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203 results for

Failure to Thrive in the Elderly

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121. Ureterocalicostomy (Overview)

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

122. Upper Respiratory Tract Infection (Overview)

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

123. Strongyloidiasis (Overview)

local cutaneous involvement, or both. During chronic uncomplicated infections, the larvae may migrate to the skin, where they can cause cutaneous strongyloidiasis, known as larva currens because of the quick migratory rate of the larva. Infection is clinically characterized by watery diarrhea, abdominal cramping, and urticarial rash. In malnourished children, strongyloidiasis remains an important cause of chronic diarrhea, cachexia, and failure to thrive. This condition can also be a health (...) the preleukemic phase of HTLV-1 infection [ ] ; the Strongyloides antigen accelerates leukemogenesis, and treatment of the infection may actually decrease HTLV-1 viral load [ ] Hypogammaglobulinemia Malignancy/neoplasms, particularly hematologic malignancies (lymphoma, leukemia): Studies have suggested that Strongyloides infection may be associated with increased incidence of gastrointestinal lymphoma [ ] Organ transplantation [ , , , ] and malnutrition Chronic renal failure and end-stage renal disease

2014 eMedicine.com

124. Strongyloidiasis (Overview)

local cutaneous involvement, or both. During chronic uncomplicated infections, the larvae may migrate to the skin, where they can cause cutaneous strongyloidiasis, known as larva currens because of the quick migratory rate of the larva. Infection is clinically characterized by watery diarrhea, abdominal cramping, and urticarial rash. In malnourished children, strongyloidiasis remains an important cause of chronic diarrhea, cachexia, and failure to thrive. This condition can also be a health (...) the preleukemic phase of HTLV-1 infection [ ] ; the Strongyloides antigen accelerates leukemogenesis, and treatment of the infection may actually decrease HTLV-1 viral load [ ] Hypogammaglobulinemia Malignancy/neoplasms, particularly hematologic malignancies (lymphoma, leukemia): Studies have suggested that Strongyloides infection may be associated with increased incidence of gastrointestinal lymphoma [ ] Organ transplantation [ , , , ] and malnutrition Chronic renal failure and end-stage renal disease

2014 eMedicine.com

125. Albright Syndrome (Overview)

, 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

126. Hutchinson-Gilford Progeria (Overview)

with the cutaneous and musculoskeletal manifestations may not occur until age 6-12 months or older, when the development of failure to thrive engenders a more thorough evaluation. Previous Next: Prognosis The average life expectancy for a patient with HGPS is 13 years, with an age range of 7-27 years. Data from the largest cohort of HGPS patients indicated a mean survival of 14.6 years, with an increased mean survival of 1.6 years in patients treated with a protein farnesylation inhibitor after a median follow (...) -up of 5.3 years from treatment initiation. [ ] Morbidity and mortality in persons with HGPS occur primarily as a result of atherosclerosis of the coronary and cerebrovascular arteries, with at least 90% of patient deaths directly related to complications of progressive atherosclerosis. Cardiovascular complications include myocardial infarction and congestive heart failure. Interstitial fibrosis, diffuse myocardial fibrosis, and calcification of the mitral and aortic valves may occur

2014 eMedicine.com

127. Hirsutism (Overview)

, but the same mechanisms do not appear to be involved in all patients. Drug-induced hirsutism can be distinguished from drug-induced hypertrichosis, in which a uniform growth of fine hair appears over extensive areas of the trunk, hands, and face and is unrelated to androgen-dependent hair growth. Adrenal causes of hirsutism CAH in children (ie, the classic form of adrenal hyperplasia) may cause hirsutism. These children may be born with ambiguous genitalia, symptoms of salt wasting, and failure to thrive (...) . Idiopathic hirsutism in an elderly woman. Although the terms hirsutism and hypertrichosis often are used interchangeably, hypertrichosis actually refers to excess hair (terminal or vellus) in areas that are not predominantly androgen dependent. Whether a patient is hirsute often is difficult to judge because hair growth varies among individual women and across ethnic groups. What is considered hirsutism in one culture may be considered typical in another. For example, women from the Mediterranean

