Chronic disease Flashcards
What is the most abundant organic molecule in nature?
Carbohydrates
Name the main functions of carbohydrates
- Immune functions
- Intercellular communication
- Structural components
- Energy source
- Energy storage `
What is the simplest form of sugar
Monosaccharides (1 sugar unit)
How many sugar units do oligosaccharides contain?
3 to 10 sugar units
What is the generic name of a monosaccharide with 3 carbons. State an example too
Generic name: triose
Example: glyceraldehyde
What are the most common functional groups in monosaccharides
- Aldoses (-ose) (aldehyde function)
- Ketoses (-ulose) (ketone function)
Define isomers
Compounds that have the same chemical formula but different structures
Epimers
Carbohydrate isomers that differ in configuration around only one specific carbon atom
What are enantiomers?
Pair of structures that are mirror image of each other
What are the most naturally occurring sugars (D or L isomers)?
- D isomers
Most monosaccharide with 5 or more carbon atoms from a ring structure. TRUE OR FALSE
TRUE
What is a pyranose ring
A cyclic monosaccharide with 5 carbon atoms and 1 oxygen atom
What is a furanose ring
A cyclic monosaccharide with 4 carbon atoms and 1 oxygen atom
Cyclization creates an anomeric carbon centre. TRUE OR FALSE
TRUE
What is an anomeric carbon atom?
A carbon that is derived from the carbonyl carbon compound of the open - chain form of the carbohydrate molecule
Name some features of fructose
- it is sweeter than glucose
- source: fruits, vegetables and honey
What is glucose the primary energy source for?
- the brain
- cells with few or no mitochondria
- essential in exercising muslce
Where can glucose be obtained?
Diet
Degradation of glycogen
Gluconeogenesis
What is the feature of galactose and where can it be found
- less sweet than glucose
- source: dairy products
What does maltose consist of?
Glucose + Glucose
Galactose + glucose =
Lactose
Glucose + ___ = sucrose
Fructose
What is the bond between sugars called?
- Glycosidic bond
How are glycosidic bonds formed
Through condensation reactions
Where is sucrose found
Sugar cane and sugar beets
What kind of bond is in maltose
1,4 - glycosidic bond (alpha)
How is maltose formed
By the degradtion of starch
What bonds are in sucrose
1, 2- glycosidic bond (beta)
What kind of bonds are in lactose?
1,4 glycosidic bonds
Where is lactose found?
In mammalian milk
What are the 3 important polysaccharides
. Cellulose - structural
. Starch - storage
. Glycogen - storage
What bonds are in cellulose and cellulose is a major component of …… (1)
- 1,4 glycosidic bonds (beta)
- (1) plant cell walls
What are the two types of starch?
- Amylose: unbranched, alpha 1,4 glycosidic bonds
- Amlopectin: branched - alpha 1,6 glycosidic bonds & alpha 1,4 glycosidic bonds
Glycogen has a branched structure and is similar to amylopectin. TRUE OR FALSE
TRUE
What causes lactose intolerance?
The inability to produce insufficient amounts of lactase so lactose does not get broken down.
State another sugar intolerance (not lactose)
Isomaltose/ Sucrose
What are the symptoms of sugar intolerance
- Undigested carbohydrate will pass into the large intestine cause OSMOTIC DIARRHOEA
- Bacterial fermentation of carbohydrate produces lot of CO2 and H2. > causes ABDOMINAL CRAMPS, DIARRHOEA and FLATULENCE (farting)
How do you manage sugar intolerance?
- withholding dietary sugar (not always possible as sucrose is also found in fruits etc.)
- enzyme replacement therapy (lactase/sucrase is taken when ingesting meals that contain lactose/sucrose)
What is galactosaemia?
Inability to metabolise galactose - leads to accumulation of galactose which is then oxidised and reduced to toxic metabolites
Glucose is broken down via glycolysis into ….. (1)
(1)Pyruvate
in anaerobic conditions: Lactate
Glucose > Pyruvate > Acetyl Co A > CO2
Metabolism of glucose
What cells are monosaccharides absorbed by?
Intestinal mucosal cells
Glucose and galactose are actively transported by what?
Sodium - dependent glucose (SGLT - 1)
Fructose is actively transported by what?
Sodium - independent monosaccharide (GLUT - 5)
How are carbohydrates digested?
- Mouth - amylase breaks down carbohydrates
- Stomach - stomach acid kills any bacteria
- Small intestine (duodenum) - pancreatic amylase breaks down carbohydrates into Dextrin and Maltose
Small intestine makes lactase, sucrase and maltase
Sugars absorbed into small intestine - Liver - absorbed sugar is processed by liver and storage as glycogen
- Other glucose is moved through the body by bloodstream
What does pancreatic amylase break down carbs into ?
