Exam 2 - Nut/Vit/Min/Wound healing Flashcards
Properties of Fat soluble vitamins and which ones?
- ADEK
- Stored in liver and adipose tissue
- Up to a year Reserve
- need intermittent renewal
- require healthy liver function
Vitamin A Function
- Rhodopsin precursor
- formation and maintenance of mucosa
- promotes healthy skin
- Wound Healing
Forms of Vitamin A?
Retinol (preformed)
Beta-carotene (provitamin)
Function of rhodopsin?
visual purple
Prevents glare blindness from Quick dark to light transition
Symptoms of too much Vitamin A?
- roughness, scaling, weak hair
- High A can interfere with D and Ca+ absorption
How does Vitamin A promote wound healing?
Migration of
- Macrophages: engulf bacteria
- Monocytes: cytokines stim. Inflammation
- Fibroblasts: contractile properties
Function of healthy skin and mucosa?
- First line of defense.
- Bacteria get trapped on mucosa and cannot penetrate intact skin.
Symptoms of Vit A Deficiency?
- glare / night blindness
- xerophthalmia : dry eye
—Low mucosa
—Conjunctival and corneal changes
Keratinization : dry scaly skin - reduced saliva secretion
Dietary Sources of Vitamin A
Retinol: animal sources
Beta-carotene
- found as carotenoids in plant Foods
- orange foods and spinach
- carrots, cantaloupe, apricots, tomato juice
What is vitamin D a precursor for?
D is precursor (prohormone) that must be activated
calcitriol = activated vitamin D
Dietary sources of Vitamin D?
D3: cholecalciferol
Animal sources: Fish, eggs, fortified foods
Skin synthesis: UV rays
D2: ergocalciferol
Plant sources: Mushrooms, yeast
Function of calcitriol?
- Stimulates absorption of Ca+ and Phosphorus
- Cooperates with parathormone and calcitonin in calcium cycle
- Develop strong bones
Vitamin D deficiency
- Rickett’s: Bone growth retardation
- Low Ca+ in blood = osteoclastic activity (breakdown) = osteoporosis
Vitamin E Function
- anti-inflammatory
- Antioxidant: destroys free radicals
- Wound Healing
Vitamin E’s role in wound healing?
- Anti-oxidant properties prevents lysis of cells
- Stabilizes cell walls
What are free radicals?
- Unpaired electrons
- destroy cells membranes
- Initiate oxidation reactions → aging
- Product of normal cell metabolism
- Found in air pollutants
Symptoms of Vitamin E Deficiency
- Hemolytic anemia
- Disrupts myelin sheath formation
- Difficulty walking, neuropathy (numbness/tingling)
What is hemolytic anemia?
(lysis = break)
- RBC membranes exposed to oxidation
- Rupture and leak contents (oxygen)
- cell death
Dietary sources of vitamin E
Vegetable oils (canola, safflower….)
Nuts, fortified cereals
Function of vitamin K
- coagulation
- clotting
- prevents bone resorption
- antidote for warfarin
- wound healing
Role of Vitamin K in wound healing
Clotting Factors
- K Initiates liver synthesis of 4 clotting proteins (inactive precursors that depends on K for activation)
- Ca+ and K needed for fibrin clot
Vitamin K Deficiency: causes and symptoms
Liver disease
- Cannot synthesize clotting factors –> bleeding in gums, urine, stool
Newborns
- Sterile intestinal tract = no flora = no vit K
- At risk for hemorrhage
- Prophylactic K shot given at birth
Vitamin K Dietary Sources
Menaquinone
- Missing in newborns
- Synthesized by intestinal bacteria
Phylloquinone
- Animal and plant foods
- Dark leafy greens, brussel sprouts, broccoli, asparagus
2 forms of vitamin K
Menaquinone
Phylloquinone
Properties of Water soluble vitamins and which ones?
- Require acid for absorption
- required daily replenishment
- B1, B9, B12, Iron, C, Ca+
Function of B1 / Thiamine
“energine”
- Supports cellular energy for metabolism via TPP
What is TPP?
thiamine pyrophosphate
Thiamine + phosphate = energy
What is the function of TPP?
Stimulates glucose metabolism
Cannot generate glucose without TPP
What is the function of glucose?
Required for cellular energy
GI needs glucose to power further glucose absorption
CNS runs on glucose
Symptoms of B1 deficiency?
- Hindered lipogenesis → Damaged myelin sheaths
— Nerve pain, prickly/deadening sensations, paralysis - GI: Hindered GI function → reduced glucose absorption
- CNS: Low cognition, fatigue
- CV: cardiac failure → edema
- MS: fatigue, heaviness
Chronic alcohol abuse interferes with B1 absorption
What is a banana bag
B1/thiamine IV = given in ER to alcoholics
Dietary sources of B1?
- Whole or enriched grains
- legumes
Function of B9 / Folate
- DNA synthesis and cell division
- Need B9 and B12 to make hemoglobin and myelin sheath
Role of B9 / folate in pregnancy
- Coenzyme in DNA synthesis and cell division
- Component in Thymine (nitrogenous base) in DNA that controls genetic characteristics
- Supplement before and during
Symptoms of B9 deficiency
- Megaloblastic anemia
- Spina Bifida
- Alcohol interferes with absorption
- glossitis ( red, sore tongue)
Low B9 may mask low B12 due to identical anemia
What is megaloblastic anemia?
- Mega = large
- Blast = immature cell (RBC)
- Large cell, but not functional.
- Cannot carry O2
- short lifespan
What is spina bifida?
