NUTRITIONAL DISEASES and NEOPLASIA

Nutritional Diseases

A consequence of inadequate intake of proteins and calories or deficiencies in the digestion or absorption of proteins resulting in the loss of fat and muscle mass, weight loss, and generalized weakness.

• Primary Malnutrition

• Secondary Malnutrition

What are the 2 Types of Dietary Insufficiency?

Primary malnutrition

One or all components (vitamins/ minerals/ carbohydrates/ fats/ proteins) are missing from the diet. Lack of nutrients.

Secondary malnutrition

• From malabsorption, impaired utilization or storage, excess loss, or increased need for nutrients.

• Diet is good but the body has problems with absorption or excretion.

• Poverty

• Chronic and acute illness

• Chronic alcoholism

• Ignorance

• Failure of diet supplementation

What are the conditions or reasons why dietary insufficiency happens?

• Marasmus

• Kwashiorkor

What are the 2 Severe Acute Malnutrition?

Marasmus

• Develops when the diet is severely lacking in calories.

• They are deficient of all types of nutrients.

1. Pediatric patients

2. 60%

3. Underweight

4. Growth retardation

5. Loss of muscle mass (due to gluconeogenesis)

6. Adaptive response — amino acids

MARASMUS

1. Is frequently observed in?

2. Their weight falls to __ of normal for sex, height, and age.

3. They are classified as?

4. They suffer from __ retardation.

5. This happens because of catabolism.

6. The type of response their body does because __ is the source of energy.

Kwashiorkor

• Protein deprivation is relatively greater than the reduction in total calories.

• Their source of nutrition is from carbohydrates.

• Edematous

• Hepatomegaly

• Flaky paint skin

• Hypoalbuminemia

What are the manifestations of Kwashiorkor?

Maintain oncotic pressure

Purpose of albumin in the body?

1. Cachexia

2. AIDS patients or advanced cancers

1. A severe weight loss as a secondary malnutrition to a chronic condition.

2. Seen in what individuals?

Anorexia nervosa

Self-induced starvation, resulting in marked weight loss

• Amenorrhea (decreased GNRH)

• Hypothyroidism (low thyroid hormones)

Anorexia nervosa have no calorie source. Hence, their hormones are deranged. They manifest it through what conditions?

1. Gelatinous transformation of bone marrow

2. Increase fat in bone marrow and deposition of gelatinous material

3. Pathognomonic

1. What happens to the bone marrow of patients with anorexia nervosa?

2. Why does this occur?

3. It is considered as?

Cardiac arrhythmia → sudden death

What is the serious complication of anorexia nervosa?

Obesity

Their BMI (body mass index) is greater than 30 kg/m².

1. Ischemic heart disease

2. Genetics or Acquired (through diet or insulin dysfunction)

3. Energy balance dysfunction — there is a decrease in leptin, leaving ghrelin activity unopposed

» para mas madali intindihin: mas maraming ghrelin kaysa leptin, kaya lagi kang gutom.

OBESITY

1. It is an independent risk factor for?

2. How is it acquired?

3. What is its pathogenesis?

1. Ghrelin

2. Leptin

1. It stimulates appetite

2. It suppresses appetite

• Fat Soluble

• Water Soluble

What are the 2 Classifications of Vitamins?

Fat soluble vitamins (ADEK)

What vitamins are more dangerous in aspects of toxicity?