Dextrin and Maltose
What are health behaviours?
Behaviours that affect our health positively or negatively
Why is the behaviour for health promotion and prevention important?
Because most diseases e.g cardiovascular or diabetes could be avoided by reducing obesity, smoking, physical inactivity and improving diet
What does the biomedical approach to medicine assume?
It assumes that all disease can be explained using physiological process and that treatment is for the disease, not the person
- ignores the social factors (e.g class difference - lower class more likely to develop certain illnesses)
- ignores the psychological factors on health (e.g stress, attitude towards certain health related behaviours)
How can it be proved that psychological factors are also involved in the treatment of diseases?
- the placebo effect
What is the approach to medicine called that is more holistic?
- Biopsychosocial approach
- takes into consideration
1. Bio (virus, bacteria)
2. Psychological (Behaviour, Beliefs, Coping, Stress, Pain & emotions)
3. Social ( class, employment, culture and ethnicity)
How can your health behaviour have a reactive influence?
Drinking alcohol due to stress or taking too many painkillers due to pain
How can your health behaviour have a proactive influence?
Deciding to regularly exercise in order to prevent high cholesterol, deciding to eat healthily to stay a healthy weight,
How can we help patients change behaviours (e.g stop smoking) and take up health protective behaviours (e.g more exercise)
By understanding why people carry out health risk behaviours
How can a doctor explore a patient’s attitude towards smoking?
By asking questions like:
- What do you think about smoking?
- What are the good/bad things about smoking?
- What do your friends and family think about smoking
- Would you want to give up smoking for someone?
- Do you think you can give up smoking?
- If you tried smoking what things would make it difficult for you to succeed?
- Have you ever thought about giving up smoking?
Define health
Health is a state of complete, physical, mental and social wellbeing and not merely the absence of disease and infirmity.
What is health psychology?
A branch of psychology hat studies the psychological processes in health, illness and health care
What are the 3 main goals of health psychology?
- Understand psychological factors
- Promote and maintain health
- Prevent and treat illness
Name some differential diagnosis for widespread musculoskeletal pain
- Inflammatory arthritis
- Fibromyalgia
- Myositis (inflammation in muscles)
- Hypothyroidism
What are the features of widespread pain? (SOCRATES)
Onset: Progressive
Timing: Pain worse in the morning
Site: Difficult to localize the pain
Stiffness: worse in the morning and lasts more than 30 minutes
What some associated symptoms of widespread msk pain?
- Temporal headaches
- Blurred vision
- Rashes, mouth ulcers and Raynaud phenomenon
- Abdominal pain and confusion
What blood tests can be carried out for widespread msk pain?
- ESR and CRP to check for inflammatory arthritis
- Calcium levels (low in osteomalacia)
- Parathyroid hormone levels (to exclude hyperparathyroidism)
- Vitamin D levels (to exclude osteomalacia)
What is osteomalacia?
Softening of bone usually caused by vitamin D deficiency
What is fibromyalgia?
Widespread chronic pain that is non - specific
What are the associated symptoms of fibromyalgia?
- Depression
- Insomnia
- Altered bowel habits
- Poor concentration
- Allodynia - (pain even though the stimulus isn’t painful)
How common is fibromyalgia?
2-5%
What are the main risk factors of fibromyalgia?
- Women (between 30 and 60)
- Middle age
- Stressful life events
What is a key feature of fibromyalgia?
Poor response to analgesia
What investigations can be carried out for fibromyalgia?
- No specific investigations: most investigations should be done to rule out other conditions
How do you manage fibromyalgia?
- Educate patients about their condition, reassure that they do not have destructive arthritis, explain why further investigations might not be useful
- Physiotherapy/exercise
- Cognitive behavioural therapy: encourages patients to develop coping mechanism to deal with their symptoms
- Drug therapy: Antidepressants, Ketamine or Tramadol can be administered.
What are the finding upon examining a patient with fibromyalgia?
- Tender points
- No muscle weakness
- No synovial inflammation
What are the causes of fibromyalgia?
CAUSE IS STILL NOT FULLY DISCOVERED
- Infection: pain follows viral infections in 20%
- 20% have persistent symptoms after Lyme Disease
- Trauma e.g Neck/Leg fracture etc.
Could have genetic associations (HLA)
Fibromyalgia could also have psychological impact on wellbeing. TRUE OR FALSE
TRUE
Give three examples of macronutrients
- Carbohydrates
- Fats
- Proteins
These are converted to energy