Pathology Nutrition Ii

Front 1

what makes clinical diagnosis of dietary deficiencies complex?

Back 1

in pts, they tend to be multiple deficiencies w/ multiple manifestations
(exception: iron-deficiency anemia)

Front 2

what kinds of demands can induce dietary deficiencies

Back 2

1. physiologic (growth, preg, lactation)
2. pathologic (infection, cancer, tx, trauma, GI dz)
3. genetic factors

Front 3

what are micronutrients?

Back 3

vitamins and minerals

Front 4

what are macronutrients?

Back 4

protein, fat, carbs

Front 5

what are fat and carbs primarily used for?

Back 5

energy

we need a small amount of essential fatty acids (EFA)

kids need more EFA and fat

Front 6

where are nutritional deficiencies usually seen first in adults (which 3 sites)?

Back 6

skin/mucosae
CNS and PNS
bone marrow

Front 7

what are the indications of dietary deficiency in kids?

Back 7

bone growth and growth=highly sensitive indicators

Front 8

what can x.s proteins cause?

Back 8

exacerbate metabolic and excretory problems of chronic liver and renal dz

red meat can exacerbate gout

Front 9

which is more common: deficiency or xs of micronutrients?

Back 9

vit A and D, Ca+2, iodides, minerals:
excess intake can be harmful but RARE

deficiency much more common

Front 10

what are other non-nutrient dietary components that cause dz?

Back 10

microbes, toxins, psoralens, heavy metals, combustion products, nitrate/rites, pesticides, etc.

Front 11

what are preventive compounds?

Back 11

antioxidant plant products
inducers of phase I and II xenobiotic detox enzymes
estrogen antagonists
etc.

Front 12

which vitamins are fat soluble?

Back 12

ADEK

Front 13

what's the solubility of Vit B?

C?

Back 13

both water-sol

Front 14

what do fat sol Vits require for absorption?

where are they stored?

Back 14

intact GI fat absorption

in tissues (liver and adipose)

Front 15

why is liver a good source of vitamins (or fortified milk)?

Back 15

because the liver is the major storage site of fat sol vits

milk contains fat which is req'd for absorption of ADEK

Front 16

what's the vit A precursor?

Back 16

B-carotene

Front 17

what foods contain B-carotene (the vit A precursor)

Back 17

orange, yellow, some green vegetables

Front 18

which foods are a good source of fat soluble vitamins

Back 18

grains and other plants

Front 19

whats the primary source of vit D?

Back 19

dietary, but can be synthesized in skin

Front 20

what's the source of Vit K?

Back 20

synth in intestine by bacteria
it's effeciently recycled

Front 21

what's the main nutritional effects of dz of the biliary tract?

Back 21

decrease fat absorption and fat sol vits

Front 22

what vit def can severe liver dz cause?

Back 22

interferes w/ Vit D activation

and

reduces serum proteins for Vit A binding

Front 23

which vitamins function as hormones and bind specific receptors to activate a variety of genes?

Back 23

Vit A and D

Front 24

why is Vit A important?

Back 24

normal vision (several fxns)
mucus-secretion in GI/GU tracts
immunity to infection
normal fetal development

Front 25

how does Vit A fxn in normal vision?

Back 25

retinal pigments (non-hormonal fxn)
nl differentiation of ocular epithelium, lacrimal ducts and glands

Front 26

what effects does Vit A have in fetal development?

Back 26

retinoic acid binds nuclear R's as tsc regulator of patterning genes (HOX genes)

Front 27

what dose of Vit A is toxic?

Back 27

very large dose (>10X RDA) over weeks/months

Front 28

acute effects of Vit A toxicity?

Back 28

increased intracranial pressure (causes HA, vomit, papilledema, seizure, death)

Front 29

what are the chronic effects of Vit A toxicity?

Back 29

fatty liver
fibrosis and cirrhosis
dermatitis
bone overgrowth
resultant pain

Front 30

what are the effects of too much Vit A on the fetus?

