Spondilitis Tb Ppt
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P O T T ‘S D I S E A S E
Pembuat : TONDO BAYU (11-2011-048)MERCY SYLVIA (11-2012-009)
Pembimbing : dr. Suhana, SpOT
POTT’s DISEASE
• Definition– Pott’s disease is a presentation of extrapulmonary
tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints.
– It is named after Percivall Pott (1714-1788), a London surgeon who trained at Barts.
– Scientifically, it is called tuberculous spondylitis and it is most commonly localized in the thoracic portion of the spine.
– AKA: Pott's syndrome, Pott's caries, Pott's curvature, angular kyphosis, kyphosis secondary to tuberculosis, tuberculosis of the spine, tuberculous spondylitis and David's disease
POTT’s DISEASE
• Etiology– Pott’s disease is caused when the vertebrae
become soft and collapse as the result of caries or osteitis. Typically, this is caused by mycobacterium tuberculosis. As a result, a person with Pott'sdisease often develops kyphosis, which results in a hunchback.
Pathophysiology Of Tuberculous Spondylitis
Tuberculous spondylitis
“Cold Abscesses”• Not as hot, warm or painful as other
abscesses
• Hidden deep inside the body
• May burst out leaving behind a track, or sinus, which discharges pus
POTT’s DISEASE
• Epidemiology– Approximately 1-2% of total tuberculosis cases are attributable to
Pott’s disease. The incidence rate here in the Philippines is approximately 20-30% of the entire patient diagnosed to have Tuberculosis. Most of the cases of the Pott's disease in the Philippines are caused by the non-compliance of the treatment regimen of TB.
– Tuberculosis worldwide accounts for 1.7 billion infections, and 2 million deaths per year. Over 90% of TB occurs in poorer countries, but a global resurgence is affecting richer ones.
– The disease affects males more than females in a ratio of between 1.5 and 2:1.
– In the USA it affects mostly adults but in the countries where it is commonest itaffects mostly children.
POTT’s DISEASE
• Risk Factors– Tuberculosis/Endemic TB– Poor socioeconomic conditions– Diabetes– Steroid Use– Chronic Disease– Immunosuppression– IV drug Abuse– Rheumatoid Arthritis
POTT’s DISEASE
• Signs and Symptoms– Localized back pain– Paravertebral swelling – Systematic signs and symptoms of TB – Neurological signs may occur leading to paraplegia– Spinal mass, sometimes associated with numbness,
tingling, or muscle weakness of the leg
POTT’S DISEASE
POTT’S DISEASE
POTT’S DISEASE
PHYSICAL ASSESSMENT
POTT’S DISEASE
Body Parts Actual Findings Analysis
Height Change of shape of back
kyphosis
Weight Weight loss Anorexia
Vital signs Normal Findings Actual Findings Analysis
Temperature 36.5-37.5 degrees Celsius
Increase in temperature Febrile
General SurveyNormal Findings Actual Findings Analysis
Body built mesomorph Ectomorph Deviation from Normal
Overall hygiene and grooming
clean and neat Self bathing hygiene deficit
Deviation from Normal
PHYSICAL ASSESSMENT
Assessment of the SkinNormal Findings Actual Findings Analysis
Skin color
Varies from light to deep brown; from ruddy pink to
light pink; from yellow overtones to olive
-Fundamentals of Nursing 8th edition Kozier and Erb’s
page 579
redness erythema
Presence of edema
No edema
-Fundamentals of Nursing 8th edition Kozier and Erb’s
page 579
with edema edema
Skin temperature
Uniform: within normal range
-Fundamentals of Nursing 8th edition Kozier and Erb’s
page 579
Warm skin temperatureFebrile
Deviation from Normal
PHYSICAL ASSESSMENT
Assessment of the Nose
Palpate the maxiliary and frontal sinuses for tenderness
Not tenderTenderness in one or more sinuses
Deviation from normal
Assessment of the Thorax
Posterior Thorax Normal Findings Actual Findings Analysis
Inspect the spinal alignment for deformities.
Spine is vertically aligned. Spinal column is straight, right and left shoulder and hips are at
the same height.
- Fundamentals of Nursing 8th edition
Kozier and Erb’s page 614
Exaggerated spinal curvatures
Kyphosis due to gibbous formation
Palpate the posterior thorax
No tenderness, no masses
Pain with palpation over the spine
Deviation from normal
PHYSICAL ASSESSMENTAssessment of the Musculoskeletal System
Normal Findings Actual Findings Analysis
Inspect the muscle for size.
Equal in size on both body parts.
- Fundamentals of Nursing 8th edition Kozier and Erb’s page 640
Muscle atrophy Deviation from Normal
Test muscle strength.
Equal strength on each body sides
( sternocleidomastoid, trapezius, deltoid, biceps, triceps, wrist and
finger, grip strength, hip and hamstring.
