Thorax and Abdomen Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C.

Thorax and Thorax and AbdomenAbdomen

Orthopedic Assessment III Orthopedic Assessment III – Head, Spine, and Trunk – Head, Spine, and Trunk

with Labwith Lab

PET 5609CPET 5609C

Clinical AnatomyClinical Anatomy

Thorax – bone cavityThorax – bone cavity Formed by 12 pairs of ribs that join Formed by 12 pairs of ribs that join

posteriorly with the thoracic spine and posteriorly with the thoracic spine and anteriorly with the sternumanteriorly with the sternum

Thoracic Cavity:Thoracic Cavity: Lined with a thin layer of tissue (pleura)Lined with a thin layer of tissue (pleura) One lung in each thoracic cavityOne lung in each thoracic cavity Mediastinum is between the chest cavityMediastinum is between the chest cavity

Heart, Aorta, Superior and Inferior Vena Cava, Heart, Aorta, Superior and Inferior Vena Cava, Trachea, Major Bronchi, and EsophagusTrachea, Major Bronchi, and Esophagus

Spinal cord – protected by vertebral columnSpinal cord – protected by vertebral column

Clinical AnatomyClinical Anatomy Muscles of Muscles of

Inspiration:Inspiration: Diaphragm:Diaphragm:

Separates thoracic and Separates thoracic and abdominal activitiesabdominal activities

Innervation: phrenic Innervation: phrenic nervenerve

Inhalation – diaphragm Inhalation – diaphragm contracts enlarging the contracts enlarging the thoracic cavity and thoracic cavity and reducing intra-thoracic reducing intra-thoracic pressure (air drawn into pressure (air drawn into lungs)lungs)

Exhalation – diaphragm Exhalation – diaphragm relaxes and air is relaxes and air is exhaled by elastic recoil exhaled by elastic recoil of the lungsof the lungs

Clinical AnatomyClinical Anatomy Muscles of Inspiration:Muscles of Inspiration:

Intercostal muscles:Intercostal muscles: External intercostal muscles: (outside of the ribcage) External intercostal muscles: (outside of the ribcage)

Elevate the ribs and expand the transverse dimensions of Elevate the ribs and expand the transverse dimensions of the thoracic cavity (aid in quiet and forced inhalation)the thoracic cavity (aid in quiet and forced inhalation)

Internal intercostal muscles: (inside the ribcage)Internal intercostal muscles: (inside the ribcage) Depress the ribs decreasing the transverse dimensions of Depress the ribs decreasing the transverse dimensions of

the thoracic cavity (aid in forced expiration)the thoracic cavity (aid in forced expiration) Scalene muscles:Scalene muscles:

Elevate the 1Elevate the 1stst and 2 and 2ndnd ribs ribs SCM, trapezius, serratus anterior, pectoralis SCM, trapezius, serratus anterior, pectoralis

major/minor and latissimus dorsi (secondary major/minor and latissimus dorsi (secondary muscles)muscles)

Muscles of Expiration:Muscles of Expiration: Abdominal muscles (rectus abdominis, Abdominal muscles (rectus abdominis,

internal/external obliques, transverse internal/external obliques, transverse abdominisabdominis

Clinical AnatomyClinical Anatomy Respiratory Tract Anatomy:Respiratory Tract Anatomy:

Trachea:Trachea: Connects larynx to 2 principle bronchiConnects larynx to 2 principle bronchi Left bronchus → 2 segmental bronchi (2 lobes)Left bronchus → 2 segmental bronchi (2 lobes) Right bronchus → 3 segmental bronchi (3 lobes)Right bronchus → 3 segmental bronchi (3 lobes)

Pleura:Pleura: Parietal pleura – lines thoracic wallParietal pleura – lines thoracic wall Visceral pleura – surrounds lungsVisceral pleura – surrounds lungs

Alveoli:Alveoli: Terminal branches of bronchiolesTerminal branches of bronchioles Gas exchangeGas exchange Capillary system → blood exchanged (pulmonary Capillary system → blood exchanged (pulmonary

arteries and veins)arteries and veins)

