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INTRODUCTION
The skeletal system is as vital to life as any organ system because of its
essential roles in mechanical support and mineral homeostasis.
The skeletal system is composed of bones that vary in size and shape (tubular,
flat, cuboid).
The bones are interconnected by a variety of joints that allow for a wide range
of movement while maintaining structural stability.
Bone is a type of connective tissue, and it is unique because it is one of the few
tissues that normally undergo mineralization.
Biochemically, composed of admixture of inorganic elements (65%) and
organic matrix (35%).
The rate of mineralization can vary, but normally there is a 12- to 15-day lag
time between the formation of the matrix and its mineralization. Bone that is
unmineralized is known as osteoid.
The organic component includes the cells of bone and the proteins of the
matrix.
The generation and stimulation of these cells are regulated by cytokines and
growth factors such as bone morphogenic proteins (BMPs), fibroblast growth
factor (FGF), platelet-derived growth factor (PDGF), insulin-like growth
factor, and transforming growth factor-13
SEL-SEL DAN MATRIKS TULANG
2. OSIFIKASI ENDOCHONDRAL
- JAR. TULANG RAWAN HYALIN SBG MODEL → TULANG
- SEL MESENKIM → SEL CHONDROSIT → OSTEOBLAST
- CONTOH PEMBENTUKAN TULANG PANJANG
TAHAP-TAHAP OSIFIKASI
ENDOCHONDRAL :
1. RESTING ZONE
2. PROLIFERATION ZONE
3. HYPERTROPHIC ZONE
A. MATURATION
B. DEGENERATION
C. CALSIFICATION
PENYAKIT-PENYAKIT TULANG
A. OSTEOPETROSIS
- MERUPAKAN PENYAKIT OSTEOSKLEROTIK
(PENINGKATAN KEPADATAN TULANG PER UNIT AREA)
- CAUSA : KEGAGALAN OSTEOCLAST DALAM MERESORPSI
TULANG SELAMA PROSES OSIFIKASI
- HEWAN PENDERITA : ANJING, DOMBA, KUDA, SAPI DAN
BEBERAPA STRAIN MENCIT
- HISTOPATOLOGI :
- GROWTH PLATE : NORMAL
- TULANG TRABECULAR : TERDAPAT TULANG RAWAN
- TULANG KOMPAKTA : NORMAL
B. OSTEOGENESIS INPERFEKTA
- MERUPAKAN BENTUK OSTEOPENI ( KURANGNYA MASA TULANG)
- KELAINAN INI DAPAT TERJADI PADA : TULANG, DENTIN,
TENDON DAN SKLERA
- DAPAK KLINIK PADA HEWAN TERSERANG : MULTIPLE FRAKTURE
PERSENDIAN KENDOR, GANGGUAN PERTUMBUHAN DENTIN
- CAUSA : KEGAGALAN OSTEOBLAST/ODONTOBLAST DALAM
SINTESIS COLLAGEN TIPE 1 DAN PROTEIN
NONCOLLAGEN TERTENTU
- HEWAN PENDERITA : DOMBA, SAPI DAN ANAK ANJING
- HISTOPATOLOGI :
- GROWTH PLATE : NORMAL
- TULANG TRABECULAR : LEBIH DOMINAN DR TLG. NORMAL
- TULANG KOMPAKTA : PERTUMBUHAN LAMBAT
- GIGI : BERWARNA PINK KRN PULPA DENTIS TERLIHAT
AKIBAT TIPISNYA MAHKOTA GIGI
C. CRANIOMANDIBULAR OSTEOPATHY (LION JAW)
- MERUPAKAN GANGGUAN OSIFIKASI TERUTAMA PADA TULANG
PIPIH AKIBAT FAKTOR GENETIK
- DITEMUKAN PADA ANJING TERRIER
- BENTUK KELAINAN :
- PENEBALAN DAN DEFORMITAS PADA TLG
MANDIBULA ; OCCIPTAL DAN TEMPORAL
- HISTOPATOLOGI :
- GROWTH PLATE : TIDAK TERLIBAT
- TULANG TRABECULAR : DENSITAS MENINGKAT AKIBAT
PROLIFERASI DAN PENINGKATAN AKTIVITAS OSTEOBLAST
PADA ENDOOSTEUM
- TULANG KOMPAKTA : MENEBAL AKIBAT PENINGKATAN
AKIVITAS OSTEOBLAST PADA PERIOSTEUM SERTA
GANGGUAN PROSES MODELING DAN REMODELING
2. PENYAKIT TULANG METABOLIK
A. OSTEOPOROSIS
- MERUPAKAN PENYAKIT PENYAKIT TULANG SISTEMIK AKIBAT
GANGGUAN NUTRISI, HORMONAL, ATAU TOKSIN
- ABNORMALITAS DAPAT DITEMUI BAIK PADA TULANG YANG
SEDANG TUMBUH ATAU TULANG DEWASA (SELAMA PROSES
MODELLING DAN REMODELLING)
- SECARA KLINIS DITANDAI DENGAN SAKIT PADA TULANG DAN
FRAKTUR SEKUNDER SEHINGGA DENSITAS TULANG MENURUN
- BERKURANGNYA DENSITAS TULANG TANPA DISERTAI RASA
SAKIT SERING DISEBUT OSTEOPENIA
- PADA HEWAN YANG SEDANG TUMBUH OSTEOPOROSIS BERSIFAT
REVERSIBLE
- PADA HEWAN DEWASA SECARA FISIOLOGIS
REPLACEMENT/PENGGANTIAN TULANG TERJADI SANGAT
LAMBAT
- CAUSA : DEFISIENSI KALSIUM
- CAUSA : - DEFISIENSI KALSIUM
- KELAPARAN
- KURANGNYA AKTIVITAS FISIK
- AKIBAT PEMAKAIAN GLUKOKORTIKOID JANGKA
PANJANG
- BERKURANGNYA ESTROGEN (POST MENOPAUSAL
OSTEOPOROSIS)
GAMBARAN HISTOPATOLOGI :
Berkurannya
Absorbsi kalsium
Meningkatnya
sensitivitas Osteok
terhadap PTH
Menurunnya sintesis vit. D
Yang aktif oleh ginjal
OSTEOMEYLITIS
PERADANGAN PADA TULANG DAN RUANG SUMSUM
- CAUSA :
- BAKTERI (80- 90% OLEH STAPHYLOCOCCUS AUREUS) ;
