Pathology - Upper Limb PDF

UPPERLIMB PATHOLOGY characterized by gradual deterioration of the articular cartilage with hypertrophic bone 1. BURSITIS formation Inflammation of the...

UPPERLIMB PATHOLOGY characterized by gradual deterioration of the articular cartilage with hypertrophic bone 1. BURSITIS formation Inflammation of the bursae or fluid filled sacs that Degeneration of cartilage and formation of encloses the joints osteophytes (bony outgrowths) RA: fluid filled joint space with possible RA: narrowing joint space with periosteal on calcification joint margins Olecranon Bursitis 6. OSTEOMYELITIS 2. CARPAL TUNNEL SYNDROME Local or generalized infection of bone or Painful disorder of the wrist and hand that results bone marrow from compression of the median nerve RA: soft tissue swelling and loss of fat-pad RA: possible calcification in carpal sulcus detail 3. FRACTURE 7. OSTEOPETROSIS Break in the structure of bone caused by a force Hereditary disease marked by abnormally RA: disruption in bony cortex with soft dense bone tissue swelling Marble bone disease TYPES: RA: chalky white or opaque appearance a) Barton's fx - fx and dislocation of the posterior lip of the distel radius. (John Rhea 8. OSTEOPOROSIS Barton) Reduction in the quantity of bone or atrophy of skeletal tissue b) Bennett's fx - fx of the base of the 1st Bone mineral density loss (BDM) metacarpal bone (Edward Hallaran) RA: long bones demonstrating thin cortex c) Boxer's fx - transverse fx that extends 9. PAGET'S DISEASE through the metacarpal neck, commonly Osteitis deformans seen in the 5th metacarpal. (Bar Room's Characterized by bone destruction followed fracture) by a reparative process of overproduction of very dense yet soft bones that tends to fx d) Colles' fx - transverse fx of the distal radius easily. in w/c the distal fragment is displaced James Paget posteriorly. Pelvis, femur, skull, vertebrae, clavicle and humerus e) Smith's fx - reverse of Colles'. Transverse RA: "cotton wool", mixed areas of sclerotic fx of the distal radius in w/c the distal and cortical thickening fragment is displaced anteriorly. Men > women 4. JOINT EFFUSION Accumulation of fluid in the joint cavity RA: fluid-filled joint cavity 5. OSTEOARTHRITIS 10. RHEUMATOID ARTHRITIS Degenerative Joint Disease (DJD) Chronic systemic disease with inflammatory Normal part of aging process changes throughout the connective tissue Noninflammatory joint disease  1st, 2nd and 3rd MCP joints or the 3rd PIP, Often found in hands and feet of the joint adolescents and young adults. 3x more common in women than in men RA: closed joint spaces with subluxation of b. Osteochondroma (exostosis) → most common MCP joint type of benign bone tumor Aged 10-20 11. SKIER'S THUMB Arises from the outer cortex with the tumor Ulnar collateral ligament injury (UCL) growing parallel to the bone pointing away Gamekeeper's thumb from the adjacent joint. Sprain or tear of the ulnar collateral ligament of the thumb, near the MCP joint of the hyperextended thumb HUMERUS AND SHOULDER GIRDLE Folio method PATHOLOGY RA: widening of inner MCP joint space of thumb 1. AC DISLOCATION Injury in w/c the distal clavicle usually 12. MALIGNANT BONE TUMOR displaced superiorly A. Multiple myeloma→ most common primary Caused by a fall cancerous bone tumor RA; widening of AC joint space These tumors occur in the various parts of the body arising from bone marrow or 2. BANKART LESION marrow plasma cells. Injury of the anteroinferior aspect of the Ages 40-70 glenoid labrum R.A: multiple "punched-out" osteolytic Arthur Sydney Blundell Bankart lesions scattered throughout the affected RA: Small avulsion fx of the anteroinferior bone aspect of the glenoid rim b. Osteogenic Sarcoma → Osteosarcoma 3. HILL-SACHS DEFECT Second most common type of primary Anterior dislocation of the humeral head cancerous bone tumor Moogis