1. Pathological changes in PEM

2. GIT CHANGES
• UPPER GIT CHANGES:-
• Mucosa atrophic and shiny
• Gums are frequently affected
• Necrotic ulcer seen k/a NOMA
• Oral thrush may present
• Tongue papillae flattened
• Salivary gland changes
• Parotid gland enlarged d/t
1. Inspissation of secretion
2. Hyperplasia of gland
3. Acute parotitis

3. LOWER GIT CHANGES
• ATROPHY OF MUCOSA AND VILLI
• INFILTRATION WITH PLASMA CELLS
• COLUMNAR CELLS ARE REPLACED BY CUBOIDAL
CELLS
• PANETH CELLS ARE REDUCED
• BRUSH BORDER ENZYMES (DISACCHARIDASE)
DEFICIENT
• HOOK WORM INFESTATION
• RECTAL PROLAPSE

4. LIVER CHANGES
• Visceral protein component severely affected in
Kwashiorkar
• FATTY LIVER occurs mainly in Kwashiorkar
• D/T deposition of triglyceride
• Liver enlarged , pale and firm in consistency
• Fat accumulation absent in marasmus

5. Fatty liver

6. Changes in Pancreas
• It reduced to cord like tissue
• Acini and acinar cells are reduced
• Zymogen granules disappear
• Varying degree of duct proliferation
seen

7. Endocrinal changes
• Exocrine pancreatic secretion
decreases
• Glucagon,insulin secretion decreases
• Growth hormone increases
• Thyroid involution and fibrosis
• Adrenal gland atrophied and thin
• Cortisol increase catechol unaltered

8. Changes in muscles
• Somatic component i.e protein in skeletal
muscles more severely affected in marasmus
• Muscles wasted
• Severe depletion of protein from non collagen
fibers
• Hyalinisation , absent striation ,vacuolation of
myofibrils
• Catabolism in muscle mass d/t reduction in cell
size

9. Hair and Nail changes
• Cysteine and copper low in hair
• Transverse ridges in nail d/t growth
cessation

10. Skin changes
• It is mainly d/t atrophy and pigmentary
disturbance
• Epidermis is thin ,hyperkeratosis and
desquamation
• Nitrogen content of skin depleted
• Tyrosine level decreases in flaky paint
dermatitis

11. Flaky paint dermatitis

12. Changes in heart
• Heart small in atrophic
• C.O ,systolic pressure ,pulse pressure
decreases
• Heart thin walled ,pale ,flabby d/t
atrophy of muscle fibre

13. C.N.S changes
• Myelinisation in white matter impaired
• Cerebral atrophy
• Decrease number of neuron
• Decrease lipid, cholesterol ,muramic
acid

14. PERIPHERAL NERVES
• Nerve conduction decreases mainly in
kwashiorkar
• Degenerative changes seen in anterior
horn cells

15. Respiratory system
• Secondary infective changes may
present d/t decrease immunity.

16. LYMPH NODE
• Lymphoid atrophy more marked in
kwashiorkar
• Depletion of lymphocytes
• Loss of germinal centers in lymph node
of mesentry, axilla, tonsil, spleen,
appendix
• Tonsils become small in size

17. Haematopoietic system
• Bone marrow becomes hypoplastic d/t
decrease number of red cell precursors
• Following type of anemia seen
1. IDA-microcytic hypochromic
2. Folic acid deficiency –megaloblastic
• Other deficiency- copper,zinc,vitamins
A,E,K
• Increase LDH in platelet leads to
prolonged bleeding time and purpura

18. Bony changes
• Slowing of growth of bones at the ends
of long bone
• Osteoporosis and delay in ossification
• Lamellar hypoplasia seen in teeth

19. Kidney changes
• Kidney atrophies
• Focal areas of calcification seen
• Cloudy swelling of epithelial cells of
PCT and DCT seen

20. Immune system
• CMI decreases
• Immunoglobulin synthesis increases
more in kwashiorkar
• Complement factor level decreases