Nutrition

Nutrition DR.
Abo-Asrar
Nutrition neonatology Infection Nutrition
Nutrition
nutritional disorder nutritional disorder pure Genetics
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Nutrition DR. Abo-Asrar
Rickets
Nutritional disorder Kwashiorkor marasmus
full sheet examination full history examiner discussion Direct face to face discussion
Nutritional disorder no excuse
fatal Nutritional disorder fatal Nutritional disorder
nutritional disorder
Pure written clinical written
Tetany tetany
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Nutrition DR. Abo-Asrar Nutritional assessment nutritional disorder written
title
Hyper vitaminosis D Hyper vitaminosis written vitamin D Hyper vitaminosis D dose D Hypo
written
Nutritional disorder written clinical clinical written clinical written Rickets Marasmus Rickets
written
Kwashiorkor
Kwashiorkor Marasmus Rickets 80 %
Rickets
Rickets
rickets rickets bone
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basics
Nutrition DR. Abo-Asrar bone
bone Medulla cortex cortex hematology medulla bone medulla
cortex cortex cortex Protein part protein cortex osteoid tissue soft tissue protein bone soft tissue part cortex Protein part osteoid tissue bone matrix
cement Mineral part Mineral part Ca phosphate
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Nutrition DR. Abo-Asrar cement Ca phosphate
collagen fibers collagen fibers
cortex fragile bone liable to fracture fragile
protein part part osteoporosis protein part osteoporosis defect bone
bone
protein part
osteoporosis defect osteoid tissue
bone
Protein part
protein deficiency Marasmus

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Nutrition DR. Abo-Asrar Kwashiorkor Kwashiorkor Marasmus
muscle bone Kwashiorkor
Muscle muscle
osteoporosis
Marasmus bone Osteoporosis bone
mineral part mineral part Rickets bone mineralization defect rickets mineral part of the bone defect rickets
Osteomalacia Rickets Osteomalacia
adult
defect in mineralization of the bone Osteomalacia defect in mineralization of the bone Rickets
collagen fibers
Liable to fracture bone diseases X -ray Osteogenesis imperfecta bone

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collagen fibers supporting
Nutrition DR. Abo-Asrar bone diseases osteogenesis imperfecta X - rays
osteoporosis rickets osteogenesis imperfecta
bone
cortex defect cortex Protein part bone Mineral part collagen fibers supporting
mineralization of the bone Mineralization of the bone Mineralization of the bone
rickets defect
apotosis
Mitosis
mineralization of the bone mineral part
functioning New bone bone Mineral part

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active
osteoblast cell osteoblast cells New bone Osteoblast
deposition of calcium and phosphate inside the bone New bone formation
Osteoclast cells
bone bone osteoclast Osteoblast
Osteoclast osteoblast
Branched cells branched cells bone marrow bone marrow osteoclast stem cells bone marrow
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Osteoblast
Nutrition DR. Abo-Asrar osteoclast osteoblast bone marrow stem cells
colony Dendritic cells Dendritic cells dendritic cells generation dendritic cells bone marrow osteoblast osteoblast osteoclast
stem cells of the bone marrow osteoclast
new bone formation old bone
Mineralization of the bone osteoclast Osteoblast osteoblast osteoblast osteoblast New bone formation Rickets Patho physiology Rickets patho physiology
Ca metabolism vitamin D metabolism biochemistry Rickets vitamin D deficiency Patho physiology and clinical manifestations of rickets
Osteoblast bone osteoblast

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Nutrition DR. Abo-Asrar dendritic cells dendritic cells nucleus
blood bone Mineralization bone
Osteoblast Osteoblast vesicle
vesicle blood vesicle Phosphorus bone vesicle blood
In organic In organic chemistry phosphorus
osteoblast
In organic phosphorus is in organic calcium phosphorus
osteoblast
calcification
Osteoblast Ossification
vesicle osteoblast
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10
Nutrition DR. Abo-Asrar osteoblast vesicle
Organic phosphate
vesicle vesicle
Phosphorus phosphorus Organic phosphate Phospho ethanol amine Phospho ethanol amine
phospho ethanol amine organic phosphate Organic In organic Phosphorus Organic form Organic phosphate Organic phosphate vesicle in organic phospho ethanol amine
Phospho ethanol amine
organic
osteoblast
New bone formation
osteoblast
osteoblast cell membrane
vesicle
cell membrane bone matrix

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vesicle
11
Nutrition DR. Abo-Asrar Organic phosphate
bone matrix Organic phosphate bone matrix
New bone osteoblast cytoplasm In organic form cytoplasm osteoblast cytoplasmic enzyme organic phosphate phosphorus Alkaline phosphatase osteoblast cytoplasm alkaline phosphatase organic phosphate alkaline phosphatase in organic phosphorus
In organic bone matrix In organic In organic Phosphorus bone bone calcium phosphate bone crystals calcium apatite crystals
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12
crystal calcium apatite crystal
crystals technology dynamics
Underlying physiology Physiology Manual worker
Manual worker bone mineral density Mineral part
fracture Non manual worker
manual worker
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13
Nutrition DR. Abo-Asrar Mental worker vast activity manual work
bone mineral density bone
fracture
fissure fracture comminuted fracture
bone
manual workers muscular activity Osteoblast Osteoblast
Insertion
origin muscle muscular activity contraction muscle Insertion origin origin
bone
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Insertion
14
Nutrition DR. Abo-Asrar bone crystals bone pressure friction energy
Osteoblast main stimulus inside the bone calcium apatite crystals bone crystals friction calcium phosphorus crystals muscle contraction osteoblast calcium phosphate Osteoblast New crystals
fully saturated
bone
muscle contraction crystals crystals
Pressure
bulk
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crystals
Osteoblast osteoblast saturation
bone
crystals
bone
crystals
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Rickets
phosphate crystals crystals bone
rickets
crystals
rickets
Osteoblast activity Osteoblast alkaline phosphatase organic phosphate crystals alkaline phosphatase
alkaline phosphatase Phosphorus In organic
serum
serum alkaline phosphatase
laboratory investigations rickets alkaline phosphatase rickets Osteoblast hyperactivity osteoblast hyperactivity rickets osteoblast rickets osteoblast osteoblast hyperactivity
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alkaline phosphatase
osteoblast alkaline phosphatase alkaline phoshphatase
rickets
alkaline phosphatase osteoblast hyper activity osteoblast activity number of calcium apatite crystals bone bone crystals friction energy continuous stimulation alkaline phosphatase alkaline phosphatase
Osteoblast
rickets
rickets
osteoblast activity Osteoblast activity rickets calcium apatite crystals
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apatite crystals friction energy osteoblast alkaline phosphatse osteoblast
rickets alkaline phosphatase Hypophosphatsia phosphatsia alkaline phosphatase osteoblast alkaline phosphatase bone organic phosphate
Hypo
rickets
In organic form bone rickets
diagnostic investigation Hypophosphatasia alkaline phophatase alkaline phosphatase alkaline phosphatase kwashiorkor marasmus Hypophosphatasia alkaline phosphatase
in organic
organic organic phosphate phospho ethanol amine
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19
Nutrition DR. Abo-Asrar bone
Urine urine hypophosphatasia diagnostic investigation urine Organic phosphate phosphorus urine in organic Urine Organic phosphorus Hypophosphatasia diagnostic investigation phospho ethanol amine urine hypo phosphatsia
Hypo phosphatsia resistant rickets
calcium metabolism
Ca metabolism
Factors affecting calcium absorption
factors affecting calcium absorption factors affecting calcium absorption
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PH of the duodenum
first part of the duodenum
Calcium site of absorption absorption PH of the duodenum
calcium absorption
calcium absorption acidic PH Acidic PH absorption
acidic PH alkaline PH calcium absorption alkaline PH
nutrient alkaline
breast milk reaction breast milk acidic nutrient alkaline acidic PH of the stomach PH of the stomach duodenum acidity calcium absorption cow milk alkaline calcium buffalo milk
reaction alkaline cow
rickets
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2:1
gut
calcium phosphorus ratio absorption calcium phosphorus ratio 1:1 2:1 calcium absorption calcium phosphorus ratio
phosphorus
breast milk
exactly breast milk
Level of absorption of calcium in breast milk cow milk phosphorus excess phosphate phosphorus absorption cow milk buffalo milk rickets alkaline PH excess phosphate excess phosphate calcium absorption
gut
calcium
absorption gut content of the food food contents iron absorption vitamin C protein absorption
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Nutrition DR. Abo-Asrar absorption absorption acidic vitamin C activity
acidity acidity acidity absorption calcium
absorption iron
oxalate absorption
Phytate
Hormonal factors Hormonal factors metabolism hormonal factors active form of vitamin D hormone 1, 25 dihydroxy cholcalciferol vitamin D3 Active form of vitamin D 1, 25 dihydroxy cholcalciferol active form of vitamin D
bone calcium Phosphorus Osteoblast phosphorus calcium bone

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vitamin D main goal
23
Nutrition DR. Abo-Asrar bone formation serum calcium serum calcium bone vitamin D GIT receptor calcium and phosphorus
absorption
receptors
absorption
GIT receptors Phosphorus GIT GIT GIT
kidney re absorption of phosphate mainly Kidney calcium phosphorus kidney
bone bone bone osteoblast activity osteocalast osteoclast activity suppression bone osteoblast stimulation osteoclast suppression
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24
Nutrition DR. Abo-Asrar cells suppression activation dominant
heart
peace maker S. A. node
decerbrated brain death beats Monitor neurologically died heart Normal peace maker of the heart
peace maker sympathetic Para sympathetic thyroxin thyroxin peace maker factors
bone Local dynamic
Osteoblast
osteoblast Osteoclast new bone formation
vitamin D GIT kidney
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25
Nutrition DR. Abo-Asrar calcium and phosphate bone bone osteobalst New bone mineral part rickets
osteomalacia
vitamin D Hyper vitaminosis D D vitamin D calcium intake

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vitamin D
with out calcium
vitamin D without viatmin D vitamin D Vitamin D Phosphorus
phosphorus
GIT
phosphorus tubules Osteoblast bone osteoblast activity Osteoblast serum calcium serum calcium serum calcium osteoblast new bone
serum
osteoblast phosphate
serum calcium Hyper vitaminosis D without ca supplementation hypo calcemia tetany hypo calcemia tetany
vitamin D Phosphorus Osteoblast Osteoblast fully saturated

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GIT
27
Osteoblast vitamin D Osteoblast
fully saturated
serum calcium calcium Phosphate pathological calcification Pathological calcification phosphate urine calcium phosphate Oxalate calcium oxalate stones renal parenchyma Nephro calcinosis calcification vessels calcification valves of the heart calcification hyper calcemia And metastatic calcification
rickets
Hypo vitaminosis D
hypo calcemia and tetany

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hyper vitaminosis D
28
Nutrition DR. Abo-Asrar calcium supplemention metastatic calcification Hyper calcemia adequate calcium supplemention
para thyroid hormone vitmain D GIT para thyroid hormone serum calcium serum calcium calcium sensor para thyroid calcium receptor calcium senosr 10.5 8.5
serum clacium
para thormone horomone Para thormone hormone serum calcium
bone bone osteoblast suppression osteoclast Hyper activity osteoblast Osteoclast bone
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activity
29
kidney Urine urine
receptors
serum calcium bone calcium
bone calcium
serum calcium serum phosphate serum phosphate
urine urine
urine Urine calcium Phophate
phosphate urine calcium phosphate calcium Phosphate calcium bone
Para thormone hormone serum calcium serum phosphate urine phosphate urine calcium urine bone Phosphorus calcium bone rachetic manifestations
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calcitonin

Ultra violet rays
dark races
ultra violet rays Nucleus
Ultra violet rays
receptors ultra violet rays
sensitivity
ultra violet rays ultra violet rays Ultra violet rays receptors Ultra violet rays sensitivity
extremities
Ultra violet rays

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Ultra violet rays vitamin A and vitamin D
Ultra violet rays
white races
receptors vitamin D
receptors sensitivity
Ultra violet rays Ultra violet rays Ultra violet rays 4 12 Ultra violet rays
Ultra violet rays
Ultra violet rays skin burn cnacer
Ultra violet rays
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Nutrition DR. Abo-Asrar extremities of the day
Ultra violet rays Human being
Ultra violet rays Ultra violet rays Ultra violet rays
ultra violet rays Ultra violet rays Pollution
Ultra violet rays
ultra violet rays
skin Ultra violet rays 7 dehydro cholesterol vitamin D3 ultra violet rays Ultra violet rays skin cholesterol
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receptors
33
Nutrition DR. Abo-Asrar 7 dehydro cholesterol ultra violet rays vitamin D3 cholcalciferol vitamin D vitamin D ultra violet rays
vitamin D
Intake plant sources animal sources ergosterol Ultra violet rays Intake Plant
ergosterol vitamin D2 ergo calciferol calciterol ergosterol Ultra violet rays ergo calciferol
vitamin D2
ergo calciferol vitamin D
vitamin D2 vitamin D3 vitamin D Vitamin D3 vitamin D3
Liver
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34
Nutrition DR. Abo-Asrar site of the stores Liver
vitamin D3
vitamin D
vitamin D3 vitamin D3
cholecalciferol vitamin D3 vitamin D2 vitamin D2 stomach vitamin D3 vitamin D2 stomach cholecalciferol
vitamin D2
calciferol vitamin D3
stomach vitamin D3 fat soluble vitmain D3 absorption fat soluble bile vitamin D absorption first part of the duodenum second part second part
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35
Nutrition DR. Abo-Asrar jejunum absorption vitamin D3 vitamin D3 exposure to ultra violet rays in take Even
site of the stores Liver stores
Vitamin D3
Liver Vitamin D3
vitamin D stores Liver
Iron animal milk breast milk vitmain D deficient vitamin D deficient
Milk animal milk breast milk Both are deficient of vitamin D stores breast milk deficiency artificial milk rickets
rickets iron deficiency

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stores
36
Nutrition DR. Abo-Asrar stores stores stores Preterm stores
Intra uterine growth retardation stores vitamin D deficiency stores onset of rickets Vitamin D deficiency rickets
stores rickets
rickets preterm Intra uterine growth retardation vitamin D deficiency
stores
stores
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weaned
vitamin D
artificial milk
rachitic stores breast milk
delayed weaning Rickets faulty weaning Faulty weaning
vitamin D faulty weaning
delayed weaning faulty weaning vitamin D
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Nutrition DR. Abo-Asrar activation activation vitamin D activation activation OH active form 1,25, dihydroxy 2OH Liver carbon atom 25 25 hydroxy cholcalciferol Kidney 1 carbon atom 1,25, dihydroxy cholcalciferol
metabolism of Vitamin D Metabolism vitamin D deficiency
Vitamin D deficiency
vitamin D deficiency Intake vitamin D faulty weaning non nutrition
faulty weaning
malnutrition
malabsorption syndrome
absorption vitmain D deficiency malabsorption bile vitamin D absorption bile
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Nutrition DR. Abo-Asrar Obstructive jaundice repeated attacks of gastroentritis
repeated infection repeated attacks of gastroenteritis repeated attacks of gastroenteritis rickets
rpeated gastroentritis
rickets gastroenteritits
rickets
complication
absorption Intake absorption Ultra violet rays
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Ultra violet rays
ultra violet rays
rickets
ultra violet rays
Ultra violet rays
ultra violet
Ultra violet rays
rickets
pollution Ultra violet rays

