Please enable JavaScript.

Coggle requires JavaScript to display documents.

BONES (Bone Diseases (*Osteomyelitis (dropped image link (dropped image…

- - - - Pathogens
        
        almost all infections are Staph. Aureous (strains)
        
        Other Bacteria
        
        salmonella after sickle cell disease
        
        Pseudamonas aeruginosa
        
        Staphylococcus Aureus
        
        most common cause of infection
        
        Etiology By Age
        
        less than or greater than 30
        
        think that by 30 your bones are fully developed
        
        Age <30
        
        growing bones
        
        Signs and Symptoms
        
        child/adolescent cardinal signs:
        --> limp
        --> raised C reactive protein
        --> fever
        
        Epiphysial plate
        
        where there is still bone growth
        most susceptible to infection
        
        Age >30
        
        growing bones
        
        Diaphysis
        
        Notes:
        
        sequestrum = necrosis of bone due to devscularization
        
        bones are mostly closed system
        --> infection raised pressure
        --> thrombosis and infarction
        
        Treatment
        
        anti-staph. Aereus
        
        penicillins
        --> flucoxacillin
        
        kill off infection and reduce pressure in the bone
        
        Diagnosis
        
        C reactive protein raised
        
        MRI --> shows early signs
        
        X-ray --> shows later signs
        
        Clinical Cases
        
        Clinical Case
        
        Clinical Case
        
        Notes:
        
        note that
  - - - RIDCKETS
        D = Deficient D vitamin = main cause of ricket's (= osteomalacia in adults)
      - Clinical Cases
        
        Clinical Case
        
        Notes:
        
        note that
        
        Clinical Case
        
        Osteomalacia
        
        Notes:
        
        Osteomalacia primarily affects osteoid bone
        --> OSTEO-
        
        osteoid is the organic portion of bone that is initially laid down by osteoblasts
        
        inorganic calcium and phosphate are then added to the osteoid to make mature lamellar bone
        --> osteoid laid down --> spongy bone --> lamellar bone
        
        ostrteomalacia vs. osteoporosis
        
        osteoporosis does not have pain in the bones, where osteomalacia DOES
        
        osteoporosis has normal mineralization of bones, where osteomalacia DONES NOT
        
        osteoporosis is more due to incorrect ratio of osteoclast to osteoblast activity
        --> excessive bone reabsorption
        --> more risk of fractures
        
        Case example:
  - - - 3 distinct phases of Paget's Disease
        
        1 = Osteoclast phase
        
        2 = Mixed Clast / Blast stage
        
        3 = Blast phase
        
        *Bisphosphonates
        
        tx for osteoporosis, Paget's disease, osteogenesis imperfecta (DOMINANT human hunters)
        
        pyrophosphate analogs --> attach to bone
        
        osteoclasts then degrade them
        --> makes toxic ATP like molecules in the osteoclasts
        --> apoptosis in osteoclasts and lower bone turnover
        
        Side effects of bisphosphonates
        Bisphosphonate esophagitis
        
        this is simply becasue the tablets are way too huge
        --> note they can be given by IM
        
        this is the reason you have to be sitting upright for 30 minutes when taking them
        --> you must also take them with a full glass of water to stop esophagitis
        
        Bisphosphonate fractures and bone necrosis
        
        since bisphosphonates are causing apoptosis in CLASTS
        --> you dont have a good ability to remodel bone anymore
        
        so in some people they can get stress fractures and necrosis of their bones
        --> especially the jaw = mandible and maxillary bones
        
        1 more item...
        
        RANK/OPG ratio
        
        leads to the different stages of Paget's disease
        
        HIGH RANK/OPG ratio = high CLAST activity
        
        LOWRANK/OPG ratio = high BLAST activity
        
        Clinical presentation of PAGETS disease
        
        normal calcium, phosphate levels, but ALK PHOSPH is high
        
        BEAUTY PAGETS DISEASE has 3 PHASES of competition
        --> 3 phases of Pagets disease
        Phase 1 of PAGETS disease = the HAT competition where CRAMER is the Judge
        
        large HAT size in Pagets disease
        
        CRAMER = CLASTS are phase 1 of Pagets
        
        Phase 2 of PAGETS disease = MOSAIC dress competition where 3 judges are = ALP skier, Calcitonin cow, PTH
        
        MOSAIC dress = phase 2 = mixed CLASTS / BLAST stage
        --> also in the final stage you get mosaic lamellar modelling
        
