NUTR Exam Review

Vitamins and Minerals

• Coenzyme used in metabolism:
  • Deficiencies:
    • Dry Beri Beri: peripheral neurologic defects, bilateral and occur in a stocking-glove pattern
    • Wernicke-Korsakoff syndrome: alcoholics who do not consume foods fortified with thiamine, psychomotor slowing or apathy
    • Infantile Beri Beri: breastfed from thiamine deficient mothers
    • Cardiovascular (wet) Beri Beri: peripheral edema
• Vitamin B3 (Niacin):
  • Sometimes used to lower LDL and TG
  • Supplementation can induce flushing, give aspirin
  • Deficiency: Pellagra, characterized by 3D's- diarrhea, dementia, and dermatitis
• Vitamin B12 (Cobalamin):
  • Activated folate
  • Deficiency: inadequate absorption, can develop in vegans, causes megaloblastic anemia, damage to the white matter of the spinal cord and brain
• Folate:
  • Involved in RBC maturation and synthesis of purine and pyrimidine
  • Required for the development of fetal nervous system
  • Deficiency: results from inadequate intake, malabsorption, various drugs, causes megaloblastic anemia (indistinguishable from B12)
• Vitamin C:
  • Roles: synthesis of collagen, carnitine, hormones, neurotransmitter, and antioxidant

Water and Body Fluids

• Role and function of water:
  • Carries nutrients and waste products throughout the body
  • Maintains the structure of large molecules such as proteins and glycogen
  • Participates in metabolic reactions
  • Serves as the solvent for minerals, vitamins, AA, glucose, and many other small molecules
  • Maintains blood volumes
  • Aids in the regulation of normal body temperature
  • Acts as a lubricant around joints and inside the eyes, spinal cord, and amniotic sac surrounding the fetus
• Water regulation:
  • Effects of dehydration: thirst, dry mouth, lips, and throat, rapid pulse, low BP, lack of energy, weakness, impaired kidney function, reduced quantity of urine, and concentrated urine
• Regulatory systems:
  • Hypothalamus and pituitary gland regulate water excretion
  • Hormones: aldosterone, ADH, and renin
  • Water loss, low blood volume, and low BP: cells in the kidney release renin, cascade of events, release of aldosterone, kidneys hold on to water
• Hyponatremia vs. Hypernatremia:
  • Hyponatremia: low sodium levels
  • Hypernatremia: high sodium levels

Minerals

• Major:
  • Calcium (Ca):
    • Hypercalcemia: Ca level exceeds 13 mg/dL, causes include primary or secondary hyperparathyroidism, malignancy, Paget's disease, Addison's disease, Vit D intoxication
    • Hypocalcemia: blood levels < 8.5 mg/dL, causes include surgery, severe illness, sepsis, osteoblastic metastases, hyperphosphatemia, CKD, medications, malnutrition, blood transfusion, large volume IV, rhabdo, acute pancreatitis
  • Magnesium (Mg):
    • Deficiency: inadequate intake, vomiting/diarrhea, alcohol abuse, malnutrition, people using diuretics and PPIs, effects: low blood Ca, muscle cramps, seizures, hallucinations associated with alcohol withdrawal, worsens inflammation in chronic disease
    • Toxicity: rare but can be fatal, occurs with high intake of non-food sources, accidental position or overuse in adults, effects: diarrhea, abdominal cramps, severe acid-base imbalances, and K depletions
  • Potassium (K):
    • Elevated K: hyperkalemia EKG changes
    • Low K: hypokalemia, muscle weakness, fatigue, palpitations
  • Sodium (Na):
    • Deficiency: muscle cramps, mental apathy, loss of appetite
    • Toxicity: HTN
  • Phosphorus (P):
    • Deficiency: unknown
    • Toxicity: calcification of non-skeletal tissue, kidneys
• Trace:
  • Copper:
    • Deficiency: anemia, bone abnormalities
    • Toxicity: Wilson's disease, inherited, poor coordination, Kayser-Fleischer Ring, Dx by liver biopsy, treatment: chelation
  • Iron:
    • Deficiency: most common deficiency, inadequate intake, blood loss, labs: decrease in transport iron, decrease in iron stores, and ferritin levels
    • Toxicity: hemochromatosis, hereditary disorder, increased intestinal absorption of iron, causes: liver disease, heart problems, diabetes, and infertility
  • Iodine:
    • Deficiency: Goiter, cretinism
    • Toxicity: decreased thyroid activity
  • Zinc:
    • Deficiency: growth retardation, delayed sexual maturity, impaired immune function, loss of taste, poor wound healing, eye and skin lesions
    • Toxicity: loss of appetite, impaired immunity, low HDL, n/v/d, headaches, copper, and iron deficiencies

