[P] Week 5: Environmental and Nutritional Disease - Part 1 Flashcards by Geno Alinsub

Q

What are the two dieatary Insufficiency?

A

Primary Malnutrition
Secondary Malnutrition

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Q

DIETARY INSUFFICIENCY

It is commonly seen in chronically ill patients, elderly, or bed-ridden patients.
Bed-ridden or hospitalized malnourished patients have an increased risk of infection, sepsis, impaired wound healing, and death after surgery

A

Secondary Malnutrition

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Q

DIETARY INSUFFICIENCY

What are the most obvious signs of secondary malnutrition?

A

Depletion of subcutaneous fat in the arms, chest wall, shoulders, or metacarpal regions.
Wasting of the quadriceps and deltoid muscles.
Ankle or sacral edema.

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Q

Condition that lead to primary ort secondary malnutrition

A

Poverty
Acute and chronic illnesses with increased catabolism.
Chronic alcoholism
Ignorance and failure of diet supplementation
Self-imposed dietary restrictions
Other causes may also be GIT diseases and malabsorption syndromes, genetic diseases, and inadequate total parenteral nutrition (TPN).

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Q

Malnutrition is defined as the consequence of inadequate intake of protein and calories to meet the body’s needs.

A

Severe Acute Malnutrition (SAM)

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Q

SAM is formerly known as the?

A

Protein Energy Malnutrition

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Q

The WHO defines severe acute malnutrition (SAM) as a state characterized by a weight for height ratio that is ____ standard deviations below the normal range

A

three (3)

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Q

What are the Determination of State of Malnourishment

A

Body Mass Index (BMI)
Skinfold Thickness
Measurement of Serum Proteins

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Q

DETERMINATION OF STATE OF MALNOURISHMENT

Computed using both the height and weight of person and then comparing it to a standardized chart

A

Body Mass Index (BMI)

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Q

DETERMINATION OF STATE OF MALNOURISHMENT

Classification:

underweight
Normal
Overweight
Obese

A. Below 18.5
B. 18.5 to 24.9
C. 25 to 29.9
D. Above 30

A

ABCD

In/de -crement of 5

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Q

DETERMINATION OF STATE OF MALNOURISHMENT

Measures fat stores and muscle mass.

A

Skinfold thickness

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Q

DETERMINATION OF STATE OF MALNOURISHMENT

Measurement of serum proteins (albumin, transferrin, and others) can provide an estimate of the adequacy of the visceral protein compartment.

A

Measurement of serum protein

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Q

What are the type of Severe Acute Malnutrition

A

Marasmus
Kwashiorkor

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Q

TYPES OF SEVERE ACUTE MALNUTRITION

Develops when the diet is severely lacking in calories.
Weight falls to 60% of normal for sex, height, and age.
Growth retardation and loss of muscle mass and subcutaneous fat as a result of catabolism and depletion of the somatic protein compartment

A

Marasmus

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Q

TYPES OF SEVERE ACUTE MALNUTRITION

Manifestations include:
- Emaciated extremities
- Head appearing too large for the body
- Anemia
- Multivitamin deficiencies
- Defects in T cell immunity making them prone to infections

A

Marasmus

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Q

TYPES OF SEVERE ACUTE MALNUTRITION

Occurs when protein deprivation is relatively greater than
the reduction in total calories.
Marked protein deprivation is associated with severe loss of the visceral protein compartment, and the resultant hypoalbuminemia gives rise to generalized or dependent
EDEMA.

A

Kwashiorkor

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Q

TYPES OF SEVERE ACUTE MALNUTRITION

Characteristic skin lesions with alternating zones of hyperpigmentation, desquamation, and hypopigmentation, giving a “flaky paint” appearance.
Hair changes includes loss of color or alternating bands of pale and darker colors, straightening, fine texture, and loss of firm attachment to the scalp.

A

Kwashiorkor

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Q

TYPES OF SEVERE ACUTE MALNUTRITION

Other findings include:
o enlarged fatty liver
o apathy
o listlessness
o loss of appetite
This is the most common form of severe acute malnutrition among African children who have been fed a carbohydrate-rich diet.

A

Kwashiorkor

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Q

Enumerate the Eating Disorders

A

Anorexia Nervosa
Bulimia

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Q

EATING DISORDERS

self-induced starvation, resulting in marked weight loss.
It has the highest death rate of any psychiatric disorder.

