Week 12 - Osteomyelitis/osteoporosis Flashcards
What is osteomyelitis?
Osteomyelitis is an infection in the bone.
How can infection reach the bone?
Infection can reach the bone through indirect blood (hematogenous) or direct trauma/surgery (exogenous).
What are some predisposing factors for osteomyelitis? (3)
include vascular insufficiency, IV drug use, and immunodeficiency /immunosuppression.
What is the most common pathogen that causes osteomyelitis?
Staphylococcus aureus (Staph aureus)
How does the organism reach the bone in hematogenous osteomyelitis?
The organism reaches the bone through the bloodstream and attaches to the tissue.
What does bacterial growth in the bone lead to?
Bacterial growth causes bone destruction, abscess formation, and purulent exudate.
Is swelling significant in hematogenous osteomyelitis?
No, there is minimal swelling
What happens when exudate builds up beneath the periosteum?
It shears blood vessels, leading to necrosis (tissue death).
What are sequestra in osteomyelitis?
Sequestra are fragments of bone that have lost their blood supply (devascularized).
How do infectious organisms reach the bone in hematogenous osteomyelitis?
They reach the metaphysis through a nutrient blood vessel.
What does bacterial growth in the bone cause?
It causes bone destruction, abscess formation, and the spread of infection into the medullary cavity and compact bone.
How does the infection spread to the outside of the bone?
The infection spreads through the cortex to the outside of the bone.
What happens when purulent exudate collects beneath the periosteum?
It leads to necrosis of the cortical bone and the formation of devascularized bone fragments, called sequestra.
What are the signs and symptoms of bacteremia associated with bone lesions?
Pain, fever, loss of movement, tenderness, erythema (redness over the affected bone), and swelling.
What symptom indicates redness over the affected bone in osteomyelitis?
Erythema
What are common inflammatory symptoms in osteomyelitis?
Tenderness, swelling, and fever.
What imaging techniques can be used to diagnose osteomyelitis?
X-rays, bone scans, and MRIs can be used.
What might X-rays show in osteomyelitis?
They may show periosteal elevation.
What lab tests are used to diagnose osteomyelitis?
Blood cultures and bone aspiration culture are used.
What antimicrobial therapy is used in osteomyelitis treatment?
Antimicrobials are used to treat the infection.
How is pain managed in osteomyelitis?
Analgesia is used for pain management.
What surgical treatments are used for osteomyelitis?
Debridement and surgical drainage are common treatments
How does chronic osteomyelitis typically occur?
It generally occurs secondary to an open wound.
What can cause chronic osteomyelitis to develop?
Delayed or inadequate treatment of hematogenous osteomyelitis can lead to chronic osteomyelitis.
What is the hallmark feature of chronic osteomyelitis?
The presence of a sequestrum, which is dead bone separated from living bone.
What structure forms around the dead bone in chronic osteomyelitis?
An involucrum forms around the dead bone.
What imaging techniques are used to diagnose chronic osteomyelitis?
X-rays and bone scans are used.
What diagnostic tool is used to assess sinus tracts in chronic osteomyelitis?
Sinograms are used.
What lab test is performed for chronic osteomyelitis?
Wound culture and sensitivity testing are performed.
What medications are used to treat chronic osteomyelitis?
Antimicrobials and long-term antibiotics (ABX) are used.
What surgical treatment is performed in chronic osteomyelitis?
Surgery is done to remove sequestra.
What physical measure is used in the treatment of chronic osteomyelitis?
Immobilization is used.
How is bacteria introduced to the bone in direct osteomyelitis?
Bacteria are introduced directly into the bone through a penetrating wound or fracture (#).
What does local inflammation and trauma do to the bone in direct osteomyelitis?
It may devitalize the bone.
What does devitalized bone create in direct osteomyelitis?
It creates an inert matrix for organisms to proliferate.
What is a common systemic symptom of osteomyelitis?