Pregnancy/Lactation/Breastfeeding

• The role of B12, folate, and choline during pregnancy:
  • Folate and B12: important for increased blood volume, folate necessary to prevent neural tube defects, increase from 400-600 mcg/day
  • Choline: necessary for closure of neural tube and normal brain/spinal cord development, no in PNV
• The role of Vit D, Ca, and Iron during pregnancy:
  • Vitamin D and Ca: insufficient may produce abnormal fetal bone growth or tooth development
  • Iron: absorption increases threefold, still often low, body gives priority to fetus, supplement needed
• Potential vitamins/minerals depleted during lactation:
  • ????
• Contraindications to breastfeeding:
  • Alcohol, tobacco, caffeine
• Possible supplements for the breastfed infant:
  • Vitamin D
• Carbohydrate in breast milk:
  • Lactose
• Depleted nutrient in breast milk:
  • Vitamin D?
• Protective factors in breast milk:
  • Immunological protection

Nutrition of the Infant

• When to transition to cow's milk:
  • 1 year old
• Risks of transitioning to cow's milk too soon:
  • GI bleeding, iron deficiency

Diet-Drug Interactions

• How drugs may alter food intake:
  • Suppress appetite, cause dry mouth, alter sense of taste, stimulate appetite, wt gain, unintentional weight loss
• How drugs alter nutrient absorption:
  • Medications that most often cause nutrient malabsorption: antineoplastic drugs, antiretroviral, NSAIDs, antibiotics
  • Medications bind to nutrients in the GI tract, preventing their absorption
  • Reduced stomach acid affects the absorption of B12, folate, and Iron
• How drugs alter nutrient excretion:
  • Drugs that increase urine production may reduce nutrient reabsorption in the kidneys
  • Diuretics, depletion of K+, Na+, and Ca+
  • Some drugs are designed to retain certain minerals, potassium sparing diuretics, promote Na+ and water retention

Stress Response

• Hormonal Response to Stress:
  • Catecholamines: increased metabolic rate, glycogen breakdown, glycogen production, release of fatty acids, glucagon secretion
  • Glucagon: glycogen breakdown, glucose production, release of fatty acids
  • Cortisol: protein degradation, enhancement of glucagon's action, glucose production, release of fatty acids
  • Aldosterone: sodium reabsorption in the kidneys
  • Antidiuretic Hormone: water reabsorption in the kidneys

Digestive Organs

Pathway of Digestion

• Mouth (epiglottis prevents flow into lungs, upper esophageal sphincter)
• Esophagus (lower esophageal sphincter closes)
• Stomach (passes through pyloric sphincter)
• Small intestine (ileocecal valve, passes by appendix)
• Large intestine/colon rectum (anus)

Movement

• Peristalsis: wavelike contractions
• Segmentation: periodic squeezing of segments

Process of Digestion

Mouth

• Salivary glands secrete saliva containing:
  • Water
  • Salts
  • Enzymes (amylase)
• Amylase breaks down amylose