Heart Heart ChamberChamber

FunctionFunction

Right Right AtriumAtrium

Receives deoxygenated blood via:Receives deoxygenated blood via:

Superior vena cava (head, neck, upper Superior vena cava (head, neck, upper extremities)extremities)

Inferior vena cava (trunk and lower Inferior vena cava (trunk and lower extremities)extremities)

Role: Delivers blood to right ventricleRole: Delivers blood to right ventricle

Right Right VentricleVentricle

Receives deoxygenated blood from right Receives deoxygenated blood from right atriumatrium

Role: Delivers blood to lungs via left and Role: Delivers blood to lungs via left and right pulmonary arteriesright pulmonary arteries

Left AtriumLeft Atrium Receives oxygenated blood from lungs via Receives oxygenated blood from lungs via right and left pulmonary veinsright and left pulmonary veins

Role: Delivers blood to left ventricleRole: Delivers blood to left ventricle

Left Left VentricleVentricle

Delivers oxygenated blood through aortic Delivers oxygenated blood through aortic valve to ascending aortavalve to ascending aorta


Digestive Tract Anatomy:Digestive Tract Anatomy: Esophagus:Esophagus:

Carries food/liquid to stomachCarries food/liquid to stomach Small intestine:Small intestine:

Duodenum, jejunum, ileumDuodenum, jejunum, ileum Large intestine:Large intestine:

Cecum, ascending colon, transverse Cecum, ascending colon, transverse colon, descending colon, sigmoid coloncolon, descending colon, sigmoid colon

Rectum and AnusRectum and Anus


Lymphatic Organ Lymphatic Organ Anatomy:Anatomy: Spleen:Spleen:

Left upper quadrant Left upper quadrant (level of 9(level of 9thth-11-11thth ribs) ribs)

Solid organSolid organ Function:Function:

Produce and destroy Produce and destroy red blood cellsred blood cells

Blood reservoirBlood reservoir Increased risk of Increased risk of

injury → injury → mononucleosismononucleosis


Urinary Tract Anatomy:Urinary Tract Anatomy: Kidneys:Kidneys:

Filter bloodFilter blood Regulate electrolyte levels:Regulate electrolyte levels:

Maintain balance of water, sodium, potassiumMaintain balance of water, sodium, potassium Location:Location:

Posterior part of the abdominal cavity: (level of Posterior part of the abdominal cavity: (level of T12 – L3 vertebrae)T12 – L3 vertebrae)

Right kidney: sits below the diaphragm and Right kidney: sits below the diaphragm and posterior to the liver; sits slightly lower than posterior to the liver; sits slightly lower than left kidneyleft kidney

Left kidney: sits below the diaphragm and Left kidney: sits below the diaphragm and posterior to the spleenposterior to the spleen

Note: Lower portion of kidneys susceptible to Note: Lower portion of kidneys susceptible to trauma (unprotected by ribs)trauma (unprotected by ribs)


Urinary Tract Anatomy:Urinary Tract Anatomy: Ureters:Ureters:

Muscular ducts that propel urine from the kidneys Muscular ducts that propel urine from the kidneys to the urinary bladderto the urinary bladder

Length: 10-12 inches (adults)Length: 10-12 inches (adults)

Urinary Bladder:Urinary Bladder: Solid, muscular, and elastic organ Solid, muscular, and elastic organ Collects urine excreted by the kidneys Collects urine excreted by the kidneys Urine enters the bladder via the ureters and exits Urine enters the bladder via the ureters and exits

by urethraby urethra Urethra:Urethra:

Tube connects urinary bladder to outside the bodyTube connects urinary bladder to outside the body excretory function in both sexes (pass urine); excretory function in both sexes (pass urine);

reproductive function in males (passage for semen) reproductive function in males (passage for semen)


Reproductive Tract Anatomy:Reproductive Tract Anatomy: Testes:Testes:

Produce sperm and male sex hormones (testosterone) Produce sperm and male sex hormones (testosterone) Epididymis:Epididymis:

Coiled tube on posterior aspect of testes (stores Coiled tube on posterior aspect of testes (stores sperm)sperm)

