2. ASSESSMENT OF NUTRITION
Macronutrient assessment
1) Body Mass Index (Quetelet Index)
It is calculated by the formula weight/ height2 (Kg/m2)
However the disadvantage is it doesn’t describe the
distribution of body fat.
BMI non Asian BMI Asian
Underweight <18.5 <18.5
Normal 18.5-24.9 18.5-22.9
Overweight 25-29.9 23-24.9
Obese 30-39.9 25-29.9
Morbidly obese >40 >30
3. 2) Waist Circumference:
Normal <94 cm in men and <80 cm in women
3) Waist:Hip ratio:
<0.8 in females <0.9 in males
inceased waist hip ratio has increased risk of coronary
artery disease
9. PALLOR
Sites of examination
Examined in the areas where blood vessels are near
to the surface.
Lower palpebral conjunctiva, Tongue, Nails, Palmar
crease
Seen in Anemia.
On hyperextension of the palm, if palmar creases are
light in colour than the surrounding skin then the
concentration of hemoglobin is usually less than
8g/dl.
Non anemic causes of pale skin: Fair skinned
individuals, hypopituitarism, hypogonadism
11. ICTERUS
Yellowish discolouration of skin,mucous membrane
and sclera.
Due to increased bilirubin.
Yellowish discolouration of sclera is due to the high
elastin content in the sclera
Sites to examine icterus
Upper bulbar conjunctiva, lower surface of tongue
It denotes the concentration of serum bilirubin of
atleast 3mg/dL
12.
13. Differential diagnosis of yellowish discolouration of
skin
Carotenoderma ( increased intake of carrots, oranges
and leafy vegetables): here there is no yellowish
discolouration of sclera
Quinacrine
Chronic exposure to phenols
Long standing anemia
14. CYANOSIS
Cyanosis is the bluish discolouration of skin and mucous
membrane.
It results from the increased amount of reduced hemoglobin
the the blood.
Manifests when the reduced hemoglobin is >4g/dL
Cyanosis may be masked in severe anemia
Types:
1) Central cyanosis: Due to the decreased SaO2
Respiratory cause: High altitude, Alveolar
hypoventillation, pulmonary A-V shunts & fistula,
Cardiac causes: Congenital heart diseases
Sites: Skin, lips, tongue
15. Other causes: Methemoglobinemia,
sulfhemoglobinemia
2) Peripheral cyanosis
Exposure to cold, arterial obstruction, reduced
cardiac output, venous obstruction.
Sites to be examined: tip of the nose, ear lobule, nails
16. CLUBBING
Bulbous enlargement of the distal part of the fingers
and toes due to proliferation of connective tissue
Theories:
1) Platelet derived growth factor theory: This is the
most accepted theory. There is release of PDGF
from the platelets in response to imflammation or
hypoxia leading to vasodilation and proliferation of
soft tissues
2) Neurogenic theory: Vagal mediated stimulation
causing vasodilation
17. 3) Humoural theory: GH, PTH, estrogen,PG, bradykinin
causes vasodilation and clubbing
4) Ferritin theory
5) Hypoxic theory
Normal angle between the nail bed and and nail is known as
Lovibond angle and is about 160.
Causes:
Hereditary
Idiopathic
Respiratory: Bronchogenic carcinoma,
bronchiectasis, cystic fibrosis
Cardiac: Cyanotic heart disease, infective endocarditis
18. GIT causes: Liver cirrhosis,Imflammatory bowel
disease
Hypertrophic osteoarthropathy: Clubbing along with
subperiosteal distal diaphyseal new bone formation
with symmetric arthritis like changes in shoulders,
elbow, knee, ankle seen in lung cancers,
mesothelioma, bronchiectasis, hepatic cirrhosis.
21. LYMPHADENOPATHY
Check for the number, size, site consistency and
tenderness.
Some important lymph node involvement in certain
diseases.
Jugulodigastric nodes: URTI, tonsillitis
Virchow’s node (Troisier sign): enlargement of left
supraclavicular node due to GIT or testicular
malignancies.
Right supraclavicular nodes: malignancy of right lung
and left lower lobe
Axillary lymph nodes: Carcinoma breast, Lymphoma
Epitrochlear nodes: Secondary syphilis. Non hodgkin’s
lymphoma
Periumbilical nodes ( Sister Mary Joseph’s nodule)
abdominal malignancy
22. EDEMA
Accumulation of fluid in interstitial space.
Types:
Pitting type: Apply firm pressure on the shin of
tibia or 2cm above the medial malleolus for 20-30 s
and see for pitting.
Causes: Congestive cardiac failure, nephrotic
syndrome, liver cirrhosis, hypoproteinemia
Non pitting type: Graves disease (non pitting due to
deposition of hyaluronic acid), filariasis (lymphatic
obstruction)