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What is the 3/3 rule of constipation?
It is normal to go 3 times per week or 3 times per day or anything in between
What are the 3 Fs?
Fiber, fluid and fun
What are the drugs that can cause constipation
- analgesics and anticholinergics
- antihistamines, antispasmodics, antidepressants, antipsychotics
- Cation containting supplements: iron, calcium, aluminum
- neurally active agents: opioids antihypertensives
What is an Enterocele?
Weakness in the tissue that holds the bowel in place and the bowel falls down behind the uterus and into the vagina
What are some things that can weaken the wall and cause an enterocele?
Straining, manual labor, child birth
What is an anterior rectocele?
Rectum that pushes the wall of the vagina, pelvic floor dysfunction
What are the Alarm symptoms for constipation that might be colon cancer?
- Over 50
- unexplained weight loss
- evidence of GIB
- perisistent or progressive pain
- FH colon cancer
- fasting nocturnal or large volume diarrhea
what are B symptoms
- wt loss
- low grade fever
- night sweats
A Gaping or asymetric anal opening (i.e. a �gaping asshole�) is a sign of what type of disorder?
Neurologic disorder impairing sphincter function
Having the patient strain during the rectal exam is useful for diagnosing patients with what?
Dyssynergic defication, rectal prolapse
How do you do a physical examination for a rectocele?
Have female patient strain with the examining finger oriented anteriorly
In a patient with constipation you can do a barium X ray to identify what 4 disorders
obstruction, megarectum, megacolon, hirshsprungs disease
loss of normal colonic relfexes and sensation
colon that is dialated and the patient is unable to move through the colon, thus they are dependent on more and more laxitives for defecation
- in coordination of contraction of colonic and rectal muscles and internal and external sphincters
- leads to attempts to defecate against closed anal sphincters
- with or without difficulty deficating strain even with soft stools
- on examination they are inable to voluntarily relax the external sphincters on request
- Lifelong constipation
- occasional passage of an enormous formed stool
- causes are congenital (hirschsprung disease) or aquired defects in the intrinsic innervation of the colon
What are some bowel diseases that can cause constipation
IBS, slow colonic transit, pelvic floor dysfunction
what are some neurological conditions that can cause constipation?
Parkinson's, MS, colon surgery, spinal cord injury, diabetes mellitus, pseudo-obstruction
What are some complications of chronic constipation
- urinary obstruction/infection
- spontaneous perforation
- stercolar ulcer � ischemia on bowel wall
- fecaliths- appendix
What anticonstipation medications should be avoided unless nessisary?
Prokinetics, lubricating agents, routine enemas
What medications should be used for constipation
- stool softeners/ bulking agents
- osmotic agents
- stimulating agents
what are some lifestyle/diet modifications that can help constipation
- fiber fluids fun
- D/C or change offending meds if possible
- bowel retraining
- educations and reassurance
What must you give with fiber/bulk laxitives?
How do surfactants work?
Lower stool surface tension and soften so that more water enters more easily not as good as laxatives
What are osmotic agents?
- Non-absorbable agents to promote fluid shift
- intestinal water secretion increases
- increases stool frequency
Name some osmotic agents
PEG, Lactulose, Saline
How do stimulant laxatives work?
Alter electrolyte transit at mucosa and increase motor activity
What is a fecal impaction?
- Large mass of bulky dry hard stool in the rectum secondary to chronic constipation
- watery stool may form higher in the bowel and leak around the impaction causing soiling or diarrhea
What are some complications of fecal impaction
- dilitation- toxic megacolon
- rectal tears
- rectal tissue necrosis
What are some symptoms of fecal impaction?
- Urge to deficate without ability to have a BM
- abdominal pain
- bloated or hard abdomen
- nausea and vomiting
- rectal discomfort
- generally ill feeling
- leakage of wet stool or thin/pencil stool
What is a contraindication to manual disimpaction, suppositories and enemas for fecal impation?
Patients who are myelosuppressed or have altered bleeding times
What are some motility tests that can be done for a patient with chronic constipation
- anorectal manometry
- pelvic floor electromyography
- anal endosonography
Anal fissures found on the sides of the anus are indicative of what diseases?
- Chron's disease
- ulcerative colitis
Anal fissures that are in the verticle plain of the rectum (the top and bottom) are indicative of what?
