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Questions and Answers
What is the primary principle for treating obesity in children?
What is the primary principle for treating obesity in children?
Which of the following is NOT a clinical manifestation of obesity in children?
Which of the following is NOT a clinical manifestation of obesity in children?
Which of these is NOT a clinical manifestation of Marasmus?
Which of these is NOT a clinical manifestation of Marasmus?
In Marasmus, what is the likely cause of the low serum cholesterol levels?
In Marasmus, what is the likely cause of the low serum cholesterol levels?
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What is the recommended calorie intake for a 10-14 year old child on a diet for several months?
What is the recommended calorie intake for a 10-14 year old child on a diet for several months?
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Which of the following is NOT a characteristic of Pickwickian Syndrome?
Which of the following is NOT a characteristic of Pickwickian Syndrome?
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Which of the following laboratory findings is NOT typically associated with Marasmus?
Which of the following laboratory findings is NOT typically associated with Marasmus?
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Which of the following is NOT a common sign of Kwashiorkor?
Which of the following is NOT a common sign of Kwashiorkor?
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Why is anemia relatively uncommon in Marasmus?
Why is anemia relatively uncommon in Marasmus?
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What is the primary role of thiamine, riboflavin, and niacin in the body?
What is the primary role of thiamine, riboflavin, and niacin in the body?
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What is the most significant period for treatment of Kwashiorkor, in terms of mortality rate?
What is the most significant period for treatment of Kwashiorkor, in terms of mortality rate?
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Kwashiorkor primarily affects children in which age range?
Kwashiorkor primarily affects children in which age range?
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Which of the following is NOT a recommended strategy for increasing energy expenditure in children with obesity?
Which of the following is NOT a recommended strategy for increasing energy expenditure in children with obesity?
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Which of the following statements about the etiology of Marasmus is TRUE?
Which of the following statements about the etiology of Marasmus is TRUE?
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Which of the following is the most common cause of obesity in children?
Which of the following is the most common cause of obesity in children?
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Which of the following factors distinguishes Kwashiorkor from other types of malnutrition?
Which of the following factors distinguishes Kwashiorkor from other types of malnutrition?
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What is the significance of the finding that Glucose tolerance curves are diabetic-type in Marasmus?
What is the significance of the finding that Glucose tolerance curves are diabetic-type in Marasmus?
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What is the significance of a "flaky-paint rash" in Kwashiorkor?
What is the significance of a "flaky-paint rash" in Kwashiorkor?
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In the context of treating obesity, what does "R/O" stand for?
In the context of treating obesity, what does "R/O" stand for?
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Which of these would be the MOST likely explanation for the low serum cholesterol levels found in Marasmus?
Which of these would be the MOST likely explanation for the low serum cholesterol levels found in Marasmus?
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What is the recommended calorie intake for rehabilitation of a patient with Kwashiorkor?
What is the recommended calorie intake for rehabilitation of a patient with Kwashiorkor?
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Which of these is the MOST likely explanation for the low urinary hydroxyproline/gm crea levels found in Marasmus?
Which of these is the MOST likely explanation for the low urinary hydroxyproline/gm crea levels found in Marasmus?
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Which of the following is NOT a potential cause of mortality in patients with Kwashiorkor?
Which of the following is NOT a potential cause of mortality in patients with Kwashiorkor?
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What is the most significant consequence of severe Kwashiorkor occurring early in childhood?
What is the most significant consequence of severe Kwashiorkor occurring early in childhood?
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Which of the following is NOT a typical symptom of Beriberi?
Which of the following is NOT a typical symptom of Beriberi?
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What is the underlying biochemical cause of the symptoms associated with Beriberi?
What is the underlying biochemical cause of the symptoms associated with Beriberi?
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In the context of Beriberi, what is the primary effect of thiamine deficiency on the nervous system?
In the context of Beriberi, what is the primary effect of thiamine deficiency on the nervous system?
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What is the key difference between 'wet beriberi' and 'dry beriberi'?
What is the key difference between 'wet beriberi' and 'dry beriberi'?
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Which of the following is a characteristic of infantile beriberi?
Which of the following is a characteristic of infantile beriberi?
