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    Roxanita is offline Senior Member
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    Physiology N* Q-19

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    A 5-year-old girl from sub-Saharan Africa is brought to the health clinic by her mother because of diarrhea for the past 4 weeks. Her pulse is 150/min, and blood pressure is 80/40 mm Hg. Physical examination shows edema of the face, abdomen, and legs. She is listless and has reddish hair. Serum albumin concentration is 1.2 g/dL. Compared with a healthy child, which of the following findings is most likely in this girl?
    A ) Decreased interstitial fluid volume
    B ) Decreased interstitial hydrostatic pressure
    C ) Decreased plasma oncotic pressure
    D ) Increased capillary hydrostatic pressure
    E ) Increased plasma volume

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    protein

    decreased oncotic pressure

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    Roxanita is offline Senior Member
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    try

    c) Decreased plasma oncotic pressure

    The question is describing a 5y.o. little girl from Africa with history of 4 weeks with diarrhea; generalized edema; listless; hair changes; hypoalbuminemia. We have everything to determine that we have a case of PEM (protein energy malnutrition) called Kwashiorkor.

    Check this out


    http://www.fao.org/DOCREP/W0073e/w0073e05.htm

    Kwashiorkor occurs when protein deprivation is relatively greater than the reduction in total calories. This is the most common form seen in African children who have been weaned (often too early, owing to the arrival of another child) and are subsequently fed an exclusively carbohydrate diet. The prevalence of kwashiorkor is also high in impoverished countries of Southeast Asia. Less severe forms may occur worldwide in persons with chronic diarrheal states in which protein is not absorbed or in those with conditions in which chronic protein loss occurs (e.g., protein-losing enteropathies, the nephrotic syndrome, or after extensive burns).

    Kwashiorkor is a more severe form of malnutrition than marasmus. Unlike marasmus, marked protein deprivation is associated with severe loss of the visceral protein compartment, and the resultant hypoalbuminemia gives rise to generalized or dependent edema.


    The weight of children with severe kwashiorkor is typically 60% to 80% of normal. However, the true loss of weight is masked by the increased fluid retention (edema). In further contrast to marasmus, there is relative sparing of subcutaneous fat and muscle mass. The modest loss of these compartments may also be masked by edema. Children with kwashiorkor have characteristic skin lesions, with alternating zones of hyperpigmentation, areas of desquamation, and hypopigmentation, giving a "flaky paint" appearance.

    Hair changes include overall loss of color or alternating bands of pale and darker hair, straightening, line texture, and loss of firm attachment to the scalp.

    Other features that differentiate kwashiorkor from marasmus include an enlarged, fatty liver (resulting from reduced synthesis of carrier proteins) and a tendency to develop early apathy, listlessness, and loss of appetite.

    In kwashiorkor (rarely in marasmus), the small bowel shows a decrease in the mitotic index in the crypts of the glands, associated with mucosal atrophy and loss of villi and microvilli. In such cases, concurrent loss of small intestinal enzymes occurs, most often manifested as disaccharidase deficiency. Hence, infants with kwashiorkor initially may not respond well to a full-strength, milk-based diet. With treatment, the mucosal changes are reversible.

    The bone marrow in both kwashiorkor and marasmus may be hypoplastic, mainly because of decreased numbers of red cell precursors. How much of this derangement is due to a deficiency of protein and folates or to reduced synthesis of transferrin and ceruloplasmin is uncertain. Thus, anemia is usually present, most often hypochromic microcytic anemia, but a concurrent deficiency of folates may lead to a mixed microcytic-macrocytic anemia.

    The brain in infants who are born to malnourished mothers and who suffer PEM (protein energy malnutrition) during the first 1 or 2 years of life has been reported by some observers to show cerebral atrophy, a reduced number of neurons, and impaired myelinization of the white matter, but there is no universal agreement on the validity of these findings.

    Many other changes may be present, including:
    (1) thymic and lymphoid atrophy (more marked in kwashiorkor than in marasmus): (2) anatomic alterations induced by intercurrent infections, particularly with all manner of endemic worms and other parasites; and (3) deficiencies of other required nutrients, such as iodine and vitamins.

    Figure: Kwashiorkor. The infant shows generalized edema, seen in the form of puffiness of the face, arms, and legs. Here is a picture of classic kwashiorkor, with pitting edema and dead skin at the joints.


    http://www.freerepublic.com/focus/f-news/1169179/posts

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