Pathologies related to the low back III Flashcards

1
Q

What are other terms for nephrolithiasis?

A

kidney stones or renal calculi

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2
Q

What is the urinary system structure composed of?

A

kidneys, ureters, bladder, and urethra

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3
Q

What are urinary system functions?

A
  • filter fluid from renal blood flow
    - remove waste
    - retain essential substances for electrolytes and pH
  • stimulates RBC production
  • blood pressure regulation
  • converts vitamin D (absorbs Ca2+ to its active form)
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4
Q

What is the etiology of nephrolitasis?

A
  • disorders that lead to hyperexcretion of Ca2+ and uric acid (hyperthyroidism)
  • NOT primarily drinking water
  • obesity
  • high animal protein intake
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5
Q

What is the incidence/prevalence of nephrolithiasis?

A

3rd MOST common urinary tract disorder behind infections and prostate conditions

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6
Q

What is the pathogenesis of nephrolithiasis?

A

Hard mass of salts composed of CA2+ > uric acid and other minerals deposited in urinary system as follows

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7
Q

What are clinical manifestations and S&S of nephrolithiasis?

A
  • referred pain into T10-L1 dermatomes
    > may begin with intermittent unilateral LBP
    > Progress to acute/severe back and flank ( between ribs and iliac crests) and possibly abdominal pain
  • radiating pain to the groin and perianal regions
  • bladder dysfunction
  • eventually unrelenting pain
  • N&V due to pain severity
    -infection (kidney or urinary tract) could occur so infection S&S may be present
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8
Q

What are clinical manifestations and S&S of nephrolithiasis?

A
  • Murphy percussion test over kidney determines referral
    > one firm and closed fisted percussion over 12th costovertebral angle
    > WNL = painless
  • pain also may be present with bladder palpation/percussion
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9
Q

What is the referral for nephrolithiasis?

A

Urgent but possibly emergent referral depending on pain severity

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10
Q

Is the skeleton metabolically active?

A

YES

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11
Q

What happens to the skeleton throughout life?

A

Undergoes continuous remodeling with an annual turnover of bone

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12
Q

Why is remodeling of the skeleton necessary?

A
  • to maintain the structural integrity of the skeleton
  • serve metabolic demands as a storehouse of Ca2+ and phosphorus
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13
Q

When does bone mass peak?

A

Between 25-35 years

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14
Q

What is osteoporosis?

A

A persistent progressive metabolic disease characterized by:
- low bone mass
- impaired bone quality
- decreased bone strength
- enhanced risk of fractures

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15
Q

What are the types and etiology of osteoporosis?

A
  • PRIMARY - most common, associated with aging
  • secondary - consequence of disease or medication
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16
Q

What is the incidence/prevalence of osteoporosis?

A
  • 70% undiagnosed, found during investigation of other conditions
  • increasing in younger individuals
  • MOST COMMON METABOLIC BONE DISEASE
  • expected to increase with aging population
  • highest in post-menoposal biological women with estrogen deficits and Scandinavian ancestry
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17
Q

What is a precursor to osteoporosis?

A

opteopenia or low bone mass

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18
Q

What percentage of women and men will suffer an osteoporotic fx over 50yo?

A

33% women, 20% men

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19
Q

What are internal risk factors for osteoporosis?

A
  • lower hormone levels (estrogen)
  • genetics
  • social habits; > 2 beers, > glass of wine, > 1 liquor shop or > 3 cups of caffeine per day
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20
Q

Why can lower estrogen effect osteoporosis?

A
  • limits release of Ca2+ into blood and absorption
  • associated with menopause and abnormal menses
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21
Q

What can lower testosterone do that effects osteoporosis?

A

limits release of Ca2+ into blood

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22
Q

How can genetics impact osteoporosis?

A
  • family hx
  • also plays a role with parathyroid for Ca2+ balance and smaller bone stature
23
Q

What are other risk factors for osteoporosis?

A
  • physical inactivity
  • depression alters hormone levels
  • meds, particularly ≥ 3 months of corticosteroid use
  • tobacco - smoking AND smokeless
  • low vitamin D and Ca2+ levels associated with easting disorders, low protein, SAD or conditions that alter absorption of nutrients
24
Q

What patients with risk factors should have a Dexa (DXA) scan?

A
  • biological women at 65
  • men at 70
25
Q

What is the pathogenesis of osteoporosis?

