11- Nutritional Disorders (Final) Flashcards
1
Q
What does Vita mean
A
Life
referring to the amines of life
2
Q
Vitamin is named by
A
Kazimerz Funk
in December of 1913
3
Q
First Vitamin to be discovered
A
Vitamin A
4
Q
Vitamin A discovered by
A
Elmer McCollum in 1913
5
Q
2 types of vitamins
A
Water-soluble (Bs, C )
Fat-soluble (A, D, E, K)
6
Q
Vitamin B1 AKA
A
Thiamine
7
Q
Vitamin B1 function
A
- Maintains neural membranes and nerve conduction, especially in peripheral nerves
- Prevents development of cancer
8
Q
Most important source of B1 is
A
husks of grains (unpolished grain)
9
Q
Which type of grains may lead to B1 deficiency if included in diet
A
Refined grains
10
Q
Who’s in risk of B1/Thiamine deficiency
A
- Alcoholics
- 1st trimester of pregnancy
- Fast-growing teens
11
Q
Alcohol effect on B1/Thiamine
A
- Alcohol competes with B1 in neural functions and in biochemical reactions
- Alcoholics are also more likely to spend their money on alcohol than good nutrition
12
Q
How pregancy leads to B1/Thiamine deficiency
A
1st trimester of pregnancy → Morning sickness (vomiting > causes the pregnant women to lose the vitamins and nutrition needed)
13
Q
Vitamine B1 Deficiency can cause
A
Beriberi
14
Q
Beriberi discovered by
A
Christiaan Eijkman
15
Q
Beriberi 3 types:
A
1) Dry Beriberi
2) Wet Beriberi
3) Wernicke encephalopathy and Korsakoff’s psychosis
16
Q
1) Dry Beriberi targets:
A
nervous system
17
Q
1) Dry Beriberi Characterized by
A
Non-specific peripheral polyneuropathy
with myelin degeneration and disruption of all 3
neurological arcs: sensory, motor and reflex arcs
18
Q
1) Dry Beriberi Manifestations:
A
- wrist drop, foot drop, and 1st toe drop
- Paresthesia, numbness, loss of reflexes
19
Q
2) Wet Beriberi targets
A
heart
20
Q
2) Wet Beriberi Characterized by
A
- Enlargement of the heart with thinning of the heart (muscle) wall
- Cardiac failure
- Peripheral vasodilation
- Peripheral edema (pitting)
- Dyspnea and orthopnea – shortness of breath
21
Q
Name the condition:
Enlargement of the heart with thinning of the heart (muscle) wall
A
flabby myocardium
22
Q
Wernicke encephalopathy targets
A
mamillary bodies in the brain
23
Q
Wernicke encephalopathy Characterized by
A
psychological problems:
- Global confusion
- Apathy
- Listlessness
- Disorientation
- Ophthalmoplegia
24
Q
Define Ophthalmoplegia
A
paralysis of one or more eye muscles
25
Ophthalmoplegia is caused due to a damage of ____ and results in \_\_\_\_
CNS
resulting in irregular eye movements
26
when Wernicke encephalopathy patient is seen with Ophthalmoplegia, Pt is porbably
(Pt condition)
close to death
27
Korsakoff’s psychosis 3 Manifestation
**Retrograde amnesia** (loss of memory of
events after the cause of the amnesia)
**Inability to acquire new information**
**Confabulation** – excessive talking
28
Name the condition:
**memory disturbance** defined as the **production of fabricated distorted** or **misinterpreted memories** about oneself or the world without the conscious intention to deceive
Confabulation
29
Korsakoff’s psychosis happens due to atrophy of
mamillary processes
30
Vitamin B2 AKA
Riboflavin
31
Vitamin B2 – (Riboflavin) Deficiency
is usually seen in people with
(name the condition)
ariboflavinosis
32
Define ariboflavinosis
chronic debilitating diseases (associated w/ degeneration of tissue)
* Oncologic diseases
* Renal diseases
33
Vitamin B2 (Riboflavin) Deficiency Symptoms:
* Cheilosis
* Glossitis
* Superficial interstitial keratitis
* Dermatitis
34
Define Cheilosis
(non-inflammatory) – cracks in the corner of the mouth
35
Cheilosis can lead to
infection and become **cheilitis** - with inflammation (secondary infection)
36
Define Glossitis
inflamed red tongue
37
Glossitis may lead to
Atrophy of tissue and loss of taste
38
Define Superficial interstitial keratitis
hardening of the cornea
39
