logging in or signing up Osteomyelitis ksbarot Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 14207 Category: Education License: All Rights Reserved Like it (17) Dislike it (0) Added: March 07, 2008 This Presentation is Public Favorites: 3 Presentation Description No description available Comments Posting comment... By: ramrom2011 (9 month(s) ago) i like it Saving..... Post Reply Close Saving..... Edit Comment Close By: ramrom2011 (9 month(s) ago) i like it Saving..... Post Reply Close Saving..... Edit Comment Close By: wali113 (10 month(s) ago) nice Saving..... Post Reply Close Saving..... Edit Comment Close By: wali113 (10 month(s) ago) nice Saving..... Post Reply Close Saving..... Edit Comment Close By: dr.virus89 (11 month(s) ago) how can i download this file??? Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Slide1: OSTEOMYELITIS Slide2: OSTEOMYELITIS INFLAMMATORY PROCESS IN BONE & BONE MARROW ACUTE & CHRONICSlide3: PATHOPHYSIOLOGY Hematogenous Osteomyelitis Contiguous-Focus Osteomyelitis Peripheral Vascular Disease-associated Slide4: PATHOPHYSIOLOGY Microorganisms enter bone (Phagocytosis). Phagocyte contains the infection Release enzymes Lyse bone Slide5: PATHOPHYSIOLOGY Bacteria escape host defenses by: Adhering tightly to damage bone Persisting in osteoblasts Protective polysaccharide-rich biofilmSlide6: PATHOPHYSIOLOGY Pus spreads into vascular channels Raising intraosseous pressure Impairing blood flow Chronic ischemic necrosis Separation of large devascularized fragment New bone formation (involucrum) (Sequestra)Slide7: PATHOLOGY Acute Infiltration of PMNs Congested or thrombosed vessels Chronic Necrotic bone Absence of living osteocyte Mononuclear cells predominate Granulation & fibrous tissueSlide8: Hematogenous OsteomyelitisSlide9: HEMATOGENOUS OSTEPMYELITIS Rapidly growing bone Children: Long bone, Femur, Tibia, Humerus Older patients: Vertebral boneSlide12: HEMATOGENOUS OSTEOMYELITIS Neonate & infant < 1 year old Septic arthritis is common. Growth deformities is common. Soft tissue involvement is common.Slide13: HEMATOGENOUS OSTEOMYELITIS Children: 1 – 16 years old Most frequent in the metaphysis of long bone. Slugging blood flow through a sinusoidal venous system. Deficency of phagocytic cells. Poor collateral circulation Susceptibility of this region to trauma. Slide15: HEMATOGENOUS OSTEOMYELITIS Children: 1 – 16 years old History of antecedent trauma in 30% Involucrum Sequestration Associated septic arthritisSlide16: HEMATOGENOUS OSTEOMYELITIS Adult Less common Spread infection to joint space. Vertebral Osteomyelitis is common> 50ySlide18: HEMATOGENOUS OSTEOMYELITIS Special consideration Sickle cell disease Injection drug users (IDUs) Hemodialysis HIV/AIDS Immunosuppression Prosthetic orthopedic deviceSlide19: HEMATOGENOUS OSTEOMYELITIS Microbiologic features Staphylococci Aureus, Epidermidis Streptococci Group A & B Haemophilus influenzae Gram-negative enteric bacilli Anaerobes Polymicrobial Mycobacterial Fungi Slide20: HEMATOGENOUS OSTEOMYELITIS Clinical manifestation Classic presentation: Sudden onset Usually presentation: Slow, insidious High fever, Night sweats Fatigue, Anorexia, Weight loss Restriction of movement Local edema, Erythema, & Tenderrness Slide21: HEMATOGENOUS OSTEOMYELITIS Differentials Cellulitis Gas gangrene Neoplasm Aseptic bone infection Slide22: Clenched fist osteomyelitisSlide23: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Lab study: WBC May be elevated, Usually normal C-Reactive Protein (CRP) Erythrocyte Sedimentation Rate (Usually is elevated at presentation Falls with successful therapy) Blood culture ( Acute osteomyelitis + ve > 50% ) {Slide24: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging Radiology: Normal Soft tissue swelling Periosteal elevation Lytic change Sclerotic changewSlide25: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging MRI: Early detection Superior to plan X ray & CT Scan & radionuclide bone scan in slected anatomic location. Sensitivity 90 – 100% Slide26: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging Radionuclide bone scan: A 3-phase bone scan ( Technetium 99m ) Positive as early as 24 h after onset of symptoms. False positive Tumor, osteonecrosis Artheritis, Cellulitis, AbscessSlide27: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging CT – Scan: Useful in evaluation of Spinal, pelvic, Sternum, Calcaneus Provides exellent images of bone cortex Is used for biopsy localizationSlide28: Os + gaz