Stomach

• Gastric glands secrete gastric juice containing:
  • Water
  • Enzymes (HCl + pepsin)
• Pepsin breaks down proteins
• Minor events: digestion of some fat (gastric lipase), sucrose (by stomach acid), attachment of protein carrier to Vit B12

Small Intestine

• Intestinal juice secreted by intestinal glands contains:
  • Enzymes for CHO and PRO digestion
• Pancreatin juice for fat, PRO, and CHO digestion
• Bicarbonate neutralizes acidic chyme
• Bile from the liver (concentrated and stored in the gallbladder) is a coenzyme used in metabolism

Vitamins and Minerals

Vitamin B1 (Thiamine)

• Deficiency: Beri Beri, Wernicke-Korsakoff syndrome, infantile Beri Beri, cardiovascular Beri Beri

Vitamin B3 (Niacin)

• Sometimes used to lower LDL and TG
• Deficiency: Pellagra (3D's: Diarrhea, Dementia, Dermatitis)

Vitamin B12

• Activated folate
• Deficiency: megaloblastic anemia, damage to white matter of spinal cord and brain

Folate

• Involved in RBC maturation and synthesis of purine and pyrimidine
• Deficiency: megaloblastic anemia

Vitamin C

• Roles: synthesis of collagen, carnitine, hormones, neurotransmitter, antioxidant

Choline

• Role: pregnancy

Water and Body Fluids

Role and Function of Water

• Carries nutrients and waste products throughout the body
• Maintains structure of large molecules
• Participates in metabolic reactions
• Serves as a solvent for minerals, vitamins, amino acids, and glucose
• Maintains blood volume
• Aids in the regulation of normal body temperature

Water Regulation

• Thirst
• Dry mouth, lips, and throat
• Rapid pulse
• Low blood pressure
• Lack of energy and weakness
• Impaired kidney function
• Reduced urine quantity; concentrated urine

Regulatory Systems

• Hypothalamus and pituitary gland regulate water excretion
• Hormones: ADH, aldosterone, renin

Minerals

Major Minerals

Calcium

• Hypercalcemia: Ca level exceeds 13 mg/dL
• Hypocalcemia: blood levels < 8.5 mg/dL
• Corrected Ca formula: total Ca + (0.8 * normal albumin - pt's albumin)

Magnesium

• Deficiency: inadequate intake, vomiting/diarrhea, alcohol abuse, malnutrition, people using diuretics and PPIs
• Effects: low blood Ca, muscle cramps, seizures, hallucinations
• Toxicity: rare, but can be fatal, occurs with high intake of non-food sources

Potassium

• Elevated K: hyperkalemia, EKG changes
• Low K: hypokalemia, muscle weakness, fatigue, palpitations

Sodium

• Deficiency: muscle cramps, mental apathy, loss of appetite
• Toxicity: hypertension

Pregnancy and Lactation

The Role of B12, Folate, and Choline

• Folate and B12: important for blood volume increase in the mother
• Choline: closure of neural tube and normal brain/spinal cord development in fetus

The Role of Vit D, Ca, and Iron

• Vitamin D and Ca: insufficient may produce abnormal fetal bone growth or tooth development
• Iron: absorption increases threefold in pregnancy, still often low, body gives priority to fetus for delivery of iron

Potential Vitamins/Minerals Depleted during Lactation

• Na+ and Ca+

Stress Response

Hormonal Response to Stress

• Catecholamines: increase metabolic rate, glycogen breakdown, and glucagon secretion
• Glucagon: glycogen breakdown, glucose production, and fatty acid release
• Cortisol: protein degradation, enhancement of glucagon's action, and glucose production
• Aldosterone: sodium reabsorption
• Antidiuretic hormone: water reabsorption

Water Soluble Vitamins

Thiamin (Vitamin B1)

