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SD IV: Block 3 Week 2 > Nutritional Diseases > Flashcards

Nutritional Diseases Flashcards

1
Q

What are some causes/risk factors of malnutrition?

A

poverty

acute and chronic illnesses

self imposed dietary restrictions

chronic alcoholism

GI diseases

etc

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2
Q

What is SAM?

A

severe acute malnutrition

a state characterized by a weight for height ratio that is 3 SD below the normal range

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3
Q

Cancer cachexia

A

hypercatabolic state defined by a loss of muscle mass (with or without loss of fat) that cannot be explained by diminished food intake

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4
Q

What 3 mechanics cause muscle atrophy and muscled degradation leading to cachexia?

A

1.Proteolysis-inducing factor (PIF) produced by tumors degrades myosin heavy chain through the proteasome

  1. TNF, IL-1, IL-6 produced by tumors and host activate NF-κB which initiates transcription of ubiquitin ligases MAFBx & MuRF1
  2. Alterations in dystrophin-glycoprotein complex leads to dystrophin degradation by the proteasome
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5
Q

Understand this slide.

A

Understand slide

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6
Q

What are the C/F of bulimia?

A
  1. Electrolyte imbalances (hypokalemia) – predisposes to cardiac arrhythmias
  2. Pulmonary aspiration of gastric contents
  3. Esophageal and stomach rupture
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7
Q

Understand this slide.

A

Understand slide.

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8
Q

What is leptin secreted by and what is this secretion regulated by?

A

Secreted by fat cells, output is regulated by the adequacy of fat stores.

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9
Q

MOA of leptin.

A

With abundant adipose tissue, leptin
reduces food intake by stimulating POMC/CART neurons and inhibiting NPY/AgRP neurons

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10
Q

What is the result of leptin secretion?

A
  • Stimulates physical activity, heat production, and energy expenditure
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11
Q

What is the most common pathogenesis behind how leptin deficiency can lead to massive obesity?

A
  • mutations in the melanocortin receptor 4 gene (MC4R) are more common (4% to 5% of patients)
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12
Q

How does leptin resistance occur?

A

the anorexigenic response of leptin is blunted in states of obesity despite high levels of circulating leptin

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13
Q

What is adiponectin refferred to as?

A

guardian angel against obesity

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14
Q

Where is adiponectin produced?

A

in adipose tissue

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15
Q

Function of adiponectin?

A

stimulates fatty acid oxidation in skeletal muscle, prevents leptin resistance

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16
Q

MOA of adiponectin.

A
  • Binding to receptors AdipoR1 (skeletal muscle) and AdipoR2 (liver) activate cAMP dependent protein kinase A, which phosphorylates and inactivates acetyl coenzyme A carboxylase, a key enzyme for fatty acid synthesis
  • Decreases glucose production in the liver and increases insulin sensitivity, protecting against the metabolic syndrome
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17
Q

Overall effects of adiponectin.

A

Anti-inflammatory, anti-atherogenic, anti-proliferative, and cardioprotective effects

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18
Q

What is gherlin? What is it produced by?

A

produced in stomach, only gut hormone that increases food intake

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19
Q

What is the MOA of ghrelin?

A

activates orexigenic NPY/AgRP neurons

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20
Q

Where is PYY and GLP-1 secreted by?

A

(peptide YY) and glucagon-like peptide - 1 are secreted from endocrine cells in the ileum and colon, anorexigenic

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21
Q

MOA of PYY and GLP-1?

A
  • Act centrally through NPY/AgRP neurons to decrease food intake
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22
Q

Indications for GLP-1 agonists?

A

agonists of GLP-1 receptor have been approved for
treatment of obesity and type 2 diabetes

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23
Q

Function of BAT?

A

brown adipose tissue

expends energy by non-shivering thermogenesis.

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24
Q

What does WAT produce?

A

white adipose tissue

produces cytokines such as TNF, IL-6, IL-1, and IL-18; chemokines; and steroid hormones creating a chronic proinflammatory state with high levels of CRP

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25
Q

What is metabolic syndrome?

A

abnormalities of glucose and lipid metabolism coupled with hypertension and evidence of a
systemic proinflammatory state

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26
Q

What are ways obesity can lead to cancer?

A
  1. Hyperinsulinemia promotes growth of both normal and abnormal neoplastic cells
  2. Increased synthesis of estrogen can lead to cancers of he endometrium and breasts
  3. Reduced adiponectin: adiponectin normally suppresses cell proliferation and promotes apoptosis
  4. pro-inflammatory state
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27
Q

Understand this slide.

A

Understand slide.

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28
Q

Nitrosamines and nitrosamines are examples of endogenous or exogenous carcinogens?

A

endogenous

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29
Q

Aflatoxin is an example of endogenous or exogenous carcinogens?

A

exogenous

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30
Q

High animal fat intake combined with low fiber intake has been implicated and what type of cancer?

A

causation of colon cancer

31
Q

Dietary fiber, or roughage is believed to have a preventive effect against what condition of the GI?

A

diverticulosis of the colon

32
Q

VIt A has what benefits?

