Pathophysiology Three

Question 1

what is cachexia?

Answer 1

• weight loss, wasting of muscle, loss of appetite, and general debility that can occur during a chronic disease

Question 2

what are some diseases associated with cachexia

Answer 2

• cancer
• COPD
• DHF
• chronic kidney disease
• chronic inflammatory diseases (HIV/AIDs, rheumatoid arthritis, etc)

Question 3

sarcopenia

Answer 3

age related loss of muscle mass, strength and function

Question 4

can you have sarcopenia and cachexia at the same time

Answer 4

yes

Question 5

cachexia reduces ______ and ______ of life

Answer 5

quality
length

Question 6

T or F: cachexia increases chemo toxicity and decreases efficacy

Answer 6

T

Question 7

t or f: cachexia increases post-surgical complications and increases medical costs

Answer 7

T

Question 8

what is the #1, 2, and 3 causes of death in the US

Answer 8

1 - heart disease
2 - cancer
3 - COPD

Question 9

COPD cachexia develops in ________% of patients

Answer 9

20-40

Question 10

what is a major cause of cachexia

Answer 10

cytokine excess

Question 11

______ energy expenditure and ________ energy intake are hallmarks of cachexia

Answer 11

increased
decreased

Question 12

as a result of negative energy balance in cachexia, when you add inflammation you get ________ muscle protein synthesis and _____ muscle protein degradation

Answer 12

decreased
increased

Question 13

can you come back from refractory cachexia?

Answer 13

no. you may be able to go from cachexia to precachexia though

Question 14

what cancer has the highest frequency of weight loss?

Answer 14

pancreatic or gastric cancer

Question 15

what is the key to prevent cachexia?

Answer 15

early detection

Question 16

more weight lost in cachexia = more ________ lost

Answer 16

muscle
*not just losing fat!

Question 17

T or F: administering exogenous IGF-1 prevented cachexia

Answer 17

F
IGF-1 decreased in those with cancer

Question 18

what is PIF?

Answer 18

proteolysis inducing factor

Question 19

why/what patients is PIF important for

Answer 19

• important in cancer, burns, and sepsis patients

Question 20

what does PIF activate

Answer 20

increases calpain activity
- calpains chop up scaffolding for sarcomeres and allow proteins to be exposed for degradation

Question 21

studies show increase in __________ activity in gastroc muscle from control mice to mice treated with PIF

Answer 21

proteasome

Question 22

More PIF = ______ protein degradation

Answer 22

more

Question 23

what is sepsis

Answer 23

a potentially life threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs

Question 24

what is septic cachexia

Answer 24

when an extreme response to infection destroys muscle tissue

Question 25

who is at risk for septic cachexia

Answer 25

- very young or old - immunocompromised (cancer, AIDS, severe burns/injury, pneumonia, meningitis, cellulitis, UTI, ruptured appendix)

Question 26

what are primary causes of muscle weakness and cachexia with sepsis

Answer 26

- muscle function decreased - decreased protein synthesis - increased protein degradation - sattelite cell activity blocked

Question 27

increased TNF-a = _______ force production

Answer 27

decreased

Question 28

T or F: sepsis affects all muscle fiber types the same

Answer 28

F

Question 29

overall muscle protein synthesis is _______ in sepsis

Answer 29

decreased

Question 30

calpains are _____ in sepsis

Answer 30

increased

Question 31

T or F: calpains, myofilament release, ubiquitin and proteasome mRNA all increase in sepsis

Answer 31

T: calpains release myofilaments so proteasomes can go chop up the myofilaments.

Question 32

T or F: a fast twitch muscle (like EDL) suffers more damage from sepsis than a slow twitch muscle (like soleus)

Answer 32

T, type 2 muscles undergo more damage from sepsis than type 1

Question 33

if TNF-a is involved, muscle function and contractile force _______

Answer 33

decreases

Question 34

if there is decreased protein synthesis, translation of RNA is _______ and type _____ muscles are effected more than type ______ muscles

Answer 34

decreased 2 1

Question 35

increased protein degradation __________ calpain-proteasome system, caspases, and UPS

Answer 35

increases

Question 36

what is a neuromusclar disease

Answer 36

any condition that affects the structure and/or function of any component of your neuromuscular system including peripheral nerves, NMJ, and muscle fibers

Question 37

what is a mixed UMN/LMN disorder

Answer 37

ALS

Question 38

what are some LMN diseases

Answer 38

peripheral nerve injury Gullain-Barre syndrome chronic inflammatory demyelinating polyneirapthy SMA poliomyelitis charcot-marie-tooth disease

Question 39

what are some diseases at the NMJ

Answer 39

- botulism - lambert-eaton myasthenic syndrome (LEMS) - nyasthenia gravis (MG)

Question 40

ALS

Answer 40

- progressive neurodegenerative disease - cause muscles to weaken, twitch, and waste - normal cognition - eventually lose voluntary movement - fatal (from respiratory failure) - no cure

Question 41

SMA

Answer 41

- autosomal recessive disorder (mutations to survival motor neuron gene 1) - skeletal muscle weakness caused often more severe in the trunk and upper leg/arm than in muscles of hands and feet - ALSO: respiratory infections, scoliosis, and joint contractures (chronic shortening of muscles and tendons)

Question 42

Poliomyelitis

Answer 42

- highly infectious viral disease - mostly affects children - preventable with vaccination - in acute forms, causes inflammation of motor neurons oof the spinal cord and brain stem - leads to paralysis, muscular atrophy, and often deformity

Question 43

Gullain-Barre syndrome

Answer 43

- caused by immune system attacking PNS - rapid onset muscle weakness - typically both sides of body affected - initial symptoms are changes in sensation or pain often in the back along with muscle weakness, beginning in feet/hands then spreading to arms and upper body

Question 44

chronic inflammatory demyelinating polyneuropathy

Answer 44

- acquired autoimmune disease of PNS characterized by progressive weakness and impaired sensory function in arms and legs - symmetric weakness in prox and distal muscles - increased incidence with advancing age

Question 45

Myasthenia Gravis

Answer 45

- women <40, men >60 - autoimmune disease - antibodies block, alter, or destroy the ACh receptor/activity

Question 46

what is the main symptom we need to know for MG?

Answer 46

drooping eyelid

Question 47

burns induce skeletal muscle _________

Answer 47

proteolysis (muscle wasting/cachexia)

Question 48

burns cause hypermetabolic response which causes increases in...

Answer 48

body temp glycolysis proteolysis lipolysis futile substrate cycling

Question 49

what are some treatments for burn-induced muscle wasting

Answer 49

- GH injections - insulin - catecholamine antagonists - IGH1 and IGH binding - anabolic steriods

Question 50

Why is oxandrolone a good steroid to treat burns?

Answer 50

it doesnt harm the liver and doesnt cause androgen effects