Acute and chronic anal fissures
Your patient has a tearing pain with defecation and sometimes a throbbing pain following defecation. They also report blood on the toilet paper after they go. You diagnose
blood on toilet paper or stool
- can ulcerate with internal sphincter fibers seen at base
- may develop sentinel pile or sentinel tag
- may require surgery
Which hemorrhoids are painful internal or external
what are some risk factors for hemorrhoids
pregnancy, obesity, chronic diarrhea, loss of muscle tone, chronic constipation, portal hypertension, professions with lots of sitting
First degree hemorrhoids
second degree hemorrhoids
prolapse through anus on straining but spontaneous reduction
Third degree hemorrhoids
Prolapse and may require manual/digital reduction
Fourth degree hemorrhoids
Cannot be reduced just hang out all the time
What are some treatments for internal hemorrhoids
- rubber band ligation
- infrared coagulation
- bipolar diathermy
- laser photocoagulation
Treatment for a bleeding hemorrhoid
Treatment for a iritation and pruritus from a hemorrhoid
analgesic creams hydrocortisone suppositories sitz baths
Treatment for thrombosed hemorrhoids
acute may require surgical intervention if significant symptoms
Define Orthostatic intolerance
Family of disorders that produce symptoms of cerebral hypoperfusion in response to postural challenge; they involve the dysfunction or disregulation of postural reflexes
What 4 syndromes cause Orthostatic intolerance?
- Orthostatic hypotension
- delayed orthostasis
- postural orthostatic tachycardia syndrome
- neurally mediated hypotension (vasovagal reflex or reflex syncope)
What are the symptoms of orthostatic Intolerance
- Dizziness or lightheadedness
- Visual blurring
- Darkening of visual fields
- Generalized weakness
- Loss of conciousness
immediate orthostasis is defined as a postural decrease in BP of >____mmHg for systolic BP and a decrease of >____ mmHg for diastolic BP
Immediate Orthostasis can occur with ______ insufficiency where there is inadequate tachycardial compensation or with ____ depletion where the patient becomes tachycardic but not enough to compensate.
- Autonomic insufficiency
- Volume depletion
What are 4 classes of medications that can cause Euvolemic orthostatic hypotension
- antihypertensive agents
- tricyclic agents
- monoamine oxidase inhibitors
- dopamine agonists
What are 2 endocrine diseases that can cause Euvolemic orhtostatic hypotension?
- Adrenocortical deficiency
What are some Neurological conditions that can cause euvolemic orthostatic hypotension?
- Parkinson's disease
- multisystem failure
- CNS tumor
What are 3 things you can educate an orthostatic hypertension patient to do in order to reduce episodes?
- Orthostatic precautions � pause at the side of the bed
- Small, frequent, low carbohydrate meals- increased shunt to internal organs with large meals or meals heavy on carbs which are vasodilitory
- Avoid alcohol- vasodilitor and diuretic
What type of clothing can a person with orthostatic hypotension wear to decrease symptoms?
What physical maneuvers can help prevent falls in an orthostatic hypotension pt.?
- Leg crossing
- isometric hand gripping
- respiratory manuvers pursed lip or sniff
- Elevate the head of the bed at night (activates the RAS reducing nocturnal diuresis)
What dietary changes would you make for a patient with orthostatic hypotension?
Increase sodium in diet
What medication can you perscribe for an OH patient with anemia?
Erythropoietin- use in anemic patients less than 35% aim for normal hct
How does caffeine help pts with orthostatic hypotension?
Inihibits vasodilating effects of adenosine and increases sympathetic tone
What medications could you give a patient with OH to improve their symptoms? (5)
What med for OH should you avoid in a patient with urinary retention?
Midodrine (also dose while pt is awake)
How do NSAIDs help to raise BP?
Prostacyclin inhibition, vasoconstrictor and activation of RAS
What NSAIDs are used for OH?
What is the biggest problem with medical management of OH?
BP effects of therapy are posture independent so when the patient moves to sitting or laying position their BP jumps to hypertensive state
The Goals of OH therapy are a standing SBP > ___ mmHg and a Supine BP of <___ mmHg which can be achieved with timing of midodine dosing, HOB and nocturnal nitrates
90mmHG and 180 mmHG
What med can you add at night to a patient with OH who is hypertensive at rest?
Your patient is a 78 year old female who reports feeling faint at different times of the day she does not think it occurs with postural change because it never occurs directly after standing. She also has not noticed any abnormal heart flutters or palpitations, anxiousness or neurological changes. You suspect...
