Diseases of the Human Body Diseases List Part 1

Prematurity: extreme immaturity ICD-9 CM Code 765.00
Usually implies birth weight less than 1000 grams. This code requires additional information depending on weeks of gestation (765.20-765.29)
Prematurity: other preterm infants ICD-9-CM Code 765.10
Usually implies birth weight of 1000 to 2499 grams. This code requires additional codes for weeks of gestation (765.20- 765.29)
Infant Respiratory Distress Syndrome (IRDS)
ICD-9-CM Code 769

Also known as hyaline membrane disease, this condition happens in an infant where they lack the surfactant which properly allows the alveoli and the lungs to expand without surface tension.

Symptoms: Shortly after birth- exhibits signs of respiratory distress including; nasal flaring, grunting respiration, and sternal retractions.

Treatment includes drug and respiratory therapy, has been improving as technology has advanced.

Bronchopulmonary Dysplasia
ICD-9-CM Code 770.7

BPD is a serious chronic lung disease which occurs after an insult to the lungs. This can be a sequel to IRDS, lung infection, or extreme prematurity. The lungs are stiff, obstructed, and hard to ventilate.

Symptoms include; dyspnea, tachypnea, wheezing, cyanosis, nasal flaring, and sternal retractions.

Treatment includes replacement of the damaged alveoli. Children can regrow new alveoli until about 8 years of age. Medications include; diuretics, bronchiodilators, anticholinergic drugs, and theophylline. Some sterioids which act as an anti-inflammatory may also help.

Retinophathy of Prematurity
ICD-9-CM Code 362.21

Occurs in infants born before 28 weeks of gestation. ROP, or retrolental fibroplasia is an abnormal growth of the blood vessels in the retinas of an infants eyes.

Symptoms; no visible symptoms. Screening occurs on infants weighing less than 1500 grams with a gestational age less than 31 weeks. This screening evaluates the entire eye to determine the stages of vessels supplying the eyeball.

Treatment: Mild ROP resolves without treatment. In more severe cases laser treatment is used to create a vascular shunt which eliminates abnormal vessels before they create scar tissue to cause permanent damage. In some severe cases other treatments are needed and occasionally can be so severe that blindness occurs.

Necrotizing Enterocolitis
ICD-9-CM Code 777.5

NEC is an accute inflammatory process caused by ischemic necrosis of the mucosal lining of the small intestine, large intestine, or both. It is a condition of premature infants or sick neonates. This condition develops after birth.

Symptoms: feeding intolerance, abdominal distentions, bile-colored emesis, diahrrhea, blood in the stool, decreased or abscent bowels sounds, lethargy, and body temperature instability.

Treatment: infants are usually hospitalized in the NICU. Aggressive and immediate treatment necessary for the infant to survive. This treatment includes, NPO status, feeding tube inserted, pH and fluids are administered and monitored. In some cases colonostomy or ileostomy may be necessary until the infant grows and closure with anastomosis can be preformed.

Robinow Syndrome
ICD-9-CM unkown

May be present in two forms; dominant, or recessive. Robinow syndrome is a genetic condition of small stature.

Symptoms: small stature, interorbital distance, bulging forehead, depressed nasal bridge, malaligned teeth, and short limbs. Other manifestations may be present.

Treatment: is a genetic condition with no known cure. Treatment involves addressing any treatable conditions such as dental abnormailties, cleft palate, and orthopedic conditions including scoliosis.

Cri-du-Chat syndrome (Cat’s Cry Syndrome)
ICD-9-CM Code 758.31

Deletion of genenic material from chromosome 5 results in cri-du-chat. It is a rare disorder and usually results in stillborn children. Many who are born die shortly after birth. Those who survive will progress to maturity but may have various medical and mental problems.

Symptoms: small head (microcephaly), deficiency of cerebral brain tissue, and mental retardation. Those who are born have a mewing cat’s cry, small head, and poor muscle tone. Motor and language skills are slow to develop and language skills may be delayed. Mental development may be slow and retarded or behavioral problems then occur.

Treatment: No cure for Cri-du-chat. Treatment supports the infants bodily functions as long as the infant survives. Developed children may need special schooling and supportive care. They can possibly live to have a normal life span.

Down Syndrome
ICD-9-CM Code 758.0

Formerly called mongolism. Down syndrome is a congenital form of mild to severe mental retardation accompanied by facial features and distinct physical abnormalities. Caused by an extra chromosome in DNA on chromosome 21 (trisomy 21)

Symtpoms; in addition to mental retardation, associated with heat defects and other congenital abnormalities. flat back skull, typical slant to the eyes, flat nasal bridge, low-set ears, protruding tongue, and small weak muscles are common visible symptoms.

Cerebral Palsy (CP)
ICD-9-CM Code 343.9 (Infantile cerebral palsy, unspecified)

CP is the most common crippler of children and is congenital, bilateral, non-progressive paralysis. It is a result from damage of the CNS.

Symptoms: shortly after birth the infant will have difficulty sucking or swallowing. The muscles may be floppy or stiff, with reduced voluntary movement. When the infant is lifted the legs may be difficult to separate and the infant may cross their legs.

Treatment: There is no cure for CP but early treatment helps the child reach optimal accomplishments. Mild or severe cases, the goal of the treatment is to minimize handicap by providing therapeutic measures.

Discuss the following major types of Cerebral Palsy (CP)
1. Spastic cerebral palsy
2. Athetoid cerebral palsy
3. Ataxic cerebral palsy

1. Spastic cerebral palsy- characterized by hyperactive reflexes or rapid muscle contractions, and older children will manifest a scissor gait walk. Approximately 70% of patients with CP fall into the category.

2. Athetoid cerebral palsy- characterized by involuntary muscle movements, difficulty with speech. 20% of CP patients fall into this category.

3. Ataxic cerebral palsy- characterized by lack of control over voluntary movements, poor balance, and wide gait.

It is important to note that patients may exhibit signs of all three types with varying degrees from mild to severe. Symptoms become more exaggerated as the child grows but however some symptoms can be static (remaining constant).

Muscular Dystrophy
ICD-9-CM Code 359.1 (Hereditary progressive muscular dystrophy)

MD is a progressive degeneration and weakening of the skeletal muscles. There are several types of this disease but all are rare. Most common type is known as Duchenne MD which begins soon after birth before the age of 5 years.

Symptoms: initially effect muscles of the shoulders, hips, thighs, and calves causing a waddling gait and toe walking. Some may have lordosis or other spinal deformities. Children will have difficulty running, climbing stairs, and tends to fall easily. As the disease progresses it involves all of the muscles causing crippling immobility. Children with MD become susceptible to serious pulmonary infections. Some MD types such as Duchenne will cause mental impairment.

Treatment: There is no known sucessful treatment for MD. Physical therapy, exercise, surgery, and the use of orthopedic appliances help minimize deformities and preserve mobility. Corticosteriods may be prescribed to slow muscle degeneration. Anticonvulsants may control siezures and some muscle activity. Most infections are warded off with antibiotics.

Spina Bifida Occulta
ICD-9-CM Codes
756.17 (Spina bifida occulta)

Spina Biffida occulta is one of three types of spina bifida. This one is the mildest form and is when there is a separation or gap between the spinal vertebrae because they fail to fuse. Typically the lumbosacral region is effected.

Symptoms include: dimpling tuft of hair over the affected region, malformation without displacement of the chord, hermangioma over the site where the vertebrae have not completely fused.

Treatment: Usually requires no intervention other than prudent observation throughout the child’s growth and development. Treatment depends on the degree of neurological involvement. If the child becomes symptomatic with neurological problems, surgical intervention to repair the defect is necessary.

ICD-9-CM code
741. 90 (Spina bifida without mention of hydrocephalus)

Meningocele is the second level of failure of the spinal column to fuse during the developmental stage. The meninges prodtrude through an opening in the spinal column thus, forming a sac that becomes filled with cerebrospinal fluid (CSF).

Symptoms: There is no nerve involvement; therefore infant usually has no neurologic problems. The sac formed over the defect will permit passage of light during trans-illumination, indicating no spinal cord or neurologic involvement. The skin over the area may be fragile and rupture which is a potential problem.

Treatment: Usually consists of surgical intervention to correct the defect in the first 24-48 hours of life. Because the spinal cord is not involved paralysis usually does not occur.

ICD-9-CM code
741.90 (Myelomeningocele without mention of hydrocephalus)

Also known as spina bifida cystica. This is the most severe form of spina bifida. It is a protrusion of a portion of the spinal cord and the meninges through a defect in the spinal column.

Symptoms: spinal nerves or the spinal cord is present in the herniation, the infant will exhibit neurologic symptoms of impairment. The infant may have musculoskeletal malformations, immobile joints, or paralysis of the lower extremities depending on the level of the defect.

Treatment: surgical intervention within the first 24 hours of life to prevent further deterioration of the involved nerves, infection, and rupture of the herniation. A large number of children with this level die before the age of 2 years.

ICD-9-CM code
741.0 (with spina bifida only)
331.3 (communicating)
331.4 (obstructive)

The amount of CSF is greatly increased or its circulation is blocked causing an abnormal enlargement of the head and characteristics of pressure changes in the brain.

Symptoms: fontanelles begin to bulge, sutures of the skull separate, scalp veins become distended, infant has high pitched cry, irritable, episodes of projectile vomiting. Eventually downward displacement of the eyes occurs. Neurological signs include abnormal muscle tone of the legs.

Treatment: Surgical interventions to place a shunt in the ventricular or subarachnoid spaces to train off excess CSF. Some catheters empty into the peritoneal cavity, and other shunt cavities empty into the right atrium of the heart. If left untreated the pressure build up will cause mental retardation.

ICD-9-CM code

A severe form of neural tube defect occurs in early gestation with failed of the cephalic aspect of the neural tube to close. Fetus or neonate has no cranial vault and little cerebral tissue.

Symptoms: no cranial vault, little cerebral tissue, bones of the base skull and orbits are present. Infants die in utero or during childbirth. The few who survive only live for a short time. There is not enough cerebral tissue to sustain life.

Treatment: There is no current effective treatment. Infants who survive the birthing process die shortly after.

Ventricular Septal Defect
ICD-9-CM Code 745.4

The most common congenital cardiac disorder. Is an abnormal opening between the left and right ventricles. When the deficit is small there is little functional disease but when it is large is very serious. Condition can go undetected until later in childhood, adolescence, or even adulthood.

Symptoms: A loud systolic murmur can be heard, failure to gain weight, restlessness, irritability, increased heart-rate and respiration.

Patent Ductus Arteriosus
ICD-9-CM Code

PDA results when the ductus fails to functionally close. In normal fetal circulation, the patent ductus short-circuits shunting the circulation from the lungs and directs blood from the pulmonary trunk to the aorta. If PDA continues after birth, oxygen circulation is compromised. Detected after birth during physical examination.

Symptoms: Heart murmur hear during first physical examination.

Treatment: Close is attempted by drug therapy using antiprostaglandins. Another option is surgical closure of the ductus.

Coarctation of the Aorta
ICD-9-CM Code

Deficit is characterized by narrowed aortic lumen, causing a partial obstruction of the flow of blood through the aorta.Result is an increased left ventricular pressure and workload and decreased pressure in distal narrowing.

Symptoms: pulmonary edema, pale and cyanotic with weakness, dyspnea, tachycardia. Systemic blood pressure is elevated in arms but no pulse felt in leg vessels due to decreased pressure.

Atrial Septal Defect

ICD-9-CM code

ASD is an abnormal opening between the right and left atria. Defect can vary in size and location. Small septal defects may show atypical symptoms or even fatigue, shortness of breath, and frequent respiratory tract infections. Large defect causes cyanosis, dyspnea, and syncope.

Symptoms: a classic systolic cardiac murmur can be heard.

Treatment: closure is achieved with surgical repair

Cyanotic Defects

Central cyanosis is a sign that the atrial blood is not fully oxygenated.

Symptoms: cyanotic with blue tinge to the skin

Tetrology of Fallot
ICD-9-CM code 745.2
Involved four congenital heart defects…
1. Ventricular septal defect, an abnormal opening in the ventricular septum
2. Pulmonary stenosis, a tightening of the pulmonary valve or vessel.
3. dextroposition (displacement to the right) of the aorta, which overrides the ventricular septal defect.
4. right ventricular hypertropy, caused be increased pressure in the ventricle.Symptoms: infants born as blue babies, deoxygenated blood, hypoxia, tachycardia, tachypnea, dyspnea, and siezures. Bone marrow hypoxia causes polycythemia. Cardia murmurs can be heard.

Transposition of the Great Arteries
ICD-9-CM code 754.10

aorta and pulmonary artery are reversed. the aorta orginates from the right ventricle, and pulmonary artery originates from the left ventricle. Results in a close loop circulatory system one in pulmonary and another closed in systemic.

Symptoms: Happen a few hours after birth: cyanosis, tachypnea, followed by signs of heart failure

Treatment: Immediate surgical intervention is indicated and prostaglandins are administered to the infant to keep the ductus arteriosus patent and foramen ovale from closing. Prognosis is poor unless pediatric surgeons are readily available and transportation to the surgical wing is switft.

Clubfoot (Talipes Equinovarus)
ICD-9-CM code 754.51

an obvious nontraumatic deformity of the foot of the newborn in which the anterior half of the foot is adducted and inverted.

Symptoms: besides the obvious deformity the heel is drawn up, with the lateral side of the foot being convex and the medial aspect being concave.

Treatment: cast application or splints, treatment must start early during the neonatal period. Physicians use a variety of applications and treatments to form the food properly as the child matures.

Congenital Hip Dysplasia
ICD-9-CM code
755.63 (other congenital deformity of hip)
754.3 (Congenital dislocation of hip)

CHD is an abnormal development of the hip joint that ranges from an unstable joint to dislocation of the femoral head from the acetabulum.

Symptoms: asymetric folds of the thigh of the newborn with limited abduction to the hip. Shortened femur can be noted when the hips and knees are flexed at right angles.

Treatment: various devices to reduce the congenital hip dislocation. Formal head returned to propery position in the acetabulum, legs are held in place by a harness, splint, or cast. Early treatment is best and yields better results.

Cleft Lip and Palate
ICD-9-CM code 749.20

Congenital birth defect consisting of one or more clefts in the upper lip. The cleft palate is a hole in the soft and hard palates.

Symptoms: extended completely through the hard and soft palates into the nasal area. Difficulty with nasal regurgitation and feeding due to air leaks. Major problem with infant appearance.

Treatment: surgical repair and extreme cases need multiple repairs. Special feeding utensils may be needed and eventually speech therapy.

Cryptorchidism (Undescended Testes)
ICD-9-CM code 752.51

Failure of one or both of the testicles to descend from the abdominal cavity into the scrotum.

Symptoms: detected at birth, may be unilateral or bilateral, no symptoms just visible absence of testes.

Treatment: Often will descend spontaneously on their own, if it does not happen by 4 years of age treatment is done through surgical manipulation (orchiopexy) or hormonal drug therapy. If left untreated, child will become sterile as an adult. All children who suffer from this have an increased risk of testicular cancer in their future.

Wilm’s Tumor (nephroblastoma)
ICD-9-CM code 189.0

A highly malignant neoplasm of the kidney that affects children younger than 5 years. It is also the most common kidney tumor for children. Can occur in one or both kidneys.

Symptoms: mass in kidney region which is firm and nontender, hematuria, pain in the abdomen or chest, hypertension, anemia, vomitting, intestinal obstruction, constipation, weight loss, and fever.

Treatment: Prompt recognition is required because the tumor is invasive and will metastasize. Tumor is surgically removed followed by chemotherapy with or without radiation therapy.

ICD-9-CM code 605

Setnosis or narrowing of the opening of the foreskin in a male infant.

Symptoms: difficulty urinating, parents have difficulty taking care of the area, results in accumulation of secretions. Generally develop in uncircumcised males.

Treatment: circumcision alternatively parents who decide to not have the surgery preformed need to wash the glans pubis and prepuce and slide it back over the glans.

Congenital Plyoric Stenosis
ICD-9-CM code 750.5

Congenital disorder and is a gastric obstruction associated with narrowing of the pyloric sphincter. Also called congenital hypertropic pyloric stenosis.

Symptoms: projectile vomitting after feeding, failure to gain weight, hungry but continuing to feed. If left untreated for too long dehydration may occur.

Treatment: surgical intervention where the pylorus is incised and sutured to relieve the obstruction.

Hirschsprung’s Disease (Congenital Aganglionic Megacolon)
ICD-9-CM code 751.3

Congenital condition where there is an impairment of intestinal motility that causes an obstruction in the distal colon.

Symptoms: vary slightly depending on age of the child. Neonatals fail to pass meconium with in 48 hours, bile-stained or fecal vomitus, and unwilling to geed. After neonatal period infants fail to thrive, obstinate constipation, vomiting, and abdominal distention. If condition continues child will become feverish and have explosive diarrhea. Older children experience more chronic symptoms; constipation, abdominal distention, ribbonlike stools, foul smelling stools, palpable fecal masses, and visible peristalsis.

Treatment: consists of reliefe of the obstruction by surgical intervention; the affected bowel is excreted, the normal colon is joined with the anus. A temporary colostomy is preformed proximal to the aganglionic section of the colon. Electrolyte and fluid balance is maintained. After colon recovers, colostomy is closed.

Cystic Fibrosis
ICD-9-CM code 277.0 (cystic fibrosis)

Inherited disorder and is a chronic dysfuntion of the exocrine glands affecting multiple systems of the body.

Symptoms: become apparent soon after birth, primarily attack the lungs and digestive system, copious thick and sticky mucus that accumulates and blocks glandular ducts, dry paroxysmal cough, exercise intolerance, pneumonia, bulky diarrhea, vomiting, and bowel obstruction. Pancreatic changes occur and far and fiber replace normal tissue. Sweat gland involvement causes increased concentration of salt.

Treatment: CF is considered fatal however early diagnosis and treatment have greatly increased life expectancy. Treatment involves supportive measures that help the child to lead as normal of a life as possible and prevent pulmonary infections. High calorie diets, high sodium-chloride diet, chest physiotherapy, pancreatic enzyme supplementation, and use of aggressive antibiotics are used during infection. Occaisonally oxygen therapy is needed.

ICD-9-CM code 270.1

PKU is an inborn error in the metabolism of amino acids that causes brain damage and mental retardation when not corrected.

Symptoms: defect is an enzyme needed to change amino acids (phenylalanine) in the body into the substance (tyrosine) the body needs. As a result, phenylalanine accumulates creating a toxicity causing damage to the brain. Symptoms may not begin until the infant is 4 months old and characteristic of musty odor of perspiration and urine is noted. Other signs include rashes, irritability, hyperactivity, personality disorders, and evidence of arrested brain development.