Cornea is avascular and relies on ____ and ____ for nutrients and waste removal
intraocular fluid and tears
40
how can deficiency in B2 lead to Superficial interstitial keratitis
a **capillary net forms** around and **penetrates** into the **cornea** resulting in inflammation and damage to the cornea (**ulceration**)
41
Ulceration is painful due to ____ (receptor) in the cornea
nociceptors
42
damage that happens while the cornea begins to heal
fibrosis and loss of vision
43
Define Dermatitis
Inflammation seen in the nasolabial folds, behind the ears, and groin (scrotum and vulva)
44
Vit B2 (**does/does not**) affect the nervous system
Vit B2 **does not** affect the nervous system
45
Vitamin B3 AKA
Niacin
nicotinic acid
nicotinamide
46
Vitamin B3 Used as a medicine for its ____ ability (nitroglycerine treatment)
vasodilation
47
Vitamin B3 – Niacin Can be produced by
gut flora from tryptophan
48
why B3 – Niacin cannot be absorbed when eating plants
In plants B3 is bound
49
B3 leads to decreased production of ____ and prevent \_\_\_\_
B3 leads to decreased production of **lipoproteins** (LDLs) and prevent **arteriosclerosis**
50
Vitamin B3 – Niacin Deficiency results in
Pellagra
“pelle agro" = dry skin
51
Vitamin B3 – Niacin Deficiency symptoms (The 4 Ds)
* Dermatitis
* Diarrhea
* Dementia
* Death
52
Define Dermatitis B3
* develops on skin exposed to sun
* Casal’s necklace
* Glove-and-stocking lesions
53
Define Diarrhea
**Atrophy/degeneration** of epithelial cells of **intestinal mucosa** with involvement of submucosal layer
54
define Dementia
* Degeneration of cortical neurons
* Loss of function
55
Vitamin B6 AKA
pyridoxine
56
where is Vitamin B6 – pyridoxine found
all foods
57
what can lead to deficiency of Vitamin B6 – pyridoxine
* Thermolabile
* medications
58
Defince Thermolabile
a small amount of heat that can destroy B6
59
what are Some medications compete with B6 in biochemical reactions and may lead to deficiency
* Izoniazid
* Estrogens
* penicillamine
60
Define Izoniazid
antituberculosis medication
61
how can Estrogens effect the body
Estrogens (from birth control, or treatment) have **hyperplastic activity** → promotes **replication of** **cells** especially in **endometrium**, which could lead to cancer (breast and uterine)
62
D-penicillamine is used for treating
Wilson’s disease and systemic sclerosis
63
Vitamin B6 – pyridoxine deficiency symptoms
* Cheilosis/cheilitis
* Glossitis
* Peripheral polyneuropathy
* Convulsions – especially in infants and children
* Increased sloughing of epithelial cells
64
Explain the process and the effects of Increased sloughing
* decreased life span, rapid turnover
* Nidus formation
* Seborrheic dermatitis
65
Define nidus
organic **core of urinary stones**, in this case a **clump
of epithelial cells**from inside the bladder
66
# define Seborrheic dermatitis
* Dandruff
* Scaly and greasy squamous epithelial cells
67
Vitamin B12 AKA
cyan
cobalamin
extrinsic factor of Castle
68
B12 can only be found in _____ food source
animal
69
B12 cannot be absorbed directly, requires assistance via \_\_\_\_
proteins
70
When food is eaten, salivary glands secrete
R-binder
71
R-binder binds to ____ and carries it from the stomach to ____ where they dissociate
B12, duodenum
72
\_\_\_\_ produce and secrete intrinsic factor
Stomach parietal cells
73
intrinsic factor secreted by stomach
AKA
intrinsic factor of Castle
74
In the duodenum, ____ and ____ bind and move to the iluem
intrinsic factor and extrinsic factor
75
in the ileum, ____ factor binds to recptors which allows it to move into the blood circulation where it dissociate with ____ extrinsic factor
in the ileum, **_intrinsic_** factor binds to recptors which allows it to move into the blood circulation where it dissociate with **_extrinsic_** extrinsic factor
76
what causes B12 deficiency
Inadequate dietary intake
surgical removal of stomach or ileum
malnutrition or alcoholism
