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yr 3 GI > vitamin deficiency - A D C > Flashcards

vitamin deficiency - A D C Flashcards

1
Q

Vit A deficiency syndrome

A

xerophthalmia

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2
Q

what is B1 (thiamine) deficiency syndrome

A

BeriBeri,

Wernicke’s encephalopathy

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3
Q

what is B2 (riboflavin) deficiency syndrome

A

angular stomatitis,

cheilitis

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4
Q

what is B6 (pyridoxine) deficiency syndrome

A

polyneuropathy

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5
Q

what is vit C deficiency syndrome

A

scurvy

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6
Q

what is vitamin D deficiency syndrome

A

rickets

osteomalacia

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7
Q

what is vitamin E deficiency syndrome

A

haemolysis,

neurological deficit

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8
Q

aetiology of deficiency of fat sol vitamins (A D E K)

A

malnutrition

malabsorption syndromes with steatorrhea (CF, coeliac)

bile acid def (eg cholestasis, bile acid malabsorption)

medications or supplements (orlistat, mineral oil)

genetic disorders - hereditory forms of rickets

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9
Q

aetiology of deficiency of water soluble vitamins - B C

A

restricted diet - vegan

malabsorption disorder - gastritis, gastric resection

congenital disorders - hartnup disease

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10
Q

RF for scurvy

A

poor

pregnant

odd diet

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11
Q

definition of xerophthalmia

A

dry eyes secondary to deficient tear production

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12
Q

complication of xerophthalmia

A

if left untreated - progess to keratomalacia

-> here cornea softens, thins and eventually ulcerates

blindness

immunosuppression - increase risk of measles

poor growth

dry age related macular degeneration

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13
Q

epidemiology of xerophthlamia

A

peak incidence 2-5yrs

40million children affected worldwide

big cause of blindness in tropics

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14
Q

sx of xerophthalmia

A

conjunctivae become dry

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15
Q

signs of xerophthalmia

A

night blindness (nyctalopia)

tunnel vision

poor acutity

dry conjunctivae (xerosis)

cornea is unwettable and loses transparency

small oval/triangular foamy plaques occur, raised from interpalpebral conjunctiva - Bitot spot

xerosis cutis - dry skin

retinopathy

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16
Q

Ix for xerophthalmia

A

visual fields

dark adapted electroretinography

low plasma vit A

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17
Q

Mx of xerophthalmia

A

vit A replacement

address cause - alcoholism, nutrition, poverty

improve diet - liver, kidney, butter, egg yolks, leafy veg

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18
Q

Px of xerophthalmia

A

vit a reverses the changes

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19
Q

aetiology of vitamin A deficiency

A

disorders associated with fat malabsorption - IBD, coeliac, CF, pancreatic insufficiency, cholestasis

malnutrition - most common cause in developing countries

20
Q

aetiology of vitamin D deficiency

A

lack of sun

malnutrition - chronic alcohol abuse

malabsorption disorders - fat malasorption, chronic GI disease

CKD or advanced liver disease = impaired hydroxylation of precursers

breastfeeding withourt supplements

preterm infants at increased risk

CP450 induces eg anticonvulsants increase the metabolism of vit D

21
Q

clinical features of vit D deficiency

A

oesteomalacia

rickets

sx of hypocalcaemia

22
Q

sx and signs of hypocalcaemia

A

SPASMODIC

  • spasms - carpopedal spasms = trousseau’s sign
  • perioral paraesthesia
  • anxious, irritable, irrational
  • seizures
  • muscle tone increased in smooth muscle = colic, wheeze, dysphagia
  • orientation impaired (time, place, person) and confusion
  • dermatitis - atopic, exfoliative
  • impetigo herpetiformis
  • Chvostek’s sin, choreoathetosis, cataract, cardiomyopathy (long QT)
23
Q

features of mild hypocalcaemia

A

cramps

perioral numbness/parasthesiae

24
Q

features of severe hypocalcaemia

A

carpopedal spasm (esp if brachial artery compressed - Trousseau’s sign)

laryngospasm

seizures

neuromuscular excitability demonstrated by tapping over parotid (facial nerve) = facial muscles twitch - Chvostek’s sign

cataracts if chronic

25
Q

Mx of hypocalcaemia

A

mild - give Ca with daily plasma levels

in CKD - may need alfacalcidiol

severe - calcium gluconate IV over 30mins, if due to resp alkalosis - correct

26
Q

complications of vitamin D deficiency

A

hypophosphtaemia

hyperparathyroidism

osteoporosis

treatment related vit D toxicity

increased risk of:

