Osteomalacia is a softening of the bones caused by defective bone mineralization, most commonly due to a vitamin D deficiency. Symptoms include bone pain, muscle weakness, and an increased risk of fractures. The condition is diagnosed through blood and urine tests showing low calcium and phosphorus levels, and may be confirmed with a bone biopsy. Treatment focuses on supplementing with vitamin D, calcium, and phosphorus.
Formation of hard, pebble and stone like structure mainly made up of cholesterol in gall bladder is called cholelithiasis.
Know more about cholelithiasis
Gallstones are hardened deposits of bile that can form in your gallbladder. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum)
A chronic, progressive disease characterized by widespread fibrosis(scarring) and nodule formation.
The development of cirrhosis is an insidious, prolonged course, usually after decades of chronic liver disease.
Nutritional anemia refers to types of anemia that can be directly attributed to nutritional disorders. Examples include Iron deficiency anemia and pernicious (Vitamin B12 deficiency) anemia.
This PPT contains all necessary detail about cholecystitis and its management and covers all aspects of this disease according to nursing point of view. Helpful for studetns.
PYLORIC STENOSIS
Pyloric stenosis is a medical condition in which the pylorus, the muscular valve between the stomach and the small intestine, becomes abnormally narrowed or obstructed, leading to the obstruction of the gastric outlet. This narrowing of the pylorus prevents the proper passage of food from the stomach to the small intestine.
The exact cause of pyloric stenosis is still unknown, but it is believed to have a multifactorial etiology.
Genetic factors are thought to play a role, as there is a higher incidence of pyloric stenosis among siblings and family members.
Environmental factors may also contribute to the development of the condition, but specific triggers remain unidentified.
The hallmark symptom of pyloric stenosis is projectile vomiting, which occurs shortly after feeding.
Vomitus is often non-bilious and may resemble curdled milk.
Forceful vomiting that may project several feet away from the infant.
Signs of hunger and irritability despite frequent feeding attempts.
Weight loss or poor weight gain.
Dehydration and electrolyte imbalances due to excessive vomiting.
Palpable “olive-shaped” mass in the epigastric region.
Infants appear hungry, irritable, and unsatisfied after feeds.
Physical Examination:
Palpation of the abdomen may reveal a palpable “olive-shaped” mass in the epigastric region, which represents the hypertrophied pylorus.
The “olive” can often be felt when the infant is in a relaxed state and the stomach is empty.
Abdominal Ultrasound:
Abdominal ultrasound is the primary diagnostic tool for confirming pyloric stenosis.
Fluid and Electrolyte Management:
Prior to surgery, infants with pyloric stenosis often require fluid resuscitation and correction of electrolyte imbalances caused by excessive vomiting.
Intravenous hydration and electrolyte replacement may be necessary to restore the infant’s fluid and electrolyte balance.
Atropine Therapy:
In some cases, medical management with intravenous atropine may be attempted as a temporary measure to relieve pyloric spasm and improve the passage of food.
Surgical management of pyloric stenosis involves performing a pyloromyotomy.
This procedure is typically done under general anaesthesia and can be performed as an open surgery or laparoscopically.
Postoperative Nursing Care:
Monitor vital signs, surgical site, and signs of infection, such as fever, redness, swelling, or discharge.
Administer prescribed pain medications and antibiotics.
Observe for complications, such as bleeding or infection, and report any abnormalities to the healthcare team.
Encourage early feeding and monitor for successful feeding tolerance, ensuring the infant is retaining and digesting food properly.
Educate parents about postoperative care, including incision care, feeding techniques, and signs of potential complications, emphasizing the importance of follow-up visits and ongoing care.
Formation of hard, pebble and stone like structure mainly made up of cholesterol in gall bladder is called cholelithiasis.
Know more about cholelithiasis
Gallstones are hardened deposits of bile that can form in your gallbladder. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum)
A chronic, progressive disease characterized by widespread fibrosis(scarring) and nodule formation.
The development of cirrhosis is an insidious, prolonged course, usually after decades of chronic liver disease.
Nutritional anemia refers to types of anemia that can be directly attributed to nutritional disorders. Examples include Iron deficiency anemia and pernicious (Vitamin B12 deficiency) anemia.
This PPT contains all necessary detail about cholecystitis and its management and covers all aspects of this disease according to nursing point of view. Helpful for studetns.
PYLORIC STENOSIS
Pyloric stenosis is a medical condition in which the pylorus, the muscular valve between the stomach and the small intestine, becomes abnormally narrowed or obstructed, leading to the obstruction of the gastric outlet. This narrowing of the pylorus prevents the proper passage of food from the stomach to the small intestine.
