Protein energy malnutrition physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Physical examination of patients with kwashiorkor is usually remarkable for rounded prominence of the cheeks known as the moon face, and distended abdomen due to an enlarged liver, hyperkeratosis and hyperpigmentation of the skin, generalized edema especially on the dependent areas of the body like the feet. On the other hand, patients with marasmus usually look listless, emaciated | Physical examination of patients with [[kwashiorkor]] is usually remarkable for [[Moon face|rounded prominence of the cheeks]] known as the [[moon face]], and [[distended abdomen]] due to an [[enlarged liver]], [[hyperkeratosis]] and [[hyperpigmentation]] of the [[skin]], [[generalized edema]] especially on the dependent areas of the body like the feet. On the other hand, patients with [[marasmus]] usually look [[Wasting|listless]], [[Emaciation|emaciated]] with monkey-like faces due to absence of [[subcutaneous fat]] pad in the cheeks. The skin looks [[atrophic]] and [[Xerostomia|dry]]. | ||
==Physical Examination== | ==Physical Examination== | ||
Physical examination of patients with kwashiorkor is usually remarkable for rounded prominence of the cheeks known as the moon face, and distended abdomen due to an enlarged liver, hyperkeratosis and hyperpigmentation of the skin, generalized edema especially on the dependent areas of the body like the feet. On the other hand, patients with marasmus usually look listless, emaciated and hungry looking with monkey like faces due to absence of subcutaneous fat pad in the cheeks. The skin looks atrophic and dry. | [[Physical examination]] of patients with [[kwashiorkor]] is usually remarkable for [[Moon face|rounded prominence of the cheeks]] known as the [[moon face]], and [[Abdominal distension|distended abdomen]] due to an [[Hepatomegaly|enlarged liver]], [[hyperkeratosis]] and [[hyperpigmentation]] of the [[Skin changes|skin]], [[generalized edema]] especially on the dependent areas of the body like the feet. | ||
<ref name="pmid12700964">{{cite journal| author=Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN et al.| title=Bacteriuria and urinary tract infections in malnourished children. | journal=Pediatr Nephrol | year= 2003 | volume= 18 | issue= 4 | pages= 366-70 | pmid=12700964 | doi=10.1007/s00467-003-1118-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700964 }} </ref><ref name="pmid25475887">{{cite journal| author=Jones KD, Berkley JA| title=Severe acute malnutrition and infection. | journal=Paediatr Int Child Health | year= 2014 | volume= 34 Suppl 1 | issue= | pages= S1-S29 | pmid=25475887 | doi=10.1179/2046904714Z.000000000218 | pmc=4266374 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25475887 }} </ref><ref name="pmid26084628">{{cite journal| author=Ahmed M, Moremi N, Mirambo MM, Hokororo A, Mushi MF, Seni J et al.| title=Multi-resistant gram negative enteric bacteria causing urinary tract infection among malnourished underfives admitted at a tertiary hospital, northwestern, Tanzania. | journal=Ital J Pediatr | year= 2015 | volume= 41 | issue= | pages= 44 | pmid=26084628 | doi=10.1186/s13052-015-0151-5 | pmc=4472394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26084628 }} </ref> | On the other hand, patients with [[marasmus]] usually look listless, [[Emaciation|emaciated]] and [[Emaciation|hungry looking]] with monkey like faces due to absence of [[subcutaneous fat]] pad in the cheeks. The skin looks [[atrophic]] and dry.<ref name="pmid12700964">{{cite journal| author=Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN et al.| title=Bacteriuria and urinary tract infections in malnourished children. | journal=Pediatr Nephrol | year= 2003 | volume= 18 | issue= 4 | pages= 366-70 | pmid=12700964 | doi=10.1007/s00467-003-1118-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700964 }} </ref><ref name="pmid25475887">{{cite journal| author=Jones KD, Berkley JA| title=Severe acute malnutrition and infection. | journal=Paediatr Int Child Health | year= 2014 | volume= 34 Suppl 1 | issue= | pages= S1-S29 | pmid=25475887 | doi=10.1179/2046904714Z.000000000218 | pmc=4266374 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25475887 }} </ref><ref name="pmid26084628">{{cite journal| author=Ahmed M, Moremi N, Mirambo MM, Hokororo A, Mushi MF, Seni J et al.| title=Multi-resistant gram negative enteric bacteria causing urinary tract infection among malnourished underfives admitted at a tertiary hospital, northwestern, Tanzania. | journal=Ital J Pediatr | year= 2015 | volume= 41 | issue= | pages= 44 | pmid=26084628 | doi=10.1186/s13052-015-0151-5 | pmc=4472394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26084628 }} </ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
