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Pathological Exam
Lower GI - small intestines & large intestines Diabetes insipidus - type of adult pituitary hypofunction resulting from damage to the posterior pituitary Therapy Advice for the Patient with Diabetes Mellitus - 1. Exercise regularly, particularly aerobic exercise, to Stimulate the cardiovascular system and improve circulation. Walking is particularly good.
- Wear shoes that provide good support but have plenty of room for the toes. A deeper toe box-depth shoe is needed to avoid rubbing of the skin. Shoes and socks should not be tight.
- Do not wear any socks that are tight round the lower leg or knee such as knee-high socks that restrict the circulation. Cotton socks or those that wick away moisture are preferred. Generally white socks are better as dyes may irritate the skin.
- Check feet daily, or have your care provider check them for you. A long-handled mirror is useful to see the soles of the feet. Be sure to check between the toes. Any signs of redness, rubbing, or other skin irritation should be reported to a podiatrist or physician immediately.
- Visit a podiatrist or chiropodist regularly to have toenails cut and any foot problems resolved. If the skin is cut, there is a greater chance of infection in patients with DM and a longer healing time. Feet should not be soaked too long because this will soften the skin and make it prone to breakdown.
- Eat a balanced diet and try to control weight.
- Test blood sugar levels regularly and take the prescribed medicine as indicated by the physician.
- Follow all medical advice for control of the diabetic symptoms.
- If you experience increased occurrences of weakness, fatigue, blurred vision, or changes in bladder or bowel habits, visit your physician.
- Dry feet well after bathing to prevent skin irritation and breakdown.
- Use a bed cradle at night to keep the weight of the bedclothes off the feet.
- Use light-weight bed clothes that are not tucked in. A light-weight comforter-type quilt is preferable.
- Use an assistive device to ambulate when balance is poor. Your physical therapist will determine the appropriate device and provide instructions for proper use.
- Exercise more in the morning than the afternoon to prevent hypoglycemic episodes during the night.
- Do NOT exercise alone. Take a friend with you or exercise with a group of people.
- Be aware that hypoglycemia may occur after exercise sessions and check glucose levels accordingly.
- Do NOT sit too close to fires with your feet and do NOT place feet on a central heating radiator. Take care when using heating pads. Do NOT leave heating pads turned on when you are asleep. Do NOT sleep with a hot water bottle next to your feet.
- When taking a bath check the water temperature with your elbow to make sure it is not too hot. You may not be able to detect the temperature with your feet and could get a burn if the water is too hot. Water for a bath should be mildly warm, not hot.
- Do NOT walk around the house or outside without shoes. You are at risk of injuring your feet. You may not know you have stepped on something and could easily get an infection.
- Do not exercise in very high or very low temperatures. If it is very hot outside, do not go out for a run. Try to exercise in a controlled climatic environment (e.g., taking a walk in a shopping mall rather than outside). Precautions for the Physical Therapist Assistant when Treating Patients with DM - 1. Do not fatigue the patient v with overexertion. Too much exertion can deplete the insulin levels and lead to hyperglycemia.
- Monitor vital signs carefully before, during, and after exercise sessions.
- Check the dorsalis pedis pulse (pedal pulse) before each treatment session, particularly if performing treatment for lower extremity ischemic ulcers.
- Monitor patients for signs of hypoglycemia and hyperglycemia. If a patient has an episode, administer sugar and contact the physician.
- Beware of extreme thirst as this could be a precursor to a hyperglycemic episode.
- When applying thermal agents, use extra insulating layers and test skin carefully for sensitivity to warmth and cold. When using hot packs, check the patient's skin every 5 minutes to ensure the skin is not too red. If arterial supply is impaired, do not use hot packs over the affected area. Consider using heat proximally on the limb to stimulate circulation through an indirect heating effect.
- When using aquatherapy, ensure patients have taken their required insulin and have eaten correctly. Watch the patient for signs of fatigue and hypoglycemia.
- Keep whirlpool temperatures below body temperature to avoid stressing the impaired circulation. Generally, water temperature should be 97° Fahrenheit.
- Warn patients that they may have hypoglycemia several hours after exercise and instruct them to monitor glucose levels carefully.
- If you think a patient is hypoglycemic, administer some fruit juice as long as they are conscious. If the patient is actually hyperglycemic, it will not make it worse. If the patient is hypoglycemic, it could prevent a coma.
