B.sc agriculture i principles of plant pathology u 1.1 introduction to plant pathology
Principles of Clinical Pathology & Decision Making
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Transcript of Principles of Clinical Pathology & Decision Making
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C H A P T E R 1PAT H O L O GY
PRINCIPLES OF CLINICAL PATHOLOGY & DECISION
MAKING
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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
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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
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TERMINOLOGY
• Clinical presentation – the overall "picture" of signs, symptoms, medical history, and physical examination
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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
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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
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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
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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
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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
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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
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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
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CLINICAL DECISION MAKING
• Recognizing characteristic patterns of signs and symptoms can suggest potential pathogenesis and help to determine a course of action
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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
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MEDICAL HISTORY
• Purposes• determine potential pathogenesis• identify co-existing conditions• determine the stage of the injury or illness• identify contraindications to treatment
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MEDICAL HISTORY
• Procedures• must be thorough and complete• established rapport with patient• guides the physical examination
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MEDICAL HISTORY
• Components• chief complaint• description and course of present illness• personal medical history• family medical history• review of systems
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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?
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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?
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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
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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
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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
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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
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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
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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
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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
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RED FLAGS
• Constant pain• Heart palpitations• Fainting• Night pain or night sweats• Visual problems• Unexplained weight loss
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RED FLAGS
• Severe shortness of breath• Recurrent nausea or vomiting• Difficult or painful urination• Blood in urine or stool• Excessive malaise or fatigue
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ASSESSMENT OF GENERAL MEDICALILLNESSES
• 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
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DIFFERENTIAL DIAGNOSIS
• Your assessment may identify more than one condition that might be causing the problem