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] |
associated\twith\tpoorer\tprognosis,\tblood\tmagnesium\tlevels\tshould\tbe\tmeasured\tin\tHF\tpatients\tand\ntreated\taccordingly.\tPoor\tdietary\tintake\tof\tmagnesium\thas\tbeen\n\tassociated\twith\televated\ths-CRP,\ta\nproduct\tof\tinflammation.\tHypermagnesemia\tmay\tbe\tfound\tin\tsome\tcases\tof\trenal\tfailure,\tHF,\tand\nhigh\tdoses\tof\tfurosemide.\nThiamin
|
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] |
high\tdoses\tof\tfurosemide.\nThiamin\nPatients\twith\tHF\tare\tat\trisk\tfor\tthiamin\tdeficiency\tbecause\tof\tpoor\tfood\tintake;\tuse\tof\tloop\tdiuretics,\nwhich\tincreases\texcretion;\tand\tadvanced\tage.\tThiamin\tis\ta\trequired\tcoenzyme\tin\tthe\tenergy-\nproducing\treactions\tthat\tfuel\tmyocardial\n\tcontraction.\tTherefore\tthiamin\tdeficiency\tcan\tcause
|
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] |
contraction.\tTherefore\tthiamin\tdeficiency\tcan\tcause\ndecreased\tenergy\tand\tweaker\theart\tcontractions.\tStudies\thave\tshown\tthiamin\tdeficiency\tto\tbe\nassociated\twith\tHF,\tin\tgreat\tpart\tdue\tto\tthe\teffect\tof\tcommonly\tused\tmedications.\tLoop\tdiuretics\n(e.g.,\tfurosemide)\tcan\tdeplete\tbody\tthiamin\tand\tcause\tmetabolic\tacidosis.\tSupplementation\twith
|
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thiamin\thas\tbeen\tshown\tto\timprove\tcardiac\tfunction,\turine\n\toutput,\tweight\tloss,\tand\tsigns\tand\nsymptoms\tof\tHF\t(\nDiNicolantonio\tet\tal,\t2013\n).\tThiamin\tdeficiency\tis\tdiagnosed\tusing\terythrocyte\nthiamin\tpyrophosphate.\tThiamin\tstatus\tshould\tbe\tassessed\tin\tHF\tpatients\ton\tloop\tdiuretics\tand
|
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] |
appropriate\tsupplementation\trecommended\tif\tnecessary.\tThiamin\tsupplementation\t(e.g.,\t100\nmg/day)\tcan\timprove\tleft\tventricular\tejection\tfraction\t(fraction\tof\tblood\tpumped\tout\n\tof\tthe\tventricles\nwith\teach\theartbeat)\tand\tsymptoms.\nVitamin\tD\nPatients\twith\ta\tpolymorphism\tof\tthe\tvitamin\tD\treceptor\tgene\thave\thigher\trates\tof\tbone\tloss\tthan\tHF
|
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patients\twithout\tthis\tgenotype.\tVitamin\tD\tmay\timprove\tinflammation\tin\tHF\tpatients\t(\nVieth\tand\nKimball,\t2006\n).\tIn\ta\tdouble-blind,\trandomized,\tplacebo-controlled\ttrial,\tsupplementation\twith\nvitamin\tD\t(50\tmcg\tor\t2000\tinternational\tunits\n\tof\tvitamin\tD\n3\n\tper\tday)\tfor\t9\tmonths\tincreased\tthe
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0.0017387605039402843
] |
of\tvitamin\tD\n3\n\tper\tday)\tfor\t9\tmonths\tincreased\tthe\nantiinflammatory\tcytokine\tIL-10\tand\tdecreased\tthe\tproinflammatory\tfactors\tin\tHF\tpatients\n(\nSchleithoff\tet\tal,\t2006\n).\tAs\ta\tsteroid\thormone,\tvitamin\tD\tregulates\tgene\texpression\tand\tinversely\nregulates\trenin\tsecretion\t(\nMeems\tet\tal,\t2011\n).\tWith\tthe\trecent\tstudy\tshowing\ta\trelationship\tbetween
|
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] |
).\tWith\tthe\trecent\tstudy\tshowing\ta\trelationship\tbetween\nvitamin\tD\tdeficiency\tand\tthe\tdevelopment\tof\tHF\t(\nPorto,\t2018\n),\tthe\tcase\tfor\tsupplementation\tof\nvitamin\tD\tis\tnow\tstronger.\nCardiac\ttransplantation\nCardiomyopathies\trepresent\ta\theterogeneous\tgroup\tof\tdiseases\tthat\toften\tlead\tto\tprogressive\tHF;
|
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] |
types\tinclude\tdilated\tcardiomyopathy,\thypertrophic\tcardiomyopathy,\trestrictive\tcardiomyopathy,\tand\narrhythmogenic\tright\tventricular\tcardiomyopathy\t(\nWexler\tet\tal,\t2009\n).\tCardiac\ttransplantation\tis\tthe\nonly\tcure\n\tfor\trefractory,\tend-stage\tHF.\tBecause\tthe\tnumber\tof\tdonor\thearts\tis\tlimited,\tcareful
|
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] |
selection\tof\trecipients\twith\tconsideration\tof\tthe\tlikelihood\tfor\tadherence\tto\tlifelong\ttherapeutic\nregimen\tand\ttheir\tquality\tof\tlife\tis\timperative.\tNutrition\tsupport\tbefore\tand\tafter\ttransplantation\tis\ncrucial\tto\tdecrease\tmorbidity\tand\tmortality.\tThus\tthe\tnutrition\tcare\tof\tthe\theart\ttransplant\tpatient\ncan\tbe\tdivided
|
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can\tbe\tdivided\n\tinto\tthree\tphases:\tpretransplant,\timmediate\tposttransplant,\tand\tlong-term\nposttransplant.\nPretransplant\tmedical\tnutrition\ttherapy\nA\tcomprehensive\tnutrition\tassessment\tof\tthe\tpretransplant\tpatient\tshould\tinclude\ta\thistory,\tphysical\nand\tanthropometric\tassessment,\tand\tbiochemical\ttesting.\tRecommended\tlifestyle\tchanges\tbefore
|
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] |
transplantation\tinclude\trestricting\talcohol\tconsumption,\tlosing\tweight,\n\texercising,\tquitting\tsmoking,\nand\teating\ta\tlow-sodium\tdiet\t(\nWexler\tet\tal,\t2009\n).\tExtremes\tin\tbody\tweight\t(less\tthan\t80%\tor\tmore\nthan\t140%\tof\tideal\tbody\tweight)\tincrease\tthe\tpatient’s\trisk\tfor\tinfection,\tdiabetes,\tmorbidity,\tand
|
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] |
higher\tmortality.\tPretransplant\tcomorbidities\tsuch\tas\thyperlipidemia\tand\thypertension\talso\treduce\nsurvival\trates.\tIf\toral\tintake\tis\tinadequate,\tan\tenteral\tfeeding\tshould\n\tbe\ttailored\tto\tthe\tnutritional\nand\tcomorbid\tconditions\tof\tthe\tpatient.\nImmediate\tposttransplant\tnutrition\tsupport
|
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] |
Immediate\tposttransplant\tnutrition\tsupport\nNutrition\tguidelines\tare\tconsistent\tfor\tall\ttypes\tof\torgan\ttransplants\tand\tnot\tspecific\tjust\tto\theart\ntransplants\t(\nTable\t32.8\n).\tThe\tnutritional\tgoals\tin\tthe\tacute\tposttransplant\tpatient\tare\tto\t(1)\tprovide\nadequate\tprotein\tand\tcalories\tto\ttreat\tcatabolism\tand\tpromote\thealing,\t(2)\n\tmonitor\tand\tcorrect
|
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0.020852666348218918,
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0.06336982548236847,
0.11354578286409378,
0.05781716853380203,
-0.0312334056943655
] |
monitor\tand\tcorrect\nelectrolyte\tabnormalities,\tand\t(3)\tachieve\toptimal\tblood\tglucose\tcontrol\t(\nHasse,\t2015\n).\tIn\tthe\nimmediate\tposttransplant\tperiod\tnutrient\tneeds\tare\tincreased,\tas\tis\tthe\tcase\tafter\tany\tmajor\tsurgery.\nProtein\tneeds\tare\tincreased\tbecause\tof\tsteroid-induced\tcatabolism,\tsurgical\tstress,\tanabolism,\tand\nwound\thealing.