  • low BMD and fractures in HIV
  • cancer - prostate, colon, breast, ovarian, pancreatic
  • autoimmune disease
  • T2DM
  • heart disease
  • HTN
  • neurocognitive dysfunction
  • infectious disease
  • OA
  • depression
  • schizophrenia
27
Q

definition of vitamin D deficiency

A

serum 25-hydroxyvitamin D level of <50nanomoles/L

28
Q

epidemiology of vitamin D deficiency

A

most common nutritional deficiency worldwide

in US and Europe 40% >50yrs are deficient

29
Q

RF for vitamin D deficiency

A

people of colour

obesity

malabsorption

history of liver failure of CKD

>50yrs

history of tumour

steroids, anti-epileptics, highly active antiretroviral therapy, rifampicin, St John’s wort

neonates

children who avoid outside

inadequate diet and supplements

malabsorption

mutations

granulomatous disease eg sarcoid/rickets - increased vit d destruction

primary hyperparathyroidism - increased destruction

hyperthyroidism - enhances the metabolism of 25-hydroxyvitamin D = reduced levels

30
Q

clinical features of vit D deficiency

A

bowed legs

widening of ends of long bones - rickets (hypertrophy of the epiphuseal plates = widening fo wrists)

delayed tooth eruption and early dental caries - rickets

chest deformity - in rickets, muscle traction on softened ribcage -> pectus carinatum, thoracic asymmetry, widening of thoracic base

throbing, aching bone discomfort and/or irritability - osteomalacia

head sweating - in children, from increased neuromuscular activity

localised/generalised bone tenderness

prox muscle weakness

rachitic rosary

frontal bossing - rickets, increased bone formation and flattening of forehead

waddling gait - due to pain in hips

31
Q

Ix for vitamin D deficiency

A

serum 25-hydroxyvitamin D - <50nanomoles/L (52-72 is insufficiency)

serum ALP - high in rickets/osteomalacia due to high bone turnover rate

serum Ca - normal due to secondary hyperparathyroidism

fasting serum phosphate - low normal/low - secondary hyperparathyroidism = phosphturia

plain-film XR of knees and wrists - cupping splaying and fraying of metaphysis, and looser’s zones (pseudofracture)

32
Q

principle of Mx of vitamin D deficiency

A

should have serum 25-hydroxyvitamin D >75nanomoles/L

correction promotes growth and deposition of calcium into the skeleton

children with skeletal manifestations should be treated aggressively - earlier intervention = better prognosis with resolution of deformity

correction in adults improves BMD and stimulates mineralisation of the collagen matrix = resolution of pain

33
Q

Mx of vitamin D deficiency

A

vitamin D2 (ergocalciferol) or Vit D3 (cholecalciferol) - oral for 6-8wks

then lower maintenance dose continued

high dose needed if intestinal or fat malabsorption syndromes, taking glucocorticoids, st john’s wort, rifampcin highly active antiretroviral therapy

need Ca supplement

if unable to metabolise 25 hydroxyvit D to 1,25 dihydroxyvit D, or no recognition of 1,25 - give vut d and 1,25 (calcitriol) or one of the active analogues (paracalcitol or doxercalciferol)

in CKD - high phosphate - need phosphate binder eg calcium carbonate. if GFR <50% might need calcitrion/active metabolite