in diabetic footSlide30: Septic arthritis Of Right hipSlide31: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Ultrasonography Simple & inexpensive Demonstration anomaly 1 – 2 days after onset Soft tissue abscess, Fluid collection, & Periosteal elevation It allows for aspiration It doesn’t allow for evaluation of bone cortex. Slide32: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Neddle Aspiration or Open biopsy: From: Soft tissue collection Subperiosteal abscess Intraosseos lesions For: Smear Culture Pathology Slide33: TREATMENT Initial treatment shoud be aggressive. Inadequate therapy Chronic disease Antibiotic use: Surgery Parenteral High doses Good penetration in bone Full course Empiric therapySlide34: TREATMENT Empiric Initial Therapy Neonate S.aureus PRP + Infant<2 y G –ve bacilli Cefotaxime Children S.aureus PRP + H.Infenza Ceftriaxone Adult S.aureus PRP or 1st cephSlide35: TREATMENT Indication for Surgery Diagnostic Hip joint involvement Neurologic complication Poor or no response to IV therapy SequestrationSlide36: TREATMENT Monitoring Therapeutic Response Symptoms & Signs ESR & CRP Radiography Serial Bone Scan? Slide37: PROGNOSIS Is related to: Causative organisms Duration of symptoms & sign Patient age Duration of antibiotic therapySlide38: COMPLICATION Bone abscess Bacteremia Fracture Loosing of the prosthetic implant Overlying soft-tissue cellulitis Draining soft-tissue tractSlide39: Post Osteomyelitis TreatmentSlide40: Septic Osteomyelitis Post Osteomyelitis ScarSlide41: Post Osteomyelitis Deformity of the ForearmSlide42: CONTIGUOUS-FOCUS OSTEOMYELITISSlide43: Contiguous-focus Osteomyelitis Clinical setting: Postoperative infection Contamination of bone Contiguous soft tissue infection Puncture woundsSlide44: Contiguous-focus Osteomyelitis Microbiologic features Staphylococci Aureus, Epidermidis Gram-negative bacteria Anaerobic infection Unusual organisms Clostridia, Nocardia Slide45: Contiguous-focus Osteomyelitis Diagnosis Leukocyte count Blood culture (infrequently positive) ESR & CRP Radiologic evaluation Technetium bone scan Open bone biopsy Culture of wound & draining sinuses??Slide46: Contiguous-focus Osteomyelitis Treatment Surgery is essential. 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Osteomyelitis ksbarot Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 14207 Category: Education License: All Rights Reserved Like it (17) Dislike it (0) Added: March 07, 2008 This Presentation is Public Favorites: 3 Presentation Description No description available Comments Posting comment... By: ramrom2011 (9 month(s) ago) i like it Saving..... Post Reply Close Saving..... Edit Comment Close By: ramrom2011 (9 month(s) ago) i like it Saving..... Post Reply Close Saving..... Edit Comment Close By: wali113 (10 month(s) ago) nice Saving..... Post Reply Close Saving..... Edit Comment Close By: wali113 (10 month(s) ago) nice Saving..... Post Reply Close Saving..... Edit Comment Close By: dr.virus89 (11 month(s) ago) how can i download this file??? Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Slide1: OSTEOMYELITIS Slide2: OSTEOMYELITIS INFLAMMATORY PROCESS IN BONE & BONE MARROW ACUTE & CHRONICSlide3: PATHOPHYSIOLOGY Hematogenous Osteomyelitis Contiguous-Focus Osteomyelitis Peripheral Vascular Disease-associated Slide4: PATHOPHYSIOLOGY Microorganisms enter bone (Phagocytosis). Phagocyte contains the infection Release enzymes Lyse bone Slide5: PATHOPHYSIOLOGY Bacteria escape host defenses by: Adhering tightly to damage bone Persisting in osteoblasts Protective polysaccharide-rich biofilmSlide6: PATHOPHYSIOLOGY Pus spreads into vascular channels Raising intraosseous pressure Impairing blood flow Chronic ischemic necrosis Separation of large devascularized fragment New bone formation (involucrum) (Sequestra)Slide7: PATHOLOGY Acute Infiltration of PMNs Congested or thrombosed vessels Chronic Necrotic bone Absence of living osteocyte Mononuclear cells predominate Granulation & fibrous tissueSlide8: Hematogenous OsteomyelitisSlide9: HEMATOGENOUS OSTEPMYELITIS Rapidly growing bone Children: Long bone, Femur, Tibia, Humerus Older patients: Vertebral boneSlide12: HEMATOGENOUS OSTEOMYELITIS Neonate & infant < 1 year old Septic arthritis is common. Growth deformities is common. Soft tissue involvement is common.Slide13: HEMATOGENOUS OSTEOMYELITIS Children: 1 – 16 years old Most frequent in the metaphysis of long bone. Slugging blood flow through a sinusoidal venous system. Deficency of