Back 30

severe damage during development by exposure to high bld levels of vit A or therapeutic retinoids

Front 31

what are the major functions of Vit D?

Back 31

1. stimulate SI absorption of Ca+2 and phosphorus
2. maintain normocalcemia (w/ PTH)
3. stim renal DT Ca+2 reabsorption (via PTH)

Front 32

what are 2 effects Vit D has that act through upregulation of PTH?

Back 32

mobilize bone Ca+2 to maintain normocalcemia

stimulate renal dist tub reabsorption of Ca+2

Front 33

what are some factors that lead to Vit D deficiency??

Back 33

dietary
environmental (uv radiation)
age-related
metabolic
genetic
Dz's of GIT, liver, kidneys (intefere w/ absorption and activation)

Front 34

which ion's supply and metabolism are bound w/ Vit D requirements?

Back 34

Ca+2

Front 35

What does Vit D deficiency cause in kids and adults?

Back 35

rickets and osteomalacia

osteopenia/osteoporosis complex--may respond to increased Vit D and Ca

Front 36

besides excess ingestion of Vit D, what else can cause Vit D toxicity?

Back 36

aberrant cells in sarcoidosis or hematopoeitic tumors that produce Vit D

Front 37

what are manifestations of Vit D toxicity?

Back 37

due to hypercalcemia:
fatigue, depression, anorexia, cardiac arrhyth, metastatic calcification, nephrolithiasis

Front 38

what's Vit E?

where do we get it from?

Back 38

alpha tocopherol and related compounds

plentiful in foods

Front 39

when do we get Vit E deficiency?

Back 39

severe fat malabsorption (it's plentiful in food), poor parenteral nutrition, rare genetic disorders

Front 40

whats the major fxn of Vit E?

what's its partner in crime and what do they do together?

Back 40

antioxidant in cell membranes

acts w/ selenium to term free radical lipid peroxide chain rxns

Front 41

what are the most sensitive tissues to free rad lipid peroxidation (w/o Vit E and selenium)?

Back 41

CNS and PNS and RBCs

Front 42

how does nervous system degeneration manifest in Vit E deficiency?

Back 42

mostly posterior columns of SC:
loss of deep tendon reflexes, vibration, position sense, and ataxia
loss of pain sensation, dysarthria, musc weakness (includes ocular muscles)

Front 43

what effect does Vit E def have on the eyes?

Back 43

causes musc weakness--of ocular muscles

Front 44

what is Vit K used for?

Back 44

cofactor for gamma-carboxylase to form gamma-carboxygluatamate Ca++ binding sites in clotting factors: prothrombin (II), VII, IX, X.
also need Vit K for:
anticoag proteins C and S
osteocalcin and BMP

Front 45

what effect does Vit K deficiency have on bone?

Back 45

it is required for the function of osteocalcin and bone morphogenic protein (BMP)

Front 46

which clotting factors require Vit K to fxn?

Back 46

2 (prothrombin)
7
9
10

Front 47

how is Vit K deficiency picked up in newborns?

Back 47

serious bleeding:

normally they have sufficient amts w/in 1 wk from GI bacteria

Front 48

how is Vit K recycled in the liver?

Back 48

by epoxide reductase

Front 49

what's epoxide reductase?

Back 49

recycles Vit K in the liver

blocked by coumarin/warfarin anticoagulants: causes vit K and prothrombin deficiency

Front 50

what does inhibition of epoxide reductase cause?

Back 50

warfarin:
Vit K not recycled--Vit K and prothrombin deficiency

Front 51

generally, what do water soluble vitamins do?

Back 51

function as or as components of coenzymes

Front 52

what's B1?