- Fundamentals of Nursing 8th edition Kozier and Erb’s page 640
Weakness Deviation from Normal
Assess range of motion
Varries in accordance to a person genetic make-up Fundamentals of Nursing 8th edition Kozier and Erb’s
page 641
Decrease range of motion. Pain in movement
Deviation from Normal
BonesInspect the skeleton for
structureNo deformities Bones misaligned Deviation from normal
Palpate the bones to locate any areas of edema or tenderness
No tenderness or swelling Presence of tenderness or swelling Deviation from normal
Joints
Inspect the swelling. Palpate each joint for tenderness, smoothness of movement, swelling, crepitation, and
presence of nodules.
No swelling
No tenderness, crepitation or nodules
Joints move smoothly
Swelling joints Deviation from Normal
Assess joint range of motion
Varies to some degree in accordance with person’s genetic make-up and degree of physical activity
Decreased range of motion Deviation from normal
DIAGNOSTICS
Blood cp( ESR)
Range of motion in the spine.
A series of neurological tests
complete medical history
blood immunoglobin profile
X-rays
magnetic resonance images (MRIs)
CT scan guided biopsy
Bone scans
Diagnosis
DIAGNOSTIC PROCEDURE
– Blood Test- elevated ESR– Tuberculine Test– Radiographs of the spine– Bone Scan– CT of the Spine– Bone biopsy
• MICROBIOLOGY– Needle biopsy– Acid-fast strain and culture
DIAGNOSTIC PROCEDURE
• Imaging Studies
– CT scanning• CT scanning provides much better bony detail of irregular lytic
lesions, sclerosis, disk collapse, and disruption of bone circumference.
• Low-contrast resolution provides a better assessment of soft tissue, particularly in epidural and paraspinal areas.
– MRI• MRI is the criterion standard for evaluating disk-space infection
and osteomyelitis of the spine and is most effective for demonstrating the extension of disease into soft tissues and the spread of tuberculous debris under the anterior and posterior longitudinal ligaments. MRI is also the most effective imaging study for demonstrating neural compression.
LABORATORY RESULTS:
• Laboratory Studies
– Tuberculin skin test (purified protein derivative [PPD])-• Results are positive in 84- 95% of patients with Pott disease who
are not infected with HIV
– The erythrocyte sedimentation rate (ESR)• May be markedly elevated (>100mm/h).
– Microbiology studies • Are used to confirm diagnosis. Bone tissue or abscess samples
are obtained to stain for acid-fast bacilli (AFB), and organisms are isolated for culture and susceptibility. CT-guided procedures can be used to guide percutaneous sampling of affected bone or soft-tissue structures. These study findings are positive in only about 50% of the cases.
LABORATORY RESULTS
• Aspirate from joint space & abscess• Transparency: turbid.• Colour: creamy.• Consistency: cheesy.• Fibrin clot: large.• Mucin clot: poor.• WBC: 25000/cc.mm.
LABORATORY RESULTS
• Imaging Studies– Radiography
• •Radiographic changes associated with Pott disease present relatively late. The following are radiographic changes characteristic of spinal tuberculosis on plain radiography:
• •Lytic destruction of anterior portion of vertebral body• •Increased anterior wedging• •Collapse of vertebral body• •Reactive sclerosis on a progressive lytic process• •Enlarged psoas shadow with or without calcification
– •Additional radiographic findings may include the following:• •Vertebral end plates are osteoporotic.• •Intervertebral disks may be shrunk or destroyed.• •Vertebral bodies show variable degrees of destruction.• •Fusiform paravertebral shadows suggest abscess formation.• •Bone lesions may occur at more than one level.
LABORATORY RESULTS
• Imaging Studies
– X-Ray spine
• Early:-• Narrowed joint space.• Diffuse vertebral osteoporosis adjacent to joint.• Erosion of bone.• Fusiform paraspinal shadow of abscess in soft tissue.
• Late:-• Destruction of bone.• Wedge-shaped deformity (collapse of vertebrae anteriorly).• Bony ankylosis.
LABORATORY RESULTS• Imaging Studies
– CT SCAN• CT scanning reveals early lesions and is more effective for
defining the shape and calcification of soft-tissue abscesses.
• In contrast to pyogenic disease, calcification is common in tuberculous lesions.
– MRI• MRI findings useful to differentiate tuberculous spondylitis
from pyogenic spondylitis include thin and smooth enhancement of the abscess wall and well-defined paraspinal abnormal signal, whereas thick and irregular enhancement of abscess wall and ill-defined paraspinal abnormal signal suggest pyogenic spondylitis. Thus, contrast-enhanced MRI appears to be important in the differentiation of these two types of spondylitis.
DIFFERENTIAL DIAGNOSIS
– Osteitis Piogen – Poliomielitis– Skoliosis idiopatik– Metastasis spinal cord– Pulmo infection after empiema
– Kifosis senilis
Complication • Spinal cord injury• Empyema tuberculosis
Treatment
• Drug treatment
• Bed rest
• Spinal braces
• Surgery
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