Pathology of the skeletal system

Question 1

Metabolic

Answer 1

The metabolic syndrome, also known as syndrome X, is a set of five conditions, which together increase a patient’s risk of developing cardiovascular disease 1.

There are five central components of metabolic syndrome:
hyperinsulinaemia
impaired glucose tolerance
dyslipidaemia
hypertension
centripetal obesity
It has been recognised for more than thirty years that the key metabolic phenomenon underlying the five elements of the metabolic syndrome is the development of insulin resistance 1.

The metabolic syndrome is a constellation of interrelated abnormalities (namely obesity, dyslipidaemia, hyperglycaemia, and hypertension) that increase the risk for cardiovascular disease and type 2 diabetes.

Question 2

congenital

Answer 2

Congenital: Anomalies or abnormalities present at birth and arise from genetic factors, prenatal influences, or developmental issues during pregnancy.
* These conditions can affect various body systems, including the skeletal, cardiovascular, neurological, gastrointestinal, and renal systems. They often require careful evaluation and management from healthcare professionals.
Additive or Destructive?
* Additive: Some congenital conditions may result in the addition of abnormal structures or tissues. For example, in polydactyly (extra fingers or toes), there’s an addition of digits.

• Destructive: Other congenital conditions may involve the destruction or absence of normal structures. For instance, in spina bifida, there’s a failure of the spinal column to close properly, resulting in spinal cord damage.

Radiological Signs and Images
Skeletal Abnormalities:
* Radiological Signs: Irregular bone formation, abnormal joint alignment, or missing/duplicate skeletal elements.

• Images: X-rays show bony structures, revealing malformations such as abnormal curvature (scoliosis), fusion (syndactyly), or absence (agenesis) of bones.

Cardiac Anomalies:
* Radiological Signs: Enlarged heart chambers, abnormal cardiac silhouette, or vascular abnormalities.

• Images: Chest X-rays may reveal cardiomegaly (enlarged heart), pulmonary congestion, or specific cardiac defects like atrial septal defects (ASD) or ventricular septal defects (VSD).

Question 3

Hormonal

Answer 3

Hormonal pathology are disorders which originate from different areas in the body.
-hormonal pathologies caused by over or under production of hormones, or if they body doesn’t respond properly.
-hormones are produced in response to stimuli.
-eg- diabetes, thyroid issues, growth dysfunctions
-CT and MRI.
-skeletal disorders as a result of a decrease in calcium, such as osteoporosis. will be shown on bone density scans.
-mri-show pathologies
-ct-pituitary disorders

Question 4

degenerative

Answer 4

Additive - When there is an increase in the thickness of the bone causing higher attenuation
Destructive - A reduction in the bone or tissue leading to a lower attenuation

There are many examples of destructive diseases with Osteoarthritis (OA) being one of the most common examples of this.
OA is a degenerative and destructive disease as it is the result of cartilage wearing away over some time, leading to bone-on-bone contact. The reduction in cartilage thickness can be due to:
Direct injury - Trauma can harm the cartilage as the impact on the ground or other objects can reduce the thickness. Repetitive trauma will deteriorate the cartilage at a faster rate.
Overuse injuries - overusing a specific joint means there is more friction so the joint space is reduced. This mechanism can have a more harmful effect if a bad technique is used
obesity - Excessive weight puts more stress on the knee joint which increases the rate of degeneration.
Genetics - Some people have Rheumatoid arthritis which is an autoimmune disease that targets the cartilage causing the destruction of the cartilage.

However, OA is partly additive as it forms osteophytes. Osteophytes are formed as a protective measure by forming calcium deposits on new bone growth that increase the surface area to distribute the force applied to the bone. Osteophytes cause pain and reduce movement in the joint.

The radiological signs for OA include:
Osteophytes - Small projections of dense bones
Subchondral sclerosis - thickening of the bone lining that articulates on the bone
Reduces joint space - Reduction of joint space is due to the thinning of bone.

Answer 5

Define -The term idiopathic is often used to describe a disease with no identifiable cause.

Describe- It may be a diagnosis of exclusion; however, what specific minimum investigations need to be performed to define idiopathic is not always clear. This commentary describes the problems inherent in reaching a definition for the term idiopathic.

he main symptoms of idiopathic pulmonary fibrosis, including progressive SOB and dry cough, are often nonspecific. Chest high-resolution computed tomography is the primary modality used in the initial assessment of patients with suspected idiopathic pulmonary fibrosis.

Additive example: Diffuse idiopathic skeletal hyperostosis (DISH) is a type of arthritis that affects tendons and ligaments, mainly around your spine. These bands of tissue become hardened (calcified) and form growths called bone spurs where they connect to your bones.

Destructive example: Idiopathic osteolysis is characterised by a spontaneous onset without previous causative factors, followed by rapid destruction and resorption of the involved bones. This process results in severe deformities with joint subluxation and instability.