HypoPhosphateMic
-
Upload
adri-yandra-hidayat -
Category
Documents
-
view
223 -
download
0
description
Transcript of HypoPhosphateMic
![Page 1: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/1.jpg)
![Page 2: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/2.jpg)
Hypophosphataemic rickets and osteomalacia
Occurs impaired renal tubular reabsorption
of phosphateCalcium levels normal, no
hyperparathyroidism defective of bone mineralization
Familial hypophosphaetamic rickets◦Commonest form, X-linked◦Infancy looks normal, with genu valgum/varus◦Adult heterotopic bone formation
![Page 3: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/3.jpg)
Treatment◦Phosphate (up to 3 gr/day) and large
dose of vitamin D◦Bony deformities may require
bracing or osteotomy
![Page 4: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/4.jpg)
![Page 5: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/5.jpg)
![Page 6: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/6.jpg)
• Hyperparathyroidism–Primary : adenoma,hiperplasia–Secondary : persistent hypocalcemia–Tertiary : when secondary hyperplasia
leads to autonomous activityStimulating tubular absorption,intestinal
absorption,bone resorption calcinosis, stone formation, recurrent infection, impaired function(kidney)
Severe cases : osteoclastic hyperactivity produces subperiosteal erosion,endosteal cavitation,and replacementof marrow spaces by vascular granulationand fibrous tissue (osteitis fibrosa cistica)
![Page 7: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/7.jpg)
1. Primary hyperparathyroid- Middle age, women:man = 2:1- Clinical features : due to hypercalcemia, chronic hypercalciuria, chondrocalcinosis- Xray : subperiosteal cortical resorption of middle phalanges(pathognomonic)- Biochemical : hypercalcemia, hypophosphatemia, serum PTH↑- Diagnosis : exclusions of other causes hypercalcemia in which PTH level decreased- Treatment : conservatives (adequate hydration and dietary Ca restriction)
![Page 8: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/8.jpg)
#parathyroidectomy indication:- unremitting hypercalcemia, recurrent renal calculi, progressive nephrocalcinosis ,severe osteoporosis#post operative hungry bone syndrome, treated with one of the fast acting vit D metabolites
![Page 9: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/9.jpg)
![Page 10: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/10.jpg)
2. Secondary hyperparathiroidismeas response of chronic hypocalcemia (rickets,osteomalacia)
![Page 11: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/11.jpg)
Renal osteodistrophy
- Diffuse bone changes which are variable combination of rickets or osteomalacia, secondary hyperparathyroidism, osteoporosis, osteosclerosis
- Children clinically more severely affected, they are stunted, pasty faced, rachitic deformities
![Page 12: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/12.jpg)
![Page 13: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/13.jpg)
Xraywidened and irregular epiphyseal platesosteosclerosis in axial skeletonrugger jersey in lateral xray of spine
Treatment hemodyalisis or renal transplatation
vit d 500.000 IU daily1,25 DHCC in resistant cases
![Page 14: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/14.jpg)
Scurvy
Causes failure of collagen syntesis and osteoid formation
Clinical : -infant irritable,-anemic,-gum spongy and bleeding-subperiosteal bleeding-->pain & tenderness near large joint
![Page 15: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/15.jpg)
Xray : bone rarefaction, most in long bone metaphysis
Treatment : large dose vit c
![Page 16: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/16.jpg)
Hypervitaminosis Hypervitaminosis A
◦Children : excessive dosage◦Clinical : bone pain, headache,
vomiting (↑intracranial pressure)◦Xray: ↑density in metaphysis and
subperiosteal calcification
![Page 17: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/17.jpg)
Hypervitaminosis D◦PTH like effect◦Ca is withdrawn from bones◦Treatment :
Vit D dose regulated Low ca diet, plentiful fluids (infants)
![Page 18: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/18.jpg)
Fluorosis
Fluorine stimulates osteoclast activity
Clinically: • subperiosteal new bone accretion
and osteosclerosis (vertebra,ribs,pelvis,forearm, and leg)
• Backache,bone pain,joint stiffness• Stress fracture (sometimes)
![Page 19: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/19.jpg)
- Xray :osteosclerosis,osteophytosis, and ossification of ligamentous and fascial attachment
![Page 20: HypoPhosphateMic](https://reader035.fdocuments.in/reader035/viewer/2022062217/55cf8f5c550346703b9b9112/html5/thumbnails/20.jpg)
Paget disease (osteitis deformans)- Enlargement and thickening of bone
but internal architecture is abnormal and the bone is unusually brittle
Clinical :• Pelvis and tibia the commonest site• Asimptomatic;pain,deformity• Limb looks bent and thick,skin
undully warm