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Flashcards in 9. Infections Deck (80)
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1

Diabetic, steroid-immunosuppressed, and
hemodialysis patients are particularly vulnerable
to

suppurative osteomyelitis

2

mc source/spread of osteomyelitis

Hematogenous

3

4 Major Pathways of Spread of Suppurative
Osteomyelitis:

- Hematogenous
- Spread from contiguous source of infection
- Direct implantation
- Postoperative infection (iatrogenic)

4

• Fever
• Chills
• Pain
• Swelling
• Loss of limb function
• Elevated WBC
• ESR, +CRP

Suppurative Infection Infants/Young Children

5

• Chronic, insidious process
• Fever
• Malaise
• Edema
• Erythema
• Pain

Suppurative Infection
in Adults

6

Boys between ages 2-12 are most
susceptible to

suppurative osteomyelitis

7

Usually affects large tubular bones of
extremities

suppurative osteomyelitis

8

Diaphyseal and metaphyseal vessels penetrate physis to enter epiphysis

Infantile Vascular Pattern of infection

9

Physis becomes effective barrier around age

8-18 months

10

High incidence of septic arthritis with epiphyseal
involvement in

infantile osteomyelitis

11

Slow turbulent blood flow in metaphysis
rendering great environment for infection
with no metaphyseal vessels penetrating the
physis

Childhood Vascular Pattern of infection

12

In adults communication between epiphysis and
metaphysis occurs via

blood vessels that
gradually penetrate physis as it fuses

13

Increased intramedullary pressure in bone due to

pus formation

14

Hyperemia adjacent to infarction that stimulates
osteoclastic activity resulting in

regional osteoporosis

15

Infection penetrates endosteum entering Haversion systems crossing cortex to the

subperiosteal space

16

Few Sharpe’s fibers attaching periosteum to cortex in children, thus periosteum is easily stripped away
from cortex which results in

periostitis aka periosteal reaction

17

Cortical and medullary infarcts result in

Sequestrum
(Dead bone)

18

to wrap or cover

involucrum

19

defect in involucrum which decompresses bone by discharging inflammatory products
from bone

Cloaca

20

Associated with chronic osteomyelitis and allows seeding of adjacent soft tissues

Cloaca

21

Chronic ulcer with draining sinus, that has
become malignant

Marjolin Ulcer

22

defined as the
malignant degeneration of a chronic wound or scar

Marjolin’s Ulcer

23

On biopsy Marjolin’s Ulcer have been most commonly identified as

squamous cell and basal cell carcinomas

24

If even remote clinical suspicion of bone
infection, do

bone scan or MRI

25

MRI with and without Gd contrast is Excellent for Detecting

Infection

26

Soft tissue findings on plain film may be seen within
__ days of bacterial contamination of bone

3

27

Bone sequestrum occurs ~3-6 weeks after onset usually appear

sclerotic

28

90% of infections involve

extremities

29

Highest incidence of suppurative spondylitis occurs in

debilitated patients (50-60)

30

cortical erosion and
intramedullary sequestrum seen in

Chronic Osteomyelitis