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Which of the following is a valid preventive measure for Beriberi?
Which of the following is a valid preventive measure for Beriberi?
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What is the most effective way to diagnose Beriberi?
What is the most effective way to diagnose Beriberi?
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Which of the following best describes the pathogenesis of Wernicke's encephalopathy?
Which of the following best describes the pathogenesis of Wernicke's encephalopathy?
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Which of the following is NOT a clinical manifestation of riboflavin (Vitamin B2) deficiency?
Which of the following is NOT a clinical manifestation of riboflavin (Vitamin B2) deficiency?
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A patient presents with anorexia, weakness, irritability, and dermatitis that first appeared as symmetrical erythema, followed by drying, scaling, and pigmentation with vesicles and bullae at times. The dermatitis is predominantly affecting the back of the hands, wrists, forearms, neck, and lower legs. What is the most likely diagnosis?
A patient presents with anorexia, weakness, irritability, and dermatitis that first appeared as symmetrical erythema, followed by drying, scaling, and pigmentation with vesicles and bullae at times. The dermatitis is predominantly affecting the back of the hands, wrists, forearms, neck, and lower legs. What is the most likely diagnosis?
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What is the recommended daily intake of thiamine for nursing mothers?
What is the recommended daily intake of thiamine for nursing mothers?
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Which of the following is NOT a common cause of impaired absorption of riboflavin?
Which of the following is NOT a common cause of impaired absorption of riboflavin?
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Which of the following best describes the role of riboflavin in the body?
Which of the following best describes the role of riboflavin in the body?
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A patient presents with angular stomatitis, cheilosis, and seborrheic dermatitis of the face. What dietary recommendations would you make to prevent further development of these symptoms?
A patient presents with angular stomatitis, cheilosis, and seborrheic dermatitis of the face. What dietary recommendations would you make to prevent further development of these symptoms?
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Which of the following is NOT a gastrointestinal symptom associated with niacin deficiency (pellagra)?
Which of the following is NOT a gastrointestinal symptom associated with niacin deficiency (pellagra)?
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What is the recommended daily intake of niacin for adults?
What is the recommended daily intake of niacin for adults?
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Flashcards
Nutritional Pathology
Nutritional Pathology
The study of how poor nutrition affects health and causes disease.
Macronutrients
Macronutrients
Nutrients needed in large amounts: carbohydrates, proteins, and fats.
Micronutrients
Micronutrients
Essential vitamins and minerals required in smaller amounts.
Malnutrition
Malnutrition
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Marasmus
Marasmus
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Clinical Manifestations of Marasmus
Clinical Manifestations of Marasmus
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Specific Nutritional Deficiency
Specific Nutritional Deficiency
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Electrolyte Imbalance
Electrolyte Imbalance
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Thiamine Deficiency
Thiamine Deficiency
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Beriberi
Beriberi
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Wet Beriberi
Wet Beriberi
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Dry Beriberi
Dry Beriberi
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Infantile Beriberi
Infantile Beriberi
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Neurological Symptoms of Thiamine Deficiency
Neurological Symptoms of Thiamine Deficiency
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Diagnosis of Thiamine Deficiency
Diagnosis of Thiamine Deficiency
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Prevention of Thiamine Deficiency
Prevention of Thiamine Deficiency
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Kwashiorkor
Kwashiorkor
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Clinical Manifestations of Kwashiorkor
Clinical Manifestations of Kwashiorkor
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Flaky-paint rash
Flaky-paint rash
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Treatment of PEM
Treatment of PEM
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Prognosis of PEM
Prognosis of PEM
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Obesity Definition
Obesity Definition
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Obesity Classification
Obesity Classification
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CDC Overweight Percentiles
CDC Overweight Percentiles
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85th percentile BMI
85th percentile BMI
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95th percentile BMI
95th percentile BMI
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Etiology of obesity
Etiology of obesity
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Clinical manifestations of obesity
Clinical manifestations of obesity
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First principle of obesity treatment
First principle of obesity treatment
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Second principle of obesity treatment
Second principle of obesity treatment
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Pickwickian Syndrome
Pickwickian Syndrome
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Energy-Releasing Vitamins
Energy-Releasing Vitamins
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Riboflavin Function
Riboflavin Function
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Riboflavin Deficiency Symptoms
Riboflavin Deficiency Symptoms
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RDA for Riboflavin
RDA for Riboflavin
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Niacin Deficiency Etiology
Niacin Deficiency Etiology
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Pellagra Symptoms
Pellagra Symptoms
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Riboflavin Sources
Riboflavin Sources
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Riboflavin Treatment
Riboflavin Treatment
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Study Notes
Nutritional Disorders
- Nutritional pathology is a branch of pathology that investigates how inadequate or excessive nutrition affects health, leading to disease. It combines biochemistry, physiology, and clinical medicine.
