Pathophysiology (M11)

Musculoskeletal & Reproductive Disorders

Complete Fracture (types)

= bone fully broken 

comminuted: 2/more fragments

based on break direction 

• spiral (encircles bone) 

• transverse (straight across) 

• oblique (@ angle) 

• linear (along bone length) 

Incomplete Fractures (types)

= bone damaged but in 1 piece (children)

• greenstick: 1 side broken

• torus: outer portion of bone buckles, doesnt break

• bowing: in bone pairs (ex. tibia/fibula), one bone breaks, other bends (diff to treat)

Open v. Closed Fracture? Causes: Sudden Injury? Pathologic? Stress? 

• O: compound, broken skin

• C: simple, skin intact 

causes: 

• SI: from fall/massive muscle contraction 

• P: from prior disease weakening bone (ex. infection), spontaneous (little/no stress) 

• S: due to repeated stress (microfractures occur) 

Fracture Healing 

• like soft tissue (longer) 

• forms callus (new CT, form bridge/heal broken bone) w bone remodeling 

• no scar tissue

Fracture Healing Process

fracture disrupts periosteum/vessels, bleeding → clot forms

NIPBR

• N: Necrosis

• I: Inflam

• P: Procallus (fibro/chondro)

• B: Bony callus

• R: Remodelled

Dislocation v. Subluxation 

D: 

• displacement of 1/more bones in joint

• opposing surfaces lose all contact 

• often shoulder joint 

S: 

• displacement of 1/more bones in joint

• opposing surfaces lose some contact (partial dislocation) 

Posture: Scoliosis? Kyphosis? Lordosis 

• S: lateral deviation of spinal column 

• K: ↑ curvature of upper spine, cause: ex. loss of bone density in vert (ostero)

• L: ↑ curvature of lower spine, cause: misalined vert (obesity/preg)

Strain v. Sprain v. Avulsion

ST:

• tear/stretch of tendon

• lower back, neck 

SP: 

• tearing of ligament 

• ankle 

A:

• complete sepertation of tendon/ligament from bone

Osteroporosis 

• ↓ mineralized bone mass/density → fragile

• old bone reabsorbed faster than new bone deposited 

• thinner/porous bones

Osteroporosis & Age/Post Menopausal

A: peak bone mass = 30

• less osteoblasts + less active 

• unknown till fracture occurs/too late

M: 

• ↓ bone mass after meno (estrogen deficiency → ↑ osteoclasts) 

• also in young W

Osteroposis Men v. Women

• more common in W

• ↓ in bone protecting hormones in men more gradual (slower loss) 

• M begin w denser bones 

Secondary Osteroporosis

w other conditions: 

• long term corticosteroid use

• endo disorders → excess cort (ex. hyperparathyroidism/cushings) 

• alcholism 

Manifestations of Osteroporosis

• kyphosis

• fractures (thin/sparse spongy bone) → often long bones 

Osteomyelitis 

= infections bone disease 

• exogenous (common) → pathogen enters joints

• hematogenous → carried in blood

• prim causative organism: staphylococcus aureus 

Events of Hematogenous Osteomyelitis in Children 

1. metaphyseal region in long bone 

2. purulent exudate → cuts off blood supply, bone cortex dies (sequestrum= dead bone)

3. osteoblasts stimulated→ lay down bone layer ontop seques (involcrum= new bone)

adults: axial skeleton 

manifestation: chills, fever, loss of movement in area 

Osteoarthritis

• age related, synovial joint disorder

• degenerative

• morning stiffness (<30)

• loss of articular cartilage

• asymmetrical

• heberden nodes (bony bumps on fingers)

• usually: hands, hips, spine

Osteoarthritis: Loss of Cartilage

1. early, articular cartilage changes structure 

2. fluid filled cysts devlop 

3. cartilage coated projects of bone @ edge of joint (osteopytes→ bony growths on bone edge), may grow out 

4. small pieces may break off (joint mice→ small frags of B/Cart) → enter synovial cavity 

5. irritated synovial mem = synovitis, joint effusion 

6. joint capsule thickens + sticks to underlying bone (restricts move)

Osteoarthritis Manifestations

• pain in 1/more joint (heavy use/load bearing)

• stiff joints (1st mins of use) 

• joint enlargement 

• limited range of motion (creaking sound)

Inflammatory Joint Disease

= inflam in synovial mem/articular cartillage w sys signs of inflam

• infectious: intro of pathogens through wound/blood

• noninfectious: common, immune reactions/deposition of monosodium urate crystals 

Rheumatoid Arthritis

• autoimmune

• inital synovial mem inflam

• symmetrical

• morning stiffness >30

• common: fingers, wrists, elbows

• production of AA (rheumatoid factors) → react to host ab in synovial mem 

Rheumatoid Arthritis @ Cellular Level:

1. Ag in synovial tissue triggers immune response (complement proteins activated → immune response)

2. immune cells stimulate edema/granulation tissue production

3. gran tissue = pannus (growth of fibrovascular tissue → lympho, macro, fibro, mast cells)

