Chapter 7 Diagnosis and Treatment Surgery Copyright 2011

Chapter Objectives § Main components of a patient history. § Main methods used in

Key Terms anesthesia Loss of the ability to feel pain, as by administration of

Key Terms (cont’d) excision Removal by cutting (suffix -ectomy) fixation Holding or fastening a

Key Terms (cont’d) ophthalmoscope An instrument for examining the interior of the eye otoscope

Key Terms (cont’d) remission A lessening of disease symptoms; the period during which this

Key Terms (cont’d) suture To unite parts by stitching them together; also the thread

Key Terms Alternative and Complementary Medicine acupuncture An ancient Chinese method of inserting thin

Key Terms Alternative and Complementary Medicine (cont’d) holistic health care Practice of treating a

Key Terms Alternative and Complementary Medicine (cont’d) meditation Process of clearing the mind by

Supplementary Terms Symptoms clubbing Enlargement of the ends of the fingers and toes because

Supplementary Terms Diagnosis alpha-fetoprotein (AFP) A fetal protein that appears in the blood of

Supplementary Terms Treatment catheter A thin tube that can be passed into the body;

Supplementary Terms Surgery drain Device for allowing matter to escape from a wound or

Abbreviations History and Physical Examination ADL Activities of daily living BP Blood pressure bpm

Abbreviations History and Physical Examination (cont’d) h/o History of H&P History and physical HPI

Abbreviations History and Physical Examination (cont’d) PE Physical examination PE(R)RLA Pupils equal (regular) react

Abbreviations History and Physical Examination (cont’d) TPR Temperature, pulse, respiration VS Vital signs WD

Abbreviations Diagnosis and Treatment ABC Aspiration biopsy cytology AFP Alpha-fetoprotein BS Bowel sounds bx

Abbreviations Diagnosis and Treatment (cont’d) EBL Estimated blood loss ICU Intensive care unit I&D

Abbreviations Diagnosis and Treatment (cont’d) postop Postoperative preop Preoperative PSS Physiologic saline solution RATx

Abbreviations Views for Radiography AP Anteroposterior LL Left lateral PA Posteroanterior RL Right lateral

Abbreviation Orders AMA Against medical advice NPO Nothing by mouth (Latin, non per os)

Diagnosis ■ Determination of nature and cause of illness ■ Starts with patient history

Physical Examination ■ Inspection – Visual examination ■ Palpation – Touching body surface with

Vital Signs ■ Temperature ■ Pulse rate – Measured in beats per minute ■

Examination Tools ■ Ophthalmoscope – For examining eyes ■ Otoscope – For examining ears

Examination Procedures ■ Endoscope – Examines body cavities Copyright © 2011 Wolters Kluwer Health

Examination Procedures (cont’d) ■ Biopsy – Removal of tissue for microscopic examination – Specimens

Imaging Techniques ■ Used to produce visual images of body ■ Most common is

Treatment ■ Determined if appropriate by diagnosis ■ May consist as any combination of:

Surgery ■ One method of treating disease by manual operations ■ Usually done by

Purpose of Surgery ■ Treatment – Excision of diseased or abnormal tissue – Also

Surgical Instruments Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Alternative and Complementary Medicine ■ Disease causes have shifted ■ People looking to other

Alternative and Complementary Medicine (cont’d) ■ Other treatments include: acupuncture, biofeedback, massage, meditation, herbal

Roots for Physical Forces Root Meaning Example Definition of Example aer/o air, gas aerobic

Roots for Physical Forces (cont’d) Root Meaning Example Definition of Example phon/o sound, voice

Suffixes for Diagnosis Suffix Meaning Example Definition of Example -graph instrument for recording data

Suffixes for Diagnosis (cont’d) Suffix Meaning Example Definition of Example -meter instrument for measuring

Suffixes for Surgery Suffix Meaning Example Definition of Example -centesis puncture, tap arthrocentesis puncture

Suffixes for Surgery (cont’d) Suffix Meaning Example Definition of Example -stomy surgical creation tracheostomy

Cancer ■ Several methods to diagnose – Physical examination – Biopsy – Imaging –

Cancer (cont’d) – Staging ■ Procedure for seeing how far tumor has spread ■

Pretest 1. Determination of a disease's nature cause is called: (a) prognosis (b) diagnosis