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Liver Liver liver cirrhosis stores Liver rickets rickets renal disease Hydroxylation
durg induced rickets rickets Drug induced Drug induced rickets rickets drugs anti epileptic
rickets
anti epileptic drugs
anti epileptic drugs Liver vitamin D Liver catabolism Liver vitamin D toxic rapid hydroxylation
Osteomalacia
osteoporosis osteoporosis
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Nutrition DR. Abo-Asrar osteomalacia GIT vitamin D receptors block cortisone GIT vitamin D receptors block
Osteomalacia
osteoporosis
osteomalacia
osteoporosis
osteoporosis catabolism of protein bone osteomalacia GIT vitamin D receptor block absorption
calcium absorption
ant acids rickets rickets anti acids calcium absorption rickets antiacids
history etiology History
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43
Nutrition DR. Abo-Asrar rachetic rachetic rickets hisotry
rickets
preterm
Full term
preterm
Preterm
full term Pre term stores
700 800 Intra uterine growth retardation stores
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44
calcium absroption
artificial milk rickets alkaline PH phosphate
delayed weaning stores
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45
delayed weaning delayed weaning
delayed weaning
delayed
vitamin D
faulty weaning
vitamin D absroption
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46
Nutrition DR. Abo-Asrar repeated attacks of gastroenteritis malabsroption obstructive jaundice Liver affection vitamin D
mal
Liver
anti epileptic drug
Chronic ITP rickets What ever
6 : 33
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47
metabolism of calcium Factors affecting calcium metabolism vitamins D metabolism vitamin D deficiency rickets rickets in general patho physiology of rickets
patho physiology satisfied
Patho physiology of Rickets

bone Mineral part of the bone mineral part mineralization of the bone defect rickets
bone
mineral part calcium
mineral part calcium rickets cortex of the bone calcium osteoid tissue deposition suppression
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48
osteoid tissue depot over depot bone Mineral part osteoid tissue part mineral part cement
tissue
bone calcium over deposition of osteoid Limit suppression
osteoid tissue
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osteoid tissue Over deposition
bone
bone bone Joint
Joint joint two bones
Joint joint
Joint very smooth
smooth cartilage smooth cartilage
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50
Nutrition DR. Abo-Asrar cartilage smooth surface cartilage
cartilage Joint space synovial fluid joint space
synovial fluid
cartilage cartilage cartilage
cartilage
cartilage
cartilage cartilage
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51
Nutrition DR. Abo-Asrar cartilage proliferation
bone
calcium osteoid tissue deposit
proliferation of the cartilage
patho physiology of rickets 9 : 05 rickets rickets vitamin D
Phosphorus kidney bone
vitamin D absorption GIT reabsorption deposits of calcium
bone rickets bone
Osteoid tissue suppression cartilage proliferation suppression excess osteoid tissue deposit
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52
Nutrition DR. Abo-Asrar Of the cartilage proliferation of the
Mineral part
osteoid tissue growth
rate
growth of the bone muscle
bone and muscles
skeletal system weak bone and muscles weak Motor development Normal
delayed motor development
History
growth and development Neck support
crawling supported with one hand
In child manner In child manner
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53
Nutrition DR. Abo-Asrar say
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54
rickets history History of delayed motor development
bone skeletal system
teeth teeth
Jaw
sockets
Mineral part teeth cartilagenous ossification
calcification eruption of the teeth Mineral part
Lateral incisor last molar growth and development
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rickets motor development delayed dentation and delayed delayed motor development rachetic delayed dentitation
growth and development Phenomena Phenomena phenomena two parameters
teething Motor development
crawling
Motor development Motor development
dentitation Motor development Motor
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Phonemoena rachetic rachetic Hisotry History of delayed motor development delayed dentitation
Osteoid tissue
flat bone of the skull New bone formation growth flat bone center of the growth frontal bone development Parital bone
flat bone new bone formation
sutures fontanell
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Nutrition DR. Abo-Asrar New bone formation mineral part frontal bone pareital bone fontanells growth and development anterior fontanel anterior fontanell
anterior fontanell 2.5 delayed closure delayed closure fontanell delayed closure failure of growth of the flat bone of the skull failure of growth New bone formation
excess osteoid tissue deposit bone soft tissue bone New bone formation Osteiod tissue Layers layers
Layers of osteoid tissue
frontal bone
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box shaped skull
bone
frontal
box shaped skull pareital bossing
frontal and pareital bossing Excess osteoid tissue deposit excess osteoid tissue deposit deficiency of calcium inside the bone
skull circumference skull circumference skull circumference
circumference skull
Increase of skull
signs frontal bossing box shaped skull pareital bossing skull circumference fontanell
sutural line sutural line

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sutural line
craniotabes craniotabes rickets
rickets
craniotabes
hydrocephalus Hydrocephalus
craniotabes
rickets
Pressure effect
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board
board
craniotabes still rachetic suture line
craniotabes so narrowing joint space
skull manifestations of rickets frontal bossing pareital bossing box shaped skull skull circumference anterior fontanell delayed closure craniotabes
rickets chest section thoracic verteberae transeverse spine

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Nutrition DR. Abo-Asrar transverse spine ribs rib
sternum cartilagenous part X - ray chest and heart sternum
bony part rib
rib cartilagenous part cartilage
Intra thoracic pressure Negative Positive Negative negative pressure Intra thoracic pressure Negative pressure Negative pressure bone traction negative pressure traction bone suction negative flat bone traction rib
rickets Mineral part Mineral part traction

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traction
rib rib rib verteberae rib
vertebrae
rib cartilage cartilage traction Rib rib rib sternum cartilage
costo chondoral junction rib
costo chondral junction costo chondoral junction

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sulcus
groove sulcus
groove 29 : 10
sulcus
groove
Longitudinal sulcus Longitudinal sulcus
sternum Longitudinal sulcus sternum chest deformity sternum groove sternum Protruded anteriorly
sternum
sternum sternum
sternum Pigon chest

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Nutrition DR. Abo-Asrar chest Pigon chest pigon sternum negative pressure sternum sternum sternum
antero posterior diameter of the chest
sternum antero posterior diameter flat chest flat chest shoe maker chest Pectus exacavtum What ever flat chest Negative suction sternum
Longitudinal sulcus rib pigon chest longitudinal sulcus flat chest
Lower ribs ribs diaphragm ribs diaphragm very powerful muscle diaphragm ribs diaphragm rib rib insertion of the diaphragm rib
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Nutrition DR. Abo-Asrar rib Insertion of the diaphragm insertion of the diaphragm
Insertion of the diaphragm
sulcus
groove Longitudinal Horizontal Horizontal sulcus Miss Harrison Harrison
Harrison sulcus
Harrison sulcus Horizontal sulcus weak ribs traction of the diaphragm of the diaphragm Insertion of the groove
chest mechanism
of the cartilage
cartilage Proliferation of the cartilage Proliferation cartilage costo chondral junction cartilage Thicken
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Nutrition DR. Abo-Asrar thick growing cartilage proliferation proliferation chest cartilage
rachetic rosere
rib
rib
cartilage proliferation
clinical signs chest rickets Longiutidnal sulcus Harrison sulcus pigon chest flat chest rachetic roseri chest chest signs
Manifestations
Long bones long bones

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Normal straight
tibia
Mineral part collagen support
bone
support
muscles Muscles
wires
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bone
support support
Muscles abductor adductor extensors flexors muscle support equal
osteoid tissue
Muscle muscle Muscle support wire
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Nutrition DR. Abo-Asrar bone Muscle supporting Deformities deformities rickets
crawling crawling
Muscle
bowing upper limb bowing bowing Muscle weakness bone weakness
osteoid tissue
excess
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genu valgus genu valgus deformity
genu varus deformity
tibia femur deformity
curvature curvature What ever
tibia
extremities bowing upper limb deformity genu varus Lower limb genu valgus curvature femur deformity
deformity Bone weakness Muscle weakness

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Nutrition DR. Abo-Asrar 42 : 53
extremities cartilage proliferation cartilage Proliferation cartilage
Hip shoulder muscles shoulder shoulder deltoid deltoid cartilage
Hip joint Hip joint Muscles cartilage knee extremities cartilage ulna radius proliferation cartilage proliferation of the cartilage ulna radius broadening broadening cartilage proliferation
broadening
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rickets
foot
45 : 14
osteoid tissue cartilage proliferation broadening pressure

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bone is very weak
73
Nutrition DR. Abo-Asrar the cartilage proliferation of the
fibula Maleollus lateral Medial
tibia tibia tibia tibia Medial
tibia embryology tibia two separate bones maleouli bone
maleollus maleollus fibula
cartilage cartilage cartilage cartilage cartilage cartilage joint Human being fusion anatomy non functioning rickets joint
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Proliferation of the cartilage cartilage
shaft
maleollus
cartilage
ankle broadening cartilage proliferation groove Lateral broadening
Maleollus
medial
groove two lines of growth cartilage two horizontal groove
Marfan sign cartilage proliferation at two different points Marfan sign fibula tibia Lower end maleolli
Medial maleollus Marfan sign Lateral medial
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wrist
upper limb
extremities broadening deformities Marfan sign
muscle generalized muscle weakness generalized muscle weakness vitamin D deficiency
para thyroid gland sensors serum calcium 8.5 serum calcium para thormone Para thormone para thormone
serum calcium
bone Kidney urine serum phosphate
ATP Muscle adenosine tri phosphate Phosphate ATP

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Nutrition DR. Abo-Asrar energy Msucle Muscle weakness even degeneration of the muscle generalized muscle weakness and hypotonia Myopathy generalized muscle weakness and hypotonia
back muscle
back muscles
weakness Kyphosis
Scoliosis Khypho scoliosis muscle weakness of the back Muscle vertebrae deformity muscle
kypho scoliosis
scoliosis
kyphosis
vertebrae deformity muscle weakness correctable kyphosis
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Pot belly abdomen abdomen pot belly
hernia Inguinal hernia Umblical
spleen
Liver
Ligaments
Muscle spleen liver ptosed of the organ spleen Liver Ptosis
respiratory muscle
weakness severe condition respiratory muscle
chest stagnant secretion repeated chest infection repeated T.B. complications of rickets
Pathophysiology of rickets clinical manifestations of rickets rickets clinical pictures
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Clinical pictures of rickets
history of delayed motor mile stones
delayed dentation deformities
complications
By examination
Examination
skull circumference bossing parietal frontal bossing abnormal shape of the skull box shaped skull delayed closure of the anterior fontanel fontanel craniotabes
sulcus
chest deformity pigon chest sternum flat chest Horizontal longitudinal rachetic rosari
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spleen
Liver
hernia ptosed
Inguinal
ubmlical hernia Upper border
spleen
liver
extremities extremities broadening Marfan sign curvature deformity in femur genu valgus genu varus bowing deformity curvature of the tibia of the femur
kyphosis scoliosis Kypho scoliosis
kypho scoliosis
scoliosis
kyphosis
correctable
complications of rickets 57
Complications of rickets
complications complications of rickets Repeated chest infection rickets
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bronchopneumonia
Infection chest pneumonia brochiolitis chest infection What ever
bronchitis
infantile rickets complicated complicated
repeated chest infection clinical
repeated chest infection
rickets
defect in immune function Immune deficient rickets defect in immune deficiency chemotaxis macrophage migration phagocytosis Intra cellular killing
macrophage nearly paralyzed macrophage
defect in macrophage migration
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Nutrition DR. Abo-Asrar immune function Migration Down Macrophage defect
immune deficiecny T cell function defect T cell humoral and cell mediated Immune deficiency
repeated chest infection immune deficiency chest deformity flat chest Pigon chest Inflation Lung Infaltion stagnant secretion stagnant chest infection
muscle weakness and hypo tonia hypo tonia muscle weakness hypo tonia Muscle weakness stagnant secretion chest infection
repeated chest infection
GIT complications muscle weakness

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Nutrition DR. Abo-Asrar Even gut muscle may be affected
Muscle weakness
rickets constipation diarrhea gastroenteritis Infection Liable to infection gastroentritis
motility of the gut motility of the gut anterior abdominal muscles are weak The muscle is weak
Potential cyanosis Potential cyanosis micturation defecation local reflex contraction of the wall and relaxation of the sphincter
diaphragm vertical diameter anterior abdominal wall muscle contraction antero posterior diameter
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Nutrition DR. Abo-Asrar antero posterior diameter Intra abdominal pressure vertical diameter evacuation of the viscous muscle
Local reflex
Muscle weakness constipation May be complicated by gastro entritis gastro entritis complicated defected Macro phages diarrhea complications deformity complications bone deformity
complications tetany and convulsions hypo calcemia and tetany Hypo calcemia and tetany
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Nutrition DR. Abo-Asrar Hypo calcemia and tetany Laboratory investigations tetany and convulsions
anemia Complication anemia pallor rickets
Pallor
rickets rickets associated with iron deficiency anemia commonly complications association
Ca absorption Iron
factors
oxalate Phytate iron deficiency rickets
iron deficiency anemia Lymph adenopathy organomegaly neglected cases pallor generalized lymph adenopathy Lymph node
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Nutrition DR. Abo-Asrar spleen Pallor Lymph node spleen Leukemia
Leukemia bone marrow bone marrow pseudo leukemia infantum pseudo leukemia infantum pallor Organo megaly Lymph adenopathy anemia
hemolytic anemia Hemolytic anemia RBCs life span 120
Hemolytic anemia
repeated infection repeated infection reticuloendothelial system hyperplasia Hyper plasia reticulo endothelial system
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Nutrition DR. Abo-Asrar reticulo endo thelial system spleen
spleen Phagocytic function RBCs trabeculi hemolytic anemia hyper splenism reticulo endothelial system hyper plasia repeated infection
infection
pallor Lymph adenopathy splenomegaly rickets anemia lymph adenopathy organo megaly associated iron deficiency anemia
splenomegaly
rickets anemia Lymph adenopathy
complication
Pelvis
deformity female
obstructive labor
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Nutrition DR. Abo-Asrar complications Repeated chest infection constipation GIT deformities tetany anemia obstructed labor adult
gastroentritis
deformity in pelvis
investigations
Investigation
rickets Investigations radiological laboratory investigations rickets vitamin D Vitamin D deficiency What ever the etiology vitamin D GIT GIT calcium absorption absorption serum calcium serum calcium vitamin D serum calcium
rickets
Para thyroid Para thyroid calcium sensors
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Nutrition DR. Abo-Asrar serum calcium Para thormone hormone Para thyroid hormone Para thyroid hormone
para thyroid hormone serum calcium serum calcium
bone osteo clast stimulation And suppression for osteoblast bone calcium phosphate 1 : 11 : 45 bone bone
kidney renal tubules Kidney renal tubules kidney Urine kidney
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89
Nutrition DR. Abo-Asrar urine parathormone bone bone rachetic manifestations
rickets
Mineralization of the bone
bone
vitamin D parathormone
New bone formation Old bone
bone mineralization mineralization of the bone vitamin D Parathormone
serum clacium serum calcium normal low Parathormone Normal serum calcium serum calcium serum calcium
Low
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Nutrition DR. Abo-Asrar Low serum calcium tetany
rickets
tetany
serum clacium parathormone serum calcium Parathyroid gland failure hypo parathyroid gland Para thyroid serum clacium failure of the para thyroid gland
parathyroid bone bone bone matrix
bone neglected cases of rickets stores of calcium bone Parathormone
serum calcium of bone stores severe type of rickets
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Nutrition DR. Abo-Asrar tetany complications
D rachetic vitamin D Shock therapy 600,000
vitamin D
vitamin D bone serum bone serum calcium tetany iatrogenic vitamin D without calcium supplementation complications of rickets tetany tetany failure of the parathyroid gland severe type of rickets of the bone stores High dose of vitamin D without calcium Iatrogenic supplementation
rickets
laboratory investigations radiological laboratory investigations 1 : 17 : 26
rickets
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Nutrition DR. Abo-Asrar rickets laboratory investigations radiological
rickets serum calcium Normal serum calcium 10.5 8.5
Normal serum calcium 11 9 serum calcium Normal Low Parathormone normal serum calcium
Low
serum phosphate
rickets normal serum phosphorus 6.5 4.5 level serum phosphorus serum Phosphorus
urine Parathromone
urine
Hypo phosphatemia even 1.5 Phosphate
alkaline phosphatase rickets

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93
Nutrition DR. Abo-Asrar alkaline phosphatase
osteoblast Number of crystals of the bone bone crystals
osteoblast stimulation alkaline phosphatase alkaline phosphatase alkaline phosphatase Osteoblast hyper activity Hyper activity osteoblast Osteoblast Hyper activity of the bone crystals
bone crystals
alkaline phosphatase Normal level international unit 200 140
500 alkaline phosphatase
500 international unit per liter osteoclast

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Osteoblast
94
Nutrition DR. Abo-Asrar heart S.A.node bone peace maker of the heart Other factors Para sympathetic sympathetic thyroxin heart rate brain death heart
osteoblast
Osteoblast main control bone
alkaline phosphatase serum calcium normal or low low serum phosphate
urine analysis urine analysis
urine parathormone urine analysis Phosphate
research rickets level
Page |
95
Nutrition DR. Abo-Asrar rickets very poor rickets
research vitamin D level 25 hydroxy cholicalciferol 1,25 hydorxy cholicalciferol
vitamin D deficiency rickets Vitamin D parathyroid hormone
for research 700 600 Parathormone parathormone
parathormone Level vitamin D generalized amino aciduria urine
vitamin D amino acid reabsorption role tubules vitamin D amino acid urine laboratory investigations radiological investigations
Page |
urine excretion generalized amino aciduria
96
treatment
Treatment
rickets
rickets rickets prevention rickets
treatment preventive medicine rickets
iron supplementation vitamin D and calcium
stores
breast feeding milk artificial rickets artificial milk exposure to ultra violet rays vitamin D early proper feeding vitmain D
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97
Nutrition DR. Abo-Asrar vitamin D supplementation
vitamin D supplementation 800 400
dose 800 400 full term preterm Intra uterine growth retardation 1200 800 800 - 1200 inter national unit per day stores 800 800 400 requirements Intra uterine growth retardation pre term
1200
rickets Vitamin D deficieny rickets vitamin D
1200 800 Oral vitamin D 2000 - 6000 international unit 1500 - 5000 Oral
minimum 1500 international unit
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98
Nutrition DR. Abo-Asrar 6000 international unit per day Oral
oral vitamin D Injection Intra muscular Intra venous intra muscular vitamin D IM IV Oil fat embolism fat embolism intra muscular fat embolism IV vitamin D
IV
600,000 international unit
calcinosis
shock therapy one injection
Page |
99
Nutrition DR. Abo-Asrar supplementation calcium absorption vitamin D vitmain D
complications deformity
alkaline phosphatase Normal lab or radiological laboratory alkaline phosphatase normal
activity alkaline phosphatase alkaline phosphatase
osteoblast laboratory Normal
phosphate alkaline phosphatase