• Involved in metabolism of carbohydrates, fats, amino acids, glucose, and alcohol
• Found in fortified cereals and unrefined carbohydrates
• Deficiency causes:
  • Wet Beri Beri: cardiovascular problems
  • Infantile Beri Beri: heart failure, absent deep tendon reflexes, aphonia
  • Dry Beri Beri: peripheral neuropathic defects
  • Wernicke-Korsakoff syndrome: in alcoholics, encephalopathy and psychosis
• At-risk populations: developing countries with high refined carbohydrate diet, malabsorption syndrome, and alcoholics
• Treatment: 100mg Thiamine

Riboflavin (Vitamin B2)

• Found in milk, fortified cereal, and animal products
• Deficiency causes:
  • Sore throat, lesions on mucosa
• At-risk populations: individuals who don't consume enough milk, fortified cereal, or animal products
• Diagnosis: clinical diagnosis or measure urinary excretion of riboflavin
• Treatment: B supplements or Riboflavin

Niacin (Vitamin B3)

• Found in milk, fortified cereal, and animal products
• Deficiency causes:
  • Pellagra: 3 D's (dermatitis, diarrhea, dementia)
  • Advanced Pellagra: asymmetric photosensitive rash
• At-risk populations: developing countries, patients with malabsorption issues, alcoholics, anorexia, and HIV patients
• Treatment: oral or IM supplementation

Pantothenic Acid (Vitamin B5)

• Essential component of Coenzyme A
• Found in fish, broccoli, eggs, tomatoes, and whole grains
• Benefits: helps patients with RA and lipid metabolism

Pyridoxine (Vitamin B6)

• Found in most foods
• Deficiency causes:
  • Peripheral neuropathy, pellagra-like syndrome, anemia, and seizures in infants
• At-risk populations: secondary deficiency caused by protein undernutrition, malabsorption, alcoholism, certain medications, and excessive loss during hemodialysis
• Treatment: supplement, treat underlying cause (e.g., anorexia)

Biotin

• Coenzyme for lipid and carbohydrate metabolism
• Found in yeast, soybeans, peanut butter, and mushrooms
• Benefits: helps with N/V, alopecia, and dermatitis

Folate (Vitamin B9)

• Involved in RBC maturation and synthesis
• Required for fetal nervous system development
• Deficiency causes:
  • Megaloblastic anemia
  • Increased risk of neural tube birth defects in pregnant mothers
• At-risk populations: malabsorption, use of various drugs, and pregnant mothers
• Diagnosis: lab test, measures neutrophil hypersegmentation
• Treatment: oral folate supplementation

Cobalamin (Vitamin B12)

• Stored in high levels in the liver
• Helps with neuron development, neural transmission, and folic acid absorption
• Deficiency causes:
  • Megaloblastic anemia, damage to white matter of spinal cord and brain, and peripheral neuropathy
• At-risk populations: vegans, H. pylori, malabsorption, gastric bypass patients, and pregnant mothers
• Diagnosis: measure blood serum and Schilling test to determine etiology
• Treatment: oral or parenteral B12 supplementation

Ascorbic Acid (Vitamin C)

• Increases metabolic function, collagen synthesis, hormonal regulation, and decreased hypoxia-inducible factor
• Found in citrus fruits, strawberries, and leafy greens
• Deficiency causes:
  • Scurvy: hemorrhagic manifestations, abnormal osteon and dentin formations
• Symptoms: fatigue, depression, connective tissue defects, and impaired bone growth in infants
• Clinical diagnosis
• Upper limit: 2000mg/day
• Toxicity: acidic urine, nausea, and diarrhea

Note: The format of the original text has been reorganized to facilitate easier studying and understanding of the material.Here are the study notes based on the provided text:

• Major Minerals*

Calcium

• Found in milk, dark leafy greens, and calcium supplements
• Function: essential for bone health, muscle function, and nerve function
• Deficiency: hypocalcemia (muscle cramps, twitching, numbness in fingers and toes)
• Toxicity: hypercalcemia (constipation, kidney stones, abdominal cramps)

