Download - Nutritional disorders
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Nutritional disordersNutritional disorders
Premed 2Premed 2PathophysiologyPathophysiology
Dr. ROOPADr. ROOPA
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PROTEIN-CALORIE PROTEIN-CALORIE MALNUTRITIONMALNUTRITION
1. Marasmus1. Marasmus-deficiency of ALL nutrients-deficiency of ALL nutrients-low proteins, vitamins, calories-low proteins, vitamins, calories-less than 1 year old, not breastfed-less than 1 year old, not breastfed
2. Kwashiokor2. Kwashiokor-deficiency of protein, calories OK-deficiency of protein, calories OK-more than 1 year old-more than 1 year old-fatty liver , EDEMA, depigmented bands of -fatty liver , EDEMA, depigmented bands of
hair hair and skinand skin
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MARASMUSMARASMUS
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KwashiorkorKwashiorkor
Kwashiorkor sufferers show signs of thinning Kwashiorkor sufferers show signs of thinning hair, hair, edema, inadequate growth, and weight , inadequate growth, and weight loss. loss.
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MARASMUSMARASMUS Poor growthPoor growth Loss of muscleLoss of muscle Loss of subcutaneous Loss of subcutaneous
fatfat
KWASHIORKORKWASHIORKOR Poor growthPoor growth Loss of muscleLoss of muscle (+) subcutaneous fat(+) subcutaneous fat
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Water soluble vitaminsWater soluble vitamins B1 – ThiamineB1 – Thiamine B2 – RiboflavinB2 – Riboflavin B3 – NiacinB3 – Niacin B6 – PyridoxineB6 – Pyridoxine B12 – CobalaminB12 – Cobalamin Folic acidFolic acid Vitamin C – Ascorbic acidVitamin C – Ascorbic acid
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Water soluble vitaminsWater soluble vitamins Regular intake is necessaryRegular intake is necessary B12 – stored in liver in large amountsB12 – stored in liver in large amounts
- deficiency takes years to develop- deficiency takes years to develop Toxicity rareToxicity rare Excreted in the urineExcreted in the urine Sources: vegetables, cereals, grains, meat, Sources: vegetables, cereals, grains, meat,
dairy products, fruitsdairy products, fruits
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Thiamine deficiency (B1)Thiamine deficiency (B1) Common in Western countries: alcoholism, Common in Western countries: alcoholism,
dietsdiets 1. Dry Beri-beri1. Dry Beri-beri
neuropathy of the peripheral limbsneuropathy of the peripheral limbsmuscle atrophymuscle atrophy
2. Wet beri-beri2. Wet beri-beridilated vessels, dilated heartdilated vessels, dilated heartHigh-output cardiac failureHigh-output cardiac failure
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Thiamine deficiency (B1)Thiamine deficiency (B1) 3. Wernicke-Korsakoff deficiency3. Wernicke-Korsakoff deficiency
- alcholism- alcholism-brain stem, diencephalon degenerates-brain stem, diencephalon degenerates-hemorrhage in the brain-hemorrhage in the brain-Wernicke’s triad:-Wernicke’s triad:
confusionconfusionataxiaataxiaophthalmoplegiaophthalmoplegia
-memory loss, confabulation-memory loss, confabulation
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RIBOFLAVIN (B2)RIBOFLAVIN (B2) Rare deficiencyRare deficiency Always added to bread, cereal productsAlways added to bread, cereal products Deficiency: Deficiency:
cheilosis (fissures at mouth angles)cheilosis (fissures at mouth angles)glossitis (inflammation of the tongue)glossitis (inflammation of the tongue)increased blood vessels in the corneaincreased blood vessels in the corneaseborrheic dermatitisseborrheic dermatitis
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NIACIN(B3)NIACIN(B3) Niacin, tryptophan deficiencyNiacin, tryptophan deficiency Important part of nicotinamide adenine Important part of nicotinamide adenine
dinucleotides (NAD, NADP)dinucleotides (NAD, NADP) PELLAGRA:PELLAGRA:
dementiadementiadermatitisdermatitisdiarrheadiarrhea
