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Patho > 18. HIV + NUTRITION > Flashcards

18. HIV + NUTRITION Flashcards

1
Q

pathogenesis of HIV

A

virus with gp41 and gp120

gp120 binds to CD4

gp41 penetrates membrane

viral genome into host

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2
Q

3 phases of HIV infection

A

acute
chronic
crisis aids

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3
Q

Acute retroviral syndrome primary infection

A

Infection of CD4+ T cells

Viremia => body wide seeding of
lymphoid tissue, ↓CD4 count

40-90% develop flu like symptoms
Fevers, chills, night sweats & rashes, lymphadenopathy, diarrhea & vomiting 3-6wks after infection & resolve 2-4 wks later spontaneously

No symptoms may be present
Activation of CD8+ T cells
↓↓ viral load, ↑ CD4 count (800)
Seroconversion
Antibody production 3-7wks

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3
Q

Clinical latency

A

Asymptomatic period “clinical latency”, 2-15yrs or more

Continuous HIV replication and cell destruction in spleen and lymph nodes

Co-receptor switch to CXCR4

Gradual decreased in function and no. of CD4 T cells

Persistent generalized lymphadenopathy (PGL)
Minor opportunistic infections
Oral or vaginal candidiasis, herpes zoster and TB

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4
Q

persistent generalized lymphadenopathy (PGL)

A

Presence of lymph nodes >1 cm at 2 or more extrainguinal sites for > 3 months

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5
Q

AIDS (final crisis phase)

A

Breakdown of host defense

Dramatic ↑↑ in plasma viral load & life threatening disease

Fever (>1month), fatigue, wt. loss & diarrhea

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6
Q

AIDS indicator (defining) diseases emerge

A

Serious opportunistic infections

Secondary neoplasms e.g. Kaposi’s sarcoma, Non Hodgkin’s lymphoma, cervical cancer

Clinical neurological disease

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7
Q

opportunistic infection

A

protozoal

fungal

bacterial myco avium

viral

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8
Q

Pneumocystis pneumonia (PCP)

A

= Pneumocystis jirovecii pneumonia (PJP)
Caused by the yeast-like fungus Pneumocystis jirovecii.
Typically dry/non-productive cough because sputum becomes too viscous to be coughed up.
PaO2 is strikingly lower than would be expected from symptoms.

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9
Q

progressive multifocal leukoencephalopathy

A

by jc virus polioma
infect oligodendrocytes
shown by luxol fast blue stain

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10
Q

AIDS-Defining Neoplasms

A

kaposi sarcoma
primary lymphoma of brain
invasive cancer of uterus

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11
Q

kaposi sarcoma

A

by HHV 8

purple redish macules plaques and nodules

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12
Q

4 types of kaposi sarcoma

A

classic
endemic
immunosuppresed
epidemic/AIDS

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13
Q

Squamous cell carcinoma of uterus

A

by HPV
16 18 31 33

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14
Q

Pathogenesis of Central Nervous System Involvement

A

HIV predominantly infect microglia
Imported by infected T cells or monocytes
Mechanism of HIV-induced damage of the brain is idiopathic
Neurologic deficit (»neuropathologic changes ) is caused indirectly by viral products and by soluble factors produced by infected microglia(IL-1, TNF, and IL-6). gp41 induced nitric oxide and Direct damage of neurons by soluble HIV gp120

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15
Q

Protein energy malnutrition(PEM)

A

= severe malnutrition
Inadequate consumption of protein and/or energy resulting in a range of clinical syndromes

16
Q

Marasmus

A

Caused primarily by severe reduction in caloric intake
Results in > 60% reduction in body weight adjusted for height and sex
Child suffers growth retardation and loss of muscle (catabolism)
Loss of somatic protein compartment&raquo_space;> visceral protein compartment
Albumin levels either normal or only slightly reduced
Extremities are emaciated, head appears to be too large for the body
Anemia, multivitamin and T cell mediated immuno deficiency

17
Q

Kwashiorkor

A

Protein deficiency with adequate calorie intake

Severe than marasmus
Severe loss of the visceral protein compartment with relative sparing of subcutaneous fat and muscle mass
Hypoalbuminemia  generalized edema
Weight of affected children is 60 to 80% of normal (i.e true loss of weight is masked by the edema)
Hepatomegaly with fatty liver

18
Q

predisposing factors for kwashiorker

A

Early weaning, exclusive carbohydrate diet are predisposing factors

19
Q

Physiologic Function of Vit. A

A

Maintains normal vision
Potentiate differentiation of specialized cells
Enhance immunity against infection
Photoprotective and Antioxidant

20
Q

Manifestations of vitamin A deficiency

A

Poor vision (night blindness)
earliest symptom of deficiency
Xerophthalmia
Dry conjunctivae, Bitot’s spot, corneal erosion and Keratomalasia
Lithiasis: eg. Urinary tracts and Kidney
Respiratory epithelium squamous metaplasia
Skin: Follicular hyerplasia and Hyperkeratosis  follicular or papular dermatosis.
Immune deficiency: eg complicated measles and Diarheal diseases

20
Q

metabolism of vitamin d

A

chole calciferol

25 hydroxycholecalciferol

1, 25 dihydroxycholecalciferol

20
Q

Physiologic function of Vit. D

A

Maintains Ca and P level at supersaturate level
Helping mineralization of bone
Stimulates intestinal absorpition of calcium and phosphorus
Collaborates with PTH in the mobilization of Ca from bone
Stimulates the PTH dependant reabsorption of Ca in the distal renal tubule

20
Q

Physiologic Function
vit c

A

Synthesis and stability of proteins (collagens-hydroxylation of proline and lysine)
Facilitates Iron absorption
Antioxidant

21
Q

manifestations

A

craniotabs
rachitic rosary
harrisons sulcus
squared head
pigeons breast
swellinf of wrist and ankle

22
Q

clinical manifestations of scurvy

A

hemorrhage - purpura and ecchymoses
- perifollicular hyperkeratotic papular rash

scorbutic rosary

crokscrew hair

postive rumpel leede test

anemia

23
Q

Physiologic function
B1

A

Functions as coenzyme
Maintains normal neural conduction

24
Q

Deficiency states
CAUSE

A

Polished cereal preparation
Sever protracted vomiting or diarrhea
Chronic alcoholism and IV feeding

25
Q

DISEASE

A

Polyneuropathy (Dry Beriberi)
Cardiovascular syndrome (wet Beriberi)
Wernike-Korsakoff’s syndrome (psychosis)

26
Q

Wernicke korsakoffs psychosis mnemocis

A

coat rack
confusion
opthalmoplegia
ataxia
thiamine def

retro amne
antero amnesia
confabulation
korsakofs psychosis

27
Q

Riboflavin deficiency face only

A

Cheilosis: Pallor and fissure at the angles of the mouth
Glossitis: Atrophic tongue
Eye changes: Superficial interstitial keratitis
Scaling dermatitis: Over the nasolabial folds that involves the cheeks, scrotal dermatitis

28
Q

niacin

A

pellagra

Patho (33 decks)

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