- Do NOT provide therapy if the patient is having problems with noncontrolled glucose levels or hypertension. Refer the patient back to the physician.
Recommended Blood Glucose Levels - • 70-130 mg/dl
- < 180 mg/dl following meals Type I Diabetes Mellitus (insulin-dependent, juvenile diabetes) - Onset: usually less than 25 years of age Abrupt onset 5-10% of all cases Etiology: destruction of islet of Langerhans cells secondary to possible autoimmune or viral causative factor Insulin production: very little or none Ketoacidosis can occur Treatment includes insulin injection, exercise, and diet Type II Diabetes (non-insulin dependent, adult onset diabetes) - Usually older than 45 years of age Gradual onset 90-95% of all cases Etiology: resistance at insulin receptor sites usually secondary to obesity; ethnic prevalence Insulin production: variable Ketoacidosis will rarely occur Treatment includes weight loss, oral insulin, exercise, and diet Graves' Disease - one of the more common types of hyperthyroidism and is 8 times more common in women than in men. The age of onset is typically between the ages of 30 and 40. o often have a characteristic exophthalmos, a condition of bulging eyes o A goiter is an enlargement of the thyroid, noticeable as a horizontal swelling on the anterior of the neck. o Some of the other signs and symptoms of hyperthyroidism include nervousness and tremor, depression, mood swings, fatigue, diarrhea, restlessness, tachycardia, congestive heart failure (CHF), heat intolerance, palpitations, profuse sweating. Hair loss, blurred or double vision, changes in the menstrual cycle, muscle weakness, inflammation of the ligaments and tendons, and weight loss with increased appetite.
Cushing's Disease - characterized by hypercortisolism
- Etiology: In some cases, the increased level of Cortisol arises from tumors elsewhere in the body, such as small cell lung carcinoma, that produce adrenocorticotropic hormone (ACTH) causing the adrenal glands to produce excessive amounts of cortisol.
- Signs and Symptoms: abdominal and facial obesity with the characteristic "moon face" seen in people who take steroidal medications. The "buffalo hump" appearance in the area of the upper trapezius, redness of the face, thinning of the skin which bruises easily, hypertension, hirsutism (excessive hair growth), osteoporosis, an impaired immune system, proximal myopathy (muscle weakness in the proximal extremities and shoulder and pelvic girdles), and diabetes are also present. The symptoms include fatigue, muscle weakness, mental changes, and striae (discolored areas of skin resembling stretch marks). Patients with endocrine system malfunctions - Present with decreased strength and vigor Dawn Phenomenon - also called the dawn effect, is the term used to describe an abnormal early- morning increase in blood sugar (glucose) — usually between 2 a.m. and 8 a.m. — in people with diabetes. Hypoglycemia - may lead to insulin shock, which can be life threatening if untreated
- Onset of symptoms is sudden
- Weakness, shaking
- Headache, blurred vision, pale skin (pallor)
- Confusion, nervousness
- Profuse perspiration
- Increased heart rate, palpitations
- Hunger
- Convulsions, may lead to coma
- Blood glucose levels below 70 mg/dl Hyperglycemia - • Gradual onset of symptoms
- Extreme thirst
- Confusion, lethargy
HBV virus can remain viable (able to infect a person) outside the body for prolonged periods of time, thus increasing the risk of contact. HBV in contaminated blood on the surface of a table or equipment can remain viable for as long as 7 days. o Etiology: HBV is a blood-borne pathogen transmitted through contact with contaminated blood, blood products, or through sexual contact. Specific methods of transmission may include blood transfusions; direct contact with the blood from an infected person into the eyes or a skin cut; contaminated instruments from such things as acupuncture, tattoos, and piercings; needle sharing when taking illicit drugs; unsafe sex; and from an infected mother to her child during the birthing process. The incubation period between transmission of the virus and the appearance of symptoms can be anywhere