Environmental and Nutritional Disorders: Part IV Flashcards
What is primary malnutrition?
when something is missing from the diet
what is secondary malnutrition?
malabsorption, impaired utilization or storage, or increased need
What is severe acute malnutrition (SAM)?
previously known as PEM; it is the consequence of inadequate intake of proteins and calories or deficiencies in the digestion or absorption of proteins
what are the signs of secondary PEM?
depletion of subcutaneous fat in the arms, chest wall, shoulders, and metacarpal regions; wasting of the quadriceps and deltoid muscles; ankle or sacral edema
what are the two protein components of PEM?
somatic (proteins in skeletal muscles; marasmus) or visceral (organs, primarily liver; kwashiorkor)
what is marasmus?
a severe lack of calories; weight is less 60% than the normal limit, growth retardation and muscle loss
what are patients with marasmus at risk for? and what are their albumin levels like?
albumin levels are within normal limits; they are anemic and immuno deficient, which leads to infections; the muscle proteins and subQ fat is used as fuel–> so they have emaciated extremities (“large head”)
what is kwashiorkor?
decreased protein intake (much more severe)
what does kwashiorkor lead to?
hypoalbuminemia–> generalized or dependent edema; immuno deficient and secondary infections
what is the classical presentation of a patient with kwashiorkor?
apathy, listless, and loss of appetite; depletion of visceral protein compartment–> fatty liver but sparing of the subQ fat and muscle (normal looking extremities)
what could lead to kwashiorkor in the US? (6)
chronic diarrhea, protein losing enteropathies, nephrotic syndrome, extensive burns, fad diets, or replacement of milk with rice-based beverages
what is the dermatological sign of “flaky paint” associated with and what is this?
associated with kwashiorkor; alternating zones of hypopigmentation, desquamation, and hyperpigmentation
what is pathognomonic of anorexia?
gelatinous transformation of the bone matrix (there will be fat in the bone marrow, and a mucinous matrix material
what are anorexic and bulimic patients more susceptibly to? (complication of both)
susceptibility to cardiac arrhythmia and sudden death due to hypokalemia
what are the functions of vitamin A? (3)
a component of visual pigment; maintenance of specialized epithelia; maintenance of resistance to infection
what are the syndromes associated with deficiency of vitamin a?
night blindness, xerophthalmia, blindness; squamous metaplasia; vulnerability to infection-particularly measles
what is the function of vitamin D? (2 things)
facilitates intestinal absorption of calcium and phosphorus and mineralization of bone
what are the deficiency syndromes associated with vitamin d?
rickets in children; osteomalacia in adults
what is the function of vitamin K?
it is a cofactor in hepatic carboxylation of procoagulants
what are the deficiency syndromes associated with vitamin k?
bleeding diathesis
what is the function of vitamin B1 (thiamine)
a coenzyme in decarboxylation reactions
what are the syndromes associated with deficiency of vitamin B 1 (thiamine)
dry and wet beriberi; wernicke syndrome; korsakoff syndrome
what are the functions of Niacin?
it is incorporated into NAD and NADP, which are involved in redox reactions
what are the syndromes associated with deficiency of Niacin?
Pellagra- three Ds: dementia, dermatitis, and diarrhea
what is the function of vitamin B 6 (pyridoxine)?
its derivatives serve as coenzymes in many reactions
what is associated with a deficiency of vitamin B6 (pyridoxine)?
cheilosis, glossitis, dermatitis, peripheral neuropathy, maintenance of myelinization of spinal cord tracts
what is the function of vitamin c?
serves in many oxidation-reduction reactions and hydroxylation of collagen
what is the syndrome associated with deficiency of vitamin c?
scurvy
when might you get a secondary deficiency of vitamin a? (5)
with fat malabsorption (diseases such as CYSTIC FIBROSIS, celiac disease, crohn disease, bariatric surgery, or mineral oil laxative)
when might a child have a vitamin a deficiency?
when they have infections their stores are depleted
what is one of the earliest signs of a vitamin a deficiency?
night blindness
what type of metaplasia occurs with vitamin a deficiency?
epithelial to squamous metaplasia and keratinization
what is xerophthalmia?
dry eye
what are bitot spots?
build up of keratin
what type of metaplasia occurs in the respiratory epithelium with vitamin a deficiency?