|
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0.008721367456018925
] |
TABLE\t32.8\nPosttransplant\tNutrient\tRecommendations\nNutrient\nShort-Term\tRecommendations\nLong-Term\tRecommendations\nCalories\n120%-140%\tof\tBEE\t(30-35\tkcal/kg)\tor\nmeasure\tREE\nMaintenance:\t120%-130%\tBEE\t(20-30\nkcal/kg)\tdepending\ton\tactivity\tlevel\nProtein\n1.3-2\tg/kg/day\n1\tg/kg/day\nCarbohydrate\n∼50%\tof\tcalories\nRestrict\tsimple\tsugars\tif\tglucose\tlevel
|
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] |
Carbohydrate\n∼50%\tof\tcalories\nRestrict\tsimple\tsugars\tif\tglucose\tlevel\nelevated\n∼50%\tof\tcalories\nRestrict\tsimple\tsugars\tand\tencourage\nhigh-fiber\tcomplex\tcarbohydrate\nchoices\nFat\n30%\tof\tcalories\t(or\thigher\twith\tsevere\nhyperglycemia)\n≤30%\tof\ttotal\tcalories\n<10%\tof\tcalories\tas\tsaturated\tfat\nCalcium\n1200\tmg/day\n1200-1500\tmg/day\t(consider\tthe\tneed\tfor
|
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] |
Calcium\n1200\tmg/day\n1200-1500\tmg/day\t(consider\tthe\tneed\tfor\nestrogen\tor\tvitamin\tD\tsupplements)\nSodium\n2\tg/day\n2\tg/day\nMagnesium\nand\nphosphorus\nEncourage\tintake\tof\tfoods\thigh\tin\tthese\nnutrients\nSupplement\tas\tneeded\nEncourage\tintake\tof\tfoods\thigh\tin\tthese\nnutrients\nSupplement\n\tas\tneeded\nPotassium\nSupplement\tor\trestrict\tbased\ton\tserum
|
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] |
Supplement\n\tas\tneeded\nPotassium\nSupplement\tor\trestrict\tbased\ton\tserum\npotassium\tlevels\nSupplement\tor\trestrict\tbased\ton\tserum\npotassium\tlevels\nOther\nvitamins\nand\nminerals\nMultivitamin/mineral–supplement\tto\tRDI\nlevels\nMay\tneed\tadditional\tsupplements\tto\nreplete\tsuspected\tor\tconfirmed\ndeficiencies\nMultivitamin/mineral–supplement\tto\tRDI\nlevels
|
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] |
deficiencies\nMultivitamin/mineral–supplement\tto\tRDI\nlevels\nMay\tneed\tadditional\tsupplements\tto\nreplete\tsuspected\tor\tconfirmed\ndeficiencies\nOther\nAvoid\tcomplementary\tor\talternative\nproducts\twithout\tproven\tsafety\tand\neffectiveness\tin\ttransplant\tpatients\nAvoid\tcomplementary\tor\talternative\nproducts\twithout\tproven\tsafety\tand
|
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] |
Avoid\tcomplementary\tor\talternative\nproducts\twithout\tproven\tsafety\tand\neffectiveness\tin\ttransplant\tpatients\nBEE\n,\tBasal\tenergy\texpenditure;\t\nRDI\n,\treference\tdaily\tintake;\t\nREE\n,\tresting\tenergy\texpenditure.\nPatients\tprogress\tfrom\tclear\tliquids\tto\ta\tsoft\tdiet\tgiven\tin\n\tsmall,\tfrequent\tfeedings.\tEnteral\tfeeding
|
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0.06694822013378143,
-0.06608206033706665,
0.014025741256773472,
0.0740739107131958,
0.014539327472448349,
-0.010737038217484951,
-0.02923664078116417,
0.056429121643304825,
0.08962235599756241,
0.022733492776751518,
0.0031426618807017803,
0.05225619301199913,
0.06807404011487961,
0.09391371160745621,
0.03948945179581642,
-0.01949724741280079
] |
before\ttransplant.\tThe\tincrease\tin\tcardiac\tfunction\thelps\n\tto\thalt\tthe\tpresurgical\tcachectic\tstate.\nHyperglycemia\tcan\tbe\texacerbated\tby\tthe\tstress\tof\tthe\tsurgery\tand\tthe\timmunosuppressive\tdrug\nregimen.\tDietary\tadjustments\tcan\tbe\tmade\tto\taid\tin\tglucose\tcontrol\t(see\t\nTable\t32.8\n).\nLong-term\tposttransplant\tnutrition\tsupport
|
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0.05288533866405487,
0.08356931805610657,
0.023664694279432297,
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0.02982168085873127,
0.0843873992562294,
0.10385973751544952,
-0.0038723524194210768
] |
Table\t32.8\n).\nLong-term\tposttransplant\tnutrition\tsupport\nComorbid\tconditions\tthat\toften\toccur\tafter\ttransplantation\tinclude\thypertension,\texcessive\tweight\ngain,\thyperlipidemia,\tosteoporosis,\n\tand\tinfection.\tHypertension\tis\tmanaged\tby\tdiet,\texercise,\tand\nmedications.\tMinimizing\texcessive\tweight\tgain\tis\timportant\tbecause\tpatients\twho\tbecome\tobese
|
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] |
after\ttransplantation\tare\tat\thigher\trisk\tfor\trejection\tand\tlower\trates\tof\tsurvival.\nIncreases\tin\ttotal\tLDL\tcholesterol\tand\ttriglycerides\tare\ta\tconsequence\tof\timmunosuppressive\tdrug\ntherapy\tand\tincrease\tthe\trisk\tof\tHF\tafter\ttransplantation.\n\tAlong\twith\ta\theart-healthy\tdiet,\tpatients
|
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] |
Along\twith\ta\theart-healthy\tdiet,\tpatients\nalso\tneed\ta\tlipid-lowering\tdrug\tregimen\tto\tnormalize\tblood\tlipids.\tStatins\tare\trecommended\tin\tthe\nearly\tand\tlong-term\tpostoperative\tperiods.\tBecause\tof\ttheir\tLDL-lowering\teffect,\tstanols\tor\tsterols\nmay\tbe\thelpful\tto\treduce\tstatin\tdosages\t(\nGoldberg\tet\tal,\t2006\n).
