4 Table 2 Relationship between clinical manifestation of B12 deficit and geriatric syndromes Clinical manifestation of B12 deficit Geriatric syndrome Hematological: Megaloblastic anemia Anergy Pancytopenia Neurological: Sub-acute combined Dizziness, syncope degeneration of spine Polyneuropathies Falls Cerebral syndromes Frailty Optic neuropathy Functional decline Cerebrovascular disease Failure to thrive Gastrointestinal: Diarrhea Anorexia of aging Weight loss Cachexy
Protein-energy malnutrition Skin and mucosa: Hunter's glossitis Mucocutaneous ulcers Angular cheilitis Cardiovascular: Atherosclerosis Dizziness Coronary disease Syncope (hyperhomocysteinemia) Venous thromboembolism Falls Psychiatric: Dementia Cognitive decline Falls Frailty
9[degrees]C), altered sensorium, cachexy
, diffuse petechial rash, hepatosplenomegaly, dispnea and bilateral diffuse pulmonary crackles.
DISTRIBUTION OF PATIENTS BY CLINICAL FEATURES, N=183 Main Comparative Clinical forms group group Solitary polyps 33 19 Multiple polyps 18 27 Diffuse polyposis 43 28 Out of them Peutz-Jeghers syndrome 9 2 Malignant polyposis 8 7 Distal part of intestine 70 65 Left side 12 6 Subtotal 3 4 Total 17 6 Villous polyps 14 9 Adenomatous 35 22 Adenopapillomatous 27 18 Hyperplastic 10 11 Proliferative 5 9 Cancer in situ 11 13 Complications Posthemorragic anemia 22 31 Cachexy
7 2 Strictures 6 3 Chronic colonic ileus 7 11 Malignization 10 5 Toxic dilatation of colon 2 1 Acute colonic ileus (intussusception) 3 5 Bleeding from rectum 35 32 Colonic perforation 1 1 TABLE 3.
The extreme mental depression and the unconquerable longing for home soon produce a state of cachexy
, loss of appetite, derangement of the assimilative functions, and, finally, disease of the abdominal viscera,--in fact, the objective phenomena of the typhoid state.
With some people the spleen increases in volume through the action of this humour, as a result of which cachexy
and dropsies ensue.