- Chronic diseases like obesity, heart disease, and diabetes are significantly influenced by diet.
- Nutritional deficiencies lead to conditions like anemia, rickets, and scurvy.
Basic Principles of Nutrition
- Macronutrients:
- Carbohydrates provide energy for growth and repair.
- Proteins are essential for growth and repair.
- Fats are crucial for energy storage and cellular structures.
- Imbalance in macronutrients leads to energy deficiencies (hypoglycemia) or excess (obesity).
- Micronutrients:
- Include vitamins (e.g., A, C, D, and B complex) and minerals (e.g., calcium, iron, and magnesium).
- Deficiencies cause diseases such as scurvy (vitamin C deficiency), rickets (vitamin D deficiency), and anemia (iron deficiency).
Malnutrition
- Malnutrition is a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients. It is often detected only through biochemical, anthropometric, or physiological tests..
Forms of Malnutrition
- Under-nutrition (e.g., marasmus)
- Over-nutrition (e.g., obesity, hypervitaminoses)
- Specific deficiencies (e.g., kwashiorkor, hypovitaminoses, mineral deficiencies)
- Imbalances (e.g., electrolyte imbalances).
Etiology of Malnutrition
- Primary Causes:
- Poverty and low purchasing power
- Ignorance and poor food habits
- Scarcity of food supply
- Overpopulation
- Secondary Causes:
- Obesity, insulin resistance, and diabetes
- Hepatobiliary disorders
- Metabolic and renal diseases
- Diarrhea and intestinal malabsorption
- Infections (especially respiratory infections)
Nutritional Deficiency - Pathogenesis Illustration
- Nutrient deficiency leads to tissue depletion.
- Physiological changes result in weight loss and anthropometric measurements changes.
- Biochemical changes in blood, urine, and other bodily fluids happen.
- Clinical and subjective symptoms follow.
- Anatomical abnormalities in organs and tissues appear.
Marasmus
- Prevalence: Common in the first year of life
- Etiology: "Balanced starvation," insufficient breast milk, or diluted milk mixtures.
- Symptoms:
- Wasting and muscle wasting
- Growth retardation
- Mental changes
- No edema (unlike a different nutritional deficiency, Kwashiorkor)
- Laboratory Data: Low serum albumin, abnormal urinary urea/creatinine ratios, low hydroxyproline, infrequent anemia
Kwashiorkor
- Prevalence: Between 1-3 years old
- Etiology: Very low protein intake, but sufficient calories from carbohydrates. Occurs in areas where starchy foods are the main staple. Not an exclusively dietary deficiency.
- Symptoms:
- Edema
- Muscle wasting
- Psychomotor changes
- Hair changes
- Diffuse depigmentation of skin
- Moonface
Treatment of PEM (Protein-Energy Malnutrition)
- Severe PEM requires immediate hospitalization (1-3 months).
- Treat underlying vitamin deficiencies, dehydration, and infections.
- Start feeding as soon as hydration and edema resolved using complete strength nutrition.
- Rehabilitation with high-energy feeds (150–200 kcal/kg/day) to recovery in 4-6 weeks.
Prognosis of PEM
- Severe PEM in infancy can lead to permanent physical and mental growth impairment.
- Early treatment improves prognosis greatly but some mortality rates still occur (up to 50% in first 48hrs depending on patient).
- Causes for mortality could include endocrine, cardiac, or liver failure; electrolyte imbalance, hypoglycaemia and hypothermia.