|
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may\tbe\thelpful\tto\treduce\tstatin\tdosages\t(\nGoldberg\tet\tal,\t2006\n).\nBefore\ttransplantation,\tpatients\tare\tlikely\tto\thave\tosteopenia\tbecause\tof\ttheir\tlack\tof\tactivity\n\tand\ncardiac\tcachexia.\tAfter\ttransplantation,\tpatients\tare\tsusceptible\tto\tsteroid-induced\tosteoporosis.
|
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0.019696906208992004
] |
Patients\trequire\toptimal\tcalcium\tand\tvitamin\tD\tintake\tto\tslow\tbone\tloss;\tweight-bearing\texercise\tand\nantiresorptive\tdrug\ttherapy\tare\toften\tnecessary.\tInfection\tmust\tbe\tavoided\tbecause\tof\tthe\tnecessity\nof\tlifelong\tuse\tof\timmunosuppressive\tdrugs.\tFood\tsafety\tshould\tbe\tdiscussed.\nCLINICAL\tCASE\n\t\nSTUDY
|
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] |
CLINICAL\tCASE\n\t\nSTUDY\nTom\tis\ta\t55-year-old\tsingle\twhite\tman\twith\thypertension\t(blood\tpressure\t145/92\tmmHg),\thigh\nlow-density\tlipoprotein\tcholesterol\t(241\tmg/dL),\tand\tlow\thigh-density\tlipoprotein\tcholesterol\t(38\nmg/dL)\tand\ta\tC-reactive\tprotein\t(CRP)\tof\t4mg/L.\tHe\thas\ta\tstrong\tfamily\thistory\tof\theart\tdisease.
|
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He\treports\tthat\the\toften\teats\tin\this\tcar,\tso\the\tfrequents\tfast-food\trestaurants.\tHe\tworks\tlong\nhours\tand,\n\tother\tthan\tgardening\ton\tthe\tweekends,\the\tdoes\tnot\texercise.\tHe\tis\t5’10”\tand\t220\tlb\nwith\ta\tBMI\tof\t31.6.\tHis\tbreakfast\tis\tusually\ta\tcheese-egg\tbiscuit,\tbacon,\tand\tcoffee\twith\tmilk\tor
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cream.\tLunch\tis\toften\ta\tbean\tand\tcheese\tburrito\tand\tice\tcream.\tHis\tfavorite\tdinner\tis\tfried\nchicken,\tmashed\tpotatoes\twith\tgravy,\tcollards\tsautéed\twith\tbacon\tfat,\tand\tpie.\nNutrition\tdiagnostic\tstatements\n•\n\tIntake\n\tof\ttypes\tof\tfats\tinconsistent\twith\tneeds\t(saturated\tfat)\t(NI-5.5.3)\trelated\tto\teating\tfast
|
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food\ton\tthe\trun\tand\tbusy\tschedule\tas\tevidenced\tby\tunfavorable\tcholesterol\tprofile\t(elevated\nLDL\tand\tlow\tHDL)\tand\tregular\tconsumption\tof\tfried\tfoods,\tbacon\tand\tfull\tfat\tdairy.\n•\t\nExcessive\tmineral\tintake\t(sodium)\t(NI-5.10.7)\trelated\tto\tfrequent\tfast\tfood\tconsumption\tas
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33\nMedical\tnutrition\ttherapy\tfor\npulmonary\tdisease\nLaith\tGhazala,\tMD,\tFRCP,\tA.\tChristine\tHummell,\tMS,\tRDN,\tLD,\tCNSC,\tBette\tKlein,\tMS,\tRDN,\tCSP,\tLD\nKEY\tTERMS\nacinar\nacinus\nacute\trespiratory\tdistress\tsyndrome\t(ARDS)\nadiponectin\nasthma\naspiration\tpneumonia\nbronchiectasis\nbronchogenic\tcarcinomas\nbronchopulmonary\tdysplasia\t(BPD)\ncancer\tcachexia\tsyndrome
|
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] |
bronchopulmonary\tdysplasia\t(BPD)\ncancer\tcachexia\tsyndrome\nchronic\tbronchitis\nchronic\tobstructive\tpulmonary\tdisease\t(COPD)\ncilia\nchylothorax\nclubbing\ncontinuous\tpositive\tairway\tpressure\t(CPAP)\ncor\tpulmonale\ncyanosis\ncystic\tfibrosis\t(CF)\ncystic\tfibrosis\trelated\tdiabetes\t(CFRD)\ndistal\tintestinal\tobstruction\tsyndrome\t(DIOS)\ndyspnea\nelastase\nemphysema
|
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dyspnea\nelastase\nemphysema\nghrelin\nhypercapnia\nhypopnea\nidiopathic\tpulmonary\tfibrosis\ninterstitial\tlung\tdisease\t(ILD)\ninterstitial\tpulmonary\n\tfibrosis\nkyphosis\nleptin\nobesity\thypoventilation\tsyndrome\t(OHS)\nobstructive\tsleep\tapnea\t(OSA)\nosteopenia\npancreatic\tenzyme\treplacement\ttherapy\t(PERT)\npancreatic\tinsufficiency\t(PI)\npleural\teffusion\npneumonia
|
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] |
pancreatic\tinsufficiency\t(PI)\npleural\teffusion\npneumonia\npulmonary\tcachexia
|
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] |
