Case Study About Pott's Disease

Naga College Foundation Naga City

Case Analysis “Pott’s Disease”

By: Michael Adrian A. Peñaflor BSN – 4G

INTRODUCTION Tuberculosis (TB) of the spine also known as Potts disease, Pott’s Caries, David's disease, Tuberculosis spondylitis and Pott's curvature, is the most common site of bone infection in TB. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. The original name

was formed after Percivall Pott, a London surgeon, who first studied the disease. When he died, Patrick David was the one who continued his work. Pott’s disease results from haematogenous spread of tuberculosis (mycobacterium tuberculosis) from other sites. The infection then spreads from two adjacent vertebrae into the adjoining disc space. If only one vertebra is affected, the disc is normal,but if two are involved the intervertebral disc, which is avascular, cannot receive nutrients and collapses. The disc tissue dies and is broken down by caseation, leading to vertebral narrowing and eventually to vertebral collapse and spinal damage. A dry soft tissue mass often forms and superinfection is rare. The disease progresses slowly. Signs and symptoms include: back pain, fever, night sweats, anorexia, weight loss, and easy fatigability. Diagnosis is based on: blood tests - elevated ESR , skin tests ,radiographs of the spine , bone scan ,CT of the spine , and bone biopsy. Gibbus formation is the pathognomonic sign of this disease. A person with Pott's disease often develops kyphosis, which results in a hunchback. This is often referred to as Pott’s curvature. In some cases, a person with Pott's disease may also develop paralysis, referred to as Pott’s paraplegia, when the spinal nerves become affected by the curvature. A person who has been diagnosed with Pott's disease may be treated through a variety of options. He or she may utilize analgesics or antituberculosis drugs to get the infection under control. It may also be necessary to immobilize the area of the spine affected by the disease, or the person may need to undergo surgery in order to drain any abscesses that may have formed or to stabilize the spine. Since Pott's disease is caused by a bacterial infection, prevention is possible through proper control. The best method for preventing the disease is reduce or eliminate the spread of tuberculosis. In addition, testing for tuberculosis is an important preventative measure, as those who are positive for purified protein derivative (PPD) can take medication to prevent tuberculosis from forming. A tuberculin skin test is the most common method used to screen for tuberculosis, though blood tests, bone scans, bone biopsies, and radiographs may also be used to confirm the disease

ASSESSMENT Data of the Patient: •

•

Name: Mr. X Adress: Sta. Cruz Ratay, Calabanga Cam. Sur

• •

• • • • • • •

Gender: M Civil status: Married Birthdate: February 6, 1967 Age: 42 Nationality: Filipino Religion: Catholic Date of Admission: August 16, 2009 Time: 5:30pm Admitting Physician: Edlyn D. Borais MD Admitting Diagnosis: T/C Demyelinating Dse. Vs Pott’s Dse.

Nursing Hx: • •

Cc: Numbness of Lower Extremities Brief Hx: 1 month PTA – Recurrent headache and accompanying Blurring of vision Patient is not known to be hypertensive 1 week PTA – Patient ha been complaining of numbness of lower extremities but still ambulatory. • • •

(-)fever (+)nausea BP was from 90/60 – 100/90

1 day PTA – Patient had foot drop and unable to ambulate •

•

•

Patient Hx: (-)DM (-)PTB Family Hx: (+)Ca – Brother (-)DM Social Hx: Smoker > 1 pack/day Occational Alcohol drinker PATHOPHYSIOLOGY Pulmonary tuberculosis

back Spread Vertebral Surgery: One Kyphosis, Spinal Disk The Extrapulmomary Vertebral pain, vertebra POTT’S of infection tissue damage evacuation mycobacterium narrow fever, paraplegia, dies isDISEASE affected, spreads night ing and ofsw bow broken pus, eats, from tuberculosis the el Anterior and disc two down urinary is by normal anorexia, adjacent decompression collapse tuberculosis Tw o Weight vertebrae are from incontinenece involved, caseation other loss, spinal into and site the the fusion adjoining avascular easy intervertebral fatigability. disc disc wspace eight cannot loss, receive nutrients and LABORATORY RESULTS collapse and easy fatigability. Aug. 16, 2009 •

yellow  Transparency: Cloudy9  pH: 6.0  Specific Gravity: 1.020 Chemical Examination:  Glucose: (-)Neg

Urinalysis Physical Examination:  Color :

 Albumin: (-)Neg Microscopic Examination:  Pus cells: 0-2  RBC: 0-1  Epithelial cells: few

•

Chest X-ray Result Examination: Chest, T-L-S AP/L Findings: There are no active parenchymal infiltrates Heart is normal in size The right CPS is blunted Bony thorax is unremarkable Impression: Normal chest study

•

•

Thoracic and Lumbosacral AP/LAT Findings: There are osteophytes in the anterior lumbar bodies The vertebral height and disc spaces are intact. The pedicles are preserved There is no fracture or destructive bone lesion seen Impression: Spondylosis deformans of the spine BUN and Creatinine Test Sample Fluid: Serum Test Name

Code

Results

Blood Urea Nitrogen Creatinine Sodium Potassium

BUN CREA Na K

3.3 76 140 4.1

Hematology Test Name WBC Count RBC Count

Result 5.7 5.48

Reference 4-10 4.2-6.3

Hemoglobin Hematocrit Platelet Count MCV MCH MCHC • Lymphocyte(P) • Monocyte • Granulocyte RDW MPV PDW • Lymphocyte(a) • Monocyte • Granulocyte

152 0.46 379 84 27.8 330 31.9 8.5 59.6

120-180 0.37-0.54 150-450 80-100 27-33 320-360 30-60 3-9 20-65

13.50 5.90 11.20 1.80 0.40 3.50

13-16 7.1-9.5 10-18 1.2-3.2 0.2-0.8 1.2-6.8

Discharge Plan

P- atient should be reminded to attend check-ups at the nearest…

O- rthopedic center

T- reatment should be taken in a…

T- imely manner

S- ight any symptoms other than the usual and report it to the physician

10 rights of drug administration • Right Medication • Right Patient • Right Dosage • Right Route • Right Time • Right Documentation • Right Assessment • Right to Education & Information • Right to Refuse • Right Evaluation