Treatment: place the infant on a phenylalanine-free diet allowing infant to grow with normal brain development. This diet is maintained for life. Newborns with this condition can not have breast milk and need close monitoring with diet. No diet sugars allowed.

Kinefelter’s Syndrome
ICD-9-CM code 758.7

male hypergonadism, appears after puberty with at least two X chromosomes and one or more Y chromosomes typically found in the XXY pattern.

Symptoms: development of the tests is abnormal, reduced levels of testosterone, puberty begins at an unusual time. Normal size penis but testes are small and body hair is scant. Body appears normal with exceptionally long legs and above average height with reduced muscle development. Infertility is common resulting from azoospermia. Mammary glands may be enlarged. Later in life complications are osteoporosis and chronic pulmonary disease.

Treatment: At the time of normal puberty long term hormone therapy replacement begins with testosterone by injected or intradermal patch. Testosterone can help to have normal sexual function and muscle and bone mass. Fertility cannot be restored. Calcium supplements help avoid osteoporosis.

Turner’s Syndrome
ICD-9-CM Code

Chromosomal disease that occurs in females with a single sex chromosome XO

Symptoms: at birth ovaries are immature or absent, female infant appears short with swollen hands and feet. Possible webbing of the feet. As these children grow they experience lack of sexual maturation, dwarfism,. sterility, cardiac and kidney defects and ovaries typically disappear. If ovaries remain eggs are either absent or sterile.

Treatment: Estrogen and growth hormone therapy. Surgical correction for abnormalities such as webbing of the neck.

ICD-9-CM code 052.9

A highly contagious, acute viral infection that is common among children and young adults.

Symptoms: a systemic disease with superficial cutaneous lesions that begin as red macules that progress to papules and then finally vesicles. Lesions are evenly distributed all over the body and even found internally. Before rash appears patient will experience: fever, malaise, and anorexia. Lesions can continue to erupt for 3-4 days and cause intense itching. Recovery is usually complete within 2 weeks, leaving the person a lifelong immunity. Possible complications include secondary bacterial infections.

Treatment: Prevention with vaccination is preferred. If un-vaccinated contraction occurs treatment is to alleviate pruritus which includes bicarbonate soda baths followed by dusting of cornstarch or application of calamine lotion. acetaminophen is administered for fever or pain. Aspirin is not an acceptable treatment because it runs the risk of Reye’s syndrome.

ICD-9-CM code 032.9 (unspecified)

An acute communicable infectious disease that causes necrosis of the mucous membrane in the respiratory tract.

Symptoms: sore throat, dysphagia, cough, hoarseness, and chils. Fever, swollen regional lymph nodes, and foul breath can be noted. The bacteria invade the nasopharynx producing a powerful exotoxin that travels throughout the body. Locally the infection and inflammation cause graysish patches of thick mucous membrane to appear in the respiratory tract (pseudomembrane). Inflammation and swelling mat interfere with airways and speech. As toxin is absorbed, it affects other vital organs with possible complications: otitis media, pneumonia, myocarditis, and paralysis.

Treatment: Diptheria antitoxin adminstered ASAP. Administration of antibiotics such as penicillin and erythromycin. Patient isolated, restricted to bed rest, and given a tolerable diet. Observation continues due to possible complications of systemic involvement.

Mumps (Epidemic Parotitis)
ICD-9-CM code 072.9 (without mention of complications)

An acute communicable viral disease causing inflammation and swelling of one or both parotid glands.

Symptoms: tenderness in the neck, in front of the ears and below the ears. Pain swallowing. Some may experience headache, muscle aches, and low-grade fever, with loss of appetite. Common complication is mumps orchitis which leads to sterility.

Treatment: Acetaminophen administered, warm or cold compresses applied for pain. Soft or liquid diet helps to minimize discomfort when chewing. Males who are experiencing testicular tenterness and swelling may need scrotal support. Isolation helps prevent spread of the disease.

Pertussis (Whooping cough)
ICD-9-CM code 033.9 (unspecified organism)

A highly contagious bacterial infection of the respiratory tract.

Symptoms: Three stages:
1. highly contagious catarrhal stage- child seems to have common cold
2. Paroxysmal stage- cough becomes violent, ending in high-pitched inspiratory whoop, followed by thick mucous.
3. convalescent period, cough gradually diminishes

Treatment: Erythromycin is the antibiotic choice. Fluid intake encouraged to prevent dehydration, nutritious diet to prevent weightloss. Quiet and lots of rest are required. Observation of patient for respiratory distress. Bronchiopneumonia, convulsion, or hemorrhages are possible complications of severity.

Measles (Rubeola)
ICD-9-CM code 055.9 (without mention of complications)

An acute, highly contagious viral disease occurring in children who have not been vaccinated.

Symptoms: coldlike symptoms, tache0-bronchitis with coughing, conjunctivitis, and photophobia. Child has a fever follwed by 3-7 days for ared blotchy rache. Rash begins behind ears, hairline, and forehead, and then progresses down the body. Before the eruption of the rash, Koplik’s sports can be detected on the oral mucosa as tiny white spots on red background. Measles can progress into Subacute Sclerosing Pancephalitis (SSPE) and infection of the CNS which causes blindness, and inability to speak. Children with SSPE usually die young.

Treatment: Uncomplicated measles run their course within 7-10 days. Acetaminophen is given for fever. If fever is persistently high, tepid sponge baths may be given. The eyes should be protected from bright light as a comfort measure. If secondary infection occurs, antibiotics are prescribed.

Rubella (German Measles, Three-Day Measles)
ICD-9-CM code 056.9 (without mention of complications)

A highly contagious viral disease, clinically resembles measles but has a shorter course with fewer complications.

Symptoms: rose-colored and slightly elevated rash that appears on the face and head which progresses down on the body. The child in addition will have a low grade fever and tenderness or enlargement of the lymph nodes.

Treatment: supportive measures including administration of mild analgesic for fever and joint pain. Patient should be isolated until rash disappears. Prevention available through vaccination older than 12 months.

ICD-9-CM code 037

An acute, potentially deadly, systemic infection characterized by painful involuntary contraction of skeletal muscles.

Symptoms: extremely febrile (temp greater than 101 deg F), irritability, profuse sweating, stiff neck, a tight jaw (lockjaw), spasms of the facial muscles, difficulty swallowing. As the infection progresses, muscles of the back and abdomen become rigid, with generalized convulsive muscle spasm (opisthotonos). Tonic spasms can cause death from asphyxiation.

Treatment: chiefly supportive with administration of sedatives and muscle relaxers to relieve spasms and seizures. If patient suffers from convulsions, repsiratory integrity must be preserved. Unimmunized patients risk is gent human tetanus globulin (TIG) withing 72 hours for temporary immunity. A booster injection of tetanus toxoid is needed if the injured person has not had a tetanus shot within 5 years.

Sudden Infant Death Syndrome
ICD-9-CM code 798.0

SIDS is a sudden unpredicted death of the infant under the age of 1 year.

Symptoms: death occurs within seconds during sleep and without sound or struggle. After death infant will have mottled complexion and cyanotic lips and fingertips. Known contributing factors can be ruled out but can include: immature respiratory control system, susceptibility to deadly arrhythmias, congenital heart disease, and myocarditits.

Treatment: resuscitation attemps fail, not unpredictable or preventable.

ICD-9-CM code 464.4

An acute, severe inflammation of the obstruction of the respiratory tract.

Symptoms: usually preceded by an upper-respiratory-tract- infection, also include; hoarseness, fever, harsh high-pitched cough, and stridor during dyspnea.

Treatment: treated symptomatically and antipyretic agents are administered. Rest, increased fluid intake, cool humidification of air. If the cause is bacterial antibiotic therapy the patient may be hospitalized for endotracheal intubation and oxygen therapy is used until the respiratory crisis passes. Prevention is available by replacing toothbrushes often after infection.

Acute Tonsillitis
ICD-9-CM code 463

A painful inflammatory and infectious process affecting the tonsils.

Symptoms: inflammation has a sudden onset, mild to severe sore throat, chills, fever, headache, malaise, anorexia, and muscle and joint pain.

Treatment: first a streptococci test is taken and the patient tests positive. A 10 day course of antibiotics, usually penicillin, is given. Patient is placed on bed rest, given a liquid diet, and given saline throat irrigations.

Adenoid Hyperplasia
ICD-9-CM code 474.12

An abnormal enlargement of the lymphoid tissue located in the space above the soft palate and mouth, causing partial breathing blockage.

Symptoms: otitis media, conductive hearing loss from eustachian tube obstruction. Childs speech has a nasal quality, and snores or mouth breathes while sleeping.

ICD-CM code 493.90

Chronic disease caused by increased reactivity of the thracheobronchial tree.

Symptoms: incessant productive and nonproductive cough, prounounced expiratory wheeze, rapid shallow respiration. The labor of breathing leads to rapid pulse, pallor, profuse perspiration, and an inability to speak more than a few words without halting.

TreatmentL medical management required, drug therapy with steroids like albuterol. Allergy evaluations and skin testing may indicate immunotherapy through injections.

Infantile Colic
ICD-9-CM code 789.00

Intermittent abdominal distress in a newborn during early infancy.

Symptoms: intermittently draws up legs, clenches fists, cries in pain. During an episode, the infant may pass gas by mouth and rectum. Babies with this condition usually thrive, gain weight, and appear to tolerate formula or milk.

Treatment: investigate possible causes, eliminate any of these possible causes, infant usually outgrows condition around 3 months of age.

Helminth (worm) infestation
ICD-9-CM code 128.9

Roundworms, pinworms, hookworms, and tapeworms can all take up residence in the GI tract causing complications. All of these worms are classified as helminthes.

Symptoms: Worm infestations occur as children introduce eggs to their mouths, after eggs are swallowed they hatch in the intestine and lay more eggs. This process causes mild to intense itching and irrigation of the area. Children generally scratch and re-ingest the eggs.

Treatment: anthelmintic agents administered and usually treatment of the entire family. Frequent showering and handwashing are advised. Can also be destroyed by laundering clothing in hot water and or bleach.

Erythroblastosis Fetalis (Hemolytic Disease of the Newborn)
ICD-9-CM code 773.2

stems from rH maternal blood incompatibility resulting in excessive rates of RBC destruction.

Symptoms: anemia, jaundice, kernicterus, and enlargement of the liver and spleen. In severe forms called hydrops fetalis, the infant is in great jepardy due to extreme hymolyisis. If the infant survives this, heart failure, edema, pulmonary congestion, lethargy, seizures, and mental retardation follow.

Treatment: Intrauterine transfusions may be indicated when the fetus shows signs of distress. After birth, phototherapy and alubmin infusions are used to reduce the amount of circulation of bilirubin in the newborn. There is a preventative medication called Rhogham or Rho (D) and is given multiple times during the pregnancy to ensure the infants safety.

Lead Poisoning
ICD-9-CM code 984.9

Environmentally caused blood toxicity resulting from ingestion or inspiration of lead dust or particles.

Symptoms: loss of appetite, vomitting, irritability, and ataxic gait. Chronic symptoms include anemia, weakness, colic, and peripheral neuritis. Evidence suggest permanent mental retardation if left untreated for long periods of time.

Treatment: source of poisoning is first eliminated, treatment involves removal of lead from the body. Chelating agents administered that bond with the lead and make a non-poisonous form a lead easily disposable by the kidneys. Antiemetics control nausea vomiting and sedation is given for convulsions. After this therapy penicillamine is given for 3-6 months.

Reye’s Symdrome
ICD-9-CM code 331.81

Combination of brain disease and fatty invasion of the inner organs, especially the liver.

Symptoms: rare and acute syndrome with is often fatal. Illness may effect children through the age of 15. Symptoms progress in 5 stages:
1. lethargy, listlessness, irritability, combativeness, vomitting, and hepatic dysfunction.
2. hyperventillation, hyperactive reflexes, hepatic dysfunction, disorientation, convulsions, and delerium.
3. organ changes and coma
4. deeper coma and loss of cerebral functions
5. sizeures, loss of deep tendon reflexes and finally respiratory arrest.

Treatment: Early recognition cuts mortality rate by 70%. Successful management to stabilize the patient to control cerebral edema, monitor blood chemistries, manage seizures, and provide mechanical ventilation.

Fetal Alcohol Syndrome
ICD-9-CM code 760.71

FAS describes birth defects born to alcoholic mothers.

Symptoms: growth retardation, facial characteristics which include smaller eye openings spaced widely and a thin upper lip. Infant will experience growth deficiencies, and CNS problems. FAS can also be associated with mental retardation.

Treatment: Depends on the effect on the newborn. Treatment is supportive because neurologic damage is irreversible. Proper nutrition is vital. Psycho-social needs of the infants and mother must be addressed.

Acquired Immunodeficiency Syndrome (AIDS)
ICD-9-CM code 042

AIDS is a progressive impairment of the immune system caused by the human immunodeficiency virus (HIV).

Symptoms: Initially it is not possible tell tell whether or not people are infected by simple observation. They remain healthy for years during the latent period and may unknowingly transmit the virus to others. Within 1-4 weeks after exposure patients will experience flu-like symptoms with sore throat, fever, body aches and often lasts around 2 weeks. As HIV progresses lymphadenopathy, weight loss, fatigue, diarrhea, and night sweats are common.T-cells become significantly lower which in turn decreases immunity therefore frequent infections occur. Later stages progress to encephalopathy and malignancy.

Treatment: Currently no cure exists but depending on the stage during diagnosis there is different treatment to low progression. HAART (highly active antiretroviral therapy) consists generally of three types of medications. Drugs used to treat HIV/AIDS are highly toxic and have serious side effects. HIV is preventative by knowing and avoiding the risk factors like human to human cell transfers.

Common Variable Immunodeficiency (Acquired Hypogammaglobulinemia)
ICD-9-CM code 279.06

CVID is a common variable immunodeficiency disease and is an acquired B-cell deficiency that results in absence of antibodies.

Symptoms: chronic or recurrent infections, gastrointestinal disease is common, diarrhea, abdominal pain, and weight loss. Lymphadenopathy, slenomegaly, and hepatomegaly are often observed. CVID is also associated with autoimmune disorders such as autoimmune hemolytic anemia. Disease progresses until T-cells are involved and susceptibility to infections escalates.

Treatment: aimed at prevention of infections, and implementing treatment early with appropriate antibiotic treatment. Proper nutrition and rest are encouraged, immune globulin replacement on a regular basis is also helpful. People with CVID must be vaccinated with live virus vaccines only.

Selective Immunoglobulin A Deficiency
ICD-9-CM code 279.01

deficiency to fail to produce normal levels of IgA. Selective deficiencies of IgM and IgG have been reported but are rare.

Symptoms: majority of patients are asymptomatic which makes it hard to diagnose. Symptoms are often recurrent sinopulmonary infections, gastrointestinal infections, and concurrent autoimmune diseases. Food allergies are also common. Anaphylactic reactions to blood transfusions are common. Children can experience otitis media and respiratory tract infections.

Treatment: No known cure for this condition therefore treatment is geared towards prevention of infection. Prophylactic antibiotics are given, if these do not reduce infections IVIG or intravenous immune globulin is administered with low concentrations.

X-Linked Agammaglobulinemia
ICD-9-CM code 279.04

Also called Bruton’s Agammaglobulemia is a condition of a severe B-cell deficiency.

Symptoms: recurrent gram-positive infections which usually occur after 6 months of age, conjunctivitis,dental caries, symptoms of juvenile rheumatoid arthritis. Lymphadenopathy and slenomegaly are noticeably absent.

Treatment: directed at improving immunity defenses and controlling infections. Intravenous infusions of immune globulin every 2-4 weeks and antibiotics are administered. Patients with this condition should never be immunized with live virus vaccinations nor given corticosterioids, and immunosuppressive drugs.

Severe Combined Immunodeficiency
ICD-9-CM code 279.2

SCID is a group of disorders that result from a disturbance in the development and function of both B-cells and T-cells. This leads to the absence of both cell-mediated immunity and antibody-mediated immunity.

Symptoms: manifestations are severe, recurrent infections with bacteria, viruses, and protozoa; chronic diarrhea with failure to thrive. By the age of 3 to 6 months, the natural maternal placental immunity begins to deplete. Common infections are pneumocytis pneumonia and mucocutaneous candidiasis. Discernible lymphoid tissue may be absent and abnormal laboratory findings are hypogammaglobulinemia and abnormal lymphocyte populations.

Treatment: Bone marrow transplantation is the only cure for most types of SCID. Gene therapy is currently being investigated as a form of treatment. Children with SCID are placed in a completely sterile environment (plastic bubble) to prevent infection.

DiGeorge’s Anomaly (Thymic Hypoplasia or Aplasia)
ICD-9-CM code 279.11

A congenital condition of immunodeficiency that results from a small or absent thymus gland.

Symptoms: identified in young children by confirming a set of structural abnormalities. Anomalies include; abnormally wide-set and downward slanting eyes; low-set ears with notched pinnas; small mouth; pallate abnormalities; and cardiovascular defects such as tetralogy of Fallot. Infants will exhibit signs of tetany due to hypocalcemia caused by hypothyroidism. Cognitive impairments often present. Patients are susceptible to infection.

Treatment: Hypocalcemia should be treated to restore the electrolyte balance and reduce the risk of seizures. Vitamin D and parathyroid hormone replacement therapy is also necessary. Repair cardiac anomalies is attempted, intravenous immune globulin and prophylactic antibiotics are often helpful to aid in protection against infections. Limited data suggest the possibility of thymus transplantation to reconstitute immune function in some patients. Appropriate developmental interventions should be instituted.

Chronic Mucocutaneous Candidiasis
ICD-9-CM code 112

CMC refers to a group of disorders characterized by persistent and recurrent candidal (fungal) infections of the skin, nails, and mucous membranes. There is a cell-mediated immunity deficiency in regards to Candida organisms.

Symptoms: usually develop in the first 2 to 3 years of life, or late onset in young adulthood occurs. Large circular lesions appear on the skin, mucous membranes, nails, or vagina. Sores in the mouth make eating difficult. Recurrent trush or diaper rash is often a first symptom of disease in infants. Patients in late stages of the disease experience recurring respiratory tract infections. Other infections and viruses may occur in advanced individuals. CMC can be associated with myasthenia gravis, thymoma, or bone marrow abnormalities. Syndromes of CMC are chronic oral candidiasis, chronic mucocutaneous candidiasis with endocrinopathy (gland failure), chronic localized candidiasis, chrconic diffuse candidiasis and candidisais with thymoma.