pulmonary\tfunction\ttests\npulmonary\thypertension\t(PH)\npulse\toximetry\nresistin\nresolvin\nspirometry\nsteatorrhea\nsurfactant\ntachypnea\ntuberculosis\t(TB)\nOptimal\tnutrition\tsupports\tthe\tdevelopment,\tgrowth,\tand\tmaintenance\tof\tthe\trespiratory\torgans,\nsupporting\tstructures\tof\tthe\tskeleton\tand\tmuscles\tand\trelated\tnervous,\tcirculatory,\tand\timmunologic
|
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systems.\tA\twell-functioning\tpulmonary\tsystem\tenables\tthe\tbody\tto\tobtain\tthe\toxygen\tneeded\tto\tmeet\nits\tcellular\tdemands\tfor\tenergy\tfrom\tmacronutrients\tand\tto\tremove\tcarbon\tdioxide\tas\ta\tbyproduct\tof\nmetabolism.\nThe\tpulmonary\tsystem\nThe\trespiratory\tstructures\tinclude\tthe\tnose,\tpharynx,\tlarynx,\ttrachea,\tbronchi,\tbronchioles,\talveolar
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] |
ducts,\tand\talveoli.\tSupporting\tstructures\tinclude\tthe\tskeleton\tand\tthe\tmuscles\t(e.g.,\tthe\tintercostal,\nabdominal,\tand\tdiaphragm\tmuscles).\tWithin\ta\tmonth\tafter\tconception,\tpulmonary\tstructures\tare\nrecognizable.\tThe\tpulmonary\tsystem\tgrows\tand\tmatures\tduring\tgestation\tand\n\tchildhooduntil\tit
|
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] |
childhooduntil\tit\nreaches\tfull\tmaturity\tand\taveoli\tdensity\tat\tabout\t20\tyears\tof\tage.\tAs\taging\toccurs,\tthe\tlungs\tlose\nelasticity\tand\tfunctional\tcapacity\tdeclines.\nThe\tprimary\tfunction\tof\tthe\trespiratory\tsystem\tis\tgas\texchange,\tand\tthe\tanatomy\tand\tphysiology\tis\ngeared\tto\tfulfill\tthis\tfunction\t(\nFig.\t33.1
|
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] |
geared\tto\tfulfill\tthis\tfunction\t(\nFig.\t33.1\n).\tThe\tlungs\tenable\tthe\tbody\tto\tobtain\tthe\toxygen\tneeded\tto\nmeet\tits\tcellular\tmetabolic\tdemands\n\tand\tto\tremove\tthe\tcarbon\tdioxide\t(CO\n2\n)\tproduced.\tHealthy\nnerves,\tand\tefficient\tblood\tand\tlymph\tcirculation\tare\tneeded\tto\tsupply\toxygen\tand\tnutrients\tto\tall
|
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] |
tissues.\tThe\tlungs\talso\tfilter,\twarm,\tand\thumidify\tinspired\tair.\nFIG.\t33.1\nFunctional\tanatomy\tand\tphysiology\tof\tthe\trespiratory\tsystem.\t\nA,\n\tVarious\tparts\tof\trespiratory\tsystem.\nB,\n\tGas\texchange\tunit.\t\nC,\n\tAlveolar-capillary\tinterface.\t\nNational\tHeart,\tLung,\tand\tBlood\tInstitute;\tNational
|
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] |
National\tHeart,\tLung,\tand\tBlood\tInstitute;\tNational\nInstitutes\tof\tHealth;\tU.S.\tDepartment\tof\tHealth\tand\tHuman\tServices.\nThe\trespiratory\tcenter\tis\tthe\tname\tfor\tstructures\tinvolved\tin\tthe\tgeneration\tof\trhythmic\trespiratory\nmovements\n\tand\treflexes\tand\tis\tlocated\tin\tthe\tmedulla\tand\tpons\t(see\t\nFig.\t39.2\n\tin\t\nChapter\t39\n).\tThe
|
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] |
Fig.\t39.2\n\tin\t\nChapter\t39\n).\tThe\nelectrical\timpulses\tgenerated\tby\tthe\trespiratory\tcenter\tare\tcarried\tby\tthe\tphrenic\tnerves\tto\tthe\ndiaphragm\tand\tother\trespiratory\tmuscles.\tContraction\tof\tdiaphragm\tand\tother\tmuscles\tincreases\tthe\nintrathoracic\tvolume,\twhich\tcreates\tnegative\tintrathoracic\tpressure\tand\tallows\tair\tto\tbe\tsucked\tin.\nThe\tair\ttraverses
|
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] |
The\tair\ttraverses\n\tthrough\tthe\tupper\tairways\tinto\tthe\tlower\tairways\t(see\t\nFig.\t33.1\n,\t\nA\n)\tand\treaches\tthe\nalveoli\t(see\t\nFig.\t33.1\n,\t\nB\n).\tThe\talveoli\tare\tsurrounded\tby\tcapillaries\twhere\tgas\texchange\ttakes\tplace\n(see\t\nFig.\t33.1\n,\t\nC\n).\tThe\tpulmonary\tartery\tcarries\tblood\tfrom\tthe\tright\tventricle\tof\tthe\theart\tinto\tthe
|
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small\tcapillaries\twhere\tgas\texchange\ttakes\tplace\twith\tthe\talveoli;\toxygenated\tblood\treturns\tback\nthrough\tthe\n\tpulmonary\tveins\tinto\tthe\tleft\tatrium\tof\tthe\theart\tto\tbe\tdelivered\tinto\tthe\trest\tof\tthe\tbody.\nThe\tlarge\tpulmonary\tblood\tvessels\tand\tthe\tconducting\tairways\tare\tlocated\tin\ta\twell-defined\nconnective\ttissue\tcompartment—the\tpleural\tcavity.
