Nutrition
"A state of enhanced metabolic activity, characterized by an increase of the basal metabolic rate"
What is hypermetabolism?
T/F: Humans have no physiological pathway for the excretion of iron.
True
You know that sudden embolic occlusion of the SMA root is a medical emergency with a poor prognosis. Name the portion(s) of the bowel most frequently affected by SMA occlusion?
What are the small intestine and right side of the colon.
Which statement accurately reflects the modern epidemiological trend of sigmoid diverticulitis according to the review?
A. It remains strictly a disease of the elderly, with incidence decreasing in younger populations.
B. The lifetime risk of developing diverticulitis from diverticulosis is higher than previously estimated.
C. It is increasingly being seen in young patients (under 50 years), with the incidence in the 18–44 age group nearly doubling over a recent 7-year period.
D. The incidence has significantly increased in patients older than 75 years, but not in younger individuals.
C. It is increasingly being seen in young patients (under 50 years), with the incidence in the 18–44 age group nearly doubling over a recent 7-year period.
T/F: Critically ill patients use proteins as an energy source.
True
Interpret: Hgb 10.9 g/dL; Hct 32.7%; MCV 77 fL; MCHC 30 g/dL
Microcytic, hypochromic anemia
What is a common misleading laboratory value when evaluating a patient with Acute Mesenteric Ischemia?
A. Amylase which suggests acute pancreatitis
B. Lactate which suggests septic shock
C. Hyperglycemia which suggests diabetic ketoacidosis
D. Elevated creatinine which suggests acute kidney injury
A. Amylase, acute pancreatitis is a common red herring and promotes misdiagnosis. Lactate is more indicative of the ischemic pathophysiology but it should be noted that patients with AMI are at high risk for bacterial translocation and subsequent sepsis. Elevated creatinine may be present but should not deter CTA. Hyperglycemia is likely secondary to a systemic inflammatory cascade / stress response. Of note, DKA should be a differential in AMI (Why?) Double points if you can answer this additional question!
In the non-operative management of mild or uncomplicated acute diverticulitis (modified Hinchey 0 and IA), what does high-level evidence now suggest regarding antibiotic use?
Antibiotics may be omitted in mild cases, supporting a nuanced, selective approach.
T/F: Critically ill patients require extreme caloric intake in order to support immune function and maintain lean body fats.
False
In this anemia, there is a defect in the freeing of iron from macrophages and/or the loading of iron onto plasma transferrin resulting in low serum iron and iron-binding capacity, increased serum ferritin and often normocytic erythrocytes.
What is anemia of chronic inflammation or disease
Should a plain radiograph be used to diagnose mesenteric ischemia- why or why not?
A plain radiograph, while often the initial test ordered, is not recommended for evaluating the presence of mesenteric ischemia, because XR is only positive when one can actively visualize a perforation via intraperitoneal air.
Failure of non-operative management (antibiotics, supportive measures) for acute diverticulitis is typically defined by persistent or worsening symptoms and objective findings (such as fever, tachycardia, or leukocytosis) after what duration of best treatment?
72 hours
This screening tool, included in the ASPEN guidelines, evaluates three clinical parameters: weight loss, BMI and reduction of food intake in the previous 5 days.
What is the malnutrition universal screening tool (MUST)?
Elevated levels of methylmalonic acid and homocysteine are more sensitive diagnostic tests for this deficiency.
What is Vitamin B12?
Name all of the following risk factor(s) for Acute Mesenteric Arterial Embolism?
A. Atrial fibrillation
B. Left ventricular dysfunction with reduced EF
C. Endocarditis
D. Mitral valve disease
ALL - all are conditions that increase one’s ability to throw a clot.
What is the primary concern that makes interval colonoscopy essential after an episode of complicated diverticulitis?
The significantly higher pooled proportional estimate of underlying malignancy (5%–11%) compared to uncomplicated cases.
For DOUBLE: When do you recommend colonoscopy? (provide population(s) and timing of procedure)
What is the only effective treatment for anemia of chronic disease/inflammation?
Correct the underlying disorder.
Adequate bone marrow iron stores should be assessed before treatment with this drug in anemia of renal disease in order to ensure an optimal response.
What is epoetin alpha (EPO)?
What is the first-line treatment in acute Mesenteric Venous Thrombosis when the disease is without signs of acute peritonitis?
Non-operative management with continuous infusion of UFH (unfractionated heparin)
In the management of a diverticular abscess (modified Hinchey II), what is the typical first-line approach for an abscess larger than 5 cm?
Broad-spectrum antibiotics and image-guided percutaneous drainage.