B2.027 Nutritional Deficiencies

Question 1

what are some major causes of malnutrition?

Answer 1

altered taste/smell
nausea/vomiting
diarrhea/malabsorption
poor food quality/availability
self imposed restrictions
metabolic disturbances
alcoholism
cytokine effects
liver disease
unpalatable diets

Question 2

how can alcohol intake cause malnutrition?

Answer 2

decreasing calorie intake
interfering with nutrient digestion and absorption
reduce protein synthesis and secretion
causing breakdown of gut proteins
increasing excretion of nutrients

Question 3

what are physical exam findings of malnutrition?

Answer 3

weight loss, low BMI, loss of subcutaneous fat, loss of muscle mass, reduced handgrip strength

Question 4

what is another name for vitamin A?

Answer 4

retinol

Question 5

what are dietary sources of vitamin A?

Answer 5

preformed: liver, fish, eggs, milk

carotenoid precursors: yellow and leafy green veggies

Question 6

what are signs of vitamin A deficiency?

Answer 6

night blindness, eye dryness, corneal ulceration, , perifollicular hyperkeratosis (small bumps on skin), and immune deficiency

Question 7

can vitamin A build up to toxic levels?

Answer 7

yes

Question 8

what are symptoms of acute vitamin A toxicity?

Answer 8

headache, vomiting, stupor, death

Question 9

what are symptoms of chronic vitamin A deficiency?

Answer 9

weight loss, vomiting, dry lips, bone and joint pain

Question 10

what is carotenemia?

Answer 10

excessive vitamin A precursors

Question 11

is carotenemia associated w toxicity?

Answer 11

no

Question 12

what are sources of vitamin D?

Answer 12

sunlight, fortified dairy products

Question 13

what can cause vitamin D deficiency?

Answer 13

diets lacking in Ca and vitamin D, limited exposure to sunlight

Question 14

what are signs of vitamin D deficiency?

Answer 14

rickets in children, osteomalacia in adults, bone pain, weakness of proximal muscles, hypocalcemia

Question 15

what are important functions of vitamin C?

Answer 15

antioxidant and important in hydroxylation of procollagen

Question 16

which disease is associated with vitamin C deficiency?

Answer 16

scurvy

characterized by bone disease in growing children and hemorrhages and healing defects in both children and adults

Question 17

what are sources of vitamin C?

Answer 17

fruits and veggies

Question 18

what are signs and symptoms of vitamin C deficiency?

Answer 18

weakness/fatigue
aching bones/joints/muscles at night
acne
hair deformities
easy bruising
loss of teeth

Question 19

what are functions of vitamin A?

Answer 19

component of visual pigment
maintenance of epithelia
maintenance of resistance to infection

Question 20

what is the primary function of vitamin D?

Answer 20

facilitates intestinal absorption of calcium/phosphorous and mineralization of bone

Question 21

what is the primary function of vitamin E?

Answer 21

major antioxidant

Question 22

what is the primary function of vitamin K?

Answer 22

cofactor in hepatic carboxylation of procoagulants

Question 23

what are the b-complex vitamins?

Answer 23

b1 (thiamine)
b2 (riboflavin)
b3 (niacin)
b5 (pantothenic acid)
b6 (pyridoxine)
b7 (biotin)
b12
folate

Question 24

what are general properties of B vitamins?

Answer 24

water soluble, function as coenzymes (needs are tied to energy intake), present in fortified foods

Question 25

what are signs of a b1 (thiamin) deficiency?

Answer 25

dry beriberi (CNS), wet beriberi (circulation), high output heart failure w tachy, elevated peripheral venous pressure, edema, peripheral neuropathy, WK syndrome

Question 26

what are sources of b1?

Answer 26

whole grains

Question 27

what are sources of b3 (niacin)?

Answer 27

grain, legumes, seed oils, made endogenously from tryptophan

Question 28

what are signs of a b3 deficiency?

Answer 28

3 D's dermatitis (skin affected by sun), dementia (atrophy of neurons), diarrhea (atrophy of columnar epithelium in GI)

Question 29

what are sources of b2 (riboflavin)?

Answer 29

meat, dairy, veggies

Question 30

what are signs of a b2 deficiency?

Answer 30

cheliosis/chelitis (cracks at angles of mouth) glossitis (shiny tongue) corneal opacities and ulcerations dermatitis

Question 31

what is a characteristic of populations affected by b6 (pyroxidine) deficiencies?

Answer 31

rare in nonalcoholics, present in over half of alcoholics

Question 32

what is megaloblastic anemia?

Answer 32

anemia with abnormally large RBC, increased mean corpuscular volume due to impairment of DNA synthesis which leads to ineffective hematopoiesis (blood cell formation)

Question 33

what are the 2 types of megaloblastic anemia?

Answer 33

pernicious (b12 deficiency) | folate deficiency

Question 34

what can cause b12 deficiency?

Answer 34

``` vegetarianism impaired absorption intrinsic factor def gastrectomy ileal resection competition from tapeworms ```

Question 35

what is a major sign of b12 def?

Answer 35

pernicious anemia caused by autoimmune gastritis that impairs production of intrinsic factor , which is required for b12 uptake from the gut

Question 36

what secretes intrinsic factor?

Answer 36

parietal cells

Question 37

what are sources of folic acid?

Answer 37

whole wheat flour, beans, green leafy veggies

Question 38

what creates a folic acid def?

Answer 38

inadequate intake malabsorption increased losses

Question 39

what is the difference between folate deficiency anemia and pernicious (b12) anemia?

Answer 39

indistinguishable but develops much more rapidly | body has less folate stores than b12

Question 40

what is the relationship between folate and pregnancy?

Answer 40

requirements increase during pregnancy | deficiency can predispose to neural tube defects

Question 41

what is the most common nutritional disorder in the world?

Answer 41

iron deficiency | inadequate hemoglobin synthesis

Question 42

what are sources of iron?

Answer 42

meats (heme iron) plants (non heme iron, require acid for absorption) fortified flour/grains

Question 43

what are signs of iron def?

Answer 43

``` pallor increasing fatigue exertional dyspnea, tachycardia pale mucous membranes spoon shaped nails ```

Question 44

depict iron deficiency from a histology perspective

Answer 44

small RBC containing narrow rim of peripheral hemoglobin normal RBC should be fully red