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76 Cards in this Set
- Front
- Back
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What is secondary malnutrition?
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It isn't due to lack of nutrition intake (primary), it is due to malabsorption or excess loss
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What is the biggest malnutrition concern with chronic alcoholics?
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Vitamin insufficiency, especially B1, folate, and Vit A, D, and E.
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What are the two protein compartments in the body?
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Somatic compartment (skeletal muscles) and visceral compartment (visceral organs, esp liver)
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What are the two ends of the spectrum of protein energy malnutrition?
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Marasmus and kwasiorkor
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What protein compartment is affected by marasmus?
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Somatic compartment
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What protein compartment is affected by kwashiorkor?
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Visceral compartment
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How do you identify somatic compartment catabolism?
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Reduction in muscle mass, usually measured as circumference of the mid-arm
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How can you identify visceral compartment problems?
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By evaluating levels of serum proteins (albumin, transferrin, etc) that are regulated by liver
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What is the criteria for diagnosing marasmus?
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When wieght falls to 60% of normal. At this point child will suffer growth retardation and loss of muscle
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T/F The somatic protein is more crucial than the visceral protein and thus is depleted last
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False, the visceral protein is much more important and is only marginally depleted initially.
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What is kwashiorkor?
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Occurs when protein deprivation is worse than actual reduction in total calories
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Why do many African children have kwashiorkor?
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Because they are weaned too early and fed a diet of almost exclusively carbohydrates
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T/F Marasmus is a more severe form of malnutrition than kwashiorkor
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False, kwashiorkor is more severe due to loss of visceral protein compartment.
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What condition develops secondary to kwashiorkor?
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Generalized dependent edema due to hypo-albuminemia
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What is cachexia?
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A particularly severe form of secondary protein energy malnutrition usually seen in cancer. Leads to severe wasting.
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T/F You would find enlarged fatty liver in pt with kwashiorkor but not in marasmus
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True
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What are the effects of kwashiorkor on mucosa of GI?
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Decrease in mitotic index in the crypts of the glands in small bowel and loss of villi and microvilli
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When would you see loss of small intestine enzyme disaccharidase?
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In kwashiorkor, due to mucosal changes
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How does PEM effect bone marrow?
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It is hypoplastic due to reduced RBC precursors. Results in hypochromic microcytic anemia
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What are common diagnostic features of anorexia or bulemia?
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Extreme weight loss and amenorrhea
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What causes amenorrhea in anorexic pts?
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Decreased secretion of gonadotropin-releasing hormone and subsequent decrease in LH and FSH
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What skin and hair manifestations are present in eating disorders?
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Dry, scaly, yellowish skin and accumulation of lanugo (fine body hair)
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T/F Amenorrhea always occurs in bulemia but rarely in anorexia
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False, occurs in anorexia predictably but in less than 50% of bulemia cases
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Why are eating disorder pts predisposed to cardiac arrhythmias?
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Because they are hypokalemic (low potassium)
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Which vitamins can be synthesized endogenously?
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Vit D and K and niacin
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T/F Deficiencies of a single vitamin are uncommon
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True, usually deficient in many vitamins
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What is the most improtant form of Vit A?
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Retinol.
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Which form of Vit A is used in visual pigment?
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Retinal
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What are carotenoids?
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They are provitamins that can be converted to active Vit A in vivo
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Where does 90% of the Vit A in the body get stored?
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In Ito cells of the liver
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Which form of retinol is acive in epithelial differentiation and growth, but not vision?
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Retinoic acid
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What role does rhodopsin play in vision?
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It is the most light sensitive pigment and functions in reduced light vision capability. It is found in the rods
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What happens to mucous secreting epithelium in Vit A deficiency?
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They undergo squamous metaplasia and differentiation to keratinizing epithelium
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What is one of the earliest manifestations of Vit A deficiency?
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Impaired vision, especially in reduced light (night blindness)
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What three conditions of the eye happen with Vit A deficiency?
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Xerosis conjunctivae, bitot spots, and keratomalacia.
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What are bitot spots?
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Build-up of keratin in small opaque plaques due to lack of Vit A
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What is keratomalacia?