A
  • primarily a metabolic disorder as osteoclastic activity > osteoblastic activity
  • secondarily an endocrine disorder due to other conditions that limit Ca2+ regulating and sex (estrogen/testosterone) hormones for bone health
  • loss of inner cancellous bone
  • wedging, compression, and fx of vertebral body MOST often in lower thoracic and upper lumbar regions
  • femurs, ribs and radius are also common areas of fx
26
Q

What should we know about clinical manifestations of osteoporosis?

A

often asymptomatic until a fx occurs, however objective changes may be observed

27
Q

What can we observe with posture with osteoporosis?

A
  • FHP
  • loss of height
  • increased thoracic and lumbar kyphosis - fulcrums or rounded and slouched posture
  • fx often occurs with a seemingly benign flexion activity (bending or sneezing)
28
Q

What are clinical manifestations for PT for osteoporosis?

A
  • severe back pain, potentially between mid-thoracic and upper lumbar region especially with flexion, compression and valsalva stresses
  • pain may refer to flanks and abdominal region
29
Q

What will we find with ROM with osteoporosis?

A

pain and limitation, primarily with flexion but possibly all directions

30
Q

What will we find in resisted testing with osteoporosis?

A

Pain and weakness, primarily with flexion but possibly with all directions

31
Q

What will we find in our stress tests with osteoporosis?

A
  • pain with compression; relief with distraction
  • pain with PA pressures
32
Q

What will we find with neuro testing with osteoporosis?

A

most often negative, possibly in more severe cases

33
Q

What are some special tests for osteoporosis?

A
  • percussion
  • supine sign (inability to lie supine due to pain)
34
Q

What are some Roman’s CPR signs in hx that can be PT implications of osteoporosis?

A
  • > 52 years of age
  • no LE pain
  • BMI > 22
  • no regular exercise
  • biological female
35
Q

What should we refer if suspected fracture?

A
  • urgent referral
36
Q

When is osteoporosis an EMERGENCY referral?

A

if neurological symptoms or inability to walk

37
Q

What should we do with a patient with an osteoporotic fx?

A
  • MOST osteoporotic fx are stable and able to tolerate rx due to ligamentous structure so proceed based on symptoms
38
Q

What should we minimize with osteoporosis?

A

vertebral body compression
- through bracing, ADs (cane, reachers)

39
Q

What is the MET focus for osteoporosis?

A
  • bone integrity: maintenance or improving density
  • balance
  • walking and resistance training
40
Q

What are some MT precautions for osteoporosis?

A
  • cautious with JM, particularly higher grades may be contraindicated, if advanced level of disease or > 3 months of corticosteroid use
41
Q

How CAN we use JM for osteoporosis?

A

to normalize motion and stresses throughout spine

42
Q

When will the majority of patients heal with osteoporosis?

A

After 8-12 weeks of conservative treatment with subsequent decline in pain

43
Q

What are some MD rx regarding percutaneous vertebroplasty for osteoporosis?

A
  • good treatment for patients with acute/subacute pain
  • addition of exercises vs. non provides better subjective outcomes starting at 6 months and lasting out to two years following sx
44
Q

What is osteomalacia?

A

bone softening without the loss of bone mass or brittleness as with osteoporosis
- also a metabolic disease

45
Q

What are some etiologic factors of osteomalacia?

A
  • insufficient intestinal Ca2+ absorption due to lack of Ca2+ or more likely low vitamin D
  • increased phosphate loss
46
Q

What can cause increased phosphate loss (etiologic for osteomalacia)?

A
  • kidney conditions
  • long term antacid use
  • hyperparathyroidism disorder that alters Ca2+ balance
47
Q

What are risk factors for osteomalacia?

A
  • lack of dietary or sunlight vitamin D
  • malabsorption conditions including age that affect digestive and metabolic functions
  • medications that alter vitamin D, Ca2+, or phosphate (i.e. antacids and anticonvulsants)
48
Q

What is the pathogenesis of osteomalacia?

A
  • lack of bone minerals, Ca2+ and phosphates leading to soft bones with possible fx but more likely bending
  • NO affect on osteocytes
49
Q

What does osteomalacia primarily affect?

A

Vertebra and femurs

50
Q

Does osteomalacia have an affect on osteocytes?

A

NO

51
Q

What are clinical manifestations of osteomalacia?

A
  • LBP and pelvic/LE pain aggravated by weight bearing
  • Ca2+ not only needed for bone strength and hormones but also neuromuscular function
  • progresses to deformities
52
Q

What are some neuromuscular function affects of osteomalacia?

A
  • myalgia/arthralgia
  • proximal muscle weakness and polyneuropathy
  • altered gait/ increased falls
53
Q

What are some deformities that osteomalacia can cause?

A
  • increased thoracic kyphosis
  • genu varum (bow legged)