ortho, rhabdo and SA lecture Flashcards
inflammation of a joint secondary to an infection is what
Septic arthritis
Causes of Septic Arthritis (Broad) and types
Bacterial
Fungal
Viral
Monoarticular or Polyarticular
Signs and symptoms
specific and non-specific
of septic arthritis
specific
-Joint pain
-Joint warmth or redness
-unilateral swelling
-Limp/refusal to ambulate
-Pain with movement of joint
non-specific
-fever
-lethargy
-irritability
-Decreased PO intake
-Favoring or a specific positioning
transient synovitis is most common in what joint
hip
transient synovitis is most common in what ages
3-10 yrs old
relationship between osteomyelitis and Septic arthritis
The infection from the joint can move into the long bone causing osteo or the osteomyelitis can move into the joint causing septic arthirits
Slipped capital femoral epiphysis (SCFE) is most common in who
obese adolescent males
avascular necrosis of femoral head
Legg-Calve-Perthes Disease (LCPD)
How does Legg-Calve-Perthes Disease (LCPD) usually present
sudden limp
Legg-Calve-Perthes Disease (LCPD) is most common in who
Males
generally Caucasians and Asians
How do you distinguish Legg-Calve-Perthes Disease (LCPD) from Septic Arthritis
X ray
risk factors for Septic arthritis
Neonate with co-infections
Joint trauma
skin lesions
Recent or concurrent illness
immunocompromised (esp HIV and sickle cell disease)
sexual activity - Neisseria Gonorrhea
Gender - males more frequently then females
Joint prosthesis
what is this
Legg-Calve-Perthes Disease (LCPD)
What is this
SCFE
Ice cream sign on x ray
SCFE
what is this
septic arthritis
lab findings for Septic arthritis
Elevated CBC, CRP, ESR
WBC > 50,000
CRP and ESR >20
imaging and cultures for Septic arthritis
non specific findings on X ray
Joint aspirate gram stain/cell count/culture
treatment for septic arthritis
joint aspiration
Emergent surgery for washout
IV antibiotics
physical therapy and mobilization
Biggest culprit for Septic Arthritis
Staph aureus
septic arthritis bugs neonates higher risk for
gonorrhea
GBS
septic arthritis bugs
toddlers higher risk for
kingella kingae
gram neg
septic arthritis bugs
adolescents
sexually active
gonorrhea
septic arthritis bugs
sickle cell disease
Salmonella
septic arthritis bugs
immune compromised or prolonged abx therapy what do you need to cover for
cover for fungal
injury to skeletal muscle that leads to cellular damage, apoptosis and necrosis
Rhabdomyolysis
“think about release of muscle content into circulation”
causes of Rhabdomyolysis
trauma
hypoperfusion (tourniquet)
exertion (seizures)
body temperature (malignant hyperthermia, electric shock, cardioversion, electrical defib)
drugs and toxins - Statins, heroin, cocaine, carbon monoxide
genetic
metabolic
conditions/electrolyte
abnormalities
infection -Herpes, HIV, legionella, strep
infection causes of Rhabdomyolysis
Herpes
HIV
Legionella
Strep
Myocytes comprised of
Potassium
Phosphorous
Creatinine kinase
myoglobin
myoglobin job is
to deliver oxygen to the cell
myoglobin is comprised of
globin and heme
when myoglobin is released what happens
when released from the muscle, it goes through glomerulus of kidney where it is filtered and then gets reabsorbed in the convoluted tubules where it gets broken down to heme and globin. A small portion of myoglobin is always excreted in urine but generally concentration is <10 micrograms/L. In rhabdo - initially your glomerulus and tubules can keep up but eventually they cant keep up and your myoglobin will shoot up. This will appear as coca cola or tea colored urine
classic sign of rhabdomyolysis
Muscle pain
Muscle weakness
Red/brown/Tea colored or coca cola colored urine
Ways Rhabdomyolysis causes AKI
1) Heme component of myoglobin builds up in that tubular epithelial cell and causes obstruction of tubular outflow.
2) myoglobin in large concentrations is cytotoxic to renal cells (direct injury)
3) Myoglobin causes vasoconstriction in the kidneys leading to hypoperfusion
electrolyte abnormalities in Rhabdomyolysis
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Hyperkalemia causes what
affects heart
-arrythmias
-ascending muscle weakness
Hyperphosphatemia leads to hypocalcemia why
bc phos binds to calcium so it decreases available calcium
Hypocalcemia
anxiety
muscle contractions
