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Osteoarthritis (Arthritis of Hands, Knees, Hips) | Causes, Risk Factors, Symptoms, Diagnosis, Treatment

Osteoarthritis is the most common type of arthritis, caused by wear and tear or overuse of a particular joint. There are a variety of risk factors for getting osteoarthritis, including increasing age, vitamin D deficiency and previous injuries. In this lesson, we discuss the differences between primary and secondary osteoarthritis, the risk factors for getting primary osteoarthritis, the pathophysiology behind why it occurs, the signs and symptoms, how it’s diagnosed and how it’s treated.

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This 3D medical animation gives a brief overview of the anatomy and physiology of a typical synovial joint, what arthritis is and how osteoarthritis affects a joint. The animation goes on to show common treatment options for osteoarthritis.

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What is osteoarthritis? Osteoarthritis is a disease in which the articular cartilage degenerates over time, causing pain and inflammation in the affected joint. Find our full video library only on Osmosis: http://osms.it/more.

Join millions of current and future clinicians who learn by Osmosis, along with hundreds of universities around the world who partner with Osmosis from Elseiver to make medical and health education more engaging and efficient. We have unparalleled tools and materials to prepare you for success in school, on your board exams, and as a future clinician. Sign up for a free trial at http://osms.it/more. If you’re interested in exploring an institutional partnership, visit osmosis.org/educators to request a personalized demo.

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What are non-urothelial cell bladder cancers? These are a small subset of bladder cancers that, confusingly, often arise from the urothelium, and include squamous cell carcinomas and adenocarcinomas.

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Join over 3 million current & future clinicians who learn by Osmosis, and over 130 universities around the world who partner with us to make medical and health education more engaging and efficient. We have unparalleled tools and materials to prepare you to succeed in school, on board exams, and as a future clinician. Sign up for a free trial at http://osms.it/more. If you’re interested in exploring an institutional partnership, visit osmosis.org/educators to request a personalized demo.

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Medical disclaimer: Knowledge Diffusion Inc (DBA Osmosis) does not provide medical advice. Osmosis and the content available on Osmosis’s properties (Osmosis.org, YouTube, and other channels) do not provide a diagnosis or other recommendation for treatment and are not a substitute for the professional judgment of a healthcare professional in diagnosis and treatment of any person or animal. The determination of the need for medical services and the types of healthcare to be provided to a patient are decisions that should be made only by a physician or other licensed health care provider. Always seek the advice of a physician or other qualified healthcare provider with any questions you have regarding a medical condition.

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R. Jeffrey Karnes, M.D., Consultant and Associate Professor, Mayo Clinic, discusses treatment options for bladder cancer. The ailment can be subdivided into sub categories and the treatments dramatically differ. Invasive treatments can include an ileal neobladder created from the patient’s small intestine can provide the best quality of life.
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Dan Reznicek MD, a Urologist in Bellingham Washington, covers the basics of bladder cancer. Bladder cancer is common and is one of the top 5 cancers diagnosed every year in the US. In addition to this video, see resources available at www.nccn.org, www.bcan.org, and visit our website at www.pacificnorthwesturology.com.

Basics:
What is bladder cancer?
How does bladder cancer happen?
What are the symptoms?
What is the workup?
How is it treated?

What is bladder cancer?
Bladder cancer is a the development of a group of cells in the lining of the bladder that begin to grow and divide uncontrollably. They are in the urothelium of the bladder.

What is the urothelium
This layer prevents you from reabsorbing the salts in the urine and the waste products that have been excreted. It is also a barrier from bacteria and infection.

The vast majority of bladder cancers in this country come from the lining of the urothelium and are known as urothelial carcinoma. Historically, it was also called transitional carcinoma.
The other bladder cancers that will not be covered in this video are small cell carcinoma, adenocarcinoma, and squamous cell carcinoma. These are quite rare, and their outcomes and treatments are different from urothelial carcinoma.

Risk factors include smoking, male sex, and exposures to certain chemicals used in the dye and textile industry.

What are symptoms of bladder cancer?

Most people are diagnosed with bladder cancer after seeing blood in the urine (also called hematuria). Sometimes your urine may look normal, but blood is seen on a urine test at your doctor’s office and that is called microscopic hematuria. See a doctor if you note blood in your urine.

Usually there is no pain with bladder cancer in early stages. In some people, they can develop irritative voiding symptoms such as burning with urination, more frequent urination, difficulty urinating or a weak stream, and the sudden urge to urinate. These symptoms will seem like a urinary tract infection but no bacteria is seen on a culture. These symptoms are less common but can occur.

If bladder cancer is caught late and spread to other areas of the body, patients may experience back pain, weight loss, tiredness, swelling, bone pain, and other symptoms.

What is the workup?

A medical history and perform a physical exam. Other tests that may be performed include urine tests with a culture, cancer markers, or microscopic exam. Imaging tests such as a CT scan, Ultrasound, or MRI may be recommended. A cystoscopy should be performed if bladder cancer is suspected or possible.

How is it treated?
Treatment depends on the stage of the cancer. TNM staging of bladder cancer is covered in the video.

Cancers that are in the lining of the bladder alone are known as non-muscle invasive bladder cancer (NMIBC). These are treated with endoscopic removal (transurethral resection of a bladder tumor [TURBT]) and may require further local therapies with drugs instilled into the bladder.