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connective\ttissue\tcompartment—the\tpleural\tcavity.\nThe\tlungs\tare\tan\timportant\tpart\tof\tthe\tbody’s\timmune\tsystem,\tbecause\tinspired\tair\tis\tladen\twith\nparticles\tand\tmicroorganisms.\tMucus\tkeeps\tthe\tairways\tmoist\tand\ttraps\n\tthe\tparticles\tand
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microorganisms\tfrom\tinspired\tair.\tThe\tairways\thave\t12\ttypes\tof\tepithelial\tcells,\tand\tmost\tcells\tthat\nline\tthe\ttrachea,\tbronchi,\tand\tbronchioles\thave\t\ncilia\n.\tThe\tcilia\tare\t“hair-like”\tstructures\tthat\tmove\nthe\tsuperficial\tliquid\tlining\tlayer\tfrom\tdeep\twithin\tthe\tlungs\ttoward\tthe\tpharynx\tto\tenter\tthe
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gastrointestinal\ttract,\tthereby\tplaying\tan\timportant\trole\tas\ta\tlung\tdefense\tmechanism\n\tby\tclearing\nbacteria\tand\tother\tforeign\tbodies.\tEach\ttime\ta\tperson\tswallows,\tmicroorganism-containing\tmucus\npasses\tinto\tthe\tdigestive\ttract,\tin\taddition\tto\tthe\tfood.\tWhen\tinhaled\tbacteria\tor\tfood\tparticles\tare
|
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not\tcleared\teffectively,\tthe\tpatient\tis\tprone\tto\tdevelop\trecurrent\tchest\tinfections\tthat\tmay\teventually\nlead\tto\tbronchiectasis.\tThe\tepithelial\tsurface\tof\tthe\talveoli\tcontains\tmacrophages.\n\tBy\tthe\tprocess\tof\nphagocytosis,\tthese\talveolar\tmacrophages\tengulf\tinhaled\tinert\tmaterials\tand\tmicroorganisms\tand\ndigest\tthem.\tThe\talveolar\tcells\talso\tsecrete
|
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] |
digest\tthem.\tThe\talveolar\tcells\talso\tsecrete\t\nsurfactant\n,\ta\tcompound\tsynthesized\tfrom\tproteins\tand\nphospholipids\tthat\tmaintains\tthe\tstability\tof\tpulmonary\ttissue\tby\treducing\tthe\tsurface\ttension\tof\nfluids\tthat\tcoat\tthe\tlung.\nThe\tlungs\thave\tseveral\tmetabolic\tfunctions.\tFor\texample,\tthey\n\thelp\tregulate\tthe\tbody’s\tacid-base\nbalance\t(see\t\nChapter\t3
|
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] |
help\tregulate\tthe\tbody’s\tacid-base\nbalance\t(see\t\nChapter\t3\n).\tThe\tbody’s\tpH\tis\tmaintained\tpartially\tby\tthe\tproper\tbalance\tof\tCO\n2\n\tand\noxygen\t(O\n2\n).\tThe\tlungs\talso\tsynthesize\tarachidonic\tacid\tthat\tultimately\tmay\tbe\tconverted\tto\nprostaglandins\tor\tleukotrienes.\tThese\tappear\tto\tplay\ta\trole\tin\tbronchoconstriction\tseen\tin\tasthma.
|
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] |
The\tlungs\tconvert\tangiotensin\tI\tto\tangiotensin\tII\tby\tthe\tangiotensin-converting\n\tenzyme\t(ACE)\tfound\nmainly\tin\tthe\tnumerous\tcapillary\tbeds\tof\tthe\tlungs.\tAngiotensin\tII\tincreases\tblood\tpressure.\tBecause\nof\tthe\tultrastructure\tand\tthe\tfact\tthat\tthey\treceive\tthe\ttotal\tcardiac\toutput,\tlungs\tare\twell\tsuited\tto
|
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] |
function\tas\ta\tchemical\tfilter.\tThey\tprotect\tthe\tsystemic\tcirculation\tfrom\texposure\tto\thigh\tlevels\tof\ncirculating\tvasoactive\tsubstances.\tAlthough\tserotonin,\t5-hydroxytryptamine\n\t(5-HT),\tand\nnorepinephrine\tare\ttotally\tor\tpartially\teliminated\tor\tinactivated\tin\tthe\tpulmonary\tcirculation,\nepinephrine\tand\thistamines\tpass\tthrough\tthe\tlungs\tunchanged.
|
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] |
epinephrine\tand\thistamines\tpass\tthrough\tthe\tlungs\tunchanged.\nEffect\tof\tmalnutrition\ton\tthe\tpulmonary\tsystem\nThe\trelationship\tbetween\tmalnutrition\tand\trespiratory\tdisease\thas\tlong\tbeen\trecognized.\nMalnutrition\tadversely\taffects\tlung\tstructure,\telasticity,\tand\tfunction;\trespiratory\tmuscle\n\tmass,
|
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] |
mass,\nstrength,\tand\tendurance;\tlung\timmune\tdefense\tmechanisms;\tand\tcontrol\tof\tbreathing.\tFor\texample\nprotein\tand\tiron\tdeficiencies\tresult\tin\tlow\themoglobin\tlevels\tthat\tdiminish\tthe\toxygen-carrying\ncapacity\tof\tthe\tblood.\tLow\tlevels\tof\tcalcium,\tmagnesium,\tphosphorus,\tand\tpotassium\tcompromise
|
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] |
respiratory\tmuscle\tfunction\tat\tthe\tcellular\tlevel.\tHypoalbuminemia,\tas\tmeasured\tby\tserum\talbumin,\ncontributes\n\tto\tthe\tdevelopment\tof\tpulmonary\tedema\tby\tdecreasing\tcolloid\tosmotic\tpressure,\tallowing\nbody\tfluids\tto\tmove\tinto\tthe\tinterstitial\tspace.\tDecreased\tlevels\tof\tsurfactant\tcontribute\tto\tthe
|
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] |
collapse\tof\talveoli,\tthereby\tincreasing\tthe\twork\tof\tbreathing.\tThe\tsupporting\tconnective\ttissue\tof\tthe\nlungs\tis\tcomposed\tof\tcollagen,\twhich\trequires\tascorbic\tacid\tfor\tits\tsynthesis.\tNormal\tairway\tmucus\tis\na\tsubstance\n\tconsisting\tof\twater,\tglycoproteins,\tand\telectrolytes,\tand\tthus\trequires\tadequate\nnutritional\tintake.
