123: Cutaneous Changes in Nutritional Disease Flashcards
(480 cards)
What are the two main types of Protein Energy Malnutrition (PEM)?
Marasmus and Kwashiorkor.
What is the primary characteristic of Marasmus?
Severe wasting and stunting with body weight for age less than 60% of expected.
What is the primary characteristic of Kwashiorkor?
Edematous or ‘wet’ PEM with body weight for age between 60% to 80% due to inadequate protein or fat intake.
What is the pathophysiological effect of adapted starvation on macronutrient intake?
Decreased intake of all macronutrients, particularly carbohydrates, leads to suppressed insulin production and muscle breakdown.
What are some clinical findings associated with Protein Energy Malnutrition (PEM)?
Failure to thrive, dry and wrinkled skin, hair loss, and loss of subcutaneous fat and muscle mass.
What is a key finding in children with Kwashiorkor?
Failure to thrive, often accompanied by edema and irritability.
What does ‘monkey facies’ refer to in the context of PEM?
The aged or wizened appearance due to loss of buccal fat pads.
What is the significance of the ‘flag sign’ in hair observed in Kwashiorkor?
It indicates alternating bands of light and dark color in the hair shaft due to intermittent periods of malnutrition.
What are the consequences of nonadapted starvation on protein synthesis?
Increased carbohydrate intake relative to decreased protein and fat intake inhibits protein synthesis, leading to hypoproteinemia and fatty liver.
What are the key differences between Marasmus and Kwashiorkor in terms of body weight and nutritional deficiencies?
Disorder | Body Weight for Age | Nutritional Deficiency |
|————|———————|————————-|
| Marasmus | < 60% of expected | Global nutrient deficiencies |
| Kwashiorkor| 60% to 80% of expected| Protein and fat deficiency from grain-derived foods |
What are the clinical findings associated with Marasmus?
- Severe wasting and stunting
- Body weight for age < 60% of expected
- Emaciated appearance
- Dry, thin, loose, wrinkled skin
- Hair growth slows, hair loss, thin, brittle hair
- Nails may show fissuring with impaired growth
- Loss of both subcutaneous fat and muscle mass
- Abdominal muscle hypotonia leading to abdominal distension
- Decreased resting body temperature and bradycardia
What are the clinical findings associated with Kwashiorkor?
- Failure to thrive, especially in children 6 months to 5 years
- Edema and irritability
- Skin findings: generalized dermatitis likened to flaking enamel paint
- Increased pigmentation on extensor surfaces of arms and legs
- Hair color developing a red tint to gray-white hair
- Flag sign observed in hair
- Peripheral edema from hypoproteinemia
- Fatty infiltration of the liver leading to abdominal distention
What are the pathophysiological differences between adapted and nonadapted starvation?
Type of Starvation | Characteristics |
|————————|——————|
| Adapted Starvation | - Decreased intake of all macronutrients, particularly carbohydrates
- Suppressed insulin production
- Muscle breakdown occurs in the first 24 hours
- Fat breakdown creates ketone bodies for brain use
- Reduced muscle breakdown and ammonia synthesis |
| Nonadapted Starvation | - Increased carbohydrate intake relative to decreased protein and fat
- Insulin production is not suppressed
- Hypoproteinemia, edema, and diarrhea develop
- Unable to manufacture lipoproteins, leading to fatty liver
- Increased susceptibility to infections and septicemia |
What are macronutrients and their primary functions?
Macronutrients include carbohydrates, proteins, and lipids. They are nutrients needed in large quantities to fuel metabolic processes and provide the substrate for building and maintaining cellular structure.
What are micronutrients and why are they important?
Micronutrients are vitamins and minerals necessary and required in minute quantities. They play essential roles in various physiological processes.
What are some conditions that put individuals at risk for nutritional diseases?
Conditions include hypercatabolic states (e.g., cancer, AIDS, hepatic/renal disease), GI diseases (e.g., cystic fibrosis, inflammatory bowel disease), GI surgery (e.g., bariatric procedures), chronic medication use (e.g., anticonvulsants, antibiotics), genetic metabolic defects, hepatic disease, and syndromes of nutrient excess.
What is Protein Energy Malnutrition (PEM) and its two main types?
PEM is a spectrum of disorders describing varying degrees of protein and calorie deficiency. The two main types are Marasmus (severe wasting and stunting due to chronic global nutrient deficiencies) and Kwashiorkor (edematous or ‘wet’ PEM caused by diets rich in carbohydrates but poor in protein and fat).
What are the clinical findings of Protein Energy Malnutrition (PEM)?
Clinical findings include failure to thrive, wasting, stunting, dry and wrinkled skin, hair loss, brittle nails, loss of subcutaneous fat and muscle mass, angular cheilitis, bradycardia, and susceptibility to infections.
What is the pathophysiology of adapted starvation?
Adapted starvation involves decreased intake of macronutrients, suppressed insulin production, muscle breakdown in early stages, fat breakdown creating ketone bodies in later stages, and eventual use of lean body mass in prolonged states.
What is the pathophysiology of nonadapted starvation?
Nonadapted starvation occurs when carbohydrate intake is increased relative to decreased protein and fat intake. Insulin production is not suppressed, leading to hypoproteinemia, edema, diarrhea, fatty liver, and susceptibility to infections.
What are the clinical findings of Kwashiorkor?
Findings include failure to thrive with edema, irritability, lethargy, dermatitis resembling flaking enamel paint, red-tinted hair, ‘flag sign’ in hair, peripheral edema, and fatty liver infiltration.
If a patient has a fatty liver and peripheral edema due to hypoproteinemia, what condition might they have?
Kwashiorkor
If a patient presents with a fatty liver, peripheral edema, and abdominal distension, what condition might they have?
Kwashiorkor
What are the steps involved in the pathophysiology of adapted starvation?
- Decreased intake of all macronutrients, particularly carbohydrates, suppresses insulin production.
- Catabolic hormones act unopposed, converting glycogen into glucose.
- Early stages: Muscle breakdown occurs within the first 24 hours, and gluconeogenesis releases glucose.
- Later stages: Fat breakdown creates ketone bodies, which are utilized by the brain and CNS, reducing muscle breakdown and ammonia synthesis.
- In prolonged states: Wasting occurs, and lean body mass is eventually used when all other sources are expended.