A

Anorexia Nervosa

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Q

EATING DISORDERS

Binge eating is the norm.
They eat large amounts of food, principally carbohydrates, which are ingested, followed by induced vomiting.
The problem here is that the stomach acid can go up to the esophagus and teeth, which can cause an injury.

A

Bulimia

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Q

VITAMIN DEFICIENCIES

important to maintain normal vision, regulation of cell growth an ddifferentiation, and regulation of life and metabolism

A

Vitamin A

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Q

VITAMIN DEFICIENCIES

name given to a group of related compounds that include retinol, retinal, and retinoic acid, which have similar biologic activities

A

Vitamin A

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Q

VITAMIN DEFICIENCIES

Sources of this vitamins comprise of:
- dairy
- oats
- carrots
- bread
- sweet potatoes.

Greatest sources include
- beef kidneys
- liver
- cod liver oil
- chicken liver

A

Vitamin A

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# VITAMIN DEFICIENCIES Vitamin A deficiency occurs worldwide either as a consequence of?

**primary malnutrition** or secondary to conditions that cause **malabsorption of fats**

# VITAMIN DEFICIENCIES Vitamin A deficiency manifestation: 1. Xeropthalmia 2. Xerosis conjunctiva 3. Bitot spots 4. Keratomalacia A. dryness of the conjunctiva B. buildup of keratin debris in small opaque plaques C. dry eyes - most devastating change D. softening & destruction of the cornea

1. C 2. A 3. B 4. D

# VITAMIN DEFICIENCIES Vitamin A is also good for skin. However, excessive use, such as using too many ____ and ____ treatments can lead to **toxicity**.

retinol products and isotretinoin

# VITAMIN DEFICIENCIES * Made from sunlight exposure. * The major function is the maintenance of adequate levels of calcium and phosphorus to support metabolic functions.

Vitamin D

# VITAMIN DEFICIENCIES Vitamin D deficiency is called what in children and adult?

Children - Rickets Adults - Osteomalacia

# VITAMIN DEFICIENCIES Vitamin D Deficiency

Manifestations include: - Craniotabes (infants) - Frontal bossing, squared appearance to the head (infants) - Rachitic rosary (beading of the ribs) - Pigeon breast deformity - Lumbar lordosis - Bowing of legs

# VITAMIN DEFICIENCIES In children, hypervitaminosis D may take the form?

**metastatic calcifications of soft tissues** such as the kidney

# VITAMIN DEFICIENCIES In adults, hypervitaminosis D it causes?

bone pain and hypercalcemia

# VITAMIN DEFICIENCIES The toxic potential of vitamin D is so great that in sufficiently large doses, it is a?

potent rodenticide

# VITAMIN DEFICIENCIES Prolonged exposure to normal sunlight does not produce an excess of vitamin D, but ____ of orally administered vitamin can lead to hypervitaminosis

Megadoses

# VITAMIN DEFICIENCIES Vitamin C is also known as?

Ascorbic Acid

# VITAMIN DEFICIENCIES A deficiency of water soluble vitamin C leads to the development of?

Scurvy characterized principally by bone disease in growing children and by hemorrhages and and healing defects in children & adults.

# VITAMIN DEFICIENCIES A person who has scurvy will have ____ when they brush their teeth

bleeding gums

# VITAMIN DEFICIENCIES TOF The popular notion that megadoses of vitamin C protect against the common cold, or at least allay the symptoms, has not been borne out by controlled clinical studies

T

familliarize the table for virtamins and trace elements thank yew

facts

defined as an **accumulation of adipose tissue** that is of sufficient magnitude to impair health

Obesity

Obesity is associated with several of the most important diseases of humans, including ?

- Type 2 diabetes, - dyslipidemia - cardiovascular disease - hypertension - cancer

CLINICAL CONSEQUENCES OF OBESITY

* Insulin resistance & hyperinsulinemia * Hypertriglycidemia & low HDL cholesterol levels * Nonalcoholic fatty liver disease * Cholelithiasis (gallstones) * Obstructive sleep apnea * Predisposing factor for osteoarthritis * Increased incidence of certain cancers in overweight people, including cancers of the esophagus, thyroid, colon, and kidney in men and cancers of the esophagus, endometrium, gallbladder, and kidney in women

TOF Diet is linked to cancer

TRUE

With respect to carcinogenesis, three aspects of the diet are of major concern, what are those?