ARCANOBAKTERIUM PYOGENES (PADA SAPI) DAN E. COLI
- VIRUS (HOG CHOLERA; CANINE HEPATITIS; FELINE LEUKIMIA )
- JAMUR (BLASTOMYCES DERMATITIDIS (SERING
MENGAKIBATKAN PYOGRANULOMATOUS)
Pathogenesis :
Organisms may reach the bone by (1) hematogenous spread, (2) extension
from a contiguous site, and (3) direct implantation (non hematogenous) on
fracture
The initiating bacteremia may follow occult injury to the intestinal mucosa
during defecation, vigorous chewing of hard foods, or minor infections of
the skin.
Bovis Mandibula Osteomyelitis & periostitis
Etiologi :
Blastomyces Actinomyces
Patogenesis :
Luka pada mucosa mulut (erupsi gigi) portal entry bakteri
masuk os mandibula radang kronik pyogranulomatous
Nekrosis menyebabkan hilangnya jaringan tulang Infeksi berlanjut
ke periostal pembentukan tulang baru dan jaringan ikat.
A
OSTEONECROSIS (AVASCULAR NECROSIS)/BONE
INFARCTION
“ Although the disease states associated with bone infarcts are diverse in
many cases the cause of necrosis is uncertain”.
A B
Femoral head with a subchondral, wedge-shaped pale yellow area of osteonecrosis.
The space between the overlying articular cartilage and bone is caused by trabecular
compression fractures without repair.
Renal Osteodystrophy
■ Other factors that are important in the genesis of renal osteodystrophy are
iron accumulation in bone and aluminum deposition at the site of
mineralization. Aluminum deposition, in particular, has received a great deal
of attention because of its iatrogenic origin. The sources of the aluminum
include dialysis solutions prepared from water with a high aluminum content
and oral aluminumcontaining phosphate binders. Aluminum interferes with
the deposition of calcium hydroxyapatite and hence promotes osteomalacia.
Aluminum is not only toxic to bone but also has been implicated as the cause
of dialysis encephalopathy and microcytic anemia in patients with
chronic renal failure.
The clotted blood provides a fibrin mesh, which helps seal off the fracture
site
- Simultaneously, degranulated platelets and migrating inflammatory cells
release PDGF, TGF-13, FGF, and other cytokines, which activate the
osteoprogenitor cells tissues and stimulate the production of osteoclastic
and osteoblastic activity.
In some cases the activated mesenchymal cells in the soft tissues and
bone surrounding the fracture line also differentiate into chondroblasts that
make fibrocartilage and hyaline cartilage.
The newly formed cartilage along the fracture line undergoes enchondral
Ossification
In this fashion, the fractured ends are bridged by a bony callus, and as it
mineralizes, the stiffness and strength of the callus increase to the point
that controlled weight bearing can be tolerated
In the early stages of callus formation, an excess of fibrous
tissue, cartilage, and bone is produced.
If the bones are not perfectly aligned, the volume of callus is greatest in
the concave portion of the fracture site.
The medullary cavity is also restored, and after this has been completed it
may be impossible to demonstrate the site of previous injury.
Callus
OSTEOARTHRITIS
Two major components of the cartilage: a special type of collagen (type II)
and proteoglycans, both secreted by chondrocytes.
Penyebab :
* Arthritis non-infektiosa :
• pecahan-pecahan tulang, duri dsb. Rasa nyeri
• traumatic secara sekunder → infectious.
* Arthritis infectiosa :
berasal radang dari organ lain mis : radang ginjal
Hematogenous → arthritis.
* Arthritis : trauma.------- infectious.
Sifat eksudat : fibrinous s/d purulent → endapan fibrin → kasar
pada permukaan sendi.
Fibrinous synovitis :(rdg sendi berfibrin)
Kausa E.colli; streptococus;Haemophilus;Mycoplasma
1. bertambahnya cairan sendi (synovial) , keruh, fibrin
→sendi tampak bengkak
2. permukaan sendi tebal
3. Cairan fibrin bisa berubah jadi jaringan ikat
GOUT
Gout:
terjadi pada spesies yang tidak mempunyai Enzim Urease
(manusia,burung,reptil)
Penyebabnya :
Ada kaitannya dengan Hiperurisemia (asam urat
serum tinggi)
Gejala kilinis :
bengkak ,radang lokal ,terjadi pengendapan kristala sam urat
dalam sendi merangsang respon pagositosis oleh leukosit terjadi :
keradangan