Term
Marasmus
-protein levels
-leptin, cortisol levels
-clinical features |
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Definition
inadequate overall intake
d/c somatic (muscle) protein, "broomstick extremities," muscle wasting
serum protein is normal or slightly d/c
breakdown of muscle protein for energy, loss of subQ fat
leptin production is low, stimulates H-P-A axis to make lots of cortisol, contributes to lipolysis
muscle wasting
head appears too large for body
growth retardation
anemia
-microcytic of iron
-macrocytic of B12 or folate
-normocytic of chronic disease
CMI (type IV) deficiency |
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Term
Kwashiorkor
-protein levels
-clinical presentation (hands, face, abdomen, skin)
-what causes the skin change, primarily?
-GI disturbance
-blood |
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Definition
inadequate protein intake, sufficient caloric intake
visceral protein (liver, organs) is d/c
somatic (muscle) protein is unchanged
ascites
enlarged, fatty liver (reduced synth of carrier component of lipoproteins
apathy, listlessness, loss of appetite
generalized, pitting edema - hypoalbuminemia, loss of oncotic pressure
puffiness in face, hands
flaky paint dermatosis
-low tyrosine levels (melanin precursor)
diarrhea - loss of brush border enzymes, parasitic infxns
anemia
defects in CMI |
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Term
Mechanisms of cancer cachexia (PEM)
-cachetic agents produced by tumors |
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Definition
PIF (proteolysis-inducing factor)
-degrades myosin heavy chain through the proteasome -> muscle atrophy
LMF (lipid-mobilizing factor)
-i/c fatty acid ox
-pro-inflammatory cytokines - TNF, IL-2, IL-6
TNF and IL-6 trigger acute phase response, i/c secretion of C-reactive protein and fibrinogen, d/c albumin plasma conc
PIF and pro-inflamm cytok cause skeletal muscle breakdown through the NF-kB-induced activation of the ubiquitin proteasome pathway --> degradation of myosin heavy chain
Alterations in the dystrophin-glycoprotein complex leading to dystrophin-degradation by the proteasome -> muscle atrophy |
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Term
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Definition
amenorrhea
-d/c GNRH, LH, FSH
osteoporosis (d/t low estrogen)
d/c thyroid hormone -> cold intolerance, bradycardia, skin/hair changes
most common COD: ventricular arrhythmia resulting from hypokalemia |
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Term
Bulimia
-features
-complications from vomiting |
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Definition
hypokalemia, metabolic acidosis
most common COD: ventricular arrythmia
pulmonary aspiration of gastric contents
esophageal and gastric cardiac rupture
tooth decay |
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Term
Vitamin A
-functions
-deficiency syndromes
-in what conditions is it used as a tx? cancer?
-where is it stored?
-sources?
-acute hypervitaminosis A |
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Definition
component of visual pigment (rhodopsin, iodopsins)
maintenance of specialized epithelia
maintenance of resistance to infxn
night blindness, xerophthalmia (dry eye), Bitot spots (keratin debris in small opaque plagues), blindness
squamous metaplasia (differentation into keratinizing epithelium)
vulnerability to infxn, esp measles and diarrhea
hyperkeratinization can lead to follicular or papular dermatosis
photoprotective and antioxidant: tx of acne, psoriasis
acute promyelocytic leukemia
90%: Ito cells of the liver, 6 mo storage
liver, fish, eggs, milk, and butter
Yellow and leafy green vegetables (carotenoids)
from eating animal livers
headache, dizziness, vomiting, stupor, blurred vision, pseudotumor cerebri
chronic: weight loss, N&D, bone and joint pain |
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Term
Vitamin D
-functions
-deficiency syndromes
-causes of vit D def
-sources?
