Questions and Answers
What is the primary cause of vitamin deficiencies?
What is the characteristic of fat-soluble vitamins?
What is the function of vitamin A in the body?
Which of the following is a characteristic of water-soluble vitamins?
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What can occur in cases of fat malabsorption disorders?
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How many vitamins are necessary for health?
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What is a common eye problem caused by vitamin A deficiency?
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What is a skin problem that can occur due to vitamin A deficiency?
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What is a respiratory tract problem that can occur due to vitamin A deficiency?
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What is a common bone problem in growing children due to vitamin D deficiency?
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What is a common cause of vitamin D deficiency?
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What is a function of vitamin D in the body?
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Which of the following is a complication of vitamin A deficiency in the urinary tract?
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Which of the following is a complication of bulimia?
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What is the endocrine finding associated with anorexia?
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What is the term for bilateral parotid enlargement seen in bulimia patients?
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What is the electrolyte abnormality seen in anorexia and bulimia patients?
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What is the term used to describe severe acute malnutrition seen in anorexia patients?
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What is a common dental complication seen in bulimia patients?
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What is the term used to describe the pattern of eating seen in bulimia patients?
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What is a potential complication of hypokalemia in anorexia and bulimia patients?
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What is the difference between primary and secondary malnutrition?
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What is the main difference between marasmus and kwashiorkor?
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What is the main difference between acute and chronic malnutrition?
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What are the consequences of severe acute malnutrition?
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What is the underlying mechanism of cachexia?
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Which of the following is an intrinsic factor contributing to diffuse dental erosion?
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What is the primary management strategy for a patient with diffuse dental erosion?
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Which of the following is NOT a potential cause of diffuse dental erosion?
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What is the term for the wasting of body mass, particularly muscle and fat, in patients with chronic illnesses?
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Which of the following is an extrinsic factor contributing to diffuse dental erosion?
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What is the primary reason for considering referral for medical and psychological evaluation in a patient with diffuse dental erosion?
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Study Notes
Vitamin Deficiencies
- Primary: diet
- Secondary: malabsorption, metabolic disorders, tissue storage, liver disease
- 13 vitamins necessary for health:
- Fat soluble (ADEK): readily stored, but poorly absorbed in fat malabsorption disorders, and can be toxic
- Water soluble (Bs/C/Folate): excreted in urine, toxicity rare
- Often multiple vitamin deficiencies present
Vitamin A
- Retinol and related substances
- Functions:
- Vision (visual pigment)
- Cell growth and differentiation (mucus-secreting epithelia)
- Lipid metabolism
- Immunity to infection
- Ito cells (liver storage)
Anorexia and Bulimia
- Anorexia:
- Self-induced starvation
- Severe acute malnutrition
- Endocrine findings: amenorrhea, decreased thyroid hormone, electrolyte abnormalities
- Lack of consumption
- Hypokalemia → cardiac arrhythmia
- Anemia, lymphopenia, hypoalbuminemia
- Bulimia:
- Complications due to vomiting, laxatives, diuretics
- Hypokalemia → cardiac arrhythmia
- Pulmonary aspiration of gastric contents
- Esophageal and gastric rupture
- Sialadenosis (bilateral parotid enlargement)
Vitamin A Deficiency
- Eyes:
- Blindness (night/total)
- Xerophthalmia
- Corneal keratin plaques (Bitot's spots)
- Keratomalacia (corneal destruction/softening)
- Respiratory tract: squamous metaplasia, pulmonary infection
- Urinary tract: keratin debris → stones
- Skin: hyperkeratosis
- Immune deficiency
Vitamin D
- Functions:
- Maintenance of plasma Ca and P
- Bone development and mineralization
- Neuromuscular transmission
- Metabolic functions
- 2 sources:
- Endogenous synthesis in skin (UV light) – major source (~90% in light-skinned)
- Exogenous – diet
- Causes of deficiency:
- Inadequate sunlight
- Diet/malabsorption
- Liver disease
- Renal disorders (decreased synthesis of 1,25 (OH)2 vitamin D, phosphate depletion)
- Rickets (growing children):
- Craniotabes
- Rachitic rosary
- Bowing of legs
Malnutrition
- Primary: diet deficient in 1 or more components
- Secondary: supply OK, problem with absorption, storage, utilization, excessive loss, increased requirements
- Severe acute malnutrition:
- Weight for height ratio below 3 SD of WHO standards
- Developing countries: ~25% children affected, high death rates
- Developed countries: older/debilitated, children in poverty
Marasmus and Kwashiorkor
- Marasmus:
- Lack of nutrient
- Diet lacking in calories
- Somatic compartment (skeletal muscle wasting)
- Kwashiorkor:
- Lack of protein
- Protein deprivation > calorie reduction
- Visceral compartment (organ wasting, esp. liver)
Cachexia
- Secondary malnutrition as a complication of
- AIDS, cancer, other illnesses
- Catabolic processes cause emaciation due to lack of energy
- Morfactor (TNF and other cytokines secreted by tumor cells) → protein degradation/fat mobilization
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