Download Clinical Medicine Exam 1: Obesity, Nutrition, Allergies, & Chronic Diseases and more Study notes Nutrition in PDF only on Docsity!
CLIn med exam 1 objectives Obesity: Learn to identify and screen for obesity Determined by BMI Normal: 18.5-24. Overweight: 25-29. Obese 1: 30-34. Obese 2: 35-39. Obese 3 (morbidly obese): > Waist circumference >40 for males, >35 for females Be able to describe the pathophysiology behind obesity Energy in > energy out In obesity there is leptin resistance->leptin doesn’t suppress appetite Most cases are due to sedentary lifestyle and excess calories Secondary causes: hypothyroidism, cushings syndrome, growth hormone deficiency Describe the health consequences and issues that obese individuals face Hypertension, congestive heart failure, stroke, coronary artery disease, sleep apnea, dyspnea, asthma, hypoventilation syndrome, metabolic syndrome, Type 2 diabetes, dyslipedemias, polycystic ovarian syndrome, yyperuricemia (gout), immobility, osteoarthritis, low back pain, GERD, fatty liver disease, hernias, colon cancer, urinary incontinence, hypogonadism, breast/uterine cancer, pregnancy complications, depression, anxiety, body image disturbance, social stigma Describe treatment options for obesity Lifestyle management-patient education about energy balance Diet Therapy: reduce overall calorie consumption; Mediterranean diet,ketogenic diet, atkins, intermittent fasting Physical activity Pharmacotherapy Surgery
Be able to discuss the various medications and their side effect profiles Orlistat- inhibits pancreatic lipases, fat excretion in stool, ADR: cramps, flatulence, steatorrhea Sympathomimetics -appetite suppressants; Phentermine, Phendimetrazine, Benzenediamine, Diethylpropion; ADR: tachycardia, hypertension Phentermine -Topiramate-combines sympathomimetic with topiramate; decreases appetite and increasing energy used Bupropion-Naltrexone : antidepressant and opioid-receptor antagonist; ADR: nausea, constipation Glucagon-like peptide 1 receptor agonists (GLP1 )-stimulate insulin secretion and interacts with brain to suppress appetite and signal feeling of fullness; ADR: nausea, vomiting, diarrhea, hypoglycemia Be able to discuss the various types of bariatric surgery and the implications of the type Sleeve gastrectomy: removes 70% of the stomach, fundus is removed-cant stimulate appetite, most commonly performed procedure, lower risk of nutritional deficiencies Laparoscopic Adjustable Gastric Banding : places tight adjustable band around entrance to stomach, high rates of revision and weight recidivism, higher rates of complications Balloon Procedures: soft saline filled balloon that promotes a feeling of satiety and restriction for minimum of 6 months Roux-en-Y Gastric Bypass- small gastric pouch that is anastomosed to a Roux limb of small bowel, restrict caloric intake, maintains major digestion and absorption of nutrients, lower rate of gastroesophageal reflux, ADE: obstruction, stricture, leak and failure, nutritional deficiencies, ulceration, dumping syndrome Be able to counsel bariatric patients about lifelong supplementation After all bariatric procedures: Iron, Thiamin Nutrition: Understand why nutrition and malnutrition are important across demographics
Indications: anorexia, apoplexy, sepsis, trauma/surgery, transition from parenteral nutrition, NICU preemies Contraindications: mechanical obstruction, intestinal ischemis, severe GI bleed, peritonitis, vomiting/diarrhea, clinical shock and high dose pressor use, severe coagulopathy, absent gag reflex, paralytic ileus, pancreatitis Parenteral Nutrition -feeding into a vein, usually when there is GI dysfunction PPN: peripheral PN solutions are more dilute and larger volumes, administered through peripheral IV catheter, given to pt who can tolerate some oral feeding TPN :administered through central line, for pt who requires intensive nutritional support who cannot tolerate enteral nutrition Indications: Be familiar