chapter 7: diagnosis and treatment; surgery

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 7: Diagnosis and

Treatment; Surgery


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.


Key Termsanesthesia 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


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


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)


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 existssign 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


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


Key TermsAlternative 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”)



(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



(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 the 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”).


Supplementary TermsSymptoms

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


Supplementary TermsDiagnosis

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


Supplementary TermsTreatment

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 (NaCl) solution compatible with living cells; also called physiologic saline solution (PSS)

paracentesis Puncture of a cavity for removal of fluid

prophylaxis Prevention of disease


Supplementary TermsSurgery

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


AbbreviationsHistory 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


AbbreviationsHistory 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



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



TPR Temperature, pulse, respiration

VS Vital signs

WD Well developed

WNL Within normal limits

w/o Without


AbbreviationsDiagnosis 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


AbbreviationsDiagnosis 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


AbbreviationsDiagnosis 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


AbbreviationsViews 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)

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


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


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


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


Examination Tools■ Ophthalmoscope

– For examining eyes■ Otoscope

– For examining ears■ Hammer

– For testing reflexes■ Sphygmomanometer (blood pressure cuff)

– For testing blood pressure


Examination Procedures

■ Endoscope– Examines body cavities


Examination Procedures (cont’d)■ Biopsy

– Removal of tissue for microscopic examination– Specimens obtained by:

■Needle withdrawal■ Small punch■ Endoscopy■ Surgical removal


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


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)


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


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)


Surgical Instruments


Alternative and Complementary Medicine■ Disease causes have shifted■ People looking to other philosophies and cultures■ Other philosophies include:

– Osteopathy– Naturopathy– Homeopathy– Chiropractic


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


Roots for Physical ForcesRoot Meaning Example Definition of Exampleaer/o air, gas aerobic pertaining to or requiring air (oxygen)

bar/o pressure barometer instrument used to measure pressure

chrom/o, chromat/o

color, stain chromatic 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


Roots for Physical Forces (cont’d)

Root Meaning Example Definition of Examplephon/o sound, voice phonograph instrument used to reproduce

soundphot/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


Suffixes for Diagnosis

Suffix Meaning Example Definition of Example-graph instrument for

recording datapolygraph 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).


Suffixes for Diagnosis (cont’d)

Suffix Meaning Example Definition of Example-meter instrument for

measuringcalorimeter 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)


Suffixes for SurgerySuffix 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)


Suffixes for Surgery (cont’d)

Suffix Meaning Example Definition of Example-stomy surgical creation

of an openingtracheostomy 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)


Cancer■ Several methods to diagnose

– Physical examination– Biopsy– Imaging– Laboratory tests

■ Two methods to classify:– Grading

■ Based on histologic changes seen through microscope


Cancer (cont’d)– Staging

■ Procedure for seeing how far tumor has spread■ Treatment may involve surgery, radiation therapy,

chemotherapy, immunotherapy, hormone therapy


Pretest1. Determination of a disease's nature cause is called:

(a) prognosis(b) diagnosis(c) titration(d) admission


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


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


Pretest

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

(a) cystoscope(b) speculum(c) barometer(d) stethosocope


Pretest

5. Removal of tissue for microscopic study is a(n):(a) biopsy (b) aeration(c) endoscopy(d) CT scan


Pretest

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


Pretest

7. A process used to evaluate the severity of cancer is: (a) radiation (b) staging(c) laparoscopy(d) endoscopy


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


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

chapter 7: diagnosis and treatment; surgery

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