Introduction Flashcards
Pathology
Study of disease, based on dysfunctions in the body
Norms vs. challenges
Disease
Abnormal structural or functional change in the body. Very multi-faceted
Organic
Structural; actual body parts
Inorganic
Functional; processes, psychological, etc.
Signs
Objective findings.
Can be noted by clinician using senses.
Ex: limited ROM, tightness, brusing
Symptoms
Subjective complaints.
Cannot be noted by clinician.
Ex: Pain, limited skill
Etiology
Cause
Diagnosis
Assigning a name to a condition
Pathogenesis
Sequence of events in which a disease develops
Syndrome
Collection of signs and symptoms that tend to run together
Prognosis
Guess as to outcome of a disease.
Ex: Is there treatment?
Endogenous
Caused by something internal (to the body)
Exogenous
Caused by something external (to the body)
Latrogenic
Caused by medical care
Idiopathic
Unknown
Incidence
of diagnoses in a given time period.
Typically per 100,000
a.k.a. Prevalence (total # seen overall)
Mortality
of deaths in a given period of time
Risk factors
Factors present that increase the risk of developing a condition.
Doesn’t mean that if present, they will develop a condition, but it does increase the risk.
Modifiable R.F.
Risk factors that can be changed
Non-Modifiable R.F.
Risk factors that can’t be changed
Why do we develop disease?
Something goes wrong in cells.
Results in loss of homeostatic function of cell.
Cell
Structural and functional unit of the body
Organization of cells in body
Cells > Tissues > Organs > Systems > Organism
Basic structure of cell
Nucleus
Organelles
Cell membrane
Nucleus
Contains genetic material
Directs function of cell
Organelles
Carry out functions
Cell membrane
Selective entry and exit of substances
Types of disease
- Organic disease
2. Non-Organic disease
Organic disease
a.k.a. Structural disease
Involves lesions
*major content for our course
Non-Organic disease
a.k.a. Functional disease
No discernable lesions
Genetic & Developmental
Structural disease
Abnormality in genetic makeup (ex: cancer)
Conditions due to factors in utero
Conditions occurring later in life as a result of changes caused by genes.
Inflammatory
Structural disease
Caused by any agent (internal or external) that evokes inflammatory response.
Internal-vascular or immunologic responses.
Degenerative
Structural disease
Degeneration or breakdown of parts over time.
Frequently due to aging
Metabolic
Structural disease
Abnormalities in cells’ ability to process or utilize substances.
Deficiencies or changes/imbalances
Ex: endocrine dysfunctions, electrolyte imbalances, enzyme deficiencies
Neoplastic & Types
Structural disease
Abnormal cell growth and reproduction
Benign - generally non spreading and non-harmful.
Malignant - generally spreading and harmful
Types of Structural Diseases
- Genetic & Developmental
- Inflammatory
- Degenerative
- Metabolic
- Neoplastic
- Idiopathic
Benign
Neoplastic disease type.
Generally non spreading and non-harmful.
Malignant
Neoplastic disease type.
Generally spreading and harmful
Idiopathic
Structural disease
Unknown causes
How are conditions diagnosed?
- Subjective history
- Physical examinations
- Clinical tests or procedures
Subjective history
First step in diagnosing conditions
Sx
History of the individual
Physical examination
Second step in diagnosing conditions
Observation of signs
Noted using senses
Clinical tests or procedures
Third step in diagnosing conditions
Invasive or Non-Invasive
Clinical lab tests
Blood Enzymes Gases Metabolic byproducts Urine CSF Saliva
Blood tests
Can look for: Blood cells (type, number) Presences or absence of substances Enzymes (from various organs, tissues) Excretion of substances (metabolic byproducts) Gases (O2, CO2)
Fluid analysis tests
Urine
CSF (cerebral spinal fluid)
Saliva
Cytology/Histology
Diagnostic procedure
Tissue sampling
Ex: needle biopsy, excisions biopsy, resection
Visualization procedures
Direct observation
Radiologic procedures
Endoscopy
Direct observation
Part of overall clinical picture
May provide diagnosis in some cases
Radiologic procedure types
X-ray CT (CAT) MRI Radionuclide studies Angiography US (ultrasound) PET
X-ray Scans
X-rays pass into body, either pass through or absorbed by tissue
Rays pass through expose white x-ray film
Higher density tissue = appears white (bone)
Lower density tissue = appears dark (muscle)
*Can see some soft tissues based on gradient
X-rays
Advantages & Disadvantages
Limitations: 2-D image Superimposition of skeletal components Less accurate soft tissue assessment Advantages: Cheap
X-rays soft tissue visibility
Low resolution, but generally can note shapes
Ex: joints, cartilage, discs
Linings of hollow tubes or organs
*Need to administer contrast medium
Ex: intestines, urinary tract, angiogram, etc.