Facial appearance in patients with [[kwashiorkor]]: | |||
*[[Apathy|Apathetic]] | |||
*Listless affect | |||
*Round face | |||
*Prominent [[cheeks]] known as the [[moon face]] | |||
General body appearance: | |||
*Very thin [[extremities]] | |||
*[[Edema]] of the dependent areas such as the [[feet]] and [[sacral]] areas of the back | |||
*[[Skin changes|discoloration of the skin]] | |||
*[[Hair]] with a fluffy texture | |||
<br clear="left" /> | |||
===Vital signs=== | ===Vital signs=== | ||
*Normal body temperature/ Hypothermia | *Normal body [[temperature]]/[[Hypothermia]] | ||
*Hypotension | *[[Hypotension]] | ||
*Bradycardia | *[[Bradycardia]] | ||
===Skin=== | ===Skin=== | ||
*Thin, dry, peeling skin with confluent areas of hyperkeratosis and hyperpigmentation | *[[Skin changes|Thin, dry, peeling skin]] with confluent areas of [[hyperkeratosis]] and [[hyperpigmentation]] | ||
*Enamel paint dermatosis | *Enamel paint [[dermatosis]] (flaking of [[skin]]) | ||
===HEENT=== | ===HEENT=== | ||
*Abnormalities of the head/hair may include presence of sparse and discoloured hair | *Abnormalities of the head/hair may include presence of sparse and [[Hair|discoloured hair]] | ||
*Eyes are jaundiced | *Eyes are [[Jaundice|jaundiced]] | ||
* | *Pursed appearance of the mouth | ||
===Neck=== | ===Neck=== | ||
*Hepatojugular | *[[Hepatojugular reflux]] due to [[hepatomegaly]] | ||
===Lungs=== | ===Lungs=== | ||
*Decreased chest expansion | *Decreased [[chest expansion]] | ||
*Distant breath sounds maybe present | *[[Breath sounds|Distant breath sounds]] maybe present | ||
===Heart=== | ===Heart=== | ||
* Bradycardia | * [[Bradycardia]] | ||
* Hypotension | * [[Hypotension]] | ||
* Presence of heart failure in severe cases | * Presence of [[heart failure]] in severe cases | ||
===Abdomen=== | ===Abdomen=== | ||
*Hepatomegaly | *[[Hepatomegaly]] | ||
===Back=== | ===Back=== | ||
*Presacral edema | *[[Sacral lymph nodes|Presacral edema]] | ||
===Genitourinary=== | ===Genitourinary=== | ||
*Reduced glomerular filtration rate | *Reduced [[glomerular filtration rate]] | ||
*Reduced capacity of the kidney to excrete sodium | *Reduced capacity of the [[kidney]] to excrete [[sodium]] | ||
*Excess acid | *Excess [[acid]] | ||
*Reduced water load | *Reduced water load | ||
*Urinary tract infections | *[[Urinary tract infections]] | ||
===Extremities=== | ===Extremities=== | ||
*Pitting edema of the lower extremities | *[[Pitting edema]] of the lower [[extremities]] | ||
*Muscle atrophy | *[[Muscle atrophy]] | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
*Patient is usually oriented | *Patient is usually oriented | ||
*Altered mental status / mental retardation | *[[Altered mental status]] / [[mental retardation]] | ||
*Hyporeflexia / areflexia | *[[Hyporeflexia]] / [[areflexia]] | ||
*Generalised muscle weakness | *[[Muscle weakness|Generalised muscle weakness]] | ||
[[File:Kwashiorkor.jpg|left|300px|thumb|Kwashiorkor in a child <br> Courtesy to Dr. Lyle Conrad - Centers for Disease Control and Prevention, Atlanta, Georgia, USA Public Health Image Library (PHIL); ID: 6901 http://phil.cdc.gov/]]<br style=clear:left /> | |||
==References== | ==References== | ||
Latest revision as of 19:34, 20 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
Physical examination of patients with kwashiorkor is usually remarkable for rounded prominence of the cheeks known as the moon face, and distended abdomen due to an enlarged liver, hyperkeratosis and hyperpigmentation of the skin, generalized edema especially on the dependent areas of the body like the feet. On the other hand, patients with marasmus usually look listless, emaciated with monkey-like faces due to absence of subcutaneous fat pad in the cheeks. The skin looks atrophic and dry.