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100
Normal
clinical manifestations of rickets clinical pictures rickets hisotry of delayed motor development Delayed dentation bone deformity complictions
On examination skull circumference Pareital bossing frontal box shaped skull craniotabes fontanel delayed closure chest Pigon chest flat chest longitudinal sulcus Harrison suclus rachetic rosari
pot belly abdomen spleen liver Ptosis
Knee
deformity
genu valgus
gene varus deformity
extremities Upper limb boradening Knee Lower limb Marfan sign
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101
correctable
Kyphoscoliosis
Scoliosis
kyphosis
complications repeated chest infection gastroentritis diarrhea constipation GIT complications tetany tetany bone deformities anemia Obstructed labor adult period
Investigations Low normal serum calcium Low serum phosphate alkaline phosphatase phosphate Urine urine amino acids vitamin D Parathormone
Prevention vitamin D complications
rickets
radiological finding renal rickets
radiological finding of rickets
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102
Radiological finding of rickets

hisotology of the bone
bone bone two lines of growth two lines of growth linear growth linear growth
Linear growth
Linear growth Linear growth of the bone epiphysis growing centers
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103
horizontal growth
waist growth
increase
two lines of growth Linear waist growth linear growth
waist growth
Linear growth
Linear growth femur femur cartilage femur mature bone line of epiphysis Morphology of the bone cartilage layer columnar cells layer columnar cells Layer zone of resting cartilage zone of resting cartilage zone single layer of collagenous fat bone femur
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104
Nutrition DR. Abo-Asrar rounded cells Layer zone of proliferating cartilage layer zone of proliferating cartilage layer Single colmnar cell colmnar cells Layer rounded cells zone of proliferating cartilage cartilagenous cells Proliferating cells Level
active cells
replicating cells
layers acellular celluar layers
avascular layer
Vascular Avascular vessel Layer
acellular and avascular layer
osteoid tissue + mineral part mineral Protein bone zone of provisional calcification board
Page |
zone of provisional calcification
105
Nutrition DR. Abo-Asrar avascular Mineral part Osteoid tissue layer acellular
Layer of mature bone
Phosphorus
bone
blood vessel
osteoclast Osteoblast rickets osteoclast osteoblast dendritic cells bone marrow stem cells bone zone of mature bone Ossified bone layers What ever mature bone
bone
linear growth of the bone
new bone formation
all through peri osteum Periosteum 10 : 10 periosteum
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106
Nutrition DR. Abo-Asrar new bone formation periosteum New bone osteoid tissue calcium phosphate
Mature bone periosteum mineral part Periosteum
New bone formation
Bone two active parts linear growth bone active part Periosteum
X- ray X- ray radiation
transparent transparent Particles
transparent
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107
X - ray
Lung
Muscle
soft tissue
grey irradiation
X - ray
soft tissue
partial absroption bone calcium phosphate Phosphorus calcium X - ray bone
X - ray bone calcium phosphate
Irradiation
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108
Nutrition DR. Abo-Asrar X -ray bone mineral density Mineral part
rickets vitamin D vitamin D calcium serum calcium serum calcium Parathormone Parathormone serum calcium
calcium absorption
rickets
parathormone bone bone mineral part X -ray
bone
decrease bone density
X -ray X -ray rarefaction of the bone rarefaction of the bone decrease of bone density
decrease in bone density rarefaction decrease bone density rarefaction bone
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109
Nutrition DR. Abo-Asrar serum calcium bone Parathormone rickets bone mineral density rarefaction of the bone
bone
Histology Linear growth
bone Hisotolgy X - ray epiphysis Linear growth irradiation
cartilage Irradiation irradiation X -ray X -ray zone of provoisional cartilagenous part
bone bone
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110
excess of osteoid tissue Osteoid tissue Osteoid tissue
cartilage
cartilage
X -ray
cubbing
Osteoid tissue Mineral part broadening broadening
cartilage
cubbing
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111
Nutrition DR. Abo-Asrar cubbing broadening rarefaction of the bone
Pathophysiology proliferation of the cartilage Proliferation of the cartilage cartilage thickness
cartilage Of the cartilage Proliferation of the
proliferation cartilage zone of provoisonal calcification zone of provisional calcification radio opaque
cartilage
cartilagenous band radi lucent cartilage radio lucent X - ray
chondroblast
fraying bone rarefaction rarefaction
X -ray
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112
rarefaction hyper parathyroidism Mineral part of the bone broadening cubbing Osteoid tissue broadening cubbing fraying Mineral part Pressure
fraying chondroblast cartilagenous proliferation zone of provisional calcification
Mature bone
periosteum bone bone X - ray
Periosteum Periosteum
Parathormone
Periostuem Periosteum
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113
Nutrition DR. Abo-Asrar osteoid tissue periosteum osteoid tissue X -ray osteoid tissue
Periosteum
parathromone
two periosteum Periosteum Periosteum bone Seperated bone seperated 2 periosteum
Double periosteum line
Rarefaction Broadening ( cubbing ) Fraying Double periosteal line
bone deformity
bone
X -ray
deformity Genu vara - genu valgus femur tibia curvature
Page |
114
rickets
Limit
green stick fracture
Green stick fracture
Manifestations of active ricktes
Manifestations of active rickets
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115
Nutrition DR. Abo-Asrar rarefaction cubbing Broadening Fraying Double perosteal line Bone deformity, even green stick fracture
X -ray
fraying active rickets
Treatment
vitamin D serum calcium Parathyroid hormone Osteoblast vitamin D extremities linear growth New bone formation Linear growth deposit of calcium zone of provisional calcification deposit zone of provisional calcification deposit chondroblast chondroblast X - ray
new bone formation
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116
new bone formation mature bone
line of ossification
rickets new bone formation broadening cubbing rarefaction of the bone green stick fracture zone of provisional calcification X -ray X -ray zone of provisional calcification
even
cubbing fraying linear deposits of Healing rickets Healing rickets
broadening
Osteoblast
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117
osteoclast osteoclast
bone density Periosteal line green stick fracture Healed rickets
Radiologically activ rickets Rarefaction of the bone cubbing broadening fraying double periosteal line bone deformity green stick fracture active healing rickets fraying line of ossification zone of provisional calcification
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118
Nutrition DR. Abo-Asrar healed rickets bone thick ossification
radiological finding of rickets pathophysiology
healed rickets
zone of provisional calcification after healing thick line thick line thick line
thick line line of calcification Osteocalst x -ray rickets X -ray
osteoclast bone
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119
Nutrition DR. Abo-Asrar hydrocortisone oral absorption of vitamin D vitamin D receptors block vitamin D receptors Osteomalacia and osteoporosis Oral cortisone oral crotisone Intra muscular IM Oral systemic effect
block
GIT
cortisone oral receptors GIT Intra muscular receptors
child two months
adult
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120
Renal Rickets
renal rickets
renal rickets
nowadays MCQ renal rickets rickets renal rickets Oral and MCQ essay
MCQ
MCQ
oral
renal rickets glomerular tubular

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121
Tubular Glomerular glomerular glomerular rickets tubular tubular rickets
clinical renal rickets glomerular
glomerular rickets
tubular
very low
serum phosphate tubular type serum phosphate
vitamin D deficiency rickets serum phosphate low very low vitmain D deficiency rickets serum phosphate Normal even zero serum phosphate glomerular type serum phosphate is high
vitamin D deficiency rickets Laboratory finding
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122
Nutrition DR. Abo-Asrar Low Normal serum calcium Low serum phosphate alkaline phosphatase
Urine urine amino acids parathormone vitamin D
phosphate glomerular type of renal rickets serum phosphate serum phosphate
rickets rickets
renal osteodystrophy chronic renal failure nephrology
Low
rickets
serum phosphate glomerular type of renal rickets parathyroid hormone vitamin D deficiency rickets Parathyroid hormone
Parathyroid hormone phosphate tubular
Parathormone
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123
urine Parathormone Normal tubular type Normal Parathyroid
glomerular type glomerular type Phosphate
Parathyroid Parathyroid hormone very high
rickets
Parathyroid hormone Usually high
Normal
Parathyroid hormone
rickets tubular type
normal
parathyroid hormone
Glomerular type
glomerular type chronic renal failure
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124
Nutrition DR. Abo-Asrar chronic renal failure chronic renal failure rickets chronic renal failure rickets chronic renal failure rickets renal osteodystorphy renal osteodystrophy renal osteodystrophy chronic renal failure rickets
Chronic renal failure rickets renal failure 1 hydroxylation of vitamin D kidney 1 hydroxylation of vitamin D 1 hydroxylation of vitamin D active form of vitamin D 1, 25 rickets rickets renal osteodystrophy rickets failure of hydroxylation of vitamin D
acidosis renal failure Metabolic acidosis chronic renal failure acidosis

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125
Nutrition DR. Abo-Asrar Failure of excretion acidotic material Urine loss of bicarb. metabolic acidosis acidosis bone calcium carbonate bone bicarb bone calcium acidosis
calcium carbonate Melting of bone calcium carbonate
bone calcium
calcium carbonate bone bone manifestations of rickets
failure of excretion of phosphate
chronic renal failure retention of phosphate phosphate retention of phosphate phosphate
Parathyroid hormone
parathyroid parathyroid hormone Parathyroid hormone Parathyroid hormone serum calcium serum phosphate
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126
kidney kidney rickets Kidney reabsorption of calcium parathormone Parathormone loss of phosphate target
Kidney kidney parathormone hormone Parathormone urine Parathormone hormone Parathormone calcium
retention of phosphate
Parathormone bone
osteitis fibrosa cystica
renal failure bone cyst
renal failure rickets failure of hydroxylation of vitamin D Melting of bone calcium acidosis
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127
Nutrition DR. Abo-Asrar rachetic hyper parathyrioidism retention of phosphate manifestations
Clinically
renal failure manifestations of rickets
Laboratory
renal failure Manifestations of rickets Laboratory serum clacium rickets
phosphorus
serum calcium Normal Low Normal bone calcium Urine Low
Low
renal osteodystrophy tetany acidosis tetany tetany
tetany tetany
acidosis acidosis
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128
Nutrition DR. Abo-Asrar phosphate phosphate alkaline phsphatase rickets alkaline phosphatase
Urine Urine vitamin D deficiency rickets urine
vitamin D 1, 25 Normal 25 hydroxy vitamin D3 cholicalciferol 1,25 Normal 25 hydroxy Normal vitamin D Normal cholcalciferol vitamin D vitamin D3 Normal
Normal
25 hydroxy vitamin D3 normal 1,25 vitmain D deficiency rickets
1 hydroxylation
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129
osteitis fibrosa cystica osteitis fibrosa cystica
radiologically diagnostic radiologically Manifestations of active rickets Manifestations of active rickets
Treatment
renal failure rickets rickets vitamin D vitamin D active form of vitamin D 1 hydroxy 1,25 1 hydroxy liver 25
active form
active form of vitamin D vitamin D vitamin D without calcium
bone
acidosis acidosis calcium carbonate sodium bicarb
Page |
130
Nutrition DR. Abo-Asrar acidosis
excess phosphate phosphate
phosphate binders Phosphate absroption
giving gut
parathyroid
resistant cases Parathyroid Parathyroidectomy resistant cases parathyroidectomy parathyroid active form of Vitamin D
parathyroid gland
resistant cases
renal osteodystrophy glomerular type active form of vitamin D acidosis absorption Phosphate binders parathyroidectomy resistant cases renal failure
bicarb
Page |
acidosis
131
Nutrition DR. Abo-Asrar with salt and water retention salt and water retention renal failure sodium bicarb
salt and water retention sodium bicarb sodium bicarb
hydrocephalus
type two
type one
endocrine
116
Page |
132
Nutrition DR. Abo-Asrar exercise
123 8
Page |
133
sodium bicarb salt and water retention bicarb
salt and water retention
sodium bicarb
1: 11: 19
Page |
134
Tubular type
tubular type tubular type Primary primary hypophosphatemic rickets primary hypo phosphatemic rickets X-linked dominant disease genetics X -linked dominant X - linked dominant primary hypo phosphatemic rickets gene tubular defect failure of reabsorption of phosphate
gene
tubular defect phosphate kidney Phosphate urine excretion of phosphate in urine urine
calcium phosphate
calcium bone calcium phosphate
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135
Nutrition DR. Abo-Asrar new bone formation bone mineral part rickets clacium Phosphate
bone bone
Phosphate Normal rickets rickets bone calcium Parathyroid hormone
Normal
bone Normal bone calcium bone Normal osteoid tissue deposit cartilage proliferation parietal bossing frontal skull circumference broadening Marfan rachetic rosari
Osteoid tissue deposit cartilage proliferation manifestations of rickets teeth Delayed dentation delayed motor development Muscle weakness delayed closure of the fontnel delayed closure of the fontanel
Page |
Hypo tonia
bone
136
Nutrition DR. Abo-Asrar symptoms
Normal
Investigations is too low Phosphate normal normal Parathyroid hormone High alkaline phosphatase alkaline phosphatase crystals crystals osteoblast alkaline phosphatase osteoblast alkaline phosphatase bone bone
X -ray rickets
radiological finding
even What ever
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137
bone New bone formation
vitamin D phosphate consumption vitamin D vitamin D and calcium
primary hypo phosphatemic rickets Marfan sign broadening bossing rachetic rosari Primary hypo phosphatemic rickets associated defect in hydroxylation of vitamin D inside the kidney gene the kidney hydroxylation of vitamin D inside the
vitamin D active form of vitamin D severe rickets
Primary hypo phosphatemic rickets
Fanconi anemia
Page |
Fanconi syndrome
138
Fanconi Syndrome
Fanconi anemia hematology Fanconi syndrome hereditary Gene defect autosomal recessive gene gene Mode of inheritance Autosomal recessive gene secondary Secondary to nephrotoxic drugs What ever nephrotoxic drug secondary to metabolic diseases hepatomegaly metabolic diseases glycogen storage disease galactosemia lipid storage diseases tyrosinemia Wilson disease What ever metabolic diseases associated kidney
acquired congenital autosomal recessive congenital type Fanconi syndrome tubular defect tubules tubular defect urine
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139
amino acids glomerulus of the kidney filtration amino acids complete reabsorption of the proximal convoluted tubules amino acids Urine amino acids
protein
urine amino acids failure to thrive failure to grow failure to thrive weight loss short stautre
failure to thrive weight and hight both are affected
Fanconi
12
say
Fanconi
urine
amino acids
Page |
140
urine urine hyper kalemia Hypo hypo kalemia electrolyte disorder bradycardia Paralytic ileus
diarrhea Manifestations of hypo kalemia
Loss of glucose Loss of glucose in urine urine urine polyuria oliguria poly uria osmotic diuresis
and poly uria polydepsia
diabetes low Normal
poly phagia polyphagia feeding center
Page |
141
Nutrition DR. Abo-Asrar urine poly phagia poly uria poly depsia weight loss diabetes differential diagonsis of
urine loss of bicarb urine loss of bicarb urine bicarb acidic alkaline urine alkaline acidic urine acidic urine alkaline urine
nephrology
Infection urinary tract infection UTI Infection Organism Infection Organism acidic urine Organism proteus
urine acidic media proteus
alkaline media
proteus
urinary tract infection
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142
Nutrition DR. Abo-Asrar proteus urinary tract infection
proteus
urinary tract infection Fanconi
urine Proteus
PH
Fanconi Alkaline media
acidosis melting of bone calcium
Loss of bicarb acidosis bone calcium bone calcium carbonate bone calcium rickets
Fanconi urine
Loss of phosphate
rickets melting of bone calcium Loss of bicarb in urine bone calcium Loss of phosphate in urine bone bone
energy Hydrocephalus
Page |
143
Nutrition DR. Abo-Asrar bossing rachetic rosari Marfan boradening bone bone bone
acidosis urine
Fanconi Syndrome
failure to thrive manifestations of hypo kalemia diabetes manifestations manifestations of acidosis rickets
Osteoporosis amino acids
Investigations
Investigations
Investigations Fanconi
Investiagtions Fanconi
Page |
144
blood urine
urine
Treatment
urine
rickets high protein diet amino acids loss
phosphate
sodium bicarb acidosis frequent meals glucose frequent meals
hypoglycemia
frequent meals
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145
KCL
renal transplantation renal transplantation
active form of vitamin D and calcium bone calcium calcium vitamin D
tubular defect associated hydroxylation of vitamin D active form Fanconi
Lignac Syndrome
spelling Lignac syndrome syndrome
mode of inheritance Autosomal recessive recessive Autosomal
cystine amino acid deposit in varient tissue In born error of metabolism
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146
Nutrition DR. Abo-Asrar cystine amino acid
kidney tubules of the kidney Fanconi Syndrome secondary primary Fanconi Secondary kidney
Fanconi
cystine amino acid reticulo endothelial system deposit reticulo endothelial system lymph nodes generalized lymph adenopathy spleen splenomegaly
hepatomeagly hepatosplenomegaly bone marrow aplastic anemia marrow cavity pan cytopenia pan reticulo endothelia system generalized lymph adenopathy lymph nodes hepatosplenomegaly aplastic anemia bone marrow failure
cornea cornea
Page |
slit lamp
147
Nutrition DR. Abo-Asrar Wilson Kayser flisher ring cystine crystals
cornea
renal tubules
autosomal recessive disease cystine amino acid deposit Fanconi syndrome
reticulo endothelial system deposit lymphadenopathy hepatosplenomegaly splenomegaly bone marrow failure
cornea cystine crystals in cornea
Treatment
Fanconi cystine free diet chelation of cystine Wilson
tissue 1: 34 : 53
Wilson tissues chelator of cupper tissues chelation of cystine D penicillamine chelation nephro toxic D pencilamine
specific chelator cystiamine

