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The Nutrition-Focused History and Physical Examination (NFPE) in Malnutrition
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Next, we examine the eyes closely. Note the presence of xanthelasma that may indicate abnormal lipid metabolism. As noted in the discussion on fat stores, receding orbital fat pads in PCM leave the eyes sunken and surrounded by dark circles. Look at the extraocular eye movements. Ophthalmoplegia (especially abducens palsy) and nystagmus (particularly vertical nystagmus) are signs of Wernicke’s syndrome (see neuro, above). Dry conjunctiva and Bitot’s spots (conjunctival thickening or clumped cells) are a sign of vitamin A deficiency. The fundi may show lipemia retinalis in chylomicronemia and papilledema with pseudotumor cerebri from vitamin A or D toxicity.
Nutritional Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Chelsea Kesty, Madeline Hooper, Erin McClure, Emily Chea, Cynthia Bartus
Clinical presentation: Vitamin A deficiency is rare; however, it may be pronounced in periods of high nutritional demand, such as pregnancy, childhood, infancy, and lactation, or in conditions associated with pancreatic insufficiency, such as cystic fibrosis. Clinical findings include diarrhea, xerophthalmia (with characteristic night blindness and corneal deposits, known as Bitot spots; Figure 31.4), and ultimately blindness. Cutaneous manifestations include follicular hyperkeratosis and roughening of the skin (phrynoderma), xerosis cutis, and acneiform lesions.
Personalization of Nutrition Advice
Published in David Heber, Zhaoping Li, Primary Care Nutrition, 2017
A second active function for vitamin A is cellular differentiation. RA is a morphogen derived from retinol (vitamin A) that plays important roles in cell growth, differentiation, and organogenesis. The production of RA from retinol requires two consecutive enzymatic reactions catalyzed by different sets of dehydrogenases. The retinol is first oxidized into retinal, which is then oxidized into RA. The RA interacts with the retinoic acid receptor (RAR) and retinoic acid X receptor (RXR), which then regulate the target gene expression within the nucleus of cells where they promote differentiation. Vitamin A deficiency accounts for 500,000 cases of blindness in children in the developing world. Vitamin A deficiency results in a thickening of the conjunctiva of the eye called xerophthalmia. The latter is due to the second function of vitamin A in maintaining the epithelial integrity of the cornea. In young children, Bitot’s spots, foamy white accumulations of sloughed cells on the conjunctiva, can be useful in diagnosing vitamin A deficiency.
Ocular manifestations of systemic diseases in children
Published in Clinical and Experimental Optometry, 2023
Cheefoong Chong, Ann L Webber, Shuan Dai
The World Health Organisation has classified the ocular manifestations of VAD into categories, namely: Night blindness, XNConjunctival xerosis, X1A (Figure 9)Bitot’s spots, X1BCorneal xerosis, X2Corneal ulceration/keratomalacia less than 1/3 of cornea, X3ACorneal ulceration/keratomalacia greater than 1/3 of cornea, X3BCorneal scar, XSXerophthalmic fundus, XF