Cardinal Manifestations of Disease

a) Pain
b) Dyspnea
c) Cardiovascular
Palpitation
Hypertension
d) Weakness
e) Fever (pyrexia)
f) Swelling/edema
g) Alteration of weight
h) Jaundice
i) Urinary Manifestations
j) Lymphadenopathy
• A. Pain
• Classification By Origin: (Bell,1989)
1. Somatic Pain
2. Neurogenous Pain
3. Psychogenic Pain
• Somatic Pain
• Results from Noxious Stimulation that innervates body tissues
• Localized to affected region
• Apparent cause
• Physical evidence of inflammation
• Usually acute or episodic
• Progresses in severity
• Somatic Pain
• Types By Location And Physical Findings:
1. Headache (Cephalalgia)
2. Other Extraoral and perioral pain
3. Pain of pulpal origin (Odontalgia)
4. Pain of dental supportive tissues and oral mucosa
5. Referred pain (Projected pain)
• Neurogenous Pain
• Pain Caused by an abnormality of the nerve itself
• Localization corresponds to affected nerve
• No apparent cause
• Inflammation present only with neurotropic viral infections
• Most are chronic or episodic
• Severity relatively constant or comparable among episodes
• Types of Neurogenous Pain:
1. Neuralgia
Types:
Viral (postherpetic neuralgia)
Glossopharyngeal
Trigeminal (tic douloureux, facial neuralgia, fothergills neuralgia, “suicide disease”)
• Neurogenous Pain
 • 2. Causalgia
Severe burning pain associated with the deformation of nerves by missiles such as
bullets that produce high velocity shock waves.
• 3. Phantom Pain
Pain in a limb that has been amputated
• Psychogenic Pain
• Hardest to manage
• No organic basis/no apparent cause
• Diffuse or vague distribution
• No physical evidence of inflammation
• Chronic course
• Variable severity relates to stress or other nonsomatic factors
• B. Dyspnea
• Difficulty in breathing /labored breathing/ shortness of breath
• Pathologic Causes:
1. Cardiovascular Disease
2. Pulmonary Diseases
3. Hematologic Causes
• Cardiovascular Disease
1. Ischemic/coronary heart disease
2. Congestive Heart Failure (right / left sided)
3. Congenital malformations of the heart
Ex. Ventricular and atrial septa defect
4. Valvular heart disease
• Pulmonary Diseases
• Chronic Obstructive Pulmonary Disease (COPDs)
a. Bronchial Asthma
b. Chronic Bronchitis
c. Emphysema
• Hematologic Disorders
1. Anemia
Types:
Iron deficiency
Hemolytic
Sickle cell (Hereditary, African American)
Thalassemia (Cooley’s Anemia, Mediterranean)
Aplastic (destruction of red bone marrow)
Pernicious (Addison-Biermer anemia)
- due to lack of intrinsic factor needed for Vit. B12 absorption
2. Leukemia
• a. Monocytic b. Lymphocytic
• C. Cardiovascular Manifestations Of Disease
1. Palpitation
Undue awareness of a pounding heartbeat
2. Hypertension
Episodic or consistent elevation of arterial blood pressure beyond what is
considered normal.
• Palpitation
• Causes:
• Strenuous physical exercise (physiological)
• Stress and anxiety
• Excessive use or intake of tobacco, coffee, tea and some drugs
• Disorders of the mechanism of heartbeat or Cardiac Arrhythmias
• Functional disorders such as anemia, hypoglycemia and thyrotoxicosis.
• Hypertension
• Classification:
1. According to Etiology
2. According to the course of hypertension
• According To Etiology
a) Essential/primary type
Idiopathic cause
No underlying cause
b) Secondary
With underlying cause
Ex. Renal, endocrine diseases (Cushing’s syndrome)
• According to Course
a) Benign
Chronic and long standing
Mild effect
Does not exhibit obvious signs and symptoms
• b). Malignant
Above 200 systolic /above 110 diastolic
Acute elevation of B.P.
Patient prone to Cerebro-vascular attack and heart attack
• Classification of Blood Pressure for Adults Age 18 Years and Older
• Blood Pressure Facts
• B.P. greater than 200/140mmHg is already considered Malignant
Hypertension
• 90% of all cases of hypertension have no direct cause. These are referred to
as essential hypertension
• D. Weakness
• Forms:
• Asthenia/ Lassitude
• Faintness
• Asthenia/ Lassitude
• Generalized muscular weakness/feebleness that is common in the following
conditions:
a. Senility
b. Severe forms of anemia
c. Nutritional deficiencies
d. Thyroid gland disorders (ex. Hyperthyroidism)
 e. Disorders of the locomotor system (ex. Osteoarthritis)
f. Endocrine disturbances (ex. Diabetes mellitus)
g. Malignant Neoplasm (ex. Stage 3 &4 cancer)
• Faintness
• Recurrent Attack of weakness
• As in the cases of:
Epilepsy (grand mal type)
Hypoglycemia
Postural hypotension
Disturbances of cardiac rate/rhythm
Emotional disturbances (anxiety, fear)
• Other Manifestations:
• Bleeding/ hemorrhage
• -may arise from:
• a. vascular dysfunction
• b. blood vessel fragility
• c. defects in blood coagulation mechanisms
• d. injury to blood vessels
• NOTE: in the oral cavity bleeding is most commonly associated w/ gingival
disease
• Alteration of Weight in the form of excessive & abrupt weight gain & weight
loss
• Fever (pyrexia)
• Swelling / Edema
• Jaundice (Icterus)
• Yellowish discoloration of the skin, mucous membrane and sclera of the eyes
due to excessive accumulation and inadequate metabolism of bile pigments
(bilirubin).
• Mainly due to liver diseases such as Hepatitis (all forms) and liver cirrhosis.
• Urinary Symptoms
• Polyuria – excessive amount of urination
• Oliguria – scanty/limited urine
• Anuria – little or no urine
• Dysuria – painful urination
• Hematuria – blood in urine
• Proteinuria- cloudy urine
• Note: Symptoms suggestive of renal, genito-urinary tract (GUT) disorders eg.
STD’s, renal stones
• Lymphadenopathy
• Presence of inflamed and palpable lymph nodes.
• Any lymph node enlargement (Lymphadenopathy) identified by palpation
should be assessed for the following:
1. Compressibility
2. Tenderness
3. Mobility
A. Single, firm, non tender and mobile
- Typical of a past infection
B. Multiple, compressible, tender and mobile
- Indicative of an active infection
C. Multiple firm, non tender, non mobile (fixed)
- Characteristic of regional metastasis of a malignant neoplasm