1. The context of exogenous carcinogens 2. The endougenous syntehesis of carinigens from dietary components 3. The lack of protective factors like **vitamins C & E, betacarotene, and selenium**

# DIET AND CANCER *The context of exogenous carcinogens* It is involved in the development of hepatocellular carcinoma.

Aflatoxin

# DIET AND CANCER *The endogenous synthesis of carcinogens from dietary components* Implicated in the generation of gastric carcinomas.

Nitrosamines & nitrosamides

# DIET AND SYSTEMIC DISEASES Restricting sodium intake reduces?

Hypertension

# DIET AND SYSTEMIC DISEASES resulting in increased fecal bulk, is thought by some investigators to provide a preventive effect against diverticulosis of the colon

**Dietary fiber or roughage**

# DIET AND SYSTEMIC DISEASES n touted to protect against heart disease (and also against devils, werewolves, vampires, and, alas, kisses), although research has yet to prove this effect unequivocally

Lowly garlic

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE Drug abuse generally involves the ____ beyond therapeutic or social norms, and may lead to drug addiction and overdose, both serious public health problems.

repeated or chronic use of mind-altering substances,

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE Cocaine is extracted from the leaves of the coca plant and is usually prepared as what water-soluble powder,

cocaine hydrochloride

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE what are the way cocain can be induced

snorted or dissolved in water and injected subcutaneously ## Footnote producing intense euphoria and neurologic stimulation, making it one of the most addictive drugs

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE TOF It can precipitate arrhythmias, induce myocardial infarction, and cause hypopyrexia.

F Myocardial Ischemia; Hyperpyrexia

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE In pregnant women, cocaine may cause

Acute decreases in blood flow to the placenta

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE In pregnant women, cocaine may cause acute decreases in blood flow to the placenta, resulting in?

fetal hypoxia and spontaneous abortion ## Footnote Neurologic development may be impaired in the fetus of a pregnant woman who is a chronic drug user

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE With chronic cocaine users, it can eventually lead to?

**perforation of the nasal septum**, aside from decreased lung diffusing capacity and related cardiomyopathy.

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE *OPIOIDS AND OPIATES* Opioid drugs of abuse include prescription drugs such as ?

- heroin - oxycodone - hydrocodone - fentanyl - tramadol - methadone

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE a street drug derived from a poppy plant that is close to morphine

Heroin

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE The effects of heroin addiction on the CNS include?

- euphoria - hallucinations - somnolence - sedation

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE Most important adverse effects of heroin

- Sudden death - Pulmonary injury - Infections - skin, heart, liver, and lungs - Skin lesions - most frequent telltale sign ▪ When injected, scarring occurs. - Kidney disease

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE Methamphetamine produces a feeling of euphoria, which is followed by a?

crash

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE Methamphetamine Long-term use leads to violent behaviors, confusion, and psychosis marked by

paranoia and hallucinations

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE This is also known as ____ or ____ and is closely related to amphetamines, but has a stronger effect in the CNS

speed or meth

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE this mental illness is linked to marijuana?

Schizophrenia

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE Marijuana use causes

euphoria and a sense of relaxation

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE Causes a heightened sensory perception (e.g., brighter colors/lights), laughter, altered perception of time, and increased appetite

Marijuana

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE Marijuana is made from the leaves of the

Cannabis sativa plant

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE Cannabis sativa plant, which contains the psychoactive substance known as

tetrahydrocannabinol (Δ9-THC)

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE About what percent of tetrahydrocannabinol (Δ9-THC) is absorbed when marijuana is smoked in a hand-rolled joint.

5 to 10%

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE TOF Marijuana has the potential to treat nausea and can decrease pain. In other countries, if pain relievers are ineffective, it’s legal to use marijuana. However, this is still legal in the Philippines

F illegal in PH

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE It is said that marijuana cigarettes contain a large number of carcinogens that are also present in?

tobacco

# INJURY BY NONTHERAPEUTIC AND DRUGS OF ABUSE Smoking marijuana cigarettes compared with tobacco cigarettes is associated with a?

