Pathologies Related to the Pelvis and Hip II Flashcards
What does the colon do?
- dehydrate food and form it into stool
- bacteria feed on waste and break it down futher
What is the function of the rectum?
stool storage prior to bowel movement
What is the prevalence of colon cancer?
- 3rd MOST common cancer
- 2nd leading cause of cancer death
Where does colon cancer commonly metastasize?
to the thorax!
What is the etiology of colorectal cancer?
UNKNOWN
What are some risk factors for colorectal cancer?
- > 50 yo
- family hx
- biological male
- IBS
- Obesity
- smoking/alcohol use
- diets low in veggies and high in sugar and animal fats (SAD)
What is the pathogenesis of colorectal cancer?
malignant neoplasm that develops in the large intestines
What will we observe with colorectal cancer?
- wavelike motion in lower Left Quadrant if obstruction
What will we find in hx with colorectal cancer?
- cancer S&S
- possible referred pain that is dull and diffuses to lower left quadrant in T10-S2 distribution
- change in bowel function, even obstruction
- Bloody (black) stools (HALLMARK SIGN!)
What will we find with palpation with colorectal cancer?
- abnormal
- <2cm and immobile but NON-TENDER due to limited inflammation with typical slow growth of MOST cancer
What will be painful with palpation AND percussion with colorectal cancer?
the lower left quadrant with inflammation
What will we find with vital signs with colorectal cancer?
fever
What should we ensure a screening of BEFORE colorectal cancer? When?
- routine screening (colonoscopy beginning at 45 years)
What helps bowel function and transit time?
EXERCISE
What kind of a referral is colorectal cancer?
Urgent referral to MD
What is the function of the cervix?
- sex cell motility
- protection from bacteria and foreign objects
- path for birthing
Is cervical cancer largely preventable?
YES
What is the PRIMARY risk factor for cervical cancer?
Human papillomavirus (HPV)
What are other risk factors for cervical cancer?
- drug and alcohol use that inhibits judgement
- > 5 sexual partners
What is the prevalence of cervical cancer?
3rd MOST common biological female cancer behind breast and colorectum
What is the incidence of cervical cancer doing?
Increasing in younger females
What is the pathogenesis of cervical cancer?
- HPV limits neoplasm suppressors in the cervix and allows malignant neoplasm to develop
What will we find in hx with cervical cancer?
- cancer S&S
- pelvic or LBP
- excessive and untimely bleeding
- bowel/bladder and/or sexual dysfunction due to pressure from enlarged cervix
What will we find with palpation with cervical cancer?
- abnormal lymph nodes
- > 2 cm, firm immobile but NON-tender due to limited inflammation with typical slow growth of MOST cancer
What will we find with vital signs with cervical cancer?
Fever
What should we ensure to PREVENT cervical cancer?
- regular OB/GYN visits annually
- HPV vaccine t 11-12 years of age (less effective after any sexual activity)
What effect does radiation have on bone density?
- decreases estrogen so decreased bone density may be a side effect
What kind of referral is cervical cancer?
Urgent referral to MD
What is chondrosarcoma?
slow growing malignant neoplasm
- literally cartilage, cancer
What is the etiology of chondrosarcoma?
sporadic and unknown
What body parts is chondrosarcoma more common in?
pelvis and femur
What demographic does chondrosarcoma effect MOST?
middle aged biological males
What is the pathogenesis of chondrosarcoma?
- chromosomal abnormalities lead to malignant cartilage neoplam and possible bony changes
What will we see on imaging (radiograph) with chondrosarcoma?
- thickening of cortex
- destruction of the medullary and cortical bone
- soft tissue mass
What are the ABCS of imaging?
- alignment
- bone density
- cartilage space
- soft tissues
What will we find in hx with chondrosarcoma?
- progressive and local swelling and pain
- cancer S&S
- possible fracture S&S if advanced
What will we find in our exam with chondrosarcoma?
- potential mechanical symptoms because of space occupying potential but wont match orthopedic conditions
- possible sign of the buttock
What will we find with palpation with chondrosarcoma?
- abnormal lymph nodes
- > 2cm, firm, immobile, NON-tender due to limited inflammation with typical slow growth of most cancer
What will we find in vital signs with chondrosarcoma?
fever
What kind of referral is chondrosarcoma?
urgent referral to MD
What is the function of the appendix?
unknown function
- possibly a storehouse of good bacteria
- others say useless
What is appendicitis?
inflammation of appendix
What population is appendicitis MOST common in?
late adolescence
- males>females
- rare in older adults half of all deaths due to rupture are in those >70 yo
What is the etiology of apendicitis?