Celiac disease, Crohn's disease
intake of some medications (ranitidine, metformin)
77
in Autoimmune chronic gastritis, mmune system produces
parietal canalicular antibodies
78
parietal canalicular antibodies destroys:
parietal cells in the stomach
79
Autoimmune chronic gastritis results in no production of ____ which leads to \_\_\_\_
Results in no production of **intrinsic factor** and **B12 cannot
be absorbed**
80
Blocking antibodies binds to:
intrinsic factor
81
Binding antibodies Bind to receptors for intrinsic factor in the
ileum
82
B12 deficiency leads to
```
Pernicious anemia (AKA malignant anemia)
Demyelination
```
83
describe Pernicious anemia (AKA malignant anemia)
A type of megaloblastic anemia
Decreased RBCs, hemoglobin, or both
84
2 types of Pernicious anemia (AKA malignant anemia)
vitamin B12 – deficient anemia
folic acid – deficient anemia
85
how can B12 deficiency leads to Pernicious anemia (AKA malignant anemia)
Lack of B12 interferes with normal hematopoeisis
86
What can lead to decreased rate of conduction
Myelin degeneration
87
Demyelination results in (symptoms)
**Numbness and tingling** in hands and feet
## Footnote
**Ataxia**
**Paraplegia**
88
Define Ataxia
**abnormal gait** because of spinocerebellar tract involvement
89
Define Paraplegia
* *subacute** combined **degeneration** of the
* *spinal cord**
90
Paraplegia maintly targets ____ (system) and may affect ____ (system)
* *Affects PNS**
* *May affect CNS** – “megaloblastic madness”, cognitive dysfunction
91
Nervous system changes are (reversible/irreversible)
Nervous system changes are **irreversible**
92
is there a correlation between severity of pernicious anemia and severity of demyelination in B12 deficiency?
No
93
Giving folic acid to people with B12 nervous system pathology may
exacerbate nervous system problems
94
megalos (Greek) means
big, large
95
types of Megaloblastic Anemias
1. vitamin **B12** deficient anemia =\> pernicious anemia
2. **folic acid** deficient anemia
96
Megaloblastic Anemias results in
big/large blood cells
97
Folic Acid role in Hematopoeisis
Folic acid **donates carbon** for DNA in blood cells
98
B12 role in Hematopoeisis
Vitamin B12 activates **tetrahydrafolate**
99
Hematopoeisis Biochemical pathway
o **Folic acid is eaten**
o **Converted to monoglutamate** in the blood circulation
o Reductase **converts** monoglutamate **into tetrahydrofolate** (active form)
o Tetrahydrofolate **donates carbon to DNA** in blood cells =\> **tetrahydrofolate** is now in its **inactive** form
o Vitamin **B12 converts inactive tetrahydrofolate into active** tetrahydrofolate so that it can now donate more carbon
o **Cycle** from active to inactive **continues 10 – 12 times** before tetrahydrofolate is discarded
o Reusing materials **allows for a higher speed of production** (hematopoeisis) rather than using tetrahydrofolate only once
100
Define Blastic blood cells
immature, normally found only in the red marrow
in megaloblastic anemia, they appear in the blood
101
define Normoblast
normal cells
102
Define Megaloblast
mature, large cells
103
Define Macrocytes
large cell
104
site of gas/nutrient exchange
Capillaries
105
what happens to RBCs while reaching cappliaries in a pt with pernicious anemia?
RBCs are too large to fit in the capillaries, they **bend**
106
normal # of lobes in Neutrophils?
2 – 5 lobes
107
Hypersegmented nutrophils has ____ lobes
more than 5
108
Define Pancytopenia
Total decrease in the number of blood cells
109
Anemia is a decreased in
RBCs
110
Leucopenia is decreased
WBCs
111
Thrombocytopenia is decreased
platelets
112
Can Adding folic acid help in a vitamin B12 deficiency?
Yes
113
how can Adding folic acid helps in a vitamin B12 deficiency
**gives** the patient **carbon** to make DNA
tetrahydrofolate can be **used once**
(B12 recycle)
114
can Adding B12 does not help in a folic acid deficiency?
