environmental disease 2 Flashcards
3 features of fetal alcohol syndrome
- Specific dysmorphic facial features.
- Growth retardation.
- Central nervous system (CNS) abnormalities:wide range of neurobehavioral problemsincluding impairment of self-regulation,cognition, and adaptive functioning:
3 conditions that cause hepatic steatosis?
alcohol
obesity
uncontrolled diabetes
how does alcohol cause hepatic steatosis?
3 ways
How does alcohol cause hepatic steatosis?
“(1) shunting of substrates away from catabolism
and toward lipid biosynthesis because of the generation of excess **reduced nicotinamide-**
** adenine dinucleotide** resulting from
metabolism of ethanol by **alcohol**
** dehydrogenase and acetaldehyde**
** dehydrogenase **
(2) impaired assembly and secretion of
* *lipoproteins**
(3) increased peripheral catabolism of fat “
basically TOO much NADH. therefore: pyruvate uses this NADH –> lactic acid instead of continuing down the ETC and being converted to acetyl coA
Robbins Basic Pathology, page 623
see neutrophils in liver with steatosis. what you you have?
steatohepatitis
how does alcohol cause steatohepatitis? 5 ways
Acetaldehyde (a major metabolite of ethanol) induces lipid
peroxidation and acetaldehyde-protein adduct formation,
which may disrupt cytoskeleton and membrane function
Alcohol directly affects cytoskeleton organization (as illustrated by
Mallory-Denk bodies), mitochrondrial function and membrane fluidity
Reactive oxygen species generated during oxidation of ethanol
by the microsomal ethanol oxidizing system react with and damage
membranes and proteins…
Cytokine-mediated inflammation and cell injury is a major
feature of alcoholic hepatitis and alcoholic liver disease in general.
TNF is considered to be the main effector of injury;
IL-1, IL-6 and IL-8 may also contribute.”
cocaine blocks dopamine reuptake in CNS.
what are the three effects?
HEP
euphoria
paranoia
hyperthermia
cocaine in the cardiovascular system
what are the effects of NE?
HTN, cardiac arrhythmia, myocardial infarct, cerebral hemorrhage and infarct
Estrogen therapy, with or without progestins, is referred to as hormone replacement therapy (HRT). HRT with estrogens and progestins is associated with an increased risk of________ HRT, with or without progestins, increases the risk of _________
know: Does HRT protect against ischemic heart disease?
what do they have a protective effect against?
what do they increase risk of?
Estrogen therapy, with or without progestins, is referred to as hormone replacement therapy (HRT). HRT with estrogens and progestins is associated with an increased risk of breast cancer. HRT, with or without progestins, increases the risk of thromboembolism.
HRT does not protect against ischemic heart disease
protective effect against endometrial and ovarian cancers
increase risk of thromboembolism and hepatic adenomas.
Acetaminophen is metabolized to ________ (N-acetyl- p-benzoquinoneimine) through the hepatic P-450 system. With very large doses, excess _______ leads to centrilobular hepatic necrosis.
Acetaminophen is metabolized to NAPQI (N-acetyl- p-benzoquinoneimine) through the hepatic P-450 system. With very large doses, excess NAPQI leads to centrilobular hepatic necrosis.
Marijuana contains the psychoactive substance Δ 9-tetrahydrocannabinol ______
Marijuana contains the psychoactive substance Δ 9-tetrahydrocannabinol (THC).
what is described?
Distinctive
form of
fibrosis of
the liver with
regenerative
nodules of hepatocytes, not properly connected to hepatic arterial supply, portal venous circulation or biliary system, and surrounded by fibrous tissue
cirrhosis
what % of alcoholics get cirrhossi? how long does it take?
15%; 15 years;
How can you differentiate cirrhosis due to alcoholism from
cirrhosis due to non-alcoholic fatty liver disease (NAFLD)?
History
hepatocellular carcinoma is the cause of death in what % of alcoholic liver disease?
3-6%
what are all below:
- Intoxication
- Accidents
- Murder
- Suicide
- Pancreatitis
- Liver disease (steatosis, hepatitis, cirrhosis)
- Gastritis (erosive, hemorrhagic and ulcerative)
- Alcoholic cardiomyopathy
- Peripheral neuropathy
- Fetal alcohol syndrome
- Cerebral atrophy
- Cerebellar degeneration
- Cancer of the mouth
- Cancer of the larynx
- Cancer of the esophagus
- Breast cancer
- Liver cancer
toxic effects of ETOH
what are mallory denk bodies?
tangled skins of deranged cytoskeletal cytokeratin intermediate filaments
what is kwashikor?
what does lack of protein cause?
This is kwashiorkor, protein starvation
with less inadequate carbohydrate nutrition.
Lack of protein for lipoprotein synthesis
causes lipid to accumulate in hepatocytes.
what is: __________is starvation with deprivation of all nutrients in proportion.
