Protein energy malnutrition physical examination

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Marasmus

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Kwashiorkor

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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:


Vital signs

Skin

HEENT

  • Abnormalities of the head/hair may include presence of sparse and discoloured hair
  • Eyes are jaundiced
  • Pursed appearance of the mouth

Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Extremities

Neuromuscular

Kwashiorkor in a child
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

  1. 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.
  2. 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.
  3. 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.

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