1. Vitamin K (Phylloquinone)

2. Vitamin A (Retinol)

3. Vitamin E (Tocopherol)

4. Vitamin D (Calciferol)

FAT SOLUBLE VITAMINS

1. This vitamin is responsible for clotting factor synthesis

2. It is used for vision, epithelial tissue, and growth

3. They act as antioxidants

4. Bone mineralization, blood calcium regulation

1. Vitamin B

2. Vitamin C

1. A vitamin used for peripheral nerves

2. A vitamin used for collagen synthesis, connective tissue repair

• B1 (thiamine)

• B2 (riboflavin)

• B3 (niacin)

• B5 (Panthothenic Acid)

• B7 (Biotin)

Vitamins responsible for Energy Metabolism

B6 (Pyridoxine, Pyridoxal, Pyridoxamine)

Vitamin responsible for Amino Acid Metabolism

1. B9 (Folic acid)

2. B12 (Cobalamin)

Vitamins for red blood cells/ neural development

Vitamin C (Ascorbic Acid)

Vitamin for collagen synthesis

Megaloblastic anemia

What is the type of anemia caused by Vitamin B9 and B12 deficiency?

Folic acid

A very important vitamin for pregnant women for the CNS development and spinal cord of babies.

1. Impaired night vision

   Blindness

   Follicular hyperkeratosis

   Growth retardation

2. Papilledema with blurred vision

   Seizure

   Hepatitis

   Bone pain

   Increase bone resorption

VITAMIN A

1. Deficiency

2. Toxicity

1. Rickets (children), Osteomalacia (adults; bowing of legs)

2. Metastatic calcification on soft tissue

   Renal calculi

VITAMIN D

1. Deficiency

2. Toxicity

1. Hemolytic anemia

   Ataxia

   Poor Joint coordination

   Ataxia

2. Bleeding

VITAMIN E

1. Deficiency

2. Toxicity

1. Hemorrhagic disease

   GI bleeding

   Ecchymoses

2. In pregnant women → newboen wity hemolytic anemia

VITAMIN K

1. Deficiency

2. Toxicity

1. B3 (Niacin)

2. B1 (Thiamine)

3. B2 (Riboflavin)

4. B6 (Pyridoxine)

5. B9 (Folic acid) and B12 (Cobalamin)

6. B9 (Folic acid)

7. B7 (Biotin)

8. C (Ascorbic Acid)

VITAMINS

1. Deficiency causes pellagra.

2. Deficiency causes beriberi, Wenicke syndrome, and Korsakoff syndrome.

3. Deficiency causes cheilosis and angular stomatitis.

4. Deficiency causes sideroblastic anemia and peripheral neuropathy.

5. Deficiency causes megaloblastic anemia.

6. Deficiency causes neural tube defects.

7. Deficiency causes alopecia and lactic acidosis.

8. Deficiency causes impaired wound healing and scurvy.

1. Chromium

2. Copper

3. Iodide

4. Selenium

5. Fluoride

6. Zinc

TRACE METALS

1. Deficiency affects the metabolic pathways

2. Deficiency affects the blood and metabolic pathways

3. Deficiency causes goiter or hypothyroidism

4. Deficiency causes muscle pain and weakness

5. Deficiency causes dental caries

6. Deficiency causes poor wound healing

1. Calcium

2. Potassium

3. Phosphorus

4. Magnesium

5. Sodium

ELECTROLYTES

1. Deficiency causes tetany and osteoporosis

2. Deficiency causes polyuria and muscle weakness

3. Deficiency causes muscle weakness and hemolytic anemia

4. Deficiency causes hypocalcemia with tetany and tachycardia

5. Deficiency causes cell lysis (problem with osmotic pressure)

1. Phosphorus

2. Potassium

3. Calcium

4. Sodium

5. Magnesium

ELECTROLYTES

1. Excess causes hypocalcemia and hypovitaminosis D

2. Excess causes heart stops in diastole

3. Excess causes kidney stones and polyuria

4. Excess causes edema and increased hydrostatic pressure

5. Excess causes neuromuscular depression and bradycardia

• Benign

• Malignant

What are the 2 types of Neoplasia?

Benign Neoplasm

This is a neoplasm that is localized. The growth of the mass does not go to other tissues. They are amenable for surgical removal.

• Seminoma

• Lymphoma

• Melanoma

• Glioma

• Mesothelioma

• Neuroblastoma

They are all malignant.