Marasmus is starvation with deprivation of all nutrients in proportion.
________ is a psychiatric disease with self-induced starvation
due to an obsession with thinness (and misperceived obesity).
Anorexia nervosa is a psychiatric disease with self-induced starvation
due to an obsession with thinness (and misperceived obesity).
_____ is a state of profound loss of lean body mass and fat
due to cytokines, principally _______.
Cachexia is a state of profound loss of lean body mass and fat
due to cytokines, principally TNF.
in the hypothalamus, which neurons does leptin stimulate to reduce food intake?
inhbiti to reduce food intake?
“With abundant adipose tissue, leptin secretion is stimulated, and the
hormone travels to the hypothalamus, where it reduces food intake by
** stimulating POMC/CART** neurons and inhibiting NPY/AgRP neurons.
…Leptin also increases energy expenditure by stimulating physical
activity, energy expenditure and thermogenesis.”
Robbins Basic Pathology, page 304
which gut peptide is a satiety signal
“Peptide YY, which is released post-prandially by endocrine cells
in the ileum and colon, is a satiety signal.”
which peptide increases food intake?
Ghrelin is produced in the stomach and is the only known gut peptide
that increases food intake.”
“Ghrelin secretion stimulates appetite,
and it may function as a
‘meal-initiating’ signal.”
intestines produce which satiety peptide?
stomach produces which petpidet that increases hunger?
pancreatic beta cells release which peptides?
adipose cells release which peptides?
intestines: PYY
stomach: Ghrelin
pancreatic Beta cells: insuling
fat cells: leptin
“In children, ___________ may take the form of metastatic calcifications
of soft tissues such as the kidney; in adults, it causes bone pain and
hypercalcemia.”
“In children, hypervitaminosis D may take the form of metastatic calcifications
of soft tissues such as the kidney; in adults, it causes bone pain and
hypercalcemia.”
BMI normal weight?
overweight?
obesity?
morbid obestity?
The recommended classifications for BMI adopted by the National Institute of Health (NIH) and World Health Organization (WHO) and endorsed by most expert groups are:
Normal weight — BMI ≥18.5 to 24.9 kg/m2
Overweight — BMI ≥25.0 to 29.9 kg/m2
Obesity — BMI ≥30 kg/m2
Morbid Obesity — BMI ≥40 kg/m2 (also called severe or extreme obesity)
Condensed from Up-to-Date, accessed 2/13/2014
in sarcoid, what do the macrophages in granulomas have that increases amts of vitamin D?
activated macrophages in granulomas have the enzyme for converting vitmain D to its most active form w/out feedback control
what is the overweight BMI cut off for ASians? Obestiy?
Overweight: BMI: 23-24.9
Obesity: BMI >25kg/m2
t/f.
Patients with abdominal obesity (also called central adiposity, visceral, android, or male-type obesity) are at increased risk for heart disease, diabetes, hypertension, and dyslipidemia.
true
how does insulin resistance lead to the accumulation of triglycerides in the hepatocytes:
• impaired oxidation of fatty acids•
increased synthesis and uptake of fatty acids•
decreased hepatic secretion of very-low-density lipoprotein cholesterol
how do we remove cholesterol from the body
Bile formation is the only significant pathway for elimination of excess
cholesterol from the body
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Adipocytes make estrogen, which contributes to gallstone formation because estrogen increases<!--EndFragment-->
A.Hepatic uptake and synthesis of cholesterol
name 4 substances that regulate the metabolic syndrome
IL-1
IL-6
IL-18
TNF
what is adiponectin?
what makes it?
how does it work?
which syndrome is it reduced in?
Adiponectin is an anti-inflammatory
cytokine produced exclusively by
**adipocytes. **Adiponectin enhances
insulin sensitivity and inhibits many
steps in the inflam-
matory process.
Adiponectin is reduced
in the metabolic
** syndrome.**
which joints are most affected by osteoarthritis in obese pts?
The weight-bearing joints
(knees and hips) are the
ones most affected by
osteoarthritis in obese
patients, and even more
weight is directed onto a
smaller joint in the knee
than the hip.
what are 5 possible mechanism by which obesity induces cancer?
LIME IGF-1
(1) Fat tissue produces excess estrogen, associated with the risk of breast, endometrial, and some other cancers.
(2) Obese people often have increased levels of insulin and insulin-like growth factor-1 (IGF-1) in their blood.
(3) Fat cells produce hormones, adipokines, that may stimulate cell growth. Leptin, more abundant in obese people, seems to promote cell proliferation.
(4) Fat cells may also have direct and indirect effects on other tumor growth regulators, including mammalian target of rapamycin (mTOR) and AMP-activated protein kinase.
(5) Obese people often have chronic low-level inflammation.
t/f.
cancers due to obesity are more fatal than average
true