phagocytic cells. Poor collateral circulation Susceptibility of this region to trauma. Slide15: HEMATOGENOUS OSTEOMYELITIS Children: 1 – 16 years old History of antecedent trauma in 30% Involucrum Sequestration Associated septic arthritisSlide16: HEMATOGENOUS OSTEOMYELITIS Adult Less common Spread infection to joint space. Vertebral Osteomyelitis is common> 50ySlide18: HEMATOGENOUS OSTEOMYELITIS Special consideration Sickle cell disease Injection drug users (IDUs) Hemodialysis HIV/AIDS Immunosuppression Prosthetic orthopedic deviceSlide19: HEMATOGENOUS OSTEOMYELITIS Microbiologic features Staphylococci Aureus, Epidermidis Streptococci Group A & B Haemophilus influenzae Gram-negative enteric bacilli Anaerobes Polymicrobial Mycobacterial Fungi Slide20: HEMATOGENOUS OSTEOMYELITIS Clinical manifestation Classic presentation: Sudden onset Usually presentation: Slow, insidious High fever, Night sweats Fatigue, Anorexia, Weight loss Restriction of movement Local edema, Erythema, & Tenderrness Slide21: HEMATOGENOUS OSTEOMYELITIS Differentials Cellulitis Gas gangrene Neoplasm Aseptic bone infection Slide22: Clenched fist osteomyelitisSlide23: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Lab study: WBC May be elevated, Usually normal C-Reactive Protein (CRP) Erythrocyte Sedimentation Rate (Usually is elevated at presentation Falls with successful therapy) Blood culture ( Acute osteomyelitis + ve > 50% ) {Slide24: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging Radiology: Normal Soft tissue swelling Periosteal elevation Lytic change Sclerotic changewSlide25: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging MRI: Early detection Superior to plan X ray & CT Scan & radionuclide bone scan in slected anatomic location. Sensitivity 90 – 100% Slide26: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging Radionuclide bone scan: A 3-phase bone scan ( Technetium 99m ) Positive as early as 24 h after onset of symptoms. False positive Tumor, osteonecrosis Artheritis, Cellulitis, AbscessSlide27: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Imaging CT – Scan: Useful in evaluation of Spinal, pelvic, Sternum, Calcaneus Provides exellent images of bone cortex Is used for biopsy localizationSlide28: Os + gaz in diabetic footSlide30: Septic arthritis Of Right hipSlide31: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Ultrasonography Simple & inexpensive Demonstration anomaly 1 – 2 days after onset Soft tissue abscess, Fluid collection, & Periosteal elevation It allows for aspiration It doesn’t allow for evaluation of bone cortex. Slide32: HEMATOGENOUS OSTEOMYELITIS Diagnosis & work-up Neddle Aspiration or Open biopsy: From: Soft tissue collection Subperiosteal abscess Intraosseos lesions For: Smear Culture Pathology Slide33: TREATMENT Initial treatment shoud be aggressive. Inadequate therapy Chronic disease Antibiotic use: Surgery Parenteral High doses Good penetration in bone Full course Empiric therapySlide34: TREATMENT Empiric Initial Therapy Neonate S.aureus PRP + Infant<2 y G –ve bacilli Cefotaxime Children S.aureus PRP + H.Infenza Ceftriaxone Adult S.aureus PRP or 1st cephSlide35: TREATMENT Indication for Surgery Diagnostic Hip joint involvement Neurologic complication Poor or no response to IV therapy SequestrationSlide36: TREATMENT Monitoring Therapeutic Response Symptoms & Signs ESR & CRP Radiography Serial Bone Scan? Slide37: PROGNOSIS Is related to: Causative organisms Duration of symptoms & sign Patient age Duration of antibiotic therapySlide38: COMPLICATION Bone abscess Bacteremia Fracture Loosing of the prosthetic implant Overlying soft-tissue cellulitis Draining soft-tissue tractSlide39: Post Osteomyelitis TreatmentSlide40: Septic Osteomyelitis Post Osteomyelitis ScarSlide41: Post Osteomyelitis Deformity of the ForearmSlide42: CONTIGUOUS-FOCUS OSTEOMYELITISSlide43: Contiguous-focus Osteomyelitis Clinical setting: Postoperative infection Contamination of bone Contiguous soft tissue infection Puncture woundsSlide44: Contiguous-focus Osteomyelitis Microbiologic features Staphylococci Aureus, Epidermidis Gram-negative bacteria Anaerobic infection Unusual organisms Clostridia, Nocardia Slide45: Contiguous-focus Osteomyelitis Diagnosis Leukocyte count Blood culture (infrequently positive) ESR & CRP Radiologic evaluation Technetium bone scan Open bone biopsy Culture of wound & draining sinuses??Slide46: Contiguous-focus Osteomyelitis Treatment Surgery is essential. Antibiotics Specific Duration