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MOD > Chapter 9 Part 3 > Flashcards

Chapter 9 Part 3 Flashcards

1
Q

Definition of malnutrition

A

consequence of inadequate intiake of proteins and calories or deficiency in digestion or absorption of proteins resulting in loss of fat and muscle tissue, weight loss, lethargy, and generalized weakness

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2
Q

An appropriate diet should consist of what three things?

A

sufficient energy source, amino acids/protein, vitamins and minerals

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3
Q

Definition of primary dietary insufficiency

A

one or all components of appropriate diet are missing

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4
Q

Definition of secondary malnutrition

A

results from malabsorption, impaired utilization or storage, excess loss, or increased need for nutrients

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5
Q

Things that lead to dietary insufficiency?

A

poverty, infection, acute and chronic illness, chronic alcoholism, ignorance and failure of supplementation, self-imposed restriction, etc.

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6
Q

What groups of people are most at risk for protein-energy malnutrition?

A

infants and children in developing countries, older and debilitated patients in nursing homes and hospitals

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7
Q

Two functional protein compartments in the body

A

somatic (skeletal m.) and visceral (liver)

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8
Q

Clinical sxs of secondary PEM

A

depletion of subcutaneous fat, wasting of quads and deltoids, ankle or sacral edema

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9
Q

Marasmus diagnostic criteria

A

weight<60% normal for sex, ht, and age

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10
Q

Clinical sxs of marasmus

A

growth retardation and muscle loss; serum albumin NL, anemia, immune deficiency

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11
Q

Pathogenesis of Marasmus

A

catabolism and depletion of somatic protein compartment

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12
Q

Fuels used by body in marasmic children

A

muscle proteins, subcutaneous fat

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13
Q

Etiology of Kwashiorkor

A

protein deficiency more severe than caloric deficit; due to chronic diarrhea, protein losing enteropathies, nephrotic syndrome, extensive burns

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14
Q

Clinical sxs of kwashiorkor

A

hypoalbuminea leading to generalized edema, vitamin and immune deficiency, hair and skin changes, fatty liver

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15
Q

Pathogenesis of Kwashiorkor

A

depletion of visceral protein compartment with sparing of subcutaneous fat and muscle

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16
Q

Small bowel changes in Kwashiorkor

A

decrease in mitotic index, mucosal atrophy and loss of villi

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17
Q

Bone marrow changes in PEM

A

hypoplastic

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18
Q

Brain changes in PEM

A

cerebral atrophy, reduced neurons, impaired myelination

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19
Q

Populations most affected by cachexia

A

AIDS, advanced cancers (esp. GI, pancreatic, lung)

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20
Q

Clinical characteristics of cachexia

A

extreme weight loss, fatigue, muscle atrophy, anemia, anorexia, edema

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21
Q

Pathogenesis of cachexia

A

proteolysis-inducing factor and lipid-mobilizing factor cause muscle breakdown through ubiquitin-proteasome pathway, typically breakdown structural proteins

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22
Q

Anorexia nervosa

A

self induced starvation leading to marked weight loss

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23
Q

What psychiatric DO has the highest death rate?

A

anorexia nervosa

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24
Q

Clinical sxs of anorexia nervosa

A

amenorrhea, decreased thyroid hormone, decreased bone density; death may result from cardiac arrhythmia or sudden death (hypokalemia)

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25
Q

Bulimia

A

binge eating and induced vomiting, often better prognosis than anorexia

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26
Q

Major complications of bulimia

A

electrolyte imbalance, pulmonary aspiration, esophageal and gastric rupture; due to vomiting and laxative use; hypokalemia/cardiac arrhythmia may result

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27
Q

Fat soluble vitamins

A

A, D, E, K

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28
Q

What vitamins can be synthesized endogenously

A

vitamin D, vitamin K, biotin, niacin

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29
Q

Major functions of vitamin A

A

maintenance of vision, regulation of cell growth and differentiation, and regulation of lipid metabolism

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30
Q

Transport/storage form of vitamin A

A

Retinol

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31
Q

Dietary source of vitamin A

A

liver, fish, eggs, milk, butter, yellow and green vegetables

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32
Q

Where is vitamin A absorbed?

A

small intestine

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33
Q

Causes of secondary vitamin A deficiency

A

fat malabsorption syndromes (Crohn, CF, colitis, celiac)

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34
Q

Causes of vitamin A deficiency i children

A

depletion in presence of infection, poor absorption in newborns

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35
Q

Side affects of vitamin A deficiency

A

night blindness, squamous metaplasia and keratinization of epithelia, xerophthalmia, bitot spots that erode cornea and lead to blindness, respiratory and UT squamous metaplasia, immune deficiency

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36
Q

Clinical sxs of vitamin A toxicity

A

headache, dizziness, vomiting, stupor, blurred vision; weight loss, anorexia, bone and joint pain

37
Q

Major function of vitamin D

A

maintain plasma levels of calcium and phosphorus, bone mineralization, neuromuscular transmission

38
Q

Hypocalcemic tetany

A

convulsive state caused by insufficient extracellular Ca required for muscle relaxation

39
Q

Rickets clinical sxs

A

frontal bossing, squared head, rachitic rosary, pigeon breast deformity, lumbar lordosis, bowing of legs

40
Q

Osteomalacia clinical sxs

A

inadequate mineralization of bone, weak and prone to fracture

41
Q

Major source of vitamin D

A

endogenous synthesis from precursor, 7-dehyrocholesterol reaction that requires UV light

42
Q

Dietary sources of vitamin D

A

deep-sea fish, plants, grains

43
Q

Steps in vitamin D metabolism

A
  1. photochemical synthesis from 7-dehydrocholesterol in skin
  2. binding of vitamin D to DBP and transportation to liver
  3. conversion to 25-hydroxycholecalciferol through CYP27A1
  4. Conversion to 1,25 dehydroxytitamin D by 1alpha hydroxylase in kidney
44
Q

What regulates production of active vitamin D?