Back 52

thiamine pyrophosphate:
for ATP synth
pentose phosphate shunt
neural membrane maintenance

Front 53

B2

Back 53

Riboflavin
in flavin mononucleotide and flavin adenine dinucleotide
in oxidation-reduction rxns
component of several mito enzymes

Front 54

Niacin

Back 54

in NAD/NADP
rxns of intermediary fat metab, carb, AA metab

Front 55

B6

Back 55

pyridoxine:
pyridoxal-5-phosphate in transaminations, deam. and caboxylations

Front 56

Ascorbic Acid

Back 56

Vit C:
activates hydroxylases and amidation enzymes
antioxidant and prooxidant
regenerates Vit E

Front 57

what Vitamin does ascorbic acid help regenerate?

Back 57

Vit C regenerates Vit E

Front 58

where are B vitamins (thiamine, riboflavin, niacin, pyridoxine) found?

Back 58

grains, vegetables, some in meat

Front 59

who is deficient in B vitamins?

Back 59

alcoholics and pts w/ chronic debilitating dz (infection, cancer, prolonged vomit/diarrhea)

Front 60

what effect can drugs have on B vitamins?

which drugs?

which vitamins?

Back 60

can enhance degradation or block action

alcohol, isoniazid

niacin and pyridoxine (B6)

Front 61

what are the symptoms of B vit deficiency?

Back 61

CNS and PNS
tongue (atrophic glossitis)
skin (dermatitis)

Front 62

which vitamins may cause dermatitis?

Back 62

too much A

too little B
(niacin/B3 def causes Pellagra)

Front 63

which vit deficiency causes atrophic glossitis?

Back 63

vit B

Front 64

what's a major manifestation of thiamine (B1), pyridoxine (B6), and B12 deficiency?

Back 64

peripheral neuropathy: myelin degeneration, axon disruption

Front 65

what are the CNS effects of Thiamine (B1) deficiency?

Back 65

CNS capillary hemorrhages
neuronal necrosis in the brain

Front 66

What are the CNS effects of B12 def?

Back 66

demyelination and degeneration of ascending and descending tracts of SC

Front 67

which vit def leads to dementia, ataxia, paralyses, and sensation abnormalities associated w/ B vitamin deficiencies?

what's the mechanism?

Back 67

Niacin deficiency

neuronal degeneration in the brain and SC tracts

Front 68

what else can thiamine def cause besides nervous system effects?

Back 68

high output cardiac failure

Front 69

where is ascobic acid found?

Back 69

fruits, veges, milk, liver, fish

Front 70

what's ascorbic acid def called?

Back 70

scurvy: mostly in severely restricted or unbalanced diets

Front 71

who gets scurvy?

Back 71

rare
ppl who eat severely restricted or unbalanced diets: alcoholics, elderly, "fad" diets

Front 72

what are the signs and Sx of scurvy?

Back 72

capillary and venular hemorrhages (skin, gingiva, joints)
severe hemorrh in CNS
wound healing/bone growth (kids) impaired
structural maint (adults) impaired

Front 73

what's the deficiency: capillary and venular hemorrhages (skin and gingiva and joints)

Back 73

Vit C deficient

Front 74

what dz's is poor diet a risk factor for?

Back 74

major US chronic Dz's:
atheroscler, CV Dz, HTN, cancer, DM, osteoporosis, OBESITY (obviously)

Front 75

what cancer risk is reduced by beta carotene intake?

Back 75

bronchogenic squamous cell carcinoma

Front 76

which cancers are reduced by Vit D intake?

Back 76

carcinomas of colon, breast and prostate

(and Ca+2 for colon cancer)

Front 77

what does selenium reduce cancer risk for?

Back 77

prostate carcinoma

Front 78

what dietary factors are highest risk for colon cancer?

Back 78

red meat intake

Front 79

what dietary factor greatly increases risk of postmenopausal breast cancer?

Back 79

high saturated fat intake

Front 80

what do sunlight, Vit D and genetics reduce risk of (2)?

Back 80

breast and prostate cancer

Front 81

what are some anticarcinogenic mechanisms found of our diet?

Back 81

antioxidant, induce detox enzymes
anti-prolif, proapoptotic, prooxidant and cell different, induce tumor suppressor genes
epigenetic effects (DNA methylation)