Phosphorus

• Found in calcium crystal structures, bones, teeth, and DNA/RNA
• Function: essential for energy transfer, protein synthesis, and bone health
• Deficiency: muscle weakness, anemia, bone softening (osteomalacia)
• Toxicity: kidney disease, calcium levels affected

Magnesium

• Found in spinach, black beans, soy milk, and yogurt
• Function: essential for heart function, muscle relaxation, and nerve function
• Deficiency: muscle cramps, weakness, fatigue, seizures, and heart rhythm disturbances
• Toxicity: rare, but can cause diarrhea, nausea, and vomiting

Potassium

• Found in fruits, vegetables, and whole grains
• Function: essential for heart function, muscle contraction, and nerve function
• Deficiency: muscle weakness, fatigue, heart rhythm disturbances
• Toxicity: rare, but

B Vitamins – Coenzymes

Vitamin B1 – Thiamine

• Involved in carbohydrate, fat, amino acid, glucose, and alcohol metabolism
• Coenzyme used in metabolism
• Deficiency:
  • Dry Beri Beri: peripheral neurologic defects, bilateral and occur in a stocking-glove pattern (predominately the lower extremities)
  • Wernicke-Korsakoff syndrome: seen in alcoholics who do not consume foods fortified with thiamine
  • Wernicke encephalopathy: psychomotor slowing or apathy, psychosis, and altered mental status (AMS)
  • Infantile Beri Beri: breastfed from thiamine-deficient mothers
  • Cardiovascular (wet) Beri Beri: peripheral edema

Vitamin B3 – Niacin

• Sometimes used to lower LDL and triglycerides (TG)
• Supplementation can induce flushing, which can be alleviated with aspirin
• Also a coenzyme used in metabolism
• Deficiency:
  • Pellagra: characterized by the 3Ds - diarrhea, dementia, and dermatitis

Vitamin B12 (Cobalamin)

• Activated folate
• Deficiency:
  • Due to inadequate absorption, can develop in vegans
  • Causes megaloblastic anemia and damage to the white matter of the spinal cord and brain

Folate (Other B Vitamin)

• Involved in red blood cell (RBC) maturation and synthesis of purine and pyrimidine
• Required for the development of the fetal nervous system
• Deficiency:
  • Results from inadequate intake, malabsorption, and various drugs
  • Causes megaloblastic anemia (indistinguishable from B12 deficiency)

Vitamin C

• Roles:
  • Synthesis of collagen, carnitine, hormones, and neurotransmitters
  • Antioxidant properties

Calcium (Ca)

• Hypercalcemia: Ca level exceeds 13 mg/dL
  • Causes: primary or secondary hyperparathyroidism, malignancy, Paget's disease, Addison's disease, Vit D intoxication
  • Clinical manifestations: constipation, anorexia, AKI, kidney stones, ST elevations of EKG, muscle weakness
• Hypocalcemia: blood levels < 8.5 mg/dL
  • Causes: surgery, severe illness, sepsis, osteoblastic metastases, hyperphosphatemia, CKD, medications, malnutrition, blood transfusion, large volume IV, rhabdo, acute pancreatitis
  • Corrected Ca: measures total Ca + (0.8*normal alb – pts alb)

Magnesium (Mg)

• Deficiency:
  • Causes: inadequate intake, vomiting/diarrhea, alcohol abuse, malnutrition, people using diuretics and PPIs
  • Effects: low blood Ca, muscle cramps, seizures, hallucinations associated w/ alcohol withdrawal, worsens inflammation in chronic disease, increased risk for HF and stroke, adverse effects on bone metabolism (increased risk for osteoporosis)
• Toxicity:
  • Rare but can be fatal
  • Occurs with high intake of non-food sources such as supplements or salts
  • Accidental poisoning or overuse in adults (such as laxatives or antacids)
  • Effects: diarrhea, abdominal cramps, severe acid-base imbalances and K depletions

Potassium (K)

