PEM Flashcards
(101 cards)
1
Q
A
2
Q
Def of Protein Caloric (Energy) Malnutrition
A
- Syndromes resulting from deficiencies of calories and/or protein intake.
3
Q
Better Term for Protein Caloric (Energy) Malnutrition
A
Because PEM is almost always accompanied by deficiency of other nutrients, the term severe childhood undernutrition (SCU) may be more accurate and is preferred.
4
Q
Wellcome Classification of PEM
A
5
Q
Limitations of Wellcome Classification of PEM
A
- Patient length is not in the consideration.
- Edema falsely increases the weight.
6
Q
WHO Classification of Severe malnutrition
A
7
Q
Def of Marasmus
A
- It’s a chronic state of undernutrition characterized by progressive loss of weight due to caloric deficiency.
- The problem is protein + caloric deficiency
- Marasmus is not a disease but complex symptoms from some underlying causes.
8
Q
FTT
A
- It means failure to gain weight, drop of weight 2 major percentiles on follow up or weight below 5th percentile for age and sex.
- Thus, FTT includes marasmus and not the reverse.
9
Q
Etiology of Marasmus
A
10
Q
Etiology of Marasmus
- Non-Organic Causes
A
11
Q
Etiology of Marasmus
- Organic Causes
A
- Inadequate Intake
- Poor Absorbtion
- Increase Metabolic Demands
- ??????
12
Q
Organic Causes of Marasmus
A
- Inadequate Intake
- Poor Absorbtion
- Increase Metabolic Demands
- ??????
13
Q
Organic Causes of Marasmus
- Inadequate Intake
A
Dieteic & Non
14
Q
Dieteic Causes of Marasmus
A
15
Q
Dieteic Causes of Marasmus
- Quantitative
A
16
Q
Dieteic Causes of Marasmus
- Qualitative
A
- Too prolonged breast-feeding.
- Lack of sugar in the formula or much-diluted formulae.
- Prolonged use of fluids in children after gastroenteritis.
17
Q
Non-Dieteic Causes of Marasmus
A
- Anorexia (anemia, CNS disorders, infections).
- Inability to suck or swallow (CNS defects, congenital anomalies).
- Vomiting.
18
Q
Absorbtion Causes of Marasmus
A
19
Q
Absorbtion Causes of Marasmus
- GIT
A
Celiac disease, Cystic Fibrosis, Schwachman syn.
20
Q
Absorbtion Causes of Marasmus
- Renal
A
Renal failure, RTA
21
Q
Absorbtion Causes of Marasmus
- Endocrine
A
DM, thyroid, GH deficiency
22
Q
Absorbtion Causes of Marasmus
- Chronic Infection
A
TB, HIV, parasites
23
Q
Metabolic Causes of Marasmus
A
24
Q
Metabolic Causes of Marasmus
- Chronic Diseases
A
Heart Failure, Chronic Heart Disease, BPD
25
Metabolic Causes of **Marasmus**
- Choronic Inflammatory Diseases
IBD, SLE
26
Metabolic Causes of **Marasmus**
- Renal
Renal failure
27
Metabolic Causes of **Marasmus**
- Endocrine
Hyperthyroidism
28
Pathophysiolgy of **Marasmus**
29
CP of **Marasmus**
30
CP of **Marasmus**
- Weight Loss
Weight < 60% of normal.
31
CP of **Marasmus**
- Characters
32
CP of **Marasmus**
- Cardinal Sign
Loss of SC fat from abdomen then Limbs then Pads of check.
33
CP of **Marasmus**
- Vitals
34
CP of **Marasmus**
- GIT
- Gastroenteritis
- Constipation
- Starvation stool (small amount, dark in color, increased mucus)
35
CP of **Marasmus**
- Others
Recurrent infection - Anemia - Vit B def
36
Degrees of **Marasmus**
37
Labs in **Marasmus**
38
Complications of **Marasmus**
39
Causes of Death in **Marasmus**
40
Prevention of **Marasmus**
* Adequate feeding.
* Immunization.
* Early diagnosis & treatment of infection.
41
Another Name of **Kwashiorker**
Red Baby
42
Def of **Kwashiorker**
- Clinical syndrome due to supply of protein & amino acids with adequate caloric supply.
- It is acute not a chronic disease
43
Etiology of **Kwashiorker**
44
Etiology of **Kwashiorker**
- Dietary inadequacy
45
Etiology of **Kwashiorker**
- Post-Infectious
46
Etiology of **Kwashiorker**
- Psychological Factors
- The consequence of another pregnancy or another birth may lead to a maternal deprivation syndrome of the breast fed infant in which anorexia is a main feature
47
CP of **Kwashiorker**
48
CP of **Kwashiorker**
- Constant Diagnostic Features
49
CP of **Kwashiorker**
- Variable Features
50
Growth Retardation in **Kwashiorker**
51
Growth Retardation in **Kwashiorker**
- Weight
52
Growth Retardation in **Kwashiorker**
- Height & Head Circumference
Are less affected than weight.