|
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nutritional\tintake.\nEffect\tof\tpulmonary\tdisease\ton\tnutritional\tstatus\nPulmonary\tdisease\tsubstantially\tincreases\tenergy\trequirements.\tThis\tfactor\texplains\tthe\trationale\tfor\nincluding\tbody\tcomposition\tand\tweight\tparameters\tin\tnutrition\tassessment.\tWeight\tloss\tfrom\ninadequate\tenergy\tintake\tis\tsignificantly\tcorrelated
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inadequate\tenergy\tintake\tis\tsignificantly\tcorrelated\n\twith\ta\tpoor\tprognosis\tin\tpersons\twith\tpulmonary\ndiseases.\tMalnutrition\tleading\tto\timpaired\timmunity\tplaces\tany\tpatient\tat\thigh\trisk\tfor\tdeveloping\nrespiratory\tinfections.\tMalnourished\tpatients\twith\tpulmonary\tdisease\twho\tare\thospitalized\tare\tlikely
|
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] |
to\thave\tlengthy\tstays\tand\tare\tsusceptible\tto\tincreased\tmorbidity\tand\tmortality\tcompared\twith\twell-\nnourished\tpatients.\nThe\tcomplications\tof\tpulmonary\n\tdiseases\tor\ttheir\ttreatments\tcan\tmake\tadequate\tfood\tintake\tand\ndigestion\tdifficult.\tFor\texample,\tpatients\twho\tare\tunable\tto\tbreathe\twell\twill\tfind\tit\ttiring\tto\tprepare
|
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food\tor\tto\teat.\tAbsorption\tand\tmetabolism\tof\tmost\tnutrients\tare\taffected.\tAs\tpulmonary\tdisease\nprogresses,\tseveral\tconditions\tmay\tinterfere\twith\tfood\tintake\tand\toverall\tnutrition\tstatus.\tFor\nexample,\tabnormal\tproduction\tof\tsputum,\n\tvomiting,\t\ntachypnea\n\t(rapid\tbreathing),\themoptysis,
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] |
vomiting,\t\ntachypnea\n\t(rapid\tbreathing),\themoptysis,\nthoracic\tpain,\tnasal\tpolyps,\tanemia,\tdepression,\tand\taltered\ttaste\tsecondary\tto\tmedications\tare\toften\npresent.\tWeight\tloss,\tlow\tbody\tmass\tindex\t(BMI),\tand\tother\tadverse\teffects\tare\tlisted\tin\t\nBox\t33.1\n.\nBOX\t33.1\nAdverse\tEffects\tof\tLung\tDisease\ton\tNutrition\tStatus\nIncreased\tenergy\texpenditure
|
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] |
Increased\tenergy\texpenditure\nIncreased\twork\tof\tbreathing\nChronic\tinfection\nMedical\ttreatments\t(e.g.,\tbronchodilators,\tchest\tphysical\ttherapy)\nReduced\tintake\nFluid\trestriction\nShortness\tof\tbreath\nDecreased\toxygen\tsaturation\twhile\teating\nAnorexia\tresulting\tfrom\tchronic\tdisease\nGastrointestinal\tdistress\tand\tvomiting
|
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] |
Additional\tlimitations\nDifficulty\tpreparing\tfood\tbecause\tof\tfatigue\nImpaired\tfeeding\tskills\t(for\tinfants\tand\tchildren)\nAltered\tmetabolism\nFood-drug\tinteractions\nMedical\tmanagement\nPulmonary\tsystem\tdisorders\tmay\tbe\tcategorized\tas\tprimary,\tsuch\tas\ttuberculosis\t(TB),\tasthma,\tand
|
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] |
lung\tcancer;\tor\tsecondary\twhen\tassociated\twith\tcardiovascular\tdisease,\tobesity,\tinfection,\tsickle\tcell\ndisease,\tor\tscoliosis.\tConditions\talso\tmay\tbe\tacute\tor\tchronic.\tExamples\tof\tacute\tconditions\tinclude\naspiration\tpneumonia,\tairway\tobstruction\n\tfrom\tfoods\tsuch\tas\tpeanuts,\tand\tallergic\tanaphylaxis\tfrom
|
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from\tfoods\tsuch\tas\tpeanuts,\tand\tallergic\tanaphylaxis\tfrom\nconsumption\tof\tshellfish.\tExamples\tof\tchronic\tconditions\tinclude\tcystic\tfibrosis\t(CF)\tand\tchronic\nobstructive\tpulmonary\tdisease\t(COPD).\nThe\tassessment\tof\tthe\tpulmonary\tstatus\tstarts\twith\tobtaining\ta\tthorough\thistory\twith\ta\tfocus\ton
|
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] |
the\tsocial\thistory\tsuch\tas\tsmoking\tand\tother\tinhalational\ttoxins\tas\twell\tas\texposure\thistory.\tTypical\nsymptoms\n\tof\tpulmonary\tdisorders\tinclude\t\ndyspnea\n\t(shortness\tof\tbreath),\tcough,\tsputum\tproduction,\nchest\tdiscomfort,\tfatigue,\tearly\tsatiety,\tand\tweight\tloss.\tThe\tpulmonary\tassessment\tcontinues\twith
|
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] |
percussion\tand\tauscultation.\tThese\tbedside\ttechniques\tprovide\timportant\tinformation\ton\tthe\npatient’s\tbreathing.\nNumerous\tdiagnostic\tand\tmonitoring\ttests\tsuch\tas\timaging\tprocedures,\tarterial\tblood\tgas\ndeterminations,\n\tsputum\tcultures,\tand\tbiopsies\talso\tcan\tbe\temployed.\t\nPulmonary\tfunction\ttests\n\tare
|
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] |
Pulmonary\tfunction\ttests\n\tare\nused\tto\tdiagnose\tor\tmonitor\tthe\tstatus\tof\tlung\tdisease;\tthey\tare\tdesigned\tto\tmeasure\tthe\tability\tof\nthe\trespiratory\tsystem\tto\texchange\tO\n2\n\tand\tCO\n2\n.\t\nPulse\toximetry\n\tis\tone\tsuch\ttest.\tA\tsmall\tdevice\ncalled\ta\tpulse\toximeter,\twhich\tuses\tlight\twaves\tto\tmeasure\tthe\tO\n2\n\tsaturation\tof\tarterial\tblood,\tis
|
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0.08544766902923584,
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0.03185107186436653,
0.051933228969573975,
0.07634291052818298,
0.05648388713598251,
0.009873815812170506
] |
2\n\tsaturation\tof\tarterial\tblood,\tis\nplaced\ton\tthe\tend\tof\n\tthe\tfinger\t(\nFig.\t33.2\n).\tNormal\tfor\ta\tyoung,\thealthy\tperson\tis\t95%\tto\t99%.\nSpirometry\n\tis\tanother\tcommon\tpulmonary\tfunction\ttest.\tThis\tinvolves\tbreathing\tinto\ta\tspirometer\nthat\tgives\tinformation\ton\tlung\tvolume\tand\tthe\trate\tat\twhich\tair\tcan\tbe\tinhaled\tand\texhaled.\nFIG.\t33.2\nPulse\toximeter.
