nutritional disorder
Introduction
Introduction Nutritional disorders are common in malnutrition. Malnutrition in a broad sense should include both undernutrition or deficiency and overnutrition.
Cause
Cause
The cause of nutritional disorders:
Malnutrition often occurs in a number of medical and surgical causes, such as chronic diarrhea, short bowel syndrome, and malabsorption. The non-medical cause of malnutrition is a shortage of poor food. Lack of nutritional knowledge, parents ignore scientific feeding methods. Malnourished patients in developed countries can usually be treated by treating the primary disease, providing an appropriate diet, educating parents and carefully following up. But in many third world countries, malnutrition is the leading cause of child death. There are complex interactions between malnutrition, social habits, the environment, and acute and chronic infections, and treatment is very difficult, and it is not just a matter of providing the right food.
Examine
an examination
Related inspection
Body function and vegetative growth hormone
Examination and diagnosis of nutritional disorders:
1. History: It is necessary to master the dietary intake of children, eating habits, conduct a dietary survey to evaluate the intake of protein and heat, whether it affects the digestion, absorption, chronic wasting disease, and understand the general condition of the family, family members Growth patterns, parental height, weight, and level of care for the child.
2. Clinical symptoms: There are often two typical symptoms. The marasmus is caused by a severe deficiency of heat energy. The child is short and thin, the subcutaneous fat disappears, the skin pushes the elasticity, the hair is dry and easy to fall off, the body is weak and weak, and the hair is weak. The other type is edema (kwashiorkor) caused by severe protein deficiency, edema around the body, edema of the eyelids and lower body, dry and shrinking skin, keratinized desquamation, or pigmentation, fragile and fragile hair, fragile nails Transverse groove, no appetite, large liver, often diarrhea and watery stools. There is also a hybrid type, somewhere in between. And can be accompanied by the performance of other nutrient deficiencies.
3. Physical measurement: Physical measurement is the most reliable indicator for assessing malnutrition. At present, there are major changes in the measurement indicators for evaluating malnutrition in the world. It consists of three parts.
(1) Low body weight: The child's age-specific body weight is less than the median minus 2 standard deviations, but higher than or equal to the median minus 3 standard deviations, which is moderate compared with the same age and gender reference population standard. Poor weight, such as a median of less than the standard population minus 3 standard deviations for severe weight loss, this indicator reflects the child's past and/or now has chronic and/or acute malnutrition, which alone cannot distinguish acute Still chronic malnutrition.
(2) Growth retardation: The age and gender height of children are 2 standard deviations below the median, but less than or equal to the median minus 3 standard deviations, which is moderate compared with the same age and gender reference population standard. Growth retardation, such as a median decrease of 3 standard deviations below the reference population, is a severe growth retardation. This indicator mainly reflects chronic malnutrition in the past or long-term.
(3) Weight loss: Children's height and weight are less than the median minus 2 standard deviations compared with the same age and the same sex reference population standard, but higher than or equal to the median minus 3 standard deviations, which is moderate weight loss. If the median of the reference population is less than 3 standard deviations, it is severely wasted. This indicator reflects the child's recent acute malnutrition.
Diagnosis
Differential diagnosis
Symptoms of dysfunction of nutritional disorders:
1, juvenile proximal spinal muscular atrophy: this disease is also known as (Kugelberg-welander, progressive muscular atrophy), is an autosomal dominant genetic disease. The onset of adolescents is mainly characterized by proximal muscle atrophy of the extremities, symmetric distribution, similar to myopathy, but fasciculation, electromyography is neurogenic damage, and muscle pathology is group atrophy, consistent with denervation.
2, chronic polymyositis: no history of genetic disease, the disease progresses slowly, the symptoms often have ups and downs, the degree of muscle weakness is more obvious than muscle atrophy. There is often pain and tenderness, and the blood sedimentation increases. Serum muscle enzymes are normal or slightly elevated, muscle pathology is consistent with changes in myositis, and corticosteroids are better.
3, myotonic dystrophy: the disease is rare, is autosomal dominant inheritance. Any age can be ill, first involving the small muscles of the distal hand and foot, no pseudo-hypertrophy, early manifestations of weakness in the distal part of the limb, occasionally facial muscle, eye muscle or throat muscle weakness. Progression is slow, and muscle rigidity and muscle atrophy gradually appear. Muscle atrophy is mainly at the distal end of the extremities, and can be developed to the facial muscles, masseter muscles, diaphragm muscles, and sternocleidomastoid muscles. Therefore, the patient's face is elongated and has an axe face and a gooseneck. Some patients may also have unclear speech and difficulty swallowing. Most patients have cataracts, alopecia, sexual dysfunction, infertility, and mental retardation. In the advanced stage, sputum and myocardial damage may occur, and serum enzymes may be normal or slightly elevated. Electromyography and muscle pathology help to identify.
4, weight loss: body fat and protein decreased, weight loss more than 10% of the normal standard, known as weight loss. The weight loss referred to here is generally positive in the short term. There is a comparison of the weight values measured before and after the weight loss, and there are obvious clothes loose, the belt becomes loose, the shoes become larger and the subcutaneous fat is reduced, the muscles are thin, and the skin is slack. , bones stand out and other circumstantial evidence. As for the weight loss after dehydration and edema subsided, it cannot be called weight loss.
