Test 1 Flashcards
• Define the metabolic disorders
OBESITY •MALNUTRITION and DEFICIENCES DISEASES •CARBOHYDRATES- Diabetes mellitus
List the conditions associated with obesity
CONDITIONS ASSOCIATED WITH OBESITY • Diabetes mellitus: • Increased resistance to insulin. • 80% of patients with NIDDM are obese. • Hypertension: • Are 8x more likely to hypertensive. • Atherosclerosis • MI is more common. • Gallstones and gallbladder disease Osteoarthritis. • Complications following surgery. • Respiratory complications: • Hypoventilation syndrome. • Cancer: • Endometrium and breast.
List the pathological findings in a patient with kwashiorkor
• There is protein deficiency with: • Muscle wasting • Failure to grow • Hypoproteinaemia mainly hypoalbuminaemia • Oedema • Body fat is maintained. Underweight but oedematous due to hypoalbuminaemia (due to adequate CHO but protein (essential amino acids) • Depigmentated hair and skin rash • Secondary infections and lethargy • Fatty liver Enzymes are low resulting in multiple metabolic upsets. • Anaemia due to inadequate synthesis of haemoglobin. • Decreased immune response with thymic atrophy leading to susceptibility to infections.
Discuss the pathogenesis of the signs of kwashiorkor i.e, oedema,
ascites, enlarged liver
• Skeletal muscles appear wasted and pale. • Heart: small and heart failure. • Pancreas is atrophic. • Intestines – villous atrophy. • Liver – marked fatty change • Infection
• List and discuss the complications of Vitamin A
Characterized by ocular complications which may cause permanent blindness: • Night blindness d/t decreased rhodopsin regeneration • Xerophthalmia • Keratomalasia • Squamous metaplasia of epithelium in other parts of the body • Bronchopneumonia • Kidney stones • Folicular hyperkeratosis
• Discuss the main presentation of Vitamin B complex
• Water soluble • Thiamine or vit B1 • Generally widely available in the diet • Deficiency occurs in chronic alcoholics and in some Asian countries • 3 main methods of presentation: • Polyneuropathy in a glove and stocking distribution (dry beriberi) • A high output cardiac failure with oedema (wet beri-beri) • Wernicke-Korsakoff syndrome
• List the clinical features of niacin b3
- Causes pellagra
- The clinical features incl:
- Dematitis of the exposed parts
- Diarrhoea
- Dementia
- Death if untreated
• Compare and contrast type 1 and type 2 diabetes mellitus
Diabetes mellitus IDDM (type 1) • Less common • Younger • Thin • Viral/autoimmune • No insulin • MHC class II link and concordance 40% • Ketotic coma
NIDDM (type 2) • Increasingly common • Older • Obese • Resistance to insulin • Normal insulin • No MHC link but concordance 100% • Hyperosmolar coma
• Discuss the complications of diabetes mellitus
Accelerated atherosclerosis and micro-angiopathy → MI, stroke, PVD • Renal – glomerulosclerosis → chronic renal failure • Retinopathy, cataract, glaucoma • Infections (renal, other, NB fungi)
The state of nutrition can be measured by:
•
Body weight. • Subcutaneous fat as measured by skinfold thickness. • Muscle mass as measured by mid-arm circumference. • Serum proteins.
RIBOFLAVINE DEFICIENCY
• Causes a sore tongue and fissuring at the corners of the mouth • Dematitis • Interstitial keratitis
DEFICIENCIES CAUSING ANAEMIA iron?
- Iron deficiency
* Results in hypochromic microcytic anaemia.
DEFICIENCIES CAUSING ANAEMIA b12?
- Vit B12
- Is a water soluble vitamin.
- Present in liver, milk, and eggs.
- Is absorbed in the presence of IF secreted by the stomach
- Necessary for nucleic acid and DNA formation
- Deficiency results in megaloblastic anaemia.
