MSP Unit 1

• Definition of pathophysiology includes the disordered physiological processes associated with disease or injury.
• Disease and disorders are caused by intrinsic factors, like genetic, congenital, neoplastic, and immunological, or extrinsic causes, like physical or chemical factors.
• Main types of causes includes etiology, intrinsic, extrinsic, and pathogenesis.

Modifiable factors

• Smoking
• High blood pressure
• Physical inactivity
• Diet
• Weight

Non-modifiable factors

• Age
• Gender
• Family history
• Ethnicity

Pathologies

• Clinical manifestations
• Signs
• Symptoms
• Sequelae
• Complications
• Resolution

Etiologies

• Incidence
• Prevalence
• Diagnosis
• Prognosis
• Treatment

Disease phases

• Acute diseases have a short duration and relatively rapid onset.
• A self-limiting condition responds to specific treatment with full recovery and no complications.
• Subacute conditions are present for longer than a few days but less than several months and describe a course between acute and chronic illness.
• Chronic conditions are long lasting and can include permanent impairment or disability requiring long-term medical management or special rehabilitation.

Cell injury

• Reversible injured cells are able to adapt.
• Alterations in cellular mechanisms are a characteristic of injured cells.
• Irreversible injured cells are unable to adapt, resulting in necrosis or cell death

Causes of Cell Injury

• Ischemia that results in insufficient or absent blood flow causes cell injury
• Circulatory and metabolism issues, respiratory inadequate transport, and inadequate transport may additionally lead to cell injury.
• Reduction in ATP synthesis and loss of aerobic metabolism along with the accumulation of ions and fluid intracellularly can cause the cells to swell.
• Bacterial infections that encounter the second line of defense triggers an inflammatory response, with endotoxins inducing systemic manifestations of sepsis, while exotoxins can damage host cells or disrupt normal processes.
• Viral infections elicit a cytopathic effect, both directly (RNA viruses disrupting integrity) and indirectly (DNA viruses inserting foreign viral protein).
• Chemical factors such as carbon monoxide and ammonia can cause cell injury.
• Heavy metals, alkylating agents in pharmaceutical drugs, and free radicals can cause cell injury.
• Oxidation creates free radicals that are linked to multiple diseases.
• Mechanical factors including physical injury impacts cell injury.
• Tissues can be affected by age, utilization, and physical factors.
• Compression, friction, torsion, and shear forces along with magnitudes of load can cause cell injury.
• Deficiencies in vitamins and minerals are nutritional factors that cause cell injury.
• Psychosocial factors include tension, fear, anxiety, depression, and isolation.
• Cellular aging can lead to pathology because of the decline of homeostatic balance.
• Free radical aging theory causes DNA damage.

Inflammation after Cell Injury

• Symptoms include the cardinal signs of inflammation
• Rubor happens due to vasodilation which leads to exudate and edema.
• Calor happens due to increased blood flow.
• Tumor swelling happens due to the capillary shift.
• Dolor occurs due to both mechanical and chemical factors.
• Necrosis is the endpoint of a pathological process, occurring with cell injury and is considered irreversible.
• Apoptosis is programmed cell death which is genetically-mediated.

Types of Necrosis

• Coagulative
• Liquefactive
• Caseous
• Fatty
• Fibrinoid

Cellular adaptations

• Cells under stress may undergo adaptations like atrophy, hypertrophy, hyperplasia, metaplasia, or dysplasia
• Altered functional demand and stress maintenance can cause adaptations.
• Removing the stressor allows a return to normal cell state.
• Atrophy happens when there is a decrease in cell size
• Hypertrophy is increase in cell size
• Hyperplasia is an increase in cell number
• Metaplasia is the change in cell type.
• Dysplasia is the change in the cell's organization.

Inflammation

• Acute inflammation has sudden onset and a short duration
• Acute inflammation causes exudation and polymorphonuclear (PMN) leukocytes, specifically neutrophils.
• Chronic inflammation lasts over time, bringing in macrophages and lymphocytes, proliferation of blood vessels, and tissue destruction.
• Transudate is a non-inflammatory effusion with clear fluid, low protein, and low WBC count, while exudate is inflammatory with higher protein and leukocytes and is classified by subtype.
• Exudate deposits collect in nearby tissue due to inflammation and vascular permeability.
• Assessment of exudate includes looking at color, consistency, odor, amount, and microscopic analysis of cell type, which may be any of sanguineous, serous, serosanguinous, catarrhal, or purulent subtypes.
• Systemic symptoms of septicemia include decreased appetite, nausea, fever, malaise, anemia, weight loss, and weakness.

Physical Therapists Role

• International Classification of Functioning, Disability, and Health describes how people live with their health condition.
• The ICF also defines the level of functioning, disability, and health for the health condition when described or evaluated.