with PICC line procedure and complications Basilic vein preferred Complications: line infiltration, phlebitis Be able to describe the cascade behind refeeding syndrome Intake of glucose causes a switch from catabolism to anabolism Rise in insulin levels, increased utilization of phosphate for glucose metabolism, drive of electrolytes intracellularly Vitamins: Be able to name common vitamins as well as their sources, role in the body and signs/symptoms of deficiencies and toxicities Be able to list water-soluble vs fat-soluble vitamins Describe where common vitamins and minerals are absorbed along the GI tract Be familiar with nutritional causes of macrocytic vs microcytic anemias Macrocytic: B9, B Microcytic: B Be able to advise patients on the recommended daily amounts of calcium and vitamin D Postmenopausal women with osteoporosis: 1200 mg of calcium, 800 IU of vitamin D
Premenopausal women or men with osteoporosis: 1000 mg of calcium and 600 IU vitamin D Know common minerals and their sources, role in the body and signs/symptoms of deficiencies and toxicities Food allergies: Know the types of hypersensitivity reactions and immunological response Type 1: allergic/immediate hypersensitivity Induces IgE releases histamine, causes degranulation 2-30 mins Ex: asthma, uticaria/hives/ food allergies Type 2:Cytotoxic IgG mediated Complement mediated lysis of cells 5-8 hours Ex: bullous pemphigoid, pemphigus vulgaris Type 3:Immune complex Antigen-antibody immune complexes, Igg or IgM, cause tissue damage 2-8 hours Ex: rheumatoid arthritis, lupus Type 4: Delayed T cell mediated 24-72 hours Ex: SJS, contact dermatitis Differentiate IgE-mediated vs non-IgE mediated reactions in regards to food allergies IgE-rapid onset, systemic features: pruritic, flusing, uticaria, conjunctiveal, sneezing, tachy/brady, nausea, vomiting, syncope, dizziness, etc. Non IgE-subacute or chronic symptoms, isolated to GI tract or skin Be familiar with common food allergies and symptoms
Nutrition and Chronic Disease: Know blood pressure guidelines, when to screen, and nutritional recommendations to provide All patients over 18 should be screened, if normal reassessed every year Gold standard: out of office ambulatory blood pressure monitoring Start treatment if: Greater than 150/90 in adults 60 in older Greater than 140/90 in adults younger than 60 Greater than 140/90 in pts with hypertension and diabetes Be familiar with different types of cholesterol and effects in the body LDL : low density lipoproteins, carry cholesterol from liver to cells of the body, “BAD CHOLESTEROL” HDL : high-density lipoproteins, collect cholesterol from body’s tissues and bring it back to liver, “GOOD CHOLESTEROL” VLDL: very low-density lipoproteins, carry triglycerides from liver to adipose tissue Be able to describe sources of cholesterol through diet and screening guidelines for lipid disorders Bad fats: trans fats: hydrogenated foods, margarine, shortenings, processed foods. Saturated fats: bad in excess: fat that is generally solid at room temp, animal sources fatty meats, poultry skin, whole milk Good Fats: Unsaturated fats: generally liquid at room temp, sOmega 3 fatty acids (salmon, tuna, mackerel), Omega 6 fatty acids: many vegetable oils, nuts Be able to define parameters for normal glucose tolerance, impaired glucose tolerance and diabetes
Be familiar with carbohydrate counting and glycemic indices Make dietary and lifestyle recommendations for diabetic patients Discuss stages of chronic renal disease and nutritional recommendations in regards to electrolytes and protein at different stages Be familiar with how malnutrition can impact immunity, mental health and cancer Know types of hypersensitivity reactions and immunological response Type 1 Allergic Type 2 Cytotoxic Type 3Immune complex Type 4 delayed Differentiate IgE mediated vs. non IgE mediated reactions Ige-rapid, affects lots of systems nonIGe- subacute, GI symptoms
- food allergies and symptoms
