Lec11 Nutritional Pathology Flashcards Preview

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Flashcards in Lec11 Nutritional Pathology Deck (58):
1

What is most prevalent nutritional disorder in US

obesity

2

Definition obestity

accumulation adipose tissue that imparis health

3

BMI? Whats normal? overweight? obese?

weight [kg]/ (height in meters )^2
normal: 18.5-25
overweight: 25-30
obesity: >30

4

Is central [visceral] or subcutaneous fat more dangerous?

central adipose tissue accumulation associated with higher risk for many diseases

5

What are main measures of body fat?

- waist and hip circumference ratio
- skinfold thickness
- mid-upper arm circumference

6

What is normal wasit-hip circumference ratio?

obesity = >0.8-0.85 for women
= >0.9-1.0 for men

7

What is steatosis

increased fat
- may resolve or may progress to steatohepatitis

8

What is oil red o stain?

-stain for fat
- use for steatosis

9

What is steatohepatitis?

- steatosis of liver wtih inflammation
- leads to: fibrosis, cirrhosis, hepatocellular carcinoma
- can be due to alcohol or metabolic stuff

10

What is a mechanical effect of obesity?

osteoarthritis

11

What are 8 major pathologic complications of obesity

- type II diabetes
- hypertenesion
- hypertriglycidemia and low HDL
- non-alcoholic steatoehpatitis
- osteoarthritis
- heart disease/atherosclerotsis
- increased risk of cancer
- respiratory stuff [sleep apnea, hypoventilation]

12

Cause of obesity

imbalance of caloric intake and energy expenditure complicated by:
- genetic
- neural
- hormonal
- psychological
- nutritional
- environmental

13

Adipocytes - what do they secrete?

- number of adipocytes set in childhood/adolescence
- secrete
-- leptin
-- adiponectin
-- TNF, IL6, IL1, IL18

14

What is leptin? Effect of disruption leptin signalling?

- secreted by adipocytes and go to receptors in brain
- signals adequacy of fat stores
- decrease appetite/food intake [anorexigenic effect]
- downregulates path that increases appetite and upregulates path that increases energy expenditure
- disruption of signaling --> overeating and weight gain

15

What is ghrelin?

- produced in stomach
- increases food intake
- ghrelin levels rise before eating and fall 1-2 hrs after eating
- in obese people: grhelin levels always remain high

16

What is peptide YY [PYY]?

- secreted by endocrine cells in ileum/colon
- levels of PYY low during fasting and increase during food intake
- cause reduction in food intake/appetite [anorexigenic]

17

Adiponectin

- secreted by adipocytes
- directs fat to muscle and away from liver
- decreases glucose production in liver
- lower levels of adiponectin in obese individuals

18

How is obesity an inflammatory state

- obesity leads to high C reactive protien that is a marker of inflammatory activity

19

What medications for managing obesity?

- meds that decrease appetite: noradrenergic, serotoninergic
- meds that partition fats, prevent fats being absorbed by GI tract

20

What surgical methods for managing obesity

roux-en-Y: bypass stomach
sleeve gastrectomy: stomach staple to make smaller
gastric banding: make stomach smaller

21

what is primary vs secondary protein/energy malnutrtion

primary: food unavailable
secondary: secondary to coexisting disease

22

Who does primary protein energy malnutrition effect?

- children in poor countries
- elderly isolated in US with inaccessibility of food

23

Marasmus

- global starvation
- wasting appearance: loss of fat/muscle especially in extremities, growth retardation
- vit and immune deficiency
- age <1 year
- normal serum albumin
- patients are alert

24

Kwashiorkor

- protein deficiency even though adequate calories
- occurs when child is switched from milk to predominantly carbohydrate diet
- edema [low oncotic pressure]
- fatty liver [low lipoproteins that are needed to transport fat out of liver]
- skin lesions
- hair hypopigmentation
- vit and immune deficiency
- age > 1 year
- low serum albumin
- patients are listless

25

Secondary causes of protein energy malnutrtition

- acute infection [ increases metabolic rate]
- chronic diseases: cancer, HIV, anorexia, bulimia, malabsorption, alcoholism

26

What is cachexia?

- extreme weight loss, fatigue, muscle atrophy, anemia, anorexia
- in cancer and HIV patients
- secondary to atrophy of diaphragm and respiratory muscles in cancer patients

27

Which proteins involved in cachexia?

- PIF [proteolysis inducing factor]
- LMF [lipid-mobilizing factor]
- cytokines [TNF-a, IL6]

28

What is proteolysis inducing factor [PIF]?

