05 - Nutritional Pathology
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- Safrole in nutmeg and Estragole in basil
- Carcinogens
- Celery, Parsnips, Parsley
- Natural Pesticides
- Aflatoxin and Botulinum
- Toxicants
- Vitamin deficiencies are more common in _______
- alcoholics
- Inadequate intake of protein and calories to meet the bodies need
- Protein-energy Malnutrition (PEM)
- Aflatoxin causes this cancer
- Hepatocellular Cancer
- PEM is most common in ________
- underdeveloped or developing countries
- PEM is associated with _____ diseases
- Diarrheal
- In developed countries PEM is associated with these 5 things
-
1. Alcoholism
2. Acute/Chronic Illness
3. Poverty
4. Diet restriction
5. Ignorance - A child with weight < ____% normal is malnourished
- 80%
- 2 protein compartments
-
1. Somatic = skeletal muscles
2. Visceral = mostly liver - Deficiency of total food intake
- Marasmus
- Deficiency of protein intake
- Kwashiorkor
- Kwashiorkor can be caused by these 4 things
-
1. babies weaned early and put on carb diet (MOST COMMON)
2. chronic diarrhea (protein not absorbed)
3. protein losing enteropathies
4. Nephrotic syndrome = lose albumin - Somatic protein compartment is more severely impacted
-
Marasmus
*serum albumin normal or slightly reduced - Visceral protein compartment is more severely impacted
- Kwashiorkor
- Associated symptoms with Kwashiorkor
-
apathy
listlessness
enlarged fatty liver
Hypoalbuminemia - Hypoalbuminemia causes _____
- Anasarca = generalized edema
- Kwashiorkor effects on skin and hair
-
Skin: alternating zones of hyperpigmentation, desquamation
Hair: loss of color or alternating bands of pale and darker hair - Both Marasmus and Kwashiorkor cause these 4 things
-
1. stunted growth
2. anemia
3. infections and defects in immunity
4. multi-vitamin deficiencies - Pitting edema is characteristic of _________
- Kwashiorkor
- Secondary PEM is common in ____1____ due to increased __2__
-
1. chronically ill and hospitalized patients
2. metabolic rate - Cachexia is __1__-like PEM and is usually associated with these __2__
-
1. Marasmus
2. AIDS, cancer, end-stage lung disease (emphysema) - Secondary PEM that is Kwashiorkor-like is usually seen in these patients (3)
-
Severe trauma
Burns
Sepsis
*edema, serum albumin < 2.8 - Anorexia presents with ______-like findings
- PEM
- Anorexia causes these 6 things
-
1. amenorrhea
2. decreased thyroid hormone release
3. decreased bone density
4. anemia
5. lymphopenia
6. Hypoalbuminemia - What is Bulimia
- binge eating followed by induced vomiting
- Most common cause of death due to Bulimia and Anorexia
- Ventricular Arrhythmias caused by Hypokalemia
- Bulimia clinical findings (3)
-
1. Menstrual irregularities
2. Pulmonary aspiration of gastric contents
3. Esophageal and Cardiac rupture -
Anorexia: ~1% of __1__
Bulimia: ~4% of __2__
About __3__% with anorexia or bulimia are male -
1. adolescent females
2. college-age females
3. 10% - Fat Soluble Vitamins
-
D
A
K
E - Water-soluble vitamins
- B and C
- Deficiency in a single vitamin are ________
- uncommon
- Small amounts of these vitamins can be synthesized endogenously
-
D
K
Biotin
Niacin -
D synthesized by __1__
K and biotin from __2__
Niacin comes from __3__ -
1. UV light
2. Intestinal microflora
3. tryptophan - causes of Secondary Vitamin Deficiency
- disturbances in intestinal absorption, transport in blood, tissue storage, metabolic conversion
- Vitamin A has ____-like activity
- Hormone
- Preformed Vitamin A is found in _______
- animals --> liver, fish, eggs, milk, butter
- Carotenoids (vitamin A precursor) is found in _____
- carrots and leafy green vegetables (spinach)
- Vitamin A is essential to the maintenance of ___________
-
mucus secreting epithelium
*ocular --> lubrication, corneal - Vitamin A ______is a component of the visual pigment _______
-
Retinal
Rhodopsin - Vitamin A deficiency can cause impaired _______ and also _________
-
night vision
squamous metaplasia in respiratory and urinary tract
-involved in differentiation of Epithelial cells -
Vitamin A deficiency:
Dry eyes = 1
Keratin build up = 2
Corneal softening = 3 -
1. Xerophthalmia
2. Bitot spots
3. Keratomalacia -
Vitamin A is involved in differentiation of ____1____.
