10 inflammatory + metabolic disorders

define acute inflammation

short duration

define chronic inflammation

long duration

which 2 body systems are involved in the inflammatory response

nervous, vascular

describe the vascular changes that occur as the first defense mechanism of the body to any injury

blood flows to the injured area = edema. edema stimulates platelets to clot. phagocytes are released to contain any chemical irritants. outside of the body, physical signs occur; joint swelling, pus formation, ulceration, scarring

tissue swelling is an outward sign of the inflammatory response. describe it

occurs due to increased plasma accumulation. causes increased pressure = pain

joint swelling is an outward sign of the inflammatory response. describe it

direct result from the accumulation of fluid. decreases the function of the joint, contributes to pain in the area

pus formation is an outward sign of the inflammatory response. describe it

causes an increase in necrotic tissue. it’s a mixture of dead leukocytes, destroyed chemical agents, necrotic tissue, and other fluids. if not removed, a cavity is created and there is further tissue death

ulceration/scarring is an outward sign of the inflammatory response. describe it

result of tissue repair at the injured site. as the tissue tries to heal itself, there is an increase in fluid (exudate) which leads to increased scarring

what is osteomyeltitis

a secondary infection

where does osteomyelitis commonly occur in bones

metaphyseal area

where does osteomyelitis commonly occur in the body

lower extremities, spine of adults

which population does osteomyelitis mostly effect

children under 5, more common in males

what is brodie’s abscess

chronic bone abscess in the metaphyseal area of bone

osteomyelitis is a secondary infection. explain

caused by staphylococcal bacteria and may remain dormant after the initial infection bc antibodies are working to contain the bacteria. the bacteria wait for an opportunity to manifest, and if not treated completely they can manifest at a later date

osteomyelitis develops in phases. what is phase 1

formation of a sequestrum

what is a sequestrum

dead bone inside living bone

describe phase 1 of osteomyelitis: formation of a sequestrum

staphylococcal bacteria lodge in the metaphyseal area and form an abscess under the periosteum. this elevates it and obstructs blood supply = bone site can fragment = necrosis of the bone. the sequestrum is formed: the infected material is surrounded by avascular sclerotic bone, a thickened periosteum, and scarred muscle

what is phase 2 of osteomyelitis development

formation of involucrum

what is formation of involucrum (osteomyelitis development)

the body tries to put up a wall around the dead bone

describe phase 2 of osteomyelitis development: formation of involucrum

irritation to the elevated periosteum causes formation of new bone called the involucrum. however, this has many sinus tracts, so exudate from the sequestrum passes through

describe phase 3 of osteomyelitis development: new bone development

the sequestrum within the abscess dies and is reabsorbed. new irregular bone forms around the abscess. the abscess can advance to the outer body surface. open sores can occur

describe phase 4 of osteomyelitis development: migration of bacteria

bacteria migrate from the primary site via the bloodstream through the nutrient artery into the bone

radiographic appearance of osteomyelitis

internal bone is thickened with irregular patches of sclerosis. has a honeycomb effect. periosteum is elevated with new irregular bone formation

osteomyelitis treatment

good prognosis if detected early and treated with antibiotics

osteomyelitis complications

bone necrosis, septic arthritis

what is osteoarthritis

degenerative disease of cartilage

describe primary OA

degenerative condition involving the cartilage of WB bones; esp knees and hips

describe secondary OA

orthopedic deformities or malunion

OA etiology

its a normal aging process and occurs gradually

when in life does OA occur

over 40

T or F: OA affects men and women equally

true

OA pathogenesis

cumulative effects of activity wear down the cartilage, exposing the underlying bone

define eburnation

occurs in OA; exposed bone rubs together and becomes hard and glossy

what happens to the periosteum during OA

becomes inflamed and irritated

during OA, the periosteum becomes inflamed and irritated. what occurs after this

results in bone spurs or osteophytes

what are osteophytes

bone spurs/lipping of bony margins

T or F: we determine OA via blood tests

false

symptoms of OA

joint stiffness, pain from loss of cartilage, decreased mobility/function of the joint

what are heberden’s nodes

a result of osteophyte formation of the bones during OA, giving the hands a bumpy external appearance

define spondylosis

OA of the spine; refers to pain caused by degeneration of the spine of any kind, but is not a pathologic condition in itself

OA radiographic appearance

narrowed joint spaces, osteophytes

OA treatment

pain killers, lifestyle changes, joint replacement if there is no relief

what is rheumatoid arthritis

autoimmune system disease which affects joints and ST

who is commonly affected by RA

women (3:1), 30-58

initial sites of RA

bilateral hands and feet

where does RA spread to

other joints and organs

when does elderly onset RA occur

over 60

when does young onset RA occur

16-40

when does juvenile idiopathic onset RA occur

under 16

RA etiology

non-bacterial inflammatory disease

RA affects many joints at once. what do we call this

polyarthritic

T or F: RA is non-specific; can affect any joint

true

RA pathogenesis

inflammation causes a thickened synovial membrane. exudate results in pannus production, which is granulated connective tissue (like sandpaper). the pannus fills the joint space and erodes the cartilage. the bony ends erode and then fuse = ankylosis. adjacent musculature atrophies and is replaced with scar tissue