Delayed orthostasis can be __ -__ mins after postural challenge
True or false Delayed orthostasis is more likely to be associated with vasovagal symptoms
_____ should be considered when lightheadedness in an older individual is recurrent, consistent, persistent, but does not occur with immediate postural challenge, the patient may not recognize the postural connection
What is the most prevalent form of orthostatic intolerance
What age range does POTS present in
14-45 years old
What does POTS stand for
Postural orthostatic tachycardia syndrome
Who is more likely to get POTS men or women?
What are the 4 possible pathophysiologies of POTS?
- Reduction in effective circulating blood volume (ECBV) � (peripheral venous sympathetic denervatino with preserved cardiac innervation, dynamic orthostatic hypovolemia)
- Acutal reduction in effective circulating blood volume- (possible renal sympathetic denervation decreased activation of RAAS, reduction in red cell mass)
- Parasympathetic insufficency leading to attenuated baroreceptor responses
- Primary sympathetic excess
What are some symptoms of POTS
racing heart, palpitations, anxiety, tremulousness, irritability, difficulty concentrating, difficulty focusing, sleeplessness, headache, lightheaded, fatigue, SOB, Exercise intolerance, nausea, bloating, abdominal cramping, constipation, diarrhea, cutaneous mottleing, dependent rubor, cold intolerance, heat intolerance, hear fainting, fainting, sweats, good days, bad days (I'm having a bad day b/c of this exam)
What are some common misdiagnoses of POTS
anxiety disorders, ADHD, depression, somatization, deconditioning
What are some Hyperadrenergic symptoms of POTS
- anxiety, fight of flight hyperactivity, overfocused concentration, mimicking ADHD, Inability to shut down at night or sleeplessness
- Gastrointestinal dysmotility, Raynaud's symptomatology, cutaneous vasomotor abnormalities
What are some hypoperfusion symptoms of POTS?
What are some cardiopulmonary symptoms of POTS?
Exertional fatigue and breathlessness
What are some of the POTS symptoms that are due to cardiac ventricular baroreceptors?
- Postural neurocardiogenic symptoms
- profound episodic fatigue
What are dome superimposed situational depression symptoms of POTS
- patients feel miserable
- often ridiculed
- depondent about normal functioning
What are the diagnostic criteria for POTS?
30 point orthostatic rise in heart rate or maximum orthostatic heart rate >120/min and less than 10 mmHg drop in SBP
3 diagnostic tests for pots
- bedside postural vital signs
- tilt table testing
- holter monitor
Accelerated heart rate of __ -___ bpm due to postural challenge or daily activities is diagnostic of POTS
____ POTS is a milder form of the disaease with partial recovery in several years
POTS caused by ______ is chronic and potentially progressive
What are the treatments for POTS?
- High sodium diet
- periodic saline infusion
- Beta blockers
What medications are used in POTS to correct hyperadrenergic tone?
What type of beta blockers are used in POTs and why?
- Hydrophilic agents to minimize risk of fatigue
What agent is used for Insomina and BP in POTS?
- very helpful for insomnia, reduces supine BP but not upright BP
- Beta blockers before bed
Why are SSRIs used for POTS?
Serotonergic pathoways appear to mediate between vagal afferens and sympathetic efferents
what two methods can you use to enhance preload in POTS patients?
- continuous saline infusion
How do you enhance cardiovagal tone in a POTS patient?
Pyridostigmine- therapy is limited by gastrointestinal hypermotility symptoms
What would you do to optimize preload in a POTS patients
- High sodium diet
What are the 3 types of shock
Does preload increase or decrease in cardiogenic shock?
Define Cardiogenic Shock
decrease in CO with evidence of insufficient tissue perfusion in the presence of adequate intravascular volume
What are the Hemodynamic criteria (Forrester class 4) for cardiogenic shock?
- Sustained hypotension (SBP < 90 mmHg for >30min)
- Increased LV filling (PCWP >15mmHg)
- Reduced systolic cardiac function
What are some MI causes of Cardiogenic shock
- Severe LV dysfunction
- Extensive RV infarction
- Mechanical complications
- acute mitral regurgitation
- Free wall rupture
- Conduction abnormalities
What are some non MI causes of Cardiogenic shock?