Physical Examination
Physical examination of patients with kwashiorkor is usually remarkable for rounded prominence of the cheeks known as the moon face, and distended abdomen due to an enlarged liver, hyperkeratosis and hyperpigmentation of the skin, generalized edema especially on the dependent areas of the body like the feet. On the other hand, patients with marasmus usually look listless, emaciated and hungry looking with monkey like faces due to absence of subcutaneous fat pad in the cheeks. The skin looks atrophic and dry.[1][2][3]
Appearance of the Patient
Facial appearance in patients with kwashiorkor:
General body appearance:
- Very thin extremities
- Edema of the dependent areas such as the feet and sacral areas of the back
- discoloration of the skin
- Hair with a fluffy texture
Vital signs
- Normal body temperature/Hypothermia
- Hypotension
- Bradycardia
Skin
- Thin, dry, peeling skin with confluent areas of hyperkeratosis and hyperpigmentation
- Enamel paint dermatosis (flaking of skin)
HEENT
- Abnormalities of the head/hair may include presence of sparse and discoloured hair
- Eyes are jaundiced
- Pursed appearance of the mouth
Neck
- Hepatojugular reflux due to hepatomegaly
Lungs
- Decreased chest expansion
- Distant breath sounds maybe present
Heart
- Presence of heart failure in severe cases
Abdomen
Back
Genitourinary
- Reduced glomerular filtration rate
- Reduced capacity of the kidney to excrete sodium
- Excess acid
- Reduced water load
- Urinary tract infections
Extremities
- Pitting edema of the lower extremities
- Muscle atrophy
Neuromuscular
- Patient is usually oriented
- Altered mental status / mental retardation
- Hyporeflexia / areflexia
- Generalised muscle weakness
Courtesy to Dr. Lyle Conrad - Centers for Disease Control and Prevention, Atlanta, Georgia, USA Public Health Image Library (PHIL); ID: 6901 http://phil.cdc.gov/
References
- ↑ Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN; et al. (2003). "Bacteriuria and urinary tract infections in malnourished children". Pediatr Nephrol. 18 (4): 366–70. doi:10.1007/s00467-003-1118-0. PMID 12700964.
- ↑ Jones KD, Berkley JA (2014). "Severe acute malnutrition and infection". Paediatr Int Child Health. 34 Suppl 1: S1–S29. doi:10.1179/2046904714Z.000000000218. PMC 4266374. PMID 25475887.
- ↑ Ahmed M, Moremi N, Mirambo MM, Hokororo A, Mushi MF, Seni J; et al. (2015). "Multi-resistant gram negative enteric bacteria causing urinary tract infection among malnourished underfives admitted at a tertiary hospital, northwestern, Tanzania". Ital J Pediatr. 41: 44. doi:10.1186/s13052-015-0151-5. PMC 4472394. PMID 26084628.