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Failure to Thrive in the Elderly

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82. Assistive Devices to Improve Independence (Follow-up)

> Geriatric Rehabilitation Updated: Mar 19, 2019 Author: Julie A Muché, MD; Chief Editor: Stephen Kishner, MD, MHA Share Email Print Feedback Close Sections Sections Geriatric Rehabilitation Overview Overview As we age, we face many physical and emotional changes that can affect our level of function and well-being. Our baby-boomer population is aging, and people are living longer. We must maintain functional independence in the elderly and address the needs of our older generation. Rehabilitation (...) of geriatric patients is imperative for the patients' well-being and for society, so that we can thrive socially and economically. [ ] Essential to geriatric rehabilitation is communication, specifically improving any sensory impairment, including those related to vision and hearing. The prevention of falls and osteoporosis can protect the patient's health and improve longevity. Addressing malnutrition can promote healing and vitalize the patient to participate in a formal rehabilitation program

2014 eMedicine.com

83. Upper Respiratory Tract Infection (Diagnosis)

to the necessary equipment are required if respiratory failure is a possibility Administer humidified oxygen to all hypoxemic patients. In patients who do not require oxygen therapy, a cool-mist humidifier may be used IV or oral glucocorticoids are commonly used to reduce symptoms and shorten hospitalization in patients with moderate to severe croup Inhaled racemic epinephrine may temporarily dilate the airways Rhinosinusitis Most cases of acute rhinosinusitis, including mild and moderate bacterial sinusitis (...) affect the prevalence of colds, because most viral URI agents thrive in the low humidity that is characteristic of winter months. Low indoor air moisture may increase friability of the nasal mucosa, increasing a person's susceptibility to infection. Laryngotracheobronchitis, or croup, occurs in fall and winter. Seasonality does not affect rates of epiglottitis. The figure below illustrates the peak incidences of various agents by season. Rhinoviruses, which account for a substantial percentage

2014 eMedicine.com

84. Ureterocalicostomy (Diagnosis)

can result in impairment of renal function, pain, infection, and/or stones. Previous Next: Presentation Clinical symptoms of obstruction include urosepsis, failure to thrive, flank pain or mass, and hematuria. As first described by Dietl, the episodes of flank pain, nausea, and vomiting may present during periods of rapid diuresis with large volumes of liquid intake (so-called Dietl crisis). This may manifest only after consumption of liquids that promote brisk diuresis, such as beer or coffee (...) ; renal capsule, peritoneal, or pericardial flap; [ ] Davis intubated ureterotomy, [ ] buccal mucosa graft, [ , ] and nephrectomy. The decision to perform a nephrectomy must be based on the level of function in the obstructed kidney and the function of the contralateral kidney. If the renal function of the affected kidney is less than 25%, surgical correction has a high risk for failure, and nephrectomy may ultimately be required. If the patient's renal function is less than 10%, recovery is unlikely

2014 eMedicine.com

85. Ureteropelvic Junction Obstruction (Diagnosis)

assistance, is the treatment of choice in older children and in most adults. [ ] Next: History of the Procedure UPJ obstruction is the most common cause of neonatal and , occurring in one per 1500 live births. Prior to the use of prenatal ultrasonography, most patients with UPJ obstruction presented with pain, hematuria, urosepsis, failure to thrive, or a palpable mass. With the enhanced ability and availability of prenatal ultrasonography, urologic abnormalities are being diagnosed earlier and more (...) may lead to progressive renal damage and deterioration. UPJ obstruction presents most frequently in childhood, but adult and elderly individuals can also present with a primary obstructive lesion. In adults, other etiologies for ureteral obstruction must be considered, including , ureteral compression due to extrinsic processes, , and other inflammatory processes. Previous Next: Epidemiology Frequency Epidemiologic features of UPJ obstruction are as follows: Ultrasonography reveals fetal upper

2014 eMedicine.com

86. Breathing-Related Sleep Disorder (Overview)

of a Z appliance, which is an original design of F. Danziger, DDS, FAGD. Previous Next: Surgery To Increase Upper Airway Size Pediatric patients The first line and most common procedure done in children with obstructive sleep apnea (OSA) and adenotonsillar hypertrophy who are surgically acceptable candidates is an adenotonsillectomy. High-risk children, including those with obesity or failure to thrive, young age, severe apnea, craniofacial anomalies, or neuromuscular or cardiac disease should (...) . [ ] In women, menopause, pregnancy, and polycystic ovaries are associated with increased risk. [ ] In children, prevalence ranges between 1 and 4 % with habitual snoring prevalence at about 7.45 %. [ ] Consequences of untreated sleep apnea can be life altering and include both cardiovascular and neurobehavioral morbidities. In children, growth failure can also occur. The aim of this article is to increase the reader's awareness of the importance of sleep-disordered breathing in daily practice. Treatment