Pretest 2. Measurements of the basic functions needed to maintain life, such as breathing

Pretest 3. The two phases recorded when measuring blood pressure are: (a) systolic and

Pretest 4. A simple device for listening to sounds within the body is a:

Pretest 5. Removal of tissue for microscopic study is a(n): (a) biopsy (b) aeration

Pretest 6. Prediction of a disease’s outcome is a(n): (a) evidence (b) prognosis (c)

Pretest 7. A process used to evaluate the severity of cancer is: (a) radiation

Pretest 8. A process used to evaluate the severity of cancer is: (a) therapy

Pretest 9. A tracheotomy is: (a) surgical incision of the trachea (b) placement of

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Chapter Objectives § Main components of a patient history. § Main methods used in patient examination. § Nine imaging techniques. § Possible forms of treatment. § Theories of alternative & complementary medicine and some healing practices used in these fields. ■ Staging and grading as they apply to cancer. ■ Basic terms for to medical examination, diagnosis & treatment. ■ Roots and suffixes pertaining to diagnosis and surgery. ■ Symbols and abbreviations used in diagnosis & treatment. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms anesthesia Loss of the ability to feel pain, as by administration of a drug auscultation Listening for sounds within the body, usually within the chest or abdomen biopsy Removal of a small amount of tissue for microscopic examination cautery Destruction of tissue by a damaging agent, such as a harmful chemical, heat, or electric current (electrocautery); cauterization chemotherapy Use of chemicals to treat disease. The term is often applied specifically to the treatment of cancer with chemicals. diagnosis The process of determining the cause and nature of an illness endoscope An instrument for examining the inside of an organ or cavity through a body opening or small incision; most endoscopes use fiberoptics for viewing Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms (cont’d) excision Removal by cutting (suffix -ectomy) fixation Holding or fastening a structure in a fixed position (suffix: -pexy) grading A method for evaluating a tumor based on microscopic examination of the cells immunotherapy Treatment that involves stimulation or suppression of the immune system, either specifically or nonspecifically incision A cut, as for surgery; also the act of cutting (suffix” -tomy) inspection Visual examination of the body laser A device that transforms light into a beam of intense heat and power; used for surgery and diagnosis Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms (cont’d) ophthalmoscope An instrument for examining the interior of the eye otoscope Instrument used to examine the ears palliative Providing relief but not cure; a treatment that provides such relief palpation Examining by placing the hands or fingers on the surface of the body to determine characteristics such as texture, temperature, movement, and consistency percussion Tapping the body lightly but sharply to assess the condition of the underlying tissue by the sounds obtained prognosis Prediction of the course and outcome of a disease radiography Use of x-rays passed through the body to make a visual record (radiograph) of internal structures on specially sensitized film; roentgenography (rent-ge-NOG-ra-fē) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms (cont’d) remission A lessening of disease symptoms; the period during which this decrease occurs or the period when no sign of a disease exists sign Objective evidence of disease that can be observed or tested; examples are fever, rash, high blood pressure, and blood or urine abnormalities; an objective symptom. sphygmomanometer Blood pressure apparatus or blood pressure cuff; pressure is read in millimeters of mercury (mm Hg) when the heart is contracting (systolic pressure) and when the heart is relaxing (diastolic pressure) and is reported as systolic/diastolic staging The process of classifying malignant tumors for diagnosis, treatment, and prognosis stethoscope An instrument used for listening to sounds produced within the body (from the Greek root steth/o, meaning “chest”) surgery A method for treating disease or injury by manual operations Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms (cont’d) suture To unite parts by stitching them together; also the thread or other material used in that process or the seam formed by surgical stitching (suffix -rhaphy) symptom Any evidence of disease; sometimes limited to subjective evidence of disease, as experienced by the individual, such as pain, dizziness, and weakness therapy Treatment; intervention vital signs Measurements that reflect basic functions necessary to maintain life Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Alternative and Complementary Medicine acupuncture An ancient Chinese method of inserting thin needles into the body at specific points to relieve pain, induce anesthesia, or promote healing; similar effects can be obtained by using firm finger pressure at the surface of the body in the technique of acupressure. biofeedback A method for learning control of involuntary physiologic