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: • 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 • nociceptorsrelay 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 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

Differential Diagnosis • Your assessment may identify more than one condition that might be causing the problem

Principles of Clinical Pathology & Decision Making