Dijagnoza i ishod obrade tjelesnog nenapredovanja u pedijatrijskoj gastroenterologiji

master's thesis

• Title (english): Diagnosis and treatment outcomes of faltering weight in pediatric gastroenterology
• Author: Mihaela Vučemilo
• Mentor: Irena Senečić-Čala (mentor)
• Committee member: Duška Tješić-Drinković (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Irena Senečić-Čala (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Tjelesno nenapredovanje (TN) u pedijatrijskoj populaciji je stanje pothranjenosti nastalo zbog jednog od 4 osnovna uzroka: neadekvatnog unosa nutrijenata, neadekvatne apsorpcije kalorija, povećanog metabolizma ili poremećenog iskorištavanja hranjivih tvari. Procjenjuje se da TN postoji u 5 do 10 posto djece u primarnoj zdravstvenoj zaštiti. Najčešća podjela je na TN organskog i neorganskog uzroka, iako je u većini slučajeva etiologija mješovite prirode. Većina slučajeva TN je nastala zbog neadekvatnog unosa nutrijenata, uzrokovanog bihevioralnim ili psihosocijalnim problemima, a procjenjuje se da je i do 80% slučajeva TN neorganskog uzroka. Pedijatar u primarnoj zdravstvenoj zaštiti će najčešće postaviti sumnju na TN u
djeteta, prateći njegovo napredovanje na krivuljama rasta. U većini slučajeva će potom pacijent biti poslan na gastroenterološku obradu. Dijagnosticiranje, kao i zbrinjavanje ovog stanja, često može biti zahtjevno te je tada potreban multidisciplinarni pristup.
Rutinska laboratorijska ispitivanja rijetko otkrivaju uzrok, ali mogu pokazati posljedice moguće malnutricije i uznapredovalost TN. Dijagnostika i liječenje mogu se provoditi putem dnevne bolnice. Najčešće indikacije za hospitalizacije su uznapredovalo TN i/ili opće loše stanje, neuspjeh ambulantnog liječenja, sumnja na zlostavljanje ili zanemarivanje, ili teški psihosocijalni poremećaj njegovatelja. U slučaju primarno gastrointestinalnih bolesti koje uzrokuju TN, znakovi i simptomi se mogu pojaviti od dojenačke dobi do puberteta, ovisno o specifičnoj bolesti. Od onih što uzrokuju TN, najčešće dijagnosticirani su celijakija, upalne bolesti crijeva (Crohnova bolest i ulcerozni kolitis) i cistična fibroza. U praksi, u većini slučajeva se uzrok ne može otkriti, te je onda važno uvesti nadohranu i pratiti pacijenta. Dugoročni učinci TN na kognitivni razvoj još uvijek nisu razjašnjeni, ali medicinska istraživanja u posljednjih deset godina su otkrila povezanost između TN u prvih nekoliko godina života s povećanim rizikom od razvoja raznih kroničnih bolesti u odrasloj dobi, uključujući koronarnu bolest srca, dijabetes i hipertenziju.

Abstract (english)

Failure to thrive (FTT) in the pediatric population is a state of undernutrition due to inadequate caloric intake, inadequate caloric absorption, increased metabolism, or defective utilization. It is estimated that it can be seen in 5 to 10 percent of children in primary care settings. The most common division is into organic and nonorganic FTT, although in most cases it is of mixed etiologies. Most cases of failure to thrive involve inadequate caloric intake caused by behavioral or psychosocial issues, and it is estimated that up to 80% cases of FTT are nonorganic. The primary care physician is
usually the first to suspect FTT by following a child's growth charts. In most cases the patient is then sent to be examined by a gastroenterologist. Both diagnosing and managing this state can be challenging, therefore a multidisciplinary approach is usually needed. Routine laboratory testing rarely identifies a cause, but can show the consequences of possible malnutrition and severity of FTT instead. In general, patients are taken care of through outpatient care. Reasons to hospitalize for further evaluation include severe FTT and/or general poor condition, failure of outpatient management,
suspicion of abuse or neglect, or severe psychosocial impairment of the caregiver. In case of gastrointestinal pathologies causing FTT, signs and symptoms can have an onset from early infancy to puberty, depending on the specific disease. Of those causing FTT, most usually diagnosed are Celiac disease, inflammatory bowel disease (Crohn's disease and ulcerative colitis), and cystic fibrosis. In practice, the cause will not be found in the majority of cases, and then it is important to prescribe nutritional support and follow up the patient. The long-term effects of FTT on cognitive development are still unclear, but medical research in the last decade has found an association between FTT in the first few years of life with an increased risk of developing a variety of chronic diseases in adulthood, including coronary heart disease, diabetes, and hypertension.

• Keywords: tjelesno nenapredovanje; TN; djeca
• Keywords (english): failure to thrive; FTT; children
• Language: croatian
• URN:NBN: urn:nbn:hr:105:625723
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-24 09:03:22