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Path Exam 7 > Nutrition > Flashcards

Nutrition Flashcards

1
Q

What are the common nutritional deficiencies of alcoholics?

A

thiamine, pyridoxine, folate (from fresh produce), vitamin A&C, PEM (protein-energy malnutrition)

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2
Q

Do we store vit B12 in our bodies?

A

Yes

We have about a 5 year supply in our livers

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3
Q

How is malnutrition defined?

A

Often by BMI less than 16 (normal 18.5-25)

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4
Q

What is marasmus?

A

PEM due to starvation
Deficient in all calories
Catabolize somatic protein (skeletal muscle) for energy
Decreased arm circumference
Leptin decreased
Look emaciated–broomstick extremities, large head
Serum albumin is normal or slightly reduced
Anemic, vitamin deficient
Immune deficient => infection => death
Lethargic, if prolonged, short stature

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5
Q

Should re-feeding of marasmus people include milk?

A

No, marasmus patients are uniformly lactose intolerant

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6
Q

What is Kwashiorkor and some causes in the US?

A

Malnutrition due to reduction in protein. Diets where most calories are carbs.
Can occur in US from protein loss:
Chronic diarrhea
Protein-losing enteropathy
Nephrotic syndrome loss of albumin through the urine
Extensive burns, trauma, sepsis
Maladaptive and more severe than marasmus

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7
Q

Clinical manifestations of kwashiorkor

A

Weight loss masked by edema (anasarca–generalized edema)
Sparing of subQ fat and muscle, loss of visceral protein
Fatty liver because can’t make the apoproteins needed to remove triglycerides
Tend to die from low immunity => infection
Depigmentation of the skin because can’t make melanin (also seen in marasmus)
Anemia, small intestine villous atrophy, flaky paint appearnace, alternating pale and dark hair from pigment loss, irritability
Angular cheilitis from B vit deficiency.
Hypoalbuminemia

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8
Q

Why does the liver get fatty during starvation?

A

Liver can’t produce the proteins needed to export fat from the liver so it builds up and accumulates.

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9
Q

What are some major complications to malnutrition?

A

Delayed wound healing
Risk infection and sepsis
Increased postop death

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10
Q

General info on Bulimia

A

Behavioral disorder
Involves bingeing and purging in one way or another–this can include excessive exercise
Generally onset in adolescence and in women
Weight kept near normal

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11
Q

Patient is bulimic and vomits often, presents with hematemesis that resolves spontaneously, what is going on?

A

Repeated retching causes Mallory-Weiss tears that are longitudinal tears in the esophagus that heal spontaneously

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12
Q

Bulimia complications

A 
Vomiting => hypokalemia => cardiac arrhythmias
Pulmonary aspiration => pneumonia
Mallory-Weiss tears => Boerhave Syndrome
Parotid gland hyperplasia => increased serum amylase
Dental erosion
Russell sign
Amenorrhea uncommon
Anemia
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13
Q

General info on Anorexia Nervosa

A

Considered a Psych problem involving body image and perceptual disturbances
Highest death rate of any psych disease

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14
Q

Anorexia nervosa clinical signs

A

Amenorrhea
Sick Euthyroid= act hypothyroid without measuring hypothyroid because of reverse T3. Causes cold intolerance, bradycardia, constipation, changes in skin and hair (lanugo)
Low bone density => osteoporosis
Anemia
Hypokalemia
Loss of gray matter
May still purge or exercise excessively
GI: early satiety, pancreatic fibrosis, malabsorptive diarrhea on refeeding
CV: thinning left ventricle, hypotension, sudden death from arrhythmia

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15
Q

What are the fat soluble vitamins?

A

ADEK

These are deficient in any condition that causes steatorrhea

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16
Q

How many water soluble vitamins are there?

A

9

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17
Q

Endogenous synthesis of vitamins

A

Vit D from precursor steroids
Vit K from biotin from intestinal flora
Niacin from tryptophan

Remainder must be ingested!

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18
Q

Which vitamins are energy releasing?

A

Thiamine–B1
Riboflavin–B2
Niacin–B3

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19
Q

Which vitamins are hematopoeietic?

A

Folic acid

Vit B12

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20
Q

Vit A types and sources

A

Vit A can come from 2 sources: meat where it is preformed, and vegetables in the form of carotenes and pro-vit-A that must be converted to retionoids

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21
Q

How is Vit A taken up and stored in the body?

