Three Clinical Presentations Prevalent at 18-25 Years

This article discusses three clinical presentations prevalent among youths aged 18-25 years - Scoliosis, Ulcerative Colitis, and Systemic Lupus Erythematosus. It provides an overview of each condition, including symptoms, causes, and treatment options. The article also highlights the importance of early detection and management of these conditions. Find study material and resources on Desklib for further understanding.

Running head: THREE CLINICAL PRESENTATIONS PREVALENT AT 18-25 YEARS 1
THREE CLINICAL PRESENTATION PREVALENT AT 18-25 YEARS
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Introduction
In human growth and development, there are stages in which some diseases or conditions
are commonly diagnosed among a particular age set. Some maladies are associated with the
elderly for example dementia, youths such as the sexually transmitted disease and in children
immature or immature immunity-related diseases (Danese & McEwen, 2012). In this task, three
clinical presentations common among youths between 18 and 25 years were considered.
Scoliosis (Konieczny, Senyurt & Krauspe, 2012), ulcerative colitis (UC) (Menon, Goyal, Nihal
& Reddy, 2013) and systemic lupus erythematosus (SLE) (Mina & Brunner, 2013) are among
the often presented clinical conditions between these ages. The first part of this task will provide
a summary of the three diseases as scoliosis will be delved in the last section.
SLE is an autoimmune disorder which affects various body systems. In particular, the
disease affects the skin leading to a distinctive rash resembling butterfly wings unfolding across
both cheeks of the face (Reynolds, 2018). These signs may occur abruptly or progress over time
which may be from mild to severe, temporal or permanent. Other signs and symptoms include
fatigue, fever, painful joints, photosensitive skin lesions, shortness of breath, dry eyes,
headaches, and fingers that change to blue or white during cold; the Raynaud’s phenomenon (Al
Daabil et al., 2014). If not controlled early, the disease can progress and affect other vital body
organs such as the heart, kidneys and the brain. The condition is prevalent tor women than men.
This scoliosis affects a high number of indigenous Australians being diagnosed with it than their
Caucasian counterparts (Mackie et al., 2015). The autoimmune reactions can be attributed to
genetic, immunological and environmental factors. Drugs such as isoniazid, viral infections,
hormonal factors and exposure to sunlight also trigger the disease. Depending on the severity of
the symptoms using various tests such as analysis of blood samples, the disease can be managed

THREE CLINICAL PRESENTATION PREVALENT AT 18-25 YEARS 3
by multiple medications such as immunosuppressive drugs like cyclophosphamide (Bertsias et
al., 2012).
UC is an inflammatory bowel disease similar to Crohn’s disease in that both occur as a
result of irritations that don’t arise from infections. The only difference between the two is that
UC inflammation is confined to both sides of the large colon continuously extending
circumferentially from the rectum (Clark-Snustad & Lee, 2016). These inflammations destroy
the colorectal mucosa forming ulcers which can be classified into proctitis, left-sided, extensive
and pancolitis by the extent of inflammation. The disease is characterized by bloody diarrhea,
mucus discharge from the rectum, lower abdominal cramping as well as fecal urgency. UC is a
long term disease with both symptomatic and asymptomatic periods whereby systemic
symptoms present as malaise, tiredness, fever, and body weight loss (Williamson & Snyder,
2014). Stress, being related to someone with UC and use of isotretinoin are the significant risk
factors for the disease (Alhusayen et al., 2013). Treatment of UC includes medications to
increase remission periods, surgery, psychosocial and nutritional interventions.
Scoliosis is a condition that manifests in the sideways or lateral curvature of the spine.
Such curves are physically examined. They can result in pain due to the inflammation of the
ligaments while in some cases of more than 100-degree curvature respiratory difficulties can be
observed. The causes are not known hence idiopathic scoliosis. The disease can also be as a
result of nonstructural factors such as muscle spasms or structural elements in case of an
abnormal spine (Canavese & Dimeglio, 2013).
Scoliosis

THREE CLINICAL PRESENTATION PREVALENT AT 18-25 YEARS 4
The word scoliosis originates from the Greek word “skolios” meaning crooked. The word
was adopted to describe the abnormal curvature of the spine to ten or more degrees on a coronal
radiographic image observed when the patient is standing (Hresko, 2013). An individual with an
unhealthy backbone as seen from the back or the front appears straight with an ‘S’ or ‘C’ shape
at the neck, upper and the lower back instead of a straight ‘I.’ However, in some cases, the spine
shows some lateral shift from the organic frontal axis. The spine is important in preserving the
body’s normal alignment to facilitate proper functioning in movement and lifting of things as
well as bearing the body’s weight. The sideways curvature of the spine is as a result of the
twisting of the vertebrae which may cause the deflection of the ribs which affects the lungs. The
disruption of the normal alignment of the spinal column may lead to the sticking out of the
shoulder blade or an uneven waist which can be observed which may affect the neurological,
hormonal and nutritional systems (Baron et al., 2015).
Musculoskeletal disorders commonly arise during growth and development of children
and adults since at this stage the bone structure is still developing. These disorders are
multifactorial comprising of for example poor sitting posture, wearing of overweight backpacks
causing uneven distribution of weighing on the spinal column causing scoliosis (Panicker &
Sandesh, 2014). The cause for the most widely recognized type of scoliosis; idiopathic scoliosis,
is obscure, yet there have been genetic variables found that are available (Emans, 2014).
Scoliosis is a dynamic malady. In its beginning periods, a mellow shift and rib distortion
are distinguished. As it advances more vertebrae rotate, making the ribs clump together on one
side of the chest and spread separated on the contrary side. The ailment can be present at early
stages during bone development asymptomatically and manifest later due to back pain usually at
the age of 18 to 25 years of age. Most cases happen in young ladies and become clear amid the

