|
|
Term
•Most of the GI function are regulated locally by ___and ___ . |
|
Definition
| hormones and local reflexes |
|
|
Term
| 3 functions of the autono,ic nervous system in the GI system |
|
Definition
•regulates local reflexes
•initiates gastric digestion
•mediates larger movements |
|
|
Term
T/F: GI hormones are found in the brain as well |
|
Definition
|
|
Term
| ____ nervous system excite pepsin and acid production |
|
Definition
|
|
Term
| ___ phase is responsible for 10% gastric secretion, while ____ is responsible for 30% and ___60% |
|
Definition
10 % gastrin secretion = Intestinal phase
30 % gastrin secretion = cephalic phase (via vagus nerve)
60% gastrin secretion = Gastric phase (via vagus nerve; gastrin-histamine stimulation occurs) |
|
|
Term
| Explain the basic mechanism of secretion of organic substances. |
|
Definition
Nerve or hormonal stimulation -activates-> transport of Cl- into the cell (base side) --activates --> Na+ ions --creates->osmotic forces --osmosis of water into interior --> causes-> increase volume and hydrostatic pressure --initiates--> minute opening of secretory border --release--> mucus |
|
|
Term
| 4 types of signaling in the GI system |
|
Definition
•Endocrine signaling
•Paracrine signaling
•Autocrine
Neurocrine signaling |
|
|
Term
In this type of GI system signaling the peptide hormone is released into the blood and reaches its target cells via the circulation (often on local circulatory pathways).
|
|
Definition
|
|
Term
| In this type of GI system form of cell signaling, the target cell is near the signal-releasing cell. |
|
Definition
|
|
Term
_____is a form of signaling in which a cell secretes a hormone or chemical messenger (called the autocrine agent) that binds to autocrine receptors on the same cell, leading to changes in the cell. |
|
Definition
|
|
Term
_____ signaling is what we understand as chemical synapse |
|
Definition
|
|
Term
| Gastrin is secreted by ____ cells of the stomach |
|
Definition
|
|
Term
| G cell of stomach is stimulated by |
|
Definition
•Ingestion of meal
•Distention of the stomach
•Products of proteins
•Gastrin releasing peptide
•Released by the nerves of the gastric mucosa during vagal stimulation |
|
|
Term
3 Primary actions of gastrin
|
|
Definition
1.Stimulation of gastric acid secretion
2.Stimulation of growth of the gastric mucosa
3.Stimulates stomach motility |
|
|
Term
•Produced by enteroendocrine (“I cells”) of duodenum and jejunum and by enteric neurons
•Secreted in response to digestive products of fat, fatty acids, and monoglycerides |
|
Definition
|
|
Term
| Cholecystokinin (CCK) is produced by the enteroendocrine ___ |
|
Definition
| I cells of duodenum and jejunum and by enteric neurons |
|
|
Term
Cholecystokinin (CCK) acts on ___ receptors on target cells (pancreatic acinar cells) whereas gastrin acts on ____ |
|
Definition
|
|
Term
| Functions of Cholecystokinin (CCK) |
|
Definition
¢Act on CCK-A receptors on target cells (pancreatic acinar cells) whereas gastrin on CCK-B
•Stimulates production of pancreatic enzymes
•Strongly contracts gall bladder
•Relaxes hepatopancreatic sphincter (of Oddi) in duodenum stimulating release of pancreatic juice and bile
•Inhibits stomach contraction
•Inhibits appetite to prevent overeating during meals by stimulating sensory afferent nerve fibers in the duodenum |
|
|
Term
| First GI hormone discovered |
|
Definition
|
|
Term