4. can grow over/erode articular cartilage/bone

Clinical Manifestations of Rheumatoid Arthritis

• gen sys manifestations of inflam: fever, fatigue, weak

• joints = painful, tender, stiff

• stiffness for about 1 hour after rising

• loss of range of motion → deformities

1. autoimmune condition

2. stiffness of joints, relieved shortly after waking

3. herberden nodes

4. intial inflam of synovial mem

1. RA

2. OA

3. OA

4. RA

Ankylosing Spondylitis 

• chronic inflam joint disease of sacroiliac joint/vert column 

• excessive bone formation @ joint → fusion of joint 

Ankylosing Spondylitis: Progression

• fibrocartilage discs inflam

• fibroblasts repair → ossified 

• fusion of joints 

Equinovarus 

• clubfoot 

• feet turn inward/downward 

• can be fixed w manipulation soon after birth (may need surgery)

Devlopmental Hip Dysplasia

• imperfect devlopment of hip joint (loose → dislocation) 

• correct w pavlik harness (doesnt work → surgery)

Dysfunctional Menstrural Cycles: Dysfunctional Uterine Bleeding (DUB)

DMC: changes in estrogen/progesterone

= heavy/irreg bleeding, absence of disease, anovulatory cycles

• common prior: menopause, after menarche (1st)

• no ovulation (no proges, unopposed est, endo keeps growing/becomes unstable) → thick endometrium

• estro ↓, degeneration of follicles → heavy bleeding

Disorders of Female Reproductive: Dysmenorrhea

= painful menstruation, 2 types

1. primary: monthly pg release from endometrium

2. secondary: pelvic pathological condition (ex. endometriosis), any time

Disorders of Female Reproductive: Amenorrhea

= lack of menstration, 2 types:

1. primary: no menarche, hypothalamic pit ovarian axis disorder (hormone imbalance)

2. secondary: menses stops for atleast 6 mon after norm cycle established → ovarian/pit/hypothalamic dysfunc, stress, weight loss

Benign Growths: Endometriosis

= functioning endometrial tissue outside uterus (ectopic)

• may follow same growth/breakdown/bleeding of monthly cycle

• lead to → fibrosis, scarring, adhesions

Cervical Cancer

• from: HPV

• risks: early intercourse, diff sexual partners, smoke

• good prognosis: slow/progressive disease (most detected w pap)

Endometrial Cancer

• in lining of the uterus

• risk: unopposed estrogen exposure → hyperplasia

• post menopausal (may get progest therapy to combat est)

Ovarian Cancer

• most deadly cancer of repro

• early menarche/late meno

• risks: ↑ age, family history, ↑ ovulation (more egg release, ↑ risk of rupture/inflam/repair → ↑ dna mutation)

• diff to detect early

Disorders of the Breast: Galactorrhea? Mastitis? Ductal Disorders?

• G: secretion of milk in non lactating breast, hormonal imbalance (benign pit tumour), M/F

• M: inflam of breast during lactation

• DD: growth within duct, ex. intraductal papillomas → benign ep tissue tumour, manifest: bloody nipple discharge

Disorders of the Breast: Fibroadenoma? Fibrocystic Changes?

F: premeno, firm/rubbery/easily moveable, asymp, not pre cancerous

FC: most frequent breast lesion, granular breast masses, prominent/painful during luteal

• (cysts to proliferative lesions w atypical cells)

Breast Cancer: Risks

most common cancer for W

increase:

• hormone changes (early menarche/late meno)

• family history/age

• ↑ breast density (lots of fibroglandular tissue)

decrease:

• birth/breastfeeding

• lobular involution (breast tissue → replaced w fatty tissue)

Breast Cancer

• arise from ep of ducts (ductule carcinoma)

• 1st sign: painless lump where most of glandular breast tissue is

Male Reproductive Disorders: Cryptorchidism? Hydrocele? Varicocele?

• C: testis fail to descend completely (stay in abdomine)

• H: excess fluid b/w tissue layers surrounding testes

• V: varicose veins supply testes, L side

Male Reproductive Disorders: Torsion of the Testis?

• testis rotate on their axis, interupts blood supply

• causes ischemia (pain/swelling)

• younger, sponatenous/w trauma

BPH

= benign prostatic hyperplasia

• age related, non malig (half of men older than 60)

• problem: enlargement interfers w urine exiting through urethra

• from: interaction b/w sex hormones, chronic inflam, gfs

BPH Symptoms & Effects

• urge to urinate, delayed start, ↓ flow force

• further obstruction → bladder cant empty all urine = loss of bladder control w ↑ intraabdom pressure

• pressure on kidneys/ureters →hydroureter, hydronephrois, eventual kid fail

Prostate Cancer

• PSA (prostate spec Ag): secreted by prostate cells (helps detect)

• diet has influence (↑ fat intake = ↑, tomato products = ↓)

Prostate Cancer: Symptoms/Effects

• tumor: periphery of prostate (asymp till late)

• early symp: bladder outlet/rectal obstruction

• late symp: bone pain, englarged lymph nodes/liver, confusion