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148
Nutrition DR. Abo-Asrar specific chelator of cystine amino acid Rickets Fanconi cystiamine
lowe's syndrome
Lowe's Syndrome
lowe's syndrome X - linked recessive renal rickets Mode of inheritence X - linked recessive Lowe's syndrome combination triad triad triad generalized muscle floppy baby glaucoma cataract Mental retarded differential diagnosis Occular manifestations cerebral manifestations weakness and hypo tonia generalized hypo tonia renal manifestations Fanconi syndrome Lowe's syndrome rickets Oculo-cerebro-renal synddrome
Fanconi syndrome
manifestations of rickets in X - ray active rickets Rarefaction of the bone cubbing broadening fraying double periosteal line
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149
Nutrition DR. Abo-Asrar bone deformity green stick fracture
healing phase line of ossifications healed rickets thick line of ossification thick line
Renal rickets renal osteodystrophy glomerular type chronic renal failure rickets Kidney hydroxylation of vitamin D Melting of bone calcium metabolic acidosis hyper para thyroidism retention of phosphate
rickets
renal failure Clinically laboratory serum phosphate Parathormone
rickets
alkaline phosphatase Low Normal calcium alkaline phosphatase urine urine excess calcium low in phosphate renal failure
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150
Nutrition DR. Abo-Asrar active form of vitamin D calcium acidosis sodium bicarbonate diet restriction of phosphate phosphate binder para thyroidectomy resistent cases
tubular type X - linked dominant disease Primary hypo phosphatemic rickets Loss of phosphate in urine defect rickets rickets Manifestations delayed closure of the fontanel delayed motor development just delayed dentitation manifestations of osteoid tissue over deposit proliferation manifestations of cartilage rickets
drug calcium vitamin D
Phosphate
Fanconi syndrome Urine amino acids glucose bicarb phosphate bicarb rickets Fanconi syndrome High protein diet acidosis
Page |
151
Nutrition DR. Abo-Asrar glucose loss in urine frequent meals calcium Vitamin D phosphate
Cystinosis deposit cystine amino acid corneal crystals cornea hepatospleno megaly Lymph adenopathy reticulo endothelial system bone marrow failure Fanconi Anemia Fanconi tubules of the kidney Fanconi cystine amino acid chelator cystiamine Lowe's syndrome glaucoma cataract Occular Hypo tonia mental retardation Cerebral Fanconi syndrome
Vitamin D dependent rickets
Vitamin D dependent rickets

Vitmain D dependent rickets deficient rickets deficient rickets vitamin D dependent rickets vitamin D dependent rickets Hereditary defect vtimain D
vitamin D metabolism
kidney hereditary defect 1 hydroxylation of vitamin D kidney

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152
1 hydroxylation of vitamin D
Kidney kidney
vitamin D dependent rickets type one
vitamin D dependent rickets type one 1 hydroxylation of vitamin D kidney 1,25 di hydroxy cholicalciferol active form of vitamin D rickets
vitamin D dependent rickets type two vitmain D metabolism 25 carbon atom hydroxylation Liver hydroxylation Kidney active form
receptors of vitamin D
defect receptor defect receptors GIT Bone Kidney
vitamin D receptors vitamin D function Number defect end organ resistence vitamin D
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153
receptors active form of vitamin D active form
receptors
number function defect High doses of active form of vitamin D active form of vitamin D
associated other defect alopecia totalis area alopecia areata alopecia areata alopecia totalis alopecia alopcia totalis alopecia universalis alopecia areata common association
hepatic rickets
Hepatic Rickets
rickets hepatic rickets liver affection liver affection
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154
Nutrition DR. Abo-Asrar Obstructive jaundice Bile obstructive jaundice GIT liver bile absorption of fat vitmain D fat soluble vitamins vitamin D mal absorption obstructive jaundice
cirrhosis rickets cirrhosis rickets Liver cirrhosis Liver vitmain D Liver stores stores 25 hydroxylation of vitamin D Liver rickets Liver cirrhosis depletion of the stores hydroxylation defect
liver
vitamin D
anti epileptic drugs anti epileptic drugs fat soluble anti epileptic liver excretion fat soluble Liver secretion toxic hepatic hydroxylation OH vitamin D OH vitamin D inside the liver
Page |
Inside the
155
Nutrition DR. Abo-Asrar toxic hepatic hydroxylation anti epileptic drugs
Hepatic rickets Liver affection Rickets
obstructive jaundice liver cirrhosis anti epileptic drugs
celiac rickets
Celiac rickets
celiac rickets malabsorption in general mal absroption syndrome malabsroption syndrome Malabsorption syndrome intestine Loops malabsorption malabsroption
Loops of the gut
gut absroption absorption gut
mal absorption synddrome In general fatty acids fatty acids
Page |
156
fatty acids
chemical reaction fatty acids
calcium soap
fatty acids
fatty acids absorption Intestinal villi intestinal villi Intestinal villi
mal absorption
vitmain D oral vtimain D parentral suppository gut vitamin D parentral hypo phosphatasia
Hypo Phosphatsia
Hypo phosphatsia autosomal recessive disease alkaline phosphatase enzyme
decrease alkaline phosphatase Hypo phosphatasia alkaline phosphatase osteoblast alkaline phosphatase organic phosphate alkaline phosphatase
Page |
157
Nutrition DR. Abo-Asrar phospho ethanol amine rickets Phosphorus Organic phosphate In organic alkaline phosphatase bone matrix Organic calcium phosphrus bone crystals
alkaline phosphatase rickets bone matrix phospho ethanol amine Organic phosphate phosphorus the bone crystals autosomal recessive disease phosphorus alkaline phosphatase
phosphrus
organic phosphate
osteoblast
new bone ricketic manifestations
bone
calcium bone
calcium hyper calcemia Hyper even nephro calcinosis Hyper calcemia Organic phophate absroption Metabolism Urine Urine urine diagnostic
Page |
urine analysis organic phosphate organic
158
Nutrition DR. Abo-Asrar urine phospho ethanol amine In urine organic phosphate urine phospho ethanol amine Hypo phosphatasia hypo diagnostic
alkaline phosphatse Kwashiorkor marasmus alkaline phosphatase
urine
phospho ethanol amine
urine
Kwashiorkor marasmus Hypo phosphatasia dianostic alkaline phosphatase organic phosphate hypo phosphatasia vitamin D alkaline phosphatase alkaline phosphatase alkaline phosphatase serum plasma transfusion
serum
blood transfusion
rickets Phosphorus
vitamin D
Page |
159
Hypo phosphatasia
alkaline phosphatase plasma alkaline phosphatase plasma transfusion Plasma
organic phosphate
Hypo phosphatasia bone Organic phosphate In organic Osteoblast bone Organic osteoblast
hyper para thyroidism
Hyper Para Thyroidism

Hyper para thyroidism primary hyper para secondary vitamin D deficiency rickets Hyper para thyroidism glomerular rickets Hyper para hypo calcemia secondary primary para thyroid gland benign
tumor
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160
Nutrition DR. Abo-Asrar malignant adenoma parathormone hormone adenoma Parathyroid hormone bone Kidney bone Kidney
phosphate
glomerular type
bone rachetic manifestations bone osteotitis fibrosa cystica
crystals
serum calcium serum phophate para thyroid hormone alkaline phosphatase bone
Surgical Para thyroid hormone calcium para thyroid active form of vitamin D adenoma tumor
para thormone
rickets calssifications of rickets
rickets classifications of rickets
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161
Classifications of Rickets
classifications
classifications of rickets vitamin D metabolism classifications
classifications basics basics classification
Rickets

rickets vitamin D deficiency rickets
vitamin D oral cholecalciferol vitamin D3 oral Mal nutrition Intake rays ultra violet exposure malnutrition In general associated atrophic rickets atrophic rickets vitamin D3
Page |
162
Nutrition DR. Abo-Asrar exposure to ultra violet rays
vitamin D3 oral absorption
Intake exposure to ultra violet rays
Intake
atrophic rickets vitamin D deficiency
intake exposure to ultra violet rays atrophic rickets
defect defect
Kwashiorkor
marasmus
atrophic rickets
vitamin D oral vitamin D oral
vitamin D oral
absroption Celiac rickets Celiac rickets Malabsroption synddrome vitmain D oral vitamin D parentral
absroption
Page |
163
Hepatic rickets Obstructive jaundice absroption bile
Liver
hydroxylation
Liver cirrhosis vitamin D vitamin D3 Liver cirrhosis
1,25 di hydroxy cholicalciferol 25 active form of vitamin D anti epileptic drugs hydroxylation toxic hepatic D anti epileptic drugs active form
hepatic rickets Liver cirrhosis Obstructive jaundice toxic hepatic hydroxylation Celiac rikcets
vitamin D renal osteodystrophy renal rickets glomerular active form tubular defect vitamin D
Page |
164
Nutrition DR. Abo-Asrar vitamin D rickets tubular glomerular vitamin D resistant vitmain D dependent rickets type one
vitamin D
Hydroxylation Kidney vitamin D hydroxylation active form type two end organ Oral vitamin D high doses
active form
Hypo phosphatasia vitamin D alkaline phosphatase plasma
Para thyroid
tumor vitamin D vitmain D resistant rickets
cholicalciferol
rickets Vitamin D deficiency rickets vitmain D deficiency rickets oral vitamin D3 Oral
Vitamin D resistant rickets oral vitamin D Modifications
Page |
165
vitamin D deficiency rickets
vitamin D vitamin D Manifestations of rickets normal variability
recent classification
Page |
166
Rickets

recent calssifications recent classifications
end organ resistance
vitamin D dependent rickets type two
vitmain D phosphorus calcium intake vitmain D phosphorus rickets
phosphate Primary hypo phosphatemic phosphate tubular defect Fanconi cystinosis renal tubular acidosis Lowe's syndrome
Primary hypo phosphatemic rickets Phosphate
bone
Page |
167
bone bone
vitmain D bone 1, 25 dihydroxy cholicalciferol vitamin D bone 1, 25 dihydroxy cholicalciferol 1, 25
intake vitmain D lack of exposure to ultra violet rays
Defect
atrophic rickets Hepatic rickets
hepatic Obstructive jaundice Cirrhosis Toxic hepatic hydroxylation active form glomerular type of rickets renal failure hydroxylation glomeruli
vitamin D
vitmain D dependent rickets type one
1, 25 dihydroxy cholicalciferol bone rickets
Page |
168
primary hypo calcemic rickets 1, 25 dihydroxycholicalciferol primary hypo phosphatemic rickets phosphorus tubular defect end organ resistance vitmain D resistant rickets type two
Phosphorus
vitmain D metabolism
rickets
rickets resembling conditions rickets vitmain D rickets hypo phosphatasia hyper para thyroidism
1, 25 dihydroxy cholicalcefrol Primary hypo calcemic defect tubular primary hypo phosphatemic type two vitamin D resistant rickets end organ resistance hypo phosphatasia Hyper para thyroidism rickes resembling conditions
calssifications
tetany
oral questions
Page |
169
Oral questions
rickets sheet sheet eye examination rickets rickets examiner
sheet rickets
rickets jaundice
eye
Jaundice obstructive jaundice cirrhosis
rickets Jaundice hepatocellular rickets
Page |
170
Nutrition DR. Abo-Asrar eye infection complications of rickets Repeated infection conjuctivitis cataract Intra occular pressure cataract cataract rickets cataract rickets Lowe's syndrome cataract Lowe's syndrome Lowe's syndrome In born error of metabolism galactosemia galactosemia rickets galactosemia Fanconi syndrome galactosemia rickets galactosemia Cataract galactosemia cataract tubular defect
glaucoma
rickets
Fanconi
Fanconi syndrome
Kayser flisher ring
cornea Wilson disease ring Kayser flisher Wilson Wilson Wilson Fanconi
Fanconi syndrome rickets

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171
Nutrition DR. Abo-Asrar cystine crystals cornea cystinosis cystine cyrstals cornea cystine crystals
Lignac Syndrome lignac syndrome cystinosis
Ulcers
cornea herpes Herpetiform corneal ulcer tyrosinemia
tyrosinemia Fanconi secondary to in bron error tyrosinemia inborn error tyrosinemia herptic form of corneal ulcer Fanconi tyrosinemia
mechanism of hepatomegaly mechanism of hepatomegaly
Jaundice Infection Cataract Kayser flisher ring Cystinosis Corneal ulcer cataract occular manifestations corneal manifestations
hyper para
rickets
corneal
palpable liver and spleen
abdomen spleen liver
rickets abdomen rickets spleen Liver
Page |
172
Ptsois of the organs hypo tonia
repeated infection cooley's anemia Hepato splenomegaly associated lymph adenopathy hepato spleno megaly liver cystinosis
spleen
cystinosis
wilson hepato spleno megaly hepato megaly Fanconi Wilson hepato spleno megaly tyrosinemia
Fanconi syndrome cirrhosis
spleen
Glycogen storage disease liver
chronic abscess hepatitis Liver disease shrunken liver splenomegaly Portal hypertension portal cirrhosis
written
Wilson rickets
galactosemia
tyrosinemia rickets
rickets rickets
Page |
173
rickets rickets rickets rickets cataract rickets kayser flisher ring
nerve cell
Nerve cell excitability

physiology Nerve and muscle excitation nerve cell stimulus stimulus threshold threshold stimulus
threshold
abdominal reflexes abdominal wall contraction reflex Underlying muscles
abdominal reflex is so exaggerated
threshold
Page |
pain
174
vaso vagal attack
15 local anesthesia
threshold
firing of the cells depolarization
threshold stimulated firing of the cells
cells Once
firing of the cells Neuronal cell
stimulus cell membrane
firing of the cell stimulus depolarization of the cell
Nerve cell gate of Na Nerve cell Ionizable calcium nerve cells gate of Na channel ionizable calcium Influx of Na inside the cell stimulus stimulus non ionizable form Ionizable calcium
channel
Ionizable calicum repelling

Page |
175
Non ionizable calcium
excitation of the cell
depolarization of the cell
channel of the nerve cell
excitation of the cell ionizable calcium
threshold non ionizable calcium threshold
ionizable calcium stimulus
threshold
Ionizable calcium stimulus
excitation of the nerve cell threshold cell membrane of the nerve cell ionizable calcium threshold Ionizable calcium
ionizable calcium threshold excitation of the cell stimulus ionizable calcium autonomous excitation of the cell
tetany
Tetany
definition of tetany
Page |
176
Definition
hyper excitability of the nerve cell excited hyper excitability threshold is so low stimulus Even
Etiology
ionizabel calcium in general serum calcium in general serum calcium ionizable non ionizable
Excitable tetany hypo calcemia
normal
serum calcium tetany
10
say
averge
total serum calcium serum calcium 45 % 55 %
active form ionizable non ionizable form
total serum calcium ionizable 45 % non ionizable 55 %

Page |
177
Nutrition DR. Abo-Asrar tetany 3 mg per dl ionizable form 30 %
10 mg / dl ionizable 4.5 mg non ionizable tetany ionizable 3 mg 45 % 5.5 mg
ionizable calcium
non ionizable calcium alkalosis Non ionizable
acidosis alkalosis
ionizable
acidosis alkalosis
rickets
renal failure tetany Say renal failure 6 serum calcium ionizable 4 mg 6 non ionizable 2 mg tetany total serum calcium acidosis tetany serum calcium alkalosis
ionizable form
2.5 mg total serum calcium tetany

Page |
ionizable calcium say 7.5 mg non ionizable tetany 3 mg Ionizable Normal
178
Nutrition DR. Abo-Asrar alkalosis tetany tetany alkalosis ionizable form of serum calcium tetany Mg Mg Para thormone Mg Para thormone hormone synthesis hypo para thyroidism Mg
Para thormone hormone Hypo calcemia Hypo calcemia Tetany tetany total serum calcium alkalosis Hypo Mg
,,,, tetany
total serum calcium serum calcium
serum calcium serum calcium
vitmain D
Page |
179
Nutrition DR. Abo-Asrar vitmain D
Para thyroid hormone bone bone clacium Para thyroid hormone para thyroid hormone
vitmain D para thormone
vitmain D Hypo calcemia vitmain D deficiency tetany
para thyroid
Page |
180
Nutrition DR. Abo-Asrar Para thyroid Para thyroid Hypo para thyroidism
Para thyroid gland is still immature
para thyroid gland is still immature pre term intra uterine growth retardation Para thyroid hypoxia diabetes Infant of diabetic Para thyroid gland gland gland hypo para thyroid gland hypo calcemia hypo calcemia
Hypo calcemia
intra uterine calcium
hypo calcemia 72 hypo calcemia 72 tetany early neonatal hypo calcemia 72 early neonatal hypo calcemia para thyroid gland still immature pre term intra uterine growth retardation Infant of diabetic mother fetal hypoxia
Page |
181
Nutrition DR. Abo-Asrar para thyroid gland
para thormone serum calcium compensation hypo calcemia activity serum clacium
cow milk feeding
artificial milk
pre mature formula Powdered milk vitamin D
cow milk
cow milk
alkaline
Page |
cow milk
182
Nutrition DR. Abo-Asrar phosphate excessive calcium cow milk
para thormone para thyroid late neonatal hypo clacemia tetany
tetany late neonatal hypo calcemia immature Para thyroid buffalo milk so early cow milk early neonatal hypocalcemia late neonatal hypo calcemia
Para thyroid
Para thyroid para thyroid gland congenitally absent
endocrine Congenital absence of the parathyroid Di Gorge syndrome Di Gorge syndrome syndromes Di Gorge syndrome Para thyroid gland embryology arch pouch tetany hypo calcemia
3rd pharyngeal parathyroid
Page |
183
Nutrition DR. Abo-Asrar thymus thymus T cell maturation Immune deficiency abnormality
T. Cells function
defect
aortic arch
hypo calcemia and tetany surgically removed
heart anomaly thymus immune deficiency parathyroid para thyroid hyper para hypo thyroidism vitamin D and calcium surgical removal of the para thyroid
tetany
para thyroid Hodgkin's lymphoma neck cervical lymph nodes Local irridation
Hypo para
neck local irridiation Irridiation para thyroid irridiation
Wilson disease para thyroid cupper deposit hemosiderosis chronic hemolytic anemia para thyroid
Irridiation
Page |
184
Nutrition DR. Abo-Asrar Wilson disease Hemosiderosis
auto immune destruction Auto immune hypo parathyroidism Para thyroid anti body familial cause Rare
para thyroid
Urine
calcium urine urine calcium
serum calcium
citrate EDTA calcium chelation exchange transfusion EDTA
clacium Citrate
EDTA
citrate serum urine hypo calcemia Alkalosis
acid base disturbance