Fracture Ages 10-20 Harold Arthur Hill Maurice David Sachs c. Ewing's sarcoma→ common primary malignant RA: Compression fx of the articular surface bone tumor in children and young adults that arises of the posterolateral aspect of the humeral from bone marrow. head R.A: onion peel appearance 4. IDIOPATHIC CHRONIC ADHESIVE d. Chondrosarcoma slow-growing malignant CAPSULITIS tumor of the cartilage Frozen shoulder Disability of the shoulder joint that is caused by chronic inflammation in and around the joint 13. BENIGN BONE OR CARTILAGINOUS RA: possible calcification or other joint TUMORS (CHONDROMAS) space abnormalities a. Enchondroma slow → growing benign cartilaginous tumor. 5. ROTATOR CUFF INJURY Acute or chronic and traumatic injury to one or more of the muscles that make up the  rotator cuff-teres minor, supraspinatus, 5. OSTEOCLASTOMA infraspinatus and subscapularis Giant cell tumors Limit the ROM of the shoulder Benign, lesions that typically occurs in the RA: partial or complete tear in musculature long bones of the young adults Proximal tibia or distal femur 6. SHOULDER DISLOCATION R.A: large "bubbles" separated by thin strips Traumatic removal of the humeral head of bone from the glenoid cavity. RA: separation between humeral head and 6. OSTEOMALACIA glenoid cavity Rickets (children) Bone softening LOWER LIMB PATHOLOGY Malacosteon (o.t) Latin-derived equivalent, mollities ossium. 1. CHONDROMALACIA PATELLAE Lack of bone mineralization secondary to a Runner's knee deficiency of calcium, phosphorus, Vit. D. Softening of the cartilage under the patella RA: decreased bone density, bowing RA: possible misalignment of patella deformity in weight bearing limbs Osteomalacia 2. GOUT Normal Bone Form of arthritis that may be hereditary in w/c uric acid appears in excessive 7. REITER'S SYNDROME quantities in the blood Sacroiliac joint and lower limbs of the young 1st MTP joint of the foot men Latin: "gutta" - drop Reactive arthritis "The disease of kings" or "Rich man's Hans Conrad Reiter disease." Bony erosion at the Achilles tendon - on the Podagra Disease (moth) posterosuperior margin of the calcaneus. RA: uric acid deposits in joint space Caused by previous infection of the Gl tract such as salmonella or STD 3. LISFRANC JOINT INJURY RA: asymmetric erosion of joint spaces; Range from sprains to fx- dislocations of the calcaneus erosion base of the 1st and 2nd metatarsals Jacques Lisfranc de St. Martin RA: Abnormal separation or avulsion fracture between base of first and second metatarsals and cuneiforms FEMUR AND PELVIC GIRDLE PATHOLOGY 4. OSGOOD-SCHLATTER DISEASE 1. ANKYLOSING SPONDYLITIS Common in boys, 10-15 years old. Bamboo Spine Apophysitis of the tibial tubercle Fusion, of Sl joint Knobby knees Stiffness and lack of mobility Robert Bayley Osgood Extensive calcification of the anterior Carl Schlatter longitudinal ligament of the spinal column RA: Fragmentation or detachment of tibial Male > female tuberosity by patellar tendon Normal spine  Early ankylosing spondylitis This fracture extends through the pedicles Advanced ankylosing spondylitis of C2 Inflammation RA: Fracture of the anterior C2 arch, usually with anterior subluxation of C2 2. DEVELOPMENTAL DYSPLASIA OF THE HIP on C3- (DDH) Congenital dislocation of the hip (CDH) o.t 5. JEFFERSON FRACTURE Comminuted fracture occurs as a result of 3. LEGG-CALVE-PERTHES DISEASE axial loading Is the most common type of aseptic or Geoffrey Jefferson ischemic necrosis. RA: Bilateral offset or spreading of the Lesions typically involve only one hip (head lateral masses of C1 relative to dens and neck of femur) 5-10 years old boys 7. KYPHOSIS Limp→ first clinical sign Abriormal or exaggerated convex R.A: flattened femoral head that later can thoracic.curvature appear fragmented 8. LORDOSIS CERVICAL, THORACIC AND LUMBAR Normal concave lumbar curvature or SPINE PATHOLOGY abnormal or exaggerated lumbar curva. 