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CP2 Lipids pt 2
Basic Lipid questions
| Question | Answer |
|---|---|
| what are the 3 ways that triglycerides are transported through the bloodstream? | LDL, VLDL, and chylomicrons |
| What happens when Triglyceride molecules are in excess in the blood? | they are deposited in to fatty tissues |
| are triglycerides and HDL levels directly or inversely proportional? | inversely |
| what are the three forms that triglycerides are stored in adipose tissue? | glycerol, monoglycerides, and fatty acids |
| what structure converts the three storage forms of triglycerides into triglycerides? | the liver |
| what percentage of triglycerides are transported through the blood via VLDLs? | 80% |
| what percentage of triglycerides are transported through the blood via LDLs? | 15% |
| when is the peak level for lipidemia after a meal? how long does that level persist? | 3-5 hours 6-8 hours |
| what triglyceride level (mg/dL) interferes with laboratory tests? if a level above this is found, what is its clinical significance? | 1,000 mg/dL acute pancreatitis |
| what is the triglyceride range (mg/dL) that is caused by an increase in VLDL? what type(s) of hyperlipoproteinemia is this considered to be? | 250-750 mg/dL Type IV |
| what is the triglyceride range (mg/dL) that is caused by an increase in VLDL and/or chylomicrons? what type(s) of hyperlipoproteinemia is this considered to be? | >750 mg/dL Type V or I |
| what is the triglyceride range that is caused by dietary factors? | 150-250 mg/dL |
| ingestion of fatty meals may ____________ triglyceride levels. | increase |
| ingestion of alcohol may ____________ triglyceride levels. | increase |
| pregnancy may cause ____________ triglyceride levels. | increased |
| diurnal variation may cause triglycerides to be __________ in the morning and ___________ at noon | lowest highest |
| diet changes in the past ____ days (___ weeks) will influence the results of the triglycerides aspect of the lipid panel. | 14 days 2 weeks |
| what is considered a normal level for triglycerides? | <150 mg/dL |
| what is considered a high level for triglycerides? | >500 mg/dL |
| what level of triglycerides would lead to an increased risk for peripheral vascular disease? | 250-500 mg/dL |
| what level of triglycerides would lead to an increased risk for pancreatitis? | >500 mg/dL |
| what level of triglycerides would lead to an increased risk for eruptive xanthomas and enlarged liver/spleen? | >5000 mg/dL |
| What are the three types of primary hyperlipoproteinemia? | HLP I, IV, and V |
| what are the five most common forms of secondary hyperlipoproteinemia? | Liver disease, nephrotic syndrome, hypothyroidism, DM, and alcoholism |
| what are the five causes of decreased levels of triglycerides? | malabsorption syndrome, hyperthyroidism, malnutrition/vegans, congenital abetalipoproteinemia, and hyperparathyroidism |
| what are the 3 levels of triglycerides where a clinical decision needs to be made? | <40 mg/dL >150mg/dL and >400 mg/dL |
| what is the make-up of fatty streaks in vascular walls? what do those streaks become? | cholesterol deposits fibrous plaques |
| what are the 5 major risk factors for cardiac risk assessment? | cigarette smoking, hypertension, low HDL, family history of premature CHD, and age |
| what should the TC:HDL ratio be for men? pre-menopausal women? | 5 4.5 |
| where is high sensitivity CRP produced and what induces its release? | liver hepatocytes interleukin 1 and 6 |
| when the body identifies a situation where inflammation is necessary what happens to hs-CRP levels? to what mg/dL? | increase from normal as high as 50 mg/dL |
| which test is more sensitive hs-CRP or standard CRP? | hs-CRP |
| utilizing lipid panel numbers and __________ levels together are a more accurate predictor of CV risk than lipid panel alone. | CRP levels |
| what is the normal range for CRP? | <0.3 mg/dL |
| what level (mg/dL) of CRP would indicate a requirement to start looking for inflammation if previously haven't? what other test would you anticipate being a of high value? | >10 mg/dL ESR |
| what is considered a low CV risk level for CRP? average? high? | <1.0 mg/dL 1.0-3.0 mg/dL >3.0 mg/dL |