T or F: RA can be detected via a blood test

true

describe how we detect RA via a blood test

the body released the antibody “rheumatoid factor” or “R factor” which is detectable

RA symptoms

painful and swollen joints, general malaise or fever, fatigue, anemia, chronic pain, weight loss

describe the nature of RA symptoms

there are flare ups and then periods of remission

list the secondary symptoms seen in RA

inflammation of nerve endings, blood vessel walls, and resp tract. subcutaneous nodules of fibrous tissue are found in the walls of bursa, tendons, and periosteum

radiographic appearance of RA

no significant bony changes, but each time there’s a flare up the deformities worsen and there is rarefaction

define rarefaction

distinct appearance of the dense cortex of bone compared to the less dense appearance of the medullary cavity

what projection do we do to evaluate RA

ballcatchers

RA cure

no known cure, so we alleviate the symptoms

elderly onset RA treatment

joint reconstruction or replacement, prosthesis, joint fusion, osteotomy to realign the joints, tendon repairs

young onset RA treatment

disease modifying anti rheumatic drugs (DMARDs)

juvenile idiopathic arthritis treatment

meds to alleviate symptoms and reduce bone destruction

alternative name for gout

gouty arthritis

what is gout

inherited metabolic disorder that affects joints

who does gout commonly affect

males and patients on diuretics for CHF, males ages 30-50, post-menopausal women

describe the nature of gout symptoms

acute attacks followed by periods of remission

where on the body is gout common

hands, feet, MTP joint of first toe

T or F: gout is polyarthritic

true

T or F: gout is contracted/spread

false

T or F: gout is inherited

true

gout pathogenesis

excess uric acid production = crystalizes in the joints = inflammation. erosions with sclerotic borders can form, or a lytic lesion within the bone forms. calcification may or may not occur, causing overhanging edges of sclerosis

what are tophi

collections of sodium urate crystals seen in gout

T or F: gout leads to bone demineralization

false

gout symptoms

localized pain, erythema, swelling, heat

radiographic appearance of gout

only seen 6-8 years after an attack and in 50% of pts. tophi are only radiopaque if they’re calcified. erosions cause a mouse bitten appearance. overhanging edges become visible as cortex is remodeled, along with irregular spicules at the sites of tendon and ligament attachments

gout treatment

meds to reduce uric acid production or promote uric acid excretion by the kidneys

gout complications

joint damage if left untreated, possible long term complication = uric acid kidney stones

what is ankylosing spondylitis

progressive inflammatory condition where joints fuse

where in the body does ankylosing spondylitis occur

spine

who does ankylosing spondylitis affect

males, 16-30

onset of ankylosing spondylitis begins in which joint

SI

first signs of ankylosing spondylitis

frequent low back pain, stiffness

T or F: ankylosing spondylitis is polyarthritic

true

ankylosing spondylitis pathogenesis

inflammation causes SI joints to widen = new bone formation and eventual fusion of the SI joint. this progresses superiorly, invading the vertebral column. whole spine will fuse. bones become very brittle and easily prone to fractures. lung capacity decreases when costovertebral joints fuse

ankylosing spondylitis radiographic appearance

bony margins are blurred, SI joint narrowing, complete spinal fusion = bamboo like appearance, anterior vertebral bodies look square

ankylosing spondylitis cure

none

ankylosing spondylitis treatment

anti-inflammatory drugs, increase exercise to maintain mobility and elasticity of ligaments/muscles/connective tissue

what is osteopenia

loss of bone density. it’s a warning sign for osteoporosis

who does osteopenia affect

ppl over 50

what is osteoporosis

overall bony demineralization due to calcium reduction in bones

list the 3 forms of osteoporosis

generalized, regional, localized

describe generalized osteoporosis

bone density is decreased overall, common in post-menopausal women

describe regional osteoporosis

confined to a specific area of the body due to immobilization. seen 7-10 days of inactivity

describe local osteoporosis

affects only a small area of the bone due to local disease (inflammation, arthritis, neoplasm, infection)

osteoporosis etiology

endocrine system directs calcium to be absorbed out of bone and into the blood = bones become thin and weakened with decreased density. can be caused by other pathologies (malnutrition, renal failure), or from prolonged corticosteroid therapy

describe how hormones affect osteoporosis

menopause decreases the estrogen supply, and estrogen is needed for reducing osteoclast activity

describe how calcium intake can affect osteoporosis

decreased calcium intake due to dietary restriction or appetite will cause calcium to be leached from bones