Page |
alkalosis
185
hyper ventilation
hyper ventilation carbon dioxide wash carbon dioxide wash respiratory alkalosis respiratory alkalosis tetany
anti epileptic drugs
hyper ventilation alkalosis epilpesy epilpesy epilpesy
attack
epilpesy
Page |
186
Nutrition DR. Abo-Asrar bicarb acidosis bicarb alkalosis
Over correction of acidosis alkalosis alkali therapy
alkali therapy
Persistence vomiting alkalosis HCL HCL bicarb alkalosis alkalosis acid base disturbance Hypo magensemia Mg Mg mal nutirition in general Mal absorption citrate EDTA HCL
Mg
chelation
chronic diarrhea chelation
Clinical manifestation of tetany

clinical manifestations of tetany manifest tetany
Page |
187
Nutrition DR. Abo-Asrar manifest tetany attack of tetany differential diagnosis manifest tetany carpo pedal spasm
manifest tetany carpo pedal spasm
carpal pedal Planter flexion
generalized convulsion
spasm
laryngeal spasm laryngeal spasm laryngesmus stridolus manifest tetany carpo pedal spasm convulsion even laryngeal spasm Manifest degree early neonatal hypo calcemia prenatal asphyxia diabetic mother still immature Para thyroid infant of diabetic mother Neonatology prematurity
Page |
188
3 mg
latent tetany Latent tetany Ionizable calcium 45 % Normal 30 % Low
3 mg Manifest tetany
4.5 mg 3 mg Say
3.5 mg manifest tetany
ionizable calcium ionizable calcium
threshold Nerve cell
tetany
complications of rickets tetany complications rickets Nutritional disorder against you
Kowashirkor
marasmus
rickets
rickets
complications of rickets tetany

Page |
189
Nutrition DR. Abo-Asrar tetany rickets tetany
tetany tetany Manifest tetany latent tetany
rickets
laboratory investigations alkaline phosphatase Phosphorus
Low Normal serum calcium Investigations
Normal
Low
Normal
serum clacium clinically Low serum calcium Manifest tetany latent tetany Manifest tetany
Latent tetany
threshold sign tempro mandibular joint neck of mandibule Mandibule Neck
hammer
tapping
Page |
190
Nutrition DR. Abo-Asrar mandibule hammer facial nerve Hyper excitable contraction contraction Chevostek sign nerve neck tapping
facial nerve facial muscle
3 mins
systole
pressure Carpal spasm
mid thigh pedal spasm
Trouseau sign systole thigh pedal spasm arm carpal
fibula anterior tibial nerve supply Neck of the fibula anterior tibial nerve tibialis anterior neck of the fibula
Page |
191
Nutrition DR. Abo-Asrar hammer excitation Nerve contraction contraction eversion of the foot threshold tibialis anterior tibialis anterior dorsi flexion
Dorsi flexion Eversion of the foot
Peroneal sign QT interval ECG ECG
Treatment
tetany calcium slowly IV brady arrhythemia cardic arrest heart 2 - 4 ml / Kg slowly IV slowly IV calcium gluconate very slowly IV
hypo Mg alkalosis
calcium supplementation
vitmain D
tetany tetany
Page |
192
written
clinical
criteria of adequate diet
Criteria of adequate diet

adequate diet adequate total Caloric supply Caloric supply
caloric supply Pre term Premature 120 Calori / Kg Pre term neoborn
120 Calori / kg / day full term 120 Calori / Kg / day 100
120 Calori / Kg / day
100
120 Calori / kg / day full term
pre term
100 Calori / kg / day
100 Calori / day
50 Calori / kg / day 50 Calori / kg /day
Page |
193
20 Calori / kg
,,,
8 8 800 100 x
= 800
12 1100 12
100 1000 2 50 100 1100 25 1600 100 50 x 2 1000 100 x 10
MCQ
Page |
194
Nutrition DR. Abo-Asrar daily requirement 25
25
100 50 20
1000 100 x 10 500 50 x 10 100 20 x 5 1600
criteria of adequate diet adequate total caloric supply caloric requirements 10 1000 1000 composition of diet criteria of adequate of diet Porportional diet Proportional diet
carbohydrates
Page |
total Calories
50 %
195
Nutrition DR. Abo-Asrar protein fat total Calories total Calories Calories Carbohydrates protein fat 15 % 35 %
50 % 15 % 35 %
protein
carbohydrates
total Calories fat composition
500
carbohydrates 150 proteins 350 fat Calories
4 125 9 fat
4.1 500 /4 9.3
Carbohydrates 500 500 fat 350 9 39 350 38.8 350 / 9 protein 150 4 37.5 150 150 / 4
fat 4 4.1
Calories supplied carbohydrates protein fat

Page |
diet
196
Nutrition DR. Abo-Asrar adequate diet
adequate amount of vitamins and minerals salts minerals Mg
vitamins vitmains vitmains vitmains
vitamins caloric supply Proteins fats carbohydartes minerals vitamins
adequate amount of water criteria of adequate diet Total Caloric supply carbohydrates fat Proportional diet Adequate amount of vitamins and minerals Adeqeuate amount of water
Proteins
Proteins
Rules diet fat carbohydrates
Page |
197
Proportional diet Proportional diet Caloric supply fat carbohydrates vitamins Minerals
palatable
palatable
palatable
Page |
198
Nutrition DR. Abo-Asrar nutritional disorder nutritional disorder
1000 1000 1000 500 total caloric supply Say
fat Minerals 50 % 35 15 vitamins
reduction of foot staffs 50 %
Under nutrition Under nutrition food contents 30 % 20 %
Under nutrition all food contents are reduced 500 1000 50 % Under nutrition under nutrition Marasmus under nutrition
Page |
marasmus
199
adequate or even
caloric supply
1000 1500 fats 1500
Kwashiorkor Kwashiorkor
Iron
Iron deficiency anemia
folic acid
Megalo blastic anemia
Page |
200
Nutrition DR. Abo-Asrar vitmain D rickets
deficiency
1000 1500
obesity malnutrition title malnutrition
vitamin D deficiecny iron rickets vitamin D vitmain D toxicity
iron deficiency anemia
Minerals
vitmain
hyper vitaminosis
malnutrition Malnutrition excess in one component of the food staffs reduction
Page |
201
under nutrition caloric supply
Malnutrition
1000 500 Under nutrition
Under nutrition
Marasmus
Kwashiorkor marasmic Kwashiorkor Marasmus Kwashiorkor manifestations edema Marasmic kwashiorkor Mixed under and malnutrition Nutritional disorder under nutrition malnutrition mixed under and malnutrition clinically
Page |
nutritional
202
Clinically
1977 Most applied clinically classifications
Wellcome classification 1977 wellcome classification 35
actual body weight
standard weight standard weight
standard deviation score percentile curve
standard weight ideal
expected weight expected body weight growth retarded 3.5 3 standard
Page |
203
Nutrition DR. Abo-Asrar 3.5 3 2.5 standard
growth development 3/4
3/4
birth weight 6
6 8
weight
Page |
204
growth
12
8 expected weigth
actual body weight
actual body weight
standard weight
expected weight
expected weight expected expected
expected
60 % 40 %
Page |
205
edema edema edema
edema marasmus edema wellcome edema marasmic Kwashorikor
marasmus marasmic kwashiorkor
edema edema
expected weight
marasmus marasmic kwashiorkor
marasmic kwashiorkor marasmus
edema edema
marasmus
marasmus
expected
60
wellcome classification marasmus Marasmic kwashiorkor edema
Page |
206
Nutrition DR. Abo-Asrar edema marasmus
spleen
Marasmus
Marasmus Marasmus marasmus Marasmus marasmus
rules
6 expected weight 75 %
kwashiorkor simple under weight
edema edema
Kwashiorkor
Page |
edema
207
Nutrition DR. Abo-Asrar simple under weight edema
wellcome calssification marasmus
Marasmus
kwashiorkor edema marasmic kwashiorkor marasmus wellcome classification simple under weight wellcome classification inborn error toxicology classification toxicology
marasmus chronic under nutrition
marasmus Marasmus
Page |
208
Marasmus
marasmus Marasmus total caloric supply
Etiology
dietic error Primary type primary type
Page |
209
1000 quantity 500
dietic error quantity total caloric supply 500 fat scanty breast milk Scanty breast milk infant feeding
Is not stasfied after feeding
Urine
stool stool bowel habits Intake
88 % failure to growth Under feeding
quantitiy infant feeding dietic history
Page |
210
Nutrition DR. Abo-Asrar Infant feeding 100 10 x month age 8 10 x 8
180 180
100
90 90 120
120
small amount
180 total amout per feed artificial milk 90 120 180
Infant feeding
6 6 6 9
12 3 3 6 9 9
Page |
211
6 10 2 6 9
12
11
Page |
212
Nutrition DR. Abo-Asrar 180
widely spaced feed
scanty breast milk small amount per feed artificial widely spaced feed breast milk artificial quantity Caloric supply weaning
delayed weaning
delayed weaning Infant feeding weaning delayed weaning
delayed weaning delayed weaning iron deficiney anemia delayed weaning rickets delayed weaning marasmus marasmus rickets iron deficiency anemia delayed weaning
quantity quality quality of milk quality of milk quality of breast milk
Page |
213
breast milk
available Bebe lac cover Bebe lac 1 cover
30 Milk 30
30
180 180 30
180
Page |
214
Nutrition DR. Abo-Asrar 180
diluted formula
180
diluted formula
quality cow milk cow milk allergy buffalo
quanitity quality cow milk cow milk allergy cow milk
mentally retarded
Mentally retarded
12
Page |
215
Cow milk protein allergy endocrine 36 % type one diabetes cow milk buffalo milk
0.5 % cow milk buffalo
type one diabetes 36 % 0.5 %
human being not an animal
cow milk protein allergy cow milk protein allergy vomiting chronic diarrhea
quality Marasmus Nursing errors irregular feeding
irregular feeding
Page |
216
irregular feeding Marasmus
hydrocephalus
engorgement of the breast breast very painful engorgement of the breast Irregular feeding failure of eructation
air emboli air emboli
Page |
217
fat muscle
100
100 gravity
Push
Intestine abdominal distention

Page |
218
conditioned reflex
colic eructation of the baby is very important difficulty of breast feeding
cleft palate
cleft lip suckling
everted nipple
flat nipple
Nipple difficulties of breast feeding marasmus Marasmus weaning
Proportionate
marasmus
Page |
219
Nutrition DR. Abo-Asrar dietic errors secondary marasmus secondary marasmus
consumption of food parasitic infection marasmus
marasmus
marked chachexia
Parasitic infection
Most common Parasitic infection pitryasis alba
Page |
220
Nutrition DR. Abo-Asrar endocrinal causes thyrotoxicosis thyrotoxicosis diabetes
Parasitic infection Thyrotoxicosis diabetes parasitic infection
clenching of the jaw Jaw mechanism parasitic infection clenching infection
saliva Excessive salivation
excessive saliva
tachycardia thyroid swelling
thyrotoxicosis tremors endocrine diabetes Investigations
Page |
221
Nutrition DR. Abo-Asrar hyper metabolic state diabetes thyrotoxicosis parasitic increase consumption ascris consumption parasite anorexia anorexia anorexia anorexia anorexia chronic infection chronic disease
attacks of gastro entritis anorexia
chronic infection malabsorption tuberculosis T. B. anorexia
anorexia
Otitis media urinary tract infection chronic infection What ever
chronic disease Liver disease anorexia renal disease renal tubular acidosis disease What ever Renal failure anorexia
anorexia
chronic disease Mechanism heart disease anorexia heart disease unable to suckle congenital heart disease
Page |
222
Nutrition DR. Abo-Asrar dyspnea
dyspnea
Heart failure
chronic disease chronic infection anorexia Heart
GIT GIT GIT GIT gastro esophageal reflux cardic sphincter
marasmus Pyloric stenosis absorption gut duodenum marasmus duodenal atresia
cleft palate
cleft lip
gut anomaly interference with feeding multi factorial multi factorial
multi factorial
marasmus
pre term pre term Marasmus
Page |
223
Nutrition DR. Abo-Asrar Neonatology jaw muscles preterm weak suckling
Jaw muscles weak suckling
bulbar cranial nerves Mature enough Poor swallowing
swallowing
suckling
still immature gut absorption digestion
multifactorial Inborn error of metabolism Metabolic disease glycogen storage galactosemia Inborn error marasmus Multifactorial Down syndrome chromosomal marasmus central cause gum
marasmus
Page |
224
Clinical manifestations of marasmus

clinical manifestations of marasmus patho physiology
cow milk
oral mucsoa fermentation milk
reflux apsiration growth hormone empty stomach other growth factors full stomach other growth factors growth hormone
Marasmus
Page |
225
Patho physiology
so easy patho physiology marasmus decrease total caloric supply calories
Calories supply
Liver
glycogen stores glycogen Liver glycogen stores calories
glycogens
Liver fat
glycogen stores fat lipolysis of fat
degrees
marasmus
fat loss First Second Third
fat fat
abdominal wall
fat abdominal wall fat
Loss of fat of the anterior abdominal wall
abdominal wall first degree marasmus extremities
fat
fat upper and lower limbs second degree
skin multiple folds skin

Page |
226
buccal pad of fat buccal pad of fat
fat fat
loss Loss
senile faceis
senile
loss of subcutaneous fat abdominal wall extremities buccal pad of fat
loss of intra abdominal fat buccal pad of fat third degree marasmus fat anterior abdominal wall Intra abdominal fat scaphoid abdomen fat
fat Muscles protein Muscle Muscle degeneration of the muscle Muscle protein
Muscle wasting
mid arm circumference Mid thigh acromion olecranon olecranon acromion Mid arm circumference Mid arm circumference acromion process mid arm
Page |
227
Nutrition DR. Abo-Asrar Olecranon acromion Mid arm circumference
Mid arm circumfernece bone skin muscle bone subcutaneous fat muscles Marasmus fat muscle fat
muscle support
msucle
multiple skin folds Mid arm circumference
Osteoid tissue caloric supply bone Osteoprosis
Of the bone bone
pathogenesis of marasmus bone Osteoporosis
skin
Muscle
Page |
228
Osteoporosis
Clinically
marasmus clinically marasmus
complications
4 edema expected 50 % 8 growth failure expected 60 %
wellcome classification without edema
senile face
Loss of subcutaneous fat loss of subcutaneous fat degrees grades Marasmus loss of subcutaneous fat of abdominal wall first degree loss of subcutaneous fat of extremities second degree loss of buccal pad of fat and intra abdominal third degree Muscle wasting mid arm circumference
Page |
229
Nutrition DR. Abo-Asrar Mid arm circumference 13.5 Marasmus 12.5
12.5
standard deviation score centile
pallor anemia anemia Marasmus iron deficiency anemia kwashiorkor megaloblastic anemia kwashiorkor anemia pallor
pallor
skin manifestations of marasmus skin manifestations of marasmus Multiple folds muscles Multiple folds buttocks buttocks folds of skin
quadricepis muscles multiple folds of skin thigh
legs thigh arm
forearm buttocks Multiple folds of skin
fold of skin
Page |
230
fat skin elasticity
dehydrated fat dehydration
dehydration
Loss of skin elasticity Marasmus signs of dehydation Loss of skin elasticity
Marasmus
skin elasticity fold of skin dehydrated dehydration sternum sternum
skin manifestations abdomen clinical abdomen fat muscle Intra abdominal scaphoid abdomen anterior abdominal wall scaphoid abdomen
abdominal wall
Intestine
Page |
231
Nutrition DR. Abo-Asrar Intestinal motility visible abdominal wall is very thin Intestinal motility
irritable Irritable
Irritable Hunger sensation
sublingual oral Hypo thermia hypo thermia decreased caloric supply caloric supply
caloric supply caloric supply
Hyper thermia
decreased caloric supply decreased caloric supply
Page |
232
Muscle rigors muscle contraction
generators heat production
rigors muscles
Heat loss Muscle generator production
muscle wasting
fat Heat loss Males females
fat fat
Page |
233
Loss of fat
heat loss fat
fat marasmus
Hypothermia dehydration dehydration hypo thermia Hypo thermia dehydration spesis
37 38
complications Muscle wasting anemia pallor skin manifestations irritable abdominal manifestations hypo thermia
Heat production
wasting Heat loss
hypo thermia caloric supply Muscle muscle Loss subcutaneous fat hypo thermia
Intake
dehydration total blood volume dehydration
hypo thermia GIT dehydration
peripheral vascular collapse