| is it appropriate to test everyones hs-CRP? | no |
| what should be assessed before considering ordering a hs-CRP? | traditional cardiovascular risk factors and a calculated absolute Framingham risk score |
| what percentage of risk should a patient be considered having of developing CHD in the next 10 years before ordering a hs-CRP? | 10-20% minimum |
| if a blood sample was taken and placed in the refrigerator overnight what would the cream that formed on top of the sample be? | chylomicrons |
| what is the main aspect of the term hyperlipemia? | increased triglycerides |
| what is the main aspect of the term hyperlipidemia? | increase of any plasma lipid |
| what is the main aspect of the term hyperlipoproteinemia? | increase of one or more lipoprotein |
| what are 3 non-modifiable risk factors for CHD? | age family history gender |
| what are 3 modifiable risk factors for CHD? | smoking blood pressure decreased HDL |
| what is the etiology of HLP type IIa? | a delay in removal of LDL (due to a lack of high affinity LDL-Apo B receptors in peripheral tissues) |
| what is the epidemiology of HLP type IIa | heterozygous familial hypercholesterolemia 1 in 500 (HA in 50's) autosomal dominant homozygous 1 in 1 million (die in 20s due to HA) |
| what are the 6 signs and symptoms of HLP type IIa? | 1. Xanthelasmas (most common physical symptom) 2. Tendon and tuberous xanthomas (elbows/knees/achilles/extensor tendons) 3. Arcus juvenilis (lipid degeneration around sclera of eye) 4. Arterial bruits 5. Claudication 6. Accelerated atherosclerosis |
| what are the 3 lab findings for HLP type IIa? | 1. increased serum cholesterol a. homozygous 500-1200 mg/dL b. heterozygous 250-500 mg/dL 2. normal triglycerides 3. increased LDL |
| outline the first 4 steps of management for a person with HLP type IIa? (9 total) | 1. intervention if HDL <30 or LDL >160 2. TC 200-240 without CAD/2+ RF--->prudent diet & 1-yr recheck 3. TC 200-240 with CAD/2+ RF--->lipopro analysis with further action 4. two step diet from AHA (decrease TF, M:P:S ratio, fiber inc, exercise) |
| outline the last 5 steps of management for a person with HLP type IIa? (9 total) | 5. recheck serum cholesterol in 4-6 wks & @ 3 mos 6. if goal isnt reached begin step two (dec dietary fat <25% of calories, sat fat <7% of calories, cholesterol <200 mg/day) 7. increase HDL 8. specifics (look in notes) 9. chemotherapy (look in notes) |
| what patient monitoring steps need to be taken for a person with HLP type IIa? | lipid panel every 6 weeks until target goals reached, then every 4-6 months to promote compliance and monitor continued response. if taking statin check LFTs at baseline, consider at 6 weeks. subsequent monitoring is unnecessary. |
| what are the 4 prognoses for a person with HLP type IIa? | 1. 1% reduction of CV events for every 1.6 mg/dL reduction in LDL 2. the incidence of xanthaomas will increase with each decade 3. achilles tendonitis will recur 4. accelerated atherosclerosis |
| what is the etiology of HLP type IV? | genetic problem causing decreased elimination of VLDL |
| what are the 4 signs and symptoms of HLP type IV? | 1. obesity 2. lipemia ratinalis 3. atherosclerosis 4. hepatosplenomegaly |
| what are the 6 lab findings for HLP type IV | 1. hyperuricemia 2. mildly abnormal FBS 3. increased triglycerides (usually 250-500 mg/dL) 4. normal cholesterol 5. normal LDL 6. decreased HDL |
| name the first 6 steps of managing HLP type IV. (12 total, see notes) | 1. therapeutic lifestyle changes [50%] 2. smoking cessation 3. dietary modifications [20-50%] (see notes) 4. moderate intensity physical activity [20-30%] 5. weight loss of 5-10% [20%] 6. abstain from alcohol [amount TGs can be lowered by] |
| name the last 6 steps of managing HLP type IV. (12 total, see notes) | 7. treat underlying illness or remove offending drug 8. improve glycemic control if diabetic 9. control other cardiac RF 10. screen family for primary hypertriglyceridemia 11. getting LDL takes priority over TG correction 12. chemotherapy |
| what are 5 follow-up recommendations for HLP type IV? | 1. repeat fasting lipid panel 2 mos after therapy initiation 2. fasting lipid panel every 6-12 mos 3. maintain TGs <1000 mg/dL 4. hepatic transaminases 5. creatine phosphokinase |
| why would you want to keep the TGs of a patient with HLP type IV below 1000 mg/dL? | to reduce risk of acute pancreatitis |
| what is the prognosis for a person with HLP type IV? | 1. association with a predisposition to premature coronary heart disease 2. good with correction of triglyceride levels 3. patients with primary hypertriglyceridemia usually require lifelong treatment |
| What is the main general consideration for metabolic syndrome? | a cluster of metabolic abnormalities that confer an increased risk factor for type 2 DM, CVD, stroke, fatty liver disease, and certain cancers |
| what metabolic abnormalities are included in metabolic syndrome? | intra-abdominal obesity, dyslipidemia, hypertension, insulin resistance, with or without impaired glucose tolerance, proinflammatory state, and prothrombotic state |
| what are the 5 identifying pieces of epidemeology for metabolic syndrome? | 1. >age 60 for 50% of cases 2. no predominant gender 3. mexican americans have highest risk 4. affects 34% of US adults >20 yrs, inc with age and obesity 5. rapidly growing epidemic worldwide |
| what are 3 diagnosing criteria for metabolic syndrome? | abdominal obesity, TG >150 mg/dL, low HDL, BP >130/85 mmHg, or fasting glucose >100 |
| how would you manage metabolic syndrome? | primary goal would be to reduce/prevent obesity, treat underlying causes, treat lipid and non-lipid risk factors if they persist |
| what is the prognosis for a person with metabolic syndrome? | increased risk of type 2 DM, CAD, acute myocaridal infarction, and all-cause mortality |
| what percent of hyperlipoproteinemias are secondary in nature? | 20% |
| what are some causes of increased cholesterol for secondary hyperlipoproteinemia? | 1. pregnancy 2. hypothyroidism 3. nephrotic syndrome 4. cholestasis (intra or extra) 5. DM 6. steroid therapy 7. medications |
| what are the 3 arch-type causes of increased triglycerides for secondary hyperlipoproteinemia? | 1. lifestyle 2. medications 3. medical conditions see notes |
| the total output of fecal fat per _____ hours in a ____ day stool collection provides the most reliable measurement. | 24 3 |
| what are the 3 major causes of steatorrhea? | deficiency of pancreatic enzymes deficiency of bile in intestinal lumen impairment of intestinal absorption |
| what is the main cause of chyluria? | fat embolism from breaking of long bones |
| what are two secondary causes of chyluria? | filariasis and kidney stones |
| what is the main aspect of gluten that triggers gluten-induced enteropathy? | gliadin |
| what are the three main sources of gluten? | wheat rye and barley |
| what is the incidence of gluten-induced enteropathy? about how many US residence live with it? | 50-75/100,000 3 million |
| what are the 2 age peaks for gluten-induced enteropathy? what is the female to male ratio of this? | 1 and 60 3:2 |
| what is a major flag to look for with a child that may have a gluten-induced enteropathy? | large appetite with weight loss |
| what grain doesnt contain gluten but is commonly contaminated with it? | oats |
| for those that have primary lactose intolerance how much milk can be tolerated on a daily basis? | 8 oz |
| what is a major piece of information for a person with secondary lactose intolerance? | dont drink milk while in a state of diarrhea |
| what percentage of infants with diarrhea have lactose intolerance? | 50% |
| what percentage of northern european descendants have lactose intolerance? african americans/latinos? native american/asians? | 15% 80% 100% |
| how soon after ingesting lactose does one with an intolerance begin to suffer symptoms? | 30 mins to 2 hours |
| what are 2 milk products that are tolerated by lactose intolerant people? | hard cheeses and yogurt |
| what would the stool pH be for someone that has lactose intolerance? | below 6.0 |
| what could you find in the stool of someone that has lactose intolerance? | glucose |
| ____% of prescription drugs and ____% of OTC drugs use lactose as a base. | 20 6 |
| most patients can tolerate ___ to ___ grams of lactose despite their lactose intolerance. | 12-15 grams |
Created by:
okeywan
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