Disorders of the Nutritional Status

Question 1

Where are the hunger and satiety centers located in the brain?

Answer 1

in the hypothalamus

Question 2

What is caloric use controlled by?

Answer 2

by metabolic rate which is regulated by thyroid hormones and by level of activity

Question 3

What are the two types of fat that store calories?

Answer 3

White: predominant storage

Brown: more in early life and declines with age

Question 4

Describe what BMI is

Answer 4

it is the ratio between your weight and height

weight/height

Question 5

If you have a BMI under 18.5 what does that mean?

Answer 5

that you are underweight

Question 6

If you have a BMI over 30 what does that mean?

Answer 6

that you are obese

Question 7

What is the waist to hip ratio that marks obesity in men and women?

Answer 7

> 1 for men

>0.8 for women

Question 8

List some of the complications of obesity.

Answer 8

systemic insulin resistance
HTN
Cardiovascular disease
Diabetes
Cancer (breast, endometrial)
Gallbladder disease
Osteoarthritis
Menstrual irregularities
Infertility
Skeletal degradation

Question 9

What are some disease processes which can cause malnutrition?

Answer 9

Crohn disease
Malabsorption syndromes
Ca
Anorexia nervosa
Severe injury/illness

Question 10

Explain how malnutrition can occur from sever injury/illness

Answer 10

the body needs protein to fight and repair. If you can’t provide the E and nutrients to do it, the body will break down organs to do so

Common organs: liver, GI tract, kidneys, heart, resp muscles

Question 11

How does marasmus present in children?

Answer 11

wasted appearance (no subcut fat)

protuberant abdomen

stunted growth

wrinkled skin

sparse, dry, dull hair

diarrhea

slow HR, low BP, low temp

frequent/concurrent infections

Question 12

What is muscle hypotonia?

Answer 12

protuberant abdomen

Question 13

What is the flag sign of marasmus?

Answer 13

sparse/dry/dull hair

Question 14

What are the two general categories of protein-energy malnutrition?

Answer 14

Marasmus (protein and calorie def)

Kwashiorkor (protein def, but high carbs)

Question 15

What can cause marasmus-like secondary protein energy malnutrition?

Answer 15

Chronic illnesses:

COPD
CHF
HIV
Ca

Question 16

How does kwashiorkor present in children?

Answer 16

stunted growth, but presence of subcut fat

generalized edema

DISTENDED abd

Flaky lesions on skin, face, peri

Dec cardiac output and tachycardia

SANDY or RED hair

Anorexia, apathy

Question 17

What causes the generalized edema in kwashiorkor?

Answer 17

Hypoalbuminemia (low albumin)

therefore dec osmotic gradient into the blood

Question 18

What is the flag sign of kwashiorkor?

Answer 18

sandy or red hair

Question 19

What can cause kwashiorkor-like secondary protein energy malnutrition?

Answer 19

HYPERMETABOLIC acute illnesses:

trauma
burns
sepsis

Question 20

Describe anorexia nervosa. In what age group is it most common?

Answer 20

Determined dieting often with compulsive exercise and possible purging and binging.

Usually accompanied by inability to recognize problem, depression, OCD, and substance abuse

Usually in adolescence

Question 21

How do eating disorders differ between men and women?

Answer 21

men are more likely to engage in binge-eating and compulsive exercise

Question 22

What are some of the causes that contribute to anorexia nervosa?

Answer 22

Genetic

Personality

Anxiety disorders

Family hx depression, obesity

peer/family/cultural pressures regarding appearance

Question 23

Describe the diagnostic criteria for anorexia nervosa.

Answer 23

1) refusal to maintain minimally normal weight for age and height (less than 85 percent)
2) intense fear of gaining weight
3) altered perception about own body size, weight, and shape
4) amenorrhea

Question 24

What is amenorrhea?

Answer 24

cessation of menstruation and loss of secondary sex characteristics

Question 25

What are some complications of anorexia nervosa?

Answer 25

Amenorrhea

Osteoporosis, kyphosis, compression fractures

Constipation

Cold intolerance (inability to shiver)

Dec HR and BP, dysrhythmias, cardiac hypotrophy

Hematologic and electrolyte abnormalities

Lanugo (inc fine hair)

Question 26

What is bulimia nervosa?

Answer 26

recurrent binge eating with vomiting or other compensatory behaviours.

Usually maintains normal weight. More common in adolescence

Question 27

Describe the diagnostic criteria for bulimia nervosa.

Answer 27

1) recurrent binging greater or less than 2/wk for 3 months
2) inappropriate compensatory behaviours (self-induced vomiting, laxative/diuretic abuse, fasting)
3) excessive exercises after binges
4) self-evaluation influenced by body shape/weight

Question 28

Describe the complications of bulimia nervosa

Answer 28

Includes anorexia nervosa comps plus:

dental caries

parotitis: inflammation of parotid glands

fluid and electrolyte disorders

esophagitis, esophageal strictures (tightening)

Gastric reflux -> aspiration pneumonia

Question 29

Describe the diagnostic criteria for binge eating.

Answer 29

1) at least 2 days per week for months

2) plus at least three of:
- eating rapidly
- eating until uncomfortably full
- eating large amounts when not hungry
- eating alone b/c of embarrassment
- disgust, depression, guilt