The exact cause of pyloric stenosis is still unknown, but it is believed to have a multifactorial etiology.
Genetic factors are thought to play a role, as there is a higher incidence of pyloric stenosis among siblings and family members.
Environmental factors may also contribute to the development of the condition, but specific triggers remain unidentified.
The hallmark symptom of pyloric stenosis is projectile vomiting, which occurs shortly after feeding.
Vomitus is often non-bilious and may resemble curdled milk.
Forceful vomiting that may project several feet away from the infant.
Signs of hunger and irritability despite frequent feeding attempts.
Weight loss or poor weight gain.
Dehydration and electrolyte imbalances due to excessive vomiting.
Palpable “olive-shaped” mass in the epigastric region.
Infants appear hungry, irritable, and unsatisfied after feeds.
Physical Examination:
Palpation of the abdomen may reveal a palpable “olive-shaped” mass in the epigastric region, which represents the hypertrophied pylorus.
The “olive” can often be felt when the infant is in a relaxed state and the stomach is empty.
Abdominal Ultrasound:
Abdominal ultrasound is the primary diagnostic tool for confirming pyloric stenosis.
Fluid and Electrolyte Management:
Prior to surgery, infants with pyloric stenosis often require fluid resuscitation and correction of electrolyte imbalances caused by excessive vomiting.
Intravenous hydration and electrolyte replacement may be necessary to restore the infant’s fluid and electrolyte balance.
Atropine Therapy:
In some cases, medical management with intravenous atropine may be attempted as a temporary measure to relieve pyloric spasm and improve the passage of food.
Surgical management of pyloric stenosis involves performing a pyloromyotomy.
This procedure is typically done under general anaesthesia and can be performed as an open surgery or laparoscopically.
Postoperative Nursing Care:
Monitor vital signs, surgical site, and signs of infection, such as fever, redness, swelling, or discharge.
Administer prescribed pain medications and antibiotics.
Observe for complications, such as bleeding or infection, and report any abnormalities to the healthcare team.
Encourage early feeding and monitor for successful feeding tolerance, ensuring the infant is retaining and digesting food properly.
Educate parents about postoperative care, including incision care, feeding techniques, and signs of potential complications, emphasizing the importance of follow-up visits and ongoing care.
Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Know the Risk Factors for Osteoporotic Fracture, Preventive Measures and exercise for osteoporosis. For more health Tips, Visit at http://gisurgery.info
Osteopenia refers to decreased bone mass.
Osteoporosis refers to osteopenia (reduced bone strength/mass) that is severe enough to increase the risk of fracture.
According to WHO, osteoporosis is defined as bone mineral density that falls 2.5 standard deviation below mean for young healthy adult of same sex and race.
Osteoporosis associated fractures :
These are adulthood fractures of any bones (chiefly hip and vertebral fractures) in the setting of trauma less than or equal to fall from standing height with exception of fingers, toes, face and skull.
Drugs associated with osteoporosis
Alcohol
Glucocorticoids
Anticoagulants
Anticonvulsants
Chemotherapy
Excess thyroxine
Endocrine disorders
Cushing syndrome
Hyperparathyroidism
Thyrotoxicosis
Diabetes mellitus (both type I and II)
Acromegaly
CATEGORIZATION OF OSTEOPOROSIS
A.Primary
Idiopathic
Postmenopausal
Senile/age related
B. Secondary (Diseases)
Hypogonadal state, endocrine disorders, nutritional and gastrointestinal disorders, rheumatologic disorders, hematological disorders/malignancy, inherited disorders and others.
Usually asymptomatic until fracture occurs
Vertebral and hip fracture common by simple fall
Loss of height due to multiple vertebral fracture and other deformities like lordoisis, kyphoscoliosis.
Fracture of femur neck, pelvis or spine causes deep vein thrombosis and pulmonary embolism, pneumonia.
INVESTIGATIONS FOR OSTEOPOROSIS
DXA (Dual energy X-ray absorptiometry)
Quantitative CT
Ultrasound
Urea, creatinine and electrolytes
Liver function test and albumin
Renal function test
Full blood count, ESR
Serum calcium and phosphate
Serum vitamin D and alkaline phosphate
Serum PTH
Thyroid function test
Testosterone, estrogen and gonadotropins
Serum cortisol
Bone biopsy
Plain radiography not diagnostic
Following non pharmacological approaches are taken:
Exercise
Appropriate calcium and vitamin D intake (Calcium 1000mg/day and vitamin D 800 IU/daily)
Cessation of smoking
Limit/ Quit alcohol intake
Get up and go exercise
Hip protectors to reduce the risk of fracture.