Myocarditis, end stage cardiomyopathy, myocardial contusion, LVOT obstruction, Obstructive tumor, septic shock with myocardial depression, pulmonary embolism, aortic dissection with acute AR or tamponade, stress cardiomyopathy (broken heart syndrome)
What is the median time from MI to shock?
What are the risk factors for development of CS?
- Elderly age 70 and up
- anterior infarction
- prior MI
- 3 vessel left main disease
- early use of beta blockers in large infarcts (can cause hypotension that may lead to shock)
What are the potential therapies for Cardiogenic shock
- Rx- pressors and inotropes
- temporary pacing
- Intra-aortic balloon pump (IABP)
- Revascularization: CABG/PCI
- Ventricular assist devices (VADs)
- Cardiac tranplantation
Action of Norepinephrine
vasoconstriction and inotropic stimulant
Action of dopamine
- at low doses � renal vascular dialation
- at medium doses- chronotropic/inotropic (beta)
- at high doses- vasoconstriction (alpha)
positive inotrope, vasodilates- decreases afterload so hard to give to a shock patient
Explain how an IABP works
- temporary balloon that is inserted through the aorta into the arch and is programmed to inflate during diastole which fills the coronary arteries and deflate during systole to decrease afterload
- Systole: decreases afterload, decreases cardiac work, decreases myocardial oxygen consumption, increases cardiac output
- Diastole: aucmentation of diastolic pressure, increases coronary perfusion
What is PCI
- Percutaneous coronary interventions
- is a stent in the coronary artery establishing patency
What is a CABG
- Coronary Artery bipass graft
- uses the internal mammary artery or saphenous vein to bypass coronary circulation and feed the heart
What is an Impella device?
Pump that runs from the ventricle to the aorta
Which generally does better LV failure or mechanical complications
What is a LVAD?
Left ventricular assist device, pump that vaccumes out blood from the ventricle into the aorta
you have a post MI patient with symptoms of confusion, lungs bibasialr rhales, no JVD, new high pitched holosystolic murmur at the 3rd and 4th intercostal space and an apical thrill, their extremities are ice cold. Their vitals are: Temp- 98.7, BP 68/40, HR 120, O2 sat- 97% What do you think is wrong with this patient?
Post infarction ventricular septal defect
- uncommon, mostly due to a posterobasal septum or ami apical septum, ECHO best diagnostic test
- IABP, dobutamine for acute stabilization100% mortality without surgery only 87% with surgery closure device
a 73 year old female presents with acute respiratory failure, (batwing edema) her BP is 68/40 despite fluid her HR is 120, her O2 sat is 68% she is intubated her lungs have diffuse rhales, increased JVP a new holosystolic murmur no apical thrill and her extremities are ice cold what do you think this patient has?
Acute Mitral regurgitation
What is the treatment for Acute mitral regurgitation
immediate repair or replacement with or without CABG ASAP surgical delay increases mortality
Other than surgery how would you treat an acute mitral regurgitation patient
- majority require mechanical ventilation
- IABP, nitroprusside, dobutamine, LVAD, emergent coronary angiography
You have a patient with an enlarged heart on CXR who presents with a BP of 68/40 and a HR of 120 O2 sat of 91% he is confused his lungs are clear he has increased JVP the heart sounds are not distant and there are no obvious murmurs the extremities are cool what do you suspect?
- RV infarction
- pulmonary embolism
- Cardiac tamponade
- constrictive pericarditis
How would you manage a RV infarction?
- Fluids to achieve PCWP of 15-18 mmHG
- Revascularization improve in hospital M and M
What is you differential for an increased JVD with clear lungs
- RV infarction
- pulmonary embolism
- constrictive pericarditis
What is your differential for new holosystolic murmur with no thrill
Acute mitral regurgitation
What is your differential for a new holosystolic murmur with apical thrill
What is Diastasis recti?
Not a true hernia, represents a weakened abdominal fascia, usually happens post pregnancy or with obesity
What type of �hernia� causes tenting when you have the patient lie on their back and put their head up?
What is the pathogenesis of diastasis recti?
The abdominal muscles bow outward because of abdominal girth
What is the treatment for diastasis recti?
Reduce obesity and PT for abdominal muscle strengthening
Where is pilonidal disease usually found?
Intergluteal cyst, abscess or sinus tract of the upper part of the natal cleft
Is pilonidal disease more common in men or women?
What is the peak incidence of pilonidal disease?
