Metabolic and Rheatic Disorders Flashcards
What shows up on the x-ray with osteopenia?
evidence of decreased bone mineral density
List the 4 causes of osteopenia
Osteoporosis
Osteomalacia
Malignancies (multiple myeloma)
Endocrine disorders
Describe what Osteoporosis is
it is a condition where the bone density and bone strength is decreased
- matrix is weakened
- mineralization is decreased
What is the cause of osteoporosis?
UKE, but occurs when bone resorption exceeds bone formation
What are the 7 things that osteoporosis is associated with (RF/causes)
GENDER:
postemenopausal osteoporosis
male hormone decline
GENETICS
ACTIVITY LEVEL
NUTRITION
BODY SIZE
RACE
AGE RELATED CHANGES
What are 2 examples of age related changes that contribute to osteoporosis?
dec osteoblast replication
dec activity levels
What are 4 types of endocrine disorders which can cause secondary osteoporosis
Hyper/hypothyroidism
Hyperparathyroidism
Cushing Syndrome
Diabetes Mellitus
what type of conditions regarding the GI can cause secondary osteoporosis?
malabsorption issues
Can alcoholism cause secondary osteoporosis?
yes
List the four medications that can cause secondary osteoporosis
Corticosteroids
Antacids with aluminum
Anticonvulsants
Antiretroviral therapy
Can prematurity cause secondary osteoporosis?
yes
Can cystic fibrosis cause secondary osteoporosis?
yes
Explain what the female athlete triad is.
It is a combination of eating disorders with excess exercise that results in weight fluctuations
Describe the three hormonal changes that result from Female Athlete Triad. What does this cause
dec……
Gonadotropin
LH and FSH
Estrogen
amenorrhea and osteoporosis/osteopenia
What is the most common complication of osteoporosis and what is the cause of this.
FRACTURES:
d/t loss of trabeculae from cancellous bone and thinning of cortex
Describe what occurs with postmenopausal osteoporosis and what this results in.
Increased osteoclast activity resulting in loss of trabeculae
Microfractures occur and bone compresses
What part of the bone is most affected by senile/age-related osteoporosis?
haversian system widens d/t loss of trabeculae
Is osteoporosis an obvious disorder?
no because the symptoms are subtle
List the 2 manifestations of osteoporosis. Is their pain associated with osteoporosis?
Sudden onset fracture
Wedging/collapse of vertebrae
(loss of height, kyphosis/dowager hump)
Pain is not present unless there is a fracture
Describe what osteomalacia is and what age group it occurs in
it is the softening of the bones d/t loss of mineralization
It is an adult condition
List the five manifestations of osteomalacia
1) Bone pain / tenderness
2) muscle wkness
3) fractures
4) delayed healing of fractures resulting in deformities
5) hyperparathyroidism
List 3 causes of osteomalacia
1) insufficient Ca2+ absorption from intestines
- poor intake or vit D def
2) Phosphate deficiency
- renal losses or poor absorption
3) Anticonvulsant use (long term)
Explain what Renal Rickets is.
Type of adult osteomalacia that occurs with CHRONIC RENAL FAILURE
Kidneys….
can’t activate vit D
excrete phosphate
Explain what Vitamin D resistant rickets is.
a type of osteomalacia caused by a GENETIC TUBULAR DEFECT
Describe what rickets is. What age group does it occur in?
It is Ca2+ deficiency that occurs in children
Results in….
Failure/delayed calcification of cartilaginous growth plate -> overgrowth and bowed legs
Metaphyseal regions of long bones widen/deform as they are unmineralized
List the 5 causes of rickets
1) Nutritional deficits
2) Kidney failure
3) Malabsorption syndromes / GI loss
4) meds (anticonvulsants, Al antacids)
5) genetic
List the 3 RF for rickets
1) Breast fed only (need a vit D supplement)
2) Dark-skinned
3) Limited sunlight
list the 8 manifestations of Rickets
1) Enlarged skull
2) Delayed fontanel closure
3) Enlarged joints
4) Slow tooth growth
5) abnormal shaped thorax
6) bowed legs
7) difficult ambulation
8) stunted growth
Describe what rheumatoid arthritis is.
It is an autoimmune systemic disease that is polyarticular
What does polyarticular mean?
that involves more than one joint surface
What is Paget disease?
abnormal bone modelling as a result of:
focal areas of excessive osteoclast mediated bone resorption followed by disorganized osteoblast repair
Describe the possible causes of paget disease
unclear, may be genetic, environmental or viral
List the 3 RF for Paget Disease
1) mid adulthood (progression)
2) men slightly more than women (pretty =)
3) Northern European heritage
What are the four manifestations of Paget Disease?
1) Lesions (isolated or widespread)
2) Long bone bowing and fractures
3) Large joint osteoarthritis
4) Cement lines
What is a cement line?
an area of new bone growth over the old
what are the common locations of Paget Disease?
skull spine pelvis femur tibia
Describe what osteoarthritis is.
