Pathologies related to the low back III Flashcards
(53 cards)
1
Q
What are other terms for nephrolithiasis?
A
kidney stones or renal calculi
2
Q
What is the urinary system structure composed of?
A
kidneys, ureters, bladder, and urethra
3
Q
What are urinary system functions?
A
- filter fluid from renal blood flow
- remove waste
- retain essential substances for electrolytes and pH - stimulates RBC production
- blood pressure regulation
- converts vitamin D (absorbs Ca2+ to its active form)
4
Q
What is the etiology of nephrolitasis?
A
- disorders that lead to hyperexcretion of Ca2+ and uric acid (hyperthyroidism)
- NOT primarily drinking water
- obesity
- high animal protein intake
5
Q
What is the incidence/prevalence of nephrolithiasis?
A
3rd MOST common urinary tract disorder behind infections and prostate conditions
6
Q
What is the pathogenesis of nephrolithiasis?
A
Hard mass of salts composed of CA2+ > uric acid and other minerals deposited in urinary system as follows
7
Q
What are clinical manifestations and S&S of nephrolithiasis?
A
- referred pain into T10-L1 dermatomes
> may begin with intermittent unilateral LBP
> Progress to acute/severe back and flank ( between ribs and iliac crests) and possibly abdominal pain - radiating pain to the groin and perianal regions
- bladder dysfunction
- eventually unrelenting pain
- N&V due to pain severity
-infection (kidney or urinary tract) could occur so infection S&S may be present
8
Q
What are clinical manifestations and S&S of nephrolithiasis?
A
- Murphy percussion test over kidney determines referral
> one firm and closed fisted percussion over 12th costovertebral angle
> WNL = painless - pain also may be present with bladder palpation/percussion
9
Q
What is the referral for nephrolithiasis?
A
Urgent but possibly emergent referral depending on pain severity
10
Q
Is the skeleton metabolically active?
A
YES
11
Q
What happens to the skeleton throughout life?
A
Undergoes continuous remodeling with an annual turnover of bone
12
Q
Why is remodeling of the skeleton necessary?
A
- to maintain the structural integrity of the skeleton
- serve metabolic demands as a storehouse of Ca2+ and phosphorus
13
Q
When does bone mass peak?
A
Between 25-35 years
14
Q
What is osteoporosis?
A
A persistent progressive metabolic disease characterized by:
- low bone mass
- impaired bone quality
- decreased bone strength
- enhanced risk of fractures
15
Q
What are the types and etiology of osteoporosis?
A
- PRIMARY - most common, associated with aging
- secondary - consequence of disease or medication
16
Q
What is the incidence/prevalence of osteoporosis?
A
- 70% undiagnosed, found during investigation of other conditions
- increasing in younger individuals
- MOST COMMON METABOLIC BONE DISEASE
- expected to increase with aging population
- highest in post-menoposal biological women with estrogen deficits and Scandinavian ancestry
17
Q
What is a precursor to osteoporosis?
A
opteopenia or low bone mass
18
Q
What percentage of women and men will suffer an osteoporotic fx over 50yo?
A
33% women, 20% men
19
Q
What are internal risk factors for osteoporosis?
A
- lower hormone levels (estrogen)
- genetics
- social habits; > 2 beers, > glass of wine, > 1 liquor shop or > 3 cups of caffeine per day
20
Q
Why can lower estrogen effect osteoporosis?
A
- limits release of Ca2+ into blood and absorption
- associated with menopause and abnormal menses
21
Q
What can lower testosterone do that effects osteoporosis?
A
limits release of Ca2+ into blood
22
Q
How can genetics impact osteoporosis?
A
- family hx
- also plays a role with parathyroid for Ca2+ balance and smaller bone stature
23
Q
What are other risk factors for osteoporosis?
A
- physical inactivity
- depression alters hormone levels
- meds, particularly ≥ 3 months of corticosteroid use
- tobacco - smoking AND smokeless
- low vitamin D and Ca2+ levels associated with easting disorders, low protein, SAD or conditions that alter absorption of nutrients
24
Q
What patients with risk factors should have a Dexa (DXA) scan?
A
- biological women at 65
- men at 70
25
What is the pathogenesis of osteoporosis?