from 6 weeks to 6 months. o Signs and Symptoms: loss of appetite, nausea and vomiting, weakness, fatigue, a low-grade fever, joint and muscle pains and aching, and a possible skin rash. o Physical Therapy Intervention: Because the HBV virus remains viable for so long outside the body, all blood or body fluids should be treated as if they are contaminated. Hepatitis C (HCV) - A viral infection affecting the liver prevalent among people who use intravenous drugs. More than 85% of people who contract HCV develop the chronic form of the disease. o Etiology: Hepatitis C (HCV) is an RNA virus transmitted via infected blood that is most common in persons who use intravenous illicit drugs or have multiple sexual partners. Hepatitis C may develop as a nosocomial infection in people who are catheterized or may also be passed from mother to child during delivery. o Signs and Symptoms: The signs and symptoms of acute HCV include a reduction in appetite, fatigue, abdominal pain and tenderness on palpation over the region of the liver in the right upper quadrant of the abdomen, and muscle and joint pains. Chronic HCV may cause liver cirrhosis. The signs and symptoms of cirrhosis of the liver include an enlarged liver and spleen, jaundice, atrophy of muscles, skin abrasions or a rash, ascites (abdominal edema), ankle edema, and occasionally neuropathy in the distal lower extremities. o Prognosis: The prognosis for people with HCV depends on the severity of the infection. People with chronic HCV are at risk for liver failure, which can be life threatening. o Medical Intervention: Prevention is the best course of action for HCV by avoiding the risk behaviors for the condition described in the etiology section. No vaccine exists or the prevention of HCV. o Physical Therapy Intervention: is often indicated for people with HCV-associated arthritis or fibromyalgia. intervention is focused on improving functional ambulation and activities of daily living (ADL), increasing joint mobility, muscle strength, and endurance, as well as teaching energy conservation techniques. Hepatitis D, E, and G - these are much less common forms of hepatitis
Human Immunodeficiency virus (HIV)/Autoimmune deficiency syndrome (AIDS) - a sexually transmitted viral disease.
- The virus is a blood-borne pathogen transmitted through intimate contact with blood products or infected semen
- Sexual transmission can occur with unprotected sex in heterosexual and homosexual relationships when micro-tears occur in the walls of the vagina or rectum, allowing the virus to gain entry to the cells and blood.
- Reduction of the spread of the virus can be effected by the use of condoms, which can prevent blood contact when used correctly.
- Other means of transmission include hared hypodermic needles in people using illegal drugs and transmission of the virus from mother to child during pregnancy, during the birthing process, and through breast milk. Phases of HIV/AIDS (asymptomatic HIV to AIDS)
- Initial infection with HIV may remain undetectable in the bloodstream for several weeks. Even though detectable in the blood, the HIV virus may not produce any symptoms for prolonged periods of time.
- The virus gradually attacks more and more of the T-lymphocytes over time. o The rate of progression of the disease depends on the rate of attack and destruction of these T- lymphocytes.
- A mean latency period of between 10 and 15 years occurs between initial infection with HIV and the development of the symptoms of full-blown AIDS. AIDS dementia complex - • A recognized group of signs and symptoms associated with advanced AIDS and may include encephalitis, behavioral changes, meningitis, a reduction in cognitive function, psychological and neuropsychiatric disorders, central nervous system lymphomas, and brain tumors.
- Other neurological symptoms can include pain, peripheral neuropathy, stroke, seizures, herpes zoster, spinal cord problems, cerebellar atrophy resulting in loss of coordination of movement and gait disorders, depression, loss of vision, brain damage, and coma. Insect (Vector)-Borne Infectious Diseases - are those diseases transmitted to humans through the bite of insects.
