Pathology of Nutritional Disorders-Parks

Question 1

What are some nutritional issues that can affects the CNS?

Answer 1

Alcohol consumption
cancer-hyperemesis
gastric bypass-malabsorption
fetal issues when mom doesn’t eat/drink good things

Question 2

What is Beri Beri?

Answer 2

weak weak
prisoners who only ate polished rice could barely walk…lacked vitamin B1 (thiamine) unless they ate the hull of the rice

Question 3

What are the complications of thiamine deficiency?

Answer 3

Wernicke encephalopathy
cardiac dilation, high output failure
weight loss
peripheral neuropathy
muscle wasting
edema

Question 4

What is Wernicke’s syndrome?

Answer 4

includes opthalmoplegia
cerebellar ataxia
mental impairment-confusion
disoriented

Question 5

What is the wernicke-korsakoff area of the brain responsible for?

Answer 5

memory of new events seriously impaired to these people may confabulate
old memories okay

Question 6

What is the pathway of damage responsible for wernicke’s?

Answer 6

Path 1: foci of hemorrhage & necrosis in mamillary bodies & walls of 3rd & 4th ventricles

Question 7

What is the pathway responsible for wernicke-korsakoff’s?

Answer 7

Path 2: prominent degeneration of the neurons in the walls of the 4th ventricle & medial thalamic nuclei

Question 8

When do you see Wernicke’s syndrome?

Answer 8

chronic alcoholics-impairs absorption of thiamine
gastric disorders-chronic gastritis, gastric carcinoma, persistent emesis
obesity surgery-gastric bypass
prisoners fed a poor diet

Question 9

What is the treatment for beri beri/Wernicke’s encephalopathy?

Answer 9

parenteral thiamine, IM, IV

Question 10

What is korsakoff’s syndrome?

Answer 10

this includes the memory impairment
confabulation
apathy

Question 11

What is a wernicke-korsakoff’s syndrome?

Answer 11

opthalmoplegia, cerebellar ataxia, confused + memory problems, confabulation, apathy
**often seen in chronic alcoholics

Question 12

57 yo F presents with increasing painful paresthesias in both legs for the past 18 mo. PT has impaired position sense & vibration sense. Serum Vit B12 low. Hematocrit low. MCV normal. Serum methylmalonic acid & serum homocysteine both high. What is the treatment?

Answer 12

Vit B12 déficience.

posterior columns responsible for loss of vibration & position sense.

Question 13

What are paresthesias?

Answer 13

numbness, tingling

Question 14

Why is there a loss of vibration & pressure w/ Vit B12 deficiency?

Answer 14

can become a demyelinating nervous system disease

Question 15

GIve 2 reasons why someone might have Vit B12 deficiency.

Answer 15

Pernicious anemia-autoimmune atrophic gastritis-lack of intrinsic factor for Vit B12 absorption
Issuse with terminal ileum absorption-Crohn’s disease

Question 16

Which columns are compromised w/ Vit b12 deficiency?

Answer 16

lateral & dorsal columns-demyelination

Question 17

When you do a gastric sleeve…which part of the stomach is removed? What is the issue with this?

Answer 17

fundus of the stomach removed–parietal cells found there–>intrinsic factor secreted that assists in vitamin b12 absorption

Question 18

What are the main issues with gastric bypass surgery?

Answer 18

Vit B12 déficience
incisional hernia
depression
staple line failure
gastritis

Question 19

51 yo M had gastric bypass surgery & develops opthalmoplegia, diplopia, weakness of left arm. Deteriorates into drowsiness and confusion. What does this patient have ?

Answer 19

thiamine deficiency
beri beri
a part of this is wernicke’s encephalopathy.

Question 20

How long does it take to deplete the liver stores of vitamin b12?

Answer 20

about 1 year if you are healthy.

Question 21

What are some dietary guidelines that can help prevent alzheimer’s?

Answer 21

minimize intake of saturated fats & trans fat
increase vegetables, whole grains
Vit E from nuts etc.
Get Vit B12
Don’t get excess iron & copper-don’t want iron overload
reduce aluminum
aerobic exercise is a must!