2014 eMedicine.com

128. Dermatologic Manifestations of Gastrointestinal Disease (Overview)

, 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

129. McCune-Albright Syndrome (Overview)

, 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

130. Geriatric Rehabilitation (Treatment)

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

131. Dermatologic Manifestations of Gastrointestinal Disease (Treatment)

, 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

132. Scrub Typhus (Follow-up)

, 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

133. Protein-Energy Malnutrition (Follow-up)

. Hepatogastroenterology . 2003 Nov-Dec. 50(54):1943-7. . Harris CL, Fraser C. Malnutrition in the institutionalized elderly: the effects on wound healing. Ostomy Wound Manage . 2004 Oct. 50 (10):54-63. . Hendricks KM, Duggan C, Gallagher L, et al. Malnutrition in hospitalized pediatric patients. Current prevalence. Arch Pediatr Adolesc Med . 1995 Oct. 149(10):1118-22. . Jilcott SB, Masso KL, Ickes SB, Myhre SD, Myhre JA. Surviving but not quite thriving: anthropometric survey of children aged 6 to 59 months (...) , and anti-inflammatory pharmacologic agents combined with more traditional forms of nutritional support to abate the protein-energy malnutrition. [ ] An intervention that brought "buddies" to the homes of the elderly who were at risk for protein-energy malnutrition was successful at decreasing such malnutrition. [ ] Long-term care Patients should receive follow-up care with nutrition professionals and social services, and their growth and development should be monitored. Previous Next: Diet and Activity

2014 eMedicine.com

134. Pyelonephritis, Acute (Follow-up)

-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

135. Papillary Necrosis (Follow-up)

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

136. Dermatologic Manifestations of Gastrointestinal Disease (Follow-up)

, 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

137. Hutchinson-Gilford Progeria (Follow-up)

and occupational therapists can develop individualized physical therapy programs to help to maintain physical activity, coordination, and flexibility. Dermatologists and/or geneticists may be the first specialists to evaluate an infant with suspected HGPS and can perform diagnostic testing, including genetic mutation analysis and skin biopsies, as needed. Pediatric gastroenterologists, feeding therapists, and nutritionists can aid in diagnosing and treating feeding disorders and failure to thrive. Pediatric (...) dentists with experience in treating children with dental anomalies can be helpful. Routine fluoride supplementation should be provided to minimize the risks of dental caries. Regular, gentle dental care minimizes the development of periodontal disease. Previous Next: Diet Infants and children with HGPS may experience feeding difficulties and failure to thrive. The use of age-appropriate nutritional supplements is recommended. Previous Next: Activity Children with HGPS do not require activity

2014 eMedicine.com

138. Geriatric Rehabilitation (Follow-up)

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

139. Strongyloidiasis (Diagnosis)

local cutaneous involvement, or both. During chronic uncomplicated infections, the larvae may migrate to the skin, where they can cause cutaneous strongyloidiasis, known as larva currens because of the quick migratory rate of the larva. Infection is clinically characterized by watery diarrhea, abdominal cramping, and urticarial rash. In malnourished children, strongyloidiasis remains an important cause of chronic diarrhea, cachexia, and failure to thrive. This condition can also be a health (...) the preleukemic phase of HTLV-1 infection [ ] ; the Strongyloides antigen accelerates leukemogenesis, and treatment of the infection may actually decrease HTLV-1 viral load [ ] Hypogammaglobulinemia Malignancy/neoplasms, particularly hematologic malignancies (lymphoma, leukemia): Studies have suggested that Strongyloides infection may be associated with increased incidence of gastrointestinal lymphoma [ ] Organ transplantation [ , , , ] and malnutrition Chronic renal failure and end-stage renal disease

2014 eMedicine Pediatrics

140. Scrub Typhus (Diagnosis)

, 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 Pediatrics

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