The cheeks are sunken in the shape of monkey cheeks

Introduction The cheek-like depression is one of the clinical manifestations of protein-energy malnutrition. Protein-energy malnutrition (PEM) occurs when the co-feed of protein and/or calories does not meet the body's need to maintain normal physiological functions. It can be divided into primary and secondary according to the cause of malnutrition. Hair, caused by insufficient food. Generally speaking, the buccal fat pad refers to a triangular cheek fat body formed by a protrusion of a fat tissue in the cheek. It prevents the cheeks from collapsing when sucking in the baby, so the cheek fat body is more developed in children, and their faces are always fat and round. According to the distribution characteristics of the capsule, vascular source and fixed ligament, the buccal fat pad is divided into anterior, middle and posterior lobes, and the posterior lobe is buccal, pterional, pterygoid and condyle to the surrounding space. Each leaf has an independent The capsule is fixed by the buccal fat pad of the maxillary ligament, the posterior tibial ligament, the inferior tibiofibular ligament, the infraorbital fissure lateral ligament, the diaphragmatic tendon ligament and the buccal ligament. Each leaf has an independent source of blood vessels that form a subcapsular vascular network. The buccal fat pad has a filling, sliding, protective and cushioning effect.

Cause

Social, economic, biological, and environmental factors can cause protein-energy malnutrition (PEM) due to inadequate food sources, poor food quality, or malabsorption. Clinically, it can be divided into three types: kwashiorkor, maradmus and marasmickwashiorkor; it is divided into light, moderate and severe according to the degree of deficiency; it is divided into acute, subacute and chronic according to the pathogenesis. Three kinds.

The ischemic disease is mainly caused by insufficient energy intake. In the initial stage, the metabolism and behavior (such as reduced activity) reduce the demand for nutrients and balance the lower level of nutrient utilization. The occurrence of protein dystrophy syndrome is associated with a severe deficiency of protein, which is mainly related to the supply of carbohydrates. In most cases, there is a lack of protein and energy, a negative balance of nitrogen, and a chronic consumptive process.

an examination

Related inspection

ECG blood test

The diagnosis of malnutrition is based on a history of eating habits, a history of malnutrition, and clinical manifestations. Subcutaneous fat consumption, weight loss, edema, reduction in total plasma protein and albumin, degree of 24-hour urinary creatinine/height ratio reduction, and dynamic observation provide objective and basic estimates of the diagnosis and severity of the disease. Although the most obvious change in chronic PEM is weight loss, attention should be paid to factors that affect weight.

1, blood, urine routine examination: red blood cell ratio reduced, mild to moderate anemia, mostly normal cytochrome type. The white blood cell count can be reduced. The absolute number of lymphocytes is often less than 1.2 × 10 9 / L, reflecting the low function of T lymphocytes. The urine specific gravity is low. The concentration capacity is reduced. Urine test was positive in patients with hunger ketosis.

2. Biochemical tests: serum essential amino acids and non-essential amino acids are often reduced. The concentration of tryptophan and cystine is lowered. Plasma protein and albumin levels are reduced, serum egg white enzymes and alkaline phosphatase levels are reduced. Serum transferrin is reduced, and if there is iron deficiency at the same time, it can be normal or slightly elevated. Other serum-operating proteins include prealbumin and vitamin A binding protein. Blood sugar and blood lipids are low. Conventional liver function tests are mostly normal. Blood urea nitrogen and urea nitrogen decreased, 24h urine creatinine (mg) / height (cm) ratio decreased, which is a sensitive indicator of protein deficiency in patients with no fever, the normal values of adult males and females are 10.5 and 5.8 respectively. Mg/cm. There are often imbalances in water and electrolyte balance. Especially hypokalemia, hypophosphatemia, hyperchloremia, metabolic acidosis. The laboratory abnormalities of wasting are less than those of protein malnutrition syndrome.

3, other examinations: ECG shows sinus bradycardia, low voltage and other changes. Echocardiography shows heart reduction and low output. The EEG shows changes such as low voltage and slow activity. X examination showed a narrowing of the heart. Osteoporosis and other changes.

Diagnosis and differential diagnosis: The diagnosis of malnutrition is mainly based on dietary habits, malnutrition history and clinical manifestations. Subcutaneous fat consumption, weight loss, edema, plasma total protein and albumin reduction, 24h urine creatinine/height ratio reduction and dynamic observation provide an objective basic estimate of the diagnosis and severity of the disease. Although the most obvious change in chronic PEM is weight loss, attention should be paid to factors that affect weight. There was no significant decrease in body weight in patients with obvious edema; in patients with obesity, when PEM occurred, there was less PEM due to fat storage and adequate subcutaneous fat. It should be noted that vitamins and other nutrient deficiencies, water and electrolyte balance may occur at the same time, causing primary disease of secondary PEM, and concurrent infection. And pay attention to the identification of heart, kidney, liver, gastrointestinal diseases. Skin malnutrition changes in the skin should be symmetrical with skin changes in pellagra, and mainly at the site of exposure.

Differential diagnosis

There was no significant decrease in body weight in patients with obvious edema; in patients with obesity, secondary PEM had less PEM due to fat storage and adequate subcutaneous fat. It should be noted that there may be a lack of vitamins and other nutrients, water and electrolyte imbalance, causing the primary disease of secondary PEM, concurrent infection, and attention to the identification of heart, kidney, liver and gastrointestinal diseases. Skin malnutrition skin changes should be differentiated from pellagra, and skin changes in pellagra are symmetrical and predominantly at the site of exposure.

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