•Secreted by enterochromaffin cells in upper small intestinal mucosa |
|
Definition
Secretin
•Secreted by enterochromaffin cells (“S cells”) in upper small intestinal mucosa |
|
|
Term
Release of secretin is stimulated by _____ |
|
Definition
|
|
Term
|
Definition
•Stimulates:
•Pepsin secretion
•Pancreatic bicarbonate secretion
•Biliary bicarbonate secretion
•Inhibits:
•Gastric acid secretion |
|
|
Term
•Secreted by epithelial cells in upper small intestinal mucosa
•Release stimulated by:
- Fatty acids and amino acids Ý
- Carbohydrates
•Inhibits stomach motility and secretions
- Slows emptying of gastric contents
•At very low levels (even lower than those needed to inhibit gastric motility)
- Stimulates insulin secretion (known as: glucose-dependent insulinotropic peptide)
|
|
Definition
|
|
Term
•Produced by endocrine M cells in stomach and upper duodenum during fasting
•Stimulates gastrointestinal motility
•Released cyclically
•Stimulates waves of gastrointestinal motility called: “interdigestive myoelectric complexes”
•Moves through the stomach and small intestine every 90 minutes in a fasted person
•Secretion is inhibited after ingestion by mechanisms that are not fully understood. |
|
Definition
|
|
Term
•Secreted by enteric neurons in small intestine
•Really a neuropeptide/neurotransmitter
•very widely distributed in peripheral and central nervous systems
Functions:
•Induces intestinal vasodilation
•Relaxes smooth muscles of trachea, stomach, gallbladder, and sphincters
•Decreases secretion of HCl
•Increases intestinal secretion
|
|
Definition
|
|
Term
____increases hunger by acting on hypothalamic feeding centers. |
|
Definition
|
|
Term
extreme obesity with uncontrollable and voracious appetite; plasma ghrelin levels are exceptionally high. |
|
Definition
¢Prader-Willi syndrome (genetic): |
|
|
Term
|
Definition
Lowest after eating.
Low in obese people
High in patients with anorexia nervosa |
|
|
Term
Target of cholecystokinin on:
Pancreas
Gallbladder
Duodenum
Stomach
CNS |
|
Definition
Pancreas - production of pancreatic enzyme
Gallbladder - contraction of gallbladder
Duodenum - relaxation of pancreaticohepatic sphincter
Stomach - inhibits gastric secretion and motion
CNS - reduces hunger |
|
|
Term
Target of gastric inhibitory peptide (GIP) on:
Pancreas
adipose tissue
skeletal muscle
Stomach
|
|
Definition
Pancreas - stimulates insulin production
Adipose tissue - stimulates lipid synthesis
skeletal muscle - stimulates glucose use
Stomach - inhibits gastric secretion (like CCK) |
|
|
Term
| What is the target organ of motilin and what are its effects? |
|
Definition
smooth muscles -
initiates migrating motor complexes (cleans out gut) |
|
|
Term
| What is the stimulus, target and effect of glucagon-like peptide 1? |
|
Definition
Stimulus = carbohydrates and lipids
Target = pancreas, brain and stomach
Effects = stimulates insulin; satiety |
|
|
Term
| Describe the 2 types of enteric neurons |
|
Definition
Sensory = Submucosal plexus of Meissner
Motor = Myenteric plexus of Auerbach |
|
|
Term
The ___regulates and modulates the Enteric Nervous System. |
|
Definition
|
|
Term
T/F: The enteric nervous system usually almost completely above the level of consciousness |
|
Definition
| False: BELOW the level of consciousness |
|
|
Term
| 3 functions of the enteric nervous system |
|
Definition
•Rivals the CNS in terms of number of neurons, complexity of wiring and number of neurotransmitters.