- Neural tube defect
- Spinal cord and coverings fail to develop normally
- Fail to close during embryonic development
Dietary sources of B9
- Supplements and fortified foods
- Dk. green leafy vegetables
- Legumes, chicken liver
function of B12 / cobalamin
- Need B9 and B12 to make hemoglobin and myelin sheath
- important for protein metabolism
- wound healing
Role B12 plays in wound healing
- Supports metabolic rate = energy
- Stimulates cell proliferation (multiplication)
- Granulation tissue = new wound tissue
Symptoms of B12 deficiency
- Low B9 may mask low B12
- Megaloblastic anemia
- pernicious anemia
- Neurological symptoms only in B12 not B9: Headache, Fatigue
- long term = irreversible neurologic impairment
- Pallor
- glossitis ( red, sore tongue)
Who is at risk for B12 deficiency and why?
At risk: vegans and elderly
Elderly
- low appetite = low dietary intake
No plant source of B12
- vegans must supplement
What causes B12 deficiency?
- low gastric acid and IF
- Need HCl- and IF (intrinsic factor) for absorption
- IF made by parietal cells in stomach
- Deficiency can be caused by gastrectomy, age, antacids
High age → low HCl-
Why would you need to supplement B12 and how?
Must supplement direct to bloodstream if low in HCl- and/or IF
- IM
- intranasal
- Sublingual
Nose and mouth are high in capillaries
What is pernicious anemia?
- Decrease in RBC due inability to absorb B12 in intestine
- Used to be fatal until B12 injections
Dietary Sources of B12
Animal products and fortified foods
Function of Vitamin C / ascorbic acid?
C = “cement”
Ascorbic = anti scurvy
-
Immune system
— Protects neutrophils from oxidative stress during early immune response - Antioxidant
-
Mineral deposition
— Maintenance of bone matrix , cartilage, collagen -
Stimulates iron absorption
— C and iron should be taken together - Wound Healing
Role of Vitamin C in wound healing?
- Synthesis of collagen
- angiogenesis: Collagen builds strong capillary walls
- Iron aids collagen synthesis
- Low iron = low wound strength
- Stim. scar tissue
Symptoms of vitamin C Deficiency?
- Poor wound healing
- Easy bruising
- Petechiae
- Weak bones
- Scurvy
What is Petechiae?
Pinpoint skin hemorrhages
What is Scurvy?
Clogged follicles, wounds open, sores form, swelling
Can lead to death from bleeding or infection
Dietary Sources of Vitamin C
Citrus fruits and juices
Tomatoes, bell peppers, strawberries, potatoes
How is Iron absorbed?
- Needs HCl- to be liberated from protein
- Need Vit C to absorb
Function of Iron
- Iron makes hemoglobin with B9 and B12
- Aids collagen synthesis with Vit C
- Wound Healing
How is Iron stored?
Stored as ferritin in liver, spleen, bone marrow
70% in RBCs
How does hemoglobin work?
Oxygen binds to hemoglobin
Iron = hemo
Globin = transport protein
Iron’s role in wound healing?
- Prevents anemia
- Optimizes tissue perfusion
- Low iron = low wound strength (collagen)
Causes of Iron deficiency
low HCl-
Malabsorption due to intestinal issues: celiac, crohn’s…
symptoms of iron deficiency
- fatigue, muscle weakness, pallor (paleness)
- Iron deficiency anemia
- pale conjunctiva
- blue sclerae
- atrophy of papillae on tongue
- spoon shaped nails
- pallor
what is Iron deficiency anemia
- Pale cells, low qty, small size
dietary sources of iron
Liver meat, chicken, fish, whole grains, fortified foods
Where is calcium found in the body?
99% found in bones and teeth
1% circulates in blood
Function of calcium
- Ca+ and phosphorus: Provide strength and rigidity to skeleton
- Nerve transmission: Muscle contraction/ relaxation
- Wound Healing: Ca+ and K form fibrin clot
How is calcium absorbed?
D –> kidney = calcitriol
calcitriol –> Ca+ absorption in sml. intestine
Symptoms of Ca+ Deficiency
- Osteoporosis
- Chvostek’s Sign
- Trousseau’s Sign
- tetany /muscle spasms
What is Chvostek’s Sign
Facial reflex from tapping on nerve
What is Trousseau’s Sign
Carpel reflex from BP cuff
What is osteoporosis
Low Ca+ = bone demineralization
Causes of Ca+ Deficiency/resorption
- Hypothyroidism = low parathormone → less mobilizing of Ca+ to bone –> Osteoclastic activity
- Low mobility = low bone density
Need mechanical stimulation for bone formation (osteoblastic activity) - Lactose intolerance
Geriatric pop = higher intolerance = low Ca+ in diet
Dietary sources of calcium
Dairy products, dk. Green vegetables, fortified foods
Function of Protein
- structural material of every cell in the body
- Growth and tissue repair
- precursors to enzymes
- combine with iron to form hemoglobin
- Globulin = antibodies fight infection
- Albumin (attracts water) = balance blood fluids
- buffer the blood
- potential energy source
- Collagen deposition
- Angiogenesis: new vessel formation
- Wound contraction
Symptoms of protein deficiency?
- dull, dry, brittle hair and nails
- easily plucked hair with no pain
- hair loss
- loss of hair pigment
- poor wound healing
- edema
Symptom of glucose deficiency
headache
low energy
What causes D deficiency?
- Celiac and crohn’s = malabsorption = deficiency
- low sun exposure
Symptom of high folate
→ stim. growth of existing tumors in colon