responses by using electronic devices to monitor bodily changes and feeding this information back to a person chiropractic A science that stresses the condition of the nervous system in diagnosis and treatment of disease; often, the spine is manipulated to correct misalignment. Most patients consult for musculoskeletal pain and headaches. (From Greek cheir, meaning “hand”) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Alternative and Complementary Medicine (cont’d) holistic health care Practice of treating a person as a whole entity with physical, emotional, social, and spiritual needs. It stresses comprehensive care, involvement in one's own care, and the maintenance of good health rather than the treatment of disease. homeopathy A philosophy of treating disease by administering drugs in highly diluted form along with promoting healthy life habits and a healthy environment (from home/o, meaning “same, ” and path, meaning “disease”) massage Manipulation of the body or portion of the body to calm, relieve tension, increase circulation, and stimulate muscles Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms Alternative and Complementary Medicine (cont’d) meditation Process of clearing the mind by concentrating on the inner self while controlling breathing and perhaps repeating a word or phrase (mantra) naturopathy A therapeutic philosophy of helping people to heal themselves by developing healthy lifestyles; naturopaths may use some of the methods of conventional medicine (from nature and path/o, meaning “disease”). osteopathy A system of therapy based on theory that the body can overcome disease when it has normal structure, a favorable environment, and proper nutrition. Osteopaths use standard medical practices for diagnosis and treatment but stress the identification and correction of faulty body structure (from oste/o, meaning “bone, ” and path, meaning “disease”). Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Symptoms clubbing Enlargement of the ends of the fingers and toes because of soft-tissue growth of the nails; seen in a variety of diseases, especially lung and heart diseases colic Acute abdominal pain associated with smooth-muscle spasms cyanosis Bluish discoloration of the skin due to lack of oxygen diaphoresis Profuse sweating malaise A feeling of discomfort or uneasiness, often indicative of infection nocturnal Pertaining to or occurring at night (roots noct/i and nyct/o mean “night”) pallor Paleness; lack of color prodrome A symptom indicating an approaching disease sequela A lasting effect of a disease (plural, sequelae) syncope A temporary loss of consciousness because of inadequate blood flow to the brain; fainting Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Diagnosis alpha-fetoprotein (AFP) A fetal protein that appears in the blood of adults with certain types of cancer bruit A sound, usually abnormal, heard in auscultation facies The expression or appearance of the face febrile Pertaining to fever nuclear medicine The branch of medicine concerned with the use of radioactive substances (radionuclides) for diagnosis, therapy, and research radiology The branch of medicine that uses radiation, such as x-rays, in the diagnosis and treatment of disease; a specialist in this field is a radiologist. radionuclide A substance that gives off radiation; used for diagnosis and treatment; also called radioisotope or radiopharmaceutical speculum An instrument for examining a canal syndrome A group of signs and symptoms that together characterize a disease condition Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Treatment catheter A thin tube that can be passed into the body; used to remove fluids from or introduce fluids into a body cavity clysis The introduction of fluid into the body, other than orally, as into the rectum or abdominal cavity; also refers to the solution thus used irrigation Flushing of a tube, cavity, or area with a fluid lavage The washing out of a cavity; irrigation normal saline solution (NSS) A salt (Na. Cl) solution compatible with living cells; also called physiologic saline solution (PSS) paracentesis Puncture of a cavity for removal of fluid prophylaxis Prevention of disease Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Supplementary Terms Surgery drain Device for allowing matter to escape from a wound or cavity; common types include Penrose (cigarette), T-tube, Jackson–Pratt (J-P), and Hemovac ligature A tie or bandage; the process of binding or tying (also called ligation) resection Partial excision of a structure stapling In surgery, the joining of tissue by using wire staples that are pushed through the tissue and then bent surgeon One who specializes in surgery Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations History and Physical Examination ADL Activities of daily living BP Blood pressure bpm Beats per minute C Celsius (centigrade) CC Chief complaint c/o Complains of EOMI Extraocular muscles intact ETOH Alcohol (ethyl alcohol) F Fahrenheit HEENT Head, eyes, ears, nose, and throat HIPAA Health Insurance Portability and Accountability Act Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations History and Physical Examination (cont’d) h/o History of H&P History and