A

Absorbed through the gut as a fat soluble vitamin. Taken up by Ito cells and stored in the liver (6 month supply). RBP (Retinol Binding Protein) transports retinol

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22
Q

Functions of Vit A

A

Maintains normal vision (every time a photon hits rhodopsin retinol is lost and must be replaced)
Signals cell growth and differentiation via RAR/RXR receptor
Activates osteoclasts
Aids host in resistance to infection
Binding activates nuclear receptors for drug metabolism

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23
Q

Vit A deficiency causes

A

General malnutrition
Malabsorption of fats:
-bile and pancreatic enzyme deficiencies
-Celiac, crohn, surgical resection of intestine
Depletion during infection–kids
Elderly: use of mineral oil laxative
Orlistat therapy for obesity (prevents fat absorption)

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24
Q

Signs of Vit A deficiency

A

Night Blindness
Higher death rate from measles, pneumonia, diarrhea
Squamous metaplasia => corneal ulcers, bitot spots in conjunctiva (tangles of keratin mixed with gas-forming bacteria), keratomalacia (corneal lesions), lung cancer, pancreatic duct problems, urinary tract stones, follicular hyperkeratosis of skin

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25
Q

Acute Vit A toxicity

A

Retinoid-induced cerebral hypertension causing symptoms suggestive of a brain tumor:

  • Headache, vomiting
  • Stupor
  • Papilledema

Carotemia acute and chronic:

  • reversible yellowing of the skin
  • resembles jaundice but doesn’t affect the sclerae
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26
Q

Chronic Vit A toxicity

A

From overdose with Vit A retinoids from Fish oils, and liver oils
Symptoms: weight loss, N/V, dryness of lips, epistaxis, bone and joint pain with hyper ostosis, fractures, hepatomegaly with fibrosis
Increased circulating lipids
Hypercalcemia from osteoclast activity
Elevated Liver enzymes: AP and GGT from hepatic injury

27
Q

Sources and functions of Vit D

A

Sources: sun converts 7-dehydrocholesterol to Vt D, all dairy in US is fortified, deep-sea fish, ergosterol grain

Acts on osteoclasts to break down bone and produce calcium, also acts in intestines to induce absorption of Ca and Phosphate

Reduces risk of colon cancer
Modulates the immune system
Enhances macrophages

28
Q

Vit D deficiency causes

A

Low intake, low sunlight, using sunblock, frequent pregnancies and breast feeding, Impaired fat absorption, diseases of small intestine, deranged metabolism

29
Q

Vit D deficiency effects

A

Low vit D => low Ca and Phosphate uptake from intestines => low serum Ca and P => increased PTH => Ca mobilization from bone => poor bone mineralization

Fracture risk
Rickets
Osteomalacia
Hypocalcemic tetany

30
Q

Signs of hypocalcemic tetany

A

Blood pressure cuff on arm causes carpal spasm = Trousseau’s sign

Chvostok’s sign = contraction of facial muscles when tap on fascial nerve at parotid gland

31
Q

Osteopenia types

A

Osteopenia is deficiency in bone

1) Osteomalacia is deficiency in Ca in the bone, shows with thickened, poorly mineralized trabeculae!
2) Osteoporosis is deficiency in osteoid in bone

32
Q

Common fractures in osteomalacia

A

Ribs, hips, wrists, vertebra

kyphoscoliosis

33
Q

Signs of osteomalacia

A

Microfractures of weak bone
Skeletal deformations from loss of rigidity
Enlargement of epiphiseal and osteochondral junctions

34
Q

Signs of Rickets in a preambulatory child

A

Bones of head soft => squared-head
Rachitic Rosary = increased size of costoshondral junction
Pigeon breast deformity

35
Q

Signs of rickets in ambulatory kids

A

bowing of legs because they are weak

expansion of epiphises

36
Q

Effects of Vit D besides skeleton

A

Increased synthesis of cathelicidin that helps kill M tuberculosis
Can help reduce incidence of cancers

37
Q

Vit D toxicity

A

Hypercalcemia
Metastatic calcifications
Nephrolithiasis

38
Q

What is abetalipoproteinemia?

A

Autosomal recessive disorder where lack certain apolipoproteins needed for chilomicron formation and VLDL formation leading to decreased fat absorption and decreased fat soluble vit absorption

39
Q

Causes of Vit E deficiency in US

A

Fat malabsorption
Low birth weight infants with immature guts
Abetalipoproteinemia

40
Q

Vit E deficiency states

A

Neurologic disease: spinocerebellar degeneration

  • absent deep tendon reflexes
  • ataxia
  • loss of position and vibration sense
  • loss of pain sensation
  • impaired vision, disordered eye movements
41
Q

Vit E toxicity

A

Interferes with absorption of Vitamins A & K and the manufacture of K dependent procoagulants

42
Q

Where does Vit K come from?