35 to 45 rare over 45yo
what is the major complication of pilonidal disease?
Can form absess and follow sinus tract to form bigger abcess
Your patient is having trouble sitting recently, they have minor discomfort around the anus. The patient said they looked at it with a mirror and were surprised to see that it was swollen and red, they also ruefully tell you that they are �hairy back there� as they drop their pants for the rectal exam before looking at the rectum what do you think is the diagnosis?
What are some signs and symptoms of Acute abscess in a patient with pilonidal disease?
- Sudden onset of severe pain and swelling
- acutely inflamed mass noted overlying the sacrum or coccyx
- fever is unusual unless cellulitis is present
- may occur following trauma
Describe a Chronic pilonidal cyst
persistent drainage from the sinus connected to the cyst 1 or more sinus openings with drainage of mucoid or purulent fluid
What are the treatment options for patients with Pilonidal cysts?
- Sitz baths/donuts
- surgical treatments- I and D if acute
- Surgical excision cysts and tracts = definitive treatment with primary or secondary closure
- Antibiotic to cover skin flora if exacerbated- no indication for long term use
- can recur Prevention is shaving hair of gluteal area
A common western diet with low fiber puts a person at risk of what disease?
Where do diverticula form?
Where blood vessels penetrate the colon
What part of the colon are diverticula most common in?
silent disease where patient has diveraticula but they don't cause a problem they are silent
when those diverticuli get infected or perforate or abscess or become inflammed
sac like protrusion of the colonic wall
What are some concerns/complications of diverticular disease?
- fistula formation- openings to bladder or vagina
What will you find on history and physical of a patient with diveraticular disease
- often asymptomatic
- crampy LLQ pain
- alternating diarrhea constipation
- with or without fever
- can develop lower gi bleed
What diagnostic tests would you run on a patient who you suspect has diverticulitis
- none if asymptomatic
- occult blood and stool leukocytes
- abdominal plain film free air for perforation
- CT of abdomen- if they don't respond to treatments
- Other- barium enema but only if not acute b/c you risk perfing their colon same with colonoscopy
What are 4 complications of Diverticulitis?
- Perforation- secondary to incresed intraluminal pressure insipissated food particles or inflammation necrosis and infection
- Peritonitis- purulent or fecal
- abscess or fistula- can cause communication
- stricture- from scarring predisposition to obstruction
What is the Treatment/Prevention for Diverticulitis
- Prevention: high fiber diet, exercise, adequate liquids
- Treatment: bowel rest, antibiotics if diverticulitis, surgical repair of any damage
- Other strategies: treat constipation, increase exercise, increase fiber
Genetic disorder that has an increased gastric polyp incidence and thus an increased risk of colon cancer require frequen colonoscopies 1-2 scopes per year starting at age 10
Familial polyposis syndrome
Clinical symptoms of colonic polyps
- generally asymptomatic
- constipation, flatulence, rectal bleeding
What diagnostic tests do you do for a patient with colonic polyps?
Colonoscopy, Occult blood test, biopsy of the polyp
This type of colonic polyp has a higher risk of cancer and tend to be on the right side and very large
hyperplastic and inflammatory
These types of colonic polyp are on the left side and generally have a lower risk of cancer
adenoma and adenomatous polyps
What are some risk factors for colon cancer?
- Pts over 50 y.o.
- Diet rich in red and processed meats
- inflammatory bowel disease
- inherited disorders (FAP, hereditary non-polyposis colon cancer)
- Heavy EtOH
List the six type of hernia
epigastric, incisional, umbilical, direct inguinal, indirect inguinal, femoral
Name the 3 ventral hernias
epigastric, umbilical, incisional
Where does the weakness occur in a ventral hernia?
In the anterior abdominal wall
Where does an epigastric hernia occur?
Area between the breastbone to the umbilicus
Are epigastric hernias mostly congenital or aquired?
What is the most common type of incisional hernia?
Which are better upper incisions or lower incisions
which are better verticle incisions or transverse incisions?
3 post surgical factors that contribute to hernia risk
tension, technique, infection
True or false once a hernia is fixed it will never rupture again
False recurrence rate after surgical repair is 25-50%
Weak muscle next to the opening of inguinal canal, occurs in men over 40 years aging or injury, or weakness in Hesselbach's triangle
Direct inguinal hernia
�weakness in Hesselbach's triangle�
Direct inguinal hernia
Most common type of hernia in men
Indirect inguinal hernia
When a loop of intestine and/or fat goes through or into the inguinal canal
Indirect inguinal hernia
Most common inguinal hernia in women
Weakness in the femoral canal area of the groin
What type of inguinal hernia is most likely to become incarcerated or strangulated?