• Acts usually almost completely below the level of consciousness
•Coordinates basal gut movements (pacemaker cells) and secretion. |
|
|
Term
Most common neurotransmitterof the ENS |
|
Definition
|
|
Term
| Most common amino acid of the ENS |
|
Definition
|
|
Term
| Function of acetylcholine in ENS |
|
Definition
¢Acetylcholine (vagal innervation) acts via muscarinic M3 receptors to stimulate secretion and to increase smooth muscle toneand motility
¢Drugs to decrease vagal tone: atropine, (butyl)scopolamine for colic
¢Drugs that decrease vagal tone by unintended side effect: antihistamines, tricyclic antidepressants, neuroleptics
¢Drugs to increase vagal tone to induce bowel contractions:
—Bethanechol (muscarinic agonist, direct parasympathomimetic)
—Neostigmine (reversible inhibitor of acetylcholinesterase),
|
|
|
Term
| Function of norepinephrine in ENS |
|
Definition
Release via sympathetic innervation
Acts on:
alpha-1 adrenergic receptor = vasocontriction and contraction of sphincters
pre-synaptic Alpha-2 receptors (cAMP) = inhibits acetylcholine release from vagus nerve
adrenergic Beta-2 receptors (cAMP) = relaxes smooth muscle
|
|
|
Term
| Function of serotonin in ENS |
|
Definition
5HT3 receptor = pain and emesis (anti-emetic = 5HT3 antagonists & analgelsics ex. Ondansetrone/Alosetron)
5-HT4 receptor = Increase acetylcholine release
|
|
|
Term
| Function of nitric oxide in ENS |
|
Definition
NO reduces intestinal ACh release and relaxes intestinal smooth muscle |
|
|
Term
Histamine is secreted from ____ in the stomach wall |
|
Definition
| enterochromaffin-like cells |
|
|
Term
|
Definition
Acts on parietal cells via H2 receptors to stimulate acid secretion. |
|
|
Term
| Function of somastatin in the GI |
|
Definition
•Somatostatin and its derivatives are used therapeutically to control upper GI bleeding. |
|
|
Term
•____and its derivatives are used therapeutically to control upper GI bleeding. |
|
Definition
|
|
Term
| Somastatin acts on receptors which mediate ___inhibition |
|
Definition
|
|
Term
____ increases intestinal secretion and peristalsis |
|
Definition
|
|
Term
What is the majority anion and cation in:
intracellular fluids
Plasma fluids |
|
Definition
intracellular fluids
- cations = K+ > Na+ > Mg2+
- anions = phosphate > protein > bicarbonate > Cl-
Plasma fluids
- cations = Na+ > K+ > Ca2+ > Mg2+
- anions = Cl-> bicarbonate > protein > other > phos
|
|
|
Term
Fluid infusion rate for :
Infant
Child
>70kg |
|
Definition
infant (0-10kg) = 100ml/kg @ 21 ml/hr
Child (10-20kg) = 1000 ml/kg +50ml/kg (every Kg >10kg) @ 58 ml/hr
>70kg = 1500 ml/kg + 50 ml/kg (every kg >20kg) @ 100ml/hr |
|
|
Term
| 3 indicators of a positive tilt test |
|
Definition
1Increase in HR of 30 beats/min or more in adults
2.15% volume loss
3. Presence of sx of cerebral hypoperfusion (e.g., dizziness, syncope)
|
|
|
Term
The preferred site of capillary fill is the ____
|
|
Definition
nail bed with the extremities at
the position of the right atrium. |
|
|
Term
•Delayed capillary refill >3 seconds predicts a volume deficit of ____. |
|
Definition
|
|
Term
| Delayed capillary refill >2 seconds when combined with other S&S predicts a volume deficit of ___. |
|
Definition
|
|
Term
•Patients in shock should have a ___ placed to accurately measure urine output. |
|
Definition
|
|
Term
•Urine output is an excellent indicator of ____, assuming the patient had normal renal function at baseline. |
|
Definition
|
|
Term
•A normal urine output is = |
|
Definition
|
|
Term
A reduced urine output ranges =
severely reduced urine output = |
|
Definition
•A reduced urine output ranges = 0.5 to 1.0 mL/kg/hour
severely reduced urine output = <0.5 mL/kg/hour |
|
|