Recurrent fever.
What happens at the trauma or operative site in osteomyelitis?
There is increased pain.
What issue with healing can indicate osteomyelitis?
Poor incisional healing.
What symptom involves fluid release from the wound in osteomyelitis?
Wound drainage.
What wound-related symptom may occur in osteomyelitis?
Wound separation
What is the primary medical treatment for osteomyelitis?
Antibiotics.
What happens if osteomyelitis does not respond to antibiotics?
Surgical management may be required.
What is the purpose of surgical decompression in osteomyelitis treatment?
To release intramedullary pressure and remove drainage.
What is the role of osteoblasts?
Osteoblasts are bone-forming cells that create new bone during remodeling.
What do osteoclasts do?
Osteoclasts are bone-destroying cells that break down calcium and phosphorus in a process called resorption.
What is the function of osteocytes?
Osteocytes maintain bone as a living tissue.
What is osteopenia?
Osteopenia is a condition characterized by decreased bone density.
What is a is a chronic, progressive metabolic disease characterized by decreased bone mass and porous bone?
Osteoporosis
What does osteoporosis increase the risk of?
Osteoporosis increases the risk of fractures.
What causes the imbalance in osteoporosis?
There is an imbalance between bone resorption and bone formation.
Who is most commonly affected by osteoporosis?
Osteoporosis is most common in elderly women, particularly due to estrogen deficiency
What is senile osteoporosis?
Senile osteoporosis refers to osteoporosis that occurs in the elderly
What conditions can predispose a person to osteoporosis? (5)
Conditions like elevated cortisol (Cushing’s), chronic diseases, kidney failure (affecting Vitamin D and calcium), prolonged immobilization, and poor diet can increase the risk.
What changes occur in the diaphysis and metaphysis of bones in osteoporosis?
There are changes such as loss of trabeculae.
What happens to trabeculae in osteoporosis?
Trabeculae become thinned.
What causes microfractures and vertebral collapse in osteoporosis?
Thinning of trabeculae leads to microfractures and vertebral collapse.
What happens in postmenopausal osteoporosis?
Increased osteoclast activity occurs in bones with large surface areas.
What changes occur in senile osteoporosis?
The osteoporotic complex is thinned by resorption, and the Haversian systems enlarge.
What is the result of the changes in bone structure in osteoporosis?
The changes lead to an increased risk of fractures.
What happens to trabeculae in osteoporosis?
There is a loss of trabeculae from cancellous bone.
What happens to the cortex in osteoporosis?
The cortex becomes thinned.
What is the result of the loss of trabeculae and thinning of the cortex in osteoporosis?
These changes lead to an increased risk of fractures.
What can compression of vertebrae lead to in osteoporosis?
Compression of vertebrae can lead to fractures
When are most people unaware of osteoporosis?
Most people are unaware until a fracture occurs or a bone scan is done
What physical change may develop in middle age due to osteoporosis?
The development of kyphosis, also known as a “dowager’s hump.”
What are common symptoms related to osteoporosis?
A decrease in height and back pain.
What is a common method used to diagnose osteoporosis?
BMD (Bone Mineral Density) assessment.
What is the technique used to measure BMD?
Dual-energy x-ray absorptiometry (DEXA).
What factors are considered in determining Bone Mass Density (BMD)?
genetic factors, sex, hormone levels, exercise, calcium intake, and age-related changes
What is the purpose of screening for osteoporosis?
To assess bone mass density and identify osteoporosis early.
What is an important aspect of osteoporosis treatment?
Prevention is key in osteoporosis treatment.
What are some dietary recommendations for treating osteoporosis?
Vitamin D and calcium intake are important.
What type of exercises are recommended for osteoporosis treatment?
Weight-bearing exercises are recommended.
What medications are commonly used in osteoporosis treatment?
Bi-phosphonates, selective estrogen receptor modulators, calcitonin, and recombinant PTH.
