Pathological changes in PEM

GIT CHANGES• UPPER GIT CHANGES:-

• Mucosa atrophic and shiny

• Gums are frequently affected

• Necrotic ulcer seen k/a NOMA

• Oral thrush may present

• Tongue papillae flattened

• Salivary gland changes

• Parotid gland enlarged d/t

1. Inspissation of secretion

2. Hyperplasia of gland

3. Acute parotitis

LOWER GIT CHANGES

• ATROPHY OF MUCOSA AND VILLI

• INFILTRATION WITH PLASMA CELLS

• COLUMNAR CELLS ARE REPLACED BY CUBOIDAL

CELLS

• PANETH CELLS ARE REDUCED

• BRUSH BORDER ENZYMES (DISACCHARIDASE)

DEFICIENT

• HOOK WORM INFESTATION

• RECTAL PROLAPSE

LIVER CHANGES

• Visceral protein component severely affected in

Kwashiorkar

• FATTY LIVER occurs mainly in Kwashiorkar

• D/T deposition of triglyceride

• Liver enlarged , pale and firm in consistency

• Fat accumulation absent in marasmus

Fatty liver

Changes in Pancreas

• It reduced to cord like tissue

• Acini and acinar cells are reduced

• Zymogen granules disappear

• Varying degree of duct proliferation

seen

Endocrinal changes

• Exocrine pancreatic secretion

decreases

• Glucagon,insulin secretion decreases

• Growth hormone increases

• Thyroid involution and fibrosis

• Adrenal gland atrophied and thin

• Cortisol increase catechol unaltered

Changes in muscles

• Somatic component i.e protein in skeletal

muscles more severely affected in marasmus

• Muscles wasted

• Severe depletion of protein from non collagen

fibers

• Hyalinisation , absent striation ,vacuolation of

myofibrils

• Catabolism in muscle mass d/t reduction in cell

size

Hair and Nail changes

• Cysteine and copper low in hair

• Transverse ridges in nail d/t growth

cessation

Skin changes

• It is mainly d/t atrophy and pigmentary

disturbance

• Epidermis is thin ,hyperkeratosis and

desquamation

• Nitrogen content of skin depleted

• Tyrosine level decreases in flaky paint

dermatitis

Flaky paint dermatitis

Changes in heart

• Heart small in atrophic

• C.O ,systolic pressure ,pulse pressure

decreases

• Heart thin walled ,pale ,flabby d/t

atrophy of muscle fibre

C.N.S changes

• Myelinisation in white matter impaired

• Cerebral atrophy

• Decrease number of neuron

• Decrease lipid, cholesterol ,muramic

acid

PERIPHERAL NERVES

• Nerve conduction decreases mainly in

kwashiorkar

• Degenerative changes seen in anterior

horn cells

Respiratory system

• Secondary infective changes may

present d/t decrease immunity.

LYMPH NODE

• Lymphoid atrophy more marked in

kwashiorkar

• Depletion of lymphocytes

• Loss of germinal centers in lymph node

of mesentry, axilla, tonsil, spleen,

appendix

• Tonsils become small in size

Haematopoietic system

• Bone marrow becomes hypoplastic d/t

decrease number of red cell precursors

• Following type of anemia seen

1. IDA-microcytic hypochromic

2. Folic acid deficiency –megaloblastic

• Other deficiency- copper,zinc,vitamins

A,E,K

• Increase LDH in platelet leads to

prolonged bleeding time and purpura

Bony changes

• Slowing of growth of bones at the ends

of long bone

• Osteoporosis and delay in ossification

• Lamellar hypoplasia seen in teeth

Kidney changes

• Kidney atrophies

• Focal areas of calcification seen

• Cloudy swelling of epithelial cells of

PCT and DCT seen

Immune system

• CMI decreases

• Immunoglobulin synthesis increases

more in kwashiorkar

• Complement factor level decreases