Treatment: directed at elminatiing infections and correcting immunologic defects. Systemic therapy with antigunal agents is the most common treatment. Other treatments include transfer of T-cells isolated from donors and sensitized to Candida have been shown to increase children’s immunities to Candida. Topical treatment of antifungal agents appears to improve skin and nail lesions. Symptoms arising from other organs and glands are addressed according to the organ or gland involved.

Wiskott-Aldrich Syndrome
ICD-9-CM code 279.12

a congenital disorder characterized by inadequate B and T cell functions.

Symptoms: eczema, thrombocytopenia with severe bleeding, increases susceptibility to bacterial and viral infections. Bleeding manifestations include petechiae, purpura, hematemesis, epistaxis, meaturia, and more serious GI and intracranial bleeding. By the age of 1, bleeding subsides and eczema develops. Children with this condition are pre-disposed to development of autoimmune disorders, leukemia, and lymphoma.

Treatment: Bone marrow transplant (BMT) which has a high success rate when donor is an HLA-matched sibling. If BMT not feasable, then splenectomy may result in increase in platelet number and size. Additional treamtnes are intravenous immune globulins, and appropriate prophylactic antibiotic therapy. Topical or systemic steroids are used to treat eczema.

Autoimmune Hemolytic Anemia
ICD-9-CM code 283.0

A hematopoieic disorder, this autoimmune disorder is a condition in which RBCs are destroyed by the antibodies.

Symptoms: fatigue, weakness, chills, fever, dyspnea, and itching. Skin is pale and jaundiced, it also bruises easily. Some patients may also be hypotensive.

Treatment: First address underlying disease or cause of the condition. Drugs may also cause hemolytic anemia. Warm and cold antibody anemias are treated differently. In warm antibody anemia, corticosterioids and cytotoxic drugs are administered to reduce antibody productiong. Splenectomy or immune globulin administration is done to reduce antibody effectiveness. Red cell transfustions may be attempted. In cold antibody anemia, the treatment involves avoiding cold like dressing warmly even in the summer, wearing gloves, and warm hats, and spending the colder months in warmer climates. Plasmapheresis is helpful in reducing hemolysis.

Pernicious Anemia
ICD-9-CM code 281.0

A chronic atrophic astritis resulting in decreased gastric production of hydrocholoric acid and shortate of intrinsic factor (a gastric protein which helps the body absorb vitamins). These factors lead to impairment of vitamin B12 absorption and a B12 deficiency.

Symptoms: sore tongue, weakness, and tingling or numbness of extremities. The lips, tongue, and gums appear pale, where as the sclera and skin appear slightly jaundiced. Due to decreased hydrochloric acid production symptoms may also be disturbances in digestion such as anorexia, nausea, vomiting, diarrhea, constipation, flatulence, and weight loss. Individuals with this condition are more vulnerable to infections because B12 deficieny caused demylination of the peripheral nerves and eventually the spinal cord. This is followed by neuritis, peripheral weakness, numbness, and paresthesia. Ataxia,, lightheadedness, altered vision, tinnitus, and optic muscle atrophy are additional symptoms that can occur during progression. CNS changes cause headaches, irritability, and depression. Patients may experience palpitations, dyspnea, tachycardia, premature ventricular contractions and even congestive heart failure.

Treatment: Monthly intramuscular injections of B12 are the primary treatment and occur for life. Blood replacement is indicated in severe cases. Supportive measures include adequate rest, gently nonirritating mouth care, a ballanced diet with high vitamin B12.

Idiopathic Thrombocytopenic Purpura
ICD-9-CM code 287.31

ITP is an acquired disorder that results from an isolated deficiency of platelets (but other blood counts are normal). IT is felt that platelet destruction and/or inhibition of platelet production is a result of autoantibodies against platelets.

Symptoms: inability to form blood clots, sponteaneous hemorrhages in the skin mucous and organs. Petechiae (small spiderlike hemorrhages under the skin) and ecchymoses, larger hemorhhagic areas are apparent. Patient may also experience epistaxis (nosebleeds), GI bleeding, menorrhagia, hematuria, and easy bruising. Clinical symptoms vary with age and older patients have more severe bleeding.

Treatment: Corticosteriods increase capillar integrity for a short time. Intravenous immune globulin may be administered to increase platelet count. Anemia needs to be corrected by blood transfusion and vitamin K administered to improve blood clotting. Therapeutic plasma exchange occasionally is attempted. Splenectomy is a last resort however, the treatment is effective. Children are often given supportive therapy and short-term steroid treatment because ITP in children is self-limited.

Immune Neutropenia
ICD-9-CM code 288.0

A decreased number of circulating neutrophils. This usually is caused by the production of antineutrophil antibodies.

Symptoms: malaise, fatigue, weakness, fever, and stomatitis. Recurrent infections are common especially in infants.

Treatment: Infants with this condition usually require little to no treatment because the condition typically resolves spontaneously. Children, adults and infants with severe cases are treated with corticosteroids, immune globulin, or G-CSF. Appropriate antibiotics are administered to treat bacterial infections. Transfusions of WBC concentrates may be indicated.

Goodpasture’s Syndrome
ICD-9-CM code 446.21

Also known as anti-GBM antibody diease, this autoimmune kidney disease is characterized by the presence of antibodies directed against an antigen in the glomerular basement menbrane (GBM).

Symptoms: glomerulonephritits, protenuria, anemia, hemoptysis, and hematuria. Systemic complaints include weight loss, fatigue, and fever.

Treatment: Choice of treatment is plasmapheresis (to remove anti-GBM antibody) combined with immunosuppressive agents (corticosteriods and cylophosphamide). Treatment is administered for 6-13 months. Hemodialysis and kidney transplants are last resorts for patients with severely compromised immune systems.

Systemic Lupus Erythematosus
ICD-9-CM code 710.0

Usually called SLE or lupus.A chronic inflammatory autoimmune disease characterized by unusual antibodies in the blood that target tissues of the body.

Symptoms: degrees of symptoms vary from patient to patient; inflamed and damaged tissue anywhere in the body. Most commonly produces inflammation of the skin, joints, nervous system, kidneys, lungs, and other organs. Butterfly rash or erythema may present on the face spreading from one cheek across the nose to the other cheek. Similar rashes may appear on other exposed areas of the body. Exposure to sun aggravates rashes. SLE may also begin with acute fever, fatigue, joint pain, malaise, or develop slowly over a period of years with intermittent fever, malaise, joint deformities and weightloss. Raynaud’s phenomenon and hairloss are common/ Disease often occurs in younger women in their 30’s to 40s.

Scleroderma (Systemic Sclerosis)
ICD-9-CM code 710.1

A chronic, progressive disease characterized mostly by sclerosis (hardening) of the skin; scarring of certain internal organs can occur. Classified as either diffuse or limited. Diffuse involves symmetric thickening of the skin on extremities while limited tends to be confined to skin on the fingers and face.

Symptoms: hardening of the skin and certain internal organs including; GI tract, heart, lungs and kidneys. Involved skin becomes taut, firm, and edamatous and is firmly attached to the subcutaneous tissue. Skin feels tough, leathery, itches, and pigmented patches may occur. Raynaud’s phenomenon is the first symptom of this condition which is followed by swelling stiffness, and pain in the joints.

Treatment: No specific treatment known. A large number of drugs have been tried including corticosteoids, vasodilators, and immunosuppressive agents but effects are merely palliative. Physical therapy helps maintain muscle strength, but does not change course of joint disease.

Sjögren’s syndrome
ICD-9-CM code 710.2

An autoimmune disease that features inflammation in various glands of the body. Result of this glandular problem is dryness in the affected areas.

Symptoms: rheumatoid arthritis, xerostomia, keratoconjunctivitis sicca. The dryness of the nasal, oral and laryngeal pharynx causes difficulty with talking, chewing, and swallowing. Patient may experience sores on the mouth and nose, dental decay may occur.

Treatment: directed towards relieving symptoms. Increased fluid intake, checking sugarless gum, using oral sprays help to relieve oral dryness. Artificial tears are used in the eyes, and wearing sunglasses is recommended. Sometimes opthalmologists will block the tear ducts with silicone or cautery or maintain adequate eye moisture. Occasionally prednisone and or antimalarial medications are used to lessen immune inflammation.

Rheumatoid Arthritis
ICD-9-CM code 714.0

RA is a chronic, inflammatory, systemic diesease that affects the joints and is one of the most severe forms of arthritis. RA commonly causes deformities and disabilities in the joints and effects women 3 times more than men. RA may begin at any age but usually occurs in the 30s and 40s

Symptoms: Inflammatory edema of the synovial membranes surrounding a joint. Inflammation spreads to other parts of the affected joint and if left untreated has the capacity to destroy cartilage and deform joints. Spinal cord can be at risk when the neck is involved. It can cause generalized inflammation around or in the lungs, cardiac muscle, in blood vessels and within layers of the skin. RA begins with obvious joint complications but patients may also experience weight loss, fatigue, persistent low grade fever, general malaise. This may accompany or precede joint stiffness which is noticed especially during periods of inactivity. Edema, pain, tenderness, erythema, and warmthin in joints occurs in a semmetric pattern and gradually emerges as the principal symptoms.

Treatment: primary objectives are to reduce inflammation and pain while preserving joint function and preventing deformity. This requires a combination of medications, rest, special exercises, and joint protection. Antiinflammatory drugs (NSAIDs) are prescribed as an alternative to aspirin. Corticosteriods, by mouth or by local injection are given to control acute flare-ups. DMARDs (disease-modifying antirheumatic drugs) such as gold compounds, penicillamine, immunosuppressive agents, and newer biologic response modifiers may slow the disease process or even stop its progression.

Juvenile Rheumatoid Arthritis
ICD-9-CM code 714.30

a form of RA that affects children (less than 16 years of age) and is most common between ages 2 and 5.

Symptoms: Various forms pauciarticular (only a few joints affected), polyarticular (many joints affected), and systemic onset of JRA includes high fevers and rashes. Systemic onset symptoms include temperature fluctiation, poor appetitie, weight loss, blotchy salmon-colored rashes over limbs and trunk of the body, anemia, and swollen stiff joints. Other symptoms include painful red eyes, swollen cervial or axillary lymph glands, irritability, and acute pericarditis. Skeletal development will be impaired if epiphyseal plates are damaged during inflammation of the joints.

Treatment: similar to adult treatment but medication dosages are adjusted based on weight. Physical non-strenuous activity is important. Well balanced diet with plenty of protein is essential. Physical therapy exercises can be cruicial for minimizing pain and reducing the crippling effects of arthritis. Braces or splints may be necessary to correct growth disturbances.

Ankylosing Spondylitis
ICD-9-CM code 720.0

Systemic and usually progressive, inflammatory disease affecting the spinal column primarily. Several times for common in men than in women.

Symptoms: fatigue, weight loss, fever, diarrhea, eyepain, photophobia due to uveitis. Pan and tenderness may be noted over sign of inflammation. As the disease progesses over years limited range of motion happens due to fusion (ankylosis), inflammation and ossification progress up spine. Eventually spinal vertabrae become fused, inflexible, and rigid. The patients posture exhibits typical forward flexion of the spine.

Treatment:No cure known. Treatment is to releive pain and swelling with antiinflammatory medication and analgesics. Patients benefit from physical therapy and moderate exercise to maintain posture and maximize motility. Surgical intervention is rarely indicated.

ICD-9-CM code 710.04

Disease of muscle that features inflammation of the muscle fibers. Muscles affected are mostly in the trunk and it results in weakness that can be severe. This disease can have flares, relapses and remissions.

Symptoms: weakness is the most common, onset can be rapid or gradual with varying degrees on muscle power and atropy. Strength is noted when patient has difficulty getting up from chairs, climbing stairs, or lifting above the shoulders. Trouble with swallowing and weakness in lifting the head from a pillow can occur. Accompanied by skin inflammation, known as dermatomyositis. Rashes may appear over face, shoulders, arms and bony priminences.

Treatment: Directed toward stopping inflammation and inhibiting the overactive immune system. High doses of steroids usually prescribed to suppress inflammation. Immunosuppressive agents, are used and gradually increase exercise therapy to rebuild strength.

Multiple Sclerosis
ICD-9-CM code 340

An inflammatory disease of the nervous system which primarily effects the CNS (spinal cord). It attacks the myelin sheath and ultimately causes scarring (sclerosis) that debilitates the nerves.

Symptoms: weakness or numbness in the limbs, optic neuritis, loss of vision in one eye, diplopia, unsteady gait, vertigo, difficulty voiding, facial numbness or pain, speech problems, dysphagia, hearing loss, impotence in men, fatigue, emotional disturbances.

Treatment: acute attacks are treated with corticosterioids. Relapsed patients may be started on medications approved to treat MS including interferon beta-1a (avonex) interferon beta-1b (Betaseron), glatiramer (Copaxone), Rebif, and mitoxantrone. Immunosuppressive therapies may be useful in progressive treatment (radiation, steriods, immune globulin, and cytotoxic drugs). Other than this the disease is treated symptomatically which may infcude muscle relaxants, vitamin supplements, physical therapy, wearing braces, and using a cane, walker, or wheelchair. Adequate rest and well balanced diet are also important.

Myasthenia Gravis
ICD-9-CM code 358.0

Chronic, progressive neuromuscular disease that is thought to stem from the presence of autoantibodies from the acetylcholine receptor.

Symptoms: extreme muscular weakness (without atropy), progressive fatigue, onset can be gradual or sudden, dropping eyelids, diplopia, difficulty talking chewing and swallowing. Muscle weakness is progressive and eventually paralysis occurs. Myasthenic crisis (sudden inability to swallow and respiratory distress) may be so severe that mechanical ventilation is necessary. Prolonged exposure to sunlight, cold, infections, and emotional distress exacerbates the symptoms.

Treatment: is supportive. Treatment is based on patients age and pregnancy status. Restricted activity, complete bed rest for severe cases, soft liquid diets are all examples of supportive treatment. Anticholinesterase drugs are effective initial treatment for the weakness and fatigue but become less effective as the condition worsens. Pyridostigmine bromide is the drug of choice for treatment. If a thymus gland tumor is present, thymectomy is needed. Corticosteriods are effective in patients who have not improved from thymectomy.

Small Vessel Vasculitis
ICD-9-CM code 447.9 (unspecified disorders of ateries and arterioles)

A category of vasculitis that primarily affects the capillaries, arterioles, and venules.

Symptoms: inflammation of the small vessels causing petechiae, purpura, erythema, ulcerations, and edema. Pain and a burning sensation can accompany lesions. Additionally, depending on the type of small vessel syndrome that the patient experiences, symptoms can include ocular lesions, genital, or oral ulcerations, abdominal pain, arthralgia, and weakness.

Treatment: identifying and preventing exposure to causative agent or managing underlying cause. Corticosteriod therapy provides relief and analgesics are given.

Systemic Necrotizing Vasculitis
ICD-9-CM code 447.8

a condition that primarily affects the medium and large arteries.

Symptoms: differ depending on the body system involved but generally include; headaches, fever, weakness, fatigue, malaise, anorexia, and weight loss. Patients also may experience muscle and joint pain, angina, dyspnea, hypertension, and visual disurbances. Ulcerations of the skin can occur and paralysis of an effective nerve leads to numbness or weakness.

Treatment: focuses on decreasing inflammation of the arteries and improving function of affected organs. Treatment addresses underlying causative factors and the systemic involvement. Corticosteriods and analgesics afford relief of the effects of inflammation. Immune suppressing medications and plasmapheresis can also lession the immune activation. Hypertenstion is treated with ACE inhibitors. Ocular problems need to be closely monitored for progression.


ICD-9-CM code 253.0

A chronic and progressive disease, it caused by the excessive production and secretion of pituitary hormones, for example human growth hormone (hGH). The excessive hGH produces one of two distinct conditions, gigantism, or acromegaly, depending on the time of life at which the dysfunction begins.

Symptoms: hypersecretion of GH before puberty and result in gigantism,sexual and mental retardation

Treatment:objective is to reduce the amount of GH that is secreted. This is preformed ideally by surgery (transsphenoidal approach) with or without the addition of radiation to the pituitary gland to reduce its size. Appropriate gonadal hormones are administered in some children who exhibit signs of hypogonadism.

ICD-9-CM code 253.2

a condition caused by a deficiency or absence of any of the pituitary hormones, especially those produced in the anterior lobe.

Symptoms: metabolic dysfunction, sexual immaturity, growth retardation, hormone deficiency, growth retardation happens in children, and headache and blindness happen when a tumor infringes on the optic nerve.

Treatment: depends on the age of patient, severity, type of deficiency, and underlying cause. If neoplasia is the cause, removal of the tumor eases the symptoms. Replacement therap with hormonal supplements, including thyroxing, cortison, sex hormones, or somatrem or smatropin hGH, is usually effective. Hormone levels must be continually monitored during hormone replacement therapy.

ICD-9-CM code 253.3

abnormal underdevelopment of the body, or hypopituitarism, occurring in children.

Symptoms: hyposecretion of the pituitary hormones especially GH, growth retardation, extremely short, body has small proportions, pubescent children do not develop secondary sex characteristics. Condition may be linked to other defects which vary on degree of mental retardation.

Treatment: Somatotropin (hGH) is administered until the child reaches the height of 5 feet. These children also may need replacement thyroid and adrenal hormones. As they approach puberty, sex hormones are administered if deemed necessary.

Diabetes Insipidus
ICD-9-CM code 253.5

disturbance in water metabolism resulting in extreme thirst and excessive secretion of dilute urine.

Symptoms: excessive thirst, diluted urine, deficiency of vasopressin, fatigue, symptoms of dehydration, dry mucous membranes, hypotension, dizziness, and poor skin tugor. Onset of symptoms may be abrupt.

Treatment: administration of vasopressin injections, nasal spraym oral demopressin acetate. In nephrogenic diabetes insipidus thiazide diretics block the ability of the kidneys to excrete free water by inhibiting reabsorpiton of sodium and chloride and increasing excretion of sodium. chloride and water. Any underlying causes should be identified and treated. Excessive diuresis is the result of trauma to the pituitary gland, symptoms may subside as the insult resolves.

Simple Goiter
ICD-9-CM code
240.0 Goiter (specified as simple)
240.9 Goiter (unspecified)

Any enlargement of the thyroid gland. Patient is usually female.

Symptoms: simple goiter, hyperplasia of the thyroid, patients may be possibly asymptomatic in early stages, enlargement of the anterior aspect of the neck, swollen mass (called a goiter), as hyperplasia increases it presses on the esophagus which produces difficulty swallowing, occasionally it enlarges so much it presses on the trachea causing dyspnea.