Bone Injury description

• Avulsion is when a tendon or ligament pulls off a piece of bone.
• A closed fracture does not have broken skin.
• A comminuted fracture has more than two bone fragments.
• A complete fracture the bone has been completely fractured through its width
• A complex fracture bone severely damages the soft tissue that surrounds the bone.
• A compound fracture pierces breaks through the skin from the inside and soft tissues
• Compression fractures compress beyond bone limits of tolerance, common in vertebral bodies
• Epiphyseal fractures affect the growth plate and epiphysis, classified using Salter-Harris.
• Greenstick fractures are incomplete.
• Hairline fractures have minimal trauma on the bones involved.
• Oblique fractures go at an angle to the axis of the bone.
• Pathologic fractures occur when a bone breaks in an area that is weakened.
• Spiral fractures are caused twisting of the bone.
• Stress fractures may extend through all or only part of the way through the bone can occur among all age groups
• Impaction when where one fragment is driven into another.
• Types of Bone repair including the Repair involves hematoma formation, soft and hard callus formation, and remodeling.
• Bone repair can be non-surgical or surgical.
• The choice of treatment depends on the degree of injury and supporting issues are there is also stability involved

Healing

• Repaired by original tissue
• Regeneration vs. repair
• Primary vs. secondary repair
• Systems

Phases of healing

• Inflammatory Phase involves swelling, redness, heat, pain, loss of function over up to 3 days or up to 48 hours.
• Fibroplasia/Repair is highly cellular and allows tissue repair within days to weeks. Remodeling/Maturation decreases fibroblasts and increases collagen cross links from type 3 to type 1 over several months with wound healing.

Perarticular Tissues

• Includes ligaments, the joint capsule, and tendons.
• Periarticular tissues influence movemen
• These tissues do not produce active motion.
• Ligaments and joint capsules guide motion, while tendons transmit tensile loads.
• Regular tissues are found in ligaments and tendons.
• Irregular tissues are found in the joint capsule and fascia.

Ligament Injury

• Grade I tears are microscopic without any laxity.
• Grade II tears have some torn ligament fibers with moderate laxity.
• Grade III tears are ligaments are completely ruptured causing profound instability and laxity.

Lligament healing Process

• Torn ligament ends must be in contact with each other
• Tissues experiencing healing must apply controlled stress to reform.
• Must be protected during remodeling from excessive force

Surgical repair

• Direct repair
• Reconstruction involves autograft and allograft.
• Augmented repair uses synthetics or an internal brace.

Additional Information

• All ligaments do not heal at the same rate or degree.
• Intra-articular and extra-articular ligaments need to respond to the type of injury
• Not to mention the effect of immobilization cartilage degeneration decreased mechanical and the structure of ligaments. Also decreased bone density causes more weakness or the atrophy of muscles

Negative Effects of Immobilization

• Alterations in normal cellular and collagen alignment occur within ligaments, along with decreased mass, collagen turnover, and cross-linking.
• There are biochemical changes GAG and H2O.
• Intra articulations proliferation of fibro-fatty CT that obliterates the joint space
• Synovial adhesions resulting in tearing, necrosis & ulcerations of cartilage
• Changes In bone like generalized osteoporosis Morphologic and biochemical changes manifest after 6 weeks of immobiliaztion because it comes with dense connective tissue remodeling Results into contraction of adaptive shorting of muscule tendon ligament

Enhanced Ligament healing

• Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S. Where tendons and ligaments meet bone
• A= Immobilization
• B= Exercise

Pharmacology

• Pharmacology's relevance to rehabilitation includes the impacts of drugs on exercise, exercise on drugs, and drugs on healing, and the impacts of age, weight, disease state, diet and ethnicity on drugs. PTs should educate patients on drugs and watch for adverse reactions.
• It's important to alert others should prescribing errors are common
• Trade or brand name should be as safe and effective as the original
• In patients can respond differently to generics must be considered
• FDA approve drugs in the Phases in clinical subjects
• Orphan drugs: FDA makes provisions for the development approval and products for drugs to treat rare diseases Off-Label prescribing FDA approves the use of rugs the treat conditions other than the drig was originally approved to treat

Drug Schedules

• Schedule 1: None accepted, lacks of accepted safety. Abuse levels are high. An example is Heroin & Ecstasy
• Schedule 2:Accepted but is dispensed and prescribed. has a server psychological or physical dependency abuse levels are high. Example is morphine
• Schedule 3: accepted and prescribed some dependence. abuse levels are less the the two previous,Example is Anabolic
• Schedule 4: accepted the abuse is more than schedule V. Example is Propoxyphene
• Schedule 5: is Accepted levels prescribed are the least .

Pharmaceutical Considerations

• Drug dose-response curves allow for comparison -Drug and potency and allow effect There is effect are related to specific rate that drug reaches the system circulation at levels administration

Routes for Drug Administration - Two main routes administration,

• EN (Enteral) - Oral, subcutaneous, buccal & rectum
• PA (Parenteral): transdermal, IV injection & subcutaneous

Pharmacokinetics

• Pharmacokinetics involves drug absorption which the transfer of a drug from the site of administration to the bloodstream
• Drug distribution involves the process by which a drug leaves the bloodstream and enters the tissues
• Drug metabolism also known as biotransformation is the chemical changes that take place in the drug after administration also Drug Elimination happens because the removal of the drug from the body
• Bioavailability -Refers extent that drug reaches
• First Pass effect extent metabolism prior or wall before reaching -the systemic circulation Factors influence drug distribution Factors influences tissue permeability of blood flow binding from plasma proteins and storage tissue

Imaging techniques

Five Priorities for PT Imaging

• Understand the radiographic report
• Able Make recommendations
• Able to explain findings in imaging
• Make Precaution based on images – aid treatment decision

Radiology

• Is based on morphological evaluation of anatomy and macroscopic pathology.
• The ABCS are how people approach systematic radiological analysis radiographer A device made
• Radiographer help in images of the bones CT(Axial-axial plane) - Advantages of using imaging from radiological assistance . quick initial ,eval ,accessibly ,low price . disadvatges being radiation-high ,bone density
• MRI: higher quality-bone and tissue. More detailed. Does not use radiation
• Ultrasound:. Chea , bed side, low images

Key concept of imaging

• Radiodensity or Radiolucency -