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19 Cards in this Set

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The Absorption of B12
1. Salivary Glands Secrete R protein haptocorrin which binds B12 to prevent acid denaturation in Stomach

2. stomach parietal cells (located midway down gastric pits) secrete intrinsic factor

R factor binds B12 in stomach once released from food by Acid

3. Pancreatic proteases cleave R factor which is immediately bound by intrinsic factor (to prevent degredation in SI by pancreatic enzymes)

4. IF-B12 complex abosrbed in distal ileum by IF specific receptor
#biochemistry #nutrition #gastrointestinal
Haptocorrin
R factor

secreted by salivary glands
binds to B12 to prevent hydrolysis by gastric acidity

degraded by pancreatic proteases

(where IF binds to prevents proteolytic degradation of B12)
#biochemistry #nutrition #gastrointestinal
Elderly Patient with Anemia and negative Fecal Occult Blood
Probably B12 deficiency 2° aging → gastric atrophy → [relative] achlorhydria → poor B12 release from eaten foods
#biochemistry #nutrition #gastrointestinal #hematology
Danger of appetite suppressants
Fenfluramine or Phentermine

↑ 5-HT release

↑ risk pulmonary htn after 3 mo → sudden cardiac death
#pathology #nutrition #pulmonology
Phentermine
appetite suppressent

↑ 5-HT release
like fenfluramine

↑ risk pulmonary htn after 3 mo → sudden cardiac death
#pathology #nutrition #pulmonology #drugs
Fenfluramine
appetite suppressant

↑ 5-HT release
like phentermine

↑ risk pulmonary htn after 3 mo → sudden cardiac death
#pathology #nutrition #pulmonology #drugs
What is the main mechanism for regulating iron stores?
Hepatically produced Hepcidin produced by liver binds ferroportin and causes its degradation

[Ferroportin is basolateral iron transporter on gut epithelium. No ferroportin → iron lost in gut shedding]

Hepcidin prodxn ↑ w/ high [iron] or inflammation
#nutrition #biochemistry #molecules
Hepcidin
Hepatically produced Hepcidin produced by liver binds ferroportin and causes its degradation

[Ferroportin is basolateral iron transporter on gut epithelium. No ferroportin → iron lost in gut shedding]

Hepcidin prodxn ↑ w/ high [iron] or inflammation

Main mechanism of iron regulation
#nutrition #biochemistry #molecules
Timeline for correcting B12 deficiency
Immediate ↑ Reticulocyte Count, drops off again

slow ↑ hemoglobin
#nutrition #hematology
Vitamin K deficiency
Bleeding

Extremely unlikely in adults as colonic bacteria produce vitamin K
#pathology #nutrition
B6 deficiency anemia
required for first step of heme synthesis

microcytic hypochromatic B6 responsive anemia

same morphology as X linked Sideroblastic Anemia, but B6 responsive
#pathology #nutrition #hematology
Neutral Aminoaciduria
Hartnup Dz

Defective Neutral AA transporters in both Kidneys and Intestine

Tryptophan is the only essential AA,
necessary for (BH4 dpt) 5HT and (B6 dpt) Niacin synth

mostly aSx, though som pts present with pelagra:
Diarrhea
(Photosensative) Dermatitis
Dementia (Ataxia)

These pts benefit from Niacin supplementation
#pathology #geneticdzs #nutrition
Ataxia + Photosensitive Skin Lesions + Loose stools
Pellagra 2° to Niacin Deficiency
Diarrhea, Dermatitis, Dementia

causes:
Corn Based Diets
Carcinoid Tumor (uses up all the 5HT)
Hartnup Dz: defective transport of neutral AA's in intestine and nephrons → no Tryptophan absorption → no Niacin prodxn
#pathology #nutrition #neoplasia #geneticdzs
Pellagra
Diarrhea,
(Photosenstive) Dermatitis
Dementia (Ataxia)

causes:
Corn Based Diets
Carcinoid Tumor (uses up all the 5HT)
Hartnup Dz: defective transport of neutral AA's in intestine and nephrons → no Tryptophan absorption → no Niacin prodxn
#pathology #nutrition #neoplasia #geneticdzs
Tocopherol
Vitamin E
#nutrition #molecules
Vitamin E molecule name
Tocopherol
#nutrition #molecules
Vitamin E deficiency
anti-oxidant which preserves cell membranes

most affected:
neurons (large surface area)
RBC's (poor antioxidant fnx)

manifestation:
Friederick's ataxia-like neuropathy w/ ataxi a & loss of proprioception and vibration +
hemolytic anemia
#pathology #nutrition #neurology #hematology
Extremity Edema
↑ Cardiac Output
↓ Extremity Sensation
Wet Beriberi

neuropathy + cardiac involvement usually high output CHF

Thiamine deficiency
#pathology #nutrition
Wet Beriberi
Wet Beriberi

neuropathic sensory-motor loss in distal extremities + cardiac involvement usually high output CHF

Thiamine deficiency

dry beriberi does not include Cardiac invovlement
#pathology #nutrition