Vitamin B 12 Deficiency

*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

-IF deficiency (pernicious anemia) -removal of terminal ileum -chrons -celiac -lakefish tapeworms -medications such as: cholestyramine, neomycin, metoformin, phenoformin, chlorine

impaired absorption of vitamin b 12

graves disease

increase serum thyroxine

why is there a murmur present?

increased pumping b/c of anemia

-surgical removal of stomach -chronic gastritis -use of histamine 2 blocking drugs or PPI -chronic pancreatitis

insufficent stomach acid or pancreatic enzymes to serape b 12 from ingested animal proteins or b12 binding proteins

if your stomach lining is destroyed you may not be able to absorb ____ ____ which leads to malabsorption of it b 12

intrinsic factor

without ___ ___ vitamin b 12 cannot be absorbed

intrinsic factor

pertinent negative that the serum antibodies showed ____ ____ and ____ ___

intrinsic factor parietal cells

what is sclera icterus and what is it indicitive of?

jaudice in the eyes billiruben has crossed the BBB

type 1 diabetes mellitus

lack of serum insulin

Albumin is made in the ____

liver

what type of anemia is vitamin b 12 deficiency?

macrocytic and hypochromic

what type of anemia does this patient have? -megaloblastic anemia -neurological abnormalities -none of the above

megablastic anemia

motor exam shows _____ results

mild results. 4/5

vitamin b 12 plays an important role in developing the ____ _____

myelin sheath

does this patient have pernicious anemia?

no because he has negative ID and parietal cell antibodies

is the patients lipid panel normal?

no, HIGH LDL

is the patients renal function normal or abnormal?

normal because patients Bun and creatitin were normal

what five areas does the mental status test for?

orientation, registration, attention, calculation, recall/language

what does B 12 make?

RBC

anemia is defined as an abnormally low number of circulating ____ or low concentration of ____. this results in diminished oxygen carrying capacity of the blood.

RBC hemoglobin

what will the patients skin look like?

pale with slight jaundice. patient is pale b/c they are deficient in RBC

_____ of the mucous membranes. This is because of decreased RBC

pallor

damage to the spinal cord and myelin sheath will cause what?

paraesthisia to the distal extremities

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

paranoia

_____ _____ 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

perncious anemia

vitamin b 12 deficiency can cause ____ _____

perncious anemia

what can vitamin B 12 trigger?

pernicious anemia

RBC are an abnormal shape

poikliocytosis

long history of ____ _____ is a risk factor. patient is not taking in enough vitamin b 12

poor nutrition

Why is the Hb and Hct low?

poor nutrition and alcohol abuse cannot absorb the vitamin b 12 based off of the serum antibodies

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

Name 3 chief complaints of a pt with vitamin B 12 deficiency

problems talking and concentrating memory issues numbness in legs and trouble walking

The reticulocytes are low because not enough RBC being _____. what does this mean?

produced Aplastic Anemia

what is alchlorhydira?

production of hydrochloric acid in gastric secretions is low in the stomach

what does the romberg test, test for?

proprioreception

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

infants and children show symptoms more ___

rapidly

what do the patients eyes present with? ___ ___

sclera icterus

pts mental status will show

slow response time. mild loss of mental status

*why is there significant discomfort in the neck?*

spread to the spinal cord?

lymphocytes will appear in the walls of the ____ in pernicious anemia

stomach

-anorexia with weight loss -burning or soreness of the tongue with changes in taste -N/V -neurological symptoms -paraesthisa -symptoms can mimic Alzhemiers -psychotic manifestations -spinal cord damage

symptoms associated with vit b 12 deficiency

why is the significance of the romberg test in this patient?

tests the patients proprioreception, shows the patient has ataxia

patients BMI will most likely be ______. why?

underweight pt will typically be malnourished

meat supplies you with what?

vitamin b 12

If the patient is positive for intrinsic factor and parietal cells does this mean that the patient has pernicious anemia?

YES

Patients mother developed bacterial thyroiditis. Is bacterial thyroiditis a risk factor for vitamin B 12 deficiency?

YES

will the patient have a positive babinski?