53
Growth Retardation in **Kwashiorker**
- Muscles
54
Growth Retardation in **Kwashiorker**
- SC Fat
- Preserved (indicating adequate caloric intake).
- Detected by skin fold.
55
Edema in **Kwashiorker**
56
Edema in **Kwashiorker**
- Site
- Starts in the dorsum of feet then hands then become generalized.
- Never associated with ascites & pleural effusion.
57
Edema in **Kwashiorker**
- Type
Soft Pitting
58
Edema in **Kwashiorker**
- Pathogenesis
59
Psychomotor & Mental Changes in **Kwashiorker**
60
Psychomotor & Mental Changes in **Kwashiorker**
- Features
- Lethargy, apathy, loss of interest to surrounding & misery.
- Mental development appears to be below normal for the age.
61
Psychomotor & Mental Changes in **Kwashiorker**
- Pathogenesis
- Decreased Manganese.
- A defect in the metabolism of aromatic amino acids.
62
Skin Changes in **Kwashiorker**
63
Skin Changes in **Kwashiorker**
- Site
Common over pressure & flexure sites (e.g., buttocks & elbow).
64
Skin Changes in **Kwashiorker**
- Pathogenesis
65
Hair Changes in **Kwashiorker**
- CP
66
Hair Changes in **Kwashiorker**
- Pathogenesis
67
GIT Disorders in **Kwashiorker**
- CP
Anorexia, vomiting, diarrhea & steatorrhea.
68
GIT Disorders in **Kwashiorker**
- Pathogenesis
69
Anemia in **Kwashiorker**
- Deficiency of iron, protein, folic acid and B12.
- Recurrent infections
70
Vitamin Deficiency in **Kwashiorker**
- Signs of vitamins deficiency may be encountered as (Vit A, B, C)
E.g., Signs of riboflavin (B2) def. angular stomatitis, cheilosis, glossitis and blepharitis.
71
Investigations in **Kwashiorker**
72
Investigations in **Kwashiorker**
- Urea N / Creatinine N
73
Investigations in **Kwashiorker**
- Non Essential AA / Essential AA
74
Investigations in **Kwashiorker**
- Plasma Proteins
75
Investigations in **Kwashiorker**
- total Serum AA
76
Investigations in **Kwashiorker**
- Serum Cholesterol
77
Investigations in **Kwashiorker**
- Serum Electrolytes & Minerals
78
Investigations in **Kwashiorker**
- Serum Enzymes
79
DDx of **Kwashiorker**
80
Complications & Causes of Death **Kwashiorker**
81
Prevention of **Kwashiorker**
82
TTT of **PEM**
- Hospitalization
- Dietetic Managment
- TTT of associated Conditions
83
TTT of **PEM**
- hospitalization
84
Dieteic Managment of**PEM**
- Route
Nasogastric tube "gavage feeding" due to presence of anorexia.
85
Dieteic Managment of **PEM**
- Frequency
Every 1-2 Hours
86
Dieteic Managment of **PEM**
- quantity
87
Dieteic Managment of **PEM**
- Regimen (Quality)
88
Dieteic Managment of **PEM**
- Supplments
89
Dieteic Managment of **PEM**
- Complications
- Refeeding syndrome D2 hypophosphatemia
- Protein intoxication
90
Complications of Dietetic managment of **PEM**
- Reefeding Syndrome
91
Complications of Dietetic managment of **PEM**
- Protein Intoxication
with hepatomegaly, hyperammonemia.
92
Refeeding Syndrome
93
TTT of **PEM**
- TTT of Associated Conditions
94
TTT of Associated Conditions with PEM
- Anemia
- Iron (after 1st week of nutritional rehabilitation)
- Vitamin B12, folic acid
95
TTT of Associated Conditions with PEM
- dermatitis
2% aqueous gentian violet solution.
96
TTT of Associated Conditions with PEM
- Xerophthalmia
Vitamin A drops orally and locally, antibiotic.
97
TTT of Associated Conditions with PEM
- diarrhea & Infection
Proper antibiotics
98
Time frame for treatment of PCM
99
Time frame for treatment of PCM
- Initial Phase
100
Time frame for treatment of PCM
- Rehabilitation Phase
101
Time frame for treatment of PCM
- Follow up Phase