physical HPI History of present illness HR Heart rate Hx History I&O Intake and output IPPA Inspection, palpation, percussion, auscultation IVDA Intravenous drug abuse NAD No apparent distress NKDA No known drug allergies P Pulse Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations History and Physical Examination (cont’d) PE Physical examination PE(R)RLA Pupils equal (regular) react to light and accommodation PMH Past medical history pt Patient R Respiration R/O Rule out ROS Review of systems T Temperature Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations History and Physical Examination (cont’d) TPR Temperature, pulse, respiration VS Vital signs WD Well developed WNL Within normal limits w/o Without Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations Diagnosis and Treatment ABC Aspiration biopsy cytology AFP Alpha-fetoprotein BS Bowel sounds bx Biopsy CAM Complementary and alternative medicine Ci Curie (unit of radioactivity) C&S Culture and (drug) sensitivity (of bacteria) CT Computed tomography D/C, dc Discontinue, discharge Dx Diagnosis Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations Diagnosis and Treatment (cont’d) EBL Estimated blood loss ICU Intensive care unit I&D Incision and drainage MET Metastasis MRI Magnetic resonance imaging NCCAM National Center for Complementary and Alternative Medicine NS, N/S Normal saline NSS Normal saline solution PCA Patient-controlled analgesia PET Positron emission tomography PICC Peripherally inserted central catheter Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviations Diagnosis and Treatment (cont’d) postop Postoperative preop Preoperative PSS Physiologic saline solution RATx Radiation therapy Rx Drug, prescription, therapy SPECT Single-photon emission-computed tomography TNM (Primary) tumor, (regional lymph) nodes, (distant) metastases UV Ultraviolet Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Abbreviation Orders AMA Against medical advice NPO Nothing by mouth (Latin, non per os) AMB Ambulatory OOB Out of bed BRP Bathroom privileges QNS Quantity not sufficient CBR Complete bed rest QS Quantity sufficient DNR Do not resuscitate STAT Immediately KVO Keep vein open TKO To keep open Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diagnosis ■ Determination of nature and cause of illness ■ Starts with patient history – Description of symptoms – Past medical history – Family, social history as relevant ■ Physical examination follows Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physical Examination ■ Inspection – Visual examination ■ Palpation – Touching body surface with hands, fingers ■ Percussion – Tapping body and listening to sounds made ■ Auscultation – Using a stethoscope to listen to body sounds Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Vital Signs ■ Temperature ■ Pulse rate – Measured in beats per minute ■ Respiration – Measured in breaths per minute ■ Blood pressure – Systolic recorded when heart contracting – Diastolic recorded when heart relaxing Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Examination Tools ■ Ophthalmoscope – For examining eyes ■ Otoscope – For examining ears ■ Hammer – For testing reflexes ■ Sphygmomanometer (blood pressure cuff) – For testing blood pressure Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Examination Procedures (cont’d) ■ Biopsy – Removal of tissue for microscopic examination – Specimens obtained by: ■ Needle withdrawal ■ Small punch ■ Endoscopy ■ Surgical removal Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Imaging Techniques ■ Used to produce visual images of body ■ Most common is Radiography (X-rays) – Best at showing dense tissues – Soft tissues enhanced by contrast mediums ■ Other methods: – Sound waves – Radioactive isotopes – Radio waves – Magnetic fields Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Treatment ■ Determined if appropriate by diagnosis ■ May consist as any combination of: – Counselling – Drugs – Surgery – Radiation – Physical therapy – Occupational therapy – Psychiatric treatment ■ Followed up done with Prognosis (prediction of outcome of disease) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Surgery ■ One method of treating disease by manual operations ■ Usually done by cutting an incision into skin ■ Anesthesia dulls pain ■ Incision sealed after surgery with sutures, adhesive stripes, staples, skin glue ■ Operations now performed with laser ■ Some procedures require cautery Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Purpose of Surgery ■ Treatment – Excision of diseased or abnormal tissue – Also can repair wounds or correct problems ■ Diagnosis – Remove tissue for lab biopsy ■ Restoration – To compensate for lost function ■ Relief – Palliative treatment (therapy to provide relief, not intended as cure) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Alternative and Complementary Medicine ■ Disease causes have shifted ■ People looking to other philosophies and cultures ■ Other philosophies include: – Osteopathy – Naturopathy – Homeopathy – Chiropractic Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Alternative and Complementary Medicine (cont’d) ■ Other treatments include: acupuncture, biofeedback, massage, meditation, herbal