9. SCOLIOSIS 1. CHANCE FRACTURE Abnormal or exaggerated lateral curvature A transverse fracture through the of spine vertebral body, pedi cles, and spinous process. 10. METASTASES Often associated with hyperflexion Primary malignant neoplasms that spread to injuries, typically in the thoracolumbar distant sites via blood and lymphatics region. a. Osteolytic destructive lesions with irregular Radiographic Appearance (RA): margins and decrease density Horizontal fracture line; often best seen on lateral views. b. Osteoblastic proliferative bony lesions of increased density c. Combination osteolytic and osteoblastic moth-eaten appearance of bone resulting from the mix of destructive and blastic lesions. 2. CLAY SHOVELER'S FRACTURE 11. SCHEUERMANN'S DISEASE Results from hyperflexion of the neck Idiopathic R.A: double spinous process sign; Avulsion Adolescent kyphosis fx of the spinous process of any vertebra RA: Mild kyphosis and/or scoliosis, most C6-T1 commonly involvement of the thoracic spine 3. COMPRESSION FRACTURE 12. SPINA BIFIDA Often involves collapse of a vertebral body, Congenital condition in w/c the posterior which results from flexion or axial loading aspects of the vertebrae fail to develop, thus RA: wedge shaped vertebral body exposing part of the spinal cord. 4. HANGMAN'S FRACTURE 13. SPONDYLOLISTHESIS Blunt trauma A condition where one vertebra slips forward over the vertebra below it. Can 2. PECTUS CARINATUM result from degenerative changes, trauma, Pigeon chest or congenital defects. RA: Anterior protrusion of the lower sternum and xiphoid process 14. SPONDYLITIS Inflammation of the vertebrae, often 3. PECTUS EXCAVATUM associated with conditions like ankylosing Funnel chest spondylitis, which leads to pain and stiffness Hallowed Chest in the spine. RA: Depressed sternum 15. SPONDYLOSIS Foraminal stenosis Neck stiffness CHEST PATHOLOGY Zygapophyseal joints and intervertebral foramina 1. ASPIRATION RA: Decrease intervertebral joint space Mechanical obstruction Foreign objects are swallowed 16. SPONDYLOLYSIS Relieved by Heimlich maneuver Dissolution of a vertebra, such as from RA: radiodense or radiopaque outline aplasia (lack of development) of the vertebral arch and separation of pars 2.ATELECTASIS interarticularis Collapsed of all or portion of the lungs Common in L4 Or L5 Is a condition rather than a disease RA: Defects in the pars interarticularis As the result of obstruction of the bronchus (scottie dog appearing to wear a collar) or puncture or "blowout" RA: radiodense lung regions with shift of heart and-trachea in severe cases 17. TEARDROP BURST FRACTURE 3. BRONCHIECTASIS Comminuted vertebral body fragments Is an irreversible dilatation or widening of avulsed from anteroinferior border bronchi or bronchioles RA: radiodense lower lungs 18. TRANSITIONAL VERTEBRA Is an incidental finding that occurs when the 4. BRONCHITIS vertebra takes on a characteristic of the Is an acute (short-term) or chronic (long- adjacent region of the spine term) condition in which excèssive mucus is LS region secreted into the bronchi RA: bony projections extended laterally from Chief cause is cigarette smoking transverse processes RA: Hyperinflation and dominant lung markings of LL BONY YHORAX PATHOLOGY 5. CYSTIC FIBROSIS The most common inherited disease 1. RIB-FLAIL CHEST A condition in which secretions of heavy Disruption of bony cortex of the rib mucus cause progressive" clogging" of bronchi Paradoxical breathing  RA: increased rådiodense in specific lung 2. Bronchopneumonia→ bronchitis of both lungs. regions Gaused by Streptoccocus or Staphylococcus bacteria. 