34
Q

prognosis of Vit D deficiency

A

most asymptomatic

if symptomatic children

  • earlier intervention better
  • in 1 week - biochem changes (raise in phosphorus and ca) and XR changes
  • physical exam normal in 6mo

in adults

  • improve BMD after 1-2yrs
  • stimulate mineralisation of matrix = resolution of bone pain from osteomalacia
  • improvement in secondary hyperparathyroidism, muscle strength, osteomalacioc bone pain - in 3-6mo
35
Q

definition of vit C deficiency

A

scurvy is a life threatening disorder due to Vit C deficiency

36
Q

RF for vit C deficiency

A

refugees

victims of famine

older people

alcohol misuse

atypical diet

children with autism or idiosyncratic behavioural abnormalities

infants only drinking cow’s milk

end stage renal disease and/or haemodialysis dependance

smoking

surgery

sepsis

HIV

critical illmess

ARDS

pancreatitis

37
Q

signs and sx of vit C deficiency

A

constitutional sx

endothelial dysfunction and haemorrhage sx:

  • easy bruising/bleeding
  • myalgia
  • arthralgia
  • joint swelling
  • petechial and perifollicular haemorrhages - legs and feet
  • oral mucosal petechiae
  • coiled hairs
  • follicular hyperkeratosis
  • bleeding from gums, nose, hair follicles, or into joints, bladder and gut

gait impairment/leg pain - impaired bone growth - frog like leg position with little leg movement

pedal oedema - from cardiac failure or local endothelial dysfunction

poor wound healing

tooth loss - haemorrhaging gingivitis affecting intradental papillae

gingival discolouration

gum swelling

lid petechiae and haemorrhage

proptosis - from retrobulbar, periorbital, or orbital subperiosteal haemorrhage

conjunctival and subconjunctival haemorrhage

foul breath - halitosis

oedema

38
Q

Ix for vitamin C deficiency

A

FBC and peripheral smear - normocytic anaemia, micro or megaloblastic if other deficiencies are presnt

serum ascorbic acid - identify amount and severity of deficiency, and exclude haematological disorders - deficient level <11.4micromol/L

leukocyte ascorbic acid - deficient level <57nanomol/10(8) cells

whole blood ascorbic acid - deficient level <17micromol/L

XR of knee and wrist - corner fraction sign, ground glass appearance, trabecular atrophy, Pelkan’s sign, Frankel’s sign

  • Pelkan’s - irregularities, fragmentation and spurs at the metaphyseal margins
  • Frankel’s - lucent line immediately beneath a white line at margin of growth plate
39
Q

Mx of vitamin C deficiency

A

diet change

ascorbate supplements - oral 300-500mg/day

parenteral if severe disease, poor enteric function or swallowing or multiple deficiencies

start as soon as possible

after 2 weeks follow general approach to prevention - can be as little as 6.5mg/day

chronic supplementation might be indicated in some

40
Q

prognosis of vitamin C deficiency

A

after treatment signs and sx improve rapidly - once body stores achieve a level sufficient to meet demands

if not treated rapidly risk of death is high

long term - full recovery, provided no major haemorrhagic complications occur eg stroke

41
Q

complications of vitamin C deficiency

A

intracerebral haemorrhage

endocardial haemorrhage

neck and back pain

42
Q

aetiology of vitamin C deficiency

A

always due to lack of dietry intake

43
Q

pathophysiology of vit C deficiency

A

it is in fruits, veg, organ meats, certain animal milks

absorbed from gut by active and passive transport

Vit c is essential for collagen synthesis = blood vessel lose their integrity = perivascular oedema, erythrocyte extravasion and haemorrhage

Vit C also increases iron absorption - so get iron deficiency

plays a role in noradrenaline synthesis, amidation of peptide hormones and tyrosine metabolism

modifies host disease - malignancy, atherosclerosis, dementia

44
Q

epidemiology of vitamin C deficiency

A

endemics

rare

45
Q

gingivitis

A

gum inflammation+- hypertrophy

46
Q

constitutional sx of vit C deficiency

A

arthralgia

myalgia

weakness

lethargy

nausea

emesis

weight loss

dry skin

depression

dyspnoea

listlessness

anorexia

cachexia

yr 3 GI (52 decks)

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