Tropical sprue physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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Overview

There are no diagnostic physical signs in patients with TS. Although, in one extreme is the emaciated patient with progression to develop nutritional deficiencies resulting in signs os anemia, glossitis, stomatitis, dermatosis, peripheral edema, depigmentation of hair, xerosis conjunctivae. On the other extreme is a patient with no abnormal physical finings on examination, with the majority of patients falling in between these two extremes.

Physical Examination

Skin

Hyper pigmentation of the skin is associated with Folate or Vitamin B12 deficiencies.

HEENT

Eyes: Xeroxis Conjunctivae, most commonly seen in south indian patients due to low dietary intake of vitamin A. Signs of anemia include pallor of the conjunctiva. Tongue: Glossitis

Heart

Severe anemia leads to circulatory overload and Congestive heart failure.

Abdomen

• Abdominal swelling due to distended intestine with clearly evident peristaltic waves may sometimes be seen.
• Loud, prolonged and disordered borborgymi, has to be differentiated from that of intestinal obstruction.
• When there is severe anemia, hypoproteinemia, or both, ascites and mild hepatosplenomegaly may be present.

Neuromuscular

• Peripheral neuritis, is associated with Vitamin B deficiencies.
• Subacute combined degeneration of the cord due to vitamin B12 deficiency occurs very rarely.
• Severely ill patients rarely may develop altered consciousness and coma due to electrolyte disturbances.