An apathetic male infant in an underdeveloped country is found to have peripheral edema, a “moon” face, and an enlarged, fatty liver. Which of the following is the basic defect causing this change in the liver?
a.Decreased protein intake leads to decreased lipoproteins
b.decreased caloric intake leads to hypoalbuminemia
c.decreased carbohydrate intake leads to hypoglycemia
d.decreased fluid intake leads to hypernatremia
e.decreased fat absorption leads to hypovitaminosis
ans:
Protein-energy malnutrition (PEM) in underdeveloped countries leads to a spectrum of symptoms from kwashiorkor at one end to marasmus at the other. Marasmus, caused by a lack of caloric intake (i.e., starvation), leads to generalized wasting, stunted growth, atrophy of muscles, and loss of subcutaneous fat. There is no edema or hepatic enlargement. These children are alert, not apathetic, and are ravenous. In contrast, children with kwashiorkor, which is characterized by a lack of protein despite adequate caloric intake, have peripheral edema, a “moon” face, and an enlarged, fatty liver. The peripheral edema is caused by decreased albumin and sodium retention, while the fatty liver is caused by decreased synthesis of the lipoproteins necessary for the normal mobilization of lipids from liver cells. Additionally, these children have “flaky paint” areas of skin and abnormal pigmented streaks in their hair (“flag sign”). In children with marasmus, the skin is inelastic due to loss of subcutaneous fat. In either severe kwashiorkor or marasmus, thymic atrophy may result in the reduction in number and function of circulating T cells. B cell function (i.e., immunoglobulin production) is also depressed, so that these children are highly vulnerable to infections.