dipesh yadav
TRANSCRIPT
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-short stature (disease of height)-failure to thrive (disease of weight)
Dipesh yadav (Roll No:140,Group K, Batch: Aug-10)
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SHORT STATURE
Definition: height below 3rd centile or more than 2 standard deviations below the median height for that age and sex according to the population standard.
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Etiology:Physiological or normal variant short stature:A. FamilialB. Constitutional
Pathological short statureC. Under nutritionD. Chronic systemic illness
• Renal: renal tubular acidosis, chronic renal failure, steroid dependent nephrotic syndrome
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Etiology (cond.)
• Cardiopulmonary: congenital heart disease, cystic fibrosis, asthma
• Gastrointestinal and hepatic: malabsorption, chronic liver disease
• Chronic severe infectionsC. Endocrine causes
• Growth hormone deficiency/ insensitivity• Hypothyroidism• Cushing syndrome• Pseudohypoparathyroidism• Precocious or delayed puberty
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D.Psychosocial dwarfismE. Children born small for gestational ageF. Skeletal dysplasia, e.g.;
achondroplasia, ricketsG.Genetic syndromes, e.g.; Turner
syndrome, Down syndrome
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Feature Familial Short Stature Constitutional Short Stature
1) Sex Both equally affected More common in boys
2) Family History Of short stature Of delayed puberty
3) Height Velocity Normal Normal
4) Puberty Normal Delayed
5) Bone Age Normal Less than chronological age
6) Final Height Short, but normal for targetheight
Normal
Comparison
Detailed historyCareful examinationLaboratory evaluation
Diagnosis
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Assessment of a child who presents with short stature
• Accurate height measurement • Assessment of body proportion• Assessment of height velocity• Comparison with population norms• Comparison with child’s own genetic
potential• Sex maturity rating (SMR): Tanners staging
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Clues to etiology of short stature from history
History Etiology
Low birth weight Small gestational age
Polyuria Chronic renal failure, renal tubular acidosis
Diarrhea, offensive greasy stools
Malabsorption
Neonatal hypoglycemia, jaundice, micropenis
Growth hormone deficiency
Headache, vomiting, visual problem
Pituitary/ hypothalamic space occupying lesion
Lethargy, constipation, weight gain
hypothyroidism
Dietary intake Under nutrition
Social history Psychosocial dwarfism
History for timing of puberty in parents
Constitutional delay of growth
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Clues to etiology of stature from examination
Examination finding Etiology
Disproportion Skeletal dysplasia, rickets, hypothyroidism
Dimorphism Congenital syndromes
Pallor Chronic anemia, chronic renal failure
Hypertension Chronic renal failure
Frontal bossing, depressed nasal bridge, crowed teeth, small penis
Growth hormone deficiency
Goiter, coarse skin Hypothyroidism
Central obesity, striae Cushing syndrome
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Investigation:Level 1 ( essential investigations):
1.Complete hemogram with ESR
2.BONE AGE
3.Urinalysis ( Microscopy, pH, Osmolality)
4.Stool ( parasites, steatorrhea, occult blood)
5.Blood ( RFT, Calcium, Phosphate, alkaline phosphatase, venous gas, fasting sugar, albumin, transaminases)
Level 2 (investigations for short stature)
1.Serum thyroxin, TSH
2.Karyotype to rule out Turner syndrome in girls
Above is normal and bone age is delayed proceeds to level 2
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Investigation (contd.)
• If above investigations are normal and height between -2 to -3→ observe height velocity for 6-12 months
• If height < -3 SD → proceeds to level 3 investigations
Counselling of parents ( for physiological causes)Dietary advice ( Under nutrition, Celiac disease)Limb lengthening procedures ( skeletal dysplasia )Levothyroxine ( In Hypothyroidism)GH s/c injections ( GH deficiency, Turner syndrome)Monitoring with regular & accurate recording of height
is mandatory for a good outcome in any form of therapy
Management:
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FAILURETO
THRIVE
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Failure to thriveDefinition:• Is a term used for when a child’s weight for age is
below the fifth percentile or crosses two major percentile lines
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Etiology:Organic causes:• Gastrointestinal- gastro esophageal
reflux, malabsorption, inflammatory bowel disease, pyloric stenosis
• Neurological- mental retardation, cerebral palsy
• Renal- renal tubular acidosis, chronic renal failure
• Cardiopulmonary- congenital heart disease, cystic fibrosis, asthma
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• Endocrine- Hypothyroidism, diabetes mellitus, adrenal insufficiency
• Infections- chronic parasitic or bacterial infections of gastrointestinal tract, tuberculosis, infection with HIV
• Genetic- Inborn errors of metabolism, chromosomal anomalies
• Miscellaneous- lead poisoning, malignancy, collagen vascular disease
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Non organic causes:• Poverty• Misperceptions or lack of knowledge about diet and
feeding practices • Lack of breastfeeding, feeding diluted formulae• Dysfunctional parent-child relationship with abuse &
neglect
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• Clinical features: Poor growth Poor development Poor cognitive function
-the degree of FTT is measured by weight, height and weight for height as percentage of median value for age on appropriate growth charts
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• Diagnosis: History Physical examination Observation of parent-child interaction Weight gain in response to adequate calorie
feeding establishes the diagnosis of psychological FTT
• Management: Nutritional rehabilitation T/t of organic causes if present Remedial measures for psychological factors
involved
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Indications for hospitalization • Severe malnutrition• Diagnostic & laboratory evaluation
needed for organic cause• Lack of catch up growth during
outpatient T/t• Suspected child abuse or neglect
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