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31 Cards in this Set
- Front
- Back
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When is an infection of the soft tissue called?
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Cellulitis
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What is an infection of the bone called?
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Osteomyelitis
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What is an infection of the joint called?
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Septic or pyogenic arthritis
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What need to be present for an infection to occur?
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Host
Pathogen Immune response Damage to host tissue |
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How is Osteomyelitis classified?
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According to the Cierney-Mader classification. It is based on the anatomical(medullary, superficial, localized, diffuse) and physiological (host is either normal, compromised, or the treatment will be worse then the disease) characteristics of the patient.
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What are the categories of osteomyelitis?
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Can follow hematogenous spread, be secondary to a contigous force, or be associated with vascular insuffiency.
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What occurs during acute hematogenous osteomyelitis?
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The bacteria seeds the bone from a distant site.
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Who is hematogenous osteomyelitis most often seen in?
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Very young patients, older adults, and IV drug abusers.
Can also be seen in patients with sickle cell disease and patients on hemodialysis. |
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Where is the most common site of acute hematogenous osteomyelitis in children? In adults?
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In children it is mainly seen in the long bones particularly around the growth plate. In adults it is usually seen in the thoracic or lumbar vertebrae.
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What are the signs and symptoms of acute hematogenous osteomyelitis?
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Pain on ambulation
Localized tenderness/swelling Fever/chills/night sweats Malaise |
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What laboratory values are associated with acute hematogenous osteomyelitis?
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Elevated WBC
Blood cultures + Elevated ESR/CRP |
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What is the current treatment for acute hematogenous osteomyelitis?
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IV-antibiotic for two weeks followed by a PO-antibiotic for 2-3 months
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Why has the incidence of vertebral osteomyelitis increased in recent years?
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Increasing rates of nosocomial bacteremia due to intravascular devices and other forms of instrumentation.
Increasing age of the population Increasing IV drug abuse |
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What patients are typically affected by vertebral OM?
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Primarily adults with most patients being older then 50 yrs and men being affected twice as often as women.
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Contiguous focus OM is a direct extension of:
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Postoperative infections
Puncture wounds Bite wounds Ulcerations/lacerations Open fxs Septic arthritis |
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How does contiguous focus OM present clinically?
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Local signs of infection
Fever Draining sinus Radiographs show signs Bone may be probed |
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What is the technique used when probing to bone?
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Use a stainless steel blunt probe
Hold it like a pencil Explore gently via path of least resistence Feel for hard or gritty structure without intervening soft tissue |
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What lab findings are associated with contiguous focus OM?
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WBC frequently normal
ESR nonspecific Blood culture rarely helpful Superficial culture not helpful Bone culture definitive |
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What is the treatment for contiguous focus OM?
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Initial surgical debridement
Appropriate post-op wound care Parentereal antibiotics for 4-6 weeks Definitive debridement if needed |
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What are the three main causes of vascular insuffiency OM?
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Arteriosclerosis
DM w/ arterial disease Frostbite |
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What is vascular insuffiency OM?
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Occurs when the bone becomes infected in the face of ischemic soft tissue. Occurs mainly in the lower extremities.
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What is the clinical presentation of vascular insuffiency OM?
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Muted or absent inflammatory response
Gangrenous changes Ischemic pain Seen commonly in the forefoot |
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What are the lab findings when vascular insuffiency OM is present?
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Blood results likely to be falsely negative or muted
Noninvasive vascular studies may show decreased perfusion Invasive vascular studies will show decreased perfusion |
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What is the bacterial etiology of vascular insuffienciency OM?
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Polymicrobial in nature
Gram negative and gram postive aerobes found Anaerobes are seen when frank skin necrosis is present |
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What is the treatment for vascular insufficiency OM?
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Address ischemia first
Vascular consult Removal of non-viable tissue as appropriate Allow auto-amputation Antibiotics to prevent spread |
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What are the two types of septic arthritis?
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Hematogenous and direct inoculation
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What are predisposing factors for hematogenous septic arthrtis?
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RA
Immunosuppression Previous trauma to joint |
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What are causes of direct inoculation septic arthritis?
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Surgery/Arthroscopy
Puncture wounds Animal bites Intra-articular injections Adjacent OM |
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What is the clinical presentation of septic arthritis?
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Almost always monoarticular
See cardinal signs of infection and constitutional symptoms Joint swelling Limited and painful ROM w/ guarding Plain films show increased soft tissue, only sometimes will bone changes be seen Increased signal on MRI |
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What are the lab findings with septic arthritis?
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Leukocytosis
Positive gram stain Blood cultures may be + A joint aspirate culture and synovial fluid analysis should also be performed. |
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What is the treatment for septic arthritis?
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Aspiration
Repeat aspiration Surgical drainage Systemic antibiotics |