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PYRIDOXINE (B6)PYRIDOXINE (B6) May lead to deficiency of GABAMay lead to deficiency of GABA Convulsions in kidsConvulsions in kids Seen also in alcoholism, antiTB drug useSeen also in alcoholism, antiTB drug use Glutamate ( glutamic acid decarboxylase and Glutamate ( glutamic acid decarboxylase and
pyridoxal phosphate as a cofactor)----GABApyridoxal phosphate as a cofactor)----GABA
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Cobalamin (B12)Cobalamin (B12) Reduced DNA replicationReduced DNA replication Reduced cell divisionReduced cell division Found almost always in MALABSORPTION: Found almost always in MALABSORPTION:
Pernicious anemia Pernicious anemia Crohn’s disease, Fish tapeworm infection Crohn’s disease, Fish tapeworm infection
(Diphyllobotrium latum, vegetarians(Diphyllobotrium latum, vegetarians MEGALOBLASTIC ANEMIA + MEGALOBLASTIC ANEMIA +
NEUROLOGIC ABNORMALITIESNEUROLOGIC ABNORMALITIES
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FOLIC ACID FOLIC ACID May be due to malabsorption or due to May be due to malabsorption or due to
increase demandincrease demand Cancer therapy, alcoholic, dietersCancer therapy, alcoholic, dieters MEGALOBLASTIC ANEMIA ONLYMEGALOBLASTIC ANEMIA ONLY
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ASCORBIC ACIDASCORBIC ACID Serves as cofactor of the synthesis of proline Serves as cofactor of the synthesis of proline
and hydroxyproline ---- collagen synthesisand hydroxyproline ---- collagen synthesis SCURVYSCURVY Poor wound healingPoor wound healing Abnormal bleedingAbnormal bleeding Bone changes Bone changes
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FAT-SOLUBLE VITAMINSFAT-SOLUBLE VITAMINS Vitamin AVitamin A Vitamin D ( calciferol)Vitamin D ( calciferol) Vitamin E (alpha-tocopherol)Vitamin E (alpha-tocopherol) Vitamin KVitamin K Toxicity common, hypervitaminosisToxicity common, hypervitaminosis
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Vitamin AVitamin A RetinoidsRetinoids A part of rhodopsin (visual pigment)A part of rhodopsin (visual pigment) Needed for good epitheliumNeeded for good epithelium Animal products, vegetablesAnimal products, vegetables
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Vitamin AVitamin A Vitamin A deficiencyVitamin A deficiency 1. Night blindness1. Night blindness 2. Squamous metaplasia2. Squamous metaplasia 3. Xeropthalmia (dry 3. Xeropthalmia (dry
eyes)eyes) 4. Blindness4. Blindness 5.Keratomalacia (soft 5.Keratomalacia (soft
cornea)cornea)
Vitamin A excessVitamin A excess 1. alopecia (baldness)1. alopecia (baldness) 2. liver damage2. liver damage 3. bone changes3. bone changes
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Vitamin DVitamin D Synthesized in the skin by exposure to sunlightSynthesized in the skin by exposure to sunlight Food sources: milk, butter, eggsFood sources: milk, butter, eggs Needed for calcium absorption in the intestinesNeeded for calcium absorption in the intestines
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Vitamin DVitamin D Vitamin D deficiencyVitamin D deficiency Rickets: childrenRickets: children Osteomalacia: adultsOsteomalacia: adults
Vitamin D excessVitamin D excess Poor growthPoor growth Excessive calciumExcessive calcium HypercalciuriaHypercalciuria NephrocalcinosisNephrocalcinosis Renal calculi (stones)Renal calculi (stones)
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Vitamin EVitamin E RareRare Deficiency may cause neurologic Deficiency may cause neurologic
abnormalitiesabnormalities
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Vitamin K Vitamin K Needed in the synthesis of clotting factors II, Needed in the synthesis of clotting factors II,
VII, IX, X (2, 7, 9, 10)VII, IX, X (2, 7, 9, 10) Synthesized by bacteria in our intestinesSynthesized by bacteria in our intestines Food sources: vegetables, dairy productsFood sources: vegetables, dairy products Malabsorption, antibiotic useMalabsorption, antibiotic use Hemorrhagic diasthesisHemorrhagic diasthesis Hemorrhagic disease of the newbornHemorrhagic disease of the newborn