Some cancers involve the muscle of the bladder and require further treatment. Muscle invasive bladder cancer is treated with surgery, chemoradiation, or a combination of therapies. If left untreated, muscle invasive bladder cancer can be deadly and we highly recommend treatment.

Metastatic cancer is less common and describes bladder cancer that has spread beyond the bladder and into other organs. 4% of cancers are diagnosed at this stage. At this point in time, metastatic bladder cancer is incurable, but new treatments are being discovered each year. Treatments at this stage are focused on slowing the cancer growth and lengthening survival.

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Transurethral resection of bladder tumour (TURBT) is the surgical removal (resection) of bladder tumours.

Find more reliable information on TURBT at EAU Patient Information: https://patients.uroweb.org/turbt/
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Find out more about the GLA:D Australia program here: https://gladaustralia.com.au/

Professor Ewa Roos from Denmark discusses the strong evidence for exercise in helping people with hip and knee arthritis and how a successful program was developed in Denmark. La Trobe Sport and Exercise Medicine Research Centre is now happily assisting physiotherapists in Australia to provide the same program – GLA:D Australia
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Bladder Infections: To Treat or Not to Treat in Older Adults?

“Asymptomatic bacteriuria in long-term care is more common than actual Urinary Tract Infections. About 35 to 40% of men and about 50% of women in long-term care have it—that’s even higher for women with urinary incontinence.”

-Jamie Smith, MSN, FNP
_______________________________________________________________________

When someone is aged and frail, the risk of a bladder infection is higher, raising the chances of delirium, hospital admission, or even death.

In this episode of This Is Getting Old: Moving Towards An Age-Friendly World, Jamie Smith, a Family Nurse Practitioner in geriatrics and nursing home care, describes bladder infections and things you and healthcare professionals should know about helping the older adults decide whether or not to treat with antibiotics.

Part One of ‘Bladder Infections: To Treat or Not to Treat in Older Adults?’.

What Is A Bladder Infection?

A Urinary Tract Infection (UTI) a bacterial infection within the bladder. It’s an acute illness that affects the genitourinary system and is commonly known as a “bladder infection” – and means you have an infection of your genitourinary system, so your bladder, kidneys, ureters or urethra with a “positive urine” with a urine sample.

The typical symptoms include: burning sensation with urination, abnormal urgency and frequency in urination. In addition, you may have severe pubic pain or “gross hematuria” (where your pee turns different colors like pinkish or reddish).

Asymptomatic Bacteriuria (ASB), also known as a colonized state. ASB is where you have a positive urine sample, but lack the typical genitourinary symptoms that go along with a UTI. The presence of bacteria in ASB is in quantitative counts of ≥ 100,000 colony-forming units/milliliter (CFU/mL) or ≥ 100 CFU/mL in a catheterized specimen. Thus, in the absence of urinary tract symptoms, asymptomatic bacteriuria is determined by white blood cells in the urine.

“It’s critical to differentiate between UTI and colonized state because when you give antibiotics to older adults, that increases their risk of antibiotic resistance, drug to drug interaction, and increased health care cost.” – Jamie Smith, MSN, FNP.

To Treat or Not To Treat?

Telling the difference between a UTI and ASB is tricky in older adults, especially those in long-term care facilities because localized genitourinary symptoms are far less pervasive in them. Consequently, there have been differences in treatment protocols from place to place regarding a bladder infection.

✔️ Differences in Protocols For Treatment at ER/ Hospital vs Long-term care settings
Whenever a family member requests a patient to go out because they’re confused about whether it’s a UTI or ASB, one of the first things the ER does is check a Complete Blood Count (CBC) and a Basic Metabolic Panel (BMP). Even if the urine has trace amounts of bacteria, let’s say the patient is confused that they can’t tell if there are any genitourinary symptoms, the ER will typically go ahead and prescribe an antibiotic.

✔️ Protocols for Treatment at Skilled Nursing Facilities or at Home

Bladder infection treatments are different in long term care facilities or at home because the staff or family members can tell if the older adult is having symptoms. If the older adult is not having any symptoms associated with the urinary tract, that’s classified as colonized. We don’t treat colonized states because we look at Loeb’s or McGreer’s Criteria, and if they don’t qualify, we don’t treat them because of the risk of harm by giving them an antibiotic.

Risks of Harm in Older Adults

It’s imperative to differentiate between UTI and ASB (colonized state). Because when you give antibiotics to older adults, that increases their risk of Clostridium difficile (C. diff), antibiotic resistance, a drug to drug interaction, and increased health care cost.

Part Two of ‘Bladder Infections: To Treat or Not to Treat in Older Adults?’

Role of Cognition in Treating Asymptomatic Bacteriuria

Remember that treating ASB is not always straightforward. Long term care patients sometimes will have a cognitive impairment, and they can’t always tell you if the symptoms are there.

There are several tools that you can use. The AMDA Watchlist, for instance, is a urinary tract infection flip manual. This one-pager watchlist can be used by staff or family members, and it helps care providers figure out if it’s a UTI or colonized state.

Read the full article at www.MelissaBPhD.com/podcast-blog

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Specialists at the Johns Hopkins Greenberg Bladder Cancer Institute (GBCI) outline a basic overview of the functions of the bladder, and the different types of cancer that can affect the bladder. Learn about symptoms and risk factors for the disease, and how the GBCI’s multi-disciplinary clinical approach is moving research forward. https://www.hopkinsmedicine.org/greenberg-bladder-cancer-institute/about-bladder-cancer/

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