A

parathyroid hormone (triggered by hypocalcemia), hypophosphatemia activating 1alpha-hydroxylase, feed back (inhibits its own activity)

45
Q

Effects of vitamin D on Ca and PO4 homeostasis

A

stimulation of intestinal Ca absorption thru TRPV6, stimulation of kidney Ca absorption thru TRPV5, expression of RANKL on osteoblasts triggering osteoclast differentiation, mineralization of osteoid matrix

46
Q

Morphological changes of bone in Rickets

A

loss of cartilage palisades, overgrowth of epiphyseal cartilage, persistence of cartilage masses that project into the marrow cavity, abnormal overgrowth of capillaries and fibroblasts, deformation of skeleton

47
Q

Function of Vitamin K

A

cofactor for Factors II, VII, IX, X, Protein S and protein C

48
Q

Clinical sxs of vitamin K deficiency

A

bleeding diathesis

49
Q

Function of vitamin B1

A

thiamine, coenzyme in decarboxylation reactions

50
Q

Clinical sxs of thiamine deficiency

A

dry and wet beriberi, Wernicke-Korsakoff syndrome

51
Q

Function of niacin

A

incorporated into NAD and NADP, involved in redox readtions

52
Q

Clinical sxs of niacin deficiency

A

dementia, dermatitis, diarrhea (pellagra)

53
Q

Function of Vitamin B6

A

pyridoxine, derivatives used as coenzymes in intermediary reactions

54
Q

Clinical sxs of pyridoxine deficiency

A

cheilosis, glossitis, dermatitis, peripheral neuropathy

55
Q

Function of Vitamin C

A

re-dox reactions and hydroxylation of collagen

56
Q

Dietary sources of vitamin C

A

milk, some animal products, many fruits and vegetables

57
Q

Scurvy

A

bone disease in growing children, hemorrhages and healing defects

58
Q

Populations most likely to have vitamin C deficiency

A

chronic alcoholic, people who live alone (have erratic and inadequate eating patterns)

59
Q

Clinical signs of vitamin C deficiency

A

bleeding of skin, gums, and joints, inadequate osteoid synthesis, impaired wound healing

60
Q

Clinical features of zinc deficiency

A

acrodermatitis enteropathica, anorexia, diarrhea, growth retardation, depressed mental function, impaired night vision, depressed wound healing

61
Q

Clinical feature of iron deficiency

A

hypochromic microcytic anemia

62
Q

Clinical feature of iodine deficiency

A

goiter and hypothyroidism

63
Q

Clinical features of copper deficiency

A

muscle weakness, neuro defects, abnormal collagen cross-linking

64
Q

Clinical features of fluoride deficiency

A

dental caries

65
Q

Clinical features of selenium deficiency

A

myopathy, cardiomyopathy

66
Q

Vitamin C excess sxs

A

iron overload, hemolytic anemia if G6PD deficient, calcium oxylate kidney stones

67
Q

Vitamin D toxicity sxs

A

metastatic calcifications in kidney, bone pain, hypercalcemia

68
Q

What diseases are obesity and excess body weight associated with?

A

increased incidence of type 2 diabetes, dyslipidemias, CV disease, HTN, CA

69
Q

Definition of obesity

A

accumulation of adipose tissue sufficient magnitude to impair health

70
Q

Normal BMI

A

18.5-25

71
Q

BMI>30

A

obese

72
Q

BMI25-30

A

overweight

73
Q

Components of afferent system

A

leptin, adiponectin, ghrelin, PYY, insulin

74
Q

Neurons in arcuate nucleus responsible for feeding

A

POMC and NPY/AgRP

75
Q

Function of POMC neurons

A

satiety, anorexigenic

76
Q

Function of NPY neurons

A

feeding, orexigenic

77
Q

When is leptin release stimulated

A

abundance of fat stores

78
Q

Functions of adiponectin

A

fatty acid oxidation, causing decrease in fat mass

79
Q

Consequences of obesity

A

metabolic syndrome characterized by adiposity, insulin resistance, hyperinsulinemia, glucose intolerance, HTN, hypertriglyceridemia, decreased HDL

80
Q

Increased risk of CAD for obese persons due to what two factors?

A

hypertriglyceridemia, low HDL

81
Q

Percentage of cancers attributable to obesity

A

4% in men, 7% in women

82
Q

What types of CAs associated with obesity

A

esophagus, pancreas, colon, rectum, breast, endometrium, kidney, thyroid, gallbladder

83
Q

How might elevated insulin levels lead to CA?

A

elevated levels of IGF-1, a mitogen expressed in many CAs - promotes PI3/AKT path

84
Q

Increased levels of what adipose-related hormone may cause CA?

A

estrogen

85
Q

Aspects of diet that are of most concern in carcinogenesis?

A

content of exogenous carcinogens, endogenous synthesis of carcinogens, lack of protective factors

86
Q

What might aflatoxin cause?

A

hepatocellular carcinoma

87
Q

What two molecules are associated with generation of gastric tumors

A

nitrosamines, nitrosamides

88
Q

Dietary causation of colon CA

A

high animal fat, low fiber

89
Q

What vitamins and minerals are associated with anticarcinogenic effects?

A

Vitamin C, Vitamin E, B-carotenes, selenium

MOD (34 decks)

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