Lumbar Metastatic Disease Diagnosis

Lumbar Metastatic Disease Diagnosis Arlena Davis What additional historical information do you want to collect from the patient? Healthcare professionals are supposed to gather historical information from the patient when diagnosing lumbar pain. Gathering historical information ensures proper diagnosis of lumbar pain and treatment. The following historical information would be obtained from the patient. The doctor will determine whether the patient has had any spinal problems since birth. Also, the doctor will determine whether the patient has had lumbar pain before and any treatment. In addition, the physician will determine whether the lumbar pain was sudden or gradual. This is by asking the patient to describe how the pain began. Further, the patient will be required to state what increases or decreases the pain including rest or activity. Additionally, understanding the family history is vital in diagnosing lumbar pain. The health professional should determine if there is family history of lumbar pain. The doctor determines whether the patient is suffering from any disease that might cause the lumbar pain. Injuries and accidents can cause lumbar pain and the health professional should determine if the patient had an accident or injury. Wong,  D.A., Transfeldt, E., Macnab, I. (2007).  Macnab’s backache. Philadephia: Lippincott Williams and Wilkins What additional physical examination should you complete immediately and why? Physical examination is vital when diagnosing lumbar pain. Additional physical examinations are required to determine whether the patient has lumbar pain or not. The patient will do several movements while sitting, lying down and standing. This will make it easy to assess muscular and sensory problems causing the pain. Palpation is critical in identifying the affected area. Palpation helps the doctor feel tenderness and alignment of joints. This helps identify the inflamed lumbar area. Also, examining the leg pulse as pain increases the pulse. General examination of legs and trunk is done to identify the causes of the lumbar pain. Straight leg testing and nerve tests are done to determine whether the patient symptoms are due to pressure on the nerves or nerve compression. Tollison, C.D., Satterthwaite, J.R., Tollison, J.W. (2002).  Practical pain management. Philadephia: Lippincott Williams and Wilkins What differentials should you consider? A differential diagnosis is important when diagnosing lumbar pain as different diseases cause pain. Various diseases affecting the bladder, colon, abdomen aorta and kidney can cause pain. Therefore, different tests should be performed to rule out the diseases. Abdominal and pelvic ultrasounds are critical in ruling out the diseases. Clinical and neurological observations should be done to eliminate the diseases. CT, MRI, blood tests, urine tests, and complete blood tests are needed to differentiate different diagnoses. Beirman, R., Bull, P., Eaton, S.(2011). Cases in differential diagnosis for the physical and manipulative therapies. Australia: Elsiever Australia The clinical scenario suggests what diagnosis? The diagnosis shows that the patient has lumbar metastatic disease. The in house lumbar x-ray showed that lumbar vertebrae had lesions which are a sign for metastatic disease. The metastatic disease causes pain in the lumbar area. Metastatic disease occurs when cancer cells break away from a cancerous tumor and travel though the blood and lymph vessels to other regions including the lumbar vertebrae. The cancer cells settle in the lumbar vertebrae and start to grow and produce new tumors. The metastatic disease compresses or damages nerves and causes pain. Rabbani, S.A., Singh, G. (2007).  Bone metastasis: Experimental and clinical therapeutics. New York City: Springer Why does he have an elevated calcium and alkaline phosphatase? The patient has high levels of alkaline phosphate and calcium. He has alkaline phosphates of 850 and calcium of 11. The high levels of calcium and alkaline phosphates are due to the metastatic disease. Cancer cells affect the bones including lumbar vertebrae and damage them. Calcium is released into the blood as the cancer cells damage the bones. The level of calcium in the blood increases as more bones are damaged. The high levels of calcium in the blood lead to loss of appetite. The levels of alkaline phosphates increase as the damaged bones dissolve. Therefore, the high levels of alkali phosphates and calcium show that the lumbar vertebrae are damaged and have dissolved. The elevated levels of alkali phosphates can also be due to liver damage as the patient has hepatomegaly. Lipton, A et al. (2011). The Science and Practice of Bone Health in Oncology: Managing Bone Loss and Metastasis in Patients With Solid Tumors. J Natl Compr Canc Netw, s1-s30 Why does he have hepatomegaly and elevated ALT/AST? The patient has hepatomegaly which is the swelling of the liver. Cancer metastases cause the liver to swell. The patient has a swollen liver because of the metastatic disease. Cancer cells have spread to the liver and caused inflammation or swelling of the liver. Liver function tests are used to determine liver functioning or the condition of a patient’s liver. The tests include AST and ALT. The AST and ALT tests were done to determine whether the patient had liver damage. AST and ALT levels are raised if the patient has liver damage. The patient’s AST and ALT levels are 600 and 700 respectively. The AST and ATL levels can increase suddenly showing a sudden liver injury or gradually depicting continuing liver damage. Thus, the patient AST and ALT levels are high because he has liver injury caused by the metastatic disease. Wallach, J.B.(2007).  Interpretation of diagnostic tests. Philadephia: Lippincott Williams and Wilkins What additional screening blood test can help you confirm your diagnosis? Why is it used? There are different blood tests that can be used to confirm metastatic disease diagnosis. Blood chemistries can be done. A blood test is done to determine the amount of calcium in the blood. Calcium dissolves in the blood after bones are damages and this increases calcium levels. The patient is said to have metastatic disease if he has abnormal levels of calcium(high levels).A blood test is done to determine the level of alkaline phosphates in the blood as high levels show metastatic disease. A complete blood count can also be done as patients with metastatic bone diseases have no enough red blood cells. Schwab, M. (2008).  Encyclopedia of cancer. New York City: Springer References Beirman, R., Bull, P., Eaton, S. (2011). Cases in differential diagnosis for the physical and manipulative therapies. Australia: Elsiever Australia Lipton, A et al. (2011). The Science and Practice of Bone Health in Oncology: Managing Bone Loss and Metastasis in Patients With Solid Tumors. J Natl Compr Canc Netw, s1-s30 Rabbani, S.A., Singh, G. (2007).  Bone metastasis: Experimental and clinical therapeutics. New York City: Springer Schwab, M. (2008).  Encyclopedia of cancer. New York City: Springer Tollison, C.D., Satterthwaite, J.R., Tollison, J.W. (2002).  Practical pain management. Philadephia: Lippincott Williams and Wilkins Wallach, J.B. (2007).  Interpretation of diagnostic tests. Philadephia: Lippincott Williams and Wilkins Wong, D.A., Transfeldt, E., Macnab, I. (2007).  Macnab’s backache. Philadephia: Lippincott Williams and Wilkins