Pharmacological agents
Bisphosphonates ( decrease osteoclast activity)
Postmenopausal hormone replacement therapy
Denusumab (anti- RANKL antibody)
Anti- sclerostin antibodies
Cathepsin k antibodies
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2. DEFINITION
Osteomalacia is derived from Greek: osteo-
which means "bone", and malacia which means
"softness".
Osteomalacia is the softening of the bones
caused by defective bone mineralization that is
phosphorus and calcium.
The most common cause of the disease is a
deficiency in vitamin D, which is normally
obtained from the diet and/or from sunlight
exposure.
3. CAUSES
Insufficient nutritional quantities
or faulty metabolism of vitamin D
or phosphorus
Renal tubular acidosis
Malnutrition during pregnancy
Malabsorption syndrome
Hypophosphatemia
Chronic renal failure
Tumor-induced osteomalacia
4. CAUSES contin…..
Long-term anticonvulsant therapy
(certain medications, including some
medications prescribed for epilepsy)
Coeliac disease
Cadmium poisoning , Itai-itai disease
5. SIGNS AND
SYMPTOMS
Weak bones
Bone pain
Spinal bone pain
Pelvic bone pain
Leg bone pain
Muscle weakness
6. Hypocalcemia
Compressed vertebrae
Pelvic flattening
Easy fracturing
Bone softening
Bending of bones
7. RISK FACTORS
The risk of developing osteomalacia is
highest in people who have both
inadequate dietary intake of vitamin D
and little exposure to sunlight, such as
older adults and those who are
housebound or hospitalized
8. DIAGNOSIS OF
OSTEOMALACIA
Blood and urine tests. In cases of osteomalacia
caused by vitamin D deficiency or by phosphorus loss,
abnormal levels of vitamin D and the minerals calcium
and phosphorus are often detected.
X-ray. Slight cracks in your bones that are visible on X-
rays, referred to as Looser transformation zones, are a
characteristic feature of people with osteomalacia.
Bone biopsy. During a bone biopsy, your doctor inserts
a slender needle through your skin and into your bone
to withdraw a small sample for viewing under a
microscope. Although a bone biopsy is very accurate
in detecting osteomalacia, it's not often needed to
make the diagnosis
9. CLINICAL
FEATURES
Osteomalacia in adults starts
insidiously as aches and pains in the
lumbar (lower back) region and thighs,
spreading later to the arms and ribs.
The pain is symmetrical, non-radiating
and is accompanied by sensitivity in
the involved bones. Proximal muscles
are weak, and there is difficulty in
climbing up stairs and getting up from
a squatting position
10. Due to demineralization bones become
less rigid.
Physical signs include deformities like
triradiate pelvis and lordosis. The
patient has a typical "waddling" gait.
However, those physical signs may
derive from a previous osteomalacial
state, since bones do not regain their
original shape after they become
11. Pathologic fractures due to weight
bearing may develop. Most of the time,
the only alleged symptom is chronic
fatigue while bone aches are not
spontaneous but only revealed by
pressure or shocks.
It differs from renal osteodystrophy
where the latter shows
hyperphosphatemia.
12. COMPLICATIONS OF
OSTEOMALACIA
If you have osteomalacia, you're more
likely to experience broken bones,
particularly in your ribs, spine and legs
13. PREVENTION OF
OSTEOMALACIA
Spend a few minutes in the sun. For most people, 15 minutes
of direct sun exposure a couple of times a week is sufficient
for proper vitamin D production.
Eat foods high in vitamin D. These include foods that are
naturally rich in vitamin D, including oily fish (salmon,
mackerel, sardines) and egg yolks. Also look for foods that
are fortified with vitamin D, such as cereal, bread, milk and
yogurt.
Take supplements, if needed. If you don't get enough vitamins
and minerals in your diet or if you have a medical condition
affecting the ability of your digestive system to absorb
nutrients properly, ask your doctor about taking vitamin D and
14. TREATMENTS OF
OSTEOMALACIA
Treatment may involve vitamin D,
calcium, and phosphorus supplements,
taken by mouth. Larger doses of
vitamin D and calcium may be needed
for people who cannot properly absorb
nutrients into the intestines.
Regular blood tests may be needed to
monitor blood levels of phosphorus
and calcium in persons with certain