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Erosion of corneal surfaces with destruction of the cornea leading to blindness. Due to lack of Vit A
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T/F Vit A deficeincy commonly results in immune impairment and susceptibility to common infections
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True
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T/F Megadoses of Vit A have a protective effect against lung cancer
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False
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Synthetic retinoids are often used to treat acne. When is this contraindicated?
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During pregnancy as it causes congenital malformations
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What 2 bone disorders commonly occur in Vit D deficiency?
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Rickets in children and osteomalacia in adults
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How does Vit D effect neural and muscle activity?
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By maintaining correct concentration of Ca in ECF. This is required to prevent hypocalcemic tetany
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What is an easy way to check for hypocalcemia clinically?
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By checking for Chvostek's sign by tapping facial nerve and looking for muscle response (twitches)
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What is the plant-based form of Vit D?
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Ergosterol, becomes converted to Vit D in the body
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Where in the body is Vit D altered?
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In the liver first, then the kidney
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Where is the active form of Vit D made?
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In the kidneys
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What is the active form of Vit D?
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1,25-OH commonly called calcitriol
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How is calcitriol production regulated?
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Feedback loop, PTH stimulation of a1-hydroxylase, and low phosphate levels stimulate a1-hydroxylase as well.
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How does Vit D affect osteoblasts?
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It induces them to synthesize osteocalcin that is needed to mineralize bone
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T/F Vit D deficiencies are mostly due to insuffieient dietary intake
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False, moslty due to limited exposure to sunlight
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What is rachitic rosary?
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Deformation of chest from overgrowth of cartilage or osteoid tissue at costochondral junction
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What is pigeon breast deformity?
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Weakened metaphyseal areas of ribs become protruded anteriorly and sternum sticks out.
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What is osteomalacia?
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It is the excess build-up of osteoid matirx
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What is osteopenia?
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It is a reduced production of osteoid with failure of mineralization. Produces bones prone to fractures
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T/F You can get an excess of Vit D from exposure to sunlight
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False, you can only get excess amounts if you take oral supplements
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What are the effects of too much Vit D?
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Metastatic calcification of soft tissue and toxicity in really large doses
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What is the most clearly established function of Vit C?
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It activates hydroxylases that hydroxylate procollagen so it can acquire a stable helical configuration and crosslink
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What effect does scurvy have on blood vessels?
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Makes them weak and prone to hemorrhage
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Which vitamin acts synergistically with Vit C?
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Vit E
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What is the most striking feature of scurvy?
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Hemorrhages leading to purpura and ecchymoses and bleeding
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T/F The effects of scurvy are much more pronounced in adults than growing children
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False, much worse in children
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What effect does scurvy have on bone development?
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It disturbs the process of osteoid matrix formation rather than mineralization like rickets
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What is considered to be the normal BMI?
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25kg/m2, greater than 27 or less than 20 is considered a health risk
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Excess body fat will cause higer risks if it is located in the _________ area
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Abdominal
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Which gene is a key player in energy homeostasis and has been implicated in obesity?
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Ob gene that codes for leptin
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What does leptin do?
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It binds to two types of neurons in the hypothalamus and stimulates the production of molecules that induce or reduce food intake
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T/F Leptin energy uptake by stimualting apatite and regulates inergy expenditure by stimulating thermogenesis
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True
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What happens to people with defective leptin gene?
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They continue to eat and gain weight out of control
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T/F Risk of developing hypertension decreases proportionately with weight gain
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False, it increases with weight gain
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What is the association between obesity and heart disease?
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The association is not clear, more associated with diabetes and hypertension secondary to obesity
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What is Pickwickian syndrome?
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It is a constellation of respiratory abnormalities in very obese persons. Also called hypoventilation syndrome
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T/F Obese patients who are normotensive are not at higher risk for stroke
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True, risk is associated with hypertension not obesity
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T/F Obese women are at a higher risk of developing breast cancer than are leaner women of the same age
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False, they are at higher risk of endometrial cancer only
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What are some examples of cholesterol lowering lipids?
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Vegetable oils such as corn and safflower, and fish oil
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With respect to carcinogenesis, what 3 aspects of the diet are of concern?
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Possible content of exogenous carcinogens, endogenous synthesis of carcinogens from dietary components, and lack of protective factors
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Which dietary components have been considered anti-carcinogenic?
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Vit C and E, b-carotene, and selenium
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