Rickets Flashcards
Rickets – word’s orginin is unknown
– Maybe Rucket – to _________________ , Dorset word
– Or Rhakhis – _________
Rhachitis ‘’ ________________________ ’’
breath with difficulty
Spine; inflammation of spine
Rickets
Definition: A deficiency disease resulting from a lack of __________ or _________ and from insufficient ______________ , characterized by defective _____________ and occurring chiefly in _________. Also called rachitis.
vitamin D or calcium
exposure to sunlight
bone growth ; children
Normal Bone Processes
•Calcium and Phosphate
-Constitutes the ________ component of bone
–Deficiency leads to disease (i.e., _______ and/or ___________)
crystalline; Rickets; osteomalacia
•Rickets:
-Deficient _________ at ______________
•Osteomalacia:
–impaired ____________ of the __________.
mineralization; growth plate
mineralization; bone matrix
Open plates: Occur in ____________________.
Closed plates: Happens in ____________________
Osteomalacia and rickets
osteomalacia only!
Mineralization Defects
Classified according to Predominant mineral deficiency:
– 1)______________ (hypophosphatemic) rickets
Primarily caused by _________ deficiency
– 2)_____________ (hypocalcemic) rickets
Primarily caused by ___________ deficiency
Associated with decrease levels of phosphorus or calcium, respectively.
Phosphopenic ; phosphate
Calcipenic; calcium
Pathogensis of Rickets
Growth Plate thickens:
•_______________ grow and ____________
• _________ invasion of growth plate into ____________
-this requires __________ of the growth plate cartilage
-Can be _________ or prevent by deficiency of calcium or phosphorous
-In such circumstances ___________________ accumulates and ____________ . In addition, the _____________ of the growth plate becomes _____________, losing their regular _________________ orientation.
Chondrocytes; hypertrophy
Vascular; primary bone; mineralization
delayed; growth plate cartilage
thickens; chondrocytes; disorganised
straight columned
The Pathogenic processes of Rickets (2)
_______ Accumulation in __________
Decreased ______________________ of the invovled skeletal sites
2nd-ary increase in _________ of the growth plate. Compensatory mechanism due to ________________ by increase size
Bone __________ is compromised - if such condition does not improve, _________ occurs.
Osteoid ; metaphysis
biochemical resistance ; diameter
decrease strenght ; stability
bowing
Zones of the normal bone
From A-E
Reserve zone
Maturation zone
Proliferative zone
Hypertrophic zone
Primary Spongiosa
Clinical manifestation of rickets
Usually @ _________,________, and _____________ junctions.
Typically @Sites of (slow or rapid?) bone growth, where ____________________________________ are required for mineralization.
distal forearm, knee, and costochondral
Rapid
large quantities of calcium and phosphorus
Clinical Manifestations of rickets (Skeletal)
Delay in closure of the _________
Parietal & frontal _________ (due to excess osteoid)
_________ ( soft skull bones)
_________ of the costochondral junction (_____________)
fontanelles; bossing
Craniotabes ; Enlargement
rachitic rosary
Skeletal clinical manifestations of Rickets
The development of __________ sulcus ( caused by pull of the __________ to the __________)
__________ chest deformity (The weakened ribs bend inwards due to the pull of respiratory muscles, causing __________ of __________)
Harrison sulcus ; diaphragmatic attachments
lower ribs ; Pigeon chest
anterior protrusion of sternum
Skeletal clinical manifestations of rickets
______________ of the wrist + ankle & bowing of the ______________ & __________
Genus _________ (knocked), Genus ________ (bowleg), or __________ deformity (combination of valgus deformity of 1 leg with varus deformity of the other leg)
Enlargement ; distal radius & ulna
Valgus ; Verus ; Windswept
Clinical Manifestations (Extra-Skeletal)
Depends upon the type of ricket
___________ of the ___________ is typical for hypocalcemic rickets, whereas ___________ of the ________ occur more often in phosphopenic rickets.
Hypocalcemic _________, _____eased muscle tone leading to delayed ___________, recurrent infections, increased ___________
Hypoplasia of the dental enamel
abscesses of the teeth
seizures ; decreased
motor milestones; sweating
Clinical Manifestations of rickets
GENERAL Failure to thrive; _______ abdomen; Muscle __________ (especially (proximal or distal?) ); Fractures
HEAD: ___________ ; Frontal ___________; Delayed ___________; Delayed ___________; caries
CHEST : ___________; ___________ groove; or Respiratory infections
Protuding ; weakness ; proximal
Craniotabes; bossing; fontanelle closure
dentition ; Rachitic rosary; Harrison
Clinical manifestations of Rickets
BACK: __________ , __________ , __________
EXTREMITIES Enlargement of _______ and _______; _______ or ______ deformities; __________ deformity ; __________ of the tibia and femur; Leg pain.
HYPOCALCEMIC SYMPTOMS : __________, __________; Stridor due to laryngeal spasm
Scoliosis ; Kyphosis ; Lordosis
wrists ; ankles
Valgus ;? varus ; Windswept
Anterior bowing ; Tetany
Seizures
Radiography in rickets
Best visualised @ growth plate of rapidly growing bones.
– Upper limb __________
– Knee ___________ above and below
distal Ulna
Metaphyses
As disease progresses:
Disorganization of the growth plate becomes more apparent:
with __________ ,
__________,
formation of __________
__________.
cupping,
splaying,
formation of cortical spurs
stippling.
Biochemical Findings in Rickets
Alkaline phosphatase: ____ in all forms of rickets
Serum phosphorus: ____ in both hypocalcemic and phosphopenic rickets
Serum Ca+2: ___ in hypocalcemic rickets (normal 9-11mg/dl)
Serum PTH: _____ in hypocalcemic rickets, but ________ in hypophosphatemic rickets
25-OH vitamin D reflect the amount of vitamin D stored in the body, and is ______ in vitamin D deficiency.
1,25-OH2 vitamin D can be ___________ in hypocalcemic rickets and usually is _____________ in phosphopenic rickets
↑; ↓; ↓; ↑; normal
↓
↓, N or ↑
N or slightly ↑
A child with clinical signs of rickets should include _______ history with particular attention to given ________ and _________ intake
Medication history
Measurement of serum ________ and live enzymes
dietary
calcium and vitamin D
creatinine
PREVENTION of rickets
1.Exposure to ________________
__________ and __________ ———- per day
2. Lactating mothers should receive supplemention with ______ or _________ to ensure prevention of rickets in their babies.
3. _______ exposure to mothers
sunlight (ultraviolet light)
Early morning and evening 15 minutes
milk or vitamin D
Sun
Prevention of rickets
- Vitamin D supplementation (careful of _________ ): In prematures, twins and weak babies, give Vitamin D _____IU per day
For term babies and infants the demand of Vitamin D is _____IU per day
toxicity
800; 400
Prevention of rickets
5. Calcium supplementation:
________gm/day, for premature, and weak babies
0.5-1
Treatment of Rickets
EITHER: _______________ therapy: 300,000-600,000 IU orally or IM in 2-4 divided doses over one day
OR: High dose vit D 2000-5000 IU orally for 4-6wks followed by 400 IU daily orally as maintenance
OR: (5000-10,000 U) is given daily for 2-3 months until healing and alkaline phosphatase concentration is approaching to the normal
Adequate dietary ________ and __________ provided by milk, formula & other dairy products
Symptomatic hypocalcaemia need ____________ as 20mg/kg or ______________ as 100mg/kg as a bolus, followed by ___________ tapered over 2- 6 weeks
Vitamin D. stoss
Calcium & phosphorus
IV CaCl ; Calcium gluconate
oral calcium
