Nutritional Pathology 1

Question 1

anemia

Answer 1

condition in which blood does not have enough healthy red blood cells

Question 2

atrophic gastritis

Answer 2

associated with pernicious anemia - chronic inflammation of stomach mucosa, leading to loss of gastric glandular cells that then get replaced
decrease in chief and parietal cells
intestinal metaplasia -a change from normal gastric epithelium to that of the small intestine

Question 3

pernacious anemia components

Answer 3

MEGABLASTOMIC anemia w/

1. atrophic gastritis
2. complete achlorhydria -absence of hydrochloric acid in gastric secretions
3. malabsorption of vitamin b12
4. deficiency of intrinsic factor

Question 4

fundus secretion

Answer 4

chief cells and parietal cells

Question 5

parietal cells

Answer 5

HCL and IF secretion

Question 6

absorption of Vit b12

Answer 6

R-binders in saliva, Intrinisc Factor from stomach - into the duodeunum
IF receptors in the ileum

Question 7

enzyme reactions with vit b12

Answer 7

1. methyltransferase in conversion of homocysteine to methionine
2. isomerization of methyl malonyl CoA to succinyl CoA

Question 8

cobalamin

Answer 8

we cannot make this - get it from environment like Vit b12

corring ring + cobalt =cobalamin

Question 9

major causes of vitamin B12 deficiency

Answer 9

dietary lack of vit b12
lack of intrinsic factor (PA and gastrectomy)
competition for vit B12
impaired ileal absorption of Vit b12
- chrohns and illeal resection
congenital deficiency of TC II - transcobalamin

Question 10

most common cause of Vit b12 deficiency + the other two main causes

Answer 10

lack of IF - intrinsic factor
Impaired ileal absoorption
Congenital deficiency of of TII - part of the absorption process

Question 11

chronic gastritis

Answer 11

lymphocytes (T-cells) histiocytes - destruction of the glandular epithelium of the stomach

Question 12

T/F Pernicious anemia is an auotoimmune disease

Answer 12

T
90% of the time - there are antibodies produced against the parietal cells (which function in secreting the intrinsic factor)
70% of the time there are antibodies against the intrinsic factor
50% of the time there are anibodies to thyroid tissue

Question 13

antibodies attack what?

Answer 13

the complex of vit b12 and intrinsic factor

Question 14

atrophic glossitis

Answer 14

strawberry tongue - tongue with b12 deficiency

‘beefy red’ tongue

Question 15

causes of megoblastomic anemia

Answer 15

vitamin b12 deficiency
folate deficiency
erythroleukemia (proliferation of immature red and white blood cells)

Question 16

vit b12 role in methyltrasnferase

Answer 16

makes homocysteine –> methionene

Question 17

vit b12 converts…

Answer 17

malonyl CoA to –> succinyl CoA

Question 18

Chrohns and ileal resection will result in?

Answer 18

impaired ileal absorption of vit b12

Question 19

description of hematopoietic system in anemia?

Answer 19

hypercellular marrow
erythroid hyperplasia
MEGABLASTOSIS
giant metamyelocytes

Question 20

peripheral smear in anema

Answer 20

macro-ovalocytes (abnormal RBC’s)
hypersegmented polys - neutrophils are hypersegmented
giant platalets

Question 21

neurological disorders associated with PA

Answer 21

Symmetric numbness and tingling of extremities, impaired vibratory and position sense, spastic ataxia
degeneration of the posterior and lateral columns of the spinal cord (fatty tissue / myloid undergoes lysis/degeneration)
75% of untreated patients
could occur in absence of anemia

Question 22

what can the schillings test do?

Answer 22

determine if vit b12 is being absorbed or not - checks level of excreted urine (if less than normal - repeat test but give oral IF before Vit b12 - if excretion is increased - patient most likely has PA

Question 23

Folic acid deficiency vs PA

Answer 23

LACKS THE NEUROLOGICAL FINDINGS - but results in megaloblastic anemia similar to B12 defciency

Question 24

T/F humans are entirely dependent on dietary sources like green vegetable, fruits, liver for folate?

Answer 24

TRUE - humans need to ingest and folic acid is tricky in that it is lost due to heat / overcooking food

Question 25

FH4

Answer 25

tetrahydrofolate acid
derivative of folic acid and used to transfer 1 carbon unit (formyl, methyl groups) in the synthesis of various compounds (purines, methionine, dTMP)

Question 26

hypercellular marrow

Answer 26

1 neutrophil will look like 3

Question 27

what FH4 does

Answer 27

tetrahydrofolate (derivative of folic acid) acts as an INTERMEDIARY in the transfer of one-carbon units (formyl, methyl groups) in the synthesis of various compounds (purines, methionine, dTMP)

Question 28

connection between B12 and DNA synthesis

Answer 28

Cobalamin (b12) w/ circulating folate –> FH4
FH4 w/ Thymidylate synthetase takes dUMP –>dTMP
dTMP –> DNA

Question 29

carbon transfers with folate

Answer 29

FH4 takes one carbon–> becomes derivative –> gives up carbon –> FH2

Question 30

one carbon fragments used in synthesis of?

Answer 30

Purines, METHIONENE

dTMP

Question 31

Causes of decreased folic acid?

Answer 31

decreased intake
increased need during pregnancy
inflammation of bowel
drugs

Question 32

dihydrofolate reductase

Answer 32

turn FH2 back to FH4

Question 33

primary site of iron absorption?

Answer 33

duodenum (stores it as well)

Question 34

microcytic anemia

Answer 34

small red cells with iron deficiency

Question 35

hypochromic anemia

Answer 35

red blood cells lack the coloration

typical of iron defcicency as well as PA

Question 36

storage of iron

Answer 36

Transferrin (in blood bound)

Ferririn (storage of iron in cells)