1. SCARCE STATUS AT CHILDREN DYSTROPHY The lecturer : professor Umarov R

2. The lecture purpose. To learn to diagnose and to conduct patients with a scarce status in the conditions of a polyclinic, to carry out complex actions for health protection of children.

3. Substantiation of a subject of lecture
Substantiation of a subject of lecture. Scarce status one of the most widespread pathologies at children of early age. It is the background status burdening a current of sharp diseases and promotes increase of death rate at children. In this connection knowledge of these pathologies important for the doctor of the general practice.

4. (From greek Dis-frustration, trophic - nutrition) the pathological status arising at chronic frustration a food, characterised by deviations in growth and development and fall of resistibility of an organism.

5. The dystrophy can develop in any Age, but especially often meets at children of chest and early age.

6. Allocate dystrophies of three types: hypotrophy, paratrophy, hypostatura.

7. Hypotrophy It is a-dystrophy characterised
Exhaustion development. It is observed at % of children of early age.

8. Etiology. Among the reasons hypotropy it is possible to allocate: 1
Etiology. Among the reasons hypotropy it is possible to allocate: 1. Prenatal the factors, an insufficient nutrition and diseases of mother in early terms of pregnancy-gestoz; infringement of matochno-placentary blood circulation and pre-natal hypoxy a fruit, professional harm, stresses, bad habits, pre-natal infections.

9. 2. Exogenous the reasons: Alimentary factors: quantitative underfeeding : at hypogalactia; at difficulties of feeding by a breast of mother, the flat, involved nipple, a small bottom jaw, a short bridle of language, etc. Qualitative underfeeding : use of a mix inappropriate to age; later introduction of feedings up. Infectious factors: pre-natal generalized infections, intranatal infections, toxico-septic statuses. Toxic factors: use at artificial feeding of dairy mixes with the expired period of storage, hypervitaminous and D, poisonings, including medicinal, etc. Defects of leaving

10. 3. Endogenous causes: a) perinatal entsefalrpatii, bronchopulmonary dysplasia, and b) congenital malformations of the gastrointestinal tract, the cardiovascular system. c) hereditary and secondary immunodeficiencies, and d) the primary and secondary malabsorption, genetic abnormalities in metabolism. e) endocrine disease, diathesis.

11. Pathogenesis. At the heart of malnutrition is a violation of recycling nutrients (especially proteins) in the intestine, breaking all kinds of metabolism: - reduced enzymatic activity of the stomach, intestines, pancreas - violated splitting (secondary maldigistiya) and absorption of substrates (secondary malabsorption), characterized dysbiosis - increased endogenous "consumption" of proteins, decreased synthesis of enzymes - hypoproteinemia, hypoalbuminemia, acidaminuria, tendency to hypoglycaemia, increased glycolysis, accumulation of lactic acid acidosis - reduced reactivity infections occur malosimptomno, latent.

12. The clinical picture. The leading clinical symptoms of malnutrition are weight loss. Depending on the underweight malnutrition distinguished: I degree (underweight 10-20%), II degree (underweight 20-30%) and III degree (underweight 30%).

13. Various kinds hypotrophy
A healthy child;
B-I degree malnutrition (the thickness of subcutaneous fat on the trunk and extremities, especially on the belly, reduced);
In-degree malnutrition II (subcutaneous tissue is almost completely absent in the stomach and chest, in other parts of the body, legs and face, its thickness is reduced);
G-III degree malnutrition (no subcutaneous fat, the skin wrinkled, going to fold, the person has the old look, swollen abdomen)

14. Treatment. Take into account the etiology of the disease, the degree of depletion and the presence of underlying disease. Treatment should be comprehensive, include the correction or elimination of the etiological factor, diet therapy, rational mode, special care, detection and treatment of foci of infection, rickets, anemia and other related diseases.

15. With malnutrition degree I often sufficient to remedy the defect-feeding, establish treatment and care, then underweight quickly eliminated. Children with malnutrition II and especially III degree, often suffering from low tolerance for food, in the first days of treatment daily amount of food is reduced to 3/4, Vi, Vi, and even before relying on rules (depending on the patient). Missing amount of food filled with liquid (tea, rose hip extract, glucose, fruit juice, fruit and vegetable broths).

16. When I wasting much calculation and correction of power produced by 1 kg of body weight were to become, which consists of the child's weight at birth, and the average rate of increases in body weight over the period of the life lived. With malnutrition II and III level, where much pronounced disorders of metabolism, and therefore the understanding of basic nutrients, especially fat, requires a clear individualized dietary interventions. With malnutrition II degree of protein and carbohydrates in the daily diet of the child count on were to become 1 kg of body weight, and the amount of fat per 1 kg of actual body weight or with a relatively satisfactory state of the child on the body weight, which is the average value between the actual and were to become.

17. With malnutrition III extent necessary amount of protein and carbohydrate count on were to become approximately 1 kg of body weight (actual body weight + 20% of actual body weight). Fat is only calculated on actual body weight, as tolerance to fat in these children dramatically reduced.

18. Lure children with malnutrition is usually prescribed with caution on the background of positive dynamics of body weight, in the absence of acute diseases. As the first feeding is introduced milk porridge of various cereals, then weeks prescribed second feeding in the form of vegetable puree. All kinds of foods are introduced gradually, beginning with small doses, and in 7-10 days is adjusted to the required amount.

