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Clinical Features of Cor Pulmonale

In this article, we will discuss the Clinical Features of Cor Pulmonale. So, let’s get started.

Clinical Features

Productive cough

Dyspnea

Chest discomfort

Headache

Abdominal pain

Lower extremity swelling

Ascites

Physical Signs include:

Orthopnea

The patient sits with elbows supported on a table and legs dangling by the side of the chest

Pursed lip breathing and cyanosis (presents in patients with COPD with acute exacerbation)

Periorbital edema

Jugular venous distention (raised JVP) and ‘VY’ (wave) collapse due to tricuspid regurgitation

Peripheral edema

 

 

 

 

 

 

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The Principles of Training (Exercise)

In this article, we will discuss the Principles of Training and The FITT Principle of Prescribing Aerobic Exercise. So, let’s get started.

Principles

Overload principle: An exercise overload specific to the activity must be applied to enhance the physiological improvement and bring a training response e.g. athletes, cardiac patient training program.

Specificity principle: Specific adaptations bring specific training effects e.g. swimming, bicycling, running, etc.

Individual difference principle: A person’s relative fitness level is important at the start of training and it is unrealistic to expect the same outcome for everyone with particular training.

Reversibility principle: Detraining occurs if a person terminates exercise program.

The FITT Principle of Prescribing Aerobic Exercise

Frequency: Number of days per week dedicated to exercise sessions.

Intensity: It determines how hard a person works in order to do then activity. It can be defined on the basis of either absolute or a relative scale. Absolute intensity refers to the amount of energy expended per min of activity while relative intensity takes a person’s level of exercise capacity or cardiorespiratory fitness into consideration to assess the level of effort.

Time: The length of time in which an activity or exercise is performed. Duration is generally expressed in minutes.

Type: The mode of exercise performed.

 

 

Pathology and Clinical Features of Acute Empyema Thoracis

In this article, we will discuss the Pathology and Clinical Features of Acute Empyema Thoracis. So, let’s get started.

Pathology

In acute empyema, there is accumulation of large amount of pleural fluid with many polymorphs, bacteria, and cellular debris. Fibrin gets deposited on both layers of pleura (visceral and parietal) and there is a tendency towards loculation. Later, as the disease progresses (empyema becomes chronic), fibroblasts grow from both the layers into the exudate resulting in adhesions of both the surfaces of pleura and form an inelastic membrane called thickened pleura or pleural peel.

Clinical Features

Patients with aerobic infection (parapneumonic pleural effusion) present with acute onset of fever with chills, productive cough with mucopurulent expectoration (bronchopleural fistula), dyspnea and chest discomfort.

Patients with anaerobic infection present with subacute illness with non-specific signs and symptoms such as weight loss, leucocytosis, mild anemia and history of predisposing factor for aspiration from the oral cavity. Tubercular empyema presents with long-standing (for weeks and months) low-grade fever along with weakness and cough.

In acute phase, there are signs of toxemia such as fever, tachypnea, tachycardia, and pleural effusion. Presence of tenderness on percussion with some edema of the chest wall. Clubbing of fingers and toes are usually seen. Rarely there is a sign of empyema necessitans (empyema may track into the subcutaneous tissue of chest wall and presents as a localized swelling with positive cough impulse, and is mostly seen with actinomycotic infections).

Chronic cases present with pleural thickening and loculation of pus will show significant deformity with retraction of chest on the same side of empyema and even scoliosis. The signs will be dull percussion note with diminished breath sounds. extensive pleural calcification may occur. Tubercular empyema is often chronic and present with thickened pleura.

Gastrectomy

In this article, we will discuss the general points about Gastrectomy. So, let’s get started.

Gastrectomy

  • It is defined as the removal of the whole or part of the stomach.
  • It is mostly indicated for stomach/duodenal ulcers; however, recently it is used primarily for gastric adenocarcinomas, primary gastric lymphomas or leiomyosarcomas.
  • Gastrectomy is either partial, total or sleeve.
  • Antrectomy, a limited form of gastrectomy in which the antrum(part of the stomach) is removed.
  • Gastrectomy can either be performed via open surgery or laparoscopic surgery.
  • Risks include acid reflux, diarrhea, gastric dumping syndrome, infection, internal bleeding (hemorrhage), leakage from the site of incision (operation), nausea, vomiting, stomach acid leaking into the esophagus causing scarring, narrowing or constriction (stricture), vitamin deficiency, weight loss, dyspnea, pneumonia or damage to the adjacent structures.
  • Vitamin and mineral supplementation is necessary post gastrectomy.

 

Modified Ashworth Scale

In this article, we will discuss the Modified Ashworth Scale. So, let’s get started.

Modified Ashworth Scale

Modified Ashworth Scale is used as a simple measure of Spasticity (muscle tone).

0 – No increase in muscle tone

1 – Slight increase in muscle tone, manifested by a catch or by minimal resistance at the end range of motion when the affected part moves in flexion or extension.

1+ – Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder range of motion.

2 – More marked increase in muscle tone through most of the range of motion, but the affected part/parts easily moved.

3 – Considerable increase in muscle tone, passive movement becomes difficult

4 – Affected part/parts rigid in flexion or extension.

PT Master Guide
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