-toxicity |
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Definition
facilitates intestinal absorption of Ca and phosphorus
-1,25-dihydroxyvitamin D stimulates intestinal absorption of Ca in the duodenum through the interaction with nuclear vit D receptor and the formation of a complex with RXR; TRPV6
-1,25-dihydroxyvitamin D increases Ca renal reabsorption through the increased expression of TRPV5
-Vitamin D maintains calcium and phosphorus at supersaturated levels in the plasma (stimulate osteoclasts to dissolve bone)
Contributes to the mineralization of osteoid matrix and epiphyseal cartilage in bone formation
-stimulates osteoblasts
excess of unmineralized matrix
Ricketts in children - "rachitic rosary"
Osteomalacia in adults
low Ca, low phosphorus -> impaired mineralization
PTH is high
renal failure (1-alpha-hydroxylation)
not enough sun (7-dehydrocholesterol)
ileal disease (d/c reabsorption)
liver disease (25-OH-D)
alcoholism (induction of CYP, i/c metabolism of 25-OH-D into inactive metabolite)
Endogenous synthesis: conversion of 7-dehydrocholesterol to cholecalciferol
-conversion into 25-OH-D in liver (25-OHases)
-conversion into 1,25-dihydroxyvitamin D in kidney (α1-hydroxylase)
dietary sources (10-20%): deep-sea fish, plants, and grains
kids: metastatic calcifications of soft tissue
adults: bone pain, hypercalcemia |
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Term
Vitamin E
-functions
-deficiency syndromes |
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Definition
major antioxidant; scavenges free radicals
spinocerebellar degeneration |
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Term
Vitamin K
-functions
-deficiency syndromes
-possible risk factors for vit K def? |
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Definition
cofactor in hepatic carboxylation of procoag - factors II, VI, IX, X; and protein C and S
bleeding diathesis
hemorrhagic disease of the newborn (due to minimal establishment of intestinal bacterial flora that make vit K)
babies who drink only milk
those on coumadin
severe liver disease, alcoholics |
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Term
Vitamin B1 (thiamine)
-functions
-deficiency syndromes
-clinical features
-what kind of pt might get this? |
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Definition
coenzyme in decarboxylation rxns
dry beriberi - peripheral neuropathy w/ myelin degeneration, footdrop, wrist drop, sensory changes
wet beriberi - CHF: flabby, dilated heart
Wernicke syndrome
Korsakoff syndrome
tachycardia, weakness, d/c DTRs
peripheral neuropathy
edema
horizontal nystagmus, eye mvmt palsies
ataxia
mental impairment
alcoholics |
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Term
Vitamin B2 (riboflavin)
-functions
-deficiency syndromes |
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Definition
converted to coenzymes used for many enzymes in intermediary metabolism
ariboflavinosis, cheilosis, stomatitis, glossitis, dermatitis, corneal vascularization |
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Term
Vitamin B3 (Niacin)
-functions
-deficiency syndromes
-sources? |
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Definition
incorporated into NADH and NADH phosphate, involved in a variety of redox rxns
precursor for NAD
Pellagra, three "Ds": dementia, dermatitis, diarrhea
beefy red tongue
skin flaking, skin lesions
thickened, hyperpigmented skin
diet
endogenous synthesis from tryptophan |
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Term
Vitamin B6 (pyridoxine)
-functions
-deficiency syndromes |
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Definition
derivatives serve as coenzymes in many intermediary rxns
Cheilosis, glossitis, dermatitis, peripheral neuropathy
*diarrhea and peripheral neuropathy* |
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Term
Vitamin C
-functions
-deficiency syndromes
-vit C def in children?
-what would you see histologically?
-toxicity |
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Definition
many redox rxns, hydroxylation of procollagen
synthesis of supporting mesenchymal tissues
-osteoid in bone
-chondroid in cartilage
-dentin in teeth
-collagen in capillary walls
enhances iron absorption from GI tract
acts as antioxidant
scurvy
impaired collagen formation -> poor vessel support, bleed in the gums, skin, and periosteum and joints
inadequate synthesis of osteoid and impaired wound healing
anemia (impaired iron absorption)
*hyperkeratotic rash*
*corkscrew hairs*
*infantile scurvy - bone involvement, failure of osteoid matrix formation*
*ground glass osteopenia*
*subperiosteal hemorrhage at the ends of long bones*
renal calculi composed of uric acid |
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Term
Folate
-functions
-deficiency syndromes |
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Definition
essential for transfer and use of one-carbon units in DNA synth
*megaloblastic (macrocytic) anemia*
neural tube defects |
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Term
Zinc
-function
-basis of deficiency
-clinical features |
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Definition
components of enzymes, esp oxidases
inadequate supplementation in artificial diets
interference with absorption by other dietary constituents
Inborn error of metabolism
rash around eyes, mouth, nose and anus (*acrodermatitis enteropathica*)
-prematurity, exclusive breast feeding (if mother's milk is low in zinc), striking clinical signs
-appears in the first few wks after birth if baby is given cow's milk, or shortly after cessation of breast feeding
*weird rash in a baby*, vivid red plaques