Page |
234
Nutrition DR. Abo-Asrar blood volume water loss collapse
Peripheral vessels
endogenous temperature
Peripheral vascular collapse
Peripheral vessels Pale dehydration septic shock
vascular flow vascular flow
Hypo thermia infection septic shock septic shock
infection viral
bacterial
infection cell destruction cell destruction pyrogens
brain
heat regulating centres
false impression
Pyrogens
40
40
central heat regulating center
Page |
235
Nutrition DR. Abo-Asrar cell destruction Pyrogens heat regulating center
Heat regulating center shivering Production of heat muscle shivering
heat regulating center
false impression compensation
severe infection severe infection Heat regulating center toxins heat regulating center peripheral vaso dilatation toxins extremities flushing peripheral vaso dilatation
heat loss
septic shock shock
toxins Heat loss
peripheral vaso dilatation Peripheral vaso dilatation Infection
fever
Page |
236
good sign
fever
infection stable infection
Pus
toxins
Not reacting to infection Infection it is a good sign it is a very bad sign infection Infection
heat loss
septic shock Hypo thermia Hypo thermia heat regulating center toxins peripheral vaso dilatation toxins
marasmus
clinical manifestations GIT manifestations GIT manifestations of marasmus apetite marasmus Irritable
anorexia
program
Page |
237
failure
anorexia Central cause endocrine satiety center feeding center neuro transmitter signals amino acids anorexia Central cause
amino acids Kwashiorkor amino acids anorexia
diarrhea
diarrhea constipation constipation constiaption clinical diarrhea
marasmus gastro entritis
diarrhea diarrhea immunity immunity
immune system immune system Immune system
Page |
238
Nutrition DR. Abo-Asrar immunity Immunity GIT gastro entritis
repeated infection
intestinal villi
atrophy
malnutrition atrophy
normal intestinal villi Intestinal villi villi surface surface
atrophied intestinal villi
normal intestinal villi malabsorption absorption absorption
Intestinal villi GIT digestive juices lactase enzyme disaccridases Lactose digestive enzyme digestive enzyme maldigestion gastro entritis diarrhea maldigestion Malabsorption
diarrhea starvation diarrhea Marasmus starvation starvation diarrhea starvation diarrhea intestinal cells shedding intestinal villi Intestinal villi atrophy Intestine Lumen cells
Page |
Kwashiorkor
239
Nutrition DR. Abo-Asrar wall of the gut ulcers cells cells
ulcer Ulcer serum serum mucous secretion raw area ulcer ulcer raw area
raw area raw area
GIT mucous
Mucous protective mechanism
Mucous
raw area ulcer raw area healing healing excess mucous Mucous raw area raw area
bacterial flora
Lumen
Lumen sheded epithelial cells Mucous bacterial flora sheded epithelial cells Mucous bacterial flora
bacterial flora mucous

Page |
240
Nutrition DR. Abo-Asrar Mucous fermentation Mucous fermentation fermentation H2S
H2S very offensive
iron
H2S
Iron Iron absorption
H2S
Iron
absorption lumen H2S FeS Lumen
Iron absorption Iron H2S FeS
huge amount of watery stool Small amount loose
dark
H2S
Page |
241
Nutrition DR. Abo-Asrar GIT stool
very offensive H2S criteria of starvation diarrhea starvation diarrhea criteria of starvation diarrhea maldigestion malabsorption starvation diarrhea small amount Loose diarrhea very offensive
gastro entritis
stool
stool
mucous bacterial flora Microscopic examination
constipation
diarrhea Intake diarrhea
marasmus constipation
gastro entritis gastro entritis immune deficiency Immune deficiency Immune system
Page |
242
Nutrition DR. Abo-Asrar maldigestion Maldigestion malnutrition digestive jucies Full digestion of food absorption malabsorption Intestinal villi atrophy absroption
intestinal villi
atrophy
surface
starvation diarrhea diarrhea Maldigestion malabsorption huge amount of stool loose loose gastroentritis starvation diarrhea criteria
starvation diarrhea
diarrhea greenish in color dark greenish in color very offensive stool
stool offensive H2S stool very offensive
stool greenish FeS stool greenish
microscopic examination Sheded epithelium cells Mucous Bacterial flora
marasmus
gastro entritis
Page |
243
Nutrition DR. Abo-Asrar complications marasmus gastro entritis marasmus complications
complications gastro entritis marasmus Cardiovascular system GIT cardio vascular system pulse radial pulse apical pulse Low heart rate cardic muscle slow and weak pulse dehydration rapid and weak pulse dehydration shocked
weak pulse
rapid and weak pulse
respiratory muscle
shallow respiration
respiratory wasting respiratory muscle respiratory muscle wasting respiration 500 cc of air 500 300 say
weak cough reflex

Page |
weak respiratory movement
244
repeated chest infection Immune deficient shallow respiratory movement repeated chest infection shallow respiratory movement respiratory muscle weakness weak cough relfex
complications complications intercurrent infection Mineral deficiency vitmains nutritional disorder Kwashiorkor marasmus toxicity vitamin Deficiency
complications Intercurrent infection broncho pneumonia sinusitis bronchitis Otitis media pyelonephritis gastro entritis Infection Immune system immune system Infection
bleeding
blood vessel
Protection
complications Severe hemorrhage bleeding fat cells subcutaneous fat
Page |
245
Nutrition DR. Abo-Asrar wall of the vessel protection subcutaneous fat
vascular support Liable to bleed collagen fibers wall of the vessel vessel
blood vessels fat fat vascular support wall of the vessel collagen
wall of the vessel collagen fibers supporting fragile wall fragile wall of the vessel Loss of subcutaneous fat collagen fibers supporting the vessel dehydration dissminated intra vascular coagulopathy Infection dehydration bleeding Infection dehydration DIC
Intra vascular thrombus fibrinolytic system fibrinolytic system
coagulation factors
platelets
consumption hematology Platelets consumption platelets coagulation factors
coagulation factors
Page |
246
Nutrition DR. Abo-Asrar bleeding vessel wall supporting consumption DIC
collagen subcutaneous fat vessel DIC coagulation factors platelets dehydration severe infection
DIC DIC
dehydration Infection
complications mainly
Caloric supply marasmic kwashiorkor edema edema marasmic kwashiorkor faulty management caloric supply
hypo thermia
complication
hypoglycemia marasmus hypoglycemia hypoglycemia
hypo glycemia hypo glycemia hypoglycemia hypoglycemia hypoglycemia hypoglycemia
Page |
247
Intake
hypoglycemia Intake hypoglycemia
absorption malabsorption malabsorption digestion wall malabsorption absorption lactose absorption Lactase absorption malabsorption
glycogen liver fat glycogen
Liver
stores stores fasting
glycogen stores Liver glycogen storage
glycogen stores depleted glycogen stores counter regulatory hormone blood glucose cortisone epinephrine counter regulatory hormones
Page |
248
hormone counter regulatory hormone
epinephrine
counter regulatory hormones counter regulatory hormones fat metabolism Acetyl Co A
acetyl Co A
counter regulatory hormones glucose Muscle glycogen
counter regulatory hormones counter regulatory hormones Nor epinephrine epinephrine amino acids phenylanine tyrosine counter regulatory horomones thyroxine counter regulatory hormones tyrosine thyroxine tyrosine thyroxine Kwashiorkor counter regulatory hormones counter regulatory hormones
Page |
249
Nutrition DR. Abo-Asrar Hypoglycemia Hypoglycemia Kwashiorkor hypoglycemia decrease intake malabsorption glycogen stores counter regulatory hormones marasmus
Page |
250
Page |
251
full esophagus
the same
infection sepsis hypoglycemia sepsis hypoglycemia infection sepsis

Page |
252
Nutrition DR. Abo-Asrar Organism Organism hypoglycemia infection excess consumption of the glucose Hypoglycemia excess consumption of glucose Nutritional disorder hypoglycemia
Marasmus
peptic ulcer peptic ulcer peptic ulcer intestinal villi shedding Intestinal villi wall of the stomach shedding wall of the stomach acidic shedding raw area PH stomach raw area HCL
erosion of the wall of the intestine
severe ulceration hematemesis Peptic ulcer
total caloric supply
marasmic kwashiorkor kwashiorkor muscle edema protein so early 60 % edema
so early edema
edema
still
kwashiorkor marasmic kwashiorkor
edema kwashiorkor
60 % marasmic kwashiorkor
Page |
253
investigations of marasmus
Investigations
investigations of marasmus Is a clinical diagnosis marasmus marasmus clinically 8
expected
60 % centiles
actual body weight 50 centile expected
marasmus edema it is a clinical diagnosis
marasmus
marasmus Marasmus complications
Investigations Investigations
marasmus Investigations stool urine Undigested food

Page |
stool
254
Nutrition DR. Abo-Asrar Malabsorption gastroentritis complications mucous gastroentritis history fat absorption of fat steatorrhea absorption fat 9 stool
fat caloric intake
Urine analysis say urine RBCs pus cells urinary tract infection complication marasmus urinary tract infection
chronic infection repeated infection
marasmus
glucose urine glucose with or without keton bodies blood glucose 300 250 blood glucose polyuria glucose urine diabetic diabetes Loss of weight endocrine diabetes glucose urine blood glucose diabetic
Page |
255
Nutrition DR. Abo-Asrar marasmus Marasmus diabetes Once Urine amino acids urine phosphorus glucose alkaline PH Fanconi like Fanconi Fanconi Fanconi Loss of amino acids Loss of glucose caloric supply diabetes
urine urine Fanconi failure to thrive
Fanconi failure to thrive
marasmus glucose urine amino acids Marasmus urine
urine analysis
Marasmus Marasmus marasmus
chest X - ray chest X - ray chest X - ray congenital heart disease

Page |
marasmus chest X - ray heart
cardiomeglay chest X - ray
256
Nutrition DR. Abo-Asrar VSD marasmus VSD marasmus VSD Marasmus cardiology sheet marasmus VSD marasmus heart
cardiology
nutrition nutrition
congenital heart disease
congenital heart disease sheet cardiology congenital heart disease most probably VSD complicated by marasmus VSD complication marasmus
third degree marasmus complicated by VSD
marasmus marasmus VSD complicated by marasmus
chest X - ray congenital heart disease lesion Murmur
chest X - ray heart
chest X - ray chest infection tuberculosis Marasmus T.B.
tuberculosis
finding suggesting
chest X - ray
Page |
257
Nutrition DR. Abo-Asrar T.B. exclusion chest X - ray
complications pneumonia bronchitis
chest X - ray complicated complicated complicated
chest infection
tuberculin test false negative Marasmus
tuberculos tuberculin test
negative
cell mediated immunity Immune deficient tuberculin
tuberculin test
tuberculos tuberculin test
marasmus
contacts
tuberculos suggestive tuberculos until proved otherwise tuberculin test Immune deficient false negative contacts tuberculin test Marasmus Intestinal villi Malabsorption intestinal villous biopsy malabsorption
Page |
258
Nutrition DR. Abo-Asrar Investigations complications associated manifestations pallor
marasmus
CBC anemia anemia kwashiorkor
pallor CBC anemia
anemia 60 MCV 25 MCH Microcytic hypochromic anemia microcytic hypochromic anemia cupper deficiency iron deficiency microcytic hypochromic anemia cupper iron kwashiorkor kwashiorkor microcytic hypochromic anemia 13 Iron deficiency cupper microcytic hypochromic Megaloblastic anemia RBCs MCV mean corpuscular volume 100 MCV megaloblastic anemia macrocytic folic acid deficiency hematology folic acid stores folic acid folic acid deficiency folic acid deficiency kwashiorkor normocytic normochromic anemia anemia normocytic normochromic normocytic normochromic anemia
Page |
Nutrition
259
Nutrition DR. Abo-Asrar depression bone marrow Normocytic normochromic anemia anemia CBC WBCs Infection ESR ESR T.B. ESR CBC Infection
chemistry kwashiorkor
assessment chemistry protein kwashiorkor
immune globulins
kwashiorkor
unbalanced diet kwashiorkor sufficient caloric supply
Etiology
etiology first baby common
kwashiorkor
kwashiorkor
Page |
260
pregnant
Page |
261
sore throat
Page |
262
Nutrition DR. Abo-Asrar depression anorexia
kwashiorkor common kwashiorkor Kwashiorkor kwashiorkor Milk very rare very rare artificial milk Proportionate diet caloric supply kwashiorkor marasmus marasmus kwashiorkor Milk
breast milk
so rare
kwashiorkor kwashiorkor
kwashiorkor kwashiorkor
kwashiorkor
Page |
263
Nutrition DR. Abo-Asrar Primary nurtrition
weaning kwashiorkor faulty weaning faulty weaning weaning
kwashiorkor
unbalanced diet
kwashiorkor
secondary secondary secondary to other disease whooping cough text secondary to disease anorexia anorexia
kwashiorkor
Page |
264
Pathophysiology of kwashiorkor
caloric supply fat
Pathophysiology of kwashiorkor kwashiorkor excess caloric supply excess caloric supply fat excess carbohydrates intake Protein
kwashiorkor
fat excess fat
excess calories
fat
Page |
265
Nutrition DR. Abo-Asrar fat fat
subcutaneous
fat subcutaneous fat
fat fat fat buccal pad of fat
buccal pad of fat carbohydrate facies Kwashiorkor senile marasmus Kwashiorkor
extremities
fat
abdominal fat
marasmus
subcutaneous fat buccal extremities
Page |
266
Nutrition DR. Abo-Asrar abdominal fat Marasmus full
subcutaneous space fat Liver fat Liver fat liver fat
fat Liver to react with protein Liver Liver lipoprotein
Liver
protein react fatty lipoproteins Liver low denisity lipoprotein high denisity lipoprotein biochemistry fat Liver lipoprotein Liver
Lipoprotein fat
blood
Liver
Lipoprotein blood vessel Lipoprotein
blood vessel lipotropic factors
liver cells fat lipotropci factors blood vessel Liver cells lipoprotein lipotropic factors lipotropic factors amino acids methionine
vitamin B complex one of the major lipotropic factors vitmain B complex
Page |
267
Nutrition DR. Abo-Asrar fatty liver
fatty liver Lipid profile Lipoproteins fatty liver kwashiorkor Lipoprotein liver Liver liver fat
fat deposit Liver fat
Lipotropic factors Liver lipoprotein Liver
Lipotropic factors vitamin B complex Vitamin B complex vitamin B complex maldigestion Malabsorption Liver fat fatty liver liver fat deposit liver fatty liver deficiency of protein deficiency of lipotropic factors
absorption
vitmain B complex
lipoprotein amino acids
Liver
Page |
Palpation
kwashiorkor
268
Liver fatty liver fatty liver
Liver
fat
subcutaneous fat
Muscles Muscles Muscles Muscle wasting Marasmus Muscle wasting Loss subcutaneous fat Mid arm circumference wasting Muscle Mid arm circumference
Marasmus subcutaneous fat
fat
Muscle
Mid arm circumference ratio muscle fat Muscle to fat ratio kwashiorkor fat Muscle Decrease muscle to fat ratio
Page |
269
Nutrition DR. Abo-Asrar Excess fat to muscle ratio fat Muscle Mid arm circumference Muscle bone osteoporosis bone bone bone degeneration of the cardic muscle Neglected cases degeneration of the cardic muscle cardic muscle protein
marasmus Osteoporosis muscle wasting cardic muscle degeneration Heart failure marasmus Heart failure kwashiorkor cardic muscle degeneration cardic muscle Liver stores Liver fat deposits compensation albumin marasmus Liver fat deposits Liver liver albumin
Liver Liver
Liver
Marasmus compensation serum albumin
support support Hypoproteinemia

Page |
liver
kwashiorkor Liver support
270
Nutrition DR. Abo-Asrar cardic muscle degeneration
muscle
degeneration
osmotic pressure blood vessel plasma protein
Plasma protein Nephrology osmotic pressure
Osmotic pressure Plasma protein extra vascular intra vascular Intravascular volume Interstitium fluid vessel vessel Heart volume receptors anti diuretics hormone ADH
Nephrology anti diuretics hormone hypothalamus signals
collecting tubules osmotic pressure Interstitium space Interstitium space
Nephrology renal blood flow blood volume renin aldosterone renin salt and water retention Interstitium space aldosterone
Page |
271
Nutrition DR. Abo-Asrar osmotic pressure ADH Aldosterone Aldosterone ADH Liver
Liver
Marasmus
edema edema Liver
compensation edema Decrease osmotic pressure ADH Aldosterone
intestinal villi atrophy intestinal villi atrophy
shedding recovery mechanical trauma GIT digestive jucies chemical trauma thermal trauma contaminated GIT Mucosa rapid mitosis GIT
intestinal villi
atrophy
intestinal villi atrophy malabsorption Maldigestion
Page |
272
Nutrition DR. Abo-Asrar exocrine function of the pancreas endocrine exocrine function of the pancreas exocrine function of the pancreas Infected degeneration endocrine function kwashiorkor complications Marasmus kwashiorkor
marasmus acute malnutrition complications endocrinal dysfunction of the pancreas
exocrine function of the pancreas degeneration acini
pancreas
pancreas enzymes digestion pancreatic enzymes Malabsorption Maldigestion renal tubules hyaline degeneration renal tubules degeneration of the hyaline tubular dysfunction renal tubules
kidney
brain brain brain brain brain thyroxine thyrotoxicosis cretinism
very irritable
thyrotoxicosis
Page |
273
Nutrition DR. Abo-Asrar brain cells thyroxin tyrosine thyroxine tyrosine Hypo thryoid function thyroxine facial expression hypo thyroidism
thyroxin
neuronal cells Neuron neuro direct contact synaps Neuron synaps neuron
Neuron
Occiptial lobe
Optic nerve
Occipital lobe once cortical blindness cortical blindness Optic nerve
Occipital lobe
Occipital lobe
Page |
274
frontal lobe
copy
Occipital lobe Memory frontal lobe
frontal lobe
temporal lobe temporal lobe
frontal lobe I dont know
temporal lobe fronal lobe
frontal lobe neuro transmitter actions transmitter tyrosine phenyl alanine neuro transmitter tryptophan tyrosine brain phenylalanin Neurotransmitter
tryptophan
brain
Page |
275
deficiency of phenylalanine, tyrosine and
defect in neurotransmitter inside the brain tryptophan Hypothyroid function mental changes
clinical manifestation of marasmus Hypothermia hypothermia caloric supply subcutaneous fat Muscle bulk dehydration sepsis GIT manifestations Hunger sensation constipation diarrhea Irritability anorexia
heat loss
Marasmus gastro entritis maldigestion malabsorption starvation diarrhea starvation diarrhea small amount Loose stool Dark greenish in color Very offensive stool examination dead epithelial cells Mucous bacterial flora cardio vascular
Page |
276
Nutrition DR. Abo-Asrar weak pulse Low volume of the pulse bradycardia rapid weak pulse dehydration respiratory shallow respiration respiratory
chest infection vitamins deficiecny
Infection complications faulty management
edema bleeding
hypothermia hypoglycemia Peptic ulcer gastric erosion Marasmus Investigations marasmus associated manifestations Stool and urine analysis Chest X - ray tuberculin tuberculos wall of the intestine biopsy anemia CBC ESR
malabsorption
kwashiorkor caloric supply
Milk Milk neglect of protein
Page |
277
faulty weaning anorexia
kwashiorkor systemic disease
kwashiorkor Pathophysiology Liver fat subcutaneous fat hepatomegaly
kwashiorkor
Muscle wasting degenration of the cardic muscle edema intestine malabsorption Maldigestion Mental changes kidney
38 39 clinical manifestations of kwashiorkor marasmic kwashiorkor Investigations nutritional dwarfism
Clinical manifestations
clinical manifestations of kwashiorkor wellcome clasification Kwashiorkor edema expected clinical manifestations of kwashiorkor essential features Non essential features
80
60
kwashiorkor expected weight age
Page |
278
expected edema wellcome classification edema expected weight 80 % 60 Kwashiorkor actual weight
manifestations of kwashiorkor kwashiorkor wellcome Manifestations of kwashiorkor essential features non essential features essential features
essential featrues of kwashiorkor edema expected 60 - 80 % essential features
growth failure
essential features
marasmus expected
60 % edema
expected
80 %
60
Masked
kwashiorkor
Page |
Loss of weight
growth failure
279
fat edema
excess fat growth failure is not observed by the mother Masked by excess subcutaneous fat and edema expected weight expected wellcome kwashiorkor essential features edema Kwashiorkor decrease osmotic pressure kwashiorkor edema Osmotic pressure Osmotic pressure osmotic pressure plasma protein edema
classification
albumin
fat infiltration
Is affected Liver liver compensation plasma protein osmotic pressure
nephrology osmotic pressure interstitial space Intra vascular interstitial space Intra vascular edema
Page |
280
Nutrition DR. Abo-Asrar vascular volume Intra vascular volume blood vessel blood volume vascular volume Nephrology brain Hypothalamus blood volume
volume receptors anti diuretic hormone ADH hypo volumia ADH ADH volume receptors hypo thalamus ADH
renal tubules
kidney ADH renal tubules water reabsorption renal tubules water reabsorption osmotic pressure blood vessel edema
Intra vascular volume renal blood flow aldosterone renin renin renal blood flow supra renal aldosterone aldosterone distal convoluted tubules of the kidney aldosterone sodium
Kwashiorkor sodium loss in urine renal tubules Osmotic pressure