2014 eMedicine.com

87. Assistive Devices to Improve Independence (Overview)

> Geriatric Rehabilitation Updated: Mar 19, 2019 Author: Julie A Muché, MD; Chief Editor: Stephen Kishner, MD, MHA Share Email Print Feedback Close Sections Sections Geriatric Rehabilitation Overview Overview As we age, we face many physical and emotional changes that can affect our level of function and well-being. Our baby-boomer population is aging, and people are living longer. We must maintain functional independence in the elderly and address the needs of our older generation. Rehabilitation (...) of geriatric patients is imperative for the patients' well-being and for society, so that we can thrive socially and economically. [ ] Essential to geriatric rehabilitation is communication, specifically improving any sensory impairment, including those related to vision and hearing. The prevention of falls and osteoporosis can protect the patient's health and improve longevity. Addressing malnutrition can promote healing and vitalize the patient to participate in a formal rehabilitation program

2014 eMedicine.com

88. Rhinocerebral Mucormycosis (Diagnosis)

formation occur, and this allows the organism to invade the patient's blood vessels. Mucormycosis is described almost exclusively in patients with compromised immune systems or metabolic abnormalities. Rhizopus species have an active ketone reductase system that enables them to thrive in an acidic pH and glucose-rich medium. Hyperglycemia enhances fungal growth and impairs neutrophil chemotaxis; therefore, individuals with are commonly affected. Rhizopus species also favor an iron-rich environment (...) .) This diabetic patient with mucormycosis presented with complete ophthalmoplegia and proptosis. Note the complete ptosis and periorbital edema on the right side. Iron overload Iron overload states, as observed with and deferoxamine treatment in patients receiving dialysis, may be risk factors. Iron enhances fungal growth and increases susceptibility. Researchers have reported infection in patients with liver and renal failure. [ ] Burns In individuals with burns, mucormycosis generally involves only the skin

2014 eMedicine.com

89. Coronary Artery Atherosclerosis (Diagnosis)

. United States statistics In the United States, approximately 14 million persons experience CAD and its various complications. Congestive heart failure (CHF) that develops because of ischemic cardiomyopathy in hypertensive MI survivors has become the most common discharge diagnosis for patients in American hospitals. Approximately 80 million people, or 36.3% of the population, have cardiovascular disease. Annually, approximately 1.5 million Americans have an AMI, a third of whom die. In 2009, 785,000 (...) comorbidities than test subjects. The guideline is now “effectiveness-based” rather than “evidence-based.” Effectiveness-based considerations have reduced the strength of previous recommendations for use of aspirin, statins (in women with elevated C-reactive protein but normal cholesterol), and aggressive glycemic control in diabetes. The elderly and coronary artery disease Age is the strongest risk factor for the development of CAD. Most cases of CAD become clinically apparent in patients aged 40 years

2014 eMedicine.com

90. Dermatologic Manifestations of Gastrointestinal Disease (Diagnosis)

, and respiratory tracts, leading to fragility and resulting in extracutaneous complication. [ ] A retrospective analysis of 223 patients with EB found 58% of patients had GI complications. [ ] In EB simplex, constipation and gastroesophageal reflux (GOR) were frequently observed. In junctional EB, failure to thrive and protein-losing enteropathy (PLE) were the prominent findings. Constipation was common in patients with dystrophic EB. GOR and dysphagia affected most of the patients with recessive dystrophic EB (...) . [ ] Therefore, it is particularly difficult to identify the sign of Leser-Trélat in the setting of an elderly patient. As such, this finding may be more useful in younger patients, when there is a rapid increase in the size and number of lesions or when other suspicious findings such as acanthosis nigricans, florid cutaneous papillomatosis, weight loss, dysphagia, or changes in bowel movements are present. Similar to acanthosis nigricans, patients presenting with the sign of Leser–Trélat have a poor

2014 eMedicine.com

91. Breathing-Related Sleep Disorder (Diagnosis)

of a Z appliance, which is an original design of F. Danziger, DDS, FAGD. Previous Next: Surgery To Increase Upper Airway Size Pediatric patients The first line and most common procedure done in children with obstructive sleep apnea (OSA) and adenotonsillar hypertrophy who are surgically acceptable candidates is an adenotonsillectomy. High-risk children, including those with obesity or failure to thrive, young age, severe apnea, craniofacial anomalies, or neuromuscular or cardiac disease should (...) . [ ] In women, menopause, pregnancy, and polycystic ovaries are associated with increased risk. [ ] In children, prevalence ranges between 1 and 4 % with habitual snoring prevalence at about 7.45 %. [ ] Consequences of untreated sleep apnea can be life altering and include both cardiovascular and neurobehavioral morbidities. In children, growth failure can also occur. The aim of this article is to increase the reader's awareness of the importance of sleep-disordered breathing in daily practice. Treatment

