+++
CONDITION/DISORDER SYNONYM
++
++
315.4 Coordination disorder (clumsiness, dyspraxia and/or specific motor development disorder)
718.45 Contracture of joint, pelvic region and thigh
719.70 Difficulty in walking
728.2 Muscular wasting and disuse atrophy
728.89 Other disorders of muscle, ligament, and fascia
729.9 Other disorders of soft tissue
780.7 Malaise and fatigue
781.2 Abnormality of gait: Ataxic, paralytic, spastic, staggering
782.3 Edema
786.0 Dyspnea and respiratory abnormalities
786.05 Shortness of breath
787.6 Incontinence of feces
++
+++
PREFERRED PRACTICE PATTERN
++
As of July, 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ systems pathology; therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.
++
PATIENT PRESENTATION
A 75-year-old male is referred to home health for PT after a 23-hour-observation hospital stay for dehydration and cachexia. He received IV fluids and was discharged home; a friend had brought him to the hospital and took him home. The patient is referred for functional decline and muscle atrophy. His history reveals that over the past 6 months he went out less and less, as he had “occasional accidents” soiling himself and was getting increasingly depressed. He describes little or no appetite, but likes to drink tea. Initial exam reveals limited endurance, fatiguing after 10 minutes of continuous low-level activity, muscle wasting in both of the lower extremities, and difficulty rising from a standard height chair. Throughout the 45 minutes, he is almost continuously expelling gas, and there is a distinct odor of feces.
++
++
Loss of bowel control, complete or occasional.
There is a broad array of gastrointestinal (GI) disorders that may be encountered, though not managed specifically, by physical therapists.
Patients with GI pathology may receive care as a result of secondary problems such as weakness, gait abnormalities, and limited aerobic endurance.
Symptoms may be acute, postoperative, chronic, viral, bacterially related, or congenital/hereditary.
Complaints often include changes in bowel habits: Constipation, diarrhea, bowel urgency, incontinence, and cramping.
Pain is frequently referred to the low back.
+++
Essentials of Diagnosis
++