THREE CLINICAL PRESENTATION PREVALENT AT 18-25 YEARS 5
quick development period of pubescence, a reason for the development of theory suggesting that
the condition can be hormonally induced since at this stage it is chiefly regulated by hormones
(Kulis et al., 2015). Symptoms likewise incorporate shoulder unleveling, waistline disparities,
intense cerebral pains, and shortness of breath, rib bump, interminable weakness, and emotional
episodes.
Scoliosis patients are categorized into various sorts as indicated by the period of
beginning, etiology, seriousness, and kind of bend. Each variety demonstrates distinctive
qualities of the rate of bend movement and degree showing the three-dimensional disfigurement.
A high proportion of bend advancement and early beginning of scoliosis are prescient negative
parameters for an unfortunate result in idiopathic scoliosis like a thoracic deficiency disorder
(Dayer, Ceroni & Lascombes, 2014).
Most instances of scoliosis (about 80%) are grouped into idiopathic, which means the
causes are obscure. Scoliosis may likewise result from muscle loss of motion. The two
noteworthy classifications of scoliosis are idiopathic scoliosis and non-idiopathic scoliosis. The
analysis of idiopathic scoliosis is made in cases where a non-idiopathic one has been ruled out.
Scoliosis is additionally depicted dependent on the age when scoliosis creates. If the individual is
under three years of age, it is called infantile idiopathic scoliosis. Scoliosis that creates
somewhere in the range of three and ten years old is called juvenile idiopathic scoliosis, and
individuals that are more than ten years of age have adolescent idiopathic scoliosis. Also, adult
scoliosis that affects people from the age of 25yrs.
Infantile scoliosis is a condition that makes an unusual side bend in the spine. This type
of scoliosis affects youngsters from birth to three years of age with a commonness of 1%. In

THREE CLINICAL PRESENTATION PREVALENT AT 18-25 YEARS 6
contrast to different types of scoliosis, juvenile (otherwise called early onset) scoliosis affects
male children more frequently than young ladies whereby 60% of these cases are male. At this
stage the symptoms include discrepancies in shoulder height, hip position, the hanging of the
arms while standing, shoulder blade height and the location of the head may appear not central to
the body while resting. Most cases resolve individually, yet the same number of as 10% require
treatment (Alsiddiky, 2015). The etiology of scoliosis stays obscure in spite of two postulations.
The intra-uterine molding hypothesis puts forth that the spine is twisted at the season of birth and
exacerbates with development. The post-delivery assumption recommends that placing the baby
their back will prompt straightening of the skull and scoliosis. Because more dynamic bends
happen in Europe than in the U.S., a hereditary reason has been hypothesized to causing infantile
scoliosis (Wise, 2015).
Juvenile idiopathic scoliosis is traditionally characterized as scoliosis that is first
analyzed between the ages of 4 and 10. This classification contains about 10% to 15% of all
idiopathic scoliosis in youngsters. At the younger end of the range, young men are affected
marginally more than young ladies, and the bend is frequently left-sided. Further clinically
manifest as ‘S’ and ‘C’ curvatures on the spine, body leaning to one side, uneven waistline, one
shorter leg than the other, a difference in the height of the hands when bending forward and
protruding shoulder blades. At this stage, the condition may be unnoticed due to the absence of
pain. Towards the upper end of the age range, the state is progressively similar to adolescent
idiopathic scoliosis, with a prevalence of young ladies and right-sided bends (Schlosser, Colo &
Castelein, 2015). Uncontrolled curvatures may result to severe cardiopulmonary complications,
and in cases of curves of more than 30 degrees, 95% of them progress necessitating surgical
intervention on the patient (Schlosser, Colo & Castelein, 2015).