- Some of the more common ones in the news in the United States are Lyme Disease, Rocky Mountain spotted fever, and West Nile virus
the hemoglobin content of the blood and of each red blood cell, the mean corpuscular volume (size of the red blood cells), and the platelet count. Colonoscopy and Sigmoidoscopy - o A colonoscopy is performed as a screening and investigative procedure for people at risk of colon cancer. o Colonoscopy involves passing a flexible fiberoptic tube with a camera through the rectum into the colon looking at the descending, transverse, and ascending colons. If polyps are found they are usually removed during the procedure, and biopsies of the wall of the colon can be taken and sent for histological testing. o The flexible sigmoidoscopy is a test similar to the colonoscopy but only checks the rectum and sigmoid colon, which is the last one-third of the colon. Digital Rectal Exam - o A digital rectal examination (DRE) is a screening test performed by a physician to determine abnormalities of the lower rectum and anus. o A gloved, lubricated finger is inserted into the rectum to palpate the walls of the rectum. o The detection of an abnormally large prostate in the male is also possible using this test. Endoscopy - o Endoscopy involves the insertion of a flexible tube containing a camera into the body. Esophageal pH Monitoring and Esophageal Acidity Testing - o A test used for people with esophageal acid reflux to determine the amount of acid entering the esophagus during 24-hour period. o The catheter and sensor is then removed and analyzed to see how often acid has refluxed into the esophagus from the stomach. Laparoscopic Exploratory Surgery - o Laparoscopic exploratory surgery is mainly used for conditions of the abdomen and pelvis. The laparoscope is a flexible tube containing a camera that allows the surgeon to see inside the abdomen. o The advantages of laparoscopy are that only several small incisions are needed, rather than the larger incisions of traditional surgical methods, resulting in reduced healing time. Radiographic and Imaging Tests - o Angiography, CAT scan, liver scan, nuclear medicine bone scan, Positron emission tomography (PET), Magnetic resonance imaging (MRI), Percutaneous transhepatic cholangiography, and ultrasonography
Urinary System - • includes the kidneys, adrenal glands, renal blood supply, urinary bladder, and the ureters.
- serves as in eliminator of waste substances and toxins from the body in conjunction with the intestinal system. Kidneys - • two are situated high up in the abdominal cavity on either side of the spine. They lie adjacent s diaphragm, and are protected by the lower ribs
- Renal fascia encloses them, which serves both to protect and to position them. Each is the shape of a kidney bean
- The functional units of the these are called nephrons. o Approximately 1 million nephrons are endorsed within each. o Urine is formed within the nephrons and then passed through the ureter to the bladder Characteristic Signs and Symptoms of UTI - Aneuria Dysuria (pain on micturition) Fever/malaise Frequency of micturition Hematuria Hesitancy of micturition Intermittency/postvoid dribbling Nocturia Oliguria Overflow incontinence Pain in low back Stress incontinence Urgency of micturition Urge incontinence Voiding problems Aneuria - Inability to urinate
Stress incontinence - Leakage of urine when an increase in intra-abdominal pressure occurs such as with exercising, coughing, sneezing, or laughing May be the result of weakness of pelvic floor musculature, or a sign of other urinary conditions. Urgency of micturition - The need to urinate immediately Lack of ability to control the urge to urinate May be caused by weakness of pelvic floor musculature or the result of other urinary tract conditions Urge incontinence - Inability to hold urine when the urge to urinate occurs Voiding problems - May be the result of renal or bladder pathology or prostate problems in men Normal Consituents and Characteristics of Urine - Clear Yellow/amber 100-140 ml/minute 0 - 2 red blood cells Slight 1 to 2 liters per day 4.6 - 8.0 (Slightly acidic) 10-150mg/day 1.010-1.025 (a lower number indicates less concentrated urine) Creatinine Ketones - small amounts normal Urea Uric acid 95% Abnormal Constituents and Characteristics of Urine - Cloudy - indicates infection (Bacteriuria) Brown/red tones - indicates presence of blood or bile pigment (liver disease)
Careen - bile pigment present in urine indicating jaundice (liver disease) Increased in kidney disease 3 or more red blood cells - indicates urinary tract infections, trauma, malignancy, polycystic kidney disease Acetone odor - diabetes ketosis Unusual or unpleasant odor - possible infection Anuria (no urine output) Dysuria (painful urination) Frequency (frequent urination) Nocturia (night-time urination) Oliguria (reduced urine output) Polyuria (increased urine output) Urgency (inability to control the need to urinate) Below 4.6 or above 8. 30—300 mg/day may indicate diabetes mellitus or hypertension glomerular problems Above 300 mg/day indicative of kidney failure, or kidney damage Above 1.025 (indicates very concentrated urine) Bacteriuria (presence of bacteria) Glucosuria (presence of glucose as in diabetes) Hematuria (presence of blood) Ketonuria (presence of high levels of ketones due to high protein diet or diabetes) Proteinuria (presence of protein) Pyuria (presence of pus) Urinary casts (microscopic particles) - indicates inflammation of kidney tubules PT Intervention for Gastricitis - is not generally part of the treatment for gastritis. Relaxation exercises may help to reduce overall feelings of stress.