Treatment: Treatment during early stages is simple with administration of one drop per week of potassium iodide saturated solution. Prevention calls for addition of iodine to the diet. Although this is no longer seen in the US, introduction of iodized salts. Foods or drugs that are goitrogenic should be avoided. Sometimes hormone therapy such as thyroxine helps.

Hashimoto’s Thyroiditis
ICD-9-CM 245.2

a chronic disease of the immune system that attacks the thyroid gland. Eight times more common in women than men and most common between 45 and 65 years of age.

Symptoms:gradual and painless enlargement of the thyroid, pressure in the neck, difficulty swallowing, symptoms of hypothyroidism such as; sensitivity to cold, weight gain, and mental apathy.

Treatment: Lifelong replacement of thyroid hormones. Also prevents further growth of the goiter.

Graves’ Disease, Hyperthyroidism
ICD-9-CM code 242.0

a condition of primary hyperthyroidism, occurs when the entire thyroid gland hypertophies, resulting in a diffuse goiter and an overproduction of thyroid hormones.

Symptoms: increased metabolism and multisystem due to overproduction, rapid heartbeat, palpitations, nervousness, excitability, insomnia, loss of weight despite excess consumption of food, profuse perspiration, moist skin, intolerance to hot weather, muscular weakness, nail changes (onycholysis), hyperactive behavior, tremor, loss of hair. Sometimes eye develops exophthalmos which gives the patient a staring expression. Sometimes skin changes are noted. A sudden exacerbation of symptoms may signal thyrotoxicosis, or thyroid storm, due to exaggerated hormone levels which can be life threatening.

Treatment: Goal is to reduce formation and secretion of thyroid hormone. Treatment begins with the administration of antithyroid drugs, such as propylthiouracil and methimazole to block hormone synthesis. Beta-blockers are given to treat tachycardia and hypertension. Alternative treatments include radioactive iodine, surgical intervention (thyroidectomy) which is rarely done in the US.

Cretinism, a Hypothyroidism
ICD-9-CM code 243

Hypothyroidism which develops in infancy or early childhood.

Symptoms: absent thyroid gland, or thyroid hormones not being synthesized. Mental retardation, growth retardation, dwarf like development, stocky in stature, protruding abdomen, short forehead, broad nose, small wide-set eyes with puffy eyelids, wide-open-mouth, thick protruding tongue, expressionless face, dry skin, failure to fully develop sex organs, lack of muscle tone contributes to the inability to stand or walk.

Treatment: Early treatment with thyroid hormone promotes normal physical growth but may not prevent mental retardation. Hormone replacement therapy must continue for life.

Myxedma, a Hypothyroidism
ICD-9-CM code 244.9 (Primare or NOS)

Hypothyroidism that develops in an older child or adult. Patients are usually female.

Symptoms: reduced levels of T4, has onset in older childhood or adult life, clinical manifestations vary with age. As levels of T4 decrease, metabolism is slowed, and there is onset of systemic conditions. Menorrhagia, dry skin, scaly skin, little or no perspiration, bloated face, thick tongue, puffy eyelids, muscular weakness, excessive tiredness, fatigue, rare conditions include comas.

Treatment: Levothyrocine sodium (T4), is administered. The goal of medical management is to achieve normal thyroid function at the lowest possible dose. Hormone replacement therapy is a life long treatment.

Thyroid Cancer
ICD-9-CM code 193

Cancer in the thyroid gland, a bilobed structure below and anterior to the larynx.

Symptoms: malignancies may not cause symptoms until the time it is advanced. Palpitation of hard, painless lump or nodule on the thyroid gland, vocal cord paralysis, obstructive symptoms, and cervical-lymph. Adenopathy will indicate cancer. Some may exhibit dysphagia or hoarseness resulting from compression of the upper aerodigestive tract.

Treatment: Surgical intervention necessary for papillary, follicular and medullary thyroid cancers. Surgery includes total removal called thyroidectomy and removal of any lymph nodes. Administration of radioiodine to destroy any remaining thyroid tissue and tumor. Aggressive initial therapy yields lower rates of local and regional recurrence and lowers overall mortality. Risk of thyroidectomy includes vocal cord paralysis paralysis due to laryngeal nerve damage. TSH is administered after surgery to prevent tumor growth. Excessive thyroxine treatment may lead to accelerated bone loss, atrial fibrillation, and cardiac dysfunction.

For anaplastic tumors, nonsurgical treatment options such as radiotherapy and/ or chemotherapy may prolong survival. Total thyroidectomy.

ICD-9-CM code 252.00

A condition caused by overactivity of one or more of the four parathyroid glands and results in the overproduction of parathyroid hormone PTH.

Symptoms: demineralization of bone, hypercalcemia, extracellular fluid. Hypercalcemia produces symptoms of hyperthyroidism. Hypercalcemia reduces the irritability of nerve and muscle tissue, this causes patient to experience muscle weakness and atrophy, gastrointestinal pain, and nausea and vomiting. High serum calcium levels can produce conduction defects of the heart. Increased deposit of calcium in soft tissue causes low-back pain and renal calculi. Bone tenderness, arthritis type of pain, and easy fracturing of the bones result in demineralization.

Treatment: varies with the cause, if hypersecretion of PTH is caused by an adenoma. tumor will be removed via minimally invasive parathyroid surgery. If hyperplasia is the cause, 3.4 of the 4 glands are removed. When condition is secondary, the underlying cause must be treated and blood serum calcium levels reduces. Drugs that increase the excretion of calcium by the kidney or inhibit the re-absorption of calcium from the bone may be used.

ICD-9-CM code 252.1

secretion of the parathyroid hormone (PTH) by the parathyroid glands is greatly reduced.

Symptoms: hypocalcemia, possible excessive deposits of calcium into tissue, hyperexcitable nervous system. overstimulation of skeletal muscles, twitching of hands and feed, tetany, or severe sustained muscular contractions, emotional changes, confusion, irritability, sustained hypocalcimia leads to laryngospasm, arrhythmias, respiratory paralysis, and death.

Treatment: calcium replacement therapy with vitamin D to reduce hypocalcemia. Replacement therapy is life-long unless the condition is reversible. In the case of life-threating deficiency (tetany), calcium gluconate is administered intravenously. High calcium diet is encouraged.

Cushing’s Syndrome
ICD-9-CM code 255.0

Chronic hypersecretion of the adrenal cortex, results in excess circulation of cortisol.

Symptoms: fatigue, muscular weakness, changes in body appearance. Fat deposits form in the scapular area (known as buffalo humps) and the trunk, causing protrusion of the abdomen. Salt and water retention results in hypertension, edema, and moon faced characteristic may be noted. Patients may exhibit hyerlipidemia, osteoporosis, atherosclerosis, psychiatric problems, thin skin with tendency to bruise, red or purple striae (stretch marks). Predisposed infections result in suppression of immunities, excessive hair growth, amenorrhea, impotence, and some may also have diabetes mellitus.

Treatment: depends on the cause of the oversecretion of cortisol. When tumor is the cause, surgical removal or radiation of the tumor in the pituitary or adrenal gland is indicated. Drug therapy supresses ACTH secretions.

Addinson’s Disease
ICD-9-CM code 255.41

partial or failure of adrenocortical function.

Symptoms: adrenal insufficiency or hypoadrenalism, fatigue, weakness, anorexia, weight loss, gastrointestinal disturbances, bronze skin color, possible symptoms include; cardivascular difficulties, irregular pule, reduced cardiac output, orthostatic (postural) hypotension. Depression, anxiety, and emotional distress. Reduced aldosterone may cause inability to retain salt and water. Dehydration, hyperkalemia, and electrolyte imbalance occurs when the condition is life threatening.

Treatment: replacement of natural hormones with glucocorticoid and mineralcorticoid drugs, and correction of salt and potassium levels. Education about symptoms of overdose and underdose along with the role of stress and infection is important. Insufficiency or a sudden decrease in adrenocortical hormone levels is a life-threatening condition called an addisonian crisis.

Diabetes Mellitus
ICD-9-CM code 250 (4th or 5th digits required)

Chronic disorder of carbohydrate, fat, and protein metabolism caused by inadequate production of insulin by the pancreas or insulin resistance.

Symptoms: Two primary forms Type 1 and Type 2. Symptoms of both hyperglycemia, ketonuria, acidosis, polyuria, polyphagia, polydipsia, weight loss, and fatigue. Patient may have pruritus, and a fruit order of the breath in type 1 patients. Diagnostic tests of the blood and urine confirm the condition. Type 1 is usually juvenile onset which happens usually before the age of 30 years with little or no insulin secretion. Type 1 patients are insulin dependent.Type 2 is more common in adults older than 30 and pancreatic functions remain which makes it treatable with diet and medication.

Treatment: The goal is the normalize glucose levels. Well balance diet closely integrated with insulin or oral medications, exercise, blood and urine testing, and hygienic measures. Type 1 patients may require insulin therapy that closely relates to their calculated caloric intake and consistent moderate exercise. Insulin can be administered via injection, open-loop infusion pumps, insulin inhalers, and insulin pens. Type 2 patients are commonly given metformin hyrochloride which is a glucophage.

Gestational Diabetes
ICD-9-CM code 648.80 (Mother)

GDM, or type 3 diabetes, condition of damaged ability to process carbohydrate that has onset during pregnancy.

Symptoms: between 24-28 weeks of gestation, pregnant patients may be asymptomatic. Usual symptoms of diabetes mellitus; polyuria, polydipsia, and polyphagia occur.

Treatment: similar to any diabetes treatment but includes close surveilance of mother and fetus due to risk of complications. Diet is controlled with a limit on sugar intake, consistent moderate exercise, oral hypoglyemic agents such as insulin may be indicated. Patient is instructed how to self-monitor glucose levels frequently with glucometer. If delivery of infant does not terminate condition, a therapeutic diabetic regiment begins.

ICD-9-CM code 251.2 (unspecified)

abnormally low glucose levels in the blood

Symptoms: deficiency of glucose in the blood and can be serious. Sweating, nervousness, weakness, hunger, dizziness, trembling, headache, and palpitations may occur. Extremely low levels cause CNS manifestations; confusion. visual disturbances, behavior mistaken for drunkeness, stupor, coma, and seizures. Hypoglycemic syndromes are classified as drug induced (most common) or nondrug induced.

Treatment: restoration of blood glucose to normal levels through intravenous infusion of glucose. Hormone glucagon also may be given to counteract the insulin. Once stabilized complex carbohydrates and protein snacks administered to maintain normal limits. Hypoglycemia associated with tumors requires surgery. Diet is modified to correct hereditary fructose intolerance or gastrointestinal conditions that may provoke the symptoms

Precocious Puberty in Boys
ICD-9-CM code 259.1

Onset of puberty before the age of 9.

Symptoms: sexual maturity begins earlier in life, secondary sex characteristics develop. Patients family history may include altered growth pattern, or emotional disurbances. Pubic hair, and beard begin to grow, gonads and the penis increase in size and sebacous gland activity increase. Male puberty normally begins around 13-15 years.

Treatment: therapy depends on the cause of precocious puberty. When a boy’s condition is idiopathic, no specific treatment may be needed. One treatment is hormone therapy to suppress sexual maturation until the appropriate period of onset. GnRH antagonist- inhibit androgen spironolactone, androgen synthesis (ketoconazole) or block the conversions of androgens have been used. When the cause is testicular tumor or brain tumor, treatment is more invasive. Other endorcine disorders may require lifelong hormone therapy.

Precocious Puberty in Girls
ICD-9-CM code 259.1

Puberty onset before the age of 8.

Symptoms: sexual maturity such as breast enlargement, pubic hair, menstruation may occur before the age of 10. Ovarian function makes pregnancy a possibility. Emotional problems may occur.

Treatment: Depends on the cause. Tumors are treated through radiation therapy and surgical intervention. Hormone therapy may be used to suppress the secretion of gonadotropins and prevent menstruation. Some may benefit from mental health counceling to develop coping skills to emotional problems. Parents are educated on how the child is physically mature but mentally immature.

Hyperopia (Farsightedness)
ICD-9-CM code 367.0
a refractive error that occurs when light that enters the eye is focused behind the retina rather than on the retina, near vision is impaired. Requires refocusing the eye of an external corrective lens to re-position the viewed object. Can be corrected surgically.
Myopia (Nearsightedness)
ICD-9-CM code 367.1
A refractive error that results from light rays entering the eye being focused in front of the retina, causing vision to be blurred. Near objects are seen clearly but distant objects are blurry and the lens cannot be sharpened by the internal lens in the eye. Myopia occurs when the eyeball is abnormally long as measured from front to back. Can be corrected surgically.
ICD-9-CM code 367.20
A refractive error which results from irregular focusing of the light rays entering the eye. It usually is caused by the cornea not being spherical. The front of the cornea may be more egg shaped than spherical, thereby causing light rays to be unevenly diffused across the retina. This causes images to appear clearly defined, whereas others appear blurred. Can be corrected surgically.
ICD-9-CM code 367.4

The inability of the internal lens of the eye to focus and then refocus quickly to accommodate variations of distance because of a gradual loss of muscle and lens elasticity, generally a result of aging. Usually starts around the mid-40s.

Symptoms: blurred vision, eye fatigue, squinting, frequent rubbing of eyes, and headaches

Treatment: Correcting refractive errors with artificial lenses, contact lenses, or corrective surgery. Radial keratotomy is the surgical procedure done to reshape the eye but has been replaced with laser surgery.

ICD-9-CM code 379.50

involuntary, repetitive, rhythmic movements of one or both eyes.

Symptoms: repetitive or involuntary movement of one or both eyes. Movements can be horizontal, vertical, circular, or a combination of these. Blurred or decreased vision is also associated with nystagmus.

Treatment: managed by treating the underlying condition, congenital nystagmus can be lessened by using the Kestenbaum procedure in which the eyes are surgically rotated towards the null point of the eye.

ICD-9-CM code 378.9

visual defect of misalignment, failure of the eyes to look in the same direction at the same time. Primarily occurs because of weakness in nerves stimulating the muscles controlling the position of the eyes.

Symptoms: esotropia (cross-eye), both eyes turn inward; exotropia (wall-eye), both eyes turn outward. The main symptom diplopia is aquired as an adult. Diplopia is usually not present in congenital patients.

Treatment: Treatment should be ASAP. Early intervention is key. Corrective glasses, amblyopia treatment, or surgery may restore the muscle balance.

Hordeolum (Stye)
ICD-9-CM doe
373.11 (Hordeolum externum)
373.12 (Hordeolum internum)
373.13 (Abscess of the eyelid)

inflammatory infections of the sebaceous glands of the eyelids.

Symptoms: occur most often outside the edge of the lid. Pain, swelling, redness, formation of pus, and feeling of something in the eye.

Treatment: To hastan drainage, hot compresses may be applied to the eye as soon as inflammation is evident. If surrounding soft tissue becomes infected, oral antibiotics may be needed. Also treated with eye drops. If persistent, surgical intervention to drain off the pus is needed.

ICD-9-CM code 373.2

a chalazion is a small, painless, localized swelling on the margin or body of the eyelid. It occurs with occlusion of the meibomian glands.

Symptoms: chalazion may vary in size from being barely visible to pea size. Chalazia can become infected producing redness, swelling, and pain.

Treatment: Small chalazia usually disappear spontaneously over a month or two with the regular application of hot compresses. Resoultion may be facillitated by topical antibiotic treatment. Large pea-sized chalazia may not spontanously disappear and may need surgical removal.

ICD-9-CM code 370

Inflammation or infection of the cornea

Symptoms: decreased visual acuity, irritation, tearing, photophobia, and mild redness of the conjunctiva. Pain or numbness of the cornea may soon follow and is a significant sign.

Treatment: Opthamolic ointments and eyedrops may be prescribed, and the administration of a broad-spectrum antibiotic or an antiviral agent can effectively eradicate the infection. An eye patch may be needed to relieve discomfort caused by photophobia.

ICD-9-CM code
373.00 (unspecified)
373.01 (ulcerative blepharitis)
373.02 (squamous blepharitis)

Inflammation of the margins of the eyelids involving hair follicles and glands.

Symptoms: persistent redness and crusting on and around the eyelids. Symptoms may include; itching, burning, or a foreign body sensation. In severe cases, eyelashes can fall out, and the patient may experience persistent irritation of the eyes.

Treatment: if condition does not improve within 2 weeks, patient has the lids cleaned twice a day with baby shampoo and warm compresses. Antibiotic opthalmic ointments may be needed in more severe cases.

ICD-9-CM code 374.00

the eyelid margins turn inward causing lashes to rub the conjunctiva

Symptoms: sensation of a foreign body in the eye, tearing, itching, and redness. Chronic irriation of the conjunctiva may cause conjunctivitis. Entropion can also damage the cornea causing epithelial defects and vision problems if not corrected.

Treatment: For persistent irriation patient should be seen by physician and minor surgical procedures will correct the problem.

ICD-9-CM code 374.10

Condition in which the lower eyelid everts from the eyeball and the lining of the eyelid become dry and irritated.

Symptoms: eversion of the eyelid exposes conjunctival membrane lining of the eyelid. Tears are diverted away from the tear duct and run down the cheeks. Patients report dryness in the eye and tearing.

Treatment: Ectotrpion rarely disappears without treatment. Minor surgical intervention corrects the condition.

ICD-9-CM code 374.30

also called ptosis, permanent drooping of the upper eyelid, which partially or completely covers the eye.

Symptoms: usually affects one eye but can affect both. Condition may vary in severity throughout the day. Occurs at any age, often familia, and if severe, obstructs vision of the eye.

Treatment: surgical intervention preformed to elevate eyelid position or in case of myathenia gravis, systemic medication is prescribed.

ICD-9-CM code 372.30

Inflammation of the conjunctiva, mucous membrane covers the anterior portion of the eyeball and also lines the eyelids.

Symptoms: redness, swelling, itching of the conjunctiva, excessive tearing, sensitive to light. If infectious conjunctivitis, mucous discharge may be present.

Treatment: vary depending on cause. Eyes should be kept free from discharge which is accomplishes with cool compresses. For bacterial infections topical antibiotics are prescribed.

Corneal Abrasiion or Ulcer
ICD-9-CM code 918.1
371.82 (corneal injury due to contact lens)

Abrasion is the painful loss of surface epithelium. Corneal ulceration is an infection of the cornea.

Symptoms: pain, redness, and tearing, sensation of something foreign in the eye, vision impairment, history of having foreign body in the eye or recent ocular trauma.

Treatment: if foreign body is present it is removed promptly to prevent further ulceration and infection. Opthalmic antibiotic ointment is often prescribed to prevent secondary infection in cases of corneal abrasion. Application of an eye dressing may be needed to promote healing.Corneal ulcers need to be treated with intensive broad-spectrum antibiotic therapy immediately.

