Oral/systemic manifestations of Nutritional diseases

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Questions and Answers

What is the primary cause of vitamin deficiencies?

Diet (correct)

Metabolic disorders

Tissue storage

Malabsorption

What is the characteristic of fat-soluble vitamins?

They are readily stored in fatty tissues (correct)

They are often water-soluble

They are not essential for health

They are excreted in urine

What is the function of vitamin A in the body?

Cell growth and differentiation

Lipid metabolism only

Vision and immunity to infection

All of the above (correct)

Which of the following is a characteristic of water-soluble vitamins?

They are excreted in urine Signup and view all the answers

What can occur in cases of fat malabsorption disorders?

Decreased vitamin absorption Signup and view all the answers

How many vitamins are necessary for health?

13 vitamins Signup and view all the answers

What is a common eye problem caused by vitamin A deficiency?

Corneal keratin plaques Signup and view all the answers

What is a skin problem that can occur due to vitamin A deficiency?

Hyperkeratosis Signup and view all the answers

What is a respiratory tract problem that can occur due to vitamin A deficiency?

Squamous metaplasia Signup and view all the answers

What is a common bone problem in growing children due to vitamin D deficiency?

Rickets Signup and view all the answers

What is a common cause of vitamin D deficiency?

Inadequate sunlight Signup and view all the answers

What is a function of vitamin D in the body?

Maintaining plasma calcium and phosphate levels Signup and view all the answers

Which of the following is a complication of vitamin A deficiency in the urinary tract?

Keratin debris -> stones Signup and view all the answers

Which of the following is a complication of bulimia?

Pulmonary aspiration of gastric contents Signup and view all the answers

What is the endocrine finding associated with anorexia?

Amenorrhea and decreased thyroid hormone Signup and view all the answers

What is the term for bilateral parotid enlargement seen in bulimia patients?

Sialadenosis Signup and view all the answers

What is the electrolyte abnormality seen in anorexia and bulimia patients?

Hypokalemia leading to cardiac arrhythmia Signup and view all the answers

What is the term used to describe severe acute malnutrition seen in anorexia patients?

Severe Acute Malnutrition (SAM) Signup and view all the answers

What is a common dental complication seen in bulimia patients?

Enamel loss due to acid erosion Signup and view all the answers

What is the term used to describe the pattern of eating seen in bulimia patients?

Binge eating and purging Signup and view all the answers

What is a potential complication of hypokalemia in anorexia and bulimia patients?

Cardiac arrhythmia due to abnormal heart rhythms Signup and view all the answers

What is the difference between primary and secondary malnutrition?

Primary is due to dietary deficiency, while secondary is due to problems with absorption Signup and view all the answers

What is the main difference between marasmus and kwashiorkor?

Marasmus is due to lack of calories, while kwashiorkor is due to lack of protein Signup and view all the answers

What is the main difference between acute and chronic malnutrition?

Acute malnutrition has a rapid onset, while chronic malnutrition has a slow onset Signup and view all the answers

What are the consequences of severe acute malnutrition?

High death rates and increased susceptibility to infections Signup and view all the answers

What is the underlying mechanism of cachexia?

Protein degradation and fat mobilization due to TNF and other cytokines Signup and view all the answers

Which of the following is an intrinsic factor contributing to diffuse dental erosion?

GERD Signup and view all the answers

What is the primary management strategy for a patient with diffuse dental erosion?

Screening and counseling for eating disorders Signup and view all the answers

Which of the following is NOT a potential cause of diffuse dental erosion?

Vitamin deficiency Signup and view all the answers

What is the term for the wasting of body mass, particularly muscle and fat, in patients with chronic illnesses?

Cachexia Signup and view all the answers

Which of the following is an extrinsic factor contributing to diffuse dental erosion?

Soft drinks Signup and view all the answers

What is the primary reason for considering referral for medical and psychological evaluation in a patient with diffuse dental erosion?

To screen for possible eating disorders Signup and view all the answers

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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