IVP
Intravenous pyelogram
The use of dye on an x-ray to see soft tissue
MBS
Modified barium swallow. Usually put in food that is eaten.
Used by speech therapy
CT Scans
CAT scans
Computerized axial tomography
X-ray tube on movable frame surrounding patient.
Series of x-rays taken & fed into computer.
These are cross sectional images
Can view any plane, 3D images are less common
CT Scans
Advantages & Disadvantages
Advantages: Can view on any plan Can image osseous or non-osseous structures Better resolution of soft tissue than x-rays Sharp resolution Can offer 3D image Limitations: Expensive
MR Scans
MRI or magnetic resonance imaging
Patient put in strong magnetic field
Bodies protons align in field
Pulse of radio waves directed at patient, dislodges protons and makes them wobble
Wobbling protons emit signal when realigning > signal is converted by computer into image
MR Scans
Advantages & Disadvantages
Advantages:
Give the BEST results!
Good resolution & contrast of soft tissues (with high water content)
Different forms can focus on various tissues
Can scroll for 3D relationships
Limitations:
Magnetic field is an issue for some patients (metal)
Expensive
Loud and you have to stay very still
Radioisotope Studies
Radionuclide studies
Administer radioactive substance
Measure uptake and excretion
Ex: Nuclear bone scans
Angiography
Contrast dye injected into vessels
Image shows blood flow (vasculature)
Looks for blockages
Also called “angiogram, arteriogram, venogram”
Can be done with X-ray, CT, MRI (called MRA)
US
Ultrasound
High frequency sound waves in the body are reflected by tissues.
Bounce back to machine and convert into image
PET Scan
Positron emission tomography
Radioactive substance introduced into a metabolically-active molecule (glucose)
Metabolically active areas light up
Ex: abnormal glucose metabolism indicative of seizures
Endoscopy
Visual examination with fiberoptic scope
Can look at upper and lower GI tracts, broncho (lungs), cystoscopic (bladder), laparoscopic (abdominal wall), arthroscopic (joints), etc.
Electrical activity diagnostic procedures
EEG, ECG, EMG
Looks at electrical activity in the brain, tissue, muscle, etc.
EMG
Electromyography
Electrodes superficially on muscle, attached to a biofeedback unit indicates activation of muscle in clinic
Mortality
What kills people in the US?
- Heart disease
- Cancer (CA)
- Stroke (CVA)
- Accidents
- COPD (lung disease)
Mortality
Attributions in the US
OVER 50% of deaths are attributed to behavioral & lifestyle factors.
Majority are PREVENTABLE with modification (i.e. diet and exercise)
*We spend more time with patients than any other medical professional
Impact PT’s can have on mortality
*We spend more time with patients than any other medical professional - we can influence these modifiable factors that attribute to mortality
WHO
World Health Organization
The standard for many classifications
Created the ICF Disablement Model
ICF disablement model
Very basic, but powerful Focuses on the biopsychosocial approach Has the following categories: Health condition (disorder or disease) BFS (body functions and structures) Activity Participation Environmental factors Personal factors
How does the ICF affect PT’s?
Determines where we jump in at - participation, environment, treating the BFS, etc.
BFS
Body function and structures
Physiological functions of body systems and anatomical parts of the body
Activity limitations
Difficulties an individual may have executing activities. Limitations are measured mild to severe.
Participation restriction
Problems an individual may experience in involvement in life situations. Measured against societal standards.
*Social distinction
Disability
Umbrella term for impairments, activity limitations, and participation restrictions
Contextual factors
Environmental and Personal
Types of disease prevention
Primary
Secondary
Tertiary
Primary prevention
Identify risk factors, introduce diet, exercise, stress management, etc. = Education!
Removing or reducing R.F.’s
Secondary prevention
Promoting early detection and intervention of disease (to prevent further complications)
Disease is present, but goal is to keep at lowest level.
Tertiary prevention
Limiting the impact of the disease.
Decrease the degree of disability and promote rehab and restoration of function in patients with chronic and irreversible diseases.
Disease is in full swing.
Try to keep patient functional, independent, mobile, etc.
APTA’s roles of physical therapists
Examination - data collection Evaluation - clinical judgement Diagnosis - PT diagnosis Prognosis - PT prognosis Intervention Outcomes assessment
Differential diagnosis
Being able to recognize symptoms and signs of other diagnoses. Medical screening and medical referrals may be needed.
PT Contraindications
May require temporal deferral of prescription session or discontinuance (d/c).
May require new order or new assessment.
Worsening of condition, known signs/symptoms
Onset of new signs/symptoms
Unstable, worsening, or fluctuating medical status
New diagnosis
What do PT’s treat?
The patient, NOT the disease or pathology.
