49 Differential Diagnosis for PT: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary
Gastrointestinal (GI) Physiology • Functions to aid in ingestion/digestion of food, absorb water/electrolytes, and eliminate waste products • Consists of two tracks: Upper : Mouth, esophagus, stomach ○ Esophagus: Hollow tube made up of skeletal and smooth muscle; contains cardiac sphincter, which prevents reflux of contents of stomach ○ Stomach: Made up of smooth muscle that contracts to assist with the peristaltic movement of food; the stomach stores food, mixes it with gastric secretions, and empties it into small intestine through the pyloric pump Lower : Intestines ○ Intestines: Consist of large intestine and small intestine ○ Small intestine: 90% of nutrient absorption occurs in the small intestine ■ Duodenum: Connects to stomach ■ Jejunum: Middle portion ■ Ileum: Connects to large intestine ○ Large intestine ■ Cecum: Connects to small intestine ■ Colon: Reabsorption of water/ electrolytes/bile ■ Rectum GI Pathophysiology Dysphagia : Sensation of food catching in esophagus • Causes ○ Peptic esophagitis ○ Neoplasm ○ Neuro diagnosis such as a cardiovascular accident (CVA) Achalasia: Inability of cardiac sphincter to relax Odynophagia : Pain during swallowing • Caused by esophagitis/spasm, fungal infection • May mimic cardiac pain • Esophagitis pain: Relieved by upright sitting and intensified by laying supine • Cardiac pain: Relieved by nitroglycerin or supine position
Bacterial Arthritis: Can be caused by gonococci, staph, strep, and enterobacteria • Begins with infection such as pneumonia, sinusitis, or urinary tract infection • Bacteria travel through bloodstream to invade and infect synovium • Signs and symptoms: fever, chills, genral weakness, headaches, inflammation and painful swelling of one or more joints of the body Fibromyalgia: Generalized musculoskeletal pain and tenderness to touch, sleep disturbances, and fatigue • Signs and symptoms: generalized fatigue, reduced physical endurance, generalized aches and pains of muscles, tendons, and ligaments (tender points), insomnia, temperature deregulation, headache, morning stiffness Guidelines for Physician Referral • New onset of joint pain within six weeks of surgery, especially when accompanied by constitutional symptoms, rash, or skin lesions • Symmetric swelling and pain in peripheral joints may be early sign of RA • Development of progressive neurologic symptoms within one to three weeks of a previous infection or recent vaccination • Evidence of spinal cord compression in anyone with cervical RA who has progressed from generalized stiffness to new onset of cervical laxity • Presence of incontinence (bowel or bladder) in anyone with AS requires medical referral • Positive ptosis tests for MG SCREENING FOR DIGESTIVE SYSTEM DISORDERS • Can cause referred pain to left shoulder, scapula, mid-back, and hip • Pain in left shoulder (Kehr’s sign): Referred pain ○ Occurs as a result of free air/blood in abdominal cavity (e.g., ruptured spleen) ○ Diagnostic interview helpful in determining if trauma has occurred prior to experiencing shoulder pain ○ Test: Supine/lower extremity elevated
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