What are some risk factors for a femoral hernia
- Female especially older
- prior childbirth
- muscle weakness
- prior inguinal repair
What are some symptoms of inguinal herniation
- heaviness or dull sense of discomfort
- worsens with strainign lifting end of day or with prolonged standing
- manual/physically active professions are aware before more sedentary workers
- incarceration and strangulation
- pain in area of hernia
What is a sports hernia ?
Unilateral pain in the groin without demonatrated hernia
Who is more likely to get a sports hernia men or women?
Sports hernia are more common in sports that involve what motion?
Leaning forward and bending (hockey, soccer, rugby, football)
What are some causes of sports hernias?'
- repetitive strain in the inguinal area
- tear external oblique with illioinguinal nerve injury
- osteitis pubis
- myotendinous strain- adductor rectus
You have a hockey player who presents to you with groin pain especially increased with coughing and sneezing what do you diagnose?
What kind of imaging do you get for a sports hernia?
- Osteitis pubis is possible so bone scan
- MRI/US- occult hernias
What is treatment for a sports hernia?
Rest, NSAIDs, Ice packs, surgical consult if it fails conservative exploratory and repair
occurs when the antemesenteric wall of the intestine protrudes through a defect in the abdominal wall. If such a herniation becomes necrotic and is subsequently reduced during hernia repair, perforation and peritonitis may result. A Richter's hernia can result in strangulation and necrosis in the absence of intestinal obstruction. It is a relatively rare but dangerous type of hernia.
- �Lateral Ventral hernia�
- developse through the spigelian fascia
- occurs between the muscles found in the abdominal wall
- Linea semilunaris on each side of the rectus abdominus
- osften little outward evicence of swelling so may go undetected longer
- occur in men and women equally
How do you calculate BMI?
Weight in pounds/ heigh in inches squared X703
Waist Circumference is a good indicator of the risk for what two diseases?
CV and DM2
A bad waist circumference for women is
A bad waist circumference for men is
A good cholesterol level is under
A good LDL level is under
A good HDL level is over
According to Choose my plate how what should be the main make up of a typical dinner
Fruits and veggies should take up the majority with grains an protein making up a smaller portion
What patients are at risk for malnutrition
- weight changes
- food intolerance
- abnormal lab values
What diet do you give a patient with dysphagia?
Thickened liquids, mechanical soft grount and pureed food
What diet do you give a patient on Hemo/peritoneal dialysis?
Sodium, potassium, phosphorus and fluid and protein
What diet do you give to a CHF patient?
2 gm sodium, fluid restrictions
What diet do you give a pt on coumadin?
Avoid foods with high potassium levels
What are the 4 thicknesses of fluids?
- nectar thick
- spoon thick
Describe thin liquids and name some examples
- regular liquids, no adjustment needed
- buttermilk, tomatoe juice
Describe nectar thick liquids and name some examples
falls slowly from a spoon can sip through a straw
Describe a honey thick liquid and name some examples
- drops from a spoon too thick to sip from a straw
- Example: tomato sauce
- Maintains shape needs spoon too thick to drink
Describe a dysphagia diet level one
- bread- pureed or pre gelled, slurry
- fruits- pureed/well mashed no seeds etc
- Veggies pureed
Describe a dysphagia diet level 2
- mechanically altered
- soft testured so can form a bolus
- beverages have suspended pulp, bits of texture
- moist well cooked veggies cut in half
Describe a dysphagia diet level 3
- near normal texture
- exclude crunchy sticky or very hard foods
- moist breads, cereals, desserts potatoes soups
4 conditions where you really want to monitor the patients electrolyte intake...
Edema, HTN, CHF, Renal impairment
Name a disease that elevates potassium
Name some drugs that can elevate potassium
beta blockers, potassium supplements, ACE/ARBs
Name some high potassium foods
green beans, iceburg lettuce, 1 egg, one small banana, one orange, potatoe with skin
What is the dietary goal cholesterol for cholesterol reduction diet?
Name some high saturated fat foods
- Whole milk/butter/cream
What do you limit with a cholesterol reduction diet?