Episcleritis/ Scleritis
ICD-9-CM code 379.00

Inflammation of the episclera is episcleritis. Inflammation of the deeper sclera, is called scleritis. Episcleritis occurs far more common.

Symptoms:redness, irritation in an isolated portion of the eye, intense redness, pain, blurred vision. Inflammation can occur in the posterior portion of the eye, which mat cause vision loss. If left untreated perforation of the globe and loss of eye are possible outcomes.

Treatment: Mild cases of scleritis and episcleritis are treated with topical steroid eye drops. For severe cases, immuno-suppressive drugs are prescribed. Perforation of the sclera needs a surgical replair called scleroplasty.

ICD-9-CM 366

The natural lens of the eye becomes opacified. Develop slowly and gradually reduce visual acuity.

Symptoms: develop slowly and gradually reduce visual acuity. Primary symptoms is derioration of vision of the eye. Patients complain of poor night vision, yellowing or fading colors, need for bright light to read. Advanced cases the cataract may be readily visible as a while, opaque appearance which blocks light, thereby impairing vision.

Treatment: depends on the progression and amount of impairment along with age, health, and occupation. Surgery is advised when the cataracts begin to interfere with the lifestyle of the patient. Most common surgical procedure for removal is phacoemulsification where they use an ultrasonic probe to break up the cataract.

ICD-9-CM code 365

Damage to the optic nerve, often caused by intraocular pressure.

Major cause of blindess, glaucoma is more common in patients 60 years of age or older however it can occur at any age. The cilliary body of the eye produces fluid in the aqueous humor. The fluid circulates freely and the posterior and anterior chambers of the eye pass through the trabecular meshwork and drains the general circulation. There are many types of glaucoma including chronic open-angle and acute angle-closure glaucomas.

Chronic Open-Angle Glaucoma
ICD-9-CM code 365.10

obstruction that occurs in the trabecular meshwork.

Symptoms: silent disease, most common treatable cause of blindness. Symptoms appear after glaucoma has progressed which include intraocular pressure, headaches, loss of peripheral vision, vision loss, complete blindess.

Treatment: early treatment essential, if not treated promptly the disease can lead to blindness. Medications decrease aqueous humor or increase uveoscleral outflow. Laser treatment also can be beneficial to open the drainage system. Corrective surgery may be necessary to open or bypass the drainage system but most can be controlled with eye drops.

Acute Closed-Angle Glaucoma
ICD-9-CM code 365.2

The trabecular meshwork is covered by the root of the iris or adhesions between the iris and the cornea.

Symptoms: blurred vision, severe eye pain, headaches, redness, phothophobia, in severe cases can cause nausea, vomiting. Cornea of eye becomes hazy due to elevated pressure.

Treatment: laser iridotomy which creates small opening of the iris allowing filtering angle to open. Ofthen the IOP is lowered with medication before the treatment.

Macular Degeneration
ICD-9-CM code 362.50 (Senile, unspecified)

Progressive deterioration of the macula of the retina.

Symptoms: mild distortion of central vision, usually painless, develops slowly, does not effect peripheral vision. Vision may eventually disappear altogether. Most common cause of blindness in the US.

Treatment: no definitive cure known however vitamin supplements, especially A, C, E, and zinc can help slow deterioration of moderate dry macular degeneration. Other treatments include phtocoagulation, photodynamic therapy, injection of the antiangiogenic factors or a combination of all of these. Visual aids, such as hand-held magnifiers and closed circuit TV is also beneficial.

Diabetic Retinopathy
ICD-9-CM code 362.0
250.5 (code first diabetes)

disorder of the retinal blood vessels

Symptoms: microaneurysm. hemorrhages, dillation of the retinal veins, neovascularization. Condition usually occurs in both eyes affecting the sharpness and clarity of vision. Major cause of blindess.

Treatment: laser photocoagulation is effective. Condition has a tendency to recur but treatment often keeps vision maintained. In cases of vitreous hemorrhage or proliferative disease, vitrectomy may be necessary.

Retinal Detachment
ICD-9-CM code 361.9

an elevation or separation of the retinal from the choroid

Symptoms: patient sees floaters and light flashes, persists and worsens and then is followed by dark shadow that extends from the periphery inward. This may begin to lower or upper the field of vision in one of the side fields of vision.

Treatment: intervention is imperative and early treatment is advised. Retinal detachment consists of their photocoagulation or surgery. Should be done without delay to prevent additional portions of the retina from detaching. If the detachment had extended to the macula, the cntral retina, permanent reduction in the central acuity often occurs. Photocoagulation or cryotherapy can be used to treat retinal tears if no significant detachment occurs.

ICD-9-CM code 364.3

inflammation of the uveal tract, including the iris, ciliary body, and choroid.

Symptoms: Pain, photophobia, blurred vision, redness.

Treatment: varies on the specific type of ubeitis and largely of topical or severe cases of systemic steroid used. Underlying causes should be treated. Cycloplegic agents, that cause paralysis of the ciliary muscle ,are often beneficial to reduce pain and inflammation.

ICD-9-CM code 376.2

Abnormal protrusion of the eyeballs.

Symptoms: abnormally large amount of the anterior eye is exposed. Patients report dryness, gritty feeling in the affected eye or eyes, also may have double vision and restriction of eye movement. In severe cases vision becomes seriously blurred

Treatment: diagnosis determines therapy, if caused by hyperthyroidism treatment is to treat the underlying disorder. Severe cases may require surgical decompression of the orbis, and systemic steroids are beneficial to controlling edema.

Cancer of the Eye
ICD-9-CM code 239.8

Cancer may involve the glove, the orbit, the nerve, or the eyelids. Neoplasms may be benign, malignant, or metastatic from other locations (secondary tumors).

Symptoms: visible lesions, skin tags on the eye, exophthalmos, leukocoria, strabismus, impaired vision, decreased visual acuity, secondary eye tumors, pain.

Treatment: excision of the tumor, eyeball removal, radiation therapy, laser therapy. Treatment of secondary eye cancer rarely improves patient survival, but chemotherapy or radiation therapy may be given for palliation of symptoms.

Impacted Cerumen
ICD-9-CM code 380.4

an aytpical accumulation of cerumen in the canal of the outer ear. The ear wax that accumulates hardens and has a tendency to prevent sound waves from reaching the tympanic membrane, resulting in decreased hearing.

Symptoms:feeling of ear being plugged, tnnitus, otalgia, hearing loss

Treatment: cerumen must be removed. If the cerumen adheares to the wall of the ear canal, it may have to be softened first with oily drops or hydrogen peroxide and then irrigated to accomplish removal. Any hearing loss is alleviated after removal.

Infective Otitis Externa
ICD-9-CM code 380.1

Inflammation of the external ear canal. Condition usually accompanied by an infectious process.

Symptoms: pain, red, swollen ear canal, hearing loss, fever, pruritus, Drainage may be watery or purulent.

Treatment: ear canal must be kept clean and free from water. Antibiotic or steriod eardrops and systemic antibiotics may be prescribed depending on severity. Tends to recur and become chronic.

Swimmer’s Ear
ICD-9-CM code 380.12 (Acute Swimmer’s Ear)

Inflammation and resulting infection of the outer ear canal after water becomes entrapped during swimming.

Symptoms: severe pain, red and swollen ear canal, hearing loss, fever, pruritism drainage is watery or purulent, onset occurs after swimming.

Treatment: ear canal to be kept clean and dry after swimming. Antibiotic or steroid ear drops and systemic antibiotics may be prescribed, depending on the severity of the condition. Swimmer’s ear tends to recur and can become chronic for those with repeated exposure to water as in swimming.

Otitis Media
ICD-9-CM code
381.4 (nonsuppurative otis media)
382.0 (suppurative and unspecified otitis media)

inflammation of the normally air filled middle ear with the accumulation of fluid behind the tympanic membrane, occurring either unilaterally or bilaterally.

Symptoms:feeling of fullness or pressure in ear, impaired hearing, painful, infection, fever, chills, nausea, and vomiting. Children often rub or pull the affected ear and lean the head sideways toward the affected side. Dizziness can be a symptom in either type. Muffled hearing may be present or significant loss of hearing may occur.

Treatment: analgesics and decongestants provide pain releif and promote drainage. For patients who fail to respond to medication surgical evacuation of the fluid (myringotomy) is necessary.

ICD-9-CM code 387.9

primarily effects the stapes or third bone of middle ear. Movement of ossicles is impaired, which causes diminished conduction of sound waves and resulting in hearing loss.

Symptoms: gradual hearing loss of low or soft sounds which may be unilateral or effect both ears, and tinnitus. IS considered a young person’s disease which means onset usually begins after puberty and before the age of 35.

Treatment: stapedectomy is the only known cure and involves removal of the diseased stapes and replaces with a prosthesis. Hearing aids may be tried for patients who are unable to undergo surgery.

Ménière’s disease
ICD-9-CM code 386.00

Chronic disease of the inner ear that affects the labyrinth.

Symptoms: vertigo, tinnitus, progressive hearing loss, sensation of fullness or pressure in the affected ear. Symptoms have sudden onset and include; vomiting, sweating, and loss of balance can follow an acute attack of vertigo. Usually effects one ear but both may be involved.Disease manifests between ages of 40-50.

Treatment: for acute attacks medication is prescribed for nausea and vomiting. Long-term treatment includes the following: a salt-free diet, restricting fluid intake, and using diuretics, antihistamines, anticholinergics, and mild sedatives. If disease does not respond to dietary restrictions and medications, surgical intervention may be needed. Surgical destruction of the affected labyrinth, using ultrasound, relieves the symptoms but also causes permanent hearing loss unless cochlea is preserved.

Benign Paroxymal Pisitional Vertigo (BPV)
ICD-9-CM code 386.11

a vestibular system disorder, patients complain of head spinning and becomes worse with movement of head.

Symptoms: spinning sensation what gets worse with head movement, dizziness, nausea, vomitting, involunary eye movement, difficulty stanting or walking, lightheadedness, unsteadiness, and feeling faint.

Treatment: Antihistamines (Antivert, Dramamine), Anticholinergics (scopolamine), and benzodiazepines (Compazine), may be prescribed to reduce symptoms. Exercises where individual repeatedly turns the head from side to side may also be helpful.

ICD-9-CM code 386.30

inflammation or infection of the labyrinth of the inner ear.

Symptoms: fever of 100-101 def F. Main symptom of this disease is extreme vertigo. Balance is affected, and nausea and vomiting may occur.

Treatment: several days bed rest, prescriptions for tranquilizers, and antibiotics may be necessary if bacterial infection is present. Properly treated is not dangerous however untreated it can be debilitating and the labyrinth is a delicate easily damage organ.

Ruptured Tympanic Menrane

ICD-9-CM code 384.20

any tear or injury in the eardrum causes a breach in the integrity of the membrane.

Symptoms: slight pain, partial hearing loss, slight discharge or bleeding from the ear. When infection is involved, the drainage is purulent in nature. Symptoms only last for a few hours.

Treatment: Antibiotics are administered to prevent infection and a patch may be applied to the ear drum to aid in healing.

ICD-9-CM code 385.3

A pocket of skin cells, normally shed by the eardrum collect into a cystlike mass or ball and become infected. As infection material accumulates, the bone lining of the middle ear cavity erodes and occicles are damaged.

Symptoms: mild to moderate hearing loss, earache, headache, vertigo and weakness in facial muscles occur.

Treatment: if discovered early it can be removed simply. Inflation of the eustachian tube may produce some improvement and treatment with steroids and antibiotics help prevent recurrance. If discovered in advanced stage removal becomes more complicated and damage may already be extensive.

ICD-9-CM code 383.9
383.0 (acute)
383.1 (chronic)

acute or chronic inflammation of the mastoid bone or mastoid process.

Symptoms: pain and ocassional edema, possible fever and chills, profuse discharge.

Treatment: Antibiotic or slufonamine therapy percribed if not effective surgical procedure called simple mastoidectomy helps prevent further complications.

Sensorineural Hearing Loss
ICD-9-CM code 389.1

hearingloss, occupational hearing loss, sound waves reach inner ear but are not perceived because nerve impulses are not transmitted to the brain.

Symptoms: tinnitus and partial to severe hearing loss.

Treatment: treatment is necessary to halt further progression, reduction of noise levels, prevents further damage.

Cancer of the Ear
ICD-9-CM code
239.2 (Neoplasms)
171.0 (Cartilage of ear, primary malignancy)
198.89 (other specific sites)

Tumors and cancer of the ear occur and can be benign or malignant.

Symptoms: hearing loss, chronic otic discharge, visible mass or lesion on ear, loss of equilibrium, tinnitus.

Treatment: surgical excision, radiation therapy used if aggressive, nerve graft may be preformed after surgical excision of a neuroma.

Seborrheic Dermatitis
ICD-9-CM code
690.10 (Unspecified)
690.11 (cradle cap)
690.12 (infantile dermatitis)
690.18 (other seborrheic dermatitis)

One of the most common skin disorders which in this case is an inflammatory condition of the sebaceous, or oil glands.

Symptoms: gradual increase in the amount of, and change in quality of the sebum produced by the sebaceous glands. Inflammation happens in areas with the greatest amount of sebaceous glands which include: scalp, eyebrows, eyelids, sides of the nose, area behind the ears, and the middle of the chest. Skin appears red and covered with yellowish, greasy-appearing scales. Itching may occur but is usually mild. Diagnosis may include blood test, urine tests, and allergy tests but are usually not necessary. In rare cases a skin biopsy is needed if there is a possibility of the cause being another disease.

Treatment: A more effective treatment is the use of low-strength cortisone or hydrocortisone cream. Problem is prolonged used to these medications should be avoided due to problems with long term use of steroids. If scalp is involved, non-prescription shampoos contain tar, zinc , pyrithione, selenium sulfide, sulfur, and salicylic acid are recommended. Patients not responding to treatment are referred to a dermatologist who will prescribe stronger medications.

Contact Dermatitis
ICD-9-CM code 692 (fourth and fifth digit needed to specify)

An acute inflammation of the skin.

Symptoms: Caused by contact with skin irritants or allergic reaction producing symptoms of: erythemia, edema, and small vesicles that ooze, itch, burn, or sting. Diagnosis is based on appearance of the effected area, medical history, and identification of the specific irritant (may be a patch test for allergy related cases).

Treatment: throughroughly cleaning surface of irritant effective areas and followed by topical application of steroid cream. Oral steroids such as Medrol (a steroid dose pack) may be prescribed for 6-12 days. Poisonous plant dermatitis usually needs full 12 days of oral treatment. This condition may rebound after too short of a course of steroids.

Atopic Dermatitis (Eczema)
ICD-9-CM code 691.8

inflammation of the skin which tends to occur in patients with a family history of allergic conditions.

Symptoms: rash with vesicular and exudative eruptions in children and dry, leathery, vesicles in adults. The rash occurs characteristic pattern on the face, neck, elbows, knees, and upper trunk of the body which is accompanied by pruritus. Diagnosis includes review of family medical history, examination of skin, and skin testing may be done to identify allergic underlying cause.

Treatment: Objective is to reduce frequency and severity of eruptions and relieving the pruritus. No medications exist to fully eliminate eczema but topical ointments and creams containing cortisone derivatives are the primary treatment. In addition to the cortisone anti-inflammatory treatment protopic and elidel are prescribed to help treat eczema. Antihistamines, tranquilizers, and other sedatives may help to prevent or control pruritus. Secondary bacterial or viral infections may result in scratching and are the most common complication. More serious complication is infection of the herpes simplex virus.

ICD-9-CM 708 (fifth digit required to specify type)

also known as hives, is associated with severe itching followed by the appearance of redness and an area of swelling (wheal) in a localized area of skin.

Symptoms: hives can be various sizes and erupt as a few lesions anywhere on the skin and often are scattered over the body or mucous membrane. Gastrointestinal involvement can occur if patient complains of abdominal colic. When hives develop in the pharyngeal mucosa, they airway becomes obstructed causing asphyxiation. This condition is common, often acute, and self-limiting. Generally only lasts a few hours but may continue over months or even years to become a chronic condition.

Treatment: If known the antigenic factor is removed and avoided. Antihistamines bring quick relief of symptoms. An injection of epinephrine is used in severe cases. In persistent cases, a courser of prednisone is therapeutic.

ICD-9-CM code
696.1 (Psoriasis NOS)
696.0 (athropathy)
696.2 (Parapsoriasis)

A chronic skin condition marked by thick, flaky, red patches of various sizes, covered with characteristic white, silvery scales.

Symptoms: chronic, recurrent skin condition with silvery scales which can develop into dry plaques, and sometimes progressing into pustules. These generally do not cause discomfort but might be slightly itchy or sore. Affected skin appears dry, cracked, and encrusted. Most common areas where psoriasis develops are: the scalp, outer sides of arms, and legs, especially elbows, knees and trunk of the body. In addition hands and soles of feet may be affection. In some patients the condition spreads to nail beds causing nails to thicken and crumble. Psoriasis plaques can also develop in areas of physical trauma such as bug bites, poison plants, bruises, and burns (Koebner phenomenon). Psoriasis can occur at any age but is more common in the ages of 10-30 years. Diagnosis is easily recognizable upon visual inspection of the affected area. Patient history and observation of the skin, or biopsy may help when scales are not evident. Scratching lesions reveals the telltale scales.

Treatment: goal is to reduce inflammation and slow the rapid growth of skin cells. Keeping skin moist and lubricated is effective, treatment options include ultraviolet light exposure (to retard cell production), use of psoralens medication, low dose anthistamines, oatmeal baths, applications of creams containing vitamin A or D. Severe cases require chemotherapy with methotrexate, acitretin, cyclosporine, or etretinate. Pregnant or nursting women should not use these medications. Antibiotics may help, and a new group of medications known as monoclonal antibodies and fusion proteins (biologics) hare recently been approved .

ICD-9-CM code 695.3

a disorder of the facial skin, causes redness, primarily in areas where individuals blush.

Symptoms: often mistaken for complexion change, sunburn, or even acne. Redness becomes more noticeable and does not go away. The skin may being exhibiting dryness and pimples that may become inflamed or pus filled. In addition small blood vessels of the cheeks and face enlarge and show through the skin as red lines even after redness diminishes. Small knobby bumps occasionally appear on the nose, causing it to look swollen, mostly in male with rosacea. Diagnosis is based on history of facial bushing. Patient may also experience acne without whiteheads or blackheads (comedomes), dermatologists should be consulted for definite diagnosis.