- secreted in urine of patients with pancreatic cancer and cachexia
- may play role in cachexia

29

What cytokines play a role in cachexia?

- TNF-a or IL-6
- may be secreted by tumor or in response to tumor

30

What is lipid mobilizing factor [LMF]

- increases fatty acid oxidation
- increases pro-inflammatory cytokines
- may play role in cachexia

31

What is anorexia nervosa?

eating disorder characterized by excessive weight loss, food restriction, distorted body self immage

32

What is anorexia?

decreased appetite/food intake, not the same as the eating disorder

33

What is bulimia?

bing eating usually followed by induced vommiting

34

What is bulimia nervosa?

eating disorder characterized by binge eating followed by induced vomiting

35

Which vitamins are fat soluble?

- vit A, D, E, K
- can accumulate to toxic levels
- fat malabsorption syndrome can lead to low levels

36

Which vitamins are water soluble?

- B and C vit
- rarely toxic

37

Are water or fat soluble vit more likely toxic?

fat soluble

38

What is vitamin A

- group of related compounds
- retinol, retinal, retinoic acid

39

What are retinoids?

- vitamin A and other compounds with similar structure
- may or may not have vit A effects

40

Sources of vitamin A?

caratenoids [B carotene]
-- provitamins that are converted to vit A
-- found in yellow and leafy veggies [carrots]

preformed vit A in animal derived food [eggs, fish, liver, milk, butter]

41

Functions vitamin A

- helps vision, cell differentiation, growth, metabolism, resistance to infection
-mostly focus on: VISION, CELLULAR DIFFERENTIATION

42

Effects of vitamin A deficiency?

1. blindness

2. immune deficiency

3. squamous metaplasia
--- in lacrimal glands --> get dry eyes and conjunctiva
--- respiratory tract --> get pulmonary infections more easily
--- urinary tract --> get kidney and urinary stones

43

Effects of squamous metaplasia in vit A deficiency [3 places]

in lacrimal glands --> get dry eyes and conjunctiva

respiratory tract --> get pulmonary infections more easily

urinary tract --> get kidney and urinary stones

44

What is cause and effect of vitamin A toxicity? Acute vs chronic?

- overuse of dietary supplements, or lots of liver in diet [which has lots of vit A]
- acute toxicity: headache, dizziness, vomitting, blurred vision
- chronic: weight loss, anorexia, nausea, vomitting, enlarged liver

45

Therapeutic uses of vit A?

- retinoids to treat acne, psoriasis, acute promyelocytic leukemia
- retinoic acid and preformed vit A are also teratogens

46

What is vitamin C?

- ascorbic acid
- plays role in biosynthetic paths [COLLAGEN SYNTHESIS
- antioxidant
- in citrus fruits, veggies, milk, fish, liver

47

Effect of vitamin C deficiency?

- scurvy, get poorly formed collagen and thus:
- bleeding [due to weak blood vessel walls]
--- hemorrhages, swollen and bleeding gums
- bone pain
- poor wound healing

48

Why is vitamin C toxic or not toxic?

not toxic because:
- water soluble
- unstable
- poorly absorbed in intestine

49

Source of vit D

- 90% from photoconversion of precursor in skin
- 10% from diet: fish, plants, grains
- needs to be converted by liver and kidney before active effect
- acts on osteoclasts/blasts, intestine absorption, kidney itself

50

Function of vit D

CALCIUM REGULATION
- stimulates intestinal Ca reabsorption
- stimulates renal Ca reabsorption
- interacts with parathyroid hormone
- induces mineralization of bone
also [less importantly] regulation of:
- immune system, cell proliferation, cell differentiation, apoptosis, angiogenesis

51

Cause of vit D deficiency

- inadequate vit D in diet
- fat malabsorption syndrome
- limited sunlight exposure
- abnormal conversion to active form [due to liver or kidney disease]

52

3 diseases associated with vit D deficiency

- rickets [ in kids]
- osteomalacia [in adults]
- hypocalcemic tetany [muscle problem]

53

what is rickets?

- vit D deficiency in kids
- inappropriate endochondral bone formation
- get bowing in legs

54

Effect of vit D toxicity

- get high Ca, Ca deposition in soft tissue [metastatic calcification]
- bone pain and hypercalcemia

55

General function of B vitamins?

usually cofactors

56

General function of vit E?

antioxidants

57

General function of vit K?

important for clotting factors

58

How to tell marasmus vs kwashiorkor

marasmus: 1 yr old, edematous, low serum albumin, patient is listless