It is an autoimmune systemic disease that is polyarticular
What does polyarticular mean?
that it affects multiple joint surfaces
List 3 RF / causes of Rheumatoid Arthritis
Genetic predisposition
Woman > men
Peak incidence 40-50
Describe the pathophysiology of Rheumatoid Arthritis
It is a T-cell mediated response to trigger
- inflammatory mediators released
- antibodies form against autoantigens
results in synovial inflammation and joint destruction
- fluid accumulates
- Neovascularization in synovial membrane (Pannus forms)
What is the antibody that can be used to diagnose Rheumatoid Arthritis and in what percent of patients is it present in.
Rheumatoid Factor (RF)
70-80 percent
What is a pannus?
it is vascular granulation tissue specific to RA that results in inflammatory erosion of cartilage/bone
Describe the characteristics of which joints are affected by RA
Symmetrical
Polyarticular
Diarthrodial/synovial types
List the manifestations of RA
Joint pain
Swelling
Limited joint movement
Wrist and finger common: pain when turning doorknob, opening jars, buttoning shirts
FEET: pain on ball off foot when rising in the morning or widening of forefoot d/t inflamm
ANKLES, KNEES, ELBOWS, SHOULDERS, SPINE:
subluxation
joint instability
What does the thickening of synovium that stretches joint capsule and ligaments cause?
Deformities
Muscle imbalances
Swan neck deformities of hand
Describe the five extra articular manifestations of RA?
Fatigue Wkness Anorexia Wt loss Inc ESR and C-reactive protein Rheumatoid nodules
What is a rheumatoid nodule?
it is a granulomatous lesion with central necrotic core
may be….
tender
moveable
small or large
Describe the diagnosis criteria for RA
four or more of….
1) morning stiffness of >1 hr x six wks
2) 3 or more joint swelling x six wks
3) swelling of rist or finger joints x six wks
4) symmetric joint swelling x six wks
5) rheumatoid nodules
6) serum RF
7) radiographic evidence
Describe what Systemic Lupus Erythematosis (SLE) is
it is a chronic inflammatory disease affecting entire body
a type III hypersensitivity response
Describe the causes of SLE
unknown
young women
African, Hispanic, Asian dscent
familial
genetic
What is SLE often referred to as?
the great imitator b/c it affects the whole body with many subtle symptoms that imitate/mimic other disorders
List the six common complaints of SLE
1) arthralgia
2) myalgia
3) fever
4) malaise
5) fatigue
6) temp loss of cognitive abilities
List 4 triggers for SLE (systemic lupus erythematosis)
UV light
Chemicals
Food
Infectious agents
Describe the characteristics of SLE manifestations
Acute or insidious
exacerbations and remissions
What are the 6 groups of manifestations for SLE?
Skeletal
Renal
Pulmonary
Cardiac
Intergument
CNS
Describe the skeletal manifestations of systemic lupus erythematosis
Arthralgia/arthritis (common early sign) Avascular necrosis (femoral head) Contractures Tendon rupture Subluxation
Is there articular destruction in systemic lupus erythematosis?
no, it is not like other arthritis’
Describe the integument manifestations of systemic lupus erythematosis
butterfly rash on nose/cheeks fingertip lesions hair loss mucous membrane lesions sunlight sensitivity
What are the 2 renal manifestations of systemic lupus erythematosis (SLE)?
glomerulonephritis
interstitial nephritis
What are the 2 pulmonary manifestations of systemic lupus erythematosis (SLE)?
pleural effusion
pleuritis
What are the 4 cardiac manifestations of systemic lupus erythematosis (SLE)?
pericarditis
heart block
HTN
Ischemic heart disease (when chronic)
What are the 5 CNS manifestations of systemic lupus erythematosis?
Photosensitivity
Hemorrhage (stroke)
Thrombus
Seizures (esp with renal disease)
psychotic symptoms (depression, euphoria, confusion)
Describe what systemic sclerosis/scleroderma is
Autoimmune disease of the CT resulting in widespread fibrosis
results thickened skin and organ involvement.
Cause is poorly understood.
Women > Men, but men have more serious progression
What are the two types of manifestations for systemic sclerosis / scleroderma? which is the most common?
Limited (most common)
Diffuse
What areas of the body are commonly affected in limited scleroderma?
fingers, forearms, face
List the 6 manifestations of limited scleroderma
CREST ACRONYM
CALCIUM DEPOSITS of skin/soft tissue resulting in spotty discoloration
REYNAUD PHENOMENON
ESOPHAGEAL DISMOTILITY
SCLERODACTILY (disformity of fingers)
TELANGIESTASIAS (spider like veins)
and pulm HTN
Describe the characteristics of diffuse scleroderma.
Widespread, rapidly progressive fibrosis of skin with early movement to organs (kidneys, esophagus, heart, lungs)
List the manifestations of diffuse scleroderma
Stone face Hair loss Telangiestasis on face, chest, hands Reynaud phenomenon Arthralgia, myalgia malabsorption pulm fibrosis malignant HTN Pericarditis, heart blocks, myocardial fibrosis
What is ankylosing spondylitis?
chronic systemic inflammatory disease of the joints
late adolescence/early adult
Men > women
genetic
immune response destroys joints and FUSES adjacent bones
Where does ankylosing spondylitis begin?
sacroiliac joint then moves up spine