• Elevated K = hyperkalemia → EKG changes
• Low K = hypokalemia → muscle weakness, fatigue, palpitations

Sodium (Na)

• Deficiency: muscle cramps, mental apathy, loss of appetite
• Toxicity: HTN

Phosphorus (P)

• Deficiency: unknown
• Toxicity: calcification of non-skeletal tissue – kidneys

Copper

• Deficiency: anemia, bone abnormalities
• Toxicity:
  • Wilson's disease: inherited
  • Poorly coordinated movements
  • Kayser-Fleischer Ring
  • Dx by liver biopsy – Mallory hyalin bodies
  • Treatment: chelation

Iron

• Deficiency:
  • Most common deficiency
  • Inadequate intake
  • Blood loss
  • Labs:
    • Both iron stores and ferritin levels diminish
    • Decrease in transport iron: low iron → increase in transferrin → TIBC declines as transferrin is saturated
• Toxicity:
  • Hemochromatosis (iron overload)
    • Hereditary disorder of increased intestinal absorption of iron from diet
    • Hepcidin supports iron hemostasis and a deficiency of hepcidin causes hemochromatosis
    • Requires repeated blood transfusions
    • Rare metabolic disorder
    • Causes free radical tissue damage (especially in the liver)
    • More common in men

Iodine

• Deficiency: Goiter, cretinism
• Toxicity: decreased thyroid activity

Zinc

• Deficiency: growth retardation, delayed sexual maturity, impaired immune function, loss of taste, poor wound healing, eye and skin lesions
• Toxicity: loss of appetite, impaired immunity, low HDL, n/v/d, headaches, copper and iron deficiencies

Calcium (Ca)

• Hypercalcemia: Ca level exceeds 13 mg/dL
  • Causes: primary or secondary hyperparathyroidism, malignancy, Paget's disease, Addison's disease, Vit D intoxication
  • Clinical manifestations: constipation, anorexia, AKI, kidney stones, ST elevations of EKG, muscle weakness
• Hypocalcemia: blood levels < 8.5 mg/dL
  • Causes: surgery, severe illness, sepsis, osteoblastic metastases, hyperphosphatemia, CKD, medications, malnutrition, blood transfusion, large volume IV, rhabdo, acute pancreatitis
  • Corrected Ca: measures total Ca + (0.8*normal alb – pts alb)

Magnesium (Mg)

• Deficiency:
  • Causes: inadequate intake, vomiting/diarrhea, alcohol abuse, malnutrition, people using diuretics and PPIs
  • Effects: low blood Ca, muscle cramps, seizures, hallucinations associated w/ alcohol withdrawal, worsens inflammation in chronic disease, increased risk for HF and stroke, adverse effects on bone metabolism (increased risk for osteoporosis)
• Toxicity:
  • Rare but can be fatal
  • Occurs with high intake of non-food sources such as supplements or salts
  • Accidental poisoning or overuse in adults (such as laxatives or antacids)
  • Effects: diarrhea, abdominal cramps, severe acid-base imbalances and K depletions

Potassium (K)

• Elevated K = hyperkalemia → EKG changes
• Low K = hypokalemia → muscle weakness, fatigue, palpitations

Sodium (Na)

• Deficiency: muscle cramps, mental apathy, loss of appetite
• Toxicity: HTN

Phosphorus (P)

• Deficiency: unknown
• Toxicity: calcification of non-skeletal tissue – kidneys

Copper

• Deficiency: anemia, bone abnormalities
• Toxicity:
  • Wilson's disease: inherited
  • Poorly coordinated movements
  • Kayser-Fleischer Ring
  • Dx by liver biopsy – Mallory hyalin bodies
  • Treatment: chelation