19. In all forms of malnutrition vitamin, enzyme preparations
In all forms of malnutrition vitamin, enzyme preparations. In severe malnutrition, hormonal therapy. Along with drug therapy used massage and gymnastics.

20. Nutritional treatment of malnutrition in a time of increased supply
The severity
Calorie, kcal / kg / day.
Protein load, g / kg / day. I
3.5 II
4,0
III
200
4,5

21. GIPOSTATURA (Greek, hypo-under, below, statuga-growth, value)-dystrophy with a more or less uniform child behind in growth and weight satisfactory upitannosti. Etiology. This form of chronic eating disorders, usually secondary and is typical of children with heart defects, developmental disabilities and brain encephalopathy, endocrine disorders and hereditary diseases. Gipostatura also be stage elimination from severe primary malnutrition.

22. Clinic and diagnosis. Child in their physical and psychomotor development of the child comes across a smaller age. The length of the body below the age-specific, subcutaneous fat layer is expressed satisfactorily. In psychomotor child lags behind his peers, delayed eruption of teeth, bone maturation (bone age). In this case, the children are preserved signs of chronic nutritional characteristic of malnutrition II degree (trophic disorders and symptoms polyhypovitaminosis the skin disproteinemia, reducing fat absorption in the intestine, and low levels of phospholipids)

23. Gipostatury treatment aimed at the cause of the degeneration (primary disease), during the diet are based on the principles used in malnutrition II stepeni.Profilaktika is early detection and correction of severe somatic and neuroendocrine disorders, prevention of severe malnutrition.

24. PARATROPHY-chronic feeding disorder without a deficit in body weight with metabolic disorders. Allocate options paratrofii with normal length and weight of the body; proportional excess of both indicators of age norms; overweight. Currently, the most common type paratrofiya dystrophy.

25. Etiology. - Development paratrofii contribute limfatiko-hypoplastic and exudative catarrhal anomalies constitution. By paratrofii predispose frequent infections, anemia. Unbalanced or over-nutrition of the mother during pregnancy, and in some metabolic disorders in it (eg, diabetes) paratrofiya can be formed prenatally.

26. The primary cause of paratrofii is improper feeding of the child in violation of a reasonable balance between the major food ingredients: - with carbohydrate overfeeding (use in the preparation of customized mixtures greater than expected, the number of dry powder, a few lures in the form of porridge a day, the abuse of bananas, cookies, excessive amount of sweet juice, tea) - with overfeeding protein (lots of whole milk, cottage cheese, protein enpita etc) - with defects care (no massage, gym, walk).

27. Pathogenesis. Imbalance of power violates bowel function, leads to a distortion of metabolism. Occur: depression (depletion) of certain enzyme systems intestinal dysbiosis with symptoms of endogenous intoxication, anemia, acidosis, hypovitaminosis, metabolic disorders, reduced resistance, susceptibility to frequent infections.

28. Classification. Distinguish pre- and postnatal shape, the initial periods, progression, convalescence.

29. Clinical manifestations are very similar to malnutrition
Clinical manifestations are very similar to malnutrition. Paratrofii basic features are: violations of trophic tissue. Children look loose, pasty, skin they are pale, dry, sometimes with a gray shade (in the overfeeding protein), tissue turgor, and decreased muscle tone, subcutaneous fat layer is pronounced enough, but loose, flabby;

30. Metabolic disorders. Serum reduced iron content, phospholipids, increased cholesterol levels, impaired carbohydrate metabolism.

31. Neuropsychiatric disorders: stiffness, instability emotional tone, lethargy, low (up to apathy) activity, alternating unmotivated anxiety, restless sleep surface, the lag of age norms of motor skills.

32. Disorders of the intestine: - muddy chair with overfeeding baby carbohydrates. Microscopy are much detritus, salts of fatty acids, a little neutral fat

33. Frequent infections (respiratory, urinary tract, ear infections) often signs limfatiko-hypoplastic or exudative diathesis, often rickets, deficiency anemia, signs of hypovitaminosis. Clinical manifestations often along with the above symptoms include excessive severity of subcutaneous fat, which is usually particularly abundant in the abdomen, thighs and less prominent on the hands.

34. Treatment-paratrofii involves normalizing the power of the child
Treatment-paratrofii involves normalizing the power of the child. In appointing power guided by the volume of the mixture, fishing lures designed for the age were to become the child's weight. If the baby is bottle-fed, it is advisable to use adapted formulas.

35. Forecast-generally quite favorable
Forecast-generally quite favorable. However, in the long run the risk of cardio-vascular diseases, atherosclerosis, and diabetes.

37. Kwashiorkor-flow peculiar version of malnutrition among young children in tropical countries, mainly due to the power plant food (bananas) with a deficit of animal proteins. In Western countries, a consequence of the following reasons: - if prolonged diarrhea - with a decrease in protein synthesis in chronic liver diseases - with proteinuria (nephritic syndrome), infectious diseases and helminthiasis, burns, and massive blood loss.

38. The characteristic symptoms of kwashiorkor are: - neuro-psychiatric disorders, - swelling, - loss of muscle mass, down to muscle atrophy, decreased trophic tissue - behind the physical.

39. Often with kwashiorkor note: darkening of the skin with epithelial desquamation in areas of irritation, hair loss, nail changes, anorexia, signs of hypovitaminosis.

40. Kwashiorkor
A child suffering from kwashiorkor, there is a thinning of the hair, swelling of the face, underweight and stunting.