2014 eMedicine.com

92. Breathing-Related Sleep Disorder (Follow-up)

of a Z appliance, which is an original design of F. Danziger, DDS, FAGD. Previous Next: Surgery To Increase Upper Airway Size Pediatric patients The first line and most common procedure done in children with obstructive sleep apnea (OSA) and adenotonsillar hypertrophy who are surgically acceptable candidates is an adenotonsillectomy. High-risk children, including those with obesity or failure to thrive, young age, severe apnea, craniofacial anomalies, or neuromuscular or cardiac disease should (...) . [ ] In women, menopause, pregnancy, and polycystic ovaries are associated with increased risk. [ ] In children, prevalence ranges between 1 and 4 % with habitual snoring prevalence at about 7.45 %. [ ] Consequences of untreated sleep apnea can be life altering and include both cardiovascular and neurobehavioral morbidities. In children, growth failure can also occur. The aim of this article is to increase the reader's awareness of the importance of sleep-disordered breathing in daily practice. Treatment

2014 eMedicine.com

93. McCune-Albright Syndrome (Diagnosis)

, hyperthermia, tremor, sleeplessness, weight loss, or (in infants) failure to thrive Other possible manifestations include the following: Cushing syndrome Growth hormone (GH) excess (gigantism and acromegaly) Acromegaly Ovarian cysts Pituitary tumors Thyroid tumors Hypophosphatemia (hypophosphatemic rickets) Hypogonadotropic hypogonadism, particularly in the setting of hyperprolactinemia See for more detail. Diagnosis Full endocrine studies should be performed. Testicular or ovarian hyperfunction (...) , facial disfigurement, and vision and hearing problems. It is difficult to treat effectively. Current therapies focus on treating complications of FD, rather than on preventing it from developing. Current studies using bisphosphonates are promising, though it is unclear whether bisphosphonates significantly reduce the morbidity associated with these lesions. Hyperthyroidism can cause severe failure to thrive in infants and young children, decreased attention span, and . Tachycardia resulting from

2014 eMedicine.com

94. Geriatric Rehabilitation (Diagnosis)

Rehabilitation Updated: Mar 19, 2019 Author: Julie A Muché, MD; Chief Editor: Stephen Kishner, MD, MHA Share Email Print Feedback Close Sections Sections Geriatric Rehabilitation Overview Overview As we age, we face many physical and emotional changes that can affect our level of function and well-being. Our baby-boomer population is aging, and people are living longer. We must maintain functional independence in the elderly and address the needs of our older generation. Rehabilitation of geriatric patients (...) is imperative for the patients' well-being and for society, so that we can thrive socially and economically. [ ] Essential to geriatric rehabilitation is communication, specifically improving any sensory impairment, including those related to vision and hearing. The prevention of falls and osteoporosis can protect the patient's health and improve longevity. Addressing malnutrition can promote healing and vitalize the patient to participate in a formal rehabilitation program. Depression is common

2014 eMedicine.com

95. Celiac Sprue (Diagnosis)

, an immunologically mediated inflammatory response occurs that damages the mucosa of their intestines, resulting in maldigestion and malabsorption of food nutrients. Signs and symptoms Gastrointestinal symptoms Gastrointestinal symptoms may include the following: Diarrhea - 45-85% of patients Flatulence - 28% of patients Borborygmus - 35-72% of patients Weight loss - 45% of patients; in infants and young children with untreated celiac disease, failure to thrive and growth retardation are common Weakness (...) is a protein commonly found in wheat, rye, and barley. Most patients with celiac disease tolerate oats, but they should be monitored closely. When people with celiac disease ingest gliadin, the mucosa of their intestines is damaged by an immunologically mediated inflammatory response, resulting in maldigestion and malabsorption. Patients with celiac disease can present with failure to thrive and diarrhea (the classical form). However, some patients have only subtle symptoms (atypical celiac disease

