nutrition food and digestion: a case study. objectives case study introduction develop an...
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NUTRITIONFood and Digestion: A Case Study
Objectives• Case study introduction• Develop an educational foundation in both digestion and
nutrition• Apply new knowledge in discussion of case study
CASE STUDY: Max• Signalment-
• 6 months old• Intact male• Yellow Labrador Retriever
• Chief Complaint- • Vomiting and diarrhea
• Physical Exam-• Lethargy/fatigue• Dysentery• Dehydration
CASE STUDY: Max
• History of present illness-• Started having diarrhea
yesterday morning and hasn’t stopped (~6x daily)
• Diarrhea appears mucoid and bloody
• He is potty trained but is pooping in the house anyways
• Began vomiting a few hours after first diarrhea spotted
• Vomit is clear, like water
• He has not been interested in playing with his toys, even his favorite stuffed bunny
• Stopped drinking or eating
• Only pet in the home
• Inside/outside dog
NUTRITIONA Foundation
Nutrition: Pregnancy and Early Childhood
• Physical and mental growth and development will be impaired if malnourished during:• Pregnancy• First two years of life
• This damage cannot be remedied once the child has aged• It will permanently affect the child
Nutrition: A Balanced Diet• Proteins: source of materials for growth and repair.
• Carbohydrates: source of energy.
• Fats: source of energy and contain fat soluble vitamins.
• Vitamins: needed for many enzyme systems.
• Minerals: needed for healthy teeth, bones, muscles etc.
• Fiber: helps your intestines function correctly; it is not digested.
Nutrition: Protein• A little protein chemistry:
• Proteins are large molecules made up of combinations of amino acids.
• Amino acids are organic substances made of nitrogen, oxygen, hydrogen and carbon.
• Some proteins additionally contain Sulfur (S) or Iron (Fe).
• Proteins are 3D structures • Folding is dependent on amino
acids present and the environment the protein is in
• Folding may also depend on a protease that cuts the protein or a ligand binding to the protein
Nutrition: Protein
Nutrition: Protein• Mad Cow Disease
• AKA Bovine Spongiform Encephalopathy (BSE)• PRION Disease
• Caused by misfolding of a necessary protein made in the nervous system• Acquired both randomly through mutation and by eating an already misfolded protein (contaminated
food)• A “bad protein” can misfold already present “good proteins” so that they are also bad.
A bad influence persuades the good kids to also be bad• The bad kid can move in from far away• The bad kid can develop randomly from a good kid
• BSE in the United Kingdom peaked in January 1993 at almost 1,000 new cases per week• Cumulatively, through the end of 2010, more than 184,500 cases of BSE had been confirmed in the
United Kingdom alone in more than 35,000 herds
• Other prion diseases:• Scrapie – Sheep• Creutzfeldt-Jakob – Humans• Kuru – Humans• Chronic Wasting Disease – Ruminants (deer, elk, etc)
Nutrition: Protein
PrPc= Normal protein
PrPsc= mutated or acquired bad prion
Nutrition: ProteinProtein content in grams per 1 cup:
Beef Sirloin 68.8Chicken Breast 43.3Salmon 40Cheddar Cheese 32.9Eggs 24.4Soybeans 22Almonds 20.2Beans, Pinto 15Peas, black-eyed 13Beans, red kidney 13Beans, baked 13Peas 8Spinach 6
Corn 5Rice 5Veggie burger 5Peanut butter 4Noodles 3.7Potatoes 3.5Beans, green 1.6Cauliflower 2Cabbage 1.5Carrots 1Cucumber 0.7Lettuce 0.7Mushrooms 0.3
All meats are high in protein!
Nutrition: Carbohydrates
• Some carbohydrate chemistry:• Carbohydrates are organic substances made of Carbon, Hydrogen
and Oxygen.• Carbohydrates are also called “sugars” and “starches.”• Carbohydrates are used in our bodies for energy. • These are broken down in the GI tract into maltose and glucose
Fruits, breads, pastas, beans, potatoes, bran, rice, and cereals.
Nutrition: Carbohydrates• Monosaccharides
• The most basic units of carbohydrates. They are the simplest form of sugar and are usually colorless, water-soluble, crystalline solids.
• Fructose- aka “fruit sugar”• Glucose- form of sugar used in the body as
energy; all other sugars and carbohydrates will be converted into glucose in the digestive system
• Galactose- from mammals’ milk
• Disaccharides• A sugar (a carbohydrate) composed of two
monosaccharides. It is formed when two sugars are joined together and a molecule of water is removed.
• Sucrose- Glucose + Fructose• Lactose- Glucose + Galactose• Maltose- Glucose + Glucose
Hexose HexosePentose
• Oligosaccharides• A sugar composed of 3-10
monosaccharides attached together
• Polysaccharides• A sugar that consists of polymers of
chains (in some cases very long chains) of monosaccharide or disaccharide units all joined together.
• Starch- long chains of glucose formed by plants in photosynthesis
• Cellulose- long chains of glucose that are indigestible by humans; Serve as fiber in diet
• Glycogen- long chains of glucose formed by the human body to store glucose for future energy when it is in excess
Nutrition: Carbohydrates
Nutrition: Fats• Fats are organic molecules
made of Carbon, Hydrogen, and Oxygen.
• Saturated fats = unhealthy• Have only single bonds
between carbons• One carboxylic acid group• linked to cardiovascular disease
and several types of cancers
• Unsaturated fats = healthy• Have one or more double bonds
between carbons• One carboxylic acid group • lower your risk of heart disease
by reducing the total cholesterol
Healthy (unsaturated) • Sources of these fats include
vegetable oils, fish, nuts, seeds, olive oil and avocados.