|
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] |
FIG.\t33.2\nPulse\toximeter.\nChronic\tpulmonary\tdisease\nCystic\tfibrosis\nCystic\tfibrosis\t(CF)\n\tis\ta\tlife-threatening\tautosomal\trecessive\tinherited\tdisorder\tthat\tis\tmost\ncommonly\tseen\tin\twhite\tpopulations\twith\ta\tCF\tincidence\tof\t1\tout\tof\t3000\tbabies\tborn\tin\tthe\tUnited\nStates\t(\nCystic\tFibrosis\tFoundation,\t2016
|
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] |
States\t(\nCystic\tFibrosis\tFoundation,\t2016\n).\tAccording\tto\tthe\tCystic\tFibrosis\tFoundation\t2016\tPatient\nRegistry,\t29,497\tpersons\n\thave\tCF.\tCF\tis\tcaused\tby\tmutations\tin\tthe\tcystic\tfibrosis\ttransmembrane\nconductance\tregulator\t(CFTR)\tprotein,\ta\tcomplex\tchloride\tchannel\tand\tregulatory\tprotein\tfound\tin
|
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] |
all\texocrine\ttissues.\tThe\tfunction\tof\tCFTR\tis\tto\tregulate\tthe\tpassage\tof\tchloride,\tsodium,\tand\nbicarbonate\tin\tthe\tepithelial\tcells.\tDue\tto\tabsent\tor\tabnormal\tCFTR\tin\tCF,\tthe\tdecreased\tsecretion\tof\nchloride\tand\twater\tand\tincreased\n\treabsorption\tof\tsodium\tresult\tin\tthe\tproduction\tof\tthick,\tviscous
|
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] |
reabsorption\tof\tsodium\tresult\tin\tthe\tproduction\tof\tthick,\tviscous\nsecretions\tin\tthe\tlungs,\tpancreas,\tliver,\tintestines,\tand\treproductive\ttract,\tand\tlead\tto\tincreased\tsalt\ncontent\tin\tthe\tsweat\tgland\tsecretions.\tMost\tof\tthe\tclinical\tmanifestations\tare\trelated\tto\tthe\tthick,\nviscous\tsecretions\t(\nFig.\t33.3
|
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] |
viscous\tsecretions\t(\nFig.\t33.3\n).\tLung\tdisease\tand\tmalnutrition\tare\tpredominant\tconsequences\tof\tthe\ndisease.
|
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] |
FIG.\t33.3\nIllustration\tshowing\tmultisystem\tinvolvement\tin\tcystic\tfibrosis\t(CF)\tand\ttenacious\tsecretions.\nIn\tthe\tpast,\tmost\tpatients\twere\tdiagnosed\twith\tCF\tbecause\tof\tsymptoms\trelated\tto\tvarious\torgan\nsystems.\tAll\t50\tstates\tnow\tprovide\tnewborn\tscreening\tfor\tCF\tin\tthe\tfirst\t2\tto\t3\tdays\tof\tlife,\twith\tthe
|
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majority\tof\tcases\tdiagnosed\tby\t1\tmonth\tof\tage.\tScreening\tconsists\tof\tusing\ta\tneonatal\tblood\n\tspot\tto\ndetermine\tthe\tconcentration\tof\timmunoreactive\ttrypsinogen;\tif\tit\tis\televated,\tthen\tgenetic\tanalysis\nand\tsweat\tchloride\ttests\tare\tcompleted\tto\tconfirm\tthe\tdiagnosis.\tThe\tdiagnosis\tof\tCF\tin\tpersons
|
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] |
other\tthan\tneonates\twho\thave\ta\tclinical\thistory\tconsistent\twith\tthe\tdisease\tor\thave\ta\tsibling\twith\tCF,\nis\tdetermined\tby\tan\tabnormal\tsweat\tchloride\ttest\t(chloride\tlevel\tin\tsweat\t>60\tmmol/L).\tIf\n\tthe\nchloride\tsweat\ttest\tis\tabnormal,\tgenetic\tanalysis\tis\tused\tto\tconfirm\tthe\tdiagnosis\tand\tthe\tCFTR\nmutation\t(\nKatkin,\t2014
|
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] |
mutation\t(\nKatkin,\t2014\n).\tAbnormal\tsweat\tchloride\ttests\tcan\toccur\twith\tmalnutrition\tand\tadrenal\ninsufficiency.\nPathophysiology\nPulmonary\tand\tsinus\tdisease\nDue\tto\tthe\tdifficulty\tof\texpelling\tthick\tand\tviscous\tmucus\tin\tthe\trespiratory\ttract,\tCF\tpatients\npresent\twith\tchronic\tpersistent\tcough,\n\tdyspnea,\tand\twheezing.\tThick\tand\tviscous\tmucus\tis
|
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dyspnea,\tand\twheezing.\tThick\tand\tviscous\tmucus\tis\nconsidered\ta\trich\tenvironment\tfor\tbacteria\tto\tgrow,\tleading\tto\ta\tform\tof\tobstructive\tairway\tdisease,\nbronchiectasis\n,\ta\tchronic\tcondition\tof\tdilatation\tof\tthe\tbronchi\tthat\tdevelops\tas\ta\tresult\tof\trecurrent\nlung\tinfections.\tExamination\tof\ta\tpatient\twith\tbronchiectasis\tmay\tshow\tpresence\tof\t\nclubbing
|
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clubbing\n.\tDigital\nclubbing\tis\tcharacterized\tby\tincreased\tdigital\n\ttip\tmass\tand\tincreased\tlongitudinal\tand\ttransverse\tnail\nplate\tcurvature\t(\nFig.\t33.4\n),\tand\tlung\tauscultation\treveals\tdiffuse\tcoarse\tcrackles\tin\tthe\tlungs\tand\ndecreased\tbreath\tsounds.\tChest\tradiograph\tmay\tshow\thyperinflation\tin\tadvanced\tdisease,\tand\ta
|
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] |
computed\ttomography\t(CT)\tscan\tmay\tshow\tcystic\tand\tnodular\tdensities,\tthe\tclassical\tpicture\tof\ncystic\tbronchiectasis\t(\nFig.\t33.5\n).\tPulmonary\tfunction\n\ttesting\tshows\tairway\tobstruction.\tThe\nspirogram\tshows\treduced\tforced\tvital\tcapacity\t(FVC),\tknown\tas\t“restrictive\tpattern.”\tThe\treduced\nforced\texpiratory\tvolume\t(FEV\n1\n)\tand\tthe\treduced\tFEV\n1
|
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] |
forced\texpiratory\tvolume\t(FEV\n1\n)\tand\tthe\treduced\tFEV\n1\n/FVC\tratio\tare\tsuggestive\tof\tairway\nobstruction.