Maintains __2___ epithelium and ___3____ -
1. epithelial cells
2. respiratory
3. urothelium - Vitamin A deficiency predisposes to pulmonary __1__. Keratin debris from squamous metaplasia predisposes to __2__
-
1. infection
2. renal/bladder stones - Vitamin A enhances ______
- immunity
- Related Carotenoids are __1__ and __2__
-
1. photoprotective
2. Antioxidants - Vitamin A deficiency causes a higher mortality rate from _______
- measles, pneumonia, diarrhea
- Vitamin A acute toxicity symptoms
- headache, vomiting, stupor, death
- Chronic toxicity symptoms of Vitamin A
-
weight loss, lip dryness
bone and joint pain
Hepatomegaly with fibrosis - Vitamin A toxicity predisposes to ______
- bone fractures due to stimulation of Osteoclasts
- Synthetic Retinoids for acne are contraindicated during _______
- pregnancy
-
Retinoids used during pregnancy can cause _______ thru interaction with _______
Symptoms -
Retinoic Acid Embryopathy
Homeobox genes (HOX)
CNS, cardiac and craniofacial defects -
Excess vitamin A precursors are usually from eating too many ______ or from artificial ________ pills.
Symptoms -
1. carrots
2. suntanning
3. Yellow skin but Sclera remain white
*not associated with toxicity - Carotenemia = ?
- excess vitamin A precursors
- Vitamin D maintains plasma levels of _____ and _____
-
Calcium
Phosphorous - Vitamin D maintains ______ in extracellular compartment
- ionized calcium
- Vitamin D deficiency results in _______
-
Poor bone mineralization
-Rickets (if epiphyses have not closed)
-Osteomalacia (epiphyses have closed) - Vitamin D deficiency with low ionized calcium causes ___________
- continuous excitation = convulsive state
- 2 sources of Vitamin D
-
1. Diet
2. Precursor 7-dehydrocholesterol in the skin and UV light - Most active form of Vitamin D is __1__. It is activated in the __2__ by __3__ and stimulates ___&___ absorption in the gut.
-
1. 1,25(OH)2
2. kidney
3. alpha-1-hydrolase
4. Ca and Phosphorus - 1,25(OH)2 collaborates with _____ in the mobilization of ___ from bone. It stimulates the PTH-dependent reabsorption of calcium in the __________
-
Parathyroid hormone
Calcium
Distal Renal Tubules - Decreased Vitamin D absorption can cause (4)
-
Cholestatic Liver Disease
Pancretic Insufficiency
Biliary Tract Obstruction
Extensive small bowel disease -
Derangements of Vitamin D metabolism:
-increased degradation by induction of __1___
-impaired synthesis of __2__
-inherited deficiency of __3__ -
1. cytochrome P450
2. 25 and 1,25(OH)2
3. renal alpha-1 hydrolase -
End-organ resistance:
-inherited absence of or defective _____ for 1,25(OH)2 - receptors
-
Phosphate depletion:
-poor phosphate absorption due to ____1___
-excess renal tube excretion of __2__, a condition called __3__ -
1. aluminum OH antacids
2. phosphate
3. X-linked hypophosphatemic rickets - Vitamin E function
- major Antioxidant
- Vitamin E sources
-
vegetables
grains
nuts and their oils
dairy products
meat
fish - Vitamin E deficiency occurs mainly in children that have ________
-
fat malabsorption (it is a fat-solube vitamin)
*cholecstasis, cystic fibrosis, primary small intestinal disease - Neurologic manifestations of Vitamin E deficiency
-
absent tendon reflexes
ataxia
dysarthria
loss of vibration sense
pain sensation
Spinocerebellar Degeneration - Vitamin K functions
-
functional activity of Factors 2, 7, 9, 10 and Protein C and S
*Koagulation - Studies suggest Vitamin K may be helpful in treating ______
-
Osteoporosis
*may favor calcification of bone proteins -
Vitamin K deficiency due to:
-___1____ syndromes
-___2___ disease -
1. fat malabsorption
2. diffuse liver - 2 instances for the absence of Vitamin K-synthesizing bacterial flora
-
1. broad spectrum antibiotics
2. not fully developed neonates - Vitamin K deficiency has a tendency for ___1____, deficiency is induced by __2___ which is used for ____3____ disease
-
1. bleeding
2. coumarin (warfarin)
3. thromboembolic -
B1 = 1
B2 = 2
B3 = 3
B5 = 4
B6 = 5
B7 = 6
B12 = 7 -
1. Thiamine
2. Riboflavin
3. Niacin
4. Pantothenic Acid
5. Pyridoxine
6. Biotin
7. Cobalamin - All B vitamins function as _____ and needs are tied to _________
-
coenzymes
energy intake - Thiamine Deficiency occurs in developing countries where _____ is most of the diet
- polished rice
- 3 Major targets of Thiamine deficiency
-
1. nerves
2. heart
3. brain - 3 disease of Thiamine deficiency
-
1. Dry Beriberi (polyneuropathy)
2. Wet Beriberi (CV)
3. Wernicke-Korsakoff Syndrome -
Beriberi is common in __1__
Also common in:
-__2__ of pregnancy
-__3__ that impair appetite
-extended __4__ therapy without supplemental vitamins -
1. alcoholics
2. pernicious vomiting
3. delibitating diseases
4. IV glucose - What is Dry Beriberi?
- Peripheral Neuropathy with resultant atrophy of muscles of extremeties
- What is Wet beriberi?