refractory diarrhea
failure to thrive
irritability
depressed wound healing and immune response
dermatitis
alopecia |
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Term
Iron
-function
-basis of deficiency
-clinical features |
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Definition
essential component of Hb, several iron-containing metalloenzymes
inadequate diet
chronic blood loss
hypochromic microcytic anemia |
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Term
Iodine
-function
-basis of deficiency
-clinical features |
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Definition
component of thyroid hormone
inadequate supply in food and water
goiter
hypothyroidism |
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Term
Copper
-function
-basis of deficiency
-clinical features |
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Definition
component of cytochrome c oxidase, dopamine beta-hydroxylase, tyrosinase, lysysl oxidase, others involved in cross-linking colalgen
inadequate supplementation
interference with absorption
muscle weakness
neurologic defects
abnormal collagen cross-linking |
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Term
Fluoride
-function
-basis of deficiency
-clinical features |
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Definition
mechanism unknown
inadequate supply in soil, water, supplementation
dental caries |
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Term
Metabolic syndrome
what other condition (in an organ) is associated with obesity? |
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Definition
driven by obesity
visceral or intra-abdominal adiposity
insulin resistance
hyperinsulinemia
glucose intolerance
hypertension
hypertriglyceridemia
low HDL
non-alcoholic fatty liver (can progress to fibrosis, cirrhosis) |
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Term
Cholelithiasis
-what presdisposes a pt to this? |
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Definition
gallstones
6x more common in obese pts
An increase in total body cholesterol, increased cholesterol turnover, and augmented biliary excretion of cholesterol |
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Term
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Definition
associated with obesity
hypoventilation
hyersomnolence
-sleep apnea, polycythemia, eventual right sided heart failure |
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Term
Obesity & cancer... a BMI > 25 kg/h2 is associated with what types of cancer in:
-men
-women
-possible mechanism? |
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Definition
adenocarcinoma of the esophagus, and cancers of the thyroid, colon, and kidney
adenocarcinoma of the esophagus, and of endometrial, gallbladder, and kidney cancers
possibly due to hyperinsulinemia and insulin resistance
-activation of beta-catenin and Ras
-i/c IGF-1: mitogenic, anti-apoptotic |
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Term
Cancers associated with:
Nitrosamines and nitrosamides
Animal fat + low fiber intake |
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Definition
produced endogenously from food preservatives
assoc with gastric carcinomas
colon cancer |
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Term
| Kid comes in with bone pain, bow-legged. How can you tell if it's a deficiency of Vit C or D? |
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Definition
D - failure of bone mineralization, excess of unmineralized matrix, osteoid laid down around mineralized bone
-in kids, growth plate becomes thick, wide and irregular
C - failure of osteoid matrix formation, poor or absent osteoid on histo slide
-prominence of costochondral junction
-poor-quality osteoid
-hemorrhages beneath the periosteum
Note: essential lesion in both rickets and osteomalacia is failure of osteoid (bone matrix) to mineralize |
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Term
Wernicke's syndrome
Korsakoff's syndrome |
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Definition
Haemorrhages into the mammillary bodies
both assoc with thiamine (B1) def, esp alcoholics
W: stagger, nystagmus, opthalmoplegia (can't move eyes)
-symptoms typically clear when put on thiamine
K: confabulation, confused, apathetic, profound memory problems, *amnesia*
-symptoms don't clear up after thiamine administration |
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Term
Alcoholic comes in, is malnourished, dehydrated, messed up. As a smart medical student, you suspect there might also be a B1 deficiency.
What might happen if you give them glucose without first administering thiamine? |
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Definition
By increasing NADH relative to NAD+, EtOH favors the conversion of pyruvate to L-lactate instead of to glucose
pyruvate must get converted to acetyl CoA, requires thiamine
if no thiamine, get pyruvate build-up -> excess lactate -> *lactice acidosis and Wernicke's* |
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Term
Vitamin B12
-function
-what does it require for absorption?
-source
-deficiency syndromes
-folate def vs B12 def
-pts at risk for deficiency? |
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Definition
Functions in DNA synthesis and odd chain fatty acid metabolism
*intrinsic factor*
animal products
-Megaloblastic anemia
-Neurologic disease: posterior column and lateral corticospinal tract demyelination
demyelination, neuropathy and other nervous system issues vs strictly a folate deficiency (will not have nervous issues)
Strict vegans, ilieal disase (Crohn’s) |
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