Ovaries:Ovaries: Produce estrogen and progesterone and house Produce estrogen and progesterone and house

reproductive eggsreproductive eggs Fallopian Tubes:Fallopian Tubes:

Tubules lead from ovaries to uterusTubules lead from ovaries to uterus Uterus:Uterus:

Accepts the fertilized ovumAccepts the fertilized ovum

Clinical EvaluationClinical Evaluation Anatomy:Anatomy:

Abdominal cavity Abdominal cavity separated from the separated from the thorax by the thorax by the diaphragmdiaphragm

Lined with a Lined with a membrane membrane (Peritoneum)(Peritoneum)

Lower portion of Lower portion of abdominal cavity: abdominal cavity: (Pelvic region) (Pelvic region)

Surrounded by Surrounded by pelvis, vertebrae, pelvis, vertebrae, and sacrumand sacrum

Clinical EvaluationClinical Evaluation

Upper Right QuadrantUpper Right Quadrant Upper Left QuadrantUpper Left Quadrant

LiverLiver Heart, LungHeart, Lung

KidneyKidney SpleenSpleen

PancreasPancreas KidneyKidney

LungLung StomachStomach

Lower Right QuadrantLower Right Quadrant Lower Left QuadrantLower Left Quadrant

AppendixAppendix UreterUreter

UreterUreter BladderBladder

BladderBladder ColonColon

ColonColon GonadsGonads

GonadsGonads


History:History: Location of Pain:Location of Pain:

Musculoskeletal pain → ribs, costal cartilage, Musculoskeletal pain → ribs, costal cartilage, abdominal muscles (tender at injury site)abdominal muscles (tender at injury site)

Injury to internal organs → diffuse pain; referred Injury to internal organs → diffuse pain; referred pain sites (Kehr’s sign)pain sites (Kehr’s sign)

Onset of Symptoms:Onset of Symptoms: Gradual (internal bleeding can accumulate Gradual (internal bleeding can accumulate

within cavity)within cavity) Pain Pain ↑ ↑ with breathing (rib, abdominal injury)with breathing (rib, abdominal injury)

Mechanism of Injury:Mechanism of Injury: Direct blow (thoracic, abdominal, pelvic injuries)Direct blow (thoracic, abdominal, pelvic injuries)


History:History: Symptoms:Symptoms:

Pain, difficulty breathingPain, difficulty breathing Diffuse abdominal painDiffuse abdominal pain Nausea, dizzinessNausea, dizziness Vomiting of blood, blood in urine/stoolVomiting of blood, blood in urine/stool

Medical History:Medical History: Not common (acute injury)Not common (acute injury) Exercise-induced asthmaExercise-induced asthma Illnesses (mononucleosis)Illnesses (mononucleosis)

General Medical Health:General Medical Health: MedicationsMedications


Inspection:Inspection: Start → observe Start → observe

patient’s posturepatient’s posture Throat:Throat:

Position of trachea Position of trachea and larynx and larynx

Breathing pattern:Breathing pattern: Rate, respiration Rate, respiration

rate, depth, qualityrate, depth, quality Nail beds:Nail beds:

Capillary refill Capillary refill (cyanosis)(cyanosis)

Inspection:Inspection: Muscle toneMuscle tone Discoloration of Discoloration of

skin:skin: Contusions, Contusions,

wounds, abrasionwounds, abrasion Vomiting:Vomiting:

Presence of bloodPresence of blood HematuriaHematuria


Inspection:Inspection: Auscultation:Auscultation:

Lungs:Lungs: Inhalation – Inhalation –

smooth smooth unobstructed unobstructed soundsound

Absence: Absence: pneumothorax, pneumothorax, collapsed lungcollapsed lung

Rales: Rales: pneumoniapneumonia

Abdomen:Abdomen: Gurgling noises Gurgling noises

(peristalsis)(peristalsis)


Palpation:Palpation: Sternum:Sternum:

Manubrium, Manubrium, body, xiphoid body, xiphoid processprocess

Costal cartilage Costal cartilage and ribs:and ribs:

Palpate anterior Palpate anterior to posteriorto posterior

Pain, crepitus, Pain, crepitus, deformitydeformity


Palpation:Palpation: Spleen:Spleen:

Palpate for Palpate for enlarged spleen enlarged spleen under left rib cageunder left rib cage

Have patient raise Have patient raise arms above headarms above head


Palpation:Palpation: Kidneys:Kidneys:

Location → Location → under under posterolateral posterolateral portion of rib portion of rib cagecage

Right kidney Right kidney rests more rests more inferior than inferior than leftleft


Palpation: LiverPalpation: Liver Method 1:Method 1:

Place your fingers Place your fingers just below the just below the costal margin and costal margin and press firmlypress firmly

Ask the patient to Ask the patient to take a deep breathtake a deep breath

May feel the edge May feel the edge of the liver press of the liver press against or slide against or slide under your handunder your hand

Normal liver is not Normal liver is not tendertender


Palpation: LiverPalpation: Liver Method 2:Method 2:

Hands "hooked" Hands "hooked" around the costal around the costal margin from margin from aboveabove

Instruct patient Instruct patient to breath deeply to breath deeply to force the liver to force the liver down toward your down toward your fingersfingers


Palpation: Palpation: McBurney’s PointMcBurney’s Point Location → one-Location → one-

third of way third of way between right between right ASIS and navalASIS and naval

Tenderness → may Tenderness → may indicate acute indicate acute appendicitisappendicitis

Clinical EvaluationClinical Evaluation Palpation: Palpation:

AbdomenAbdomen Rigidity:Rigidity:

Occurs secondary to Occurs secondary to muscle guarding or muscle guarding or blood accumulationblood accumulation

Indication of Indication of internal injuryinternal injury

Rebound Rebound Tenderness:Tenderness:

Tests for peritoneal Tests for peritoneal irritation.irritation.

Palpate deeply and Palpate deeply and then quickly then quickly release pressurerelease pressure

↑ ↑ pain = peritoneal pain = peritoneal irritationirritation

Clinical EvaluationClinical Evaluation Palpation: AbdomenPalpation: Abdomen

Tissue density: PercussionTissue density: Percussion Patient position: hook-lyingPatient position: hook-lying Examiner: Lightly places one Examiner: Lightly places one

hand over abdomen (palm hand over abdomen (palm down); Index/middle fingers of down); Index/middle fingers of opposite hand tap the DIP opposite hand tap the DIP jointsjoints

Findings: (normal)Findings: (normal) Solid organs have a dull thumpSolid organs have a dull thump Hollow organs more resonant Hollow organs more resonant

soundsound Findings: (positive)Findings: (positive)

Hard, solid sounding echo over Hard, solid sounding echo over areas that should sound hollowareas that should sound hollow

Internal bleedingInternal bleeding


Palpation: Palpation: PercussionPercussion Hollow OrgansHollow Organs

Allow materials to Allow materials to pass through them pass through them (stomach, large (stomach, large intestine, small intestine, small intestine, pancreas) intestine, pancreas) or act as “holding or act as “holding tanks” (gall tanks” (gall bladder and urinary bladder and urinary bladder)bladder)

Less risk for injury Less risk for injury when emptywhen empty

Palpation: Palpation: PercussionPercussion Solid Organs:Solid Organs:

Significant blood Significant blood supplysupply

Liver, Spleen, Liver, Spleen, Pancreas, Kidney, Pancreas, Kidney, Ovaries, TestesOvaries, Testes

Higher risk of Higher risk of injuryinjury

BruisingBruising TearingTearing


UpperUpper Liver:Liver: Pain Pain associated with associated with cholecystitis or cholecystitis or liver lacerationliver lacerationGall bladder: Pain Pain without trauma without trauma indicates gall indicates gall bladder diseasebladder disease

Spleen:Spleen: Rigidity Rigidity under the last under the last several ribsseveral ribs

LowerLower Appendix:Appendix: Rebound Rebound tenderness tenderness indicates indicates appendicitisappendicitis

Colon:Colon: Colitis or Colitis or diverticulitis may diverticulitis may cause paincause pain

Pelvic Pelvic inflammation:inflammation: Diffuse tendernessDiffuse tenderness

Colon:Colon: Colitis or Colitis or diverticulitis may diverticulitis may cause paincause pain