Page |
281
Nutrition DR. Abo-Asrar Interstitial edema
total body sodium serum sodium
ADH dilutional hypo natremia Investigation amount concentration retention of sodium retention of water
Nephrotic syndrome destruction destruction liver Liver aldosterone ADH aldosterone ADH Liver fat Infiltrated liver function of the liver cells ADH
defect
Aldosterone
destruction
edema capillary permeability capillary integrity fragile capillary Leak permeability capillary permeability
Page |
282
Nutrition DR. Abo-Asrar edema decreased osmotic pressure Aldosterone ADH excess capillary permeability
capillaries pores capillary
capillary
edema edema pitting edema
dorsum of the hand Legs
dorsum of the foot thigh forearm edematous arm arm
lymphatic system arm arm edema edema severe condition
ascites
pericardial effusion
edema abdominal wall very rare Pleural effusion effusion very rare common
pericardial effusion
pleural effusion ascites 1 gram serum albumin
Page |
283
complications complications very early and very rapid
effusion kwashiorkor effusion abdominal wall edema applied clinical applied clinical
complications
kwashiorkor
complications
Mental changes
essential features of kwashiorkor Mental apathy
thyroxine
brain tyrosine thyroixne amino acids tyrosine thyroxine Hypothyroid function Hypo mental function Neuronal cells
direct neurotransmitter epinephrine norepinephrine
brain phenyl alanine
neurotransmitters tyrosine
spelling protein sources
tryptophan serotonine neuro transmitters inside the brain brain Neurotransmitters
Page |
284
Nutrition DR. Abo-Asrar cells connection
facial expression
facial expression Mental apathy decrease muscle to fat ratio essential features of kwashiorkor decrease muscle to fat ratio fat ratio Muscle muscle fat anthropology anthropometric anthropometric X - ray bone diameter X - ray bone fat Muscle Muscle to fat decreased muscle to fat ratio
kwashiorkor kwashiorkor wellcome classification
Page |
285
edema
growth failure
essential features mental change decrease of muscle to fat ratio
decrease muscle to fat ratio
clinically
Non essential features of kwashiorkor Non essential features of kwashiorkor Non essential features
hepatomegaly liver
palpation of the liver fat deposit Hepatomegaly Liver fat deposit Liver Liver lipoprotein
fat
lipoprotein
lipotropic factors
Liver
Lipoprotein vitamin B complex choline kwashiorkor
methainoine deficient Hepato megaly
hair changes
non essential hair follicles skin skin glue like material

Page |
Hair follicle
286
Nutrition DR. Abo-Asrar sulphar containing amino acids cystiene sulphar containing amino acids glue material cystine
dendritic cell Melanocytes
Branched cell
Melanocytes melanin melanocytes thyroxine thyroid follicle tyrosine tyrosine amino acids uptake
uptake tyrosine
Phenyl alanine
amino acids tyrosine tyrosine amino acid tyrosine
tyrosinase tyrosinase melanin tyrosine enzyme
tyrosinase enzyme
cupper
tyrosinase enzyme cofactor
Page |
287
Nutrition DR. Abo-Asrar cupper cupper tyrsoinase melanocytes cupper free iron carrier protein ceruloplasmin alpha two globulin cupper carrier protein ceruloplasmin cupper carrier melanocytes cupper tyrosinase melanin melanocytes vesicles Melanocytes vesicle Melanocytes
Melanocytes
hair follicle body
Hair follicle hair follicle
deficiency
kwashiorkor
Page |
288
easily pickable hair
easily pickable hair
14 20
easily pickable hair deficiency of sulphar containing amino acids sulphar containing amino acids deficiency of sulphar containing amino acids
tyrosine
phenyl alanine tyrosine
Intake Phenyl alanine
Phenyl alanine tyrosine enzymatic defects tyrosinase enzyme amino acids sequance enzyme
Investigations enzymes
Page |
289
Nutrition DR. Abo-Asrar tyrosinase tyrosinase cupper cofactor Malabsorption
Liver carrier protein
cupper
stores Liver ceruloplasmin ceruloplasmin
deficiency of cupper and ceruloplasmin tyrosinase
deficieny of phenyl alanine and tyrosine deficiency of tyrosinase and permease deficiency of cupper and ceruloplasmin
Page |
290
clinical fabricated
X - ray
heart
sign Fallot tetralogy cardiology
egg on side
transposition
flag sign flag sign one color flag
One color
flag sign
flag sign Microscopic finding finding color
Page |
291
flag sign flag sign Deficiency of melanin production production tyrosine phenyl alanine tyrosniase ceruloplasmin cupper
kwashiorkor
Hair changes
skin changes dermis epidermis dermatology
epidermis thin layer of fat epidermis subcutaneous fat subcutaneous fat fat fat transparent fat fat essential fatty acids non essential amino essential amino acids Non essential fatty fatty acids acetyl Co A fatty acids
Page |
essential fatty acids acids Non essential fatty acids
Acetyl Co A
292
Nutrition DR. Abo-Asrar non essential fatty acids fatty acids
Intake
essential fatty acids
essential fatty acids transparent
male
thickness
triple
female male
thickness female
superficial layer of the skin dehydration fat superficial cells evaporation of water dryness fat fat
reflection of sun lights Ultra violet rays sun burn effect
Page |
293
protective mechanism
opaque
melanocytes ultra violet rays superficial cells nucleus
color
cut
cut
superficial layer of fat
Page |
294
fat
essential fatty acids essential fatty acids maldigestion Malabsorption protective layer
erythema
erythema
sun burn
erythema Sun burn protective layer erythema
erythematous area inflammation opaque layer Opaque layer
false expression
Page |
dead cell dead cell hyper pigmentation
295
Nutrition DR. Abo-Asrar It is not acutally hyper pigmented area dead layer of the skin
healing ulcers raw area Healing regeneration and recovery raw area and ulcers raw area or ulcer desquamation Ulcer
without melanin
ulcer hypo pigmentation
erythematous hyper pigmented Ulcers Hypo pigmented area
Flaking paint appearance mixed stages erythema hyper pigmented ulcers hypo pigmented area
Page |
296
Nutrition DR. Abo-Asrar immunology Micro organism surface of the mucosa Micro organism surface of the skin Ulcer raw area organism Ulcer raw area severe infection severe infection Infection Infection excess sweating
defence mechanism adhesion of the cell
severe infection gangrene of the skin
Organism flexture ares axilla ( napkin Napkin dermatitis fungal bacterial What ever
Pressure areas Pressure areas Pressure areas Pressure area vascularity Organism
Page |
297
Organism vascularity vascular flow vascularity Pressure area
buttocks
Pressure area buttocks
Infection excess sweating Pressure area
skin changes deficiency of essential fatty acids nictotine amide tryptophan skin cells
Integrity, recovery and healing rpaid healing recovery
vitamin A cornea superficial layer of the skin skin recovery vitamin A Ulcer raw area rapid recovery
vitmain A vitamin A
deficiency vitmain A deficiecny clinical pictures malabsorption zinc deficiency zinc vitmamin A vitamin A
zinc
skin changes deficiency of essential fatty acids

Page |
298
Nutrition DR. Abo-Asrar deficiency of nictoin amide tryptophan deficiency of vitamin A deficiency of zinc skin manifestations
skin manifestations GIT manifestations kwashiorkor anorexia GIT trouble anorexia central anorexia central anorexia marasmus feeding center signals signals
Neurotransmitter
signals
Mental changes central anorexia GIT distrubance Local constipation not diarrhea marasmus diarrhea Marasmus diarrhea Gastro entritis maldigestion Malabsorption Starvation diarrhea Iron
atrophy of intestinal villi
Pallor anemic
Page |
pallor
299
Nutrition DR. Abo-Asrar Kwashiorkor anemia Microcytic hypochromic anemia deficiency of iron of cupper megaloblastic anemia folic acid deficiency B12 and folic acid deficiency Marasmus kwashiorkor Megaloblastic megaloblastic
Liver B12 15 12 supply stores Liver fat deposition Liver B12 depletion of stores
kwashiorkor
megaloblastic anemia marasmus megalo blastic anemia kwashiorkor Marasmus megaloblastic anemia folic acid deficiency B12 deficiency folic acid marasmus kwashiorkor
affected deficiency of protein
Liver
Kwashiorkor
anemia
RBCs Normocytic normochromic anemia Infection anemia Infection bone marrow depression hemolysis of the RBCs depression of the bone marrow
Page |
RBCs
300
Nutrition DR. Abo-Asrar abdominal distention scaphoid abdomen abdominal distention marasmus kwashiorkor abdominal distention weak abdominal muscles abdominal muscles
pot belly abdomen
fermentation
absorption digestion bacterial flora gases common
lumen fermentation
immune deficiency in
Lumenal parasites kwashiorkor
Upper of the jujenum duodenum fermentation parasites
general Giardia Giardia Giardia
distention generalized Hyper resonant abdominal allover percussion giardia epigastrium hyper resonant Percussion giardia Giardia giardia
stool analysis giardia very rare stool analysis nasogastric tube giardia duodenum aspirate analysis
Page |
301
Nutrition DR. Abo-Asrar giardia stool analysis giardia fermentation
giardia
intestinal obstruction Intestinal obstruction Paralytic ileus paralytic ileus hypokalemia diarrhea gut secretion Hypokalemia hypokalemia Hypokalemia diarrhea
Loss of gut secretion hypokalemia aldostrone aldosterone
Urine
Loss
aldosterone
Kwashiorkor hypokalemia diarrhea loss aldosterone Hyperaldosteronism
Aldosterone toxins paralytic ileus severe infection Liable to severe infection toxic ileus
toxins
Page |
302
Nutrition DR. Abo-Asrar abdominal distention vitamin deficiency vitamin deficiency vitamin A Keratomalacia blindness vitamin deficiecny vitamin A
toxicity
vitamin deficiency
vitamin A deficiency malnutrition
blindness vitamin A
stores
vitamin A deficiency decreased intake absorption Malabsorption absorption depletion of the liver stores Liver Liver stores liver stores vitamin A absorption vitmain A Liver stores vitamin A caroteen vitamin A
vitamin A
liver Liver
fat cells
Page |
303
Nutrition DR. Abo-Asrar deposition of fat
vitamin A Liver
caroteen Liver
Liver cells vitamin A zinc thyroxine vitamin A
thyroxine
zinc
tyrosine
thyroxine
thyroxine amino acids tyrosine hypo thyroidism
zinc
malabsorption vitamin A vitamin A deficiency Intake absorption stores
T4
T3
zinc
Liver
vitamin A thyroid
complications Kwashiorkor
complications
Complications
Marasmus
Page |
304
Nutrition DR. Abo-Asrar complications complications Marasmus Intercurrent infeciton Immune fucntion B cells T cells
Phagocytosis
migration
Macrophages
chemotaxis Interferon marasmus Marasmus
kwashiorkor
Immune deficient
infection kwashiorkor Infection kwashiorkor Organism good media edema Intercurrent infection
so common
gastro entritis
hemorrhage DIC
DIC Marasmus hemorrhage in general bleeding Marasmus Loss of subcutaneous fat
DIC
intervascular thrombosis coagulation factors Platelets consumption
hypothermia fat generators
heat production
Page |
305
Nutrition DR. Abo-Asrar Heat loss Muscle decreased heat production generators muscle wasting
sepsis dehydration
hypoglycemia complications Hypoglycemia Hypoglycemia hypoglycemia Hypoglycemia Hypoglycemia counter regulatory hormones counter regulatory hormones hyper irritability Hyperglycemia Hypoglycemia Hypoglcyemia is a fatal Hypo glycemia hyperglycemia is very weak hyperactivity endocrine hypoglycemia
epinephrine
kwashiorkor hypoglycemia counter regulatory hormones Hyper irritable
Say
tremors dilated cold skin vaso constriction

Page |
Pupil
306
Nutrition DR. Abo-Asrar vaso constriction excessive sweating Pale epinephrine
heart rate
Pulse rate severe tachycardia
false impression
Hypoglycemia hypothermia Hypothermia One of the complication Marasmus false imperssion Hypoglcemia hypoglycemia
Intake excess carbohydrate intake decrease carbohydrate intake Hypoglycemia excess carbohydrates
Malabsorption glucose stores counter regulatory hormones consumption sepsis
Marasmus heart failure kwashiorkor heart failure heart failure Heart failure Heart failure
Page |
307
Nutrition DR. Abo-Asrar degeneration of the cardic muscle degeneration of the cardic muscle Heart
cardiomyopathy
Liver compensation heart failure Marasmus Infection edema Immune deficiency severe infection volume overload volume overload management edema Intra vascular Interstitium congestive heart failure Hyper voluemia hyper voluemia during management Investitagations of kwashiorkor
toxic myocarditis
Investigations
kwashiorkor Marasmus Investigations
Nutritional assessment
assessment of the nutritional state fat electrolytes
endocrine
Page |
Oral glucose tolerance curve
308
Nutrition DR. Abo-Asrar hypoglycemic level curve hypoglycemia
free fatty acids cholesterol free fatty acids
fat
free fatty acids free fatty acids fats Lipoprotein Liver Minerals phosphorus
zinc
dilutional hyponatermia dilutional hyponatermia
total protein non essential amino acids to essential amino acids ratio albumin globulins carrier proteins enzymes Nephrology 8
total protein 6 Normal total proteins Low total proteins
normal non essential to essential amino acids ratio kwashiorkor
Page |
309
Nutrition DR. Abo-Asrar Non essential essential 2.5 albumin albumin alpha Intake beta globulins beta alpha alpha intake
immune
reticulo endothelial system
reticuloendothelial system gamma globulins
early globulins
reticulo endothelial system
advanced cases suppression
carrier protein Iron transferrin cupper ceruloplasmin thyroxine thyroid binding carrier protein enzymes AST enzymes AST Liver affection Liver and muscle ALT ALT AST ALT
muscle wasting
AST
tetany ionizable form non ionizable form bound form of calcium
Page |
310
tetany
Low
serum calcium
kwashiorkor tetany acidosis acidosis Infection
bound form of calcium ionizable form
Investigations Urine analysis Urea Urine urine marasmus Marasmic kwashiorkor kwashiorkor
Muscle catabolism of protein urea cycle Liver urea Urine
Hyper catabolism of protein of the muscles
Marasmus Liver
Marasmus
Urine Urine kwashorikor Liver Liver
hepatic encephalopathy management

