Vitamin B 12 Deficiency
Terms in this set (110)
anemia is defined as an abnormally low number of circulating ____ or low concentration of ____. this results in diminished oxygen carrying capacity of the blood.
what does B 12 make?
vitamin b 12 is essential for the synthesis of ___
what type of anemia is vitamin b 12 deficiency?
macrocytic and hypochromic
Vitamin B 12 deficency is an anemia which means you do not have enough RBC. What does this cause?
pt will feel weak and tired
deficient amounts of vitamin B 12 will cause ____ and _____ _____ injury
what can vitamin B 12 trigger?
Name 3 chief complaints of a pt with vitamin B 12 deficiency
problems talking and concentrating
numbness in legs and trouble walking
what is the history and present illness of a patient with vitamin b12 deficiency?
-pallor and fatigue
-difficulty concentrating and short term memory loss
-bilateral lower extremity numbness
-tingling in hands and feet
difficulty with gait shows that there could be a problem with the ____
do patients with vitamin b 12 deficiency typically have a problem with their cerebellum?
cerebellar problems is a differential diagnosis
Cerebellar symptoms show that the vitamin B 12 deficiency has progressed. How does the disease progress?
from peripheral to inward
patient was an alcoholic and a drug abuser. alcohol can cause the stomach lining to become aggregated. What can this cause?
decrease in vitamin b 12 absorption and folic acid absorption
Patients mother developed bacterial thyroiditis. Is bacterial thyroiditis a risk factor for vitamin B 12 deficiency?
excessive alcohol and ____ use is a risk factor
long history of ____ _____ is a risk factor. patient is not taking in enough vitamin b 12
Patients who are vegetarians and vegans lack what?
higher risk for lacking vitamin b 12 and folic acid
meat supplies you with what?
vitamin b 12
vegetables supply you with what?
what can be an initial sign of a patient with vitamin b 12 deficiency?
burning tongue (atrophic gloittis)
if your stomach lining is destroyed you may not be able to absorb ____ ____ which leads to malabsorption of it b 12
what drug suppresses the production of stomach acid which will lead to the malabsorption of vit b 12?
OTC famotidine (treats heartburn)
patient who has a vitamin b 12 deficiency can present with
patients BMI will most likely be ______. why?
pt will typically be malnourished
pt's vital signs show a wide pulse pressure. What is this indicitive of?
what can a widened pulse pressure eventually cause?
what will the patients skin look like?
pale with slight jaundice. patient is pale b/c they are deficient in RBC
what do the patients eyes present with? ___ ___
what is sclera icterus and what is it indicitive of?
jaudice in the eyes
billiruben has crossed the BBB
what will the patients tongue look like?
beefy red tongue with glossitis. tongue will burn
_____ of the mucous membranes. This is because of decreased RBC
why is there significant discomfort in the neck?
spread to the spinal cord?
why is the systolic border best heard at the right sternal border?
because the Hct is less than 20%
why is there a murmur present?
increased pumping b/c of anemia
what else can cause the murmur?
cocaine. major affect of cocaine is vasoconstriction. this can cause angia and vasoconstriction of the brain
pts mental status will show
slow response time. mild loss of mental status
why is there a mild loss of mental status?
damage to the myelin sheath
vitamin b 12 plays an important role in developing the ____ _____
what five areas does the mental status test for?
orientation, registration, attention, calculation, recall/language
motor exam shows _____ results
mild results. 4/5
why are there absent reflexes of the ankles?
disease of the spinal cord. there is damage to the myelin sheath
damage to the spinal cord and myelin sheath will cause what?
paraesthisia to the distal extremities
will the patient have a positive babinski?
because of the damage to the myelin sheath the sensory and motor pathways are messed up because of the damage to the spinal cord
ANSWER TO ALL THINGS
what does the romberg test, test for?
pt will present with:
-slapping, pins and needles
-Vit B 12 LOW
-Folic Acid LOW
-T billiruben HIGH
-Billiruben indirect HIGH
-T protein LOW
Why is the Hb and Hct low?
poor nutrition and alcohol abuse cannot absorb the vitamin b 12 based off of the serum antibodies
The reticulocytes are low because not enough RBC being _____. what does this mean?
MCV is high which indicates
MCH is high which means
Macrocytic blood vessels that have a higher concentration of hemoglobin on each RBC
why is the billiruben high?
b/c of the break down of hemoglobin
your body produces billiruben when it breaks down ____. Macrocytic cells have increased hemoglobin so when they break down the billiruben levels increase.
Albumin is made in the ____
the albumin is low because
-decreased stomach function
LDL is high is this related to the vitamin b 12 deficiency?
No, poor lifestyle habits
What is MMA
-specific test for vitamin b 12
RBC are an abnormal size
RBC are an abnormal shape
____ ____ are indicitive of megablastic anemia of either vitamin b 12 deficency or folic acid deficiency. In megablastic anemia you have 6-8 lobes
pertinent negative that the serum antibodies showed ____ ____ and ____ ___
without ___ ___ vitamin b 12 cannot be absorbed
vitamin b 12 deficiency can cause ____ _____
the patient was negative for antibodies meaning he has intrinsic factor. Does this mean that the patient has pernicious anemia?
