Multisystem Processes & Disorders


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P12_F1.jpg"}},{"insert":"\n\n"},{"insert":"It\u0027s your third day volunteering in Ghana. The introductory programme is finally over and you are ready to start work.\r\n\r\nYour first task is to treat malnourished children at the local nutrition rehabilitation center (NRC).\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P12_F2.jpg"}},{"insert":"\n\n"},{"insert":"You are introduced to your first patient: 14-month-old Ama, who is accompanied by her mother, Anita. They were referred by a local doctor, who noted that Ama was malnourished.\r\n\r\nA quick set of questions confirms that Ama has no acute complaints or known chronic illnesses.\n"}]}


{"ops":[{"insert":"Ama was born at term via vaginal delivery, following an uncomplicated antenatal period. Her birth weight was 2500 grams, which is towards the lower end of normal for Ghana.\r\n\r\nAll vaccines are up to date, as per her immunization card.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P12_F4.jpg"}},{"insert":"\n\n"},{"insert":"Ama was exclusively breastfed initially. She was introduced to liquids at three months of age, and to solids at six months. Importantly, Anita still continues to breastfeed her.\r\n\r\nHowever, Anita and her husband live a hand-to-mouth existence and are often unable to provide their daughter with sufficient food.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P12_F5.jpg"}},{"insert":"\n\n"},{"insert":"Ama\u0027s heart rate is 130 bpm (normal: 98-140), respiratory rate is 25 cpm (normal: 22-37), and blood pressure is 90\/50 mmHg (normal: 72-104\/37-56). Her underarm temperature is 94 \u00b0F (34.4 \u00b0C).\r\n\r\nShe weighs 6.5 kg and her length is 66 cm; both measurements are below the 5th percentile. Her weight-for-height z-score is -3.2, and her height-for-age z-score is -3.4.\r\n\r\nYou also measure her upper arm circumference which is 116 mm (normal: \u2265115) .\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P12_F6.jpg"}},{"insert":"\n\n"},{"insert":"During the general examination, you note that Ama is lethargic. Her skin is pallid and scale-like, with scattered areas of hypo- and hyperpigmentation all over. Bilateral 2+ pitting ankle edema is present.\r\n\r\nExamination of the abdomen reveals mild hepatomegaly and moderate ascites. The cardiopulmonary examination is normal.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P12_F7.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Anita, could you please give Ama some of this food?\u0022, you say, handing over some ready-to-use therapeutic food (RUTF). However, after 10 minutes, Ama still has not eaten anything.\n"}]}


{"ops":[{"insert":"What is your diagnosis?\n"}]}
1. Mild malnutrition
2. Moderate malnutrition
3. Severe malnutrition