Treatment: No cure but symptoms can be controlled through medical treatment with Finacea, metronidazole cream. sodium sulfecetamide, and topical anitbiotics, along with change in lifestyle. Patients are urged to identify situations that may cause harm to their skin and to avoid those triggers. Patients are advised to avoid hard exercise, sunlight, extreme heat or cold, stress, spicy foods, hot drinks, and alcohol. Laser surgery may treat extreme cases. Mild cleansers and moisturizers should be used and not contain alcohol or drying agents. Sunscreen helps.

Acne Vulgaris
ICD-9-CM code 706.1

an inflammatory disease of the sebaceous glands and hair follicles. Papules, pustules, and comedomes are usually present.

Symptoms: appearance of papules, pustules, and comedomes. Deeper boil-like lesions called nodules can occur. Scars may develop if the chronic irritation and inflammation continue for long periods of time. Acne is most often found on the face but can occur on the neck, shoulders, chest, and back. Acne can appear at any age but is more common in adolescents. In girls it usually is worst around 14-16 in boys it peaks in late teens. Diagnosis involves examination of the characteristic of the lesions and a patient history.

Treatment: topical or systemic antibiotics or both. Topically applied keratolytic agents are common treatments. Topical applications of medications related to vitamin a reduce skin oils and promotes drying and peeling of the lesions. Benzoly peroxide gels are effective and antibiotics are prescribed to kill bacteria residing on the skin. Long-term antibiotic use for acne treatment has side-effects. Often combination therapy is used to treat this condition.

Herpes Zoster (Shingles)
ICD-9-CM code 053.9

an acute inflammatory dermatomal eruption of extremely painful vesicles.

Symptoms: occurs in a bandlike unilateral pattern along the course of the peripheral nerves (dermatomes) that are effected and does not cross the midline of the body. Pain often in the form of burning or tingling begins about 2-3 days before appearance of lesions, and sometimes this is accompanied by fever. Eruptions begin as rash that rapidly develops into vesicles. The skin that overlies the affected dermatome becomes reddened and blistered. These vescicles often are grouped on a reddened area of the skin. After several days, the vesicles appear pustular, develop a crust, and then develop a scab. Diagnosis entails observation of pattern and painful vesciles and can be confirmed by culturing the virus from the vesicle scrapings. A blood sample containting the varicella-zoster antibodies also aids in the diagnosis. Can occur at any age but is most common in those older than 55.

Treatment: directed towards making the patient more comfortable. Analgesics, mild tranquilizers or sedatives, antipruritics, steroids, and betamethasone may be prescribed. Acyclovir (Zoviraz) is used orally, parenterally, or topically and is quite effective. Antibiotics may be needed to treat secondary infections. If the eye is affected, early treatment with idoxuridine is necessary and ophthalmologist is needed to supervise the latter therapy. When the pain is intolerable injections of lidocaine and nerve-block agents may be attempted. If these steps do not provide relive permanent nerve blocks are used as a last resort.

ICD-9-CM code 684

contagious, superficial skin infection which manifests with early vesicular or pustular lesions that rupture and form thick yellow crusts.

Symptoms: lesions develop usually on legs and less often on the face, trunk, and arms. Small vesicles are surrounded by a circle of reddened skin and usually are accompanied by pruritus. Adjacent lesions may develop as a result of autoinoculation resulting from scratching, but systemic symptoms are uncommon. Ulcerations with erythema and scarring also may result from scratching or abrading of the skin. Diagnosis is usually made with observation of characteristics of the lesions and to differentiate from other similar skin diseases Txanck test or Gram’s stain may be useful.

Treatment: Systemic use of antibiotics and proper cleaning of lesions two or three times a day are effective. Bactroban ointment or cream along with cephalexin, or erythromycin, or dicloxacillin are used in treatment. Avoiding infected individuals is essential.

Furuncles and Carbuncles
ICD-9-CM code 680.9 (unspecified) (fifth digit is different if specified)

A furuncle (or boil) is an abscess that involves the entire hair follicle and adjacent subcutaneous tissue. A carbuncle is either an unusually large furuncle or multiple furuncles that develop in adjoining follicles, connected by mane drainage canals.

Symptoms: Inflamed hair follicle becomes infected and the infection extends beyond the follicle. The affected area is red, swollen, and painful. Eventually the abscess bursts through the skin or discharges internally. Erythema and edema may persist at the site for several more days or even weeks. Diagnosis entails observation of the lesion. An abscess may be cultured to isolate cause of infection. Recurring boils are a problem and a physician may order blood and urine analysis to rule out underlying diseases as a primary cause.

Treatment: Hot compress every few hours to relieve discomfort and encourage draining. Surgical incision and drainage may be necessary. Antibiotic treatment is also needed for several weeks.

ICD-9-CM code 682.9 (Diffuse)

An acute, diffuse, bacterial infection of the skin and subcutaneous tissue.

Symptoms: Most often occurs in the lower extremities but any part of the body may be affected. Clinical symptoms are: erythema, pitting edema, tenderness, hot to the touch. Infection develops and spreads gradually over a couple of days. Red lines or streaks may appear proximal to the infection and run along lymph vessels to nearby lymph glands. If the lymph glands become edematous, systemic symptoms of fever and malaise may be present. Diagnosis requires physical examination of the affected part where the treating physician will check for pitting edema and other symptoms. A blood culture is ordered to aid in the diagnosis.

Treatment:The limb should be immobilized and elevated. Cool magnesium sulfate (Epsom salt) solution compresses may be used for discomfort. Warm compresses should be applies to increase circulation to the affected part. Systemic antibiotics, penicillin works best, are prescribed. Aspirin, NASAID’s or acetaminophen alone or in combination with codeine is given for pain and hospitalization is needed if cellulitis is severe.

ICD-9-CM code 110.9

Also known as tinea, is a chronic superficial fungal infection of the skin.

Symptoms: classified by the part of the body they inhabit. All lesions are characterized by an active border and are marked by scaling with central clearing. Dermatophytosis occurring on the scalp is called tinea capitis; the body, tinea corporis (cradle cap); the nails, tinea unquium; the feet, tinea pedis (athlete’s foot); and the groin region, tinea cruris. Diagnosis is based on the appearance and location. To isolate the fungus, a culture is needed.

Treatment: Antifungal medications a prescribed for topical or oral use. Shampoos and lotions are also used depending on location. Skin should be kept as clean as possible with loose fitting clothing worn. Becaise all forms of dermatophytosis tend to be persistent and chronic, meticulous management is needed to correct this condition.

Tinea Capitis
ICD-9-CM code
Tinea capitis is characterized by round, gray, scaly lesions on the scalp. It is contagious and often epidemic among children. The infected child may have a slight pruritus of the scalp or may be asymptomatic. It is rarely seen in adults.
Tinea Corporis (Ringworm)
ICD-9-CM code 110.9
Tinea corporis is characterized by lesions that are round, ringed, and scaled with vesicles. This infection can occur in anyone who has skin contact with the infected domestic animals, especially cats. It is more common in rural settings in hot humid climates. It can also be the result of autoinoculation from other parts of the body, such as tinea pedis or tinea capitis or contact with contaminated soil.
Tinea Unquium
ICD-9-CM code 110.1
Tinea unquium frequently begins at the tip of the toenails, affecting one or more nails at a time. It can also affect fingernails but is less common. The affected nail or nails appear hypertrophic or thickened, brittle, and lusterless.
Tinea Pedis (Athlete’s Foot)
ICD-9-CM code 110.4
Tinea pedis is characterized by intense, burning, stinging pruritus between the toes and on the soles of the feet. The skin can become inflamed, dry, peeling, and fissures may develop. This condition is rare in children.
Tinea Cruris (Jock Itch)
ICD-9-CM code 110.3
Tinea cruris is characterized by raised, red, pruritic vesicular patches, with well-defined borders, located in the groin area. It can be associated with athlete’s foot and occurs more often in adult men. Flare-ups are frequent in summer months and are aggravated by physical activity, perspiration, and tight-fitting clothes.
Decubulitus Ulcers
ICD-9-CM code 707.0

commonly called pressure ulcer or bed sore, is a localized area of dead skin that can affect the epidermis, dermis, and subcutaneous layers.

Symptoms: early stages the ulcer appears shiny, reddened, and appearing over a bony prominence in individuals with prolonged immobilization. Other signs eventually occur include: blisters, erosions, necrosis, and ulceration. If the decubitus ulcer becomes infected, a foul smelling purulent discharfe is present. Pain may or may not accompany the ulcer. Diagnosis entails visual examination and the ulcer is sufficient for diagnosis. If infection is suspected a culture is taken and sensitivity testing may be needed.

Treatment: if not treated vigorously the ulcer progresses from simple erosion to complete involvement of all skin layers. Eventually, the ulcer extends to the underlying muscle and bone tissue, and osteomyelitis and/or gangrene may result. Topical agents may be effective and include absorbale gelatin, sponges, granualted sugar, karaya gum patches, antiseptic irrigations, debriding agents, and antibiotics if infection is present.

Scabies and Pediculosis
ICD-9-CM code 132._ (fifth digit required to specify type)

Itch mites (scabies) and lice (pediculosis) are the two most common parasitic insects to infest humans. Human scabies infestations are caused by the human itch mite, sarcoptes scabiei. The three species of human lice are head louse, Pediculus humanus capitis; body louse, P. humanus corporis; and the pubic, or crab louse, Phthirus pubis. Lice resemble insects but in fact are wingless parasites with sucking mouths to feed on human blood. They prefer to lay eggs in hair but will lay in clothing also.

Symptoms:Both scabies and pediculosis are highly contagious. They produce intense pruritus and a sensation of something crawling on the skin. With scabies, the most common symptom is rash or wheals which is accompanied by intense burning which worsens at night. Scabies can occur on any part of the body but it is usually found in the hands, breasts, armpits, waistline, and genital area. Lice can also produce a rashe or wheals but more common symptom is the presence of nits (eggs) on hair shafts, skin, or clothing.Diagnosis usually only requires visual examination of the hair body, and clothing but other skin disorders must be ruled out when scabies is suspected. A similar rash occurring about the same time in a family usually suggests scabies.

Treatment: Goal is to remove the mites, lice, and nits to eliminate the pruritus and prevent re-infestation. To kill head lice a special shampoo is needed and repeated for 7-10 days to ensure it does not reoccur. A special fine toothed comb is used to clean out nits and dead lice. Pubic lice is treated with shampoos, creams, or lotions. Shampoos can be toxic to directions must be followed to the letter.

Scabies may be treated with special shampoos, creams, sulfur preparations, and topical steroids. Because of the intense pruritus and the scratching associated with scabies

Benign and Premalignant Tumors

A noncancerous growths or tumors of the skin fall into two categories: benign and premalignant. Benign tumors are usually a cosmetic problem. Premalignant tumors must be identified and treated ASAP to avoid development into a malignancy.

Symptoms: Signs var according to conditions experienced. Moles are the most common premalignant sign. See following cards for detailed information on each type. Diagnosis usually needs only visual examination but biopsies may help confirm the findings.

Treatment: Varies depending on the type of lesion.

Seborrhic Keratosis
ICD-9-CM code
702.11 (inflammed)
702.19 (other)
benign growths that originate in the epidermis, clinically appearing as tan-brown greasy papules or plaques and having a pasty appearance on the skin. The cause of seborrheic keratoses is unknown and although they generally have no potential for developing into malignant tumors they are differentiate from others which are. Treatment consists of cryosurgery and curettage.
ICD-9-CM code
are benign and asymptomatic and can be found all over the body, particularly the front of the lower leg. They are more common in women and are through to be caused by fibrous reactions to viral infections. These growths also can be caused by a reaction to insect bites and trauma. Dermatofibromas are scaly, hard growths that are slightly raised and pinkish brown. Treatment involves surgical removal if symptomatic.
ICD-9-CM code 238.2
a benign epithelial growth that may be cause by a virus and generally seen in people in their 60s. The growth is smooth, red, dome-shaped papule with a central crust that usually appears singly but may occur in multiples. Keratoacanthoma can disappear spontaneously but scarring is common. It has to be differentiated between squamous cell carcinoma. Treatment is surgical excision, adrenocorticosteroids applied topically, and for multiple lesions, oral istretinoin and etretinate adminsistration.
Epidermal (Sebaceous) Cyst
ICD-9-CM code 706.2
cysts develop when a sebaceous gland slowly fills with a thick fluid. This process can take many years and is usually painless and harmless. Some cysts, usually small ones, have a blackead in the pore connecting the cyst to the skin’s surface. Larger cysts most often are closed on the surface. The cysts are palpable and moveable and range in size from millimeters to several centimeters. Sebaceous cysts are commonly found on the scalp, face, at the base of the ears, and on the chest. They also can develop in any area of the body with sebaceous glands. If bacteria enter the pore, the cyst becomes infected and enlarges, and inflammation and tenderness occur. The cyst eventually may burst, releasing foul-smelling pus. Inflammation recedes, but the cyst remains and can become reinfected at another time. Treatment includes surgical removal and antibiotics if infection is present.
Acrochordon (Skin Tag)
ICD-9-CM code
Common benign skin growth or tags. Painless and usually caused by friction, they are found mainly in the axilla, on the neck and on inguinal areas of the body. They can be brown or skin colored, flat or slightly elevated, and are attacked to the body by a short stalk. Excisional surgery is the course of treatment for skin tags.
Actinic Keratosis
ICD-9-CM code 702.0
Common premalignant lesions and are seen on sun-exposed areas of the body. They are caused by long-term exposure to sunlight, and their numbers increase with age. Light-skinned people have a higher risk. Actinic keratosis initially appears in an area as an area of rough, vascular skin, which later forms a yellow, adherent crust. Treated with topical agents.
Non-Melanoma Skin Cancers
ICD-9-CM code (refer to coding manual)

BCC and SCC affect more that 1 million Americans each year. BCC arises in the basal (deepest) layer of the epidermis, and SCC in the epithelial (outer) layer. (Basal and Squamous cell carcinomas)

Symptoms:Lesions appear anywhere on the body. Most common sites are sun-exposed areas such as: face, scalp, ears, back, chest, arms, and back of the hands. About 70% of BCC lesions occur on the face. Five warning signs suggest presence of basal cell cancer:
1. shiny bump or nodule that is pearly white, red, pink, or translucent. Blood vessels may appear on the surface.
2. A sore that bleeds, heals, and recurs.
3. Reddish, irritated area, usually on the back, shoulders, extremities, or chest that may or may not be painful or cause pruritus.
4. Smooth growth with an indented center and elevated, rolled, edge, or border.
5. Scarlike area, often with poorly defined edges that is white, yellow or waxy in appearance.
SCC lesions are often present as a crusted scaly area with a red, inflamed base; as a growing tumor and nonhealing ulcer; or raised firm papule. Hyperkeratosis is an important feature that distinguishes SCC and BCC. The ulcerated lesions may be painful. Examination is usually the key diagnosis of these conditions but a biopsy is required for definitive diagnosis.

Treatment: Surgical excision, cryosurgery, electrodisiccation, curettage, or radiation therapy. Having non-melanoma skin cancer increases one’s risk of getting another BCC or SCC and developing malignant melanoma. Patients should be followed periodically for 5 years after treatment to check for recurrence, metastasis, or a new skin cancer.

Malignant Melanoma
ICD-9-CM code (refer to physicians diagnosis and current edition)

Malignant Melanoma is the most serious of the three types of skin cancer, but not as common. It arises in epiderman melanocytes, cells that make brown pigment, melanin.

Symptoms: Most occur as solitary lesions and can be found anywhere on skin with the backs of men and legs of women being the most common. Symptoms are generally change or newly pigmented area of the skin or change in a mole that may have been present since birth or childhood. Changes that may indicate the presence of malignant melanoma are: change in size, change in color, change in shape, change in elevation, change in surface, change in surrounding, change in sensation, change in consistency. Diagnosis usually first noticed by the patient and a doctor is immediately sought out. During examination a biopsy is taken where it is staged by a number of factors. In some cases CT scans are ordered.

Treatment: options are complete excision of the cancerous lesion, or sentinel lymph node biopsy which is dissected if positive. Metastatic cancer may entail high dose interferon alpha 2-b, chemotherapy, radiation therapy. Scarring is inevitable but reconstructive surgery is an option of extensive scarring.

ICD-9-CM code 270.2
Rare inherited condition where melanocytes are unable to produce melanin (skin pigment). The patient is pale skinned, white hair, with pink or pale blue eyes. Occurs in all races. Often accompanied with eye problems such as myopia, hyperopia, asitgmatism, nystagmus, strabismus, and photophobia. Patients with albanism must avoid sun to prevent eyes and skin from burning. This genetic disorder has no cure but many of the eye problems can be treated. Counseling is often included in the treatment for social problems created by lack of understanding about the disorder.
ICD-9-CM code 709.01
Possible an autoimmune condition, produces paly irregular patches of skin, often evenly located on one side of the body. The patches may enlarge, shrink, or stay the same size. Vitiligo can occur on any area of the body and effects all races. Often follows a stressful incidident and has not cure, only cosmetics to cover affected areas. Patients with this condition are encouraged to use sunscreen.
Melasma (Cholasma)
ICD-9-CM code 709.09
Occurs in women during hormonal changes, such as during pregnancy or with oral contraceptive use. Patches of darker skin develop on the face, especially over the cheeks. This condition disappears after childbirth or when oral contraceptive use is discontinued.
ICD-9-CM code 228.0
Benign lesions of proliferating blood vessels in the dermis that produce a red, blue, or purple color. Examples of hemangiomas are the nevus flammeus (port-wine stain) which is dark red to purple and usually located on the face. Strawberry hemangioma is bright red with a prodtruing rough surface. Cherry hemangioma is red to purple but smooth and dome-shaped with small papules 2-5 mm in diameter.
Nevi (Moles)
ICD-9-CM code (refer to current manual)
dark areas of skin composed of dense collections of melanocytes and some may contain hair. A mole occasionally may become malignant.
ICD-9-CM code 696.5
Pityriasis is a fungal infection that causes patches of flaky, light, or dark skin to develop on the trunk of the body. Condition is uncommon.
Abnormal Suntan
ICD-9-CM code 995.2
Unspecified adverse effect resulting from a proper drug, medicinal, or biological substance properly administered. Some drugs and certain diseases such as Addison’s disease can produce a suntan without exposure to light.
Alopecia (Baldness)
ICD-9-CM code 704. (6th digit required for specification)

loss or absence of hair, especially on the scalp

Symptoms: temporary or permanent hair loss or absence. It can appear gradually, with aging, or suddenly occurring all at once or in patchy areas. Diagnosis requires visual examination but blood and thyroid studies are needed to rule out thyroid diseases. Sometimes a biopsy is preformed if scarring is present.

