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S2 PTA 104 disease > Endocrine and metabolic systems > Flashcards

Endocrine and metabolic systems Flashcards

1
Q

Endocrine disorders

A

Pts with endocrine disorders may have decreased strength and energy to participate in therapy activities

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2
Q

Endocrine system components

A

Endocrine glands are scattered throughout the body

  • pituitary glands
  • adrenal glads
  • thyroid glands
  • parathyroid glad
  • pancreas
  • gonads
  • pineal gland
  • thymus
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3
Q

Endocrine system

A

Endocrine glands secrete hormones into blood which circulate to target cells in glands or tissues

  • hormones: chemical messengers classified by action, source, or chemical structure (steroid and non-steroid)
  • after acting on specific receptors/target cells, hormones are metabolized (excreted by kidneys) preventing excessive accumulation over time
  • the release of hormones is negative feedback mechanism
  • works with nervous systme to regulate metabolic activities
  • the maintain well-controlled blood level of a substance a balance of several hormones is required (amount)
  • the rate or timing of hormone secretions will affect overall hormone levels (when)
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4
Q

Causes of hormonal imbalance

A

Adenomas (most common cause) may be

  • secretory - excess hormone
  • destructive to gland - hormonal deficit
  • resistant target cells - create a hormone deficit
  • congenital/infection/vascular defects
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5
Q

Treatment

A

Depends on the cause of the problem

  • hormone replacement therapy: may treat hormone deficits
  • surgery/