Download Principles of Clinical Pathology & Decision Making

PRINCIPLES OF CLINICAL
PATHOLOGY & DECISION
MAKING
CHAPTER 1
PATHOLOGY
TERMINOLOGY
• Pathology – the study of the biological causes,
effects, and processes of disease
• Pathogenesis – the underlying cause of a disease or
the development of a disease
• Etiology – the mechanisms of disease
TERMINOLOGY
• Sign – an objective, observable indication of
pathology, usually discovered during physical
examination; can be seen or measured by the
clinician
• Symptom – subjective complaint reported by the
patient; an abnormal function, appearance, or
sensation experienced by the patient
• Medical conditions often produce characteristic
patterns of signs and symptoms
TERMINOLOGY
• Clinical presentation – the overall "picture" of signs,
symptoms, medical history, and physical
examination
TERMINOLOGY
• Diagnosis – refers to the specific injury, illness,
disease, or condition a patient has, as determined
by medical examination
• Differential diagnosis – the identification of several
conditions that might have similar clinical
presentations; requires referral to a physician for
further laboratory or imaging studies for clarification
of the diagnosis
TERMINOLOGY
• Coexisting or comorbid conditions – a medical
condition in addition to the primary problem; can
complicate recovery from an injury or illness, or
require treatment modifications
THEORIES OF DISEASE &
PATHOGENESIS
• Biomedical model of health and illness
• Attributes the cause of disease to abnormal cell, tissue, or
organ function
• Abnormal function can be caused by anatomical or
physiological defects, or by factors such as bacteria and
viruses
THEORIES OF DISEASE &
PATHOGENESIS
• Psychosocial theories
• Consider the psychological and social effects on illness and
disease
• Patients who cannot adapt cognitively or socially to a
major injury may be more prone to chronic illness and may
not respond to treatment as expected
• Emotional stress (e.g., academic, financial, social, etc.) can
confuse the clinical presentation of an illness
THEORIES OF DISEASE &
PATHOGENESIS
• Genetic factors
• Errors in DNA and RNA replication can contribute to
pathogenesis, the effectiveness of the immune system, and
rate of tissue healing
• Genetic and congenital disorders are commonly identified
in pediatric patients
CLINICAL DECISION MAKING
• A process used by athletic trainers to formulate a
diagnosis
• Information from medical history and physical examination
used to determine a differential diagnosis & best course of
action
CLINICAL DECISION MAKING
• The athletic trainer’s diagnosis may lead to actions
such as:
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First aid
Emergency transport
Treatment and rehabilitation
Reassessment
Modification of activity
Referral to other health care specialists
CLINICAL DECISION MAKING
• Recognizing characteristic patterns of signs and
symptoms can suggest potential pathogenesis and
help to determine a course of action
MEDICAL HISTORY
• “an account of the events” related to a patient’s
state of health
• the scope of the medical history should be
appropriate for the specific injury/illness
MEDICAL HISTORY
• Purposes
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determine potential pathogenesis
identify co-existing conditions
determine the stage of the injury or illness
identify contraindications to treatment
MEDICAL HISTORY
• Procedures
• must be thorough and complete
• established rapport with patient
• guides the physical examination
MEDICAL HISTORY
• Components
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chief complaint
description and course of present illness
personal medical history
family medical history
review of systems
HISTORY OF CURRENT INJURY/ILLNESS
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When did your condition start?
What makes your condition better?
What makes it worse?
Is your condition better or worse in
The morning or at night?
Is your condition better or worse with breathing,
urination, eating, excitement or stress, rest, or
certain body positions?
HISTORY OF CURRENT INJURY/ILLNESS
• Have you had X-rays, MRIs, or CT scans for this
• condition?
• What treatment have you received for this
condition?
• Is your condition getting better, getting worse, or
not changing either way?
• Have you ever had any condition like this before?
• Is there anything else I need to know about you or
your condition?
MEDICAL TESTS
• Imaging studies and laboratory tests, and when
those tests were performed, should be documented
• Medications (both prescription and nonprescription)
for all current and coexisting conditions should be
recorded
• Many medications have side effects or require
treatment precautions
CAUSES OF PAIN
• Mechanical
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caused by musculoskeletal injuries
appears only in the injured structure
Intermittent
related to movement or position
relieved by removing the offending stress
CAUSES OF PAIN
• Chemical
• biochemical substances released with tissue injury can
produce pain and inflammation
• this type of pain is constant, although intensity may change,
and cannot be relieved by movement or position, although
it may worsen with such changes
• medication addresses chemical causes and thus nearly
always decreases this type of pain
• poorly localized and may refer to other locations if nerves or
adjacent anatomical structures are affected
CAUSES OF PAIN
• Perceptual
• a person’s response to pain is affected by cultural, social,
and personal experiences
• it is possible for the physical (mechanical and chemical)
origin of pain to be "healed" while the perception of pain
remains
PAIN GENERATING TISSUES
• Different tissues produce different types of pain
• Cutaneous pain
• generated by skin and subcutaneous tissues pain
• localized to the area of tissue damage
PAIN GENERATING TISSUES
• Different tissues produce different types of pain
• Deep somatic pain
• originates in bones, nerves, muscles, tendons, ligaments,
arteries, or joints
• may refer or cause autonomic reactions such as sweating,
pallor, nausea, and syncope
PAIN GENERATING TISSUES
• Different tissues produce different types of pain
visceral pain
• produced by the internal organs of the cardiovascular,
hematological, pulmonary, digestive, urogenital, endocrine,
and reproductive systems can
• nociceptors relay a diffuse signal that refers to associated
dermatomes or produce a deep, gnawing ache in the
thorax or abdomen
RED FLAGS
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Constant pain
Heart palpitations
Fainting
Night pain or night sweats
Visual problems
Unexplained weight loss
RED FLAGS
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Severe shortness of breath
Recurrent nausea or vomiting
Difficult or painful urination
Blood in urine or stool
Excessive malaise or fatigue
ASSESSMENT OF GENERAL MEDICAL
ILLNESSES
• History
• Present complaints
• Medical history
• Family history
• Palpation
• Inspection
• Special Tests
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Vital signs
Percussion
Auscultation
Neurological screening
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Otoscope
Stethoscope
Sphygmomanometer
Peak flow meter
Urinalysis test strip
Glucometer
• Special Tools
DIFFERENTIAL DIAGNOSIS
• Your assessment may identify more than one
condition that might be causing the problem