**3-fold increase in the amount of carcinogen** inhaled and retained in the lungs

* Refers to conditions caused by exposure to chemical or physical agents in the ambient, workplace, and personal environment, including diseases of nutritional origin. * Most diseases are caused or influenced by this

Environmental Diseases

* According to WHO, this can be defined as the increased interconnectedness and interdependence of people and countries to encourage economic growth. As a result, there is an increase in industrialization and population. * Eventually, this leads to climate change.

Globalization

# HEALTH EFFECTS OF CLIMATE CHANGE Cardiovascular, cerebrovascular, and respiratory diseases, all of which will be exacerbated by?

heat waves and air pollution

# HEALTH EFFECTS OF CLIMATE CHANGE Gastroenteritis, cholera, and other foodborne and waterborne infectious diseases (causing diarrhea), caused by?

contamination

# HEALTH EFFECTS OF CLIMATE CHANGE TOF Vector-borne infectious diseases resulting from changes in vector number and geographic distribution related to increased temperatures, crop failures, and more less weather variation

F extreme not less

# HEALTH EFFECTS OF CLIMATE CHANGE Malnutrition caused by changes in local climate that disrupt?

Crop production

* Toxicology is defined as?

The science of poisons

It studies the distribution, effects, and mechanisms of action of toxic agents. More broadly, it also includes the study of the effects of physical agents such as radiation and heat.

Toxicology

# ENVIRONMENTAL POLLUTION significant cause of morbidity and mortality worldwide, particularly among at-risk individuals with preexisting pulmonary or cardiac disease.

Air pollution

# AIR POLLUTION The ambient air in industrialized nations is contaminated with an unsavory mixture of gaseous and particulate pollutants, more heavily in cities and in proximity to heavy industry.

Outdoor Air Pollution

# AIR POLLUTION outdoor air pollution In industrialized nations, it is more heavy / dense especially in areas with

Heavy industry

# Outdoor Air Pollution In the United States, the Environmental Protection Agency monitors and sets allowable upper limits for six pollutants:

- sulfur dioxide - CO - ozone - nitrogen dioxide - lead - particulate matter

Air pollution is a significant cause of mortality and morbidity worldwide. The effects of air pollution are drastic among those with?

pulmonary / lung problems (asthma, pulmonary pneumonia, COPD)

# HEALTH EFFECTS OF AIR POLLUTION Short or Long Term Effects ✓ Affects Central Nervous System ✓ Cardiovascular diseases ✓ Respiratory diseases ✓ Impacts on liver ✓ Impacts on reproductive system

Long term effects

# HEALTH EFFECTS OF AIR POLLUTION Short or Long Term Effects ✓ Headache ✓ Ice inflammation ✓ Coughing ✓ Painful ✓ Pneumonia ✓ Breathing ✓ Bronchitis ✓ Skin irritation

Short term effects

# HEALTH EFFECTS OF OUTDOOR AIR POLLUTANTS Identify the pollutant **Populations at Risk**: Healthy adults and children, Athletes, outdoor workers, Asthmatic **Effects**: ✓ Decreased lung function Increased airway reactivity - Lung inflammation ✓ Decreased exercise capacity Increased hospitalizations

Ozone

# HEALTH EFFECTS OF OUTDOOR AIR POLLUTANTS Identify the Polutants **Population at Risk:** ✓ Healthy adults ✓ Asthmatics ✓ Children **Effects:** ✓ Increased airway reactivity ✓ Decreased lung function ✓ Increased respiratory infections

Nitrogen Dioxide

# HEALTH EFFECTS OF OUTDOOR AIR POLLUTANTS Identify the Polutants **Population at Risk:** ✓ Healthy adults ✓ Individuals with chronic lung disease ✓ Asthmatics **Effects:** ✓ Increased respiratory symptoms ✓ Increased mortality ✓ Increased hospitalization ✓Decreased lung function

Sulfur dioxide

# HEALTH EFFECTS OF OUTDOOR AIR POLLUTANTS Identify the Polutants **Population at Risk:** ✓ Healthy adults ✓ Children ✓ Asthmatics **Effects:** ✓ Altered mucociliary clearance ✓ Increased respiratory infections ✓ Decreased lung function ✓ Increased hospitalizations

Acid aerosols

# HEALTH EFFECTS OF OUTDOOR AIR POLLUTANTS Identify the Polutants **Population at Risk:** ✓ Children ✓ Individuals with chronic lung or heart disease ✓ Asthmatics **Effects:** ✓ Increased respiratory infections ✓ Decreased lung function ✓ Excess mortality Increased attacks

Particulates

# GROUND LEVEL OZONE (O3) * Ozone accumulates in the ____ (ground-level ozone) is one of the most pernicious air pollutants.

lower atmosphere

gas formed by the reaction of **nitrogen oxides** and **volatile organic compounds** in the presence of sunlight. These chemicals are released by industrial emissions and motor vehicle exhaust.