Page |
311
Nutrition DR. Abo-Asrar hepatic encephalopathy
CBC ESR Tuberculin test Stool analysis intestinal vilous biopsy Marasmus
Marasmic kwashiorkor
Marasmic kwashiorkor
wellcome classification 60 % marasmic kwashiorkor marasmic kwashiorkor edema Marasmus edema Mental changes essential features mental changes
expected weight for age
skin Hair changes edema expected weight 60 %
Page |
312
pre kwashiorkor
laboratory clinical manifestations clinically Pre kwashiorkor
thalassemia
genetic diagnosed Especially hemoglobin electrophoresis
thalasssemia intermedia
14
13
follow up iron chelators
desferal thalassemic
kwashiorkor follow up
essential features
pre kwashiorkor pre kwashiorkor edema edema expected 80 % 60 edema Mental changes kwashiorkor edematous expected 80 % Kwashiorkor 60 edema
Page |
313
Nutrition DR. Abo-Asrar prekwashiorkor { edematous }
no edema kwashiorkor
non essential to essential amino acids 1 1 3 kwashiorkor Investigations 1 3 3 1 2 1 2
serum albumin 2.85 2.8 station 2.8
2.5
8 : 12 8 : 12 8 : 10
station
2.5
2.85 albumin Pre clinical kwashiorkor
Page |
314
Nutritional dwarfism
for normal growth nutritional disorder
Nutritional dwarfism so deficient
compensation by slow rate of growth
10th percentile endocrine 10th percentile
Nutritional dwarfism 39 treatment of marasmus and kwashiorkor Kwashiorkor marasmus

Page |
315
Treatment of marasmus and Kwashiorkor
prevention prevention Nutritional disorder
breast feeding feeding assessment assessment Over feeding weaning
feeding
Under Infant feeding
fat
proper weaning balanced diet
Proper diet
Immunity Malnutrition Malnutrition Malnutrition T.B. complication whooping cough Measles Malnutrition vaccination
Nowadays
Page |
316
family planning
family planning balanced diet
Kwashiorkor
active treatment Marasmus treatment Dietic management Non dietic management dietic management
Investigations treatment Investigations dietic management
is the child is full term but low birth weight, weaning at six months weaning full term
Page |
317
Nutrition DR. Abo-Asrar Preterm catch up phenomena Neonatology weight loss low birth weight
full term catch up phenomena weaning preterm Low birth weight weaning
even
stores Mature enough gut mucosa
enzymatic function infant feeding incidence of atopic diseases incidence of auto immune disorder explanation
: dietic management dietic management program satisfied total calories kwashiorkor marasmus total calories dietic management total calories total calories
Page |
318
Nutrition DR. Abo-Asrar marasmus 150 Marasmus 150 marasmus kwashiorkor Kwashiorkor 120 Normal Low birth weight Preterm Kwashiorkor 120
calories
expected weight actual body weight expected weight
4 6 kwashiorkor marasmus
Marasmus Kwashiorkor
expected weight
first degree maramus
expected weight
first degree marasmus
third degree marasmus
second degree marasmus
Kwashiorkor average weight
Page |
319
Nutrition DR. Abo-Asrar average weight actual weight expected
12 6
4 2
actual body weight expected weight mean Mean Mean
expected weight first degree marasmus
total calories total calories 1000
Delayed weaning
Page |
320
100
150
10
15
calculator calculator dose 10 2 15 3
4 6
Marasmus 6 averge weight 8 12 average weight average weight caloric requirements caloric requirements 150 120
first degree
Marasmus kwashiorkor
marasmus kwashiorkor
150 120
total calories
Page |
321
Nutrition DR. Abo-Asrar 3/2 3/2
average weight
Marasmus kwashiorkor
average weight 150 120 total calories
Calories 3/2 volume of milk
1200 cc
100 100 12 24 100 100 100
180
small frequent meals

Page |
322
Malabsorption
maldigestion
24
breast feed breast feed is breast feeding text book kwashiorkor Marasmus breast feeding
artificial milk
GIT malabsorption maldigestion
gut troubles
Non complicated humanized milk
Infant feeding calories
Humanized milk
humanized milk
Page |
323
Nutrition DR. Abo-Asrar humanized milk
lactose intolerance
malabsorption Maldigestion maldigestion Lactase enzyme
Lactose Lactose free milk humanized milk lactose lactose intolerance lactose free milk
steatorrhea steatorrhea skimmed milk
fat
malnutrition calories skimmed milk absorption fat
fat
Fat Digested fat Medium chain triglyceride bile skimmed milk Medium chain triglyceride
caloric supply
total calories total calories
Lactose free milk

Page |
Lactose intolerance
324
Nutrition DR. Abo-Asrar medium chain triglycerides skimmed milk steatorrhea small frequent meals
marasmus hypo proteinemia
Kwashiorkor kwashiorkor marasmus caloric supply proteins
total calories
fat
protein milk protein milk Protein milk 5 100 1.2 100 protein milk Protein milk
Infant feeding
4 4 gram per kilo gram per day 4 gram

Page |
325
enzymes
muscles
protein milk
calories
artificial milk
artificial milk diet
mixed meat
Of high biological value animal protein high biological value kwashiorkor
mental apathy mental retardation Planet protein animal protein
routes Mode of administration

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326
weaned
anorexia 100 50
anorexia
nasogastric tube
Nasogastric nasogastric nasogastric tube
Persistent vomiting nasogastric tube severe infection toxic ilues oral Chest infection
total parentral nutrition central line total parentral nutrition central line
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327
Nutrition DR. Abo-Asrar central line central line central line amino acids
total calories total calories
first sign of improvement Is improvement of apetite 100 100 100 first sign of improvement clinically Improvement of apetite dietic management
marasmus
Non dietic management Non dietic management emergency management emergency
hypoglycemia
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328
Nutrition DR. Abo-Asrar Intra venous glucose hypo glycemia hypoglycemia Hypoglycemia Hypoglycemia dehydrated re hydration hypo thermic
intra venous glucose
Loss
shivering
subcutaneous fat Loss
generator
kwashiorkor
marasmus muscle muscle wasting ,,,,, lost generators generators
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329
Marasmus marasmus
shock shock
shock
emergency management
blood transfusion
Kwashiorkor
marasmus
fresh blood fresh blood fresh blood
fresh blood anemia anemia platelets RBCs fresh blood fresh blood anemia
coagulation factors fresh blood bleeding tendency
Immune globulins immune state

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fresh blood
330
Nutrition DR. Abo-Asrar fresh blood immune globulins plasma protein kwashiorkor fresh blood plasma protein edema
general condition
enzymes apetite
fresh blood
bleeding
fresh blood fresh frozen plasma coagulation factors fresh frozen plasma fresh frozen plasma enzymes apetite
edema
Immue state
fresh frozen plasma Immune globulins
anemia anemia fresh frozen plasma albumin soft free albumin albumin
amino acids amino acids argenine
albumin amino acids amino acids amino acids
amino acids
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331
Nutrition DR. Abo-Asrar islets cells of langerhans stimulation argenine insulin
Hypoglycemia amino acids argenine hypoglycemia
anti biotics
Immune deficiency anti biotics gram negative gram positive gentamycin penicillin antibiotics available broad spectrum antibiotics
septic focus ottitis media marasmus Ottitis media pharyngitis marasmus Pharyngitis Pyelonephritis Kwashiorkor pyelonephritis septic focus protective mechanism broad spectrum antibiotics common fungus infection Immune deficiency mycostatin oral drops oral moniliasis Mycostatin
fungus
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332
Nutrition DR. Abo-Asrar Oral monaliasis
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333
esophagus
IQ
Marker
asthmatic aminophyline
Oral
skin oral moniliasis

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moniliasis Napkin dermatitis skin moniliasis
334
Nutrition DR. Abo-Asrar skin moniliasis Mycostatin cream mycostatin
Infection Infection vitamins and minerals Kwashiorkor Marasmus 50,000 Kwashiorkor
vitamin A
corneal ulcers deposits of keratomalacia vitamin A 50,000 vitmain deficiency Mineral Multivitamins deficiency correction of vitamin and mineral
Muscle wasting anbolic hormones protein biosynesis anabolic hormones anabolic hormones myosarcoma Carcinogenic effect marasmic
History
kwashiorkor
marasmus dietic failure
kwashiorkor
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Marasmus
treatment
335
blood transfusion On admission
thalassemia What is the most common cause of death in marasmus and kwashiorkor Infection Most common cause of death Heart failure Kwashiorkor
Notes
21 38 21 18
caloric requirements
average weight total calories total calories 3/2 calories
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336
marasmus treatment complications Kwashiorkor

Management fat fat High protein dietic management kwashiorkor Liver Liver
kwashiorkor Liver Marasmus
bacterial flora
bacterial flora
absorption
gut Liver Portal Liver Liver
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337
Nutrition DR. Abo-Asrar hepatic encephalopathy disturbed level of conscious
Hepatomegaly Hepatic encephalopathy Nutritional recovery syndrome hepatic encephalopathy High protein diet
recovery
Liver
calories fat recovery
fresh frozen plasma Liver
fat load
edema
Kwashiorkor Osmotic pressure Osmotic pressure Hyper volemia
congestive heart failure
Hyper volemia
hypervolemia Congestive heart failure
transient increase of the intra cranial pressure Over hydration transient increase of intra cranial pressure congestive heart Heart brain over hydration
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338
Nutrition DR. Abo-Asrar heart Over hydration comatosed
transient increase of the intra cranial pressure
kwashiorkor Hypokalemia
management
diarrhea
Urine hypoglycemia
aldosterone aldosterone
diarrhea aldosterone arrested
gut Urine
take care check
Management of kwashiorkor
Hypokalemia Over hydration hypo kalemia nutritrional recovery syndrome prognosis
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339
Prognosis
Prognosis of kwashiorkor Marasmus acute nutritional disorder marasmus kwashiorkor Kwashiorkor marasmus Kwashiorkor
complication Prognosis of kwashiorkor kwashiorkor so bad prognosis Kwashiorkor kwashiorkor reversible irreversible irreversible gut anomaly
Protein losing enteropathy protein gut transplantation available is so bad Prognosis
Prognosis Prognosis is so bad complications complications
reversible Irreversible
complications complications
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340
Prognosis
complications hepatomegaly
mental changes
mental dysfunction reversible
nutritional assessment differential diagnosis
Nutritional assessment
Nutritional Assessment
written
tetany Nutritional assessment history dietic history clinical assessment development anthropometric title laboratory assessment kwashiorkor
Immunological assessment
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341
Nutrition DR. Abo-Asrar Dietic history dietic history clinical round dietic history fat minerals vitamins
dietic history
fat total caloric count fat count protein count vitamin count
fat
content salt sugar sugar calories
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342
calories I dont know
iam so sorry
roughly
roughly
dietic history
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343
Nutrition DR. Abo-Asrar amount
clinical assessment check vitamin deficiency signs of malnutrition deficiency
anthropometric anthropometric anthropometry sheet percentile standard deviation score height Length
growth and development
subcutaneous fat skull circumference chest circumference chest to head circumference growth and development anthropometric assessment
anomalies
detect
anthropometric
Laboratory assessment laboratory assessment glucose tolerance curve
fat
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Lipid free fatty acids
344
Nutrition DR. Abo-Asrar essential and non essential amino acids ratio globulins carrier protein Protein albumin enzymes
editor
lab research work researches research work researchs available
600 500 short Protein short early detection malnutrition 600 - 500 600 500
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345
rabies
virus
Isolation
signs
free albumin 48 so early somatomedin C 36 short half life free albumin free albumin Loss
Half life 48 C so early somatomedins
editors Immunological assessment immune status so early Immune status Nutritional assessment Immune deficiency nutritional assessment vitmain Deficiency Hypervitaminosis vitamin toxicity hyper vitaminosis D
Hyper vitaminosis D
High dose of vitmain D
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hyper vitaminosis D
346
Nutrition DR. Abo-Asrar 20,000 international unit daily
free albumin
20,000 international unit per day
vitmain D vitamin D tetany adequate calcium supplementation hyper calcemia hyper calcemia bone vitamin D fully saturated bone osteoblast serum calcium
fully saturated
bone
serum calcium manifestations of hypercalcemia serum calcium gut gut constipation and vomiting vomiting constipation intestinal motility Intestinal motility intestinal obstruction anorexia anorexia distention
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347
Nutrition DR. Abo-Asrar wall of the gut
anorexia, vomiting and constipation
minerals full reabsorption kidney
renal threshold urine Mineral Urine
Poly uria
dehydation
renal stones
oxalates
kidney
nephro calcinosis renal impairment generalized muscle weakness and hypotonia tetany Ionizable calcium ionizable calcium nerve fibers tetany
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348
Nutrition DR. Abo-Asrar Ctrl + F
metastatic blood vessel brain metastatic calcification
calcification
Urine calcium
Investigations serum calcium urine
serum calcium
serum calcium urine differential diagnosis Hyper parathyroidism hyper parathyroidism urine calcium Parathormone
hyper calcemia urine Urine metastatic calcification
X - ray
vitamin D
Kidney wash renal stones full hydration
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349
vitamin D calcium absorption calcium absorption alkaline phytate Oxalate absorption
calcium absorption
alkaline PH
chelation
EDTA EDTA
resistant cases why gut vitamin D receptors block nutritional disorders summary
management of marasmus and kwashiorkor breast feeding proper weaning Proper diet proper vaccination family planning
expected weight
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dietic management total calories 150 Marasmus 120 kwashiorkor first degree marasmus
350
Nutrition DR. Abo-Asrar average weight
non weaned
total calories 3/2
Small frequent meals
humanized milk gut lactose free milk lactose intolerlance skimmed milk steatorrhea fat intolerance kwashiorkor infiltrated liver
fat hepatic encepahlopathy
weaned
available
Naso gastric tube
paralytic ileus vomiting severe infection total parentral nutrition
first sign of improvement apetite
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351
Nutrition DR. Abo-Asrar non dietic management emergency management Hypo thermic hypoglycemic dehydration shock shock
fresh blood transfusion fresh frozen plasma albumin amino acids mixture Hypo glycemia amino acids mixtures islets cells of langerhans stimulation amino acid argenine
blood component
Liable to infection
Antibiotics
deficiency
vitamins and minerals anabolics Nowadays underlying etiology
Hyper volemia
kwashiorkor Hypo kalemia Nutritional recovery syndrome
take care
bad prognosis bad prognosis irreversible irreversible bad prognosis complications

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Prognosis Prognosis reversible complications
352
Nutrition DR. Abo-Asrar bad prognosis main complications hepato meglay mental changes
Nutritional assessment Nutritional assessment Dietic history roughly
signs of vitamins, minerals
check
Clinical assessment Malnutritions Anthropometric
skull circumference
mid arm circumference growth and development Investigations free albumin
Kwashiorkor somato medins C
Lab assessment
Immunological assessment hyper vitaminosis D 20,000 international unit tetany Hyper calcemia hyper vitaminosis D vitamin D calcium
Hyper calcemia Anorexia, vomiting and constipation Poly uria Dehydration Renal stones Nephro calcinosis Generalized muscle weakness
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353
Nutrition DR. Abo-Asrar metastic calcification
nutrition
www.facebook.com/dr.tafreegh
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354

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Nutrition DR.

Nutrition neonatology Infection Nutrition

nutritional disorder nutritional disorder pure Genetics

Nutrition DR. Abo-Asrar

Nutritional disorder Kwashiorkor marasmus

Nutritional disorder no excuse

fatal Nutritional disorder fatal Nutritional disorder

Pure written clinical written

Nutrition DR. Abo-Asrar Nutritional assessment nutritional disorder written

Kwashiorkor Marasmus Rickets 80 %

Nutrition DR. Abo-Asrar bone

bone Medulla cortex cortex hematology medulla bone medulla

cement Mineral part Mineral part Ca phosphate

Nutrition DR. Abo-Asrar cement Ca phosphate

collagen fibers collagen fibers

cortex fragile bone liable to fracture fragile

protein part part osteoporosis protein part osteoporosis defect bone

osteoporosis defect osteoid tissue

protein deficiency Marasmus

Nutrition DR. Abo-Asrar Kwashiorkor Kwashiorkor Marasmus

muscle bone Kwashiorkor

Marasmus bone Osteoporosis bone

Osteomalacia Rickets Osteomalacia

Liable to fracture bone diseases X -ray Osteogenesis imperfecta bone

collagen fibers supporting

Nutrition DR. Abo-Asrar bone diseases osteogenesis imperfecta X - rays

osteoporosis rickets osteogenesis imperfecta

mineralization of the bone Mineralization of the bone Mineralization of the bone

mineralization of the bone mineral part

functioning New bone bone Mineral part

Nutrition DR. Abo-Asrar

osteoblast cell osteoblast cells New bone Osteoblast

bone bone osteoclast Osteoblast

Nutrition DR. Abo-Asrar osteoclast osteoblast bone marrow stem cells

stem cells of the bone marrow osteoclast

new bone formation old bone

Osteoblast bone osteoblast

Nutrition DR. Abo-Asrar dendritic cells dendritic cells nucleus

blood bone Mineralization bone

Osteoblast Osteoblast vesicle

vesicle blood vesicle Phosphorus bone vesicle blood

In organic In organic chemistry phosphorus

In organic phosphorus is in organic calcium phosphorus

Nutrition DR. Abo-Asrar osteoblast vesicle

Phospho ethanol amine

New bone formation

osteoblast cell membrane

cell membrane bone matrix

Nutrition DR. Abo-Asrar Organic phosphate

bone matrix Organic phosphate bone matrix

Nutrition DR. Abo-Asrar

crystal calcium apatite crystal

crystals technology dynamics

Underlying physiology Physiology Manual worker

Manual worker bone mineral density Mineral part

fracture Non manual worker

Nutrition DR. Abo-Asrar Mental worker vast activity manual work

bone mineral density bone

fissure fracture comminuted fracture

manual workers muscular activity Osteoblast Osteoblast

origin muscle muscular activity contraction muscle Insertion origin origin

Nutrition DR. Abo-Asrar bone crystals bone pressure friction energy

muscle contraction crystals crystals