6. EMPHYSEMA Irreversible and chronic lung disease 3. Lobar pneumonia (pneumococcal)→ is Airspace in the alveoli become greatly confined to one or two lobes of the lungs enlarged as a result of alveolar wall destruction and loss of elasticity 4. Viral (interstitial) pneumonia→ inflammation of Smoking and long term dust inhalation the alveoli and connecting lung structures. R.A: increased lung dimension, barrel chest, flatted diaphragm, elongated heart shadow, 11. PNEUMOTHORAX lung-fields appear very radiolucent Accumulation of air in the pleural space Causes partial or complete collapse of the 7. LUNG NEOPLASIA lung New growth or tumor Lat. Decub→ affected side up a. Benign (noncancerous) RA: lung seen diaplaced from chest wall, no → hamartoma lung markings b. Malignant (cancerous) → bronchogenic carcinoma - 12. PULMONARY EDEMA 8. PLEURAL EFFUSION Excess fluid within the lung Hydrothorax (o.t) RA: increased diffuse radiodensity in hilar Abnormal accumulation of fluid in the regions pleural cavity a. Empyema occurs when the 13. PULMONARY EMBOLI fluid is pus Sudden blockage of artery in the lung R.A: wedge-shaped opacity (Hampton's b. Hemothorax occurs when the fluid is blood Hump) 14. RESPIRATORY DISTRESS SYNDROME 9. PLEURISY (RDS) Inflammation of the pleura surrounding the Emergent condition in w/c the alveoli and lungs capillaries of the lungs are injured or infected 10. PNEUMONIA Resulting in leakage of fluid and blood into the spaces hyaline membrane Pneumonitis RA: granular pattern of increased Inflammation of the lungs that results in radiodensity throughout lungs accumulation of fluid within certain section a. Hyaline membrane disease (HMD) → infants of the lungs b. Adult respiratory distress syndrome RA: patchy infiltrate with increase (ARDS)→ adults radiodensity 15. TUBERCULOSIS TYPES: 1. Aspiration pneumonia→ caused by aspiration 16. OCCUPATIONAL LUNG SEASE of a foreign object/food, w/c irritates the bronchi (PNEUMOCONIOSIS) resulting in edema Anthacosis → Black lung pneumoconiosis Coal dust  R.A: small opaque spots or conglomerate 7. CHOLESTEATOMA Asbestosis → caused by inhalation of asbestos Is a benign, cyst like mass or tumor that is dust (fiber). most common on the middle ear or mastoid region. Silicos → is caused by inhalation of silica (quartz) RA: bone destruction involving middle ear dust. CRANIUM, FACIAL BONE PNS 8. OTOSCLEROSIS PATHOLOGY Hereditary disease that involves excèssive spongy bone formation of the middle and inner ear 1. LINEAR FRACTURE RA: excessive bone formation involving RA: Jagged or irregular lucent line with middle and inner ear sharp borders Brain Skull Linear Skull Fracture BILIARY TRACT AND UPPER GI 2. DEPRESSED FRACTURE PATHOLOGY Ping-pong fracture RA: Bone fragment 1. ACHALASIA depressed into cranial cavity Cardiospasm Esophageal aperistalsis 3. BASAL SKULL FRACTURE Distal two-thirds of the esophagus Fracture through the dense inner structures Inability to relax during swallowing of the temporal bone RA: Stricture or narrowing of the esophagus RA: Fracture visualized in dense. inner Achalasia structures of temporal bone 2. BARRETT'S ESOPHAGUS 4. PITUITARY ADENOMA Is the replacement of the normal squamous Tumor of the pituitary gland epithelium with columnar-lined epithelium RA: Enlarged, eroded aspects of sella ulcer tissue in the lower esophagus turcica Columnar epithelium lined lower oesophagus (CELLO) 5. MASTOIDITIS Norman Barrett Acute mastoiditis is a bacterial infection of R.A: stricture or "streaked" appearance of the process that can destroy the inner part distal esophagus of the mastoid process. Mastoid air cells are replaces with fluid-filled abscess. 