No, there is no tetrahydrofolate to start with
115
Differences between vitamin B12 and folic acid
Folic acid deficiency can lead to cheilosis/cheilitis
vitamin B12 effect the nervous system
116
effect of Methotrexate – Leukemia drug
Inhibits reductase
interfere with hematopoeisis
prevent cellular replication of cancer cells
Suppressed immune system (low WBCs)
117
Vitamin C AKA
Ascorbic Acid
118
Can Vit C produced in the human body?
No
119
Found in (food)
potatoes, citrus fruit, etc
120
Vitamin C – (Ascorbic Acid) function
Hydroxylation of procollagen
Synthesis of collagen peptides
Free-radical scavenger - powerful antioxidant
121
Procollagen is full of
proline
122
Proline is hydroxylated by vitamin C to become
hydroxyproline
123
hydroxyproline fucntion
Makes connective tissues:
Strong
Increased tensile strength
124
Vit C Works with vitamin E to
secures cell membranes from disruption
| (with selenium)
125
Vit C can Reduces oxidation of
**LDL**
(theoretically decreasing atherosclerosis)
126
vitamin C deficiency AKA
Scurvy
127
Scurvy can lead to
1) Bleeding diathesis
2) Skeletal changes
3) Wound healing
128
Scurvy can lead to Development of ____ and \_\_\_\_
**Petchiae** (pinpoint) and **ecchymosis** (widespread)
129
Scurvy can cause Bleeding gums which leads to
abnormal development of gums =\> tooth loss
130
Define Subperiosteal hematomas
caused by scurvy
Between periosteum and bone
leads to hemarthrosis, and Secondary osteoarthritis
131
Define Hemarthrosis
bleeding into joint space causing iron to destroy articular cartilage
132
Define Retrobulbar hematomas
Blood behind eyeball
can cause Increased pressure =\> vision loss
133
how can scurvy leads to Bowing legs
osteoid matrix is weak =\> provisional
calcification =\> weak bone
134
in addition to Bleeding diathesis, what can leads to teeth loss
Shortened alveoli to hold teeth
135
Define Pigeon chest
Protrusion of ribs and sternum
136
Vit C help in repair by
fibrosis (of connective tissue)
137
Vitamin A Discovered by
McCollum June 1913
138
Vitamin A forms
Retinol
Retinal
Retinoic acid
139
define Retinol
storage and transport form; 90% stored in the liver
enough for 9 month of supply
140
define Retinal
maintains normal vision in dim light
141
Define Retinoic acid
determining life span of epithelial cells
142
Vit A Found in (food)
orange and red plants such as carrots
143
For Vit A absorption, it needs to be eaten with \_\_\_
Fat
144
\_\_\_\_ are natural precursors for retinal, ex. beta-carotene
Carotinoids
145
\_\_\_\_ are synthetic/artificial, avoid these (teratogenic affect)
Retinoids
146
Retinal Function
Maintains normal vision in reduced light
production of visual pigments
147
photoreceptors retinal is involved in:
Rods – rhodopsin
cones – iodopsin
148
Retinal deficiency results in
Night blindness
149
night blindness, AKA
chicken disease/blindness
150
RETINOIC ACID function
**Potentiation and differentiation** of specialized **epithelial** cells, mainly mucous-secreting cells
**normal life span** of epithelial cells (ducts of
glands, GI tract, and skin)
151
RETINOIC ACID Deficiency can lead to
Xeropthalmia
Xerosis
Squamous metaplasia
Follicular and papullar dermatosis
Pulmonary infection
Nidus formation
152
Define Xeropthalmia
dry eye
obstruction of ducts of lacrimal gland
153
How can retonic acid Deficiency leads to Xeropthalmia
increased sloughing of cells causing blockage of lacrimal ducts
154
Define BITOT’S SPOTS
sloughed epithelial cells of conjunctiva form plaques close to cornea
155
Defince keratomalacia
softening damage to the cornea
156
how can Xerosis end up with blindness
BITOT’S SPOTS
=\> keratomalacia
=\> ulceration of cornea
=\> blindness via healing mechanisms
157
what can Nidus formation cause?
