C H A P T E R 1PAT H O L O GY

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 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