Pediatrics I - OSCE > PEM > Flashcards

PEM Flashcards

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1
Q
A
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2
Q

Def of Protein Caloric (Energy) Malnutrition

A
  • Syndromes resulting from deficiencies of calories and/or protein intake.
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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.

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4
Q

Wellcome Classification of PEM

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5
Q

Limitations of Wellcome Classification of PEM

A
  • Patient length is not in the consideration.
  • Edema falsely increases the weight.
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6
Q

WHO Classification of Severe malnutrition

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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.
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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.
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9
Q

Etiology of Marasmus

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10
Q

Etiology of Marasmus

  • Non-Organic Causes
A
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11
Q

Etiology of Marasmus

  • Organic Causes
A
  • Inadequate Intake
  • Poor Absorbtion
  • Increase Metabolic Demands
  • ??????
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12
Q

Organic Causes of Marasmus

A
  • Inadequate Intake
  • Poor Absorbtion
  • Increase Metabolic Demands
  • ??????
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13
Q

Organic Causes of Marasmus

  • Inadequate Intake
A

Dieteic & Non

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14
Q

Dieteic Causes of Marasmus

A
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15
Q

Dieteic Causes of Marasmus

  • Quantitative
A
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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.
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17
Q

Non-Dieteic Causes of Marasmus

A
  • Anorexia (anemia, CNS disorders, infections).
  • Inability to suck or swallow (CNS defects, congenital anomalies).
  • Vomiting.
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18
Q

Absorbtion Causes of Marasmus

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19
Q

Absorbtion Causes of Marasmus

  • GIT
A

Celiac disease, Cystic Fibrosis, Schwachman syn.

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20
Q

Absorbtion Causes of Marasmus

  • Renal
A

Renal failure, RTA

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21
Q

Absorbtion Causes of Marasmus

  • Endocrine
A

DM, thyroid, GH deficiency

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22
Q

Absorbtion Causes of Marasmus

  • Chronic Infection
A

TB, HIV, parasites

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23
Q

Metabolic Causes of Marasmus

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24
Q

Metabolic Causes of Marasmus

  • Chronic Diseases
A

Heart Failure, Chronic Heart Disease, BPD

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25
Metabolic Causes of **Marasmus** - Choronic Inflammatory Diseases
IBD, SLE
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Metabolic Causes of **Marasmus** - Renal
Renal failure
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Metabolic Causes of **Marasmus** - Endocrine
Hyperthyroidism
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Pathophysiolgy of **Marasmus**
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CP of **Marasmus**
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CP of **Marasmus** - Weight Loss
Weight < 60% of normal.
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CP of **Marasmus** - Characters
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CP of **Marasmus** - Cardinal Sign
Loss of SC fat from abdomen then Limbs then Pads of check.
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CP of **Marasmus** - Vitals
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CP of **Marasmus** - GIT
- Gastroenteritis - Constipation - Starvation stool (small amount, dark in color, increased mucus)
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CP of **Marasmus** - Others
Recurrent infection - Anemia - Vit B def
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Degrees of **Marasmus**
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Labs in **Marasmus**
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Complications of **Marasmus**
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Causes of Death in **Marasmus**
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Prevention of **Marasmus**
* Adequate feeding. * Immunization. * Early diagnosis & treatment of infection.
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Another Name of **Kwashiorker**
Red Baby
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Def of **Kwashiorker**
- Clinical syndrome due to supply of protein & amino acids with adequate caloric supply. - It is acute not a chronic disease
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Etiology of **Kwashiorker**
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Etiology of **Kwashiorker** - Dietary inadequacy
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Etiology of **Kwashiorker** - Post-Infectious
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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
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CP of **Kwashiorker**
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CP of **Kwashiorker** - Constant Diagnostic Features
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CP of **Kwashiorker** - Variable Features
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Growth Retardation in **Kwashiorker**
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Growth Retardation in **Kwashiorker** - Weight
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Growth Retardation in **Kwashiorker** - Height & Head Circumference
Are less affected than weight.
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Growth Retardation in **Kwashiorker** - Muscles
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Growth Retardation in **Kwashiorker** - SC Fat
- Preserved (indicating adequate caloric intake). - Detected by skin fold.
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Edema in **Kwashiorker**
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Edema in **Kwashiorker** - Site
- Starts in the dorsum of feet then hands then become generalized. - Never associated with ascites & pleural effusion.
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Edema in **Kwashiorker** - Type
Soft Pitting
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Edema in **Kwashiorker** - Pathogenesis
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Psychomotor & Mental Changes in **Kwashiorker**
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Psychomotor & Mental Changes in **Kwashiorker** - Features
- Lethargy, apathy, loss of interest to surrounding & misery. - Mental development appears to be below normal for the age.
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Psychomotor & Mental Changes in **Kwashiorker** - Pathogenesis
- Decreased Manganese. - A defect in the metabolism of aromatic amino acids.
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Skin Changes in **Kwashiorker**
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Skin Changes in **Kwashiorker** - Site
Common over pressure & flexure sites (e.g., buttocks & elbow).
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Skin Changes in **Kwashiorker** - Pathogenesis
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Hair Changes in **Kwashiorker** - CP
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Hair Changes in **Kwashiorker** - Pathogenesis
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GIT Disorders in **Kwashiorker** - CP
Anorexia, vomiting, diarrhea & steatorrhea.
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GIT Disorders in **Kwashiorker** - Pathogenesis
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Anemia in **Kwashiorker**
- Deficiency of iron, protein, folic acid and B12. - Recurrent infections
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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.
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Investigations in **Kwashiorker**
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Investigations in **Kwashiorker** - Urea N / Creatinine N
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Investigations in **Kwashiorker** - Non Essential AA / Essential AA
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Investigations in **Kwashiorker** - Plasma Proteins
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Investigations in **Kwashiorker** - total Serum AA
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Investigations in **Kwashiorker** - Serum Cholesterol
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Investigations in **Kwashiorker** - Serum Electrolytes & Minerals
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Investigations in **Kwashiorker** - Serum Enzymes
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DDx of **Kwashiorker**
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Complications & Causes of Death **Kwashiorker**
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Prevention of **Kwashiorker**
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TTT of **PEM**
- Hospitalization - Dietetic Managment - TTT of associated Conditions
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TTT of **PEM** - hospitalization
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Dieteic Managment of**PEM** - Route
Nasogastric tube "gavage feeding" due to presence of anorexia.
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Dieteic Managment of **PEM** - Frequency
Every 1-2 Hours
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Dieteic Managment of **PEM** - quantity
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Dieteic Managment of **PEM** - Regimen (Quality)
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Dieteic Managment of **PEM** - Supplments
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Dieteic Managment of **PEM** - Complications
- Refeeding syndrome D2 hypophosphatemia - Protein intoxication
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Complications of Dietetic managment of **PEM** - Reefeding Syndrome
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Complications of Dietetic managment of **PEM** - Protein Intoxication
with hepatomegaly, hyperammonemia.
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Refeeding Syndrome
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TTT of **PEM** - TTT of Associated Conditions
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TTT of Associated Conditions with PEM - Anemia
- Iron (after 1st week of nutritional rehabilitation) - Vitamin B12, folic acid
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TTT of Associated Conditions with PEM - dermatitis
2% aqueous gentian violet solution.
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TTT of Associated Conditions with PEM - Xerophthalmia
Vitamin A drops orally and locally, antibiotic.
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TTT of Associated Conditions with PEM - diarrhea & Infection
Proper antibiotics
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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
Pediatrics I - OSCE
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