Treatment: treatment can restore hair growth back to normal. Rogaine is a common topical treatment and Propecia or Finasteride is a drug therapy. Other options are available such as wig, tupee, or hair transplant. Transplantation is effective for certain types of hair loss. Transplantation uses minoxidil which is expensive and has side-effects. Topical superpotient steroids are also effective along with intralesional injections.

ICD-9-CM code 704.8

Inflammatory reaction of the hair follicle that produces erythemic, pustular lesions.

Symptoms: pustules of folliculitis are individual and do not combine.Usually found on the thighs and buttocks but also occur on the beard or scalp. Some patients may report mild discomfort, mainly pruritus, associated with the pustules, but folliculitis is usually asymptomatic. Diagnosis entails examination and a culture which will be postivie for S. aureus.

Treatment: for mild cases a topical antiseptic cleanser, such as providone-iodine (Betadine) is used daily. More extensive involvement requires systemic antibiotics such as erythromycin or cephalexin used with topical cleansers. Rarely does folliculitis result in a furnuncle but incision and drainage are required at that stage.

Corns and Calluses
ICD-9-CM code 700

Extremely common, localized hyperplastic areas of the stratum corneum layer of the epidermis. Ill-fitting shoes, orthopedic deformities, or faulty weight brearing can play a role in this condition. People with diabetes mellitus are also more prone to this condition.

Symptoms: Corns have a glassy core and are more painful than calluses. Corns develop on toes. Calluses are larger and commonly develop on the ball of the food and palms of the hands. Tenderness and pain over the effected area is common. Patients usually only contact medical professional when pain becomes unbearable. Diagnosis is done on physical examination and brief history.

Treatment: relieving the pressure and friction points as soon as possible is the goal in treatment. Many self help measures are available such as pads, sponge rings, and chemical agents to soften corns. A pumice stone will rub off dead skin from calluses. If these treatments are ineffective, a physician will trim the corn or callus off surgically or with strong chemicals. Warning: patients with diabetes mellitus should not use self-help measures but instead seek medical care immediately because theirs is a result of nerve damage.

Verrucae (Warts)
ICD-9-CM code 078.10

an elevated growth of the epidermis and result from hyperplasia. It is caused by a manifestation of HPV infection. The tree most common warts are plantar warts and flat warts.

Symptoms: small, hard, white or pink bump with cauliflower-like surface. Inside the wart are small, clotted, blood vessels that resemble black splinters.

Treatment: most warts disappear naturally and over the counter creams, paints, or plasters are available. These medications contain chemicals that destroy dead skin cells but will also damage healthy ones in the process. Care must be taken to minimize soreness. A physician can remove persistent warts through surgical excision, cryosurgery, or electrodesiccation. Treatment is often painful and tedious.

Deformed or Discolored Nails
ICD-9-CM code 703.9

unusual thickening, shape, and color that deviates from normal are classified as this condition.

Symptoms: Unusual thickening, color variation, change in shape of nails. Sometimes an underlying disease or disorder is the cause. Diagnosis entails examination of the nail and medical history. A blood chemistry profile will detect any underlying condition or illness.

Treatment: Deformities or discoloration caused by underlying illness resolve when illness is corrected. If no illness is the cause patients may practice self-help measures for ingrown toenails such as better fitting shoes and keeping the area clean and dry, and cutting the nail properly. If these measures do not help the physician will treat aggressively through the use of antibotics, antifungals and surgical removal which ends with a chemical applied to stop growth of the nail.

ICD-9-CM code 681.02

Infection of skin around the nail

Symptoms: cuticle or nail fold becomes edematous, red, painful. If the cuticle lifts away from the base of the nail, purulent material may be expressed from underneath. When a nail fold is affected, a blister of pus called a whitlow develops beside the nail. Chronic infections produce similar symptoms, and often several nails are affected. With the cuticle lifted, the nail roots no longer are protected and thus become damaged or deformed. Diagnosis is based on physical examination, history, and a culture of the exudate is needed to identify the specific type of bacterial or fungal infection.

Treatment: antibotics are prescribed for bacterial infection and antifungal cream or pain (ciclopirox) is prescribed for fungal infections.

ICD-9-CM code 729.1

Chronic pain condition associated with stiffness and tenderness that affects muscles, tendons, and joints throughout the body. Fibromyalgia is also characterized by restless sleep, depression, fatigue, anxiety, and bowel dysfunction.

Symptoms: affects muscles, chronic pain in muscles and soft tissues surrounding joints. Fatigue is extremely common in patients with this condition. Often symptoms include diffuse aching or burning in the muscles, stiffness, disturbed sleep patterns, poor concentration, irritability, and depressions. Some patients may note swelling and tenderness in various areas. Non-specific symptoms include headache, jaw pain, sensitivity to odors, bright lights, and loud noises. Some patients present signs of urinary frequency, bladder spasms, IBS, spastic colon, nausea, diarrhea, constipation, or abdominal pain, urinary symptoms include urinary frequency brought on by bladder spasms and irritability. Often patients wake up feeling tired, even if they have slept all through the night. Others sleep lightly and wake up during the night. Diagnosis entails a testing for an elevated nerve chemical called substance P which can be tests from spinal fluid. Many conditions mimick fibromyalgia therefore blood testing and physical examination are required to exclude other conditions. Physical examination also assesses pain points and based on the number it is diagnosed.

Treatment: no cure for fibromyalgia is known therefore treatment helps alleviate symptoms and restore function. Treatment involves patient education, stress reduction, physical activity, and medications. Attempts are made to reduce pain and improve sleep quality, low doses of antidepressants are helpful. For muscle and joint soreness, nonsteroidal antiinflammatory drugs or muscle relaxants can be helpful. Stress reduction, relaxation techniques, massage therapy, acupressure , and exercise have been found to be beneficial.

ICD-9-CM code 737.20

A spinal disorder where there is an exaggerated inward curvature of the spine. Lordosis is sometimes referred to as a swayback or saddleback deformity.

Symptoms: lumbar spine is normally curved inward, excessive inward curvature, lordosis, occurs as a person compensates for added abdominal growth caused by pregnancy, obesity, or large abdominal tumors. Can cause no symptoms but back pain may occur. Lordosis results in prortruding abdomen and buttocks with arched lower back. Diagnoses includes evaluation for degenerative and congenital diseases of the spine, and inflammation of the spine (spondylitis) and conditions involving adjacent internal organs such as kidneys, prostate gland, aorta, and pancreas.

Treatment: Resolves itself if caused by pregnancy. When obestity is the cause weight loss and exercises to strengthen core muscles are beneficial. Performing a pelvic tilt and maintaining good posture help correct the condition. Progressive untreated lordosis may result in disk disease or ruptured disk. Additional treatment will include use of a brace to correct this problem. For severe cases, spinal fusion and displacement osteotomy are considered.

ICD-9-CM code 737.10

Abnormal outward curvature of the spine (convexity backward)

Symptoms: excessive posterior curve of the thoracic spine, often has an insidious onset and is asymptomatic. As the curve progresses, the patient will begin to experience mild pain, fatigue, tenderness, decreasing mobility of the spine. Shoulders will appear rounded and head protrudes forward. Diagnoses entails visual inspection of the spine which will disclose the excessive curve in the thoracic region. Radiographic films and bone scans can document the concave curvature of the thoaracic spine along with wedging of the anterior aspect of the vertebral bodies. Older patients with osteoporosis have a loss of bone density.

Treatment: exercise to strengthen muscles and ligaments, back braces help stabilize the condition. Underlying cause will be treated if present. When other measures fail to produce results the respiratory and cardiac systems become compromises, spinal fusion with instrumentation and temporary immobilization is preformed. Kyphosis that is caused by a sudden collapse of a vertebra because of osteoporosis is sometimes treated with a newer procedure called vertebroplasty where a balloon is inflated in the vertebra and methylmethacrylate is inserted to make a cementlike foundation to maintain reestablished vertebral height.

ICD-9-CM code
737.30 (Aquired)
754.2 (Congenital)

A lateral (sideways) curvature of the spine. Typically congenital but some other diseases may cause it.

Symptoms: lateral curve of the spine, often has an insidious presentation. Can possibly go unnoticed for years before being detected. In women the first indication is unequal bra strap lengths. The patient, usually an adolescent female, reports back pain, fatigue, and sometimes shortness of breath with exertion. Diagnosis will include an observing the back to reveal lateral curve of the spine, one shoulder higher than the other, one scapula more prominent than the other, one hip higher than the other and when patient bends over there is an enlarged muscle mass on the side of the back. Radiographic films confirm diagnosis.

Treatment: varies on the extent and cause of the curve. Mild scoliosis is treated with exercise to strengthen the weak muscles. Bracing of hte back with a Milwaukee brace or a molded plastic clamshell jacket and exercise regiment is the course of treatment for growing children. Bracing may take 2-5 years to prevent further curvature of the spine. Procedures include fusion of the vertebrae and internal fixation with instrumentation by means of rods, wires, or plates and pedicle screws. Some patients are placed in body casts or plastic jackets to maintain integrity of fixation until healed. The respiratory and cardiac system may need treatment aswell if scoliosis was allowed to progress for long period of time.

ICD-9-CM code 715.9

a type of arthritis that results from the breakdown and eventual loos of the cartilage in one or more joints. Also known as degenerative join disease or degenerative arthritis.

Symptoms: weight bearing joints especially knees and hips and smallest joints at the end are more prone to be affected. Fingers are generally affected by a spur formation that leads to classic bony enlargement called Heberden node. Onset is insidious, and symptoms may vary with severity. Joint soreness, aching, and stiffness, especially in the morning and with changes in the weather; edema; dull pain; and deformity are some of the more common symptoms. Stiffness is noted, particularly after immobile for long periods of time. Clicking or crackling sounds (crepitation) are often heard with join movement. Decreased ranges of motions, joint instability, and increase in pain with use of joints is also common. Diagnosis entails evaluations to exclude other 100 forms of arthritis, underlying diseases will be detected during this process as well. The diagnostic investigation begins with physical examination and history. Radiographic films, CT scans, and MRIs may be ordered to confirm presence and document severity. Plain radiographic testing can be helpful to exclude other causes of pain in a joint. Radiographic tests also show severity and help the physician determine when surgical intervention is needed.

Treatment: cannot be cure but can be treated by symptoms. The goal is generally to reduce inflammation, pain, while maintaining joint function. Surgery is needed in severe cases. Physical therapy includes range-of-motion exercises, alternation of moist hot and cold applications, massage therapy, and elastic bandages for support. Drug therapy includes analgesics, muscle relaxants, and NSAIDs. Intraarticular steroid injections may be used for specific joints. Food supplementation with glucosamine condroitin helps reduce pain and stiffness in some patients. Supportive care may entail cane, walker, braces, or crutches to lessen the strain. Restricting physical activity in the affected joints also may be necessary. Surgery may entail joint replacement or joint fusion to increase stability in the cervical or lumbar vertebrae.

Lyme Disease
ICD-9-CM code 088.81

infectious disease caused by the spirochete bacterium. Ticks that bite the skin spread lyme disease by injecting bacterium from their jut into the human body. Lyme disease effects the skin, joints, heart, and nervous system.

Symptoms: sometimes referred to as lyme arthritis, more prevalent in the NE part of the US however has been found in all 50 states and 5 continents. Occurs in any age group, and no one is immune to this infection. Approximately half of all patients with Lyme disease have a characteristic of red, itchy, rash with a red circle resembling a bull’s eye on a target. Lyme disease can act as arthritis and cause influenza-like symptoms, such as headache, fever, fatigue, join pain, and general malaise. If the person does not seek medical attention for these symptoms, complications of muscle weakness, paralysis, and neurologic conditions will develop. Encephalitis, gastritis, or carditis may develop in some patients. Diagnosis entails observation of headache, fever, fatigue, joint pain, and general malaise which can be exhaustive. A complete history and examination and laboratory tests are important for excluding other infectious diseases. forms of arthritis, immune diseases, muscle diseases, and even cancer. Diagnosis than is based on physical examination (the discovery of tick on the skin or target lesion) and patient history. Confirmation is attained by positive test results for the Lyme antibodies or directly identifying bacterium if biopsy is attained.

Treatment: Begins with removal of the tick, if found. Early treatment is imperative in early stages because it can be completely cured with simple antibiotics. Lyme disease in the later stages requires intravenous antibiotics for a cure. Antipyretics are given for headache and fever. Bed rest is necessary if neurological symptoms are present, and physical therapy is prescribed for impaired muscoskeletal mobility.

ICD-9-CM code 727.3
727.2- if occupational origin

Inflammation of the bursa (the fluid filled sac in the joint that acts like a pillow or padding). Bursa can become inflamed, infected, or traumatized. The major bursae are located adjacent to the tendons of the large joints such as the shoulders, elbows, hips, and knees.

Symptoms: tenderness, pain when moving, flexion and extension limitations, edema at site of inflammation. The most frequently affected area is the shoulder, elbow, hip, knee, and those between tendons and muscles in the tibia. Point tenderness may be present in which case the patient can point out the greatest spot of tenderness. If bursae continually or chronically irritated and inflamed, calcifications can develop. In addition, adhesions can occur around an affected bursa, which limits movement of the tendons. Diagnosis is straightforward that is made after physical examination. However patients with bursitis that is not associated with an injury have possible underlying gout or arthritis that should be considered. In patients with abrasion or puncture wounds of the overlying skin, infection must also be considered. Range of motion may be impaired and pain is acute. MRI indicates enlarge bursa and radiographic films show calcified deposits on the site when chronic. Aspiration of the fluid from an inflamed bursa can assist in diagnosing infectious bursitis.

Treatment: Treatment includes avoidance of activities until acute pain subsides, the application of moist heat, immobilization of the affected part, use of aspirin or acetaminophen, administration of non-steroidal antiinflammatory agents, and local injection of corticosteroid. If infection is present, drainage of the inflamed bursa and use of antibiotics specific to the infectious microbe are needed. Active range-of-motion exercises to prevent adhesion and to maintain or regain motion are needed after the acute pain subsides. Surgical excision of the bursa and any accompanying calcified deposits can be required for chronic noninfectious and infectious bursitis.

ICD-9-CM code 730.20

A serious infection of bone that requires aggressive antibiotic treatment.

Symptoms: inflammation, swelling, localized heat, redness, pain, and local tenderness are signs. Other symptoms may include chills, fever, sweating, and malaise. As the infection progresses, a purulent material called subperiosteal absess may develop causing pressure and eventual fracturing of small pieces of the bone. These fractured, dead pieces of bone may in turn become surrounded by the purulent material and form a sequestrum. Diagnosis entails aspiration and culture of material taken from the site of infection to isolate causative agents. A blood culture (WBC) count, and a erythrocyte sedimentation rate is also helpful. MRI, CT, and bone scans aid in determining infection site and if it is acute or chronic.

Treatment: Is curable, requires extensive long-term antibiotic treamtnet with follow-up care to prevent recurrent infections. Parenteral or locally administered antibiotics are administered. Increased intake of proteins and vitamins A,B,and C promote cell regeneration. Bed rest is needed to conserve energy, control of chronic conditions (e.g. diabetes), immobilization of the affected part prevents fracture, and anagesics all aid in treatment. Surgical drainage is done to remove purulent material and sequestrum may also be necessary along with bone grafting. Hyperbaric oxygen are beneficial too.

ICD-9-CM code 274.9

Chronic disorder of uric acid metabolism that manifests as an acute, episodic form of arthritis; chronic deposits of uric acid form hard nodules in tissues; and/or kidney impairment or stones.

Symptoms: severe pain, usually in the toe, during an attack excruiciating, joints of the feet, ankles, and knees may also be affected. Slight fever, chills, headache, or nausea may accompany acute attack. Between attacks, the person is free of symptoms. Gout is also characterized by renal dysfunction, hyperuricemia. Diagnoses entails microscopic examination of aspirated synovial joint fluid or material from soft tissue. A serum of uric acid test can indicate hypericemia.

Paget’s Disease (Osteitis Deformans)
ICD-9-CM code 731.0

chronic bone disorder that typically results in enlarged, deformed bones resulting from irregular breakdown and formation of bone tissue. Paget’s disease can cause bones to weaken and may result in bone pain, arthritis, bone deformities, and fractures.

Symptoms: two stages; initial vascular; second sclerotic. During the vascular state bone is broken down but spaces are filled with blood vessels and fibrous tissue instead of new strong bone. During the second stage highly vascular fibrous tissue hardens and becomes similar to bone but is more fragile instead of strong. This leads to pathologic fractures. Disease can occur in part of all of the bone with most common sites being: femur, spine, skull, and clavicle. Paget’s disease usually affects people 40+ and becomes more common as age advances. Often causes no symptoms but when they do occur local bone pain becomes disabling, aching is almost continuous and is often worse by night. Patients may have edema, or deformity in the bones. If the ossicles in the ear are involved hearing loss or even deafness occur. Other complications of PD can include frequent fractures, spinal injuries, hypercalcemia, renal calculi, and infrequently serious forms of bone cancer. Diagnosis includes physical examination and patients history. Several tests and blood work are ordered. Radiographic imaging, bone scanning, and possible bone marrow biopsy assist in diagnosing. Blood analysis will indicate elevated serum concentration of alkaline phosphatase, and urinalysis reveals and elevated hydroxyproline concentration.


Marfan’s Syndrome
ICD-9-CM code 759.82

group of inherited conditions featuring abnormal connective tissue with weakness of blood vessels and excessive length of the extremities.

Symptoms: abnormally long extremities and digits. Additional deformities include subluxation of the lens of the eyes and heart and vascular abnormalities. Condition generally goes undetected until harmful complications are precipitated. A person with this syndrome appears tall and slender with long narrow digits. An asymmetry of the skull may be noted. Visual difficulties are encountered when the lens dissociation occurs. Scoliosis is another manifestation. Joints can be hyper-extensible. Mitral valve prolapse and thickening of the heart valves and aortic aneurysm may be present, but frequently goes undetected. Often first indication is rupture of an aortic aneurysm with catastrophic results. Diagnosis shows observation of a confused patient with homocystinuria because of the connective tissue abnormality. People are born with this disorder although it is generally not diagnosed until later in life. The diagnoses uses family history, physical examination, and tests of heart and blood vessels. Diagnosis of this syndrome in early childhood is possible when the lens dissociation and mitral valve prolapse abnormalities are detected.

Treatment: involves controlling excessive height with hormones before puberty, preventing glaucoma, controlling blood pressure, and preventing aortic dissection. Ophthalmic examinations should be conducted on a routine basis. Monitory blood pressure and maintaining normal levels are essential. Close observation of aortic status is necessary, and surgical replacement of diseased portions may be needed. Aortic and mitral valves may be replaced surgically. Echocardiography is used to assess status of aorta.