- primarily a metabolic disorder as osteoclastic activity > osteoblastic activity
- secondarily an endocrine disorder due to other conditions that limit Ca2+ regulating and sex (estrogen/testosterone) hormones for bone health
- loss of inner cancellous bone
- wedging, compression, and fx of vertebral body MOST often in lower thoracic and upper lumbar regions
- femurs, ribs and radius are also common areas of fx
26
What should we know about clinical manifestations of osteoporosis?
often asymptomatic until a fx occurs, however objective changes may be observed
27
What can we observe with posture with osteoporosis?
- FHP
- loss of height
- increased thoracic and lumbar kyphosis - fulcrums or rounded and slouched posture
- fx often occurs with a seemingly benign flexion activity (bending or sneezing)
28
What are clinical manifestations for PT for osteoporosis?
- severe back pain, potentially between mid-thoracic and upper lumbar region especially with flexion, compression and valsalva stresses
- pain may refer to flanks and abdominal region
29
What will we find with ROM with osteoporosis?
pain and limitation, primarily with flexion but possibly all directions
30
What will we find in resisted testing with osteoporosis?
Pain and weakness, primarily with flexion but possibly with all directions
31
What will we find in our stress tests with osteoporosis?
- pain with compression; relief with distraction
- pain with PA pressures
32
What will we find with neuro testing with osteoporosis?
most often negative, possibly in more severe cases
33
What are some special tests for osteoporosis?
- percussion
- supine sign (inability to lie supine due to pain)
34
What are some Roman's CPR signs in hx that can be PT implications of osteoporosis?
- > 52 years of age
- no LE pain
- BMI > 22
- no regular exercise
- biological female
35
What should we refer if suspected fracture?
- urgent referral
36
When is osteoporosis an EMERGENCY referral?
if neurological symptoms or inability to walk
37
What should we do with a patient with an osteoporotic fx?
- MOST osteoporotic fx are stable and able to tolerate rx due to ligamentous structure so proceed based on symptoms
38
What should we minimize with osteoporosis?
vertebral body compression
- through bracing, ADs (cane, reachers)
39
What is the MET focus for osteoporosis?
- bone integrity: maintenance or improving density
- balance
- walking and resistance training
40
What are some MT precautions for osteoporosis?
- cautious with JM, particularly higher grades may be contraindicated, if advanced level of disease or > 3 months of corticosteroid use
41
How CAN we use JM for osteoporosis?
to normalize motion and stresses throughout spine
42
When will the majority of patients heal with osteoporosis?
After 8-12 weeks of conservative treatment with subsequent decline in pain
43
What are some MD rx regarding percutaneous vertebroplasty for osteoporosis?
- good treatment for patients with acute/subacute pain
- addition of exercises vs. non provides better subjective outcomes starting at 6 months and lasting out to two years following sx
44
What is osteomalacia?
bone softening without the loss of bone mass or brittleness as with osteoporosis
- also a metabolic disease
45
What are some etiologic factors of osteomalacia?
- insufficient intestinal Ca2+ absorption due to lack of Ca2+ or more likely low vitamin D
- increased phosphate loss
46
What can cause increased phosphate loss (etiologic for osteomalacia)?
- kidney conditions
- long term antacid use
- hyperparathyroidism disorder that alters Ca2+ balance
47
What are risk factors for osteomalacia?
- lack of dietary or sunlight vitamin D
- malabsorption conditions including age that affect digestive and metabolic functions
- medications that alter vitamin D, Ca2+, or phosphate (i.e. antacids and anticonvulsants)
48
What is the pathogenesis of osteomalacia?
- lack of bone minerals, Ca2+ and phosphates leading to soft bones with possible fx but more likely bending
- NO affect on osteocytes
49
What does osteomalacia primarily affect?
Vertebra and femurs
50
Does osteomalacia have an affect on osteocytes?
NO
51
What are clinical manifestations of osteomalacia?
- LBP and pelvic/LE pain aggravated by weight bearing
- Ca2+ not only needed for bone strength and hormones but also neuromuscular function
- progresses to deformities
52
What are some neuromuscular function affects of osteomalacia?
- myalgia/arthralgia
- proximal muscle weakness and polyneuropathy
- altered gait/ increased falls
53
What are some deformities that osteomalacia can cause?
- increased thoracic kyphosis
- genu varum (bow legged)