- Trans fat
- fat all types
What are some examples of trans fat foods
margarine, shortening, fried foods, packaged foods made with hydrogenated oils, french fries, doughnuts, baked goods including pastries and pie crust, biscuits, pizza dough, cookies and crackers
Name two foods that will improve your dietary cholesterol
- Omega-3 fats
- Dietary fiber
What are some examples of Omega 3 Fats?
Salmon, tuna, mackerel, sardines, walnuts, canola, soybean, flaxseed oil or ground
What is the recommendation on Dietary Fiber and what can you eat to get it?
- 20-30 grams per day
- fruits, veggies, whole grains, dried beans
- 5 cups of fruit/veggie or 3 ounces of whole grain foods
Name some conditions that are indications for a low sodium diet
- heart failure
- renal disease
- conditions of fluid retention or swelling
ADA guidelines on sodium suggest that you limit your sodium intake to how many mg per day?
what 5 things should you monitor intake of with a patient who has chronic kidney disease
Sodium, Potassium, protein, phosphorus, calcium
What is Lactose Intolerance
Inability to digest sugar found in dairy
What causes lactose intolerance
Is lactose intolerance more common in white children or black children
What are the symptoms of lactose intolerance
bloating, flatus, diarrhea, cramps, delayed growth in children
How soon after eating dairy to lactose intolerance symptoms appear?
30 mins to 2 hours
What are some secondary causes of lactose intolerance?
Bacterial overgrowth, infectious enteritis, giardiasis, mucosal injury (celiac, IBC, Drug and radiation induced)
How do you test for Lactose intolerance?
Test for the presence of hydrogen after lactose load (urea breath test)
Treatment for lactose intolerance includes:
- avoid milk products
- alternatives: yogurt, buttermilk, aged cheese, ingest lactase
What are some food sources with high vitamin A
Liver, fish oils, fortified milk, eggs
Who gets deficiencies in vitamin A?
Elderly, achoholism, liver disease, night blindness, dry skin
Sx of Vitamin A toxicity
skin disorders, hair loss, poss teratogenic
Vitamin C food sources include:
citrus fruits, strawberries, broccoli, mixed green veggies
What are some functions of vitamin C in the body
neurotransmitter synthesis, collagen synthesis
Who is at risk for Vitamin C deficiencies
elderly men, alcholism, college students and sailors
What happens to pts with Vitamin C deficiencies?
Poor wound healing, bleeding gums, petechiae, scurvey
What happens with levels of Vitamin C that are too high?
What is a food source of Vitamin D?
What is the function of Vitamin D in the body
calcium regulation, cell differentiation
Who is at risk for Vit D deficiencies?
Elderly, those with low sun exposure
What happens to patients with Vit D deficiencies?
What happens with toxic levels of Vit D>?
hypercalcemia, renal calcuil, soft tissue calcium deposits
What are some food sources of Vitamin K
spinach, broccoli, asparagus
What cartoon character is �strong to the finish� and is NOT at risk of vitamin K deficiency? Bonus question what vitamin deficiency is this cartoon character at risk of?
- Poppy the sailor man!
- Because he is a sailor traditionally he would be at risk of ricketts because of a vitamin C deficiency however college students have passed sailors as the group of people most at risk for Vit C defic.
What can Vitamin K deficiency cause?
Bleeding deficiencies effects in factors VII, IX, X and prothrombin
Is vitamin K fat or water soluble?
Riboflavin (B2) is found in what foods?
Meat, fish, eggs, milk, green veggies, enriched foods
Deficiencies of Riboflavin lead to what manifestations?
Cheilitis, glossitis stomatitis, mucosal edema
Thiamine (B1) is found in what foods?
Pork, grains, peas, dried beans, brewer's yeast,
What is Thiamine's function in the body?
CHO metabolism, nerve functioning
What patient population is at risk for thiamine deficiency?
What are some consequences of thiamine deficiency?
- Beriberi- tingling poor coordination, weakness, edema possible cardiac dysfunction
- Wernikes encephalopathy
Wernike's encephalopathy- name the deficiency
Beriberi- name the deficiency
Chelitis, glossitis, stomatitis mucosal edemal name the deficiency
Bleeding problems � name the deficiency
Osteomalacia name the deficiency
Scurvy � name the deficiency
Ricketts- name the deficiency
night blindness � name the deficiency