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193 results for

Failure to Thrive in the Elderly

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121. 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

122. 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

123. 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

124. 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

125. 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

126. 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

127. 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

128. 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

129. 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

130. 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

131. Atrial Septal Defect, Ostium Primum (Treatment)

septal defects (ASDs) and partial atrioventricular (AV) canal defects is operative repair. Its timing has been debated over the years; more recent reports encourage a trend toward earlier repair. Patients with an isolated ostium primum ASD are typically referred for elective repair between the ages of 2 and 5 years. Occasionally, repair may be recommended at an earlier age because of significant congestive heart failure (CHF) or failure to thrive, especially if associated with significant mitral (...) syndrome manifested by chest pain, fever, pericardial inflammation with a rub, and pericardial effusion. High-dose salicylates or nonsteroidal anti-inflammatory drugs (NSAIDs) generally improve symptoms. Hemodynamically significant effusions may require pericardiocentesis. Failure to respond to salicylates may warrant pulsed steroid therapy. Diet and activity For asymptomatic patients, no specific dietary recommendations are warranted. For infants or very young children with congestive heart failure

2014 eMedicine Pediatrics

132. 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 Pediatrics

133. 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

134. Atrial Septal Defect, General Concepts (Overview)

with moderate or large (ie, nonrestrictive) atrial septal defects, but no other left to right shunting lesion (eg, patent ductus arteriosus, ventricular septal defect), have tachypnea and failure to thrive. In these individuals, the pulmonary artery pressure, when measured during catheterization or Doppler echocardiography, is at or near systemic level. In most instances, this is a flow-related phenomena (high flow/low resistance), but in infants predisposed to abnormal pulmonary vasculature, there may (...) view of a child with a secundum atrial septal defect (ASD). AO = aorta; LA = left atrium; RA = right atrium. The second type is an . This atrial septal defect presumably results from failure of the endocardial cushions to close the ostium primum. Because endocardial cushions also form the mitral and tricuspid valves, ostium primum defects are virtually always associated with a cleft in the anterior mitral valve leaflet (see the images below). Apical echocardiographic view of a primum atrial septal

2014 eMedicine Pediatrics

135. 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 Pediatrics

136. Colorectal Tumors (Follow-up)

(17%) at an early age; the mean age at diagnosis of carcinoma is 35.5 years. [ ] Close long-term surveillance is important. The amount of polyps increases the risk of chronic bleeding, which subsequently leads to iron deficiency anemia, hypoproteinemia, and failure to thrive. [ , ] Macroscopically, these polyps resemble the isolated juvenile polyps; however, histologically, they have more epithelium with a villous or papillary configuration. Epithelial dysplasia can occur. Adenomas can also (...) cessation of rectal bleeding. [ , , ] Colonoscopy is performed to eliminate juvenile polyposis (ie, >5 polyps). [ ] The polyps can be endoscopically removed. When managing a prolapsed polyp, controlling the polyp stalk prior to resection is mandatory. Failure to control the polyp stalk can result in retraction, which makes hemostatic control very difficult. [ ] Juvenile polyposis syndromes Diffuse juvenile polyposis of infancy This entity occurs within the first months of life and is not familial

2014 eMedicine Pediatrics

137. Colorectal Tumors (Diagnosis)

(17%) at an early age; the mean age at diagnosis of carcinoma is 35.5 years. [ ] Close long-term surveillance is important. The amount of polyps increases the risk of chronic bleeding, which subsequently leads to iron deficiency anemia, hypoproteinemia, and failure to thrive. [ , ] Macroscopically, these polyps resemble the isolated juvenile polyps; however, histologically, they have more epithelium with a villous or papillary configuration. Epithelial dysplasia can occur. Adenomas can also (...) cessation of rectal bleeding. [ , , ] Colonoscopy is performed to eliminate juvenile polyposis (ie, >5 polyps). [ ] The polyps can be endoscopically removed. When managing a prolapsed polyp, controlling the polyp stalk prior to resection is mandatory. Failure to control the polyp stalk can result in retraction, which makes hemostatic control very difficult. [ ] Juvenile polyposis syndromes Diffuse juvenile polyposis of infancy This entity occurs within the first months of life and is not familial

2014 eMedicine Pediatrics

138. Down Syndrome (Treatment)

to control hypersecretion in the airways. Other airway complications include subglottic stenosis and obstructive apnea, which may result from a relatively large tongue, enlarged adenoids, and midfacial hypoplasia. Adenotonsillectomy may be performed to manage obstructive sleep apnea. Previous Next: Diet and Activity No special diet is required, unless celiac disease is present. A balanced diet and regular exercise are needed to maintain appropriate weight. Feeding problems and failure to thrive usually (...) an echocardiogram if a new murmur or gallop or symptoms of heart failure develop. Continue subacute bacterial endocarditis prophylaxis in adolescents with cardiac defects; during adolescence, an additional 2% of patients die of complications of congenital heart disease, infections, leukemia, and accidents Counsel regarding the importance of protecting the cervical spine during anesthetic or surgical interventions; monitor for signs and symptoms of cervical myopathy; repeat cervical spine radiography as needed

2014 eMedicine Pediatrics

139. Colorectal Tumors (Treatment)

(17%) at an early age; the mean age at diagnosis of carcinoma is 35.5 years. [ ] Close long-term surveillance is important. The amount of polyps increases the risk of chronic bleeding, which subsequently leads to iron deficiency anemia, hypoproteinemia, and failure to thrive. [ , ] Macroscopically, these polyps resemble the isolated juvenile polyps; however, histologically, they have more epithelium with a villous or papillary configuration. Epithelial dysplasia can occur. Adenomas can also (...) cessation of rectal bleeding. [ , , ] Colonoscopy is performed to eliminate juvenile polyposis (ie, >5 polyps). [ ] The polyps can be endoscopically removed. When managing a prolapsed polyp, controlling the polyp stalk prior to resection is mandatory. Failure to control the polyp stalk can result in retraction, which makes hemostatic control very difficult. [ ] Juvenile polyposis syndromes Diffuse juvenile polyposis of infancy This entity occurs within the first months of life and is not familial

2014 eMedicine Pediatrics

140. 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 Pediatrics

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