All Benign Neoplasms end with “–oma” except?

1. Ectoderm and Endoderm

2. Squamous and Glandular epithelium

3. Mesoderm

4. Adipose and Smooth Muscle

BENIGN NEOPLASM

1. Epithelial origins

2. Give examples.

3. Connective tissue origins

4. Give examples.

1. Unusual tumors

2. Mixed tumors and Teratomas

1. These are tumors with 2 different morphologic patterns but derived same germ cell layer or from more than one germ layer.

2. Give examples.

1. Colonic polyp

2. Lipoma

3. Teratoma of ovaries

1. What is an example of a benign epithelial tumor?

2. What is an example of a benign connective tissue tumor?

3. What is an example of a benign unusual tumor?

1. Lipoma

2. Colonic polyp

1. Benign tumor of fat cells

2. Benign tumor of the large intestine

Malignant neoplasm

A neoplasm that has unregulated proliferation. It can invade.

• Carcinoma - epithelial cell origin

• Sarcoma - connective tissue origin

• 2 suffixes of Malignant Neoplasm

• What are their differences?

Metastasis

It refers to the capability of malignant neoplasm to invade other tissues.

• Squamous cell carcinoma

• Basal cell carcinoma

• Hepatocellular carcinoma

Example of Carcinoma

• Osteosarcoma - bones

• Leiomyosarcoma - smooth muscles in uterus

• Rhabdomyosarcoma - connective tissues

Example of Sarcomas

Metaplasia

It is the replacement of one type of cell with another type.

Dysplasia

It is a disordered growth of cells.

Anaplasia

It refers to when cell changes towards its primitive cell type.

Carcinoma in situ

It is severe dysplasia involving entire thickness of tissue.

The basal membrane is still intact.

Metastasis

The spread of a tumor.

1. Lymphatic

2. Hematogenous

TYPES OF METASTASIS

1. The cancer cells will go to the lymphatic vessels and circulate.

2. The cancer cells will travel through the arteries and go to other organs.

1. Malignant

2. Malignant

3. Benign

4. Malignant

5. Malignat

6. Benign

BENIGN vs. MALIGNANT

1. The differentiation is poorly differentiated.

2. The rate is rapid.

3. The mitotic figures are rare.

4. Invasiveness is infiltrating.

5. The metastasis is present.

6. The mitotic figures are numerous.

7. Has the suffix “–oma”

• Parenchyma

• Stroma

What are the parts of a tumor?

• Stroma

• Parenchyma

• These are the connective tissue in a tumor

• These are the cells that make up an organ

1. 0-25% and 75-100%

2. 25-50% and 50-75%

3. 75-100% and 0-25%

BRODER’S CLASSIFICATION (GRADING)

State the percentage for differentiated – undifferentiated

• Grade IV

• Grade III

• Grade I

• Tumor size

• Nodal involvement

• Metastasis

TNM staging stands for?

1. T4

2. Tis

3. T1mi

4. Tx

5. T0

TNM STAGING for BREAST CANCER - TUMOR SIZE

1. Tumor invades chest wall or skin

2. Carcinoma in situ

3. Tumor is less than or equal to 0.1 cm

4. Primary tumor cannot be assessed

5. No evidence of primary tumor

• For treatment

• For prognosis (chance of survival)

Importance of TNM Staging

• Environmental: Diet, obesity, smoking, alcohol, reproductive history, exposure

• Age

• Chronic inflammatory states

• Immunodeficiency states

• Genetic predisposition

What are the risk factors for cancer?

• Lung cancer

• Laryngeal cancer

• Esophageal cancer

What type of cancer can occur in smoking?

• Liver cancer

• Hepatocellular carcinoma

What cancer can occur in alcoholism?

• Leukemia

• Human T-Lymphocytic virus-1

• HTLV virus can cause ___.

• What does it stands for?

Kaposi sarcoma

AIDS can cause what cancer?