Bone Tumors
ICD-9-CM code (refer to current manual)

bone tumor describes any abnormal growth, whether malignant or benign, in the bone. The definition includes chondrogenic, osteogenic, and fibrogenic tumors.

Symptoms: pain is the most common symptom which is often worse at night or with exercise. A parent may notice the child limping or curtail physical activity. Local swelling may be evident as the neoplasm enlarges. Different varieties of malignant tumors have characteristic signs and symptoms. Osteosarcoma presents pain and swelling of the short duration and a sunburst appearance on radiograph. Patients with Ewing sarcoma also have systemic symptoms such as fatigue, fever, and pallor, leukocytosis. The ewing sarcoma has an onion skin appearance on radiograph. Chonrosarcomas present with a slow-growing mass; dull intermittent pain; and a lobular radiograph. Sometimes tumors present no symptoms and are incedentally deteced for other reason needing radiography. Diagnosis is based on history, physical examination, labratory studies, and diagnostic procedures. Many procedures include radionuclide bone scan, CT scan, and MRI scan. Biopsy may be necessary for definitive diagnosis and staging.

Muscle Tumors
ICD-9-CM code unknown

Neoplasms of muscle may be benign tumors or malignant sarcoma. The most commonly effected areas are the extremities, head and neck, trunk, and retroperitoneum.

Symptoms: often present as a painless lump of a few weeks or months, in some instances pain and tenderness may be present secondary to pressure effects on a nerve from the mass. Diagnosis is done through and MRI or other radiographic imagins suchs as radiographs or CT scans. A biopsy can compromise subsequent treatment and has to be carefully planed from imaging studies. The most common staging system is known as the TNM (Tumor, node, metastasis).

Treatment: Surgical resection of the tumor is performed on all tumors whether benign or malignant. For benign tumors, complete surgical resection is usually all that is required. Sarcomas are often combine with radiation therapy. Amputation of the affected limb may be necessary in some instances. Chemotherapy is used to an adjunct to surgery in children with rhabdomyosarcoma. Resection of pulmonary metastases may offer a survival benefit and possible cure. Follow up imaging studies may be needed especially for lung metastasis.

ICD-9-CM code 733.00

a condition characterized by loss of the normal bone density. Osteoporosis leads to porous bone that is described as compressible like a sponge.

Symptoms: often occurs in women more than men. Contributing risk factors can include small boned women, northern european or asian background, smoking, and family history of osteoporosis. Unless it occurs in the vertebrae or weight-bearing bones, it is usually symptom-less. Osteoporosis is a silent disease until a bone break causes pain. Spontaneous fractures, especially in vertebrae of the mid to lower thoracic spine, and loss of height are the most common signs. Diagnosis entails pre-screening for cancer through radiographic testing. Osteoporosis will be seen on the imaging and patients with this condition are further evaluated for hormone imbalances, kidney disease, diet inadequace, intestinal malabsorption, and use of certain medication such as corticosteroids. Diagnosis is based on results of blood serum studies, radiographic films, urinalysis, CT scan, and bone scan. The best test for osteoporisis is a dual energy x-ray (DEXA)

Treatment: can cause permanent disability without proper treatment. Treatment may vary depending on the cause. Increased dietary intake of calcium, calcium carbonate, calcium carbonate with sodium fluoride, phosphate supplements, and vitamins may be prescribed. Estrogen replacement therapy may be attempted for women with postmenopausal osteoporosis. For women not wishing to use hormone replacement therapy there are medications available such as Fosamax, and Actonel. Calcitonin nasal sprays and parathyroid hormone treatment are other options. Exercise helps to minimize condition by slowing calcium loss. Moderate exercise such as walking, swimming, riding a bike is best. Physical therapy helps those who are immobilized. If the bones become brittle exercise options will have to be limited. To alleviate pain and muscle spasms, analgestics and muscle relaxants are prescribed.

Osteomalacia and Rickets
ICD-9-CM code 268.2

Defective mineralization of the bones.

Symptoms: bones become soft, flexible, and deformed. Disorder can occur in children which impacts the growing skeleton called rickets. In adults it is referred to as osteomalacia. Early symptoms include general fatigue, progressive stiffness, tender, painful bones, backaches, muscle twitches and cramps, and difficulty standing up. As the disease progresses patient may experience fractures, bowing of the legs, chest deformity, and shortening of the spine. Diagnosis in children entails evaluation for genetic disorders, kidney problems, and bowel problems. Adults with osteomalacia are screened for metabolism disorders as well as kidney and bowel disease.

Treatment: Vitamin D supplements and adding additional vitamin D, calcium, and calcitonin to diet. Exposure to sunlight increased with vitamin D metabolism and absorption. Any underlying disorder such as kidney or bowel disease must be treated as well.

Hallux Valgus (Bunion)
ICD-9-CM code 735.0

localized area of enlargement of the inner portion of the metatarsophalangeal joint.

Symptoms: Bunions progressively enlarge overtime. Inflamed bursa develops, secondary to pressure and inflammation at the joint, it may become painful. At times the great toe may override or undercut the second toe. This causes crowding of other toes and possible development of hammer, claw, or mallet toe. Bunion development is more common among women and adolescent girls. Diagnosis entails evaluation for arthritis, and gout. Footwear will be closely scruitnized. Physical examination of the food with history may be sufficient for diagnosis. Radiographic imaging can confirm lateral displacement of the great toes and any degenerative joint changes.

Treatment: wearing roomy shoes, avoid crowding toes together, wearing less shoes with lower heels, using padding between toes or around bunion, applying ice to the bunion to reduce inflammation and lessen pain, and resting affected joints. Analgesic-antipyretic medications are given for pain, or injections of corticosteroids for severe pain. Different surgical procedures to correct deformity of hallux valgus: bunionectomy, osteotomy, and arthroplasty are the most common.

Hallux Rigidus
ICD-9-CM code 735.2

Stiff big toe that develops as a result from degeneration of the cartilage of the first metatarsophalangeal (MTP) joint.

Symptoms: pain, loss of motion in the joint, stiffness, swelling, onset may be insidious with the limitation of movement may be gradual. Diagnosis entails evaluation of history of pain, physical examination, and radiographic studies to confirm degeneration.

Treatment: corrective treatment includes drug therapy with antiinflammatory agents, wearing shoes with hard soles and low heels. Surgical intervention is indicated, a cheilectomy to remove bone spurs and degenerative changes in the joint. During cheilectomy, a portion of the dorsal aspect of the metatarsal is also removed. ROM exercises are used to rehabilitation. When the condition is extensive, arthrodeisis, or fusion of the join may be the only method of relief. Surgeons mar preform an arthroplasty and replace join with an artificial one but makes joint limited.

Hammer Toe
ICD-9-CM code 735.4

Condition in which the toed bends upward like a claw because of an abnormal flexion of the proximal (PIP) joint; it can occur in any one or four lesser toes.

Symptoms: painful and ofeten causes abrasion and inflammation where the flexed toe rubs against footwear. IT can lead to the formation of a corn on the top of the toe and a callus formation on the sole of the foot. Diagnosis entails visual inspection and imaging studies to rule out arthritis.

Treatment: Switching shoes that fit properly with enough space can reverse the process and toe will eventually straighten. Splinting of the affected toe and performing therpeutic exercises can be helpful. More advanced conditions require surgical intervention through arthroplasty or possible joint fusion.

ICD-9-CM code 800-829

(broken bones) caused by stress on the bone from a traumatic insult to the musculoskeletal system, severe muscle spasm, or bone disease. Can occur in any bone in the body.

Symptoms: pain, edema, tenderness, discoloration, inability to move affect part, deformity

Treatment depends on the location, severity, type, and cause of the fracture. Simple fractures of long bones are reduced and immobilized. Compound fractures are cleaned, debrided, reduced, and immobilized. Immobilization is accomplishes through splinting, casting, taping, and external or internal fixation. Internal fixation involves surgically implatanted pins, wires, rods, plates, screws, or other devices. Healing takes place while these tools hold the bone in proper alignment.

Colles’ fracture
fracture of the distal head of the radius, with possible involvement of the ulnar styloid. Colles’ fractures usually are the result of a fall where the person attempts to break the fall with a hand, arm, or extended elbow. Pain and swelling are experienced, treatment includes closed reduction of the fracture and immobilization with a cast.
Fracture of the humerus
obvious displacement of the bone, upper arm with shortening of the extremity and abnormal mobility of the upper arm. Closed reduction of the fractures is followed by immobilization through cast and/or sling.
Fracture of the pelvis
usually result of auto accident or a fall (usually elderly). Complications of this fracture include lacerated colon, paralytic ileus, bladder and urethral injury, pelvic hemorrhage. Treatment includes bed rest, possible immobilization with pelvic sling or skeletal traction, and open reduction or repair.
Fractured hip
usually result of a fall, occurs most often in patients with osteoporosis older than 60. Complications include lacerated colon, paralytic ileus, bladder and urethral injury, and intrapelvic hemorrhage. Treatment includes bed res, possible immobilization with pelvic sling or skeletal traction, and open reduction and repair.
Fracture of the femoral shaft
more common in young adults and usually a result of severe direct impact related to auto accidents or trauma. A notable angulation deformity and shortening of the affected leg is present. The patient is unable to move knee or hip and fracture is stabilized by skeletal traction or internal fixation with rod or plate and screws.
Fracture of the tibia
results from strong force exerted on the lower leg that causes soft tissue damage in addition to the fraction. Open or closed reduction is employed, followed by immobilization with cast.
Vertebral fracture
usually occurs in the cervical region, is the result of acceleration-deceleration trauma. Immediate immobilization is imperative to prevent spinal cord damage and resulting paralysis. Thoracic and lumbar vertebrae also can be fractured. Immobilization may be followed by surgical repair and possible insertion of surgical hardware for stabilization.
Basilar skull fracture
a fracture of the floor of the cranial vault, usually result of massive trauma to the head from an auto accident.
Le Fort fracture
bilateral horizontal fracture of the maxilla, often results when the face is forced against the steering wheel in an auto accident.
In Pott’s fracture
lower part of the fibular is fractured. The lower tibial articulation sustains serious injury.
Clavicular fracture
fracture of the clavicle (collar bone), is a common sports injury and usually involves bicycling accidents, often occurs in children
Strains and Sprains
ICD-9-CM code 840-848

A strain is an injured tendon, muscle, or other tissues resulting from overuse, overstretching, excessive forcible stretching of the tissue beyond functional capacity. A sprain is an acute partial tear of a ligament. They are classified as first, second, or third-degree, or grades.

Symptoms: strains and sprains can be acute injuries or a result of chronic overuse (cumulative trauma). Symptoms include localized pain, weakness, numbness, and possibly edema around the site of injury. With both strain and sprain injuries, using, moving, or bearing weight on affected limb is difficult and sometimes nearly impossible. Sprains may include the damage to blood vessels and nerves, and edema, ecchymosis, and sharp transient pain may develop. When sprains and strains are caused by chronic overuse, they typically cause stiffness, tenderness, and soreness. Diagnosis entails physical examination, medical history of a recent injury. Patients with obvious trauma need to be evaluated for possible fractures which radiographic studies are ordered to rule out a possibility of fracture.

Treatment: a sprain being the more serious injury requires more intense treatment. Treatment of sprains and strains entails elevation and rest of the affected limb and application of ice to control edema. Immobilization of the limb with an elastac bandage, soft cast, or splint may be needed. Analgesics and possibly antiinflammatory agents are used to control pain and inflammation. Surgery may be indicated if the injury involves a large tear or if it improperly heals.

ICD-9-CM code 830-839

the forcible displacement of a bone from its joint, thereby causing loss of joint function.

Symptoms: joint appears misshapen, is extremely painful, and rapidly becomes edematous, ecchymotic, and immovable. Injury to the ligaments and capsule of the joint is present. Other symptoms are a function of the extent of damage to the surrounding tissues, nerves, and blood vessels. Diagnosis is made by obvious abnormal appearance of the joint and history of injury. A radiographic study can confirm dislocation and if any fractures are present.

Treatment: only trained medical professionals should attempt to fix a dislocated joint. A physician should be seen within 15-30 minutes for proper re-positioning of the joint. Sometimes this process is so painful the patient is sedated. Occasionally surgery is necessary to achieve satisfactory reduction.

Adhesive Capsulitis (Frozen Shoulder)
ICD-9-CM code 726.0

a condition in which a shoulder is significantly limited in its range of motion as a result of inflammation, scarring, thickening, and shrinkage of the capsule.

Symptoms: stiff, painful and abnormal movement shoulder. The pain can be localized or spread out to the neck and upper arm. It is often severe enough to disrupt sleep. Symptoms begin gradually and become worse during the first few months after injury. With time the pain subsides, but mobility of the shoulder may often remain impaired or frozen. Diagnosis can be done usually through symptoms alone however, patient history can indicate a recent injury. Patients with this condition are also evaluated for underlying illnesses such as arthritis, injury, diabetes. Radiographic tests can be helpful in detection.

Treatment: physical therapy and kept in motion as much as possible to prevent permanent immobility. Analgesics, antiinflammatory agents, and often an injection of a steroid medication to the joint are needed. If severe and persistent, shoulder manipulation, may be helpful to increase mobility.

Severed Tendon
ICD-9-CM code 848.9

A severed tendon means the tendon (that connects muscle to bone) is completely severed thus prevents muscle from preforming and function for movement.

Symptoms: produces immediate pain, inflammation, and immobility of affected parts. Diagnosis entails physical examination of the site and a radiographic study to rule out fracture. A person with severed tendons must me evaluated for possible infections and foreign objects to the wound site.

Treatment: entails surgical intervention to suture the two tendons back together called a tenorrhaphy which immediately or may wait for the injury to heal, depending on the injury. Complications of surgical procedure may include decreased motility and stiffness.

Shin Splints
ICD-9-CM code 844.9

Painful condition involving inflammation of the periosteum, the extensor muscles in the lower leg, and surrounding tissues.

Symptoms: inflammation, edema, pain, and tenderness along the inner aspect of the tibia. The pain worsents with exercise and then disappears with rest. Shin splints occur most commonly during the first few weeks of a new exercise program or after a sudden increase in exercise. Especially common for sports and fitness enthusiasts who jog, run, or engage in high impact aerobics. Diagnosis is based on the physical examination and history of pain that worsens with exercise after rest. A patient with this condition may also have a fractured tibia bone. This can be detected with bone scanning and is considered when pain is severe and persistent.

Treatment: Rest, applications of ice and/or heat, aspirin, NSAIDs, special shoes or orthotic device to correct overpronation.

Plantar Fasciitis (Calcaneal Spur)
ICD-9-CM code 728.71

Also known as calcaneal or heel spur syndrome, it is an inflammatory response at the bottome of the heel bone. There the flat tissue (fascia) acts like a bowstring for the arch of the foot.

Symptoms: common problem for people who are active in sports. The problem begins as a dull, intermittent pain on the bottom of the foot which can progress to a sharp persistent pain. Characteristically the pain is worse on getting out of bet and taking the first few steps in the morning, after sitting for a time, after standing or waling, when beginning a sporting activity. Plantar fascia injury may also occur at the mid sole near the toes. Diagnosis entails physical examination and the patient history of symptoms. Radiographic films may sometimes show the spur.

Treatmennt: resting, applying ice to the sore area, antiinflammatories, analgesics, heel pads, and better shoes. Sometimes local cortisone injection can reduce inflamamtion. In addiction physician may tape the foot to maintain the arch and help take tension off of the plantar fascia. Shoe inserts called orthotics may also be used.

ICD-9-CM code 727.43

a benign saclike swelling or cyst that is filled with a colorless, jellylike fluid. A ganglion is formed from the tissue that lines a joint or tendon.

Symptoms: most commonly develops on the back of the wrist as a single, smooth lump. However can develop near joints such as the ankle, knee, and fingers. A ganglia may appear in mutliples or clusters and most are around the size of a pea, but others may grow as large as an inch. Ganglia may be soft to the touch or firm., and are either painless or somewhat bothersome. Pain may occur during movement. Diagnosis entails evaluation if the ganglion is presented from an underlying cause such as arthritis. A ganglion usually can be diagnoses my palpation and by observation of the lump. If in doubt the physician will use a needle to withdraw some fluid for analysis.

Treatment: Generally left alone if it does not cause pain nor interfered with function. If it is causing pain, disfigurement or impairment, several options are available. Rupturing the ganglion is possible by applying firm pressure. Needle aspiration can me used to remove fluid and installing a steroid. Sclerosing solution helps prevent recurrences.

Torn Meniscus
ICD-9-CM code 836.2

A meniscus is a semilunar cartilage found in the join of the knee. There are two menisci within the join, a medial and a lateral. A tear of the meniscus is a rack or fissure that is a result of wear or injury.

Symptoms: the medial meniscus is larger and resticts more movement than the lateral and therefore is more often injured or torn. Anterior and posterior cruciate ligament tears may accompany minsical tears. A person with this condition has acute pain when putting full weight on the affected leg and knee. The person may report the knee “locks” or “gives way”. Snapping or clicking sounds may be heard on flexion or extension. Full flexion of the affected knee may be difficult and pain increases with extension. Diagnosis entails evaluation of symptoms, physical examination, observation of limited movement and radiographic studies such as MRI.

Treatment: knee should be immobilized immediately and elevated, with ice applied to slow bleeding and edema. No weight-bearing should be allowed, and the physician should be seen ASAP. Antiinflammatory or analgesics are often needed. The treatment can usually be done arthroscopically with the patient under anesthesia unless cruciate ligaments also occured. Ligement tears require more extensive surgery for repair. Total excision or partial excision is called meniscectomy. A total meniscectomy usually is not done because it predisposes the knee to degenerative instability.

Rotator Cuff Tears
ICD-9-CM code 840.4

Four tendons of the rotator cuff are formed by muscles of the shoulder. They partially surround the head of the humerus and stabilize it in glenoid cavity or socket. The Infraspinatus muscle rotates the humerus externally, and the subscapularis rotates the humerus internally. Other muscles involved in the rotator cuff are the supraspinatus and the teres minor. Tears in any of the rotator cuff tendons limit the function.

Symptoms: immediate snapping sound and acute pain, person may be unable to abduct the arm nd range of motion becomes limited to varying degrees depending on severity of the tear. Diagnosis entails physical examination and history and confirmation can me done through arthrogram or MRI.

Treatment: managed with medication (codeine), acetominophen is given for pain, and antiinflammatory is given for inflammation. With rest and therapy, minor tears can heal with restoration of function.

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