Iron

• Deficiency:
  • Most common deficiency
  • Inadequate intake
  • Blood loss
  • Labs:
    • Both iron stores and ferritin levels diminish
    • Decrease in transport iron: low iron → increase in transferrin → TIBC declines as transferrin is saturated
• Toxicity:
  • Hemochromatosis (iron overload)
    • Hereditary disorder of increased intestinal absorption of iron from diet
    • Hepcidin supports iron hemostasis and a deficiency of hepcidin causes hemochromatosis
    • Requires repeated blood transfusions
    • Rare metabolic disorder
    • Causes free radical tissue damage (especially in the liver)
    • More common in men

Iodine

• Deficiency: Goiter, cretinism
• Toxicity: decreased thyroid activity

Zinc

• Deficiency: growth retardation, delayed sexual maturity, impaired immune function, loss of taste, poor wound healing, eye and skin lesions
• Toxicity: loss of appetite, impaired immunity, low HDL, n/v/d, headaches, copper and iron deficiencies

Hormonal Response to Stress

• Catecholamines increase metabolic rate, break down glycogen in the liver and muscle, produce glycogen from amino acids, release fatty acids from adipose tissues, and stimulate glucagon secretion from the pancreas.

• Glucagon breaks down glycogen in the liver, produces glucose from amino acids, and releases fatty acids from adipose tissue.

• Cortisol degrades protein, enhances glucagon's action on liver glycogen, produces glucose from amino acids, and releases fatty acids from adipose tissue.

• Aldosterone promotes sodium reabsorption in the kidneys.

• Antidiuretic Hormone (ADH) promotes water reabsorption in the kidneys.

Inflammatory Response

• Inflammatory response is a group of non-specific immune responses to infection or injury, mediated by compounds released from damaged tissues, immune cells, and blood vessels.

• Signs of inflammation include heat, redness, swelling, and pain.

• Clinical signs of inflammation include fever, increased heart rate and blood pressure, and increased blood neutrophils.

• Histamines are released from tissue cell injury.

• Mast cells produce and release histamines.

• Cytokines are signal proteins produced by immune cells that regulate various aspects of immune function.

• Cytokines release leads to systematic effects, including acute phase response.

• Acute phase proteins produced by the liver include CRP, complement, hepcidin, and blood clotting proteins (fibrinogen and prothrombin).

• Eicosanoids are 20-carbon molecules derived from dietary fatty acids that help regulate blood pressure, blood clotting, and other body functions.

Respiratory Stress

• Chronic Obstructive Pulmonary Disease (COPD) is characterized by chronic bronchitis, persistent inflammation, and excessive secretion of mucus in the airways and lungs.

• COPD can lead to respiratory or heart failure.

• Cigarette smoking is the primary risk factor for COPD.

• Medications for COPD include bronchodilators to improve air flow and corticosteroids to reduce inflammation.

• Emphysema is characterized by the breakdown of the lungs' elastic structure, destruction of bronchioles and alveoli, and diagnosis based on clinical signs and results of pulmonary function tests (PFTs).

GERD

• Gastroesophageal Reflux Disease (GERD) is caused by a weak or improperly relaxing lower esophageal sphincter muscle.

• Symptoms of GERD include heartburn after meals.

• Chronic GERD can lead to Barrett's esophagus, where esophageal cells are gradually replaced by gastric or intestinal lining, potentially leading to cancer.

• Treatment for GERD includes lifestyle changes, proton pump inhibitors (PPIs), and H2 blockers.

Pancreatitis

• Acute pancreatitis is characterized by the premature activation of digestive enzymes within pancreatic cells, destroying pancreatic tissue and leading to inflammation.

• Chronic pancreatitis is characterized by progressive damage to pancreatic tissue, resulting in impaired secretion of digestive enzymes and bicarbonate.

• Causes of acute pancreatitis include gallstones and alcohol abuse.

• Nutrition for acute and chronic pancreatitis includes oral fluids, nothing by mouth (NPO), fat-restricted diet, and high protein intake (1.2-1.5 g/kg).

• Related enzymes and possible nutrient deficiencies include pancreatic enzyme replacement, which may decrease folate and iron absorption.