Ground level ozone

# GROUND LEVEL OZONE (O3) a particularly important cause of morbidity and mortality related to pulmonary inflammation and secondary cardiovascular effects

Particulate matter (known as “soot”)

# GROUND LEVEL OZONE (O3) Black powdering or gray substance consisting largely amorphous carbon produce by incomplete burning of organic matte

SOOT

# AIR POLLUTION * a systemic asphyxiant that is an important cause of accidental and suicidal death. * Victims are often unaware that they are undergoing poisoning already

Carbon Monoxide (CO)

# AIR POLLUTION can’t be seen (colorless), smelled (odorless), heard, tasteless gas, and can be stopped.

Carbon monoxide (CO)

# AIR POLLUTION - The diagnosis is made by measuring carboxyhemoglobin levels in the blood. o It will alarm when there is an increased level

Carbon monoxide (CO)

# CARBON MONOXIDE (CO) Acute or Chronic poisoning * Generally, a consequence of **accidental exposure or suicide attempt**. * In light-skinned individuals, acute poisoning is marked by a characteristic generalized **cherry-red** color of the skin and mucous membranes, which results from high levels of carboxyhemoglobin.

Acute poisoning by CO

# CARBON MONOXIDE (CO) Acute or Chronic poisoning * It develops because **carboxyhemoglobin, once formed, is remarkably stable** * Even with low-level, but persistent, exposure to CO, carboxyhemoglobin may **rise to life- threatening levels in the blood.** * The slowly developing **hypoxia** can insidiously evoke widespread ischemic changes in the CNS; these are particularly marked in the basal ganglia and lenticular nuclei

Chronic poisoning by CO

The most common pollutant is tobacco smoke, but additional offenders are CO, nitrogen dioxide, and asbestos.

Indoor Air Pollution

# Indoor Air Pollution containing polycyclic aromatic hydrocarbons generated by cooking oils and coal burning are important indoor pollutants in lower income parts of the world, particularly parts of Asia.

Volatile substances

# Indoor Air Pollution containing various oxides of nitrogen and carbon particulates, is an irritant that predisposes exposed persons to lung infections and may contain carcinogenic polycyclic hydrocarbons

Smoke from burning of organic materials

# Indoor Air Pollution range from microbiologic agents capable of causing infectious diseases such as legionnaires’disease, viral pneumonia, and the common cold to less threatening but nonetheless distressing allergens derived from pet dander, dust mites, fungi, and molds that are variously responsible for rhinitis, eye irritation, and asthma.

Bioaerosols

# Indoor Air Pollution a radioactive gas derived from uranium widely present in soil and in homes, can cause lung cancer in uranium miners.

Radon ## Footnote It is also suspected that low-level chronic exposures in the home increase lung cancer risk, particularly in those who smoke tobacco.

# Indoor Air Pollution number one cause of lung cancer among nonsmokers, according to EPA estimates

Radon

# Indoor Air Pollution second leading cause of lung cancer.

Radon

# Indoor Air Pollution s used in the manufacture of building materials (e.g., cabinetry, furniture, adhesives) and mayaccumulate in the air in poorly ventilated housing

Formaldehyde

# Indoor Air Pollution at what concentration of formaldehydh causes breathing difficulties and a burning sensation in the eyes and throat and can trigger asthma attacks

0.1 ppm or higher

# Indoor Air Pollution TOF Formaldehyde is classified as a car for humans and animals.

False Carcinogen

# Indoor Air Pollution TOF Exposure to formaldehyde in the home can irritate eyes, nose, throat, and skin

T

# Indoor Air Pollution TOF formaldehyde can also increase breathing problems for people with health conditions like asthma, Acute obstructive pulmonary disorder (AOPD)

False Chronic Obstructive Pulmonary Disorder