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Collegeaantekeningen Much to be known about bone
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Collegeaantekeningen van alle 4 de collegeweken van de minor interne geneeskunde aan de VU.
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By: hilkens • 1 year ago
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Much to be known about boneBone anatomy and physiology 1/11......................................................................................................6
Plain radiography of bone 4/11.............................................................................................................8
Diagnostiek van botbiopten 9/11........................................................................................................10
Kidney transplant bone disease 7/11..................................................................................................11
Hyperparathyreoidism and hypercalciemia 8/11.................................................................................13
Parathyroid surgery 8/11.....................................................................................................................16
Fracture healing 8/11..........................................................................................................................17
Practicum Vitamine D en hypercalciemie 8/11....................................................................................18
Bone and the kidney 11/11..................................................................................................................19
Hypophosphatemia 11/11...................................................................................................................20
Brittle bones 14/11..............................................................................................................................22
Fibreuze dysplasie 15/11.....................................................................................................................26
Fibrodysplasia ossificans progressiva 18/11........................................................................................29
Osteoporose 21/11..............................................................................................................................32
Glucocorticoid osteoporosis 21/11......................................................................................................33
Bone development child 21/11...........................................................................................................34
Drugs in osteoporosis 22/11................................................................................................................35
DEXA 22/11..........................................................................................................................................36
Osteoporosevereniging 22/11.............................................................................................................37
Genetics in 25/11.................................................................................................................................37
Fall risk 25/11......................................................................................................................................37
,Endocrinology introduction: Hypoparathyroidism and
physiology of calcium and phosphate 1/11
Bones at birth: ongeveer 300
Hoeveel als adult: 206
Kleinste: stapes
grootste: femur
hoeveel procent water in botten: 50%
Hoeveel procent van je gewicht is botten: 14%
Elke 7 jaar "helemaal vernieuwd"
Functie calcium
- Bone integrity
- Muscle contraction
- Nerve geleiding
- Homeostase bloed (stolling) (trombine)
- Cardiac function - depolarization
Calcium bindt aan tropomyosine -> ontspanning spieren
Klachten hypocalciemie
- Neuromusculair: tetany, cramps, numbness, paresthesias, tingling
- Fatigue, hyperirritability, anxiety, depression
- Orthostatis, palpations
- Seizures
- Stridor
Lichamelijk onderzoek
- Confusion, irritability, hallucinaties, desorientatie, psychose, dementie
- Tetany, focal numbness, muscle spasms, laryngeale stridor, bronchospasm
- Sign van trousseau: bloedtevoer stoppen door bloeddruk band, samentrekken hand (geen
calcium aanvoer, tekort al in het bloed)
- Sign of shvosteck: in gezicht, verhoogde contractie bij n. facialis aantikken
ECG change
- Prolonge QTc interval: dus repolarisatie hart
99% zit in het kalk, de rest in het bloed en de helft daarvan is aan eiwit gebonden
,Functie phosphate
- Important intracellular molecule
- Bindt adp en atp
- Fosfolipide celmembraan
- Nucleotiden
- Binding O2 aan hemoglobine
Symptomen hypofosfaat
- Spierzwakte
- Fatigue
- Bone pain
- Bone fractures
- Appetite loss
- Irritability
- Numbness
- Confusion
- Slow growth and shorter height in children
- Tooth decay or late baby teeth
Bij fosfaat zit ongeveer 85% in het bot, minder dan 1% in het bloed
, PTH: botafbraak, meer reabsorptie in de nier, meer opname darm
- Geactiveerd bij laag calcium, hebben calciumreceptoren
- Zet vitamine D om in actieve vorm -> meer absorptie Ca darm
- Meer osteoclasten en osteoclastactiviteit, waarmee ook osteoblasten harder gaan werken,
bone resorption
- Uitplassen fosfaat
- Readbsorptie Ca nier
Vitamine D: calciumabsorptie in darm,
FGF23: gemaakt door osteocyten
- Ook uitplassen fosfaat
- Remt vitamine D en PTH
Hyperparathyrodeïsme: Hoog PTH en serum Ca
Maligniteit/hypercalciemie: Laag PTH hoog serum Ca
Hypoparathyreodie: laag PTH en laag serum Ca
Bij geen schildklier: 1,25 dihydroxyvitamin D want actieve vorm en geen PTH meer nodig
Albumine
- Omlaag bij zwamgerschap/nefrotisch syndroom/liver disease, protein- losing enteropathy
- Omhoog bij dehydratie
- You can also measure ionized calcium (not binded to albumin)
Meten bij hypocalciemie:
- Calcium
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