2014 eMedicine.com

96. Assistive Devices to Improve Independence (Diagnosis)

> Geriatric Rehabilitation Updated: Mar 19, 2019 Author: Julie A Muché, MD; Chief Editor: Stephen Kishner, MD, MHA Share Email Print Feedback Close Sections Sections Geriatric Rehabilitation Overview Overview As we age, we face many physical and emotional changes that can affect our level of function and well-being. Our baby-boomer population is aging, and people are living longer. We must maintain functional independence in the elderly and address the needs of our older generation. Rehabilitation (...) of geriatric patients is imperative for the patients' well-being and for society, so that we can thrive socially and economically. [ ] Essential to geriatric rehabilitation is communication, specifically improving any sensory impairment, including those related to vision and hearing. The prevention of falls and osteoporosis can protect the patient's health and improve longevity. Addressing malnutrition can promote healing and vitalize the patient to participate in a formal rehabilitation program

2014 eMedicine.com

97. Scrub Typhus (Overview)

, ocular pain, wet cough, malaise, and injected conjunctiva Centrifugal macular rash on the trunk Enlargement of the spleen, cough, and delirium Pneumonitis or encephalitis Central nervous system (CNS), pulmonary, or cardiac involvement Rarely, acute renal failure, shock, and disseminated intravascular coagulation (DIC) See for more detail. Diagnosis Laboratory studies in patients with scrub typhus may reveal the following: Early lymphopenia with late lymphocytosis Decreased CD4:CD8 lymphocyte ratio (...) of scrub typhus varies with the climate in different countries because the mites are able to thrive as conditions change. The mites prefer the rainy season and certain areas (eg, forest clearings, riverbanks, and grassy regions). In the past few years, cases have been noted earlier in the season because of increased mite activity as the weather warms. [ ] Areas in which mites thrive pose a greater risk to humans. The prevalence of scrub typhus in Japan has been rising, and much of the current research

2014 eMedicine.com

98. Breathing-Related Sleep Disorder (Treatment)

of a Z appliance, which is an original design of F. Danziger, DDS, FAGD. Previous Next: Surgery To Increase Upper Airway Size Pediatric patients The first line and most common procedure done in children with obstructive sleep apnea (OSA) and adenotonsillar hypertrophy who are surgically acceptable candidates is an adenotonsillectomy. High-risk children, including those with obesity or failure to thrive, young age, severe apnea, craniofacial anomalies, or neuromuscular or cardiac disease should (...) . [ ] In women, menopause, pregnancy, and polycystic ovaries are associated with increased risk. [ ] In children, prevalence ranges between 1 and 4 % with habitual snoring prevalence at about 7.45 %. [ ] Consequences of untreated sleep apnea can be life altering and include both cardiovascular and neurobehavioral morbidities. In children, growth failure can also occur. The aim of this article is to increase the reader's awareness of the importance of sleep-disordered breathing in daily practice. Treatment

2014 eMedicine.com

99. Papillary Necrosis (Treatment)

are possibilities. Ensure that the patient has medical clearance to undergo a procedure that requires . Previous Next: Postoperative Details Common complications after any instrumentation of the ureter include infection, extravasation and urinoma formation, bleeding, ureteral stricture, and urosepsis due to pyelovenous backflow. Persistent postoperative fever or failure to thrive may be harbingers of those complications. Ensure that patients clearly understand that, if they require an indwelling ureteral stent (...) that this may result in progressive renal failure and possible dialysis dependency in the future. In selected patients, ureteroscopic investigation of a ureteral filling defect may be warranted. A basket catheter can be introduced through the ureteroscope to extract the offending sloughed papilla. This is performed only in afebrile patients, after broad-spectrum intravenous antibiotics have been administered. Patients who present with hematuria, even if all the diagnostic interventions indicate papillary

2014 eMedicine.com

100. Pyelonephritis, Acute (Treatment)

-6 years of age Children 6-11 years of age UTI frequency (%) 1 1.5-3 1.5-3 1.2 Female-to-male ratio 1:1.5 10:1 10:1 30:1 Route of infection Blood Ascending Ascending Ascending Signs and symptoms Failure to thrive, fever, hypothermia, irritability, jaundice, poor feeding, sepsis, vomiting Diarrhea, failure to thrive, fever, irritability, poor feeding, strong-smelling urine, vomiting Abdominal pain, dysuria, enuresis, fever, gross hematuria, meningismus, strong-smelling urine, urinary urgency (...) -to-male ratio 1:1.5 10:1 10:1 30:1 Route of infection Blood Ascending Ascending Ascending Signs and symptoms Failure to thrive, fever, hypothermia, irritability, jaundice, poor feeding, sepsis, vomiting Diarrhea, failure to thrive, fever, irritability, poor feeding, strong-smelling urine, vomiting Abdominal pain, dysuria, enuresis, fever, gross hematuria, meningismus, strong-smelling urine, urinary urgency, urinary frequency, vomiting Dysuria, enuresis, fever, flank pain or tenderness, urinary urgency

2014 eMedicine.com

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