CHAPTER 1 PATHOLOGY PRINCIPLES OF CLINICAL PATHOLOGY & DECISION MAKING

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: 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 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 chief complaint description and course of present illness personal medical history family medical history review of systems

HISTORY OF CURRENT INJURY/ILLNESS 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 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 Constant pain Heart palpitations Fainting Night pain or night sweats Visual problems Unexplained weight loss

RED FLAGS 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 Vital signs Percussion Auscultation Neurological screening Special Tools Otoscope Stethoscope Sphygmomanometer Peak flow meter Urinalysis test strip Glucometer

DIFFERENTIAL DIAGNOSIS Your assessment may identify more than one condition that might be causing the problem