PATHOLOGY & PATHOPHYSIOLOGY
DISORDERS OF THE SKELETAL SYSTEM
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MAINTAINING BONE DENSITY
Calcium, magnesium,
phosphorus, vitamin D,
parathyroid hormone,
calcitonin, growth
hormone, oestrogen,
progesterone and
testosterone
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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OSTEOPOROSIS
Definition: Progressive decrease in the density of bones
Bones are weaker and more prone to fractures
Signs and symptoms:
None at first
Sudden back pain may occur
There may be loss of normal curve of the spine (kyphosis)
Loss of height
Easy fractures
Fractures take long to heal
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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OSTEOPOROSIS
Risk factors:
Advanced age
Family history
Petite/low body weight
Eating disorders
Female athletes
Late menarche
Early menopause
Never had children
Sedentary lifestyle
High protein diet
More than 2 cups of coffee per day
On: Thyroid medicine, corticosteroids, anticonvulsants
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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OSTEOPOROSIS
Aetiology:
Nutrient deficiencies: Calcium, magnesium, potassium,
vitamin D and K
Acidic diet
Smoking
Salt
Caffeine and alcohol
Lack of exercise
Ageing
Cushing’s disease
Hyperthyroidism
Certain medications: Corticosteroids, hypothyroidism
medications, anticonvulsants
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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OSTEOPOROSIS
Prevention:
Avoid risk factors
Weight bearing exercise
Diet: Good sources of calcium, e.g. diary (especially yoghurt),
almonds, “beans and greens”
Calcium & magnesium supplement with a 2:1 ratio
Get some sunshine
Reduce intake: Salt, animal proteins, alcohol, cigarettes and
coffee
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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OSTEOPOROSIS
Conventional treatment:
Calcium supplement
Oestrogen/testosterone therapy
Biphosphanates
Calcitonin
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
Complementary treatment:
Change the diet
Progesterone cream
Calcium & magnesium supplement
Tissue salts
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OSTEOPOROSIS
For calcium to be absorbed:
The stomach must be acidic (Antacids make calcium
absorption difficult. Older people may also have a lack of
stomach acid)
Calcium competes with other substances for absorption,
especially with phosphorus. Fizzy drinks make calcium
absorption difficult!
You need vitamin D for calcium absorption
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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OSTEOPOROSIS
Calcium loss:
Diets rich in meat increases calcium excretion in the urine
Calcium use in the body:
If blood calcium levels become low, your body will draw from
the calcium “bank” which is your bones
If the blood is acidic, your body will increase the blood
calcium levels to neutralise the acidity
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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HORMONE REPLACEMENT THERAPY (HRT)
Oestrogen can help to prevent further bone loss, but as soon as
the oestrogen is stopped, the bone loss continues
HRT has risks: Uterine cancer, breast cancer, thrombosis
Oestrogen prevents the breakdown of old bone - it does not build
new bone
Natural progesterone builds new bone
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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OSTEOARTHRITIS
The most prevalent form of arthritis
Degeneration of the articular cartilage (“wear and tear”)
Signs and symptoms:
Aching pain in one/more joints
Pain worse for activity and better for rest
In later stages of the disease, pain may also be felt at rest or
during sleep
The joint(s) may make a grinding sound when used
Limitations of joint motion
Nodes next to the joints
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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OSTEOARTHRITIS
Joints that are usually affected: Hips, knees, lumbar vertebrae,
cervical vertebrae, PIP joints of the hands, DIP joints of the
hand, 1st carpometacarpal joint, 1st metarsophalangeal joint
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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OSTEOARTHRITIS
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
© DOUGANS INTERNATIONAL. All rights reserved.
OSTEOARTHRITIS
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
© DOUGANS INTERNATIONAL. All rights reserved.
OSTEOARTHRITIS
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
© DOUGANS INTERNATIONAL. All rights reserved.
OSTEOARTHRITIS
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
© DOUGANS INTERNATIONAL. All rights reserved.
