TUGAS tgl 30/07/2014

- Metastase ovary : liver, lung, peritoneu

- Mannitol vs steroi!
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- Gyrus
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An ol! pro6le - 2gyptian re$or!s !ating 6a$1 5,000 years#
7n$i!en$e - %0/-80/ o& t"e a!ult population#
2$onoi$ ipa$t - 2stiate! to $ost Aeri$ans 15 6illion per year#
2tiology
Mus$ulos1eletal syste 9ost $oon: -- e$"ani$al origin#
o 7nterverte6ral !is$s --!egeneration or "erniation 9'():#
o )osterior apop"yseal ;oints 9-a$et ;oints:#
o Mus$le -- yo&a$ial syn!roes, spas
o (erve $opression or tra$tion#
<e&erre! pain &ro ot"er systes --G7, GU, ,=#
7n&e$tion, neoplas, or in&laation#
'istory
T"oroug" "istory $an "elp !eterine t"e etiology#
o 'istory to !eterine t"e type o& e$"ani$al etiology s"oul! in$lu!e t"e onset
o& pain, pattern o& previous episo!es o& pain, an! liitation o& a$tivity $ause!
6y pain#
o As1 a6out traua or "eavy li&ting#
o As1 a6out 6o*el an! 6la!!er $ontrol#
o See1 evi!en$e to suggest systei$ $on!itions#
o See1 evi!en$e o& in&e$tion or tuor#
'istory o& previous treatent $an gui!e e&&e$tive t"erapy#
7n$lu!e so$ial "istory an! $onsi!er se$on!ary gain#
)"ysi$al 23a
)atient stan!ing an! !isro6e!#
o S$oliosis#
o <ange o& otion -- note lo$ation o& pain#
o Motor e3a -- toe *al1ing an! "eel *al1ing#
o )alpation &or spas#
)atient sitting#
o >eep ten!on re&le3es -- 1nees an! an1les#
o Straig"t leg raises 9S.<:#
o Sensory e3a -- lig"t tou$", s"arp an! !ull over !orsu o& &eet#
o Motor e3a#
)atient supine#
o Straig"t leg raises 9-igure 1:#
o 'ip e3a#
o A6!oinal e3a#
o Motor e3a 9'oover Test - see 6elo*:#
)atient prone or si!e position#
o Motor e3a o& a6!u$tor us$les o& "ip#
o Sensory e3a o& sa!!le area#
o <e$tal e3a#
-igure 1# Straig"t .eg 9S.<:
As1 t"e patient to lo$ali?e t"e pain 6y pointing#
At t"e point t"e patient &eels pain, lo*er t"e leg an! !orsi&le3 t"e &oot to
repro!u$e s$iati$ n# pain#
A positive S.< is present *"en t"e patient e3perien$es 6ot" 6a$1 pain
an! pain into t"e posterior t"ig" at %0 !egrees or less#
A positive S.< at lo*er !egrees o& ele$ation is $orrelate! *it" a "ig"er
li1eli"oo! o& '()#
A positive $rossover S.< 9pain in t"e a&&e$te! leg *"en una&&e$te!
si!e is raise!: is also $orrelate! *it" '()#


'oover Test
T"e 'oover test is per&ore! !uring t"e straig"t leg test: As t"e patient tries to
li&t t"e leg, "e or s"e *ill put pressure on t"e $al$aneous o& t"e opposite &oot
9la$1 o& pressure is suggestive t"at t"e attept to raise t"e leg *as not genuine:#

7nitial Stu!ies
.u6osa$ral spine 3-rays 9t*o vie*s usually a!e@uate::
o (ot in!i$ate! &or ost patients unless t"e pain "as 6een present &or t*o
ont"s#
o S"oul! 6e o6taine! early i& tuor or in&e$tion is suspe$te!#
o A6tain !uring t"e &irst ont" o& pain i& patient is less t"an 20 or greater t"an
50 years o& age#
o A6tain a$utely in $ases o& traua#
.a6oratory stu!ies: Urinalysis, ,0,, SMA --o6tain as in!i$ate! to rule out systei$
illness#
M<7 or ,T: (ot usually in!i$ate! as part o& initial *or1- up# 23$eptions are in$lu!e!
in B<easons &or 7e!iate <e&erral#B
-in!ings t"at suggest patient is e3aggerating syptos:
o (egative sitting .S< *it" positive supine S.<#
o )ositive 'oover Test 9-igure 2:#
o Cer1y or @ui$1 release on otor testing#
o 0a$1 pain *it" rotation o& "ips on <AM testing#

7nitial Manageent
Goals o& t"erapy#
o )ain relie&#
o <estoration o& oveent an! a$tivity to previous level o& &un$tioning#
o )revention o& re$urren$e#
<est 9usually &or only a &e* !ays:#
o 0e! rest *it" perio!s o& stan!ing or sitting *it" a lu6ar support an! ar
rests#
o 7& s$iati$a present, stri$t 6e! rest &or 3-5 !ays, t"en progress a$tivity to in$lu!e
perio!s o& stan!ing an! sitting#
o Avoi! any &le3ion o& t"e 6a$1#
Analgesia
o )ain e!i$ations, in$lu!ing non-steroi!al, anti-in&laatory agents, aspirin,
Tylenol#
o .iit nar$oti$s to a$ute p"ase only#
o Mus$le rela3ants -- valiu *it" ar1e! spas, ot"er us$le rela3ants *it"
less !egrees o& spas#
o <e&erral to p"ysi$al t"erapy &or a$ute pain t"erapy, to in$lu!e ultrasoun!, s"ort
*ave, T2(S, ele$tro-a$upun$ture, tra$tion, an! anipulation#
)atient in&oration -- 7n&oration a6out 6a$1 $are: 7nstru$tion a6out sitting, stan!ing,
*al1ing, li&ting, et$# o6taine! t"roug" p"ysi$al t"erapy, nurses, "an!outs, 6a$1 s$"ool#
23er$ises &or &itness an! to prevent re$urren$es -- Use $aution *it" &le3ion e3er$ises#
-ollo*-up at t*o *ee1s an! &our *ee1s *it" t"oroug" e3a on ea$" visit# 7& any
iproveent o$$urs, instru$t t"e patient to return to *or1 *it" liitation o& a$tivity#
Surgery &or '() is usually not in!i$ate!# Most patients "eal *it" $onservative
t"erapy#