Low Back Pathologies 2 Flashcards
what is diffuse idiopathic skeletal hyperostosis
type of spindyloarthropathy or spondyloarthritide
aka DISH
often confused with ankylosing spondylitis
how is DISH different from ankylosing spondylosis
older ages
minimal to no SI jt involvement
no ARDC or ARJC
ossifications on ALL
no HLA rheumatic factor
relatively painless/mild symptoms
incidental discovery
incidence/prevalence of DISH
2nd most common type of arthritis next to OA
most commonly effects spine, right side of the thoracic region, but also lumbar
most often in people with type II diabetes
males > females 50-70 years of age
etiology of DISH
unknown
pathogenesis of DISH
ossification or bony outgrowths at entheses particularly of the spine but NOT bridging joints
S&S of spondyloarthropathies or spondyloarthritides
autoimmune
multi joint pain and inflammation
familial predisposition
extraarticular involvement of eyes, skin, GI, and renal and cardiac systems
“hurts to pee, see, and bend my knees”
describe the multi joint inflammation that occurs with spondy conditions
more than 30 min of pain after prolonged position
improved pain with easy movement
axial skeleton inflammation
asymmetric/unilateral involvement less likely (usually with smaller joints/at entheses)
clinical manifestations of DISH
may be asymptomatic
usually discovered from x-rays
back pain and stiffness
age appropriate spinal mobility
may not have functional limits
possible neuro if stenosis develops
URGENT REFERRAL
What might you see on imaging from DISH
ossifications along antyerolateral aspect in at least 4 successive vertebral bodies
no disc/joint degeneration
no fusion of factes
no osteoporosis
what is prostate cancer
prostate = reproductive gland below the bladder that aids in sperm function
unknown etiology
risk factots for prostate cancer
age/ethnicity
genetics
chemical exposure
high fat, red meat diet
obesity
alcohol
incidence of prostate cancer
only males
usually over 65
2nd most common cancer/death
African Americans > European Americans
pathogenesis of prostate cancer
disorganized gland cells infiltrate prostate
clinical S&S of prostate cancer
cancer S&S
often asymptomatic in early stages
lumbopelvic P!
primary tumor = bladder and sexual dysfunction
more common metastatic tumor
important questions to ask if a pt may be in the expected group for prostate cancer
always check bowel and bladder status
inquire about prostate specific antigen (PSA) screening yearly after age of 55
pelvic floor muscle training (PFMT) = over all benefit for bladder dysfunction
referral for suspected prostate cancer
URGENT
what is nephrolithiasis
aka kidney stones or renal calculi
can get them in kidneys, ureters, bladder, and urethra
function of urinary system
filter fluid from renal blood flow
remove waste
retain essential substances for fluid and contents balance
stimulate RBC production
regulate BP
convert vitamin D to active form
etiology/risk factors for kidney stones
disorders that lead to hyperexcretion of calcium (i.e. hypercalciuria, hyperthyroidism)
not primarily drinking water
obesity
high animal protein
incidence/prevalence of nephrolithiasis
3rd most common urinary tract disorder behind infections and prostate conditions
pathogenesis of nephrolithiasis
hard mass of salts composed of calcium > uric acid and other minerals
clinical manifestations and S&S of kidney stones
reffered pain into T10-L1 dermatomes (LBP, flank, and abdomen)
radiating pain into groin
bladder dysfunction/TTP
eventually unrelenting P!
N&V
kidney/urinary infection may be present
what is murphy percussion
percussion over kidney
used to determine referral
one firm closed fisted percussion over 12th costovertebral angle
WNL = painless
referral for kidney stones
mostly urgent but sometimes emergent depending on severity
function of the pancreas
exocrine = secretes enxymes for digestion, converting food/fluid to fuel
endocrine = releases insulin for sugar regulation
what is pancreatitis
severe inflammation of pancrease
can be acute (reversible) or chronic
etiology of pancreatitis
chronic alcohol consumption
high triglycerides that render insulin and receptors useless (diabetes)
obesity- contributions from high triglycerides
trauma
genetics
infectious agents
pathogenesis of pancreatitis
alcohol toxicity to pancreas cells
gallbladder bile refluxes into pancreas causing inflammation and possible fibrosis
clinical manifestations of pancreatitis
sharp right upper quadrant pain (radiates into thoracolumbar)
worsened with fatty meals/drinking alcohol
pain gets better with knees close to chest
N&V
jaundice/yellow
Grey-Turner-Sign = swollen flanks
Cullen sign = swollen umbilicus
can progress to infection S&S and vital and mental status change
PT implications for pancreatitis and referral
may lead to scarring in thoracolumbar region and be unmodifiable to JMs
urgent/possibly emergent referral depending on severity
what is an abdominal aortic aneurysm
weakening of vessel wall
incidence/prevalence of abdominal aortic aneurysm
aorta = most common site
Males > females
increasing frequency due to aging population
risk factors for aortic aneurysm
smoking
> 50 years old
male >female
vascular wall diseases (artherosclerosis/collagen disorders = weakened wall)
genetics - family history of AAA
etiology of AAA
trauma
vascular disease
infection
pathogenesis of AAA
weakening and loss of elastin in vessel walls
What might a pt with AAA tell you
Hx
-often asymptomatic/identified accidentally
-most often LBP but possibly abdominal and flank pain especially with activity
-searing, ripping, or tearing back or abdominal pain that stops all activity
observation for AAA
abdominal heartbeat
palpation S&S for AAA
non tender palpable mass (>3cm) that pulses, typically just L of midline from umbilicus
bruit with auscultation over aorta is more diagnostic than palpation alone
also absent/diminished pulses everywhere
referral for AAA
do not want to miss condition
emergency referral
MOST die before going to hospital
