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 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 [[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]] and hungry looking 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== | ||
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===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
Patients with kwashiorkor are usually apathetic and have a listless affect, with a round face with prominent cheeks known as the moon face. Despite this looks, they have very thin extremities and edema of the dependent areas such as the feet and sacral areas of the back. there is a marked discoloration of the skin and hair with a fluffy texture. | Patients with [[kwashiorkor]] are usually apathetic and have a listless affect, with a round face with prominent cheeks known as the [[moon face]]. Despite this looks, they have very thin extremities and [[edema]] of the dependent areas such as the feet and [[sacral]] areas of the back. there is a marked [[Skin changes|discoloration of the skin]] and [[hair]] with a fluffy texture. | ||
===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]] | ||
===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]] | ||
*There is pursed appearance of the mouth | *There is pursed appearance of the mouth | ||
===Neck=== | ===Neck=== | ||
*Hepatojugular | *[[Hepatojugular reflux]] may be present because of the [[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]] | ||
==References== | ==References== | ||
Revision as of 13:16, 9 August 2017
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Protein energy malnutrition Microchapters |
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Patient Information |
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Differentiating Protein energy malnutrition from other Diseases |
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Diagnosis |
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Protein energy malnutrition physical examination On the Web |
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Protein energy malnutrition physical examination in the news |
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Risk calculators and risk factors for Protein energy malnutrition physical examination |
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 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
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
Patients with kwashiorkor are usually apathetic and have a listless affect, with a round face with prominent cheeks known as the moon face. Despite this looks, they have very thin extremities and edema of the dependent areas such as the feet and sacral areas of the back. there is a marked discoloration of the skin and 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
HEENT
- Abnormalities of the head/hair may include presence of sparse and discoloured hair
- Eyes are jaundiced
- There is pursed appearance of the mouth
Neck
- Hepatojugular reflux may be present because of the 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
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.