ricket disease
TRANSCRIPT
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Case Study
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Epidemiologi
y Abad ke-20, rickets menjadi epidemik pada bayi dan
anak-anak di Asia, Amerika Utara, dan Eropa Utaray Tahun 1960-an
- Amerika Utara : rickets hanya terbatas padadefiensi calcium dan vitamin D pada ASI
- Eropa : rikets pada imigran anak-anak yangberasal dari India, Pakistan dan Bangladesh,
Afrika Utara dan Timur Tengah
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Rickets
y Rickets merupakan suatu gangguanmineralisasi tulang dan kartilago yangdisebabkan karena defisiensi vitamin D,
abnormalitas metabolisme vitamin D, ataukarena abnormalitas metabolismemaupun ekskresi fosfat organik.
y Terjadi pada anak-anak
y Dapat menyebabkan cacat permanen
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Metabolisme Vitamin D
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Patofisiologi
Etiologi :- Defisiensi vitamin D
- Kelainan traktus gastrointestinal
- Kelainan metabolisme vitamin D- Asidosis
- Gagal ginjal kronik
- Penurunan fosfat
- Generalized renal tube disorders- Defek mineralisasi primer
- Status pembentukan tulang cepat dengan atau tanpa defekrelatif pada resorpsi tulang
- Defective matrix synthesis-Fibrogenesis imperfect ossium
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Manifestasi Klinisy Pada keadaan akut:
- Berkeringat
- Tidur tidak tenang- Kelemahan pada anggota gerak
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Manifestasi Klinis
y Kepala besar,
y Perut membesar,
y Dada sempit,
y Terjadi pembengkakan pada epiphysetulang-tulang rusuk T asbeh Rickets(Rickets Rosary),
y Pembengkakan dalam bentuk vara atau valga di dekat sendi,
y Terlambatnya pembentukan gigi,
y Terganggunya kekuatan otot-otot dankemampuan berjalan anak terlambat
y Pembesaran hati dan limpa.
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Diagnosisy Penilaian Status Nutrisi
- Pemeriksaan Antropometri
- Pemeriksaan Biokimia- Observasi Klinis
- Evaluasi Diet dan Riwayat Personal
y Pemeriksaan Radiologi
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Pemeriksaan Antropometri
y Tinggi badan tidak sesuai dengan umur
y Penurunan berat badan
y Lingkar kepala lebih besar jika dibandingkan denganumur
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Pemeriksaan Biokimia
y Penurunan kadar serum kalsium
y Peningkatan kadar serum fosfat
y Peningkatan kadar serum alkali fosfatase
y Kadar PTH meningkat
y Kadar kalsium urin menurun
y Kadar fosfat urin menurun
y
Analisis gas darah = metabolik asidosisy Kadar serum 25-hydroxycholecalciferol (25(OH)D3)
rendah
y Kadar serum 1,25-dihydroxycholecalciferol tinggi
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Observasi Klinisy Kejang
y Kaku
y Pertumbuhan fisik yang lambaty Gagal tumbuh
y Apatis
y Lemah
y Lesu
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Observasi Klinisy lingkar kepala yang bertambah lebar
y deformitas tulang tengkorak
y pertumbuhan gigi lambaty rachitic rosary
y Harissons groove
y hipotonia otot potbelly & waddling gait
y Genu varum & genu valgum
y tengkorak yg lunak, pembengkakan kostokondraldan pergelangan tangan
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Evaluasi Diet dan Riwayat Personal
y asupan nutrisi terutama yang mengandung vitaminD dan kalsium pada ibu penderita selama
kehamilany riwayat ASI penderita
y riwayat paparan sinar Ultraviolet
y riwayat penyakit keluarga terutama yang terkait
dengan kelainan tulang
y Riwayat fraktur, terutama fraktur yang bersifatpatologis
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Pemeriksaan Radiologi
- Pelebaran epiphise denganiregularitas permukaan
ephiphysial -metaphysial junction
- Gambaran pseudofraktur
berupa garis radioluscent
- Deformitas tulang-tulangpanjang
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Pemeriksaan Radiologi
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Penatalaksanaan
y PenangananPrimer
- Paparan sinar matahari
- Pemberian ASI dan Vitamin D- Susu formula dan Vitamin D
- Suplemen Vitamin D
- Asupan Kalsium
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Penatalaksanaany Penanganan Sekunder
- Vitamin D 2000 4800 IU/hari selama 1 bulan
y Penanganan Tersier
- Garam kalsium intravena
- Pembedahan
y Penanganan terhadap penyakit yangmelatarbelakangi terjadinya rickets ; asidosis, gagalginjal kronik dll.
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TERIMAKASIH