THREE CLINICAL PRESENTATION PREVALENT AT 18-25 YEARS 7
Adolescent scoliosis, by far the most common type (90% prevalence) of scoliosis
affecting youth aged between 10 to 18 years. The causes of this disease are not known hence
referred to adolescent idiopathic scoliosis (AIS). However, there are essential studies currently in
this area to ascertain the probable causes of this malady such as the genetic basis for AIS since
studies have shown that 30% of these cases have families with scoliosis history (Altaf, Gibson,
Dannawi & Noordeen, 2013). At this stage, there are tendencies for clumsiness, fatigue,
headaches and painful spine are evident. Various theories such as hormonal imbalance,
asymmetrical growth together with genetic factors have been postulated to explain its risk
factors. The disease is asymptomatic although at the initial stages there can be back pains
restricted to the back area. Asymptomatic cases can be diagnosed using the Adam’s forward
bend test alongside a scoliometer (Coelho, Bonagamba & oliveira, 2013).
The adult scoliosis has a prevalence of more than 8% among adults of over 25 years. The
commonness raises to 68% in older adults of more than 60 years which results from the
degenerative alterations on the aging spinal column (Ames et al., 2016). Most adult scoliosis
cases occur from unmanaged adolescent cases due to in compliance with medication as well as
reduced physical therapy adherence. There can be gradual back pain that escalates with time
during physical activities, dull aches, and shock-like back pain from the buttock into the limb
and sharp leg pains.
The non-idiopathic scoliosis is further divided into congenital, neuromuscular and
mesenchymal types. Congenital scoliosis is brought about by an abnormality of vertebrae like
hemivertebra, single bar or square vertebra. Genetic mistakes at the initial six weeks of
embryonic development lead to failure or formation or segmentation of the front part of the
vertebral column. The resultant is an angular bend called kyphosis. Clinically, the disease may

THREE CLINICAL PRESENTATION PREVALENT AT 18-25 YEARS 8
not be evident at birth but later forms at the adolescent stage. Genes that are related with the
vertebral mutation have been distinguished in a few investigations (Maemura et al., 2013), and
comparative deformities have been induced in animal models by hypoxia or toxic operators
(Konieczny, Senyurt & Krauspe, 2012). Failure of formation type of congenital kyphosis (Type 1
deformity) occurs in the thoracolumbar spine which can is evident at birth as a bump on the
spine and worsens with growth. Type 2 deformity (failure in segmentation) occurs when two or
more don’t separate forming standard discs, and rectangular bones are diagnosed in later stages
of growth especially when the child starts to walk. Type 1 deformity presents 30-60 degree
malformations with a rapid growth of the skeleton during the first year with high possibilities of
progression. On the other hand, type 2 deformity exhibits a slower growth rate of worsening
which can become a surgical bend only at adolescence.
Neuromuscular scoliosis is brought about by the inadequacy of dynamic (active)
stabilizers of the spine, as in cerebral paralysis, spinal muscular decay, spina bifida, muscular
dystrophies or injury on the spinal cord. Surgical interventions of neuromuscular scoliosis are
related to the most noteworthy rate of intricacies contrasted with different sorts of scoliosis
(Smith et al., 2012).
Mesenchymal scoliosis results from an insufficiency of passive stabilizers of the spine as
is the case of Marfan’s syndrome and osteogenesis (Konieczny, Senyurt & Krauspe, 2012).
Scoliosis therapy is influenced by its cause, size and position of the bend and the stage of
bone growth. Adolescent idiopathic scoliosis or less than 20-degree curvature require no
treatment. However, visitations to the doctor after every six months are necessary to check on the
condition of the curve. In cases the shape in children progresses to 25-30 degrees or more,

THREE CLINICAL PRESENTATION PREVALENT AT 18-25 YEARS 9
bracing is essential to regulate the growth rate of the curvature. There are various types of braces
such as back brace that straightens the spine through relief of the asymmetrical pressure which
can be adjusted during the growth of the patient. However, in cases of congenital and
neuromuscular scoliosis, bracing not useful and it is less effective for infantile and juvenile cases
(Altaf, Gibson, Dannawi & Noordeen, 2013).
Surgical intervention is required for curves 40 or more degrees for they have a possibility of
progressing even after bone growth halts. The limitation of this therapy is that they are at times
life-threatening. Physical therapists and orthotists are essential in explaining the treatments as
well as ensuring comfortable fitting of the brace.
Alternatively, chiropractic therapy can be used in scoliosis therapy since it lowers back
pain. Chiropractic practice is a form of medicine employed in the diagnosis and treatment of
musculoskeletal conditions whereby the practitioners utilize their hands or machines to treat
bones, joints as well as muscles. The practice is most effect effective in acute, short-term pain
providing short-term remedies for scoliosis patients (Casazza, 2012).
In conclusion; SLE. UC and scoliosis are common diseases diagnosed at a youthful age
although they progress throughout the life span of an individual if not corrected. Scoliosis is a
spine deformity that can affect and manifests at various stages of growth. Early diagnosis of the
condition facilitates its management through multiple therapeutic techniques. Chiropractic
medicine is a non-operative procedure that helps alleviate the lower back pain as a result of
scoliosis as supported by research. In severe curvatures, surgical interventions are recommended.

THREE CLINICAL PRESENTATION PREVALENT AT 18-25 YEARS 10
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