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] |
FIG.\t33.4\nIllustration\tof\tclubbing\tin\ta\tpatient\twith\t“yellow\tnail\tsyndrome.”\nFIG.\t33.5\nComputed\ttomography\t(CT)\tscan\tof\ta\tpatient\tshowing\tcystic\tchanges\tof\tbronchiectasis\tin\tright\nupper\tlobe.\nSputum\tcultures\tare\tused\tto\tidentify\tbacteria\tgrowing\tin\tthe\trespiratory\ttract\tin\tCF\tpatients.\tMost\ncommon\tbacteria\tin\tCF\tpatients\tare\t\nStaphylococcus\taureus
|
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common\tbacteria\tin\tCF\tpatients\tare\t\nStaphylococcus\taureus\n\tand\t\nPseudomonas\taeruginosa\n,\twhich\ncolonize\tthe\tairways\tfrequently.\tEvidence\texists\tthat\tthese\tbacteria\tplay\tan\timportant\n\trole\tin\tdisease\nprogression.\tMany\tchildren\twith\tCF\tdevelop\tchronic\trhinosinusitis\twith\tnasal\tpolyposis.\tSome
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0.040018584579229355,
0.09167381376028061,
0.0843806341290474
] |
questions\tremain\tunanswered\tas\tto\tthe\torigin\tof\tpolyps\tin\tCF\tpatients.\nPancreatic\tdisease\tin\tcystic\tfibrosis\nSeveral\tdifferent\ttypes\tof\tpancreatic\tdisease\toccur\tin\tCF\tpatients.\nPancreatic\tinsufficiency.\nPancreatic\tinsufficiency\t(PI)\n,\tin\twhich\tthe\tpancreas\tfails\tto\tmake\tadequate\tenzymes\n\tto\tdigest\tfood
|
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] |
to\tdigest\tfood\nin\tthe\tsmall\tintestine,\tis\tthe\tmost\tcommon\tgastrointestinal\tcomplication\tof\tCF,\taffecting\napproximately\t90%\tof\tpatients\tat\tsome\ttime\tin\ttheir\tlives\t(\nRogers,\t2013\n).\nUp\tto\t90%\tof\tpatients\texhibit\tfat\tmalabsorption\tby\t1\tyear\tof\tage.\tThe\tproduction\tof\tpancreatic
|
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] |
enzymes\tis\tdecreased,\twhich\tleads\tto\tthe\tmalabsorption\tof\tfats\tand\tsteatorrhea.\t\nSteatorrhea\n\tis\ncharacterized\tby\tfoul\tsmelling,\n\tbulky,\toily\tstools\tand\tfailure\tto\tthrive\tor\tpoor\tweight\tgain.\tSuch\npatients\tmay\talso\tpresent\twith\tclinical\tfeatures\tof\tdeficiency\tof\tthe\tfat-soluble\tvitamins\tA,\tD,\tE,\tand
|
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] |
K.\tThe\tCF\tpopulation\tfrequently\tpresents\twith\tsuboptimal\tvitamin\tD\tstatus.\tCF\tpatients\talso\tsuffer\nfrom\tvitamin\tK\tdeficiencies\tand\tneed\troutine\tsupplementation.\nPancreatitis.\nThe\tabnormal\tpancreatic\tsecretions\tcause\tprogressive\n\tpancreatic\tdamage,\tso\tthese\tpatients\tcan\npresent\twith\tacute\tor\trecurrent\tpancreatitis.\nCF-related\tdiabetes.
|
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Patients\twith\texocrine\tPI\talso\tmay\tdevelop\timpaired\tfunction\tof\tthe\tendocrine\tpancreas,\tleading\tto\nthe\tdevelopment\tof\t\ncystic\tfibrosis\trelated\tdiabetes\t(CFRD)\n.\tIt\tis\tthe\tmost\tcommon\tcomorbidity\tin\nthe\tCF\tpopulation,\toccurring\tin\t20%\tof\tthe\tadolescents\tand\t40%\tto\t50%\tof\tthe\tadults\twith\n\tCF.\tCFRD
|
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] |
CF.\tCFRD\nis\tassociated\twith\tpoor\tgrowth,\tclinical\tand\tnutritional\tdeterioration,\tand\tearly\tdeath.\tThe\tAmerican\nDiabetes\tAssociation\tand\tthe\tCystic\tFibrosis\tFoundation\trecommend\tyearly\tCFRD\tscreenings,\nstarting\tat\tage\t10\t(see\t\nChapter\t29\n\tfor\tdiscussion\tof\tdiabetes\tmanagement),\tto\tbe\tperformed\tusing\ta
|
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] |
for\tdiscussion\tof\tdiabetes\tmanagement),\tto\tbe\tperformed\tusing\ta\n2-hour\t75\tmg\toral\tglucose\ttolerance\ttest\tduring\ta\tperiod\tof\tstable\thealth.\tThe\tuse\tof\themoglobin\n\tA1C\nis\tnot\trecommended\tfor\tscreening\tbecause\tit\thas\tlow\tsensitivity\tin\tCFRD\t(\nMoran\tet\tal,\t2010\n).
|
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] |
Moran\tet\tal,\t2010\n).\nHemoglobin\tA1C\tis\toften\tnormal\tin\tpatients\twith\tCFRD\tregardless\tof\tthe\tdegree\tof\thyperglycemia.\nHowever,\tif\tit\tis\talready\tmeasured\tand\tthe\tvalue\tis\t>6.5,\tthis\tis\tstill\tconsistent\twith\ta\tdiagnosis\tof\nCFRD.\nBone\tdisease\nDue\tto\tvitamin\tD\tdeficiency,\tbone\tdisease\tis\tcommon\tin\tCF\tpatients\tand\tis\tcharacterized\n\tby
|
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by\nincreased\tfracture\trates,\tlow\tbone\tdensity,\tand\t\nkyphosis\n,\twhich\tis\tincreased\tcurvature\tof\tthe\tupper\nback.\tMultiple\trisk\tfactors\tcontribute\tto\tdeveloping\tbone\tdisease—chronic\tcorticosteroid\tuse;\nmultiple\tcourses\tof\tantibiotics;\tfailure\tto\tthrive;\tmalabsorption\tof\tcalcium,\tvitamin\tD,\tvitamin\tK,\tand
|
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magnesium;\tinadequate\toverall\tintake;\tand\treduced\tweight-bearing\tactivities.\tObtaining\tand\nmonitoring\n\tserum\t25-hydroxy\tvitamin\tD\tlevel\tshould\tbe\tdone\tyearly.\nOther\tconditions\nMeconium\tileus,\trectal\tprolapse,\tbiliary\tdisease,\tinfertility,\tmusculoskeletal\tdisorders,\tand\trecurrent
|
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] |
venous\tthrombosis\tare\tother\tless\tcommon\tconditions\tthat\toccur\tin\tpatients\twith\tCF.\tMeconium\tileus\nis\tan\tobstruction\tof\tthe\tsmall\tintestine\tcaused\tby\tthickened\tmeconium\t(first\tfeces)\tthat\tcan\toccur\tin\nneonates\twith\tCF.\n\tCF\tpatients\tare\tsusceptible\tto\tsmall\tintestine\tbacterial\tovergrowth\tdue\tto
|
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] |
decreased\tmotility.\tThis\tdisorder\tinterferes\twith\tfat\tabsorption\tand\tappetite\tand\tcan\tlead\tto\tmultiple\nfood\tintolerances\tand\tdigestive\tdisturbances\t(\nBaker\tet\tal,\t2013\n)\t(see\t\nChapter\t27\n).\nMedical\tmanagement\nCF\tis\ta\tmultisystem\tdisease\tthat\trequires\ta\tmultidisciplinary\tapproach\tto\tmanage\tsymptoms,\tcorrect\ndeficiencies,
|
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