OSTEOARTHRITIS
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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OSTEOARTHRITIS
Treatment:
Weight loss
Physical rehabilitation
Medication
Surgery
Supplements: Omega 3, Glucosamine, Magnesium
Herbs: Boswelia serrata, Turmeric, Ginger
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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RHEUMATOID ARTHRITIS
Onset of the disease is usually between the ages of 30 and 50
An autoimmune disorder in which the synovial membrane of
joints become inflamed and damaged
70 to 80% of people with rheumatoid arthritis have a substance
called rheumatic factor (RF) in their blood
Rheumatoid factor is an antibody that plays a role in this disease
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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RHEUMATOID ARTHRITIS
Signs and symptoms:
Insidious onset marked by systemic manifestations, e.g.
fatigue, weight loss, general aching and stiffness
Inflammation of the joints
Exacerbations and remissions
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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RHEUMATOID ARTHRITIS
Signs and symptoms:
Usually affects joints in a symmetrical pattern
Affects the following joints first: fingers, wrists, feet and
knees
Affected joints are swollen, painful, feel spongy and warm
Affected joints may become immobile
Deformities of the hands are common
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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RHEUMATOID ARTHRITIS
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
© DOUGANS INTERNATIONAL. All rights reserved.
RHEUMATOID ARTHRITIS
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
Hands and feet:
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RHEUMATOID ARTHRITIS
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
Rheumatoid nodules:
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GOUT
Definition: Deposition of uric acid crystals in synovial joint
cavities
Pathogenesis: Increased serum uric acid
Aetiology:
Idiopathic
Kidney disease
Treatment for cancer
Some diuretics interfere with uric acid excretion
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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GOUT
Signs and symptoms:
The excess uric acid forms crystals in joints (synovial fluid is a
poorer solvent for uric acid than plasma)
The crystals create inflammation in the joint
Frequent attacks of gout cause damage to the affected joints
Acute attacks in which a joint becomes inflamed. The joint is
red, swollen and very painful. An acute attack may last for
days.
Acute attacks usually start during sleep at night
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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GOUT
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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GOUT
Treatment:
Loose weight if overweight
Decrease alcohol consumption
Avoid/decrease purine rich foods: Liver, kidney, sardines,
anchovies, mackerel, shellfish, asparagus, herring, meat
gravies, mushrooms, mussels, mincemeat, baker’s yeast,
brewer’s yeast, peanuts etc.
Avoid meat as much as possible
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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SLIPPED DISC
Ruptured disc/herniated disc
If the IV disc degenerates due to injury or ageing – the soft inner
core can bulge out
This hernia can compress, irritate or damage a nerve root
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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SLIPPED DISC
Signs and symptoms: Pain in the back, sciatica, weakness of a
leg, numbness or tingling in a leg
Treatment:
Activities that put stress on the spine should be avoided
Specific back exercises (Pilates)
Posture, posture, posture!
Pick up heavy things by bending the legs, not the back!
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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SCIATICA
Definition: Pain down the back of the leg in the area supplied by
the sciatic nerve.
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
Aetiology: Pressure on the
sciatic nerve root. This may
be due to a slipped disc,
osteoporosis or injury to the
vertebra.
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CARPAL TUNNEL SYNDROME
Definition: A set of signs and symptoms due to the entrapment
of the median nerve between the carpal bones and the
transverse carpal ligament.
Aetiology: Repetitive strain injury, pregnancy, menopause,
obesity
Pathogenesis: Oedema, subluxation or fibrotic build up
Signs and symptoms: Tingling, pins and needles, numbness and
weakness in a specific area of the hands
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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CARPAL TUNNEL SYNDROME
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
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BURSITIS
Aetiology: Repetitive
movements, e.g.
“housemaid’s knee”,
“student’s elbow” or
“weaver’s bottom”
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
Definition: Inflammation of bursa
Bursae pad the sharpest corners in the body
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ADVICE FOR BONE AND JOINT HEALTH
Learner Study Guide – Pathology & Pathophysiology, Chapter 17, pages 126-135
Keep fit and supple
Eat healthy
Consult an osteopath/chiropractor
Supplements:
Omega 3
Turmeric
Boswelia serrata
Glucosamine hydrochloride
Magnesium
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