Pelvic Pelvic inflammation:inflammation: Diffuse tendernessDiffuse tenderness

Quadrant Pain: Right Quadrant Pain: Right Left Left

Clinical EvaluationClinical Evaluation Vital Signs:Vital Signs:

Heart Rate:Heart Rate: Pulse: Pulse:

Regular / IrregularRegular / Irregular Strong / Weak Strong / Weak

Normal pulse is 60-100 beats Normal pulse is 60-100 beats per minuteper minute

Athletes tend to have a Athletes tend to have a slower pulse than non slower pulse than non athletes (well-conditioned athletes (well-conditioned strong heart)strong heart)

Normal pulse is 60-100 beats Normal pulse is 60-100 beats per minuteper minute

Athletes tend to have a Athletes tend to have a slower pulse than non slower pulse than non athletes (40-60 bpm)athletes (40-60 bpm)

Abnormal:Abnormal: Tacchycardia: > 100 bpmTacchycardia: > 100 bpm Bradycardia: < 60 bpmBradycardia: < 60 bpm


Vital Signs: Blood Vital Signs: Blood PressurePressure Patient position:Patient position:

Seated or supineSeated or supine Procedure:Procedure:

Cuff secured over upper armCuff secured over upper arm Stethoscope placed over Stethoscope placed over

brachial arterybrachial artery Inflate cuff to 180-200 mm Inflate cuff to 180-200 mm

HgHg Air slowly releasedAir slowly released Note point at which 1Note point at which 1stst pulse pulse

sound is heardsound is heard Note point at which last Note point at which last

pulse sound is heardpulse sound is heard


Vital Signs: Blood PressureVital Signs: Blood Pressure Affected by:Affected by:

Decrease in blood volume (severe Decrease in blood volume (severe bleeding or dehydration) – Hypovolemic bleeding or dehydration) – Hypovolemic shockshock

Decreased capacity of vessels (shock)Decreased capacity of vessels (shock) Rapid/weak pulse; ↓ BPRapid/weak pulse; ↓ BP

Decreased ability of heart to pump Decreased ability of heart to pump bloodblood

↓ ↓ nutrients/oxygen to organs of body nutrients/oxygen to organs of body (anoxia)(anoxia)

Clinical Evaluation

Vital Signs: Respiratory Rate Normal: 12 – 20 bpm Abnormal:

Rapid, shallow breaths:

Internal injury Shock

Deep, quick breaths: Pulmonary instruction Asthma

Noisy, raspy breaths: Airway obstruction

Clinical Evaluation

Rib Fractures: Most common injured:

5th-9th ribs (anterior and lateral portions) History:

Onset: acute (single traumatic blow) Pain: over fracture site

↑ pain with deep inspirations, coughing, sneezing, movement of torso

MOI: Force (anteroposterior direction) – outward

displacement Force (lateral side) – inward displacement

Internal injury (i.e. lungs)

Clinical Evaluation

Rib Fractures: Inspection:

Splinting posture: Holding the painful area to limit chest wall

movement during inspiration Discoloration / swelling Shallow, rapid respirations (minimize chest

movement) Palpation:

Point tenderness, crepitus, possible deformity Functional Tests:

Movement of torso causes pain ↑ pain with deep respiration, coughing, sneezing

Clinical Evaluation

Rib Fractures: Stress Fractures:

Rowing, swimming, golf Posterolateral portion of 4th-9th ribs Causes:

Overtraining, sudden increases in training Improper biomechanics

Special Tests: Rib compression test:

Contraindicated in presence of obvious fracture/lung trauma

Clinical Evaluation Lateral Rib

Compression Test: Test position:

Subject supine Action:

Examiner compresses the lateral aspect of the rib cage then quickly releases

Positive finding: Pain with compression

or release of pressure indicates possible rib fracture, contusion, or costochondral separation

Clinical Evaluation Anterior/Posterior

Rib Compression Test: Test position:

Subject supine Action:

Compress rib cage anterior to posterior and quickly release

Positive test: Pain with compression

or release of pressure indicates possible fracture, rib contusion, costochondral separation