3. ESOPHAGEAL VARICES RA: increased densities (fluid- filled) replace Dilatation of the veins in the distal mastoid air cells esophagus R.A: "wormlike" and "cobblestone" 6. ACOUSTIC NEUROMA appearance (esophagogram) Refers to the benign tumor of the auditory Lower esophagus nerve sheath that originates in the internal Esophageal varices auditory canal RA: widened internal auditory canal 4. GASTROESOPHAGEAL REFLUX DISEASE Inflammation of the small intestine (GERD) RA: thickening of the mucosal folds and Is the entry of gastric content into the poor definition of circular folds esophagus, irritating the lining of the esophagus 2. CROHN'S DISEASE Cigarette smoking, excessive intake of Regional enteritis aspirin, alcohol, caffeine Burill Bernard Crohn Is a form of inflammatory bowel disease of 5. ZENKER'S DIVERTICULUM unknown origin, involving any part of the Gl Large out pouching of the esophagus just tract but commonly the terminal ileum. above the upper esophageal sphincter R.A: "cobblestone" and "string sign" (small pharyngoesophageal diverticulum bowel series) Pharyngeal pouch Hypopharyngeal diverticulum Friedrich Albert Von Zenker 3. GIARDIASIS RA: Enlarged recess or cavity in proximal Caused by flagellate protozoan esophagus → Giardia Lamblia Beaver Fever 6. BEZOAR Contaminated food and water Describes a mass of undigested material RA: Dilation of intestine, with thickening of that becomes trapped in the stomach circular folds. Filling defect or ill-defined mass within stomach 4. MECKEL'S DIVERTICULUM Antidote (Persian) Common birth defect caused by the A. Trichobezoar→ made up of ingested hair persistent of the yolk sac (umbilical vesicle) B. Phytobezoar→ ingested vegetable fiber or resulting in a saclike out pouching of the seeds intestinal wall. Johann Friedrich Meckel 9. GASTRITIS Out pouching: 10-12 cm diameter (ileum) Inflammation of the lining of mucosa of the Out pouching: 50-100 cm diameter (prox. stomach To the ileocecal valve) RA: absence of rugae, thin gastric wall and RA: large diverticulum of ileum, proximal to "speckled" appearance of mucosa with ileocecal valve acute cases of gastritis 5. NEOPLASM 10. HIATAL HERNIA New growth Is a condition in which a portion of the R.A: "apple-core" or napkin- ring" sign (BE) stomach herniates through the diaphragmatic opening (protrusion) 6. SPRUE Great mimic Malabsorption syndrome RA: gastric bubble or protruding aspect of Unable to process and absorb certain stomach above diaphragm or Schatzki's nutrients ring R.A: "feathery" appearance LOWER GASTROINTESTINAL 7. CELIAC DISEASE PATHOLOGY Is a form of sprue or malabsorption disease that affects the proximal small bowel (prox. 1. ENTERITIS Duodenum.  Insoluble protein (gluten) found in the cereal d. Volvulus → twisting of a loop of intestine grains RA: large amount of air in sigmoid with tapered narrowing.at the site of volvulus 8. WHIPPLE'S DISEASE RA: Dilatation and distorted loops of proximal small bowel Idiopathic George Hoyt Whipple 4. ADYNAMIC OR NONMECHANICAL BOWEL OBSTRUCTION Cessation of peristalsis ABDOMEN PATHOLOGY a. Adynamic ileus→ paralytic ileus RA: large amount of air in entire dilated 1. ASCITES small and large intestine with air-fluid levels Abnormal accumulation of fluid in the peritoneal cavity of the abdomen 5. ULCERATIVE COLITIS Is a "Baglike". Chronic disease Abdominal dropsy Inflammation of the colon RA: general abdominal haziness Rectosigmoid Region BE is strongly contraindicated 2. PNEUMOPERITONEUM RA: deep air-filled mucosal protrusion of Refers to the free air or gas in the peritoneal colon wall cavity. R.A: thin, "crest-shaped". radiolucency under dome of the R. Hemidiaphragm on erect. 3. DYNAMIC OR MECHANICAL BOWEL OBSTRUCTION Is a physical blockage of the bowel that may be caused by tumors, adhesions or hernia R.A: "circular staircase" or herringbone pattern" TYPES: a. Fibrous adhesions fibrous→ band of tissue interrelates with the intestine crating a blockage Crohn's Ducase b. Cronh's disease → Regional Enteritis, Idiopathic, Terminal ileum and proximal colon Burill Bernard Crohn, an Americal gastroenterologist RA: distended loops of air-filled small intestine c. Intussusception → telescoping of a section of a bowel into another loop. Terminal ileum. RA: "coiled spring" appearance