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Pathophysiology II EXAM II > Module 2: articular structure and pathology > Flashcards

Module 2: articular structure and pathology Flashcards

1
Q

What as the synovial joint comprised of?

A

Joint capsule
Joint space
Synovial fluid
articular cartilage

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2
Q

What are the 2 parts of the joint capsule?

A
  1. Fibrous joint capsule

2. Synovial membrane (inner layer)

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3
Q

What is the outer layer of the joint capsule called?

A

Fibrous capsule (stratum fibrosum)

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4
Q

Fibrous capsule is ____ in blood supply and ____ in joint receptors.

A

Poor in blood supply but rich in joint receptors

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5
Q

What is the inner layer of the joint capsule called?

A

synovium

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6
Q

What 2 types of cells exist in the synovium?

A

Type B and Type A

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7
Q

What is the function of the Type B cells of the synovium?

A

Synovial fluid production

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8
Q

What is the function of the Type A cells of the synovium?

A

Immune function

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9
Q

What do Type B cells in the synovium secrete?

A

HA (hyaluronate/hyaluronic acid): Gel to improve viscosity of fluid-attracts H2O

Lubricin: Reduce friction of the joint

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10
Q

What do Type A Cells in the synovium secrete?

A

Immunoglobulins
lysosomal enzymes
lyse debris

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11
Q

What does the term Thixotropic properties refer to?

A

viscosity varies inversely with velocity of movement

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12
Q

at rest the synovial fluid _____ movement of the joint?

A

resists

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13
Q

At movement synovial fluid _______ ____ ____ to movement

A

provides less resistance

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14
Q

What is the function of the hyaline cartilage that covers the ends of most bones?

A

reduce friction
absorb/disperse
compressive forces

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15
Q

What is the cellular component of the articular cartilage?

A

Chondroblasts (chondrocytes)

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16
Q

What is the function of the chondrocytes?

A

produce and maintain extra-cellular matrix
Secrete enzymes that assist in matrix
Forms 2% of cartilage

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17
Q

What are the components of the extra-cellular matrix of the articular cartilage?

A

non-fibrous

Fibrous

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18
Q

What is the non-fibrous component of the articular cartilage extra cellular matrix, made up of?

A

Primarily water (60-80%)
Protein, proteoglycans (5-10%)
regulates fluid flow in/out of cartilage

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19
Q

What is the fibrous component of the articular cartilage extra cellular matrix made up of?

A 
Collagen fiber (10-30%) TYPE 2 COLLAGEN
arranged to abosorb mechanical stress
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20
Q

The fibrous component of the matrix is made up of collagen that is arranged to absorb mechanical stress. Describe Zone 1 of the cartilage bone interface:

A

Smooth surface

Reduce friction of joint surface

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21
Q

The fibrous component of the matrix is made up of collagen that is arranged to absorb mechanical stress. Describe Zone 2&3 of the cartilage bone interface:

A

transitional zones, absorb compressive forces

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22
Q

The fibrous component of the matrix is made up of collagen that is arranged to absorb mechanical stress. Describe Tidemark of the cartilage bone interface:

A

Interface between uncalcified and calcified layers

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23
Q

The fibrous component of the matrix is made up of collagen that is arranged to absorb mechanical stress. Describe Zone 4 of the cartilage bone interface:

A

Calcified cartilage, anchors cartilage to bone

24
Q

What mediators all play a role in maintaining matrix turnover?

A

Enzymes
Hormones
Mechanical stimuli

25
Q

Where are enzymes secreted from and what role do they play in matrix turnover?

A

Chondrocytes

assist in breakdown and rebuilding matrix

26
Q

What hormones stimulate chondrocytes in the matrix?

A

GH and IGF

27
Q

What occurs to fluid in the synovial space during weight bearing?

A

Fluid is pushed out of cartilage

when flow becomes slower cartilage is compressed as the resistance becomes exponentially harder.

28
Q

What is responsible for the regulation of fluid flow in/out of cartilage?

A

Proteoglycans

29
Q

What occurs to fluid in the synovial space when non-wt bearing?

A

Fluid is allowed to re-enter back into cartilage

30
Q

What is the purpose of the synovial fluid cycle of wt bearing vs. non wt bearing?

A

allows fluid to enter and exit the space and carry nutrients

31
Q

Does articular cartilage have nerve supply?

A

no

32
Q

Does articular cartilage have blood supply?

A

no

33
Q

Where does the pain in an articular cartilage injury come from?

A

inflammation/swelling/irritation of surrounding tissue.

34
Q

How well does articular cartilage regenerate?

A

very poorly.

Not a lot of blood supply

35
Q

Osteoarthritis is considered what type of disease? Inflammatory/non-inflammatory?

A

non-inflammatory but does have an inflammatory component to it.

36
Q

what is the MC joint disease?

A

Osteoarthritis

37
Q

What is the primary defect of OA?

A

loss/disruption of articular cartilage

disruption of matrix

38
Q

What gross articular cartilage changes can be seen in OA?

A

Smooth glossy surface becomes dull yellow/brown gray color with surface flaking fissures and fibrillations

39
Q

What do the cellular changes that occur during OA lead to?

A

Enzymatic changes
Hormones insensitivity
Cytokines excess
Nitric Oxide apoptosis

40
Q

what enzymatic changes occur during OA?

A

Excess enzyme secreted from chondrocytes leading to matrix breakdown

41
Q

What is responsible for the movement of synovial fluid?

A

proteoglycans

42
Q

What is broken down by lytic enzymes in OA resulting in loss of fluid regulation?

A

Proteoglycans, collagen and glycoaminoglycans

43
Q

What is normally found but is found in excess in the synovial fluid during OA?

A

PTGs

44
Q

What hormonal changes occur during OA?

A

decreased chondrocyte sensitivity to IGF and GH

45
Q

what agent is not normally found in the synovial fluid but is found in the synovium of pt’s with OA?

A

Nitric oxide

46
Q

What does NO in the synovium facilitate?

A

Chondrocyte death (apoptosis)

47
Q

What is the primary disruption of the articular cartilage matrix in OA?

A

fluid flows in/out easier due to disruption

48
Q

What occurs to fluid during rest in OA?

A

Increased volume of water in the cartilage

49
Q

During wt bearing activity with OA what occurs to the fluid?

A

fluid is pushed out too rapidly, cartilage is compressed without much resistance

50
Q

What is the net result of OA on the articular cartilage?

A

Limits the ability to absorb forces and provide adequate nutrients to chondrocytes

51
Q

What effect might OA have on surrounding structures of the articular cartilage?

A

Subchondral bone sclerosis and cuts
Osteophyte formation
Synovial thickening

52
Q

What are the primary risk factors for OA

A

trauma

genetics

53
Q

What is the typical pain that a pt with OA will complain of?

A

Morning pain/following prolonged postural positions
relief with easy activity increased with extreme
Referred pain in spine for entrapment

54
Q

Tx of OA: conservative care:

A

appropriate exercise
joint mobility
lifestyle changes

55
Q

Tx of OA: Pharmaceutical

A

targeted symptomatic relief (OTC-narcotics)

56
Q

Tx of OA: Surgical:

A

Viscosupplementation (Hyaluronic injection-joint fluid therapy)
Only approved for the the knee

57
Q

TX of OA: Cartilage “repair” strategies

A

Arthroscopic lavage
Marrow stimulating technique (microfractures)
Osteochondral autographs and allographs (OATS)
Cell-based repair

Pathophysiology II EXAM II (1 decks)

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