A
  • Normal vision in reduced light
  • Differentiation of specialized epithelial cells, mainly mucus-secreting cells
33
Q

What treatments is Vit. A used for?

A

Clinically used for treatment of Acne as well as Acute Promyelocytic Leukemia

34
Q

What are he causes of VIt. A deficiency?

A

diets lacking sufficient green and yellow vegetables, fat malabsorption

35
Q

Night blindness can be caused by what?

A

xerophthalmia (dry eye) - (xerosis conjunctivae) - keratin debris in small opaque plaques (Bitot spots) - erosion of roughened corneal surface with softening and destruction (Keratomalacia) - Total blindness

36
Q

How does follicular/papular dermatosis occur?

A

hyperplasia hyperkeratization of epidermis with plugging of the ducts of adnexal glands

37
Q

Desquamation of keratin debris in the urinary tract can lead to what?

A

renal and urinary bladder stones

38
Q

Squamous metaplasia of the airways can lead to what?

A

secondary infection

39
Q

What are causes of Vit. A toxicity?

A

megadoses of Vit A

40
Q

Acute toxicity with Vit. A.

A

headache, dizziness, vomiting, stupor, and blurred vision (due to increase in intracranial pressure
d/d brain tumor

41
Q

What do synthetic retinoids in pregnancy put the fetus at risk for?

A

↑ risk of fetal malformations

42
Q

How does Vit. D affect bone mineralization?

A

attaches to receptor on osteoblasts, stimulates release of alkaline phosphatase (dephosphorylates pyrophosphate that inhibits bone mineralization)

43
Q

Osteomalacia and Rickets is caused by what?

A

Vitamin D deficiency

Osteomalacia (in adults)
Rickets (in children)

44
Q

What are some clinical features of Vit. D deficiency.

A

Deformation of chest, Rachitic rosary, pigeon breast deformity, Harrison groove, deformed pelvis

Hypocalemia caused by Vitamin D deficiency can lead to continuous muscle contraction (tetany)

45
Q

What does Vit D toxicity cause to happen in children?

A
  • In children it may lead to metastatic calcifications of soft tissues like kidney
46
Q

What are some clinical features of Vit E deficiency?

A

hemolytic anemia (damage to RBC membrane), peripheral neuropathy, degeneration of posterior column and spinocerebellar tract

47
Q

What are some causes of Vit K deficiency in newborns?

A

use of broad spectrum antibiotics, coumarin derivatives, fat malabsorption

48
Q

What are common clinical features of Vitamin K deficiency.

A

bleeding diathesis – hemorrhagic disease of newborn in children, Gastrointestinal bleeding in adults

49
Q

What is another name for Vitamin C?

A

ascorbic acid

50
Q

What is a major function of Vitamin C?

A
  1. Activation of prolyl and lysyl hydroxylases from inactive precursors, providing for hydroxylation of procollagen
  2. Absorption of iron in duodenum
51
Q

What is a deficiency in Vitamin C caused by?

A

diets lacking in fruits and vegetables, cigarette smoking

52
Q

What are the C/Fs of vitamin C deficiency?

A

perifollicular hemorrhage

bleeding gums

hemarthrosis

anemia

53
Q

What is the main cause of thiamine deficiency?

A

alcoholism

54
Q

B1 deficiency can lead to what conditions?

A

Dry and wet beriberi

Wernicke-Korsakoff syndrome

55
Q

What is another name for Vitamin B2?

A

riboflavin

56
Q

What does defiance of B2 cause?

A

cheliosis
stomatitis

57
Q

What is another name for B3?

A

Niacin

58
Q

What are the causes of B3 deficiency?

A

include dietary deficiency (corn based diets which are deficient in tryptophan and niacin), Hartnup disease, Carcinoid syndrome

59
Q

What C/F can lead to pellagra 3Ds.

A

dementia, dermatitis, diarrhea

60
Q

Another name for Vit. B6?

A

pyridoxine

61
Q

What are the causes of VIt B6 deficiency?

A

isoniazid (used in treating TB

62
Q

What are he C/F of Vit B6 deficiency?

A

sideroblastic anemia

63
Q

What is another name for Vit B12?

A

cobalamin

64
Q

What are the major functions of Vit. B12?

A

DNA synthesis

myelinization of spinal cord tracts

megaloblastic pernicious anemia and degeneration of poster-lateral spinal cord tracts

65
Q

What is folate crucial for?

A

DNA synthesis

66
Q

What are some causes of folate deficiency?

A

alcohol
overutilization in (pregnancy)

67
Q

What are the complications of folate deficiency?

A

megaloblastic anemia, Neural Tube Defect

68
Q

Reproduce this chart.

A

Reproduce this chart.

69
Q

C/F of zinc deficiency?

A

acrodermatitis enteropathica

70
Q

C/F of iron deficiency?

A

hypochromic microcytic anemia

71
Q

C/F of iodine deficiency?

A

goiter and hypothyroidism

72
Q

C/F of fluoride deficiency?

A

dental caries

73
Q

C/F of selenium deficiency?

A

cardiomyopathy (Keshan disease)

SD IV: Block 3 Week 2 (8 decks)

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