PEM

CLINICAL FEATURES……:

CLINICAL FEATURES…… Dr. Soumitra Halder

DEPENDS ON…….:

DEPENDS ON……. Severity of nutritional deprivation Duration of nutritional deprivation Age Presence or absence of Infection

Can be compared …..:

They are High risk of detoriation . Vast majority of children sufferring from mild to moderate forms. Can be compared ….. pf Tip of iceberg- severe form Hidden part- mild and moderate form

3 Types…….:

MARASMUS KWASHIORKOR MARASMIC-KWASHIORKOR 3 Types…….

MARASMUS……:

Child alert but irritable Failure to gain weight --------Emaciation Weight is <60 percent of expected wt Growth retardation is severe Loss of s/c fat -----seems to have only skin Skin—dry,inelastic,loses turgor.wrinkled Loose skin folds 1 Axilla,groin 2 Thigh,Buttock 3 Chest,Abdomen 4 Buccal pad of fat MARASMUS……

Slide 6:

Contd………. Bony points prominent----Ribs are visible Appetite ----voracious in early stage , ultimately lost Abdomen---distended Often constipation----may have starvation diarrhea

KWASHIORKOR…..:

KWASHIORKOR…..

Edema…:

1 st starts in lower limb ↓ upper limbs ↓ Face (moon shaped & puffy) ↓ Ascites ( very rare) Edema…

Mental changes…..:

Irritable Lethargic Listless Apathetic Baby presents with moaning cry Mental changes…..

Hair…..:

Thin, Dry, Brittle,Easily pluckable, Sparse Straight ,Hypopigmented Flag sign Hair…..

Skin…..:

Erythema ↓ Hyperpigmentation ↓ Desquamation (expose raw hypopigmented skin) Lesion more ● on extremeties ●exposed to cont. pressure Crazy pavement dermatosis Severe cases------- Petechiae,Ecchymoses Mosaic form Skin…..

Others…:

G I ----Hepatomegaly ●rounded margin ●soft consistensy (fatty liver) Eye ---pale conjunctiva,Bitots spot,corneal xerosis Lips ---angular stomatitis,cheliosis Tongue ---atrophied papilla,raw tongue Others…

Slide 13:

Gland ---thyroid enlargement parotid enlargement Nail --- koilonychia

Slide 14:

MARASMUS M-K KWASHIORKOR GROWTH RETDN. 65% 60% 50% SUBCUT. FAT ABSENT ABSENT SOME LEFT OEDEMA ABSENT + ++ LIVER SHRUNKEN SMALL, ATROPHIED SHRUNKEN SMALL, ATROPHIED. ENLARGED WITH FATTY DEPOSIT Comparison among …….

Slide 15:

MARASMUS M-K KWASHIORKOR MENTAL APATHY ABSENT ABSENT PRESENT SKIN CHANGES THIN PERIFOLLICULOSIS SMOOTH, THIN FLAKY-PAINT, CRAZY PAVEMENT HAIR SILKY, DRY, THIN, SPARSE SILKY, DRY, THIN, SPARSE DEPIGMENTED, EASY PLUCKABILITY, STRAIGHT, FLAG SIGN

May our children look like this…:

M ay our children look like this … Thank you