CH 11---PATHOLOGY OF MALNUTRITION--3 Q'S

Question 1

Malnutrition may be classified into:
1-Protein-energy malnutrition——PEM
2-Vitamin deficiencies
3-A combination of both

Answer 1

KNOW

Question 2

PEM—Kwashiorkor–Severe protein deficiency

Causes:
1. Chronic diarrheal diseases (proteins not absorbed)
2. Chronic protein loss:-extensive burn-nephrotic syndrome
Manifestations
1. Marked weight loss (60-80% of normal weight)
2. Edema & MOONFACE & FLAKY PAINT SKIN
3. “FLAG SIGN” HAIR & FATTY LIVER

Answer 2

“KWASH HAS A MOONFACE WITH FLAKY SKIN AND DIARRHEA”..LOST HIS PROTEIN TOO

Question 3

Marasmus=Severe calorie (energy) deficiency in diet

Manifestations:—-Loss of major source of energy (fat) = loss of facial band of fat = (old person look)

Answer 3

MARASMUS LOOKS OLD!!

Question 4

Essential organic materials required as co-enzymes in metabolic processes:
Water soluble:—-B, C

Fat soluble:—-A, D, E, K

Answer 4

KNOW

Question 5

B1 (Thiamine)
–co-enzyme in carbohydrate metabolism

—Its deficiency (_______) impairs energy production & ATP supply

Manifestations of deficiency

1. Heart (wet beriberi): associated with peripheral vasodilation
2. CNS (dry beriberi):
   a. Peripheral neuropathy–numbness & tingling & muscle tenderness, weakness, atrophy
   b. Brain (Wernicke-Korsakoff syndrome):-most in chronic alcoholics in the Western world–CONFUSION/DEMENTIA

Answer 5

(beriberi) FOR B1 B1

NO B1 = NO ATP FOR ENERGY

“WENICKE THE ALKI”

Question 6

B2(Riboflavin)
–oxidation-reduction reactions-Constituent of Flavoprotein…FMN….FAD—–Its deficiency impairs ENERGY production
Manifestations of deficiency:
1. Lips:-cheilosis (first & most characteristic) WRINKLES
2. Tongue:- glossitis, atrophied
3. RED EYES
4. Skin: scaling dermatitis

Answer 6

NO B2 = NO ENERGY FLAVO

Question 7

B3 (Niacin,Nicotinic Acid)

Its deficiency causes PELLAGRA ; (THE 3 D’s):
1.D ermatitis
2.D iarrhea
3.D ementia

Manifestations of deficiency THE 3 D’S

1. Dermatitis:RED, DEEP BROWN, ROUGH AND THICK
2. Diarrhea: tongue→ glossitis -intestine = diarrhea
3. Dementia:CEREBRAL CORTEX AND DEG. OF TRACTS

Answer 7

PELLAGRA = NIACIN DEFICIENCY

Question 8

B6 (Pyridoxine)

Functions:

• Formation of pyridoxal phosphate
• Co-enzyme in protein metabolism

Manifestations of deficiency: (similar to other B vitamin
deficiency)

Answer 8

SAME AS NIACIN

Question 9

B12 (Cyanocobalamin)

Functions:
-Binds with intrinsic factor–IF– produced by parietal
cells of stomach absorbed in ileum & stored in
LIVER
Manifestations of deficiency:—Pernicious anemia: autoimmune disease DUE TO A LACK OF “IF”

Answer 9

NO “IF” = NO B12

Question 10

Vitamin C (Ascorbic acid)

Deficiency: causes scurvy
Function: HELPS WITH COLLAGEN
Manifestations of deficiency:
–Decreased tensile strength of collagen fibers
–TENDENCY TO BLEED
–IMPAIRED WOUND HEALING
–ANEMIA
– Skeletal changes: KIDS = Bones yield due to weight bearing & muscle tension
—ADULTS=Normal bone resorption & decreased new bone formation = rarefaction of bones (less dense)
—Alveolar margin & jaw:-falling teeth-swelling & bleeding of gums

Answer 10

KNOW

Question 11

FAT SOLUBLE VITAMINS—Vitamin A(Retinol)
Functions:
1. rhodopsin in rods for night vision
2. iodopsin in cones for daytime vision

Manifestations of deficiency:

1. Visual impairment:
   a. Failure of night vision (night blindness)
   b. Failure of regeneration of iodopsin in cones = impaired vision in bright light
2. Hyperplasia & keratinization of stratified
   squamous epithelium + squamous metaplasia of
   glandular epithelium

Answer 11

ROD LIKES –NIGHT

I LIKE—- DAY

Question 12

Vitamin D
Functions:
1.  Stimulates the parathyroid hormone
2. Stimulates calcium absorption
3. Mobilization of calcium from the bone

Deficiency: Rickets & Osteomalacia
Features:
-Due to vitamin D deficiency = DECREASE mineralization
of bone
-Rickets——– in children—The bowing of legs in a
toddler due to the formation of poorly mineralized bones
is evident.
-Osteomalacia——-in adults

Answer 12

BABY RICK AND OSTEO ADULTS

Question 13

Vitamin E
Functions:
1. Acts as an antioxidant to prevent & neutralize effects of free radicals
2. Protects against peroxidation of polyunsaturated
fatty acids (e.g. linoleic acid) in membrane phospholipids
3. Protects against hemolysis of RBCs
4. Protects against retrolental fibrosis in premature
babies receiving oxygen

Manifestations of deficiency:

1. Degeneration of axon & myelin in posterior columns of spinal cord
2. Peripheral neuropathy

Answer 13

anti-oxidant PROTECTOR

no E = no AXON

Question 14

Vitamin K

Functions:
Synthesis of coagulation factors in liver (II, VII, IX,and X)

Causes of deficiency:

1. Intestinal malabsorbtion of FAT
2. Lack of intestinal flora (newborns, prolonged antibiotic therapy)
3. Liver disease
4. Vitamin K antagonists (coumadin)

Answer 14

Manifestations of deficiency:

—– decreased plasma levels of vitamin K dependent
coagulation factors = PROLONGED coagulation time

—–BLEEDING tendency e.g. skin, mucous membrane