-
-results from peripheral dilation of arterioles and capillaries
-congestive Cardiomyopathy with Biventricular failure - Wernicke-Korsakoff syndrome results from hemorrhage of _________
- Mammilary bodies
-
Sources of Riboflavin (B2)
It absorbed in the ______ -
Meat
Dairy
Vegetables
Upper GI tract - Ariboflavinosis is caused by _________
-
severe malnourishment
-alcoholics
-chronic infections
-advanced cancer
-individuals who avoid milk - 4 Symptoms of Riboflavin deficiency
-
1. Cheliosis = cracks at angles of mouth
2. Glossitis (atrophic tongue)
3. Corneal opacities
4. Dermatitis - Sources of Niacin
-
Grains
Legumes
Seed oils - Niacin can be synthesized endogenously from _____
-
Tryptophan
*deficiency of Tryptophan can mimic niacin deficiency - Niacin deficiency causes ______, which is characterized by _______
-
Pellagra
the 3 D's
-dementia
-dermatitis
-diarrhea - Pyridoxine deficiency resemble ______
-
B2 and B3 deficiencies
*deficiency is rare - Drug that can cause Pyridoxine deficiency
-
Isoniazide
*competitive inhibitors for pyridoxine binding sites - Vitamin C function
-
formation of normal Collagen
-hydroxlation of Lysine and Proline residues - Disease caused by Vitamin C deficiency
- Scurvy
- At risk people for Scurvy
-
1. elderly who live alone
2. alcoholics
3. infants fed only processed milk - Symptoms of Vitamin C are reversible almost ________
- immediately
-
Scurvy:
- poor ___1__
- __2__ in the skin and gingival mucosa
- secondary __3__ infections
- subperiosteal __4__ and __5__ after minimal trauma
- __6__ hemorrhages that can be fatal
- Skeletal changes due to insufficient __7 -
1. wound healing
2. ecchymoses and purpura
3. gum
4. hematomas
5. hemarthrosis
6. intracerebral
7. osteoid matrix - Vitamin C deficiency in children causes
- bowing of long bones and depression of the sternum with outward projection of the ends of the ribs
-
Vitamin C: poor __1__
Vitamin D: poor __2__ -
1. osteoid production
2. mineralization (calcification of bone) - Difference in Vitamin C and D sternum symptoms
-
C: depression of sternum with outward projection of ribs
D: protrusion of sternum with overgrowth of cartilage at costochondral jxn = rachitic rosary - Folate is depleted in _____ foods
- cooked and processed
-
Folate requirement is increased during ________.
Deficiency can predispose to ________ -
pregnancy
fetal neural tube defects -
Folate and ___1___ are essential for nucleic acid synthesis
- a deficiency of either will result in ___2___ -
Vitamin B12 (Cobalamin)
Megaloblastic anemia - Combined Folate and Vitamin B12 deficiency may contribute to development of ________
- colon cancer
- Vitamin B12 deficiency causes ______
-
Sub-acute combined degeneration of the spinal cord -
Sub-acute Combined Degeneration of teh spinal cord:
-potentially __1__
-__2__ in the lower extremities progressing to __3__ and then __4__
Degeneration of both __5_ and __6__ tracts of spinal cord -
1. reversible
2. numbness
3. spastic weakness
4. paraplegia
5. ascending
6. descending - Minerals whose deficiencies can cause symptoms (5)
-
Iron
Zinc
Copper
Selenium
Iodine
*SCIZI - Mineral deficiency most common in US
- Iron
-
Iron deficiency:
-in kids, usually due to __1_
-in adults, due to __2__
-__3__ anemia -
1. inadequate intake
2. blood loss or pregnancy
3. hypochromic microcytic = defective heme synthesis - Zinc deficiency is usually due to __1__ or __2__
-
1. TPN unsupplemented by zinc
2. congenital zinc deficiency (autosomal recessive) - 2 findings in Zinc Deficiency
-
1. Acrodermatitis Enteropathica = rash around eyes, nose, mouth, and anus
2. Anorexia, diarrhea, growth retardation, imppaired night vision - Selenium fxn
-
Antioxidant
*like E and C -
Selenium deficiency is known as ___1___ disease
- results from low level in __2__
- causes __3__ -
Keshan Disease
soil, water, food
Congestive Cardiomyopathy - __% of adults in the US are obese
- 30%
- BMI in obese is greater than or equal to ____
- 30
- 3 things that begin to increase at BMI value >25
-
Hypertension
Diabetes
Coronary Artery Disease - Type of Obesity that has a higher risk for disease
- Central/Visceral
- Metabolic Syndrome is characterized by these things
-
Abdominal obesity
Insulin resistance
Hypertriglyceridemia
low HDL
Hypertension
CAD - Adipocytes secrete ____ to communicate with the Hypothalamus
- Leptin
- Net effect of Leptin
-
decrease food intake
increase energy expenditure - Leptin levels are _____ in most obese individuals
- increased
- Rarely, obesity occurs from _______
- single gene defects in leptin-melanocortin pathway
- Hormone that increases appetite
-
Ghrelin
secreted from stomach - When is Leptin increased?
- when adipose stores are adequate