A

Synthesized by endogenous bacteria

Also conserved in the healthy liver

43
Q

What factors depend on vit K for synthesis?

A

Factors VII, IX, X, II

Also, proteins S & C

44
Q

Consequences of low Vit K

A

Prolonged PT–factor VII affected first
Bleeding diathesis: gums, heamturia, melena, purpura, hematomas

Neonates: bleeding from many sites, intracranial hemorrhage, prophylaxis with injection at birth

45
Q

Thiamine actions

A

Synthesis of ATP
Maintains neural membranes and nerve conduction
Found in the brown part of brown rice

46
Q

Thiamine disease related deficiencies

A

Alcoholics!!!
Intractable vomiting of pregnancy
Vomiting or Diarrhea
Refeeding or IV glucose in chronically malnourished (must give them Thiamine supplements)
Tea and coffee reduce thiamine absorption

47
Q

Thiamine deficiency states

A

Dry beriberi: polyneuropathy (muscle weakness, loss of sensation and reflexes)

Wet beriberi: CV disease (high output heart failure, peripheral edema and vasodilation, globular heart with thin walls causing thrombi)

Wernicke-Korsakoff syndrome: CNS disease due to severe, chronic deficiency, ataxia, apathy, confusion, nystagmus, ophthalmoplegia, confabulation

Thiamine maintains myelination. Long nerves affected first => foot and wrist drop

48
Q

What does riboflavin do?

A

Oxidation reduction reactions

Mitochondrial enzyme

49
Q

Sources of riboflavin

A

meat, dairy, vegetables

50
Q

Causes of riboflavin deficiency

A

Chronic alcoholism
Advanced cancer
Anorexia nervosa
Milk Avoidance

51
Q

Riboflavin deficiency presentations

A

Angular cheilitis
Glossitis
Interstitial keratitis
Bone marrow hypoplasia (anemia)

52
Q

Niacin (B3) functions and sources

A

Participates in metabolism of fat, CHO, amino acids

From grains, legumes, seed oils, unavailable in corn, synthesized from tryptophan

53
Q

Niacin deficiency causes

A 
Corn based diets
alcoholics
Protracted diarrhea
Deficiency in protein
Long term administration of isoniazid
54
Q

Niacin deficiency

A

4 D’s
Dermatitis: (Pellegra gauntlet) mainly on exposed skin, but vaginal, oral, mucosa become red, thickend, rough, scaling and desquamation with fissures

Diarrhea: from intestinal atrophy, inflammation, ulceration

Dementia: brain, spinal cord neuronal degeneration

Death!

55
Q

When to take pyridoxine-B6

A

A cofactor in metabolism of lipids and amino acids
Found in all foods

Deficient in Alcoholics, pregnancy, long term use of isoniazid, estrogen and penicillamine

56
Q

Pyridoxine-B6 deficiency signs

A

Like many other B vitamins

Unique in cause of convulsions!

57
Q

Adverse effects of B-Vitamins

A

Adverse effects infrequent
Water soluble so pee out what don’t need

Niacin: flushing, headache in high dose

B6/B12: Roseacea skin condition

58
Q

Vitamin C (ascorbic acid) functions

A

Scavenges free radicals with vit E
In Scurvy, hydroxyproline-rich collagen lacks tensile strength, rate of synthesis of pro-collagen peptides suppressed => fragile blood vessel walls, defective collagen of wounds

59
Q

Sources of vit C

A

Fruits and veggies: citrus, tomato, green peppers highest

Milk, Fish, liver

60
Q

Causes of scurvy

A

Poor diet
Alcoholics
Milk-fed infants
Elderly

61
Q

Childhood scurvy

A

Hemorrhages due to weak vessel walls
Skeletal changes from abnormal osteoid
Scorbutic Rickets! bowing of bones, widening epiphyses, depression of sternum
Bone problems because bone formation depends on rich blood supply but is disrupted by weak vessels

62
Q

What is osteoid

A

the unmineralized organic component of bone

63
Q

Scurvy symptoms

A

Loose teeth: gingival swelling and hemorrhage, bacterial periodontal infection
Peri-follicular Rash
Impaired wound healing
Anemia due to blood loss and deficient iron absorption

64
Q

What can happen if take too much vit C?

A

Uricosuric can => kidney stones

Increases iron absorption so well may cause iron overload

Path Exam 7 (1 decks)

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