remedies, nutritional counselling ■ Holistic health care emphasizes treating individual as whole with emotional, social, and spiritual needs in addition to physical Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Roots for Physical Forces Root Meaning Example Definition of Example aer/o air, gas aerobic pertaining to or requiring air (oxygen) bar/o pressure barometer instrument used to measure pressure chrom/o, color, stain chromatic chromat/o having color chron/o time chronologic arranged according to the time of occurrence cry/o cold cryoprobe instrument used to apply extreme cold electro/o electricity electrolysis decomposition of a substance by means of electric current erg/o work synergistic working together with increased effect, such as certain drugs in combination Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Roots for Physical Forces (cont’d) Root Meaning Example Definition of Example phon/o sound, voice phonograph instrument used to reproduce sound phot/o light photoreaction response to light radi/o radiation, x-ray radiology study and use of radiation son/o sound sonogram record obtained by use of ultrasound therm/o heat, temperature hypothermia abnormally low body temperature Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Suffixes for Diagnosis Suffix Meaning Example Definition of Example -graph instrument for recording data polygraph instrument used to record many physiologic responses simultaneously; lie detector -graphy act of recording data* echography recording data obtained by ultrasound -gram† a record of data electrocardiogram record of the heart's electrical activity *This ending is often used to mean not only the recording of data but also the evaluation and interpretation of the data. †A picture taken simply using x-rays is called a radiograph. When special techniques are used to image an organ or region with x-rays, the ending -gram is used with the root for that area, as in urogram (urinary tract), angiogram (blood vessels), and mammogram (breast). Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Suffixes for Diagnosis (cont’d) Suffix Meaning Example Definition of Example -meter instrument for measuring calorimeter instrument for measuring the caloric energy of food -metry measurement of audiometry measurement of hearing (audi/o) -scope instrument for viewing or examining bronchoscope instrument for examining the bronchi (breathing passages) -scopy examination of celioscopy examination of the abdominal cavity (celi/o) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Suffixes for Surgery Suffix Meaning Example Definition of Example -centesis puncture, tap arthrocentesis puncture of a joint (arthr/o) -desis binding, fusion pleurodesis binding of the pleura (membranes around the lungs) -ectomy excision, surgical removal hepatectomy excision of liver tissue (hepat/o) -pexy surgical fixation hysteropexy surgical fixation of the uterus (hyster/o) -plasty plastic repair, plastic surgery, reconstruction rhinoplasty plastic surgery of the nose (rhin/o) -rhaphy surgical repair, suture herniorrhaphy surgical repair of a hernia (herni/o) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Suffixes for Surgery (cont’d) Suffix Meaning Example Definition of Example -stomy surgical creation tracheostomy of an opening creation of an opening into the trachea (trache/o) -tome instrument for incising (cutting) microtome instrument for cutting thin sections of tissue for microscopic study -tomy incision, cutting laparotomy surgical incision of the abdomen (lapar/o) -tripsy crushing neurotripsy crushing of a nerve (neur/o) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cancer ■ Several methods to diagnose – Physical examination – Biopsy – Imaging – Laboratory tests ■ Two methods to classify: – Grading ■ Based on histologic changes seen through microscope Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cancer (cont’d) – Staging ■ Procedure for seeing how far tumor has spread ■ Treatment may involve surgery, radiation therapy, chemotherapy, immunotherapy, hormone therapy Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pretest 2. Measurements of the basic functions needed to maintain life, such as breathing and pulse, together are called : (a) respiration (b) health signs (c) vital signs (d) etiology Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pretest 3. The two phases recorded when measuring blood pressure are: (a) systolic and sinoatrial (b) diastolic and symbiotic (c) superior and inferior (d) systolic and diastolic Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pretest 4. A simple device for listening to sounds within the body is a: (a) cystoscope (b) speculum (c) barometer (d) stethosocope Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pretest 8. A process used to evaluate the severity of cancer is: (a) therapy of the appendix (b) measurement of the appendix (c) imaging of the appendix (d) surgical removal of the appendix Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pretest 9. A tracheotomy is: (a) surgical incision of the trachea (b) placement of a tracheal tube (c) removal of a tracheal tube (d) removal of the trachea Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins