RICKETS ‫ عمار‬.

‫د‬

CC- polyuria, abnormal movement, limping

-HOPI

-sudden: trauma ,SOL

Gradual: Inflammation, joint disease-

Ask-when start walking ,how start ,how its nutrition -

: ‫تكون‬types of rickest ‫ليش اسال عن ذول ؟ الن‬

malabsorbtion nutritional , hereditary ,

-Ask about developmental history specially gross motor

- Ask about urine

-Ask about nutrition

-Ask about family history of same condition

:Malnutrition and malabsorbtion have two types

organic :organic disease-1

non organic-2

Ask about FBM ,why? Malabsorbtion , electrolyte -

disturbance ,constipation due to hyper or hypoparathyrodisim

-Ask about Vision, hearing

Examination
-General look

short stature ‫ما خلينا ع الجارت لذلك ما نكدر نكول‬

- :Specific exam of rickets

Abnormal hair-1

Frontal bossing-2

Craniotabes-3

Mouth for :abnormal distribution , caries -4

Neck: for thyroid-5

Chest :Harrison sulcus ,rachitic rosary-6

Hand :if there is no pain on movement do compression and -7

assess the movement of wrist )‫ بالنيورو‬tone ‫(مثل ما كاعد تفحص‬

Lower limb : see deformity and compression ,contor of

bone ,DDH due to hypocalcaemia

straight ‫اخلي رجله عدل واشوف ال‬

rickets Flat foot doesn't occur in hypocalcaemia (‫(لذلك ما تصير ب‬

: Investigations

, Ca, vit D , parathyroid ,RFT,LFT,ABG,X-ray

alkaline phosphatase increase in allbut give hint about

chronicity

h urine collection ,CBC 24,

DEXA scan for bone density and for osteogenesis imperfecta

:Rx
Stoss therapy :LOADING DOSE Vit D 300,000 with calcium

)Calcium maximum dose 80mg per kg (

-:If there is no absorption I should look for causes

- Genetic cause

- Celiac disease

- Renal disease

- Familial hypophosphatic

By: Qudama Zain