        Calcitonin and PTH are NORMAL in PAGETS
        
        ALP = only thing raised in PAGETS disease
        
        Phase 3 of PAGETS disease = High heels competition where you break your tibia since you can't hear the bisphosphonate bike that runs over your foot and breaks it
        
        tx of PAGETS = bisphosphonates
        
        can't hear in PAGETS due to your Ossicle bones being too large
  - - - *Drugs that increase osteoporosis risk
        
        AEDs that increase CYP
        --> also increase Vitamin D metabolism
        
        ANY drug that increases estrogen
        --> aromatase inhibitors for ER+ breast cancer
        --> GnRH agonists that kill off
        
        Risk factors for osteoporosis
        
        divide into modifiable risk factors and NON modifiable
        
        note that peak bone mass reached at 30
        --> from there it is trying to maintain it
        
        Treatment for osteoporosis
        
        bisphosphonates = integrate into bone
        --> when CLASTS resorb bone
        --> causes apoptosis
        
        PATHO PHYS of osteoporosis
        
        loss of the trabecular = spongy bone = framework
        --> Trabecular bone only makes the framework of bone and the cortical fills in the rest
- - - - Notes:
        
        note although osteoblasts and osteoclasts are responsible for bone remodelling, don't think of osteocytes as just trapped cells in the lamellar layers that are doing nothing
        
        because the blasts and clasts are busy with remodelling bone, the osteocytes are responsible for maintaining the proper calcium and phosphate in the bone
        
        they are in the layers of mature lamellar layers bone that surround the central Haversian Cannals = artery system inside bones
        
        the osteocytes get their nutrients from the Haversian central artery canal through a system of canniculus = smaller arteries that join the lacuna of each osteocyte
        
        the osteocytes actually communicate to each other through gap junctions
        --> think of osteocytes as the same as muscle cells in that to properly maintain the calcium in the bone they need to communicate through gap junctions
      - Example:
  - - - Osteoblasts and Osteoclasts
        
        CLASTS = bone resorption
        
        BALASTS = lay down new bone and regulate the CLASTS
- - - - *RANK - RANK-L and OPG
        
        OPG / RANK-L ratio = OPG Osteo BLAST Generation
        
        RANK = receptor activator NF Kappa B
        --> on OsteoCLASTS
        
        RANK- L = RANK ligand
        --> made by BOTH Blasts and CLasts
        
        OPG = OSTEO BLAST GENERATOR ligand
        --> OPG binds RANK and blocks RANK-L
        --> OPG blocks it and inhibits RANK differentiation
        
        OPG = Osteoprotegerin = OPG GEN-DEN
        --> estrogen stimulates its production
        
        "OPG GEN-DEN" = OPG Generator
        --> GEN-DEN = Denosumab Mab used for osteoporosis to replace the OPG lost by low estrogen
        
        *PTH - calcitonin - OPG RANK regulation
        
        PARATHYROID GLANDS
        
        parathyroid Hormone (PTH)
        
        increases Ca2+ and PO4- levels
        --> by stimulating osteoclasts to break down bone
        
        1 more item...
        
        PTH related conditions
        
        1 more item...
- - - - *Osteoma
        
        benign bone tumor
      - Osteoid osteoma vs OsteoBLASTOMA
        
        both have a central NIDUS
        --> NIDUS means a dark middle part of the bone
        
        these tumors happen at the distal end of the femur
      - *GCT giant cell tumor
        
        long bone benign tumor
        
        "GIANT SOAP BUBBLE"
      - *Benign Osteo Chondroma
        
        tumor of the cartilage = since CHONDRO
        
        MOST COMMON benign bone tumor
    - - *Ewing Sarcoma
        
        Ewing Sarcoma
        --> note the 3 main types of malignant bone tumors are simply named after the simple components of bone
        --> osteo + chondro = cartilage + EWING
      - *chondro Sarcoma
        
        chondrosarcoma Sarcoma
        --> note the 3 main types of malignant bone tumors are simply named after the simple components of bone
        --> osteo + chondro = cartilage + EWING
      - *osteosarcoma Sarcoma
        
        osteosarcoma Sarcoma
        --> note the 3 main types of malignant bone tumors are simply named after the simple components of bone
        --> osteo + chondro = cartilage + EWING
        
        PAGETS disease
        Paget = 3 separate steps for PAGET to paint his MOSAIC Masterpiece of the human Body