urinary tract obstruction
158
RETINOIC ACID can increase immunity and lower mortality rates to (infections)
measles, pneumonia, and infection diarrhea
159
Hypervitaminosis A is ore common and dangerous with (**Natural/synthetic)** vitamin A use
**synthetic**
160
ACUTE hypervitaminosis A Symptoms
similar to a brain tumor or intracranial pressure
(headache, nausea/vomiting, papilledema)
161
What would you do to a patient with ACUTE hypervitaminosis A and High BP
Refer Out
162
CHRONIC hypervitaminosis A symptoms
Weight loss
Nausea, vomiting
Dryness of mucosa of lips
Bone and joint pain
Hepatomegaly
Hyperostosis
163
Define Hepatomegaly
Enlarged liver due to storing excess retinol resulting in mechanical pressure on the hepatocytes
Leads to liver fibrosis
164
Hyperostosis AKA
DISH
Forestier’s Disease
165
Define Hyperostosis
ssification of the ALL (rarely PLL) causing fusion
166
Vitamin E AKA
α-tocopherol
167
What is the collective name of Vit E means
4 tocopherols and 4 tocotrienols
168
Vitamin E – (α-tocopherol) function
**Antioxidants**
cell **membrane maintenance**
**protects/repairs** damage from free radicals
169
Vit E works as antioxidant with ____ (vitamin) and
vitamin C and selenium
170
2 types of cell membranes most susceptible to vitamin E deficiency are
RBCs
neurons
171
Explain the nervous system damage due to Vit E Deficiency
**Degeneration of axons** in the posterior columns of SC
* *Loss** of nerve cells in the **DRG**
* *Myelin degeneration** of sensory axons in PNS
**Degenerative** changes in the **spinocerebellar** tract
172
Degenerative changes in the spinocerebellar tract can lead to
(Vit E neurological symptoms)
Absent tendon reflexes
Ataxia – lose balance
dysarthria
Loss of position and vibration sense
Loss of pain sensation (DRG)
173
Vit E Deficiency **does not** result in anemia EXCEPT in
premature infants
174
Hypervitaminosis E can result in
decreased production of clotting factors
175
how does Vit E lead to "decreased production of clotting factors"
**Decreased coagulative** ability of blood due to **interference with vit K**
176
Vitamin E inhibits
atheroma formation in atherosclerosis
177
How can Vit E inhibits atheroma formation in atherosclerosis
through reducing oxidation of LDLs
178
Vitamin K
explain the reason behind the letter K
Coagulation of blood (German – **K**oagulation)
179
Vitamin K is produced by
gut flora
180
Vit K can be found in (food)
Any food, usually animal source
181
Vit K is important in the production of following clotting factors:
CF 2 prothrombin
CF 7 proconvertin
CF 9 Christmas Factor
CF 10 Stuart-Prower Factor
(Produced in liver)
182
Vit K is used in productoin of which protein/hormone
Osteocalcin
183
# Define Osteocalcin
hormone that **promotes calcification of bones**
(indirectly prevents osteoporosis)
184
Vit K Deficiency can lead to
Bleeding diathesis
185
Bleeding diathesis (Vit K deficiency) symptoms
* Intracranial hemorrhage
* Ecchimoses
* Melena
* Hematoma
* Hematurea – *due to bleed in kidney*
* Bleeding gums
186
Define Melena
**black stool**
(usually the term is used for any hemorrhage from the GI tract)
187
Define Bleeding diathesis
Hemorrhagic disease of _newborns_
could result in Intracerebral hemorrhage (stroke)
188
Why new newborns are in high rish of Bleeding diathesis (Vit K deficiency)
Normal gut flora not yet established
189
How to prevent Bleeding diathesis in new born
pregnants 2 – 4 weeks prior to delivery, take a vitamin K supplement
190
Pregnants with which medications are in high risk of having newborns with Bleeding diathesis
antituberculosis or anticonvulsants
191
Iron deficiency can lead to
Hypochromic microcytic anemia
192
Iodine deficiency can lead to
Hypothyroidism
Goite
193
Selenium deficiency can result in
Kashan’s Disease
Myopathy, Congestive cardiomyopath
194
Copper deficiency can result in
Muscles weakness
hypopigmentation
195
Deficiency of Zinc can lead to
Distinctive rash, acrodermatitis enteropathica
o Anorexia, diarrhea
o Growth retardation
o Hypogonadism, infertility
o Impaired wound healing
o Impaired night vision
o Impaired immune function
o Depressed mental function