YES

is the patients hepatic function normal?

abnormal because of high billiruben and low albumin

cognetial deficiency of plasma protein carrier transcoblamin II

abnormality in the plasma transport of vitamin b 12

prevalence of vitamin b 12 deficiency increase with ____ and _____

age use of gastric acid blocking agents

deficient amounts of vitamin B 12 will cause ____ and _____ _____ injury

anemia nervous system

RBC are an abnormal size

anisocytosis

why is the billiruben high?

b/c of the break down of hemoglobin

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 systolic border best heard at the right sternal border?

because the Hct is less than 20%

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

what will the patients tongue look like?

beefy red tongue with glossitis. tongue will burn

what can be an initial sign of a patient with vitamin b 12 deficiency?

burning tongue (atrophic gloittis)

difficulty with gait shows that there could be a problem with the ____

cerebellum

medical term for "severe neck pain shooting down the back into the arms" _____ _____. what does this indicate?

cervical reticulopathy severe damage to the myelin sheath affecting the neck and the spinal cord

excessive alcohol and ____ use is a risk factor

cocaine

what else can cause the murmur?

cocaine. major affect of cocaine is vasoconstriction. this can cause angia and vasoconstriction of the brain

why is there a mild loss of mental status?

damage to the myelin sheath

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

addison disease

decrease serum cortisol

hashimotos thyroiditis

decrease serum thyroxine

persistent aberrant beliefs or perceptions held invio- lable by a person despite evidence that refutes them

delusion

-strict vegetarian diet -chronic alcoholism

dietary insufficiency of vitamin b 12

why are there absent reflexes of the ankles?

disease of the spinal cord. there is damage to the myelin sheath

vegetables supply you with what?

folic acid

need to differentiate vitamin b 12 deficiency from what?

folic acid deficiency

Cerebellar symptoms show that the vitamin B 12 deficiency has progressed. How does the disease progress?

from peripheral to inward

abnormal sensory perceptions that can occur in any of the senses, do not result from an external stimulus, and occur in the waking state

hallucinations

what can a widened pulse pressure eventually cause?

heart murmur

your body produces billiruben when it breaks down ____. Macrocytic cells have increased hemoglobin so when they break down the billiruben levels increase.

hemoglobin

Patients who are vegetarians and vegans lack what?

higher risk for lacking vitamin b 12 and folic acid

____ ____ are indicitive of megablastic anemia of either vitamin b 12 deficency or folic acid deficiency. In megablastic anemia you have 6-8 lobes

hypersegmented neutrophils

what are reticulocytes?

immature blood cell without a nucleus

MCV is high which indicates

Macrocytic anemia

ID 3 major risk factors that contributed to vitamin b 12 deficiency in this patient

-alcohol -poor nutrition -mom having hypothyroid

pt's vital signs show a wide pulse pressure. What is this indicitive of?

-anemia -thyrotoxicosis

MCH is high which means

Macrocytic blood vessels that have a higher concentration of hemoglobin on each RBC

patient who has a vitamin b 12 deficiency can present with

-malnourished -cognitive impairments -restless

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 -gait problems -tingling in hands and feet -peripheral neuropathy

the albumin is low because

-poor nutriton -decreased stomach function

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

name 8 symptoms that are consistent with the diagnosis of vitamin b 12 deficiency

- difficulty concentratining -difficulty expressing -problems with memory -numbness in the periphery -trouble walking -unsteady in the dark -shooting pain in the neck (damage to myelin sheath) -poor nutrition -fatigue

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

ID 15 objective signs that correlate with the diagnosis of vitamin b 12 deficiency

- response time slow -pallor -mild jaundice -glossitis -diminshed sensations -slap foot - 4/5 on motor exam -positive babinski -absent ankle reflex -no temperature sensation -diminished pin prick sensation - loss of vibration - cannot stand with eyes closed (romberg test)

LAB STUDIES

-Hb LOW -Hct LOW -RBC LOW -platelets LOW -WBC LOW -Reticulocytes LOW -MCV HIGH -MCH HIGH -Vit B 12 LOW -Folic Acid LOW -T billiruben HIGH -Billiruben indirect HIGH -Alb LOW -T protein LOW -LDL HIGH -MMA HIGH -homocystine HIGH

how do you treat this patient?

-IM vitamin b 12 injections and potassium -rehab for drug/alcohol abuse

human body stores _____ years worth of vitamin b 12. Symptoms of a deficiency will manifest in 3 years

3-5 years

vitamin b 12 is essential for the synthesis of ___

DNA

What is MMA

Methylmalonic Acid -specific test for vitamin b 12

do patients with vitamin b 12 deficiency typically have a problem with their cerebellum?

NO cerebellar problems is a differential diagnosis

the patient was negative for antibodies meaning he has intrinsic factor. Does this mean that the patient has pernicious anemia?

NOOOOO

LDL is high is this related to the vitamin b 12 deficiency?

No, poor lifestyle habits

what drug suppresses the production of stomach acid which will lead to the malabsorption of vit b 12?

OTC famotidine (treats heartburn)

+ intrinsic factor and parietal cells indicate

PERNCIOUS ANEMIA