- Folic acid deficiency results in megaloblastic anaemia
b6 deficiency
VITAMIN B6 • May give rise to a type of anaemia in which iron cannot be used properly in the formation of haemoglobin. • Sideroblastic anaemia
VITAMIN D DEFICIENCY
• Rickets in children • Results in excessive osteoid production • Deficient mineralisation • Softening of bones, with deformity and enlargement • Osteomalacia in adults • Softening and deformity of bones d/t demineralsation • There is low serum Ca2+ and a high ALP
VITAMIN K DEFICIENCY
• A fat soluble vitamin • Synthesized by gut bacteria and absorbed in the presence of bile • Required for the formation of prothrombin and factor V and VII by the liver • Deficiency leads to a haemorrhagic state
VITAMIN C DEFICIENCY
• Also known as scurvy • One of the 1st deficiency diseases to be discovered • Essential for formation of stable and strong collagen via the hydroxylation of proline • Complications stem from weakness of collagen in blood vessel walls • Complications: • Bleeding into the skin and from the gums • Subperiostial haematomas and bleeding into joints • Defective osteoid formation and bony deformities in children • Impaired wound healing • Anaemia may follow bleeding
Define inflammation
• It is a complex reaction of living tissue to an injury • It is divided into two patterns: Acute Inflammation Rapid onset Short duration lasts minutes to a few days Oedema, predominantly neutrophils
Chronic Inflammation:
Longer duration
Lymphocytes, macrophages, proliferation of blood
vessels and fibrosis
Discuss the signs of acute inflammation
• The defining characteristic is the reaction of blood vessels. Resulting
in:
• Increased fluid (oedema) and leukocytesin the extravascular space.
• It is a protective mechanism.
• It destroys, dilutes and walls off harmful agents.
• It is closely intertwined with the process of healing and repair.
• It consists of:
1 A vascular response
2 Migration and activation of leukocytes
3 Systemic reaction
Signs of Inflammation heat, redness, swelling, pain ( loss of function by Virchow)
• List the causes of acute and chronic inflammation
Exogenous(from outside the body) Trauma and physical injury Infections Including foreign material Chemicals (acids, alkalis) Heat or Thermal Injury Radiation
Endogenous(from within the body) Reaction to necrosis Hypersensitivity reactions Infarcts Centre of tumours Immunological Reactions Auto-immune diseases Endogenous chemicals (e.g. Bile) Metabolic products (e.g. Urate crystals)
Discuss the three components of acute inflammation
Three components:
Vascular component
Changes in the caliber of vessels, resulting in increased blood flow
Exudative component
Structural changes in the microvasculature, resulting in increased permeability,
allowing plasma proteins and leukocytes to leave the microcirculation
Cellular component
The accumulation and activation of leukocytes at the site of injury
Discuss the sequelae of acute inflammation
- Resolution (usual result)
- Suppuration
- Pus formation (living and dead neutrophils, microorganisms, cellular debris)
- An abscessis an accumulation of pus
- Repair and organisation
- Results in fibrosis
- Chronic inflammation
Describe the morphologic features of chronic inflammation
- Infiltration by mononuclear inflammatory cells
- Macrophages
- Lymphocytes
- Plasma cells
- Tissue destruction
- Induced by noxious stimulus or inflammation itself
- Attempts at healing
- Angiogenesis and fibrosis
Discuss granulomatous inflammation
Granulomatous Inflammation
• specific pattern of chronic inflammation which results in an
accumulation of activate macrophages
• Granuloma: localised collection of modified macrophages (epitheliod
cells), may contain multinucleate giant cells
• Multinucleate giant cells are formed by fusion of epitheliod cells in
the presence of poorly soluble, indigestible material
• Granulomas may be surrounded by lymphocytes and, occasionally,
plasma cells
Epitheliod Cells • Modified macrophages • Large amount of pink, pale cytoplasm (resemble epithelial cells) • Possibly develop: • In response to material that is difficult to digest • As a result of T cell-mediated delayed hypersensitivity type of immune response
