-
cardiac, respirator failure, Neurologic dysfunction in a patient that recently began aggressive feeding
Refeeding syndrome
-
TPN for patients with IBD vs. enteral feeding
equivalent
-
TPN and solid tumor oncology patients
increased risk of infection and decreased tumor resoponse rate
-
TPN and perioperative patients.
- small benefit in reduction of post operative complications (6% reduction)
- benefits seen in upper gi tract patients
-
where is Vitamin A absorbed?
Stored?
- absorbed in terminal ileum
- stored in liver
requires intact fat absorptive mechansims
-
main source of vitamine D
dermal photoisomerization
-
Vitamine D toxicity
hypercalcemia, hypercalciuria, confusion, polydipsia, polyuria, anorexia, vomiting mucslce weakness and bone demineralization
-
Vitamin K
location of absorption
proximal jejunem
-
Thiamine (vitamine B1)
defiency
Wet beriberi- high output cardiac failure, lactic acidosis, hypotension
Wernicke's Korsafoff's encephalopathy- mental status changes, nystagmus, opthalmoplegia, ataxia, coma, death
-
Riboflavin (vitamin B2) deficiency
- rare
- cheilosis, angular stomatitis, normochromic/normocytic anemia
-
Niacin (vitamin B3)
deficiency
dermatitis, dementia, diarrhea (pallegra)
-
pyridoxine (vitamin B6)
deficiency
INH and penicillamine my induce iatrogenic deficiency
-
Folate
deficiency
- Neural tube defects
- megaloblastic anemia
elevated homocystien related to deficiency
-
Selineum deficiency
cardiomyopathy
-
what are the limits of small bowel lenght needed to avoid short gut syndrome
- or 30 cm of small bowel if colon is intact
- 60 cm of small bowel if hemi colectomyu
- 100cm of small bowel if total colectomy
-
defined by
1) greator than 5 juvenile colon/rectal polyps
2) jeuvenille polyps through the GI tract
3) juveinlle polyp and family history of this syndrome
juvenille polyposis syndrome
-
What percentage of colon cancer derive from the serrated adenoma pathway
10-15%
-
Prominent mutation associated with the serrated adenoma-carcinoma sequence
BRAF mutation
Large, Right sided
-
Cowdens syndrome
- This patient meets the clinical criteria for Cowdens Syndrome. Cowdens
- Syndrome is an autosomal dominant cancer syndrome with predominant skin
- and extra-intestinal manifestations caused by a germline defect in the
- PTEN gene. Esophageal glycogen acanthosis has been described in
- association with Cowdens disease. It is also associated with polyps,
- mainly hamartomas, throughout the gastrointestinal tract in up to 75% of
- individuals. In this particular case, the hyperplastic polyps found in
- the stomach are not specific to Cowden’s Syndrome. The associated
- hamartomas in Cowden’s Syndrome may be present in skin, oral mucosa,
- breast, and intestine, while the mucocutaneous hamartomas include
- papillomas of the lips and mucous membranes, acral skin keratoses, and
- rough surfaced facial papules called trichilemmomas. The majority of
- affected individuals develop the characteristic skin lesions by age 20.
- In addition to multiple hamartomatous lesions, there is an increased
- risk of early onset breast and thyroid cancer.
-
early risk of thyroid cancer
esophageal glycogen acanthosis
hyperplastic polyps in gi track
Cowden's syndrome
-
What is the gene mutation in cowden's syndrome?
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