| Joe's Other Notes |
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| Pathology Notes: (Goodman, Catherine, and Boissonnault, William. Pathology: Implications for the Physical Therapy. NewYork: W.B. Saunders Company. 1998.) OsteoArthritis or degenerative joint disease (DJD): Proper posture, use of supports, avoiding prolonged stressful postures, varying physical activities to vary the stresses (i.e., mix biking with swimming or running), and following through with a flexiblity and strengthening exercise program are all components under the patient's control. Movitvation, education, and coaching are important roles the therapist must consider. Juvenile (Child) Rheumatiod Arthritis or Still's Disease: a chronic inflamatory disease which can range from a mild illness to a severe, destructive arthropathy (or disease of the extremities) with significant extra-articular manifestations (fever, rash, polyarthritis, myalgia, tenosynovitis, skeletal growth disturbances, pericarditis, pleuritis, peptic ulcer disease, hepatitis, and anemia). Osteoporosis: The most common DJD. As we age, we will encounter osteoporosis to certain extent (it is literally inevitable). Its is the destruction or reduction of joints. To help reduce the early signs of osteoporosis, reduce repititive joint-stressing movements. Dystonia: �Dystonia is a neurological movement disorder characterized by involuntary muscle contractions, which force certain parts of the body into abnormal, sometimes painful, movements or postures�(http://www.dystonia-foundation.org/defined)� Impairment of dystonia is due to certain muscle contractions that interfere with normal functions (cognitive, strength, and the senses, including vision and hearing). Dystonia is not fatal, but a chronic disorder and is difficult to predict. Being the third most common movement disorder (after Parkinson�s and Tremors), it affects more than 300,000 people in North America. 1911, an esteemed Berlin neurologist, Herman Oppenheim, �coined the term �dystonia� to indicate that �muscle tone was hypotonic at one occasion and in tonic muscle spasm at another.� The term became widely accepted but the definition has changed from an alteration of muscle tone to the definition mentioned above. Signs and symptoms of dystonia included, variation of muscle spasm, twisted postures (associated with spasms of the trunk and limbs), rapid to rhythmic jerking movements, and fixed postural deformities. Dystonia is classified into three categories: 1) age of onset, 2) body distribution of symptoms, and 3) etiology (its cause). First, age-onset refers to the occurrence of dystonia within the age group. Child-hood and Adolescent onsets occur (less than 28 yrs) are usually associated with gene defects. However, appearance of dystonia signs and symptoms for adult onset would typically start between the ages of 30 � 50 (after decades of normal physical function). Next, body distribution classification of symptoms refers to the number and specific areas of the body that are affected (focal or one frequent area, segmental or at least two or more adj. areas, multi-focal, generalized or several areas of both sides of body, or hemi-dystonia or affects either the left or the right side of body). Finally, dystonia is classified by its cause. The etiology is broken down into two types: Primary and secondary dystonia. Primary dystonia refers to the presence of dystonia with out any underlying disorders whereas secondary dystonia is referred to as having dystonia as a result of a stroke trauma, birth injury, or toxins. Being a chronic, neurological disorder, a part of the brain, called the basal ganglia, is involved with dystonia. The basal ganglia, or more often corrected as basal nuclei, is located deep with the white matter of the brain and are a collection of nerve cells that controls speed of movement and prevents unwanted movements�thus any changes to this portion of the brain causes movements to occur even if you don�t want to them to. According to studies, the small change in the basal nuclei remains undetected through medical tests or the MRI scan. However, it is due to the study of secondary dystonia (or dystonia appearing right after certain disorders such as a stroke) that lesions where discovered around the basal nuclei. Therefore concluding that all dystonia related occurrences are associated with the basal nuclei. Examples of specific dystonias are: blepharospasm (or a focal, excessive blinking and uncontrollable closing of eyes), oromandibular (focal, forceful contraction of tongue and jaw making it difficult to open or close mouth), spasmodic dysphonia (vocal muscles or the larynx are affected causing the voice to be coarse, strangled, breathy, or whisper type), cervical dystonia (or spasmodic torticollis, affecting neck and head muscles, thus causing deformed head or neck posture), and writer�s cramp. |
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| PATHOLOGY OUTLINE NOTES |
| I. Abnormal Factors A. Inflammation is endocarditis B. Congestive heart failure (CHF) 1. Definition: Left ht failure, inability of the left ventricle to pump effectively, resulting in congestion in the systemic & pulmonary circulation Once you are diagnosed you have it for life 2. Signs & symptoms: a. Fluid in the right lung b. Enlarged ht c. SOB especially with activity d. Edema especially in the BLE e. Lack of endurance to do any movement Esp. In the acute stage f. May need O2 in acute stage; end stage may need O2 all the time 3. Treatment & maintenance PT to inc. Endurance, dec. edema, exercise for strength and health Limit Salt (Na) intake, Rest & plan your activities, watch your weight, regular check ups and Medications Vasodialators, diuretics, digitalis C. Coronary Artery Disease (CAD) 1. Definition: Heart not getting enough blood; actually it�s Atherosclerosis ( hardening and softening of the arteries; type of arteriosclerosis; forms plaques usu. Of fat and cholesterol) 2. Arteriosclerosis- hardening of arterial walls with lipids; lack of elasticity 3. Angina pectoris : A symptom of CAD which is pain &/or numbness or pressure to your chest, arms, throat, or upper back. Sometimes confused as heartburn. a. take nitroglycerin tablet under the tongue; after 3 go get help 4. Can be no symptoms until a heart attack occurs! 5. Myocardial Infarction (MI) a. Heart attack: plaque or a blood clot in a narrow artery blocks blood flow. Heart muscle is damaged by lack of oxygen rich blood. b. Cause: 1. Blocked artery : varies by percentage a. Categories - Healthy - nothing wrong - Damaged - by high cholesterol Plaque starts & flows decreases ( CAD begins) - Narrowed - Plaques incr. , severely reduced blood flow, ht starved of oxygen and causes angina - Blocked - suffer a MI if completely blocked, usually Detected at 70% 6. Treatment a. Medication b. Modify lifestyle - ex, diet c. Bypass surgery - By pass the blocked vessels by grafting veins from another part of the body... usually the Saphenous veins in the leg or internal mammary rteries...these are "Spare� vessels in the body d. Angioplasty - widen the blocked artery by inserting the balloon. This compresses the plaque e. Atherectomy - remove plaque � Roto-rooter� f. Diagnostic test for blockage - cholesterol blood Test - Carotid Ultrasound - cardiac catherization or coronary angiogram - Treadmill - ex. On a treadmill & monitor with ECG (ELECTROCARDIOGRAM) C. Dysrhythmia or Arrhythmia 1. Definition ; abnormal heart rhythm (beat) 2. Causes a. Heart block - impulses blocked from the ventricular myocardium (AV Node) Artificial Pacemaker : Battery operated device implanted under the skin connected by wires to the myocardium. Usually the left upper chest, feels like quarter, kicks in when ht rate is too slow, adjustments can be made over the phone. b. Bradycardia - Slow ht rate, less than 60bpm. Athletes have lower than normal ht rates. (Pacemaker may be needed) c. Tachycardia - Rapid ht rate, over 100 bpm, normal during ex and stress but quickly lowers with rest d. Sinus Dysrhythmia - variation in ht rate during breathing cycle. Inc. With inhale, dec. when exhale. e. Premature Contractions (PACs) contraction occur before the next expected contraction in a cycle. f. Fibrillation - From premature contractions , muscle Fibers contract irregularly 1. Atrial - common in mitral stenosis, rheumatic ht dz., or infarction of Atrial myocardium. (Afib) treat with digoxin, in emergency use defibrillator (portable defibrillator Machines) 2. Ventricular - life-threatening : lack of ventricular pumping blood to vital tissue D. Rheumatic heart 1. Definition: valve deformity or stenosis 2. Cause: rheumatic fever (delayed inflammatory response to strep in children) 3. Characteristics: lead to mitral valve prolapse; valve leaks or dec. function 4. Treatment: valve replacement � stainless steel or pig�s valve E. Cardiomyopathy 1. Definition: dz. Of the myocardial tissue; dec. pumping action; start on the left to right and less return from the lungs 2. Characteristics a. progressive condition � fast or slow b. fatal c. inc. need for oxygen d. skinny and muscle atrophy 3. Rx: Test with echocardiogram (ejection fraction) a. PT to maintain what�s left b. Teach energy conservation c. In the terminal stage- just to maintain ROM without causing exhaustion d. With these pts., take your time and just do Rx. To their tolerance F. cardiac arrest 1. Definition: Heart failure 2. Cause- any of the above or recreational drugs or trauma 3. Rx: immediate CPR III. Blood circulation A. Normal components 1. RBC or erythrocytes- carries oxygen to the body 2. WBC or leukocytes � immune defense 3. Platelets or thrombocytes � blood clotting mechanism 4. Veins 5. Arteries B. Disorders 1. Anemia a. Definition � state of deficient RBC or hemoglobin therefore lead to hypoxia (lack of O2 in the blood) b. Characteristics � fatigue, weakness, paleness, inc. HR, SOB c. Causes � 2 groups - loss or destruction of RBC greater than bone marrow production - i.e. hemorrhage or dec. iron - dec. production of RBC or hemoglobin - i.e. not enough nutrients 2. Leukopenia � low WBC count i.e. HIV 3. Leukocytosis � high WBC; i.e. leukemia, infection 4. Thrombus � blood clot; too much platelets 5. Embolus � blood clot dislodges through the bloodstream 6. Hemophilia � genetic disorder that doesn�t form clots VI. Intermittent Claudication A. Definition: limping due to ischemic pain in calves during ex. Ischemia due to atherosclerosis B. it�s benign & can improve; 40% improve, 40% unchanged, 20% require surgery with 50 % of these needing amputation B. Underlying dz have 20% risk for mortality from MI VII. Venous thrombosis A. Definition or what you see: edema, skin pigmentation, stasis dermatitis, ulceration B. 3 Types 1.Deep Vein thrombosis (DVT) a. clot in deep vein in calf, asymtomatic or symptomatic b. S/S : combo of pain, edema, tenderness, warmth, bluish skin, prominent superficial vein c. Pain with standing/walking; relieved with rest & elevation d. Scan LE for thrombus e. could result from surgery - hip and knee f. treat with heparin to dissolve clot 2. Thrombophlebitis a. clot formation with vein inflammation b. clot forms because slow movement of blood & less pressure c. pain & discoloration of surrounding tissue d. lead to pulmonary embolism (clot in lungs) e. Treatment : drugs to dissolve clot, warm compresses, NSAIDS 3. Chronic venous insufficiency a. in leg after DVT manifested by edema & dilated superficial veins b. S/S: c/o fullness, aching or tiredness of leg without discomfort. Occurs during standing/walking and relieved with elevation. No tenderness c. get stasis dermatitis/ulceration - skin discoloration ankle/Lower leg esp. obesity d. may lead to varicose veins e. treat with medication - blood thinners VIII. Lymphedema A. Definition: accumulation of excessive lymph fluid and swelling of subcutaneous tissue due to obstruction, destruction or hypoplasia of lymph vessels B. 2 types 1. Primary - from birth or puberty a. less often in males b. c/o swelling of foot, leg or whole LE usu. Unilateral; worse in warm weather, before menstrual period & prolong dependency, without discomfort c. dorsum of foot & hand & partially pitting edema; no skin changes or evidence of venous insufficiency 2. Secondary - from infection a. explosive onset - chills, high fever, toxicity, red, hot, swollen leg, streak in skin, groin enlarged & tender b. Elderly - malignant dz IV. Circulatory shock A. Cardiogenic 1. from heart failure; ineffective pumping of blood B. Hypovolemic 1. from loss of blood volume in the blood Vessels 2. loss of fluids in the interstitial tissue C. Neurogenic 1. from widespread dilation of blood vessels caused by an imbalance in the autonomic stimulation of smooth muscles in vessel walls D. Anaphylactic 1. From allergic reaction E. Septic 1. called septicemia, from infectious agents that release toxins into the bloodstream GASTROINTESTINAL SYSTEM I. ORGANS A. Stomach B. Intestines i. Large � 1.5 meters long ii. Small � 6.0 meters long C. Pancreas D. Gall bladder E. Mouth F. Esophagus G. Duodenum H. Colon to rectum to anal canal (anus) II. Conditions A. Aspiration 1. Definition: Choking or swallowing into the trachea not the esophagus 2. Characteristics Choke or gag:�Silent Aspirator� � lack gag reflex; Drool, Moist, Nasal, Temperature, Fear of eating, Lethargic, Best detected by a SLP OR Modified barium swallow 3. Causes: a. Neurological injury b. Trauma c. Tracheotomy d. Aging- weak muscles 4. Clinical management 1. Thickened liquids of different consistencies 2. Nasogastric Tube (NG): tube in nose Peritoneal Esophageal Gastric (PEG)- tube in stomach B. Heartburn 1. Definition: pain & burning sensation in chest near sternum; increase acidic material in stomach 2. Characteristics A. Gassy feeling b. Burp frequently c. mistaken for MI 3. Clinical management a. Antacids b. Medications c. Diet C. Hiatal hernia � 1. May cause heartburn 2. Management- antacids and long term medications II. Disorders of the gastrointestinal system A. Pyloric stenosis- obstructive narrowing of the opening B. Gastritis 1. Definition: stomach inflammation; difficulty to keep food down 2. Characteristics a. Reflux- b. Cardiac sphincter doesn�t close 3. Signs and symptoms a. Pain b. Nausea c. Emesis: vomiting 4. Causes a. Bacteria b. Virus c. NSAIDs d. Alcohol e. Stress f. Smoking g. chemotherapy drugs 5. Treatment a. Relax b. BRAT diet (Banana. Rice, Apple, Toast) or bland foods c. NO acidic foods d. NO alcohol C. Ulcer 1. Definition: crater-like wound or sore in stomach or intestinal lining from tissue destruction; usually increase acid production 2. Characteristics a. �Gastric�-stomach b. Duodenum�-small intestine 3. Causes a. Stress b. Helicobacter pylori bacteria-impairs lining to produce mucous & increase secretion 4. Sign & symptoms- pain, vomit after eating, diarrhea Severe case- cough and BM has blood 5. Treatment- antibiotics, antacids, Severe case- IV drugs and EGD (esophagogastroduodenoscopy) test or colonoscopy, which leads to a diagnosis of GI bleed D. Enteritis 1. Definition: inflammation of small intestine usually accompanied with stomach inflammation and called �gastroenteritis� 2. Cause: bacteria & virus in food causing increase acid production 3. Signs & symptoms: pain, nausea, vomiting- yellow/brown bile 4. Management is like gastritis E. Diarrhea 1. Definition: loose stools, bowel moves too fast 2. S/S: abdominal cramps, nausea, dizziness/faint, weakness 3. Complications: decrease fluids/water may lead to dehydration, convulsions & death F. Constipation 1. Definition: decrease intestinal mobility, hardened stools 2. S/S: pain, uncomfortable, irritable, nausea, faint 3. Complications: a. SBO (Small Bowel Obstruction) especially elderly during summer b. Blockage in large intestine c. Blockage in colon 4. Clinical management: enema, increase water/fluids, digital, laxatives, continual stool softener, surgery to remove blockage & prevent rupture of intestines and spread infection, ambulation or active movement in upright G. Diverticulitis 1. Definition: inflammation of abnormal sac-like outpouchings of intestinal wall from constipation, obstruction or tumors 2. Usually people over 50 with low fiber diet 3. Treat like constipation H. Colitis: any inflammatory condition of the large intestine 1. S/S: diarrhea, cramps or constipation 2. Caused from stress I. Appendicitis 1. Definition: inflamed appendix; rupture dangerous- spread infection to peritoneum 2. Signs and symptoms: pain on right side, tenderness to touch, fever, redness 3. Treatment: surgery to remove appendix, ambulate after surgery; follow precautions like a Cesarean surgery Need to ambulate right after surgery; one day in hospital J. Peritonitis 1. Definition: inflamed peritoneum from bacterial infection or irritant 2. Cause: bacterial infection or ruptured appendix 3. Signs and symptoms: abdominal distention, pain, nausea, vomit, tachycardia, fever, dehydration Severe- could lead to circulatory shock or Respiratory failure 4. Treatment: antibiotics, remove infected tissue, exercise, functional training if patient becomes debilitated K. Ascites: abnormal accumulation o f fluid in peritoneal space, 1. S/S: pregnant stomach, hard to touch, decrease urine output, uncomfortable 2. Cause: CHF, liver disease, malnutrition, cirrhosis 3. Management: Active movement, find problem, diet, antibiotic therapy III. Disorders of the liver A. Jaundice 1. Definition: liver unable to digest bilirubin 2. S/S: yellowing of skin and eyes 3. Cause: a. Birth- decrease liver function b. Alcohol abuse c. Any medical problem that decreases liver function d. Chemotherapy B. Cirrhosis 1. Definition: enlarged & damaged liver 2. Causes: hepatitis, alcohol abuse, malnutrition, infection 3. S/S: nausea, anorexia, gray-white stools, weakness, pain 4. Management: a. Medication b. High protein food to repair damage c. No alcohol d. PT to restore function and strength d. Liver transplant C. Hepatitis IV. Disorders of the pancreas and gall bladder A. Pancreatitis- Inflammation of pancreas from blockage of bile duct; high amylase level 1. S/S: nausea, chest pain, vomiting, dehydration 2. Causes: variety of factors such as diabetes and diet 3. Management: medication, no food initially, advances to liquid diet then low fiber diet B. Cholecystitis- inflammation of the gall bladder 1. S/S: pain, bowel problems, gray-white stools, jaundice 2. Causes: a. Cholelithiasis- from gall stones in gall bladder that block bile duct b. Risk factors- age, genetics, obesity or rapid weight loss 3. Stone color a. Yellow- pure cholesterol b. Black/brown- pigments in stone 4. Management- a. Cholecystectomy- removes stones b. PT- post surgery for ambulation and exercise V. Nutrition A. Characteristics- food and fluid intake for maintenance of body function Balance of carbohydrates, proteins, fats, vitamins, minerals; influence strength of muscles and energy B. Disorders 1. Anorexia nervosa- refusal to eat for fear of becoming fat; usually adolescent girls to young women; male models and dancers a. Cause: emotional stress, dissatisfied with self-image b. Management: 1. Treat medical condition first then treat psychological condition 2. Monitor meal schedule 3. PT for strength and exercise 2. Bulimia- insatiable craving for food alternating with periods of self-deprivation; �Binge and Purge� disorder a. S/S: excessive vomiting that damages esophagus, pharynx, mouth, and teeth, dehydration, malnutrition, faint, gastric ulcer, weakness b. Cause: emotional stress, dissatisfied with self-image c. Management: 1. Same as anorexia 3. Obesity (morbid)- abnormal increase in the proportion of fat in the body a. Classification (Body Mass Index) 1. Mild: 20-30% overweight; BMI of 25 2. Obese: 31-50%; BMI of 27 3. Moderately obese: 51-100% 4. Severely obese: 100%+ b. S/S: 1. Hyperthyroidism: genetic predisposition 2. Weight proportion 3. Risk for variety of health problems |
| Medical Terminology Kineseology Muscle Testing Medical Illustrations |
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