- unknown in 50% of cases
- obstruction due to neoplasm, infection, foreign body preventing normal drainage
What is the pathogenesis of appendicitis?
- inflammation that can result in infection, necrosis and rupture
What will we find in hx in those with appendicitis?
- classic sequence
- periumbilical to right lower quadrant pelvic pain
- may also have right hip or groin pain
- not eating
- possible infection or cancer S&S
What makes the pain worse with appendicitis?
- increased abdominal pressure
- forward bending or knees to chest
- valsalva maneuver (coughing, laughing, straining, etc.)
What would we observe with appendicitis?
redness and swelling with infection
What would we find with ROM with appendicitis?
pain and limitation with hip and trunk flexion at end ranges
What would we find with palpation with appendicitis?
Lymph nodes
- > 2 cm diameter firm and tender if infection due to acute onset
- >2 cm diameter, firm, immobile and nontender if cancer
What will we find with our abdominal quadrant assessment with appendicitis?
- tenderness or “pinch an inch” at McBurney point
- rebound tenderness is the MOST accurate predictor of inflammation
- hot and swollen in right lower quadrant
What will we find with vital signs with appendicitis?
Fever
What kind of referral is appendicitis?
- urgent referral to MD unless severe pain then emergent referral
What is an inguinal hernia?
- congenital or acquired weakness/tearing in the abdominal organ covering that allows portions of organs to move out of the boundary or herniate
What are the etiologies of inguinal hernias?
- age
- obesity/pregnancy
- abdominal muscular weakness
- trauma like surgery or heavy lifting
What is the incidence/prevalence of inguinal hernias?
- MOST common type of hernia (75% of all hernias)
- occur at any age
What will we find in history with an inguinal hernia?
- painless and small at first
- progressively bulges and becomes painful in groin area
- more painful with increased abdominal pressure (forward bend, knees to chest, valsalva, coughing, laughing, straining, etc.)
- burning or pinching sensation
- may radiate to thigh or pelvic midline
What are clinical manifestations of an inguinal hernia?
- herniating organ may become constricted and dysfunctional and may develop systemic S&S of the respective organ that is herniated
What will we find with ROM with an inguinal hernia?
- Pain and limitation with abdominal or hip flexion activation
What will we find with palpation of an inguinal hernia?
- pain with palpation and percussion
- palpable bulge, esp with trunk flexor activity like crunch, coughing, etc.
What kind of referral is an inguinal hernia?
urgent referral to MD
What is septic or infective arthritis?
an active local infection on a weakened or compromised joint at the site of the primary infection
What are risk factors / etiologies for septic or infective arthritis?
- penetrating trauma (stabbing)
- total joint replacement
- chronic joint damage (RA, age related joint changes)
- diabetes (suppresses immune system, circulation)
- immunosuppression
- infectious disease
- substance abuse
- sickle cell disease
- renal failure affects immunity
Where is septic or infective arthritis MOST common in the body?
- LE joints, particularly the hip and knee
What populations are at an increased risk of septic or infective arthritis?
infants, children, and older adults
What is the pathogenesis of septic or infective arthritis?
- microorganism invasion that could be bacterial, viral or fungal
- multiplies rapidly due to
> weakened and compromised joint/health
> moist nature of synovial fluid in the joint - bacteria activated clotting factors that may lead to thrombosis
How soon can we see changes with septic or infective arthritis?
- MASSIVE inflammation or pannus erodes articular cartilage and subchondral bone in a FEW WEEKS (FAST)
What will we find in our hx with septic or infective arthritis?
acute and sudden onset of:
- infection S&S
- NWB
What will we find in our observation with septic or infective arthritis?
acute and sudden onset of:
- antalgic and asymmetrical gait if they can bear weight at all
What will we find in our scan with septic or infective arthritis?
- refusal to move to allow affected joint to be moved- so pain, limited ROM and weaknesses in multiple if not all directions
- possibly pain with compression and relief with distraction depending on whether bone is involved or not
- possible sign of the buttock
What will we find with palpation with septic or infective arthritis?
- severe TTP
- abnormal lymph nodes > 2cm diameter, firm, TENDER due to rapid onset of inflammation with infection
- heat
- swelling
What kind of referral is septic or infective arthritis?
EMERGENCY referral
Why is early dx of septic or infective arthritis critical?
- to avoid permanent joint and bone damage
How soon do we need to treat septic or infective arthritis to prevent damage?
4 days!