• These fats are typically liquid at room temperature
Nutrition: FatsUnhealthy (saturated)• Sources of these fats include
dairy products, animal fats and oils like coconut oil, cottonseed oil and palm kernel oil.
• These fats are typically solid at room temperature
Compare the two types of
fats. What is the
difference?
A double cheeseburger can have 35g of
saturated fat! That is almost twice the maximum daily
amount suggested!
Nutrition: Fats
• Fun fact- you can always make adipocytes, but you cannot ever kill them
• When you “burn fat” you are actually releasing the triacylglycerides into the blood stream as free fatty acids to be used as energy, effectively shrinking the size of the adipocyte
• Fat cell= Adipocyte
• Free Fatty Acids are consumed and absorbed within the GI tract
• These will be packaged onto glycerols to form units called triacylglycerides
• Triacylglycerides are stored within adipocytes
Nutrition: Fats• Diabetes
• Two types• Type 1- genetic autoimmune disease
• Unable to produce insulin
• Type 2- acquired• Does not produce enough insulin
OR
• Has insulin resistance
• Fat can play a large role in the onset of Type 2 diabetes• Adipocytes secrete adipokines • Adipokines are hormones that impair blood-glucose tolerance which will
lead to insulin resistance• To prevent or reverse Type 2 diabetes, often the patient just needs to
eat right and exercise to shrink the adipocytes causing the problem
Nutrition: Vitamins and Minerals• Vitamins:
• Fat soluble-• A, D, E, & K
• Water soluble-• B-complex & C
• Minerals: • Major-
• Sodium, Potassium, Calcium, Phosphorus, Magnesium, Manganese, Sulphur, Cobalt, and Chlorine
• Trace-• Iron, Zinc, Copper, Selenium,
Iodine, Fluorine, and Chromium
DIGESTIONA Foundation
Mouth & Esophagus• Mouth:
• Chewing• Teeth• Saliva from salivary
glands• Bicarbonate• Amylase
• Swallowing• Esophagus:
• Muscular tube that moves food into the stomach
Stomach• Releases acids and
enzymes which break down food further• Gastrin• Secretin• H+, Cl-
• Muscular contractions mix and degrade food• Chyme!
• Thick mucus layer protects against low (acidic) pH.
Small Intestine• Entry point of bile from
gallbladder• Bicarbonate• Emulsification of fat
• Entry point of pancreatic enzymes• Trypsin- protein digestion• Lipase- fat digestion• Amylase- carbohydrate digestion
• Villi and microvilli allow reabsorption of fluids and nutrients from chyme• Primary site of nutrient
absorption
Small Intestine• Major site of mucoid/bloody diarrhea
• Loss of villi/microvilli that line the walls • Lack of reabsorption of water due to mineral
shifts
Small Intestine
Large Intestine
• Reabsorbs more fluids to condense the chyme into feces
• Major site of secretory diarrhea• Lack of reabsorption of water due
to mineral shifts can cause diarrhea
• Loss of microvilli that line the walls can also cause diarrhea
Large Intestine
Large Intestine
Exit
• Ewww… GROSS?!• But very important in monitoring health in you and your
pets
CASE STUDYA Discussion
CASE STUDY: Max• Signalment-
• 6 months old• Intact male• Yellow Labrador Retriever
• Chief Complaint- • Vomiting and diarrhea
• Physical Exam-• Lethargy/fatigue• Dysentery• Dehydration
CASE STUDY: Max
• History of present illness-• Started having diarrhea
yesterday morning and hasn’t stopped (~6x daily)
• Diarrhea appears mucoid and bloody
• He is potty trained but is pooping in the house anyways
• Began vomiting a few hours after first diarrhea spotted
• Vomit is clear, like water
• He has not been interested in playing with his toys, even his favorite stuffed bunny
• Stopped drinking or eating
• Only pet in the home
• Inside/outside dog
CASE STUDY: Max• Differential Diagnoses:
• Canine parvovirus• Canine distemper• Infectious canine hepatitis• Canine coronavirus• Septicemia:
• Salmonellosis• Campylobacteriosis
• Haemorrhagic gastro-enteritis• Poisonings
Actual Diagnosis: Canine Parvovirus
Canine Parvovirus
• Virus
• Causes gastroenteritis
• Transmitted fecal-orally and through inhalation
• Very difficult to clean/kill• Bleach in a 1:32 dilution solution• Lives in environment for a very long time
Canine Parvovirus
• Pathogenesis: • Virus infects mature cells covering the
upper two-thirds of small intestine villi• This will cause sloughing of dead
mature cells which effectively blunts the villi
• Small intestine can no longer absorb nutrients
• Diarrhea and vomiting results• Dehydration and malnutrition follows• Death is common
Canine Parvovirus
• Pathogenesis: • Virus infects mature cells covering the
upper two-thirds of small intestine villi• This will cause sloughing of dead
mature cells which effectively blunts the villi
• Small intestine can no longer absorb nutrients
• Diarrhea and vomiting results• Dehydration and malnutrition follows• Death is common
Canine Parvovirus
• Pathogenesis: • Virus infects mature cells covering the
upper two-thirds of small intestine villi• This will cause sloughing of dead
mature cells which effectively blunts the villi
• Small intestine can no longer absorb nutrients
• Diarrhea and vomiting results• Dehydration and malnutrition follows• Death is common
CASE STUDY: Treating Max• To keep Max from getting further dehydrated, we will treat
him with an anti-emetic called Metoclopramide
• If Max weighs 14 lbs and the recommended dosage is 35 mg/kg for Metoclopramide with a drug concentration of 20 mg/mL, how many mL of drug should you administer to Max?• Hint: 1kg = 2.2 lbs
QUESTIONS?
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