squamous metaplasia of the respiratory epithelium (this leads to increased pulmonary infections
where can metaplasia occur with vitamin a deficiencies?
in the eye, in the respiratory tract, and in the urinary tract
what type of metaplasia occurs in the urinary tract with vitamin a deficiencies?
squamous metaplasia (the desquamation of keratin predisposes to urinary bladder stones)
vitamin a deficiency leads to an immune deficiency. What are they more susceptible to dying from? (3)
measles, PNA, infectious diarrhea
what is acute vitamin a toxicity, what are the symptoms (5) and who might have it?
too much vitamin a; headache, dizziness, stupor, blurred vision, confused with psedotumor cerebri; almost always the patient will be from alaska, canada, or Arctic region
What are the signs and symptoms of chronic vitamin A toxicity? (5)
weight loss, anorexia, n/v, bone and joint pain (because retinoic acid increases osteoclast production and activity)
what sign is seen in patients with a vitamin d deficiency?
hypocalcemic tetany (a convulsive state caused by insufficient extracellular concentration of ionized calcium, which is required for relaxation of muscles)
what are the signs of rickets? (6)
frontal bossing, squared head, rachitic rosary, pigeon breast deformity, lumbar lordosis, bowing of the legs
what does hypervitaminosis d in kids cause? in adults?
metastatic calcifications of soft tissues; bone pain and hypercalcemia; it is considered to be a potent rodenticide in large doses
what form of vitamin d do you need?
the active form- 1,25(OH)2-D3
what are the effects of vitamin C (ascorbic acid) deficiency? (3 things)
scurvy, hemorrhages, and healing defects in both children and adults
how do we get vitamin c?
it is not synthesized endogenously, so we are entirely dependent on the diet for vitamin c; milk, some animal products, fruits and vegetables
who is at risk for a secondary deficiency of vitamin c? (3)
older individuals who live alone and chronic alcoholics and those who have erratic and inadequate eating patterns
when might scurvy occur in a specific population of patients?
patients undergoing peritoneal dialysis and hemodialysis
what is the function of iron?
it is an essential component of hemoglobin as well several different enzymes
what is the basis of iron deficiency and what are the clinical features of this?
inadequate diet or chronic blood loss; hypochromic microcytic anemia
what is the normal BMI range?
18.5-25
what BMI is considered obese?
> 30
what BMI is considered overweight?
25-30
in the energy balance regulatory circuits, what are the effects of the anabolic circuits?
to increase food intake and to reduce energy expenditure
in the energy balance regulatory circuits, what are the effects of the catabolic circuits?
reduce food intake and increase energy expenditure
what are the different energy sufficient signals and where do they each come from? (4)
leptin (adipocytes in fat), ghrelin (parietal cells in stomach), insulin (beta cells in pancreas), PYY (L cells in intestines)
what is the only known gut hormone that increases food intake?
ghrelin
what is metabolic syndrome? (3 things)
abnormalities of glucose and lipid metabolism, HTN, and systemic proinflammatory state
Obese persons generally have what? both of which increase the risk of coronary artery disease. (2 things)
hypertriglyceridemia and low HDL
obesity is associated with what? that could progress to cirrhosis
nonalcoholic fatty liver disease (NASH)
what is pickwickian syndrome? and what is it associated with? (3 things)
hypoventilation syndrome- hypersomnolence, both at night and during the day, often associated with sleep apnea, polycythemia, and eventual right-sided heart failure (cor pulmonale)
obese men are at risk for what cancers? (4)
esophagus, thyroid, colon, and kidney
obese women are at risk for what cancers?
esophagus, endometrium, gallbladder, and kidney
what does hyperinsulinemia lead to?
increased free insulin-like growth factor-1 (IGF-1); the IGF-1 receptor is highly expressed in many human cancers
how does IGF-1 contribute to tumor development?
it can stimulate cell proliferation and inhibit apoptosis
what toxin is produces by fungi that is found on agricultural crops, maize, peanuts, and tree nuts that can lead to what cancer?
aflatoxin; can lead to hepatocellular carcinoma
nitrosamines and nitrosamides (preservatives) can lead to what cancer?
gastric carcinomas
high animal fat and low fiber can lead to what cancer?
colon cancer
what vitamins seem to have an anticarcinogenic effect due to their antioxidant properties? (4)
vitamin C, and E, and beta-carotenes and selenium