If the patient is positive for intrinsic factor and parietal cells does this mean that the patient has pernicious anemia?
ID 3 major risk factors that contributed to vitamin b 12 deficiency in this patient
-mom having hypothyroid
name 8 symptoms that are consistent with the diagnosis of vitamin b 12 deficiency
- difficulty concentratining
-problems with memory
-numbness in the periphery
-unsteady in the dark
-shooting pain in the neck (damage to myelin sheath)
ID 15 objective signs that correlate with the diagnosis of vitamin b 12 deficiency
- response time slow
- 4/5 on motor exam
-absent ankle reflex
-no temperature sensation
-diminished pin prick sensation
- loss of vibration
- cannot stand with eyes closed (romberg test)
ID lab findings correlating with vitamin b 12 deficiency
- Low hg, hit, platelets, rbc, wbc, reticulocytes, vitamin b 12, folic acid
-high MCV, MCH, billiruben indirect
is the patients renal function normal or abnormal?
normal because patients Bun and creatitin were normal
is the patients hepatic function normal?
abnormal because of high billiruben and low albumin
is the patients lipid panel normal?
no, HIGH LDL
does this patient have pernicious anemia?
no because he has negative ID and parietal cell antibodies
what type of anemia does this patient have?
-none of the above
medical term for "severe neck pain shooting down the back into the arms" _____ _____. what does this indicate?
severe damage to the myelin sheath affecting the neck and the spinal cord
why does this patient has a slap foot?
because of weakness and paralysis of the extremities due to the loss of the myelin sheath
why is the significance of the romberg test in this patient?
tests the patients proprioreception, shows the patient has ataxia
need to differentiate vitamin b 12 deficiency from what?
folic acid deficiency
how do you treat this patient?
-IM vitamin b 12 injections and potassium
-rehab for drug/alcohol abuse
prevalence of vitamin b 12 deficiency increase with ____ and _____
use of gastric acid blocking agents
human body stores _____ years worth of vitamin b 12. Symptoms of a deficiency will manifest in 3 years
infants and children show symptoms more ___
-anorexia with weight loss
-burning or soreness of the tongue with changes in taste
-symptoms can mimic Alzhemiers
-spinal cord damage
symptoms associated with vit b 12 deficiency
-strict vegetarian diet
dietary insufficiency of vitamin b 12
-surgical removal of stomach
-use of histamine 2 blocking drugs or PPI
insufficent stomach acid or pancreatic enzymes to serape b 12 from ingested animal proteins or b12 binding proteins
-IF deficiency (pernicious anemia)
-removal of terminal ileum
-medications such as: cholestyramine, neomycin, metoformin, phenoformin, chlorine
impaired absorption of vitamin b 12
cognetial deficiency of plasma protein carrier transcoblamin II
abnormality in the plasma transport of vitamin b 12
absence of intrinsic factor is the most common cause of vitamin b 12 deficiency in the US
major risk factors of vit b 12 deficiency
- positive FH of pernicious anemia
-scandinavian or celtic descent
-neuroendocrine disease, type 1 diabetes, addison disease, graves disease, hasimotis thyroiditis
"any process that impairs the ingestion, separation, absorption, plasma transport or transfer into cells of B12 may result in the clinical manifestation of a bit b12 deficiency*
_____ _____ is characterized by an infiltration of lymphocytes within the walls of the stomach that is associated with degeneration of parietal cells and their replacement of goblet cells. This is known as intestinal metaplasia
bone marrow biopsy will show:
-marked red blood cell hypercellularity
-megaloblastic in red and white blood cell lines
+ intrinsic factor and parietal cells indicate
lymphocytes will appear in the walls of the ____ in pernicious anemia
what are reticulocytes?
immature blood cell without a nucleus
why is it reasonable to test the serum folic acid concentration in a patient who is suspected of having it b 12 deficiency
present with similar lab findings need to differentiate
what is alchlorhydira?
production of hydrochloric acid in gastric secretions is low in the stomach
why is achyloridia reasonable to find in patients with pernicious anemia?
because there is a commonly problems with the stomach lining in patients because of improper neutrition and alcohol
If the father of an unborn child has a single defective gene/mutation for transcobalamin II deficiency and the mother has two normal genes, what is the probability that their unborn child will be transcobalamin II deficient?
If both the father and mother of an unborn child each have a single defective gene/mutation for transcobalamin II deficiency, what is the proba- bility that their unborn child will be transcobalamin II deficient?
Why is it reasonable to find lymphocytes in the walls of the stomach in patients with pernicious anemia?
type 1 diabetes mellitus
lack of serum insulin
decrease serum cortisol
increase serum thyroxine
decrease serum thyroxine
persistent aberrant beliefs or perceptions held invio- lable by a person despite evidence that refutes them
abnormal condition characterized by an elaborate, sus- picious system of thinking that is usually centered on one major theme, such as an unfaithful spouse, being poisoned, or being watched by outer space aliens
abnormal sensory perceptions that can occur in any of the senses, do not result from an external stimulus, and occur in the waking state
why is there a mild loss of mental status?
damage to the myelin sheath