佝偻病(英文ppt课件)

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Rickets of Vitamin D Deficiency,The Second Affiliated Hospital of Shantou University Medical College Ma Lian,Rickets of Vitamin D Deficienc,1,Review,Rickets：signifying a failure in inernalization of growing bone or osteoid tissue.,Failure of mature bone to mineralize is called osteomalacia.,Review,2,Etiology,Inadequate direct exposure to ultraviolet rays in sunlight,Inadequate intake of vitD (diet may contain little vitD),Growth,drug,Disease:hepatic and renal lesions、celiac disease、steatorrhea or cystic fibrosis,Or both,Etiology Inadequate direct exp,3,About Vitamin-D,Two forms : vitD2 /vitD3,vitD2 :most as irradiated ergosterol,largely replaced the fish liver oils as source,vitD3 :available in human skin as 7-dehydrocholesterol.,both are hydroxylated in the liver to 25 (OH)2D,in the renal to 1. 25(OH)2D: facilitate calcium and phosphorus absorpted,About Vitamin-D Two forms : vi,4,Pathology,the epiphyseal plate of metaphysis is well demonstrated.,The cartilage cell is orderly,The calcified matrix forms the epiphyseal plate is regular,Pathologythe epiphyseal plate,5,The degenerating cartilage, islands of capillaries, osteoblasts, and unmineralized osteoid compose of broad , irregular, rachitic imtermediate zone,The degenerating cartilage, is,6,Chemical pathology,can be conceptualized to be the bodys attempt to maintain normal serum calcium levels.,When calcium is less,parathormone is secretedincrease the calcium and phosphorus concentration,Chemical pathology can be con,7,Alkaline phosphatase (ALP). (normal level,200IU/dL) can be 500UI/dL. But may be normal in infants who have rickets and who are protein or zinc depleted.,Alkaline phosphatase (ALP). (n,8,aminoaciduria, a decrease of citrate ,and its increased urinary excretion, decreased ability of the kidneys to make an acid urine, phosphaturia, and occasionally ,mellituria.,The parathyroid glands hypertrophy,aminoaciduria, a decrease of c,9,Clinical manifestations,Early signs:,Increased sweating, particularly around the head ,which result in the occipital bone bare,Clinical manifestationsEarly s,10,Clinical manifestations,Advanced rickets:,Head:,early signs is craniotabes,Like a derby hat or ping pong ball,.,Clinical manifestationsAdvance,11,Thorax:,rachitic rosary,Harrisons groove,Pigen breast deformity,children are late in standing and walking,Thorax:,12,佝偻病(英文ppt课件),13,The deformities of the long bones :knobbing and prominence of the epiphyses,The deformities of the long bo,14,佝偻病(英文ppt课件),15,Other manifestations:,Teeth-erupting may be delayed,the enamel and extensive aries are defected.,Muscle tone is poor,Other manifestations:,16,Roentgenographic findings,Roentgenographic findings,17,Diagnosis,The diagnosis is based on:,a history of inadeuate intake of vitamin D and on clinical observation;,then confirmed chemically ;,by roentgenographic examination .,Diagnosis The diagnosis is bas,18,Differential diagnosis,Scurvy: a ledgelike depression with the chondral or sternal portion is displaced below the osseous ribs.,Chondrodystrophy :irregular、concave outlines of the distal ends of the bones ,no roentgenographic evidence of fraying,Differential diagnosisScurvy:,19,Other epiphyseal lesions: congenital epiphyseal dysplasia,cytomegalic inclusion isease ,syphilis ,rubella ,and copper deficiency.,Bowlegs :maybe a familial characteristic.,Vitamin D-resistant rickets and other metabolic disturbances with osseous lesions resembling rickets,Other epiphyseal lesions: con,20,Complications,Respiratory infections :bronchitis and bronchopneumonia,pulmonary atelectasis,Anemia due to iron deficiency or accompanying infections,Complications Respiratory infe,21,Treatment,Natural and artificial light,oral administration of vitD(preferred) daily administration:vitD,3,:50-150,g,or 1.25(OH)-D: 0.5-2,g,(except vitD refractory rickets,Treatment Natural and artifici,22,Administering 15000,g,of vitamin D in a single dose without further therapy for several months may be advantageous. More rapid healing follows, possibly with earlier differential diagnosis from genetic vitamin D-resistant rickets .,Administering 15000 g of vita,23,Roentgn-ray appearance showing healing,A: active rickets,B: healing after 27 day: new line of calcification,C: after 34 day calcification line dense;periosteal calcification increase,D: complete healing after 3 months,Roentgn-ray appearance showin,24,Prognosis,If therapy is given in time , healing begins within a few days and progresses slowly until the normal bony structure is restored,It is not a fatal disease,but complications are more likely to cause death of rachitic children than normal children,Prognosis If therapy is given,25,Prevention,Can be prevented by exposure to ultraviolet light,Administered vitD :daily requirement of vitamin D is 10,g,or 400IU,Vitamin D should also be administered to pregnant and lactating mothers,Prevention Can be prevented by,26,thank you,thank you,27,