Obesity
- Definition: Excessive accumulation of fat in subcutaneous and other tissues throughout the body.
- Classification: Overweight (>10% above desirable weight), obese (>20% above desirable weight or BMI of >30, more severe level)
- Classification Standard: Centers for Disease Control (CDC): avoids the use of the term obesity to describe certain categories but instead uses 85th percentile BMI for "at risk" levels and 95th percentile BMI as more severe.
- American Obesity Association: 85th percentile BMI for overweight and 95th percentile BMI for obesity
- Etiology: Excessive food intake compared to expenditure, genetic factors, or psychological or endocrine disorders. Insufficient exercise or lack of physical activity is another significant factor.
- Clinical Manifestations:
- Fine facial features in a taller, seemingly heavy child
- Larger upper arms and thighs
- Genu valgum (knock knees)
- Relatively small hands and fingers
- Adiposity in mammary regions
- Pendulous abdomen with striae
- External genitalia appear smaller in boys, average in girls
Treatment of Obesity
- First principle: Decrease energy intake.
- Medical evaluation to rule out underlying issues
- Food diary to assess current diet.
- Plan a tailored diet.
- Restriction on sweets, fried foods, and fats.
- Milk intake limit ( < 2 glasses /day)
- Second principle: Increase energy output.
- Obtain activity history.
- Increase physical activity.
- Involve in hobbies to reduce boredom
Complications of Obesity
- Pickwickian Syndrome: A rare complication of extreme exogenous obesity, characterized by severe cardiorespiratory distress and alveolar hypoventilation. Symptoms include polycythemia, hypoxemia, cyanosis, and congestive heart failure (CHF)
Energy-Releasing Vitamins
- Thiamine, riboflavin, niacin, and pyridoxine are cofactors for enzymes in energy metabolism. Tissues such as epithelium show rapid growth.
Thiamine (Vitamin B1) Deficiency (Beriberi)
- Pathology: Pyruvic and lactic acid accumulation in the body. This leads to cardiac failure, edema of interstitial tissue, and fatty degeneration of the myocardium.
- Types of Beriberi:
- Wet beriberi: generalized edema and acute cardiac symptoms
- Dry beriberi: similar to peripheral neuritis, no edema
- Infant beriberi: various types: acute cardiac, aphoic, and pseudomeningeal.
- Diagnosis: Clinical manifestations, therapeutic test, blood lactic and pyruvic acid test, decreased red blood cell transketolase.
- Prevention: Rich sources of thiamine include meat, whole grains, and enriched cereals.
Riboflavin (Vitamin B2) Deficiency
- Functions: Riboflavin acts as a coenzyme for flavoprotein in CHO metabolism and cellular respiration. Essential to retinal eye pigments for light adaptation
- Clinical Manifestations: Common lesions include (angular) stomatitis, cheilosis, stomatitis, nasolabial seborrhea or dyssebacia, angular palpebritis, scrotal/vulvar dermatosis, and ocular symptoms (photophobia, blurred vision, itching, and corneal vascularization).
- Diagnosis: Urinary riboflavin determination, RBC riboflavin load test.
- Prevention: Food sources rich in riboflavin include eggs, liver, meat, fish, milk, and green leafy vegetables.
- Treatment: Riboflavin 2-5mg daily and increase B-complex, parenteral if necessary
Niacin (Vitamin B3) Deficiency (Pellagra)
- Etiology: Low niacin and/or tryptophan intake.
- Clinical Manifestations:
- Beginning symptoms of anorexia, weakness, irritability, and numbness, often followed by dermatitis, diarrhea, and dementia.
- Dermatitis often appears initially symmetrical erythema, followed by drying, scaling, pigmentation, and sometimes vesicles.
- Predilection for the back of the hands, wrists, forearms (“pellagra glove”.
- Diagnosis: Diet history, look for clinical manifestations indicative of poor niacin or tryptophan diet plus clinical symptoms.
- Prevention: Eat food sources rich in niacin and tryptophan, limit corn intake.
- Treatment: Niacin (50–300mg daily for long time if needed), soothing lotions for skin lesions.
Pyridoxine (Vitamin B6) Deficiency
- Functions: Vitamin B6 is involved in various metabolic processes, including amino acid metabolism, neurotransmitter synthesis, and niacin synthesis.
- Etiology: Losses from food processing/cooking, malabsorptive diseases (e.g., celiac disease), or drug interactions (e.g., INH therapy).
- Clinical Manifestations:
- Various clinical presentations including neuropathic (irritability, depression, somnolence), pellagrous (seborrheic dermatitis, angular stomatitis, glossitis), and anemic types
- Diagnosis: Tryptophan load test, blood tests.
- Prevention: Consume foods rich in pyridoxine (e.g., meat, whole wheat, corn, egg yolks, liver)
- Treatment: Pyridoxine supplementation.
Hematopoietic Vitamins
- Necessary to produce blood, especially red blood cells.
Folic Acid (Vitamin B9) Deficiency
- Functions: Crucial for DNA synthesis, cell formation, esp. red blood cells, needed for new cell formation(e.g., in GI cells)
- Etiology: Low intake of folate, malabsorption, medications, chronic inflammation, increased requirements during pregnancy and rapid growth, or alcohol use.
- Clinical Manifestations:
- Megaloblastic anemia, irritability, failure to gain weight, diarrhea (chronic)
- Thrombocytopenic hemorrhages
- Scurvy (symptoms) may be present
- Anemia, macrocytic
- Diagnosis: Low folic acid level (<3ng/ml), abnormal blood cell morphology on lab analysis , increased homocysteine in the blood.
- Prevention: Rich dietary intake
- Treatment: Folic acid supplementation (parenteral if needed).
Cobalamine (Vitamin B12) Deficiency
- Absorption: Cobalamin requires intrinsic factor (IF) from the stomach to be absorbed.
- Etiology: Congenital deficiency (e.g., lack of intrinsic factor), inadequate intake (e.g., strict vegetarian diet), malabsorption, or disease that damages the absorption sites in the stomach or small intestine (e.g., pernicious anemia, celiac disease).
- Clinical Manifestations:
- Neurological issues like ataxia, paresthesias, hyporeflexia, Babinski responses, clonus, coma.
- Macrocytic anemia (large blood cells).
- Smooth, red, and often painful tongue
- Elevated methylmalonic acid levels in the urine (a diagnositc test for deficiency).
- Diagnosis: Low serum vitamin B12 levels, elevated serum homocysteine or methylmalonic acid
- Prevention: Eat foods rich in vitamin B12 (e.g., meat, eggs, dairy).
- Treatment: Cyanocobalamin injections or high oral maintenance dose, or both if needed to correct and/or maintain cobalamin levels.
Ascorbic Acid (Vitamin C) Deficiency (Scurvy)
- Functions: Collagen formation, synthesis of steroids, iron absorption, and maintenance of normal B vitamins and folate.
- Etiology: Dietary deficiencies, improper cooking practices, faulty dietary habits, or malabsorption.
- Clinical Manifestations:
- Easy bruising (petechiae) and ecchymosis
- Easy bleeding
- Swollen and bleeding gums (often painful)
- Poor wound healing, weak collagen , delayed bone growth and deformities
- Corkscrew hairs
- Painful and immobile legs
- Swelling (oedema)
- Diagnosis: History, clinical picture, abnormal X-rays (pencil-thin cortex, dumbell/club shaped bones,) lab values (zero or low vitamin C), and/or therapeutic test.
- Prevention: Eat fruits and vegetables rich in vitamin C.
- Treatment: Ascorbic acid supplementation
Overall note:
- These notes cover the key aspects of nutritional disorders, from their causes and symptoms to their treatment and prevention
- Several nutritional deficiencies focus on infants and early development and symptoms often appear as generalized and/or delayed development or growth
- Several disorders correlate with symptoms or conditions that require specialist diagnosis and treatment.
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Description
Test your knowledge on child nutrition and obesity-related conditions such as Marasmus and Kwashiorkor. This quiz covers clinical manifestations, dietary recommendations, and the roles of various nutrients. A must-take for anyone interested in pediatric health and nutrition.