Nutritional Assessment - Clinical Signs of Malnutrition

Question 1

What is glossitis? What causes it?

Answer 1

People with glossitis often have troubles swallowing, due to burning sensation. Often seen during burns

• Causes: deficiencies of riboflavin, niacin, biotin, vitamin B6, vitamin B12, folate, iron, zinc.
• Dietary, metabolic or drug-nutrient interactions.

Question 2

Biochemitry to confirm glossitis?

Answer 2

• B6 indicators (pyridoxal: PL, pyridoxal5’phosphate: PLP)
• B12 Shillings test and RBC panel (micro/macrocytic),
• serum zinc, riboflavin
• RBC glutathione reductase, niacin & biotin (no good markers).

Question 3

What is Angular Cheilitis?

Answer 3

Due to deficiency of B-vitamins, niacin, riboflavin, vitamin B6/

• Indicators for B vitamins can be challenging and are often not tested.
• These burns, and as they open their mouth they will split and burn.

Note that water soluble vitamins do not stick around long, and they can become depleted quite quickly

Question 4

What is Angular Stomatitis?

Answer 4

• Riboflavin deficiency usually occurs with a deficiency of other members of the B-complex.
• Ocular symptoms, such as eye strain and fatigue, itching, burning, and sensitivity to light may precede other symptoms. C
• Characteristic lesions of the lips, the most common of which are angular stomatitis and cheilosis (cracks at the corners of the mouth).
• Seen in IDA and PEM

Question 5

What is Koilonychia?

Answer 5

• Possible deficiency of iron and chromium
• Spoon shape sometimes will happen in inflammatory bowel disease, iron deficiency and Chrons disease.

Question 6

What are Meuhirkes lines?

Answer 6

Associated with protien malnutrition and hypoalbuminemia

-White lines on toenails

Question 7

What is Acanthosis Nigicans?

Answer 7

• Causes: hyperglycemia, diabetes, Cushing syndrome, acromegaly, polycystic ovary syndrome, and thyroid disease. Confirmation upon clinical chemistry including fasting glucose, OGTT, HBA1c.
• Ensure that we don’t jump to a conclusion of T2D, it could be many other issues. If it’s not diabetes, it may be more indicative of malnutrition.

Question 8

What is Xanthelasma and Arcus Senilis ?

Answer 8

Seen in hypercholesterolemia

See the cholesterol buildups, rings around the eyes and the buildup within the corner of the eyes.

Question 9

What is Finger clubbing associated with?

Answer 9

• Associated with many chronic diseases
• CF, celiac disease, IBD, hepatic diseases, etc.
• Fingers are becoming significantly clubbed at the end, which is a sign of a chronic inflammatory disease. This is different than arthritis.

Question 10

What is leukonychia of the nails?

Answer 10

Associated with chronic disease, hypoalbuminemia, liver diseases

Question 11

What is Oral candidiasis? is it realted to malnutrition?

Answer 11

• No, but may cause difficulties with intakes
• Swallowing will be very painful

Question 12

What is Apthous Ulcer? Is it related to malnutrition?

Answer 12

• No, but may impact intake
• Makes swallowing very painful

Question 13

What is Kaposi’s Sarcoma? Is it related to malnutrition?

Answer 13

-No, but may impact intake

Sores may be found in the GI tract which can effect absorption.

-This clinical stage usually means that CD4/CD8 cell counts are low