Clinical Evaluation

Costochondral Injury: MOI:

Overstretching the costochondral junction

Hyperflexion Horizontal abduction “Snap” or “pop” at time

of injury

Symptoms: Anterior pain (cartilage

junction) ↑ pain with deep

breathing, coughing, sneezing

Clinical Evaluation Pneumothorax:

Accumulation of air in pleural activity Spontaneous pneumothorax:

Diagnosis dependent on signs/symptoms – rare condition

Chest pain, dyspnea, diminished breath sounds Chest pain – usually localized to the side of the

affected lung Can radiate to shoulder, neck, back

Contributing Factors: Family history, tall and thin body build Sports-related spontaneous pneumothorax –

documented in weight lifting, football, jogging Primary spontaneous pneumothorax:

Primary cause: Bleb (imperfection in the lining of the lung) bursts causing lung to deflate

Tall thin men (ages 20-40) Secondary spontaneous pneumothorax:

Chronic obstructive pulmonary disease (COPD)

Clinical Evaluation

Pneumothorax: Tension pneumothorax:

One-way valve is created from either blunt or penetrating trauma

Air can enter, CANNOT leave the pleural space

↑ Intrathoracic pressure will collapse the lung and ↑ pressure on mediastinum

Pressure will eventually collapse superior and inferior vena cava (loss of venous return)

Clinical Evaluation Pneumothorax:

Clinical Signs: Apprehension / Agitation Cyanosis Diminished breath

sounds Distended neck veins /

Tracheal deviation Palpation:

Trauma induced – point tenderness

Vital Signs: Labored, shallow

respirations BP drops rapidly Right tension

pneumothorax

Clinical Evaluation Hemothorax:

Blood enters the pleural space

Massive Hemothorax – at least 1500cc of blood loss into thoracic cavity

Penetrating injury Can occur from blunt trauma

Blood accumulates → lung on the affected side is compressed

Mediastinum may shift away from hemothorax

Inferior and superior vena cava and contralateral lung may become compressed

Clinical Evaluation

Hemothorax: Clinical

signs/symptoms: Produced by

hypovolemia and respiratory compromise

Anxiety, apprehension Symptoms of

hypovolemic shock Decreased breath

sounds or absence at injury site

Flat neck veins

Clinical Evaluation

Spleen Injury: History:

Acute (symptoms may take a few hours to develop)

Pain: Upper left quadrant Kehr’s sign – pain in upper left shoulder

Predisposing conditions: Mononucleosis:

↑ mass, ↓ elasticity

Inspection: Impact site – contusion Nausea and vomiting

Clinical Evaluation

Spleen Injury: Palpation:

Cold and clammy skin (shock) Pont tenderness Rebound tenderness Distention in upper left quadrant

Functional Tests: Kerh’s sign Low blood pressure

Clinical Evaluation

Kidney Pathologies: Contused/Lacerated Kidney:

History: Onset: acute Pain: posterolateral portion of upper lumbar

and lower thoracic region MOI: blunt trauma or penetrating injury to

kidney Inspection:

Contusion or laceration Hematuria:

Severe bleeding → noticeable blood Laboratory analysis needed

Signs/symptoms of shock

Clinical Evaluation

Kidney Pathologies: Palpation:

Point tenderness Abdominal rigidity

Functional Testing: Pain with urination

Laboratory Testing: Hematuria

Clinical Evaluation

Kidney Stones: Collection of

incomplete kidney filtration

Crystals of uric acid, calcium

1mm – 2.5 cm

Causes: Family history, stress,

diet

Signs: Pain with urination Pain (stone passed from

bladder through urethra)

Clinical Evaluation

Urinary Tract Infections: Bacterial infections of bladder or urethra Similar signs/symptoms of kidney stones Dysuria → frequent need to urinate Hematuria (abnormal urine color)

Urethritis: Inflammation of urethra Causes: chlamydia, gonorrhea, syphilis More common in males

Clinical Evaluation Appendicitis and

Appendix Rupture: Anatomy Location: Lower Right

Quadrant of Abdomen Elongated tube connected

to the cecum (pouch-like structure of the colon)

Function of the human appendix is unknown

Considered to be a remnant of a portion of the digestive tract which was once more functional and is now in the process of evolutionary regression

Clinical Evaluation Appendicitis:

Cause: Inflammation caused by

fecal obstruction, lymph swelling, tumor

High incidence in males (ages 15 – 25)

If bursts can bleed into peritoneal cavity and cause bacterial infection

Signs and Symptoms: Mild to severe pain in

lower abdomen Nausea, vomiting, fever,

cramping, abdominal rigidity, point tenderness

McBurney’s Point – between ASIS and umbilicus

Clinical Evaluation Hollow Organ Rupture:

Blunt trauma (non-rupture): able to absorb forces (deform/return to original shape without permanent injury)

Rupture: Can be fatal (secondary to hemorrhage,

peritoneal contamination) MOI and Signs/Symptoms:

Blow to abdomen Abdominal pain, possible nausea Palpation reveals guarding, rigidity, tenderness

(point, rebound) Bowel sounds are absent (auscultation) Blood in stool

Clinical Evaluation Gastritis:

Inflammation of stomach lining Causes:

Aspirin or anti-inflammatory medications Alcohol Infection, bile entering stomach

Esophageal Reflux: Backflow of gastric juices into esophagus

Heartburn, regurgitation of stomach acid Ulcer-like pain

Intestinal Ulcers: Irritation of duodenum (peptic ulcer)

Abdominal pain, nausea, vomiting, dark stools, fatigue Causes:

Bacteria Long-term use of aspirin or anti-inflammatory

medications

Clinical Evaluation Dyspepsia:

Pain in upper abdomen Common causes:

Gastroesophageal reflux disease (GERD), stomach ulcers

GERD – stomach acid splashes out of upper valve onto walls of esophagus

Burning pain in mid-upper abdomen / heartburn

Stomach Ulcers – wounds in lining of stomach

Common causes: Stress, virus, diet

Potential for bleeding if ulcers go untreated (open wounds)

Clinical Evaluation Colitis:

Inflammation of the large intestine Symptoms:

Frequent diarrhea Abdominal pain, increased bowel sounds, fever, painful

defecation, nausea, vomiting Causes:

Disease, irritation of bowel, ulcers, ischemia, bacteria, stress

Regional Enteritis (Crohn’s Disease): Affects the ileum Produces LRQ pain, cramping

Irritable Bowel Syndrome: Alters motility of the muscles of large intestine Alternating bouts of diarrhea and constipation Abdominal pain Gas build-up, nausea, vomiting

Clinical Evaluation Testicular Contusion:

MOI: Direct blow Inspection:

Patient instructed to inspect for normal size/consistency

Ruptured testicle – soft, inconsistent texture

Testicular Torsion: Spermatic cord and testicle

twisted within scrotum Symptoms:

Acute testicular pain, swelling, tenderness

Note: Immediate referral needed

Clinical Evaluation

Menstrual Irregularities: (associated with physical activity) Female Athlete Triad:

Combination: Disordered eating Amenorrhea Osteoporosis

Disorder that often goes unrecognized Lost bone mineral density Premature osteoporotic fractures Lost bone mineral density may never be

regained

Clinical Evaluation

Female Athlete Triad: Disordered Eating:

Anorexia, Bulimia, ENDOS Amenorrhea:

Related to athlete training/weight fluctuation is caused by changes in the hypothalamus

Result: Decreased levels of Estrogen Primary Amenorrhea:

No spontaneous uterine bleeding: By the age of 14 without development of 20

sexual characteristics By the age of 16 with otherwise normal

development

Clinical Evaluation

Female Athlete Triad: Amenorrhea:

Secondary Amenorrhea: 6-month absence of menstrual bleeding in a

woman with primary regular menses 12-month absence with previous

oligomenorrhea Osteoporosis:

Loss of bone mineral density and inadequate formation of bone

Premature osteoporosis: Risk for stress fractures Fx of hip, vertebral column

Thorax and Abdomen Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C.

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Transcript of Thorax and Abdomen Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C.