Nutritional pathology Flashcards by Mas R

A child is considered malnourished when

weight is <80% of normal

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2 protein compartments in body

Somatic

Visceral

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What makes up the somatic protein compartment

Skeletal muscle

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What makes up the visceral protein compartment

Liver stores

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4 examples of Protein Energy Malnutrition

Kwashiorkor
Marasmus
Cachexia
Anorexia nervosa

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Kwashiorkor predominantly affects

Visceral protein - protein deficiency

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Marasmus predominantly affects

SOMATIC protein

Protein AND energy - caloric deficiency

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Marasmus~ starvation characterized by

Severe reduction in carloric intake
weight <60% of normal
growth retardation, loss of muscle 
PRESERVE visceral compartment
mobilize subcutaneous fat - decreased leptin
REDUCED BMR - opposite of cachexia

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Marasmus may show clinical signs such as

emaciation of extremeties
Anemia
Vitamin def
Immune deficiency - T cell mediated - infections
poor wound healing

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Kwashiorkor characterized by

Greater protein deprivation than reduction in calories

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Which PEM is more severe

Kwashiorkor IS MORE SERVERE than marasmus

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Kwashiorkor may PRESENT as

60-80% normal weight
HYPOalbuminemia and EDEMA
FLAKY Paint skin lesions hyperpigmentation and hypo
Loos of color on hair

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Clinical presentation of Kwashiorkor

1- Liver steatosis 
2- Apathy, listlessnes,anorexia 
3- vitamin deficiencies
4 - immune deficiency and infection
5- poor wound healing

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Cachexia characterized by

loss of fat and muscle
INCREASED resting energy and BMR
result of TNF, IL-2, IL-6 and proteolysis inducing factor - PIF - tumor secretions

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What does proteolysis inducing factor lead to

Breakdown of skeletal muscle

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Clinical findings of anorexia nervosa are most similar to

Marasmus

effects on endocrine system
dehydration and electrolyte imbalance
lethal cardiac arrythmias

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Medical complications of bulimia

electrolyte imbalance- HYPOKALEMIA
Pulmonary aspiration
Esophageal and gastric cardia tears

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What % of adults overweight? and obese?

30% … and additional 30% (bmi>30)

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Obesity is a disorder of…

ENERGY balance

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Central processing of food intake/expenditure is through 2 anorexigenic factors

POMC

CART

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Central processing of food intake/expenditure is through 2 ORExigenic neurons - make you hungry

Neuropeptide Y

AgRP

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Leptin is secreted by (means thin)

Adipocytes

- binds to POMC and CART neurons

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Net effect of leptin is TO

REDUCE food intake

INCREASE energy expenditure

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Loss of function mutations in leptin lead to

Early onset severe obesity

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Adiponectin is produced by

Adipocytes - directs FA to muscle for oxidation - Decrease INFLUX of FA to liver - Decrease glucose production in liver

What is the ONLY known hormone to increase FOOD intake - Orexigenic effect

GHRELIN - binds to NPY, and AgRP pathway - short term initiator of feeding - levels rise before meals

Obesity leads to increased expression of

IGF-1 - mitogenic and anti-apoptotic HIF 1 and VEGF and leads to conversion of androgens to estrogen

Insulin increases

Androgen synthesis in adrenals and ovaries

Which vitamins can be synthesized endogenously?

D K Biotin Niacin

Which minerals are needed in large amounts - still micronutrients

- Sodium - potassium - Calcium - phosphorus

Which trace minerals are needed

Cobalt, Copper Flourine, Iodine Iron, Mg Selenium, Zn

Case: Flat occipital bones, Frontal bossing, deformation of chest, Rachitic rosary

Vitamin D deficiency

Deficiency of vitamin K will cause

Bleeding

Source of Vitamin D

Fish liver, plants, grains | >80% ENDOGENOUS SOURCE

Vitamin D on skin synthesized from

7-dehydrocholesterol - need UV light

What happens to Vitamin D in liver

add 25-OH

What happens to Vitamin D in kidney

1,25 - added 1, from 1a hydroxylase

What activates alpha-1-hydroxylase

1. PTH | 2. Hypophosphatemia

What down regulates alpha-1-hydroxylase

High levels of 1,25 OH Vit D

What is the function of Vitamin D

intestinal absorption of Ca and P stimulate Ca reasborption from bone and from distal renal tubules via PTH and for normal mineralization of bone

Result of a Vitamin D deficiency

HYPOcalcemia - increased PTH production

Clinical manifestation of Vit D deficiency

- rickets - inadequatemineralization - inadequate calcification and overgrowth of epiphyseal cartilage - rachitic costochondral junction - in adults leads to osteomalacia

Case: Alcohol abuse, bilateral foot drop, sensory loss, retrograde amnesia

Vitamin B1 - Thiamin deficiency

Source of Vitamin B1 - Thiamin

- in diet, not in polished rice, white flour, white sugar

Function of Vitamin B1 -

Synthesis ATP- energy production Cofactor for transketolase Maintain neural membrane

3 causes of thiamine deficiency

1- dietary insufficiency 2- Chronic alcoholism 3- excess vomiting diarrhea - can get subclinical def - if you refeed/give glucose

3 main areas affected by thamine deficiency

1. Peripheral nerves - dry beriberi 2. Heart - wet beriberi 3- CNA - wernicke-kosrsakoff sybdrome

What does dry beriberi result in

1 - symmertric polyneuropathy 2- first appears in legs - toe drop, foot drop, sensory loss with hyporeflexia

What does wet beriberi result in

1- CVD - peripheral vasodilation 2- rapid AV shunting of blood 3- High output cardiac failure 4- peripheral edema - enlarged heart

What is Wernicke-Korsakoff syndrome

1- encephalopathy - confusion, opthalmoplegia | 2- Korsakoff- retrograde amnesia, confabulation

CNS lesions due to thiamine deficiency are found in

Mamillary bodies Periventricular regions of thalams Floor of 4th ventricle Anterior cerebellum

Case: Partial gastrectomy, megaloblastic anemia -

vitamin b12 deficiency

Sources of Vitamin B12

animal proteins, meat, eggs

Excess vitamin B12 stored in

Liver

What is the function of B12

binds to Intrinsic factor (produced by parietal cells) | - forms a complex - dissociates in ileum - binds transcobalamin, delivered to bone liver, marrow, etc.

Vitamin B12 deficiency can be due to

- decreased intake - Intrinsic factor deficiency - gastrectomy - or pernicious anemia - - other malabsorption syndrome

How does Vitamin B12 present

1- Megaloblastic anemia - (needed for DNA synthesis - and leads to defective erythrocyte maturation) 2- Neurological complications

Case: DM, Hepatomegaly, slate-grey skin

Iron excess

Normal iron absorption is

limited - iron efficiently re-utilized in the body

Increase absorption of iron with

Ascorbic acid

Iron excess can result frmo

Primary Hereditary Hemochromatosis | Secondary - ineffective erythropoiesis, increased intake, chronic liver diseaes

Hereditary Hemochromatosis is a common

Autosomal recessive trait more common in men HIGH absorption - accummulation of iron in tissues

Clinical manifestations of hemochromatosis

1 - hepatomegaly, fibrosis 2 -DM - pancreas 3- altered skin pigmentation - cardiac problems - testicular atrophy

how do you treat hemochromatosis?

Regular phlembotomy - and supportive treatment

What risk has vitamin A shown in lung cancers

Increased risk

Risk of vitamin A supplementation in head and neck cancers

Success in preventing squamous cell carcinomas

Lycopene has been shown to have some

Antioxidant properties | - tomatoes -

Nutritional pathology Flashcards

(67 cards)