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ClinChem Test3

Chpt 10- Assessment of Nutrition and Digestive Function

Macronutrient assessment consists of: Proteins, Lipids, Carbohydrates and their derivatives
Micronutrient status focuses on vitamins and minerals
Twenty amino acids are important to human body function, how many of these can NOT be made by the adult human and are considered essential nutrients eight
Humans are also unable to produce two important what? fatty acids and these must be included in the diet
Biochemical measurements of such compounds as creatinine, albumin, transferrin, and a few others provide a quantitative measure of nutritional status
Creatinine is a waste product of muscle metabolism, and provides an assessment of the total muscle mass in patients with normal renal function
Hypoalbuminemia is an indicator of protein deficiency
Retinol binding protein correlates well with protein-energy status of the patient. However, retinol-binding protein concentration is affected by glomerular filtration rate, so assessment of this protein must also be carefully evaluated like with creatinine
Transferrin is the protein that acts as a carrier for iron. It has a half life of 8 days, which makes it a sensitive marker for protein-energy nutritional status
Iron concentration must be taken into account along with transferrin concentration
Transthyretin or TBPA (PreAlbumin) is the protein that acts as a carrier for thyroid hormones
Thyroid hormone levels must be taken into account when considering Transthyretin concentration
Nitrogen Balance is the measurement of the difference between nitrogen intake and excretion
A positive nitrogen balance is recommended for certain disorders such as wound healing, anabolism and growth
Since most nitrogen is excreted in urine, nitrogen balance may be estimated by measurement of urinary urea nitrogen
Vitamins are classified by the solubility: fat soluble vitamins must have carrier molecules while water soluble vitamins do not
Trace Elements are vital to normal function and are necessary for restoring health during the recovery phase from a disease
Zinc, Copper, Selenium and Chromium are considered trace minerals
Copper is found mostly in ceruloplasmin, a deficiency in copper results in decreased hemoglobin and collagen production.
Vitamin A has three active forms : Retinol, Retinal, and Retinoic acid
What happena when the body needs vitamin A free Retinol is released from the liver bound to retinol binding protein and travels through the blood to the target cell
In Rods of the eye, Retinol is oxidized to Retinal. This aldehyde combines with opsin to form rhodopsin, a photopigment of vision
Night blindness is the result of a combined deficiency of Zinc and carrier proteins for Retinol
Macrocytic anemia may be caused by vitamin deficiencies of folic acid or vitamin B 12
Folate is a coenzyme that is necessary for carbon transfers in metabolism. Folate deficiencies also result in hematologic affects
In the small intestine Vitamin B12 becomes bound to intrinsic factor (Glycoprotein which is secreted by parietal cells of the gastric mucosa) This allows it to be absorbed by the small intestine
Failure to produce intrinsic factor causes pernicious anemia due to the bodies inability to absorb Vit B12
you can become Vitamin B 12 deficient by not taking in enough meat and eggs which contain Vitamin B 12, or you can have problems with your Intrinsic factor they will both cause a Vitamin B 12 deficiency which will result in a macrocytic anemia
Diseases that can interfere with the secretion or activation of intrinsic factor are: Destruction of Gastro Intestinal mucosa, malabsorption, intestinal parasites, gastric resection, celiac sprue( gluten intolerance), Crohn’s Disease and autoimmunity that results in destruction of the gastric parietal cells.
Folic acid is present in green vegetables, liver, and yeast
The functions of folate and Vit B 12 are linked
In the conversion of Homocysteine to methionine, Vit B12 is a coenzyme in the reaction in which a methyl group is transferred by folic acid
Folic acid is a B vitamin that is required for the production of normal red blood cells
Prediabetes is defined by results that fall into the impaired range but not the diabetic range. These results include fasting glucose 101 – 125 and 2 hour plasma glucose 140 – 199
Prediabetes and metabolic syndrome are associated with high triglycerides, low HDL, hypertension, and the development of cardio vascular disease.
The digestive enzymes or exocrine secretions, hydrolyze large molecules in food into small, soluble molecules that can be transported across the lining of the gastrointestinal tract into the blood where they can travel to cells
Nutrients are ground into small pieces by the teeth, partially digested by salivary amylase
Chief cells synthesize and secrete pepsin and pepsinogen, the precursor to pepsin
Pepsin is a proteolytic enzyme that degrades polypeptide chains
Parietal cells produce hydrochloric acid and intrinsic factor. Hydrogen Ion secretion is stimulated by the hormone gastrin, which is produced by the cells of the pyloric region of the stomach and the duodenum
First section of the small intestine is the duodenum
Both the gallbladder and the pancreas drain into the duodenum. The gallbladder drains bile, which is comprised of bile acids, and bile pigments produced by the liver.
The release of bile from the gall bladder is stimulated by the hormone cholecystokinin. Bile acids contain lipids that have been conjugated to hydrophilic groups to make them more soluble in the water-based fluids of the intestinal system
Bile pigments consist of the breakdown products of hemoglobin, which contribute to the color of the feces
The pancreas secretes sodium bicarbonate which brings the pH back up to around 8. it also releases proteolytic enzymes which attack proteins in the gastric fluid.
Pancreatic fluid secretion is controlled by hormones
Secretin controls the release of sodium bicarbonate, and cholecystokinin controls the release of catabolic enzymes
Amylase breaks down starch polymers into monosacharides, and lipase hydrolyzes triglycerides into fatty acids and monoglycerides
Final digestion of nutrients occurs in the villi, which line the lumen of the small intestine
The large intestine’s main function is to reabsorb water, if too much is reabsorbed then constipation can occur
Symptoms of Malabsorption are caused both by the effects of water absorption from nondigested substances and by nutritional deficiencies in tissue cells. Symptoms include weight loss, bruising, flatulence, bloating and diarrhea
A common consequence of malabsorption is steatorrhea, is the presence of excess fat in feces
Severe vomiting and diarrhea can result in acid base imbalance as well as dehydration or renal failure
Lab tests for malabsorption include: Fecal fat, Iron, Folate, Vit B12, D-Xylose absorption, and Lactose breath test
Gastric fluid analysis may be useful in assessing gastrin-secreting tumors such as in Zollinger-Ellison syndrome, evaluating gastric hyperacidity, and diagnosing achlorhydria
Zollinger –Ellison is a syndrome that is cause by a gastrin producing tumor or gastrinoma
High levels of gastrin cause the overproduction of stomach acid, and the high acid levels lead to multiple ulcers in the stomach and small bowel
Cystic Fibrosis is an inherited, autosomal recessive disease that affects nearly all exocrine glands in the body
Cystic Fibrosis is characterized by: COPD, pancreatic insufficiency, and abnormally high sweat electrolytes. The disease causes the exocrine glands to become clogged with viscous material
Excessive sweating leads to episodes of hypotonic dehydration, and circulatory failure. (The formation of salt crystals on skin is an indicator of CF)
The diagnosis of CF is made by clinical symptoms and positive sweat chloride test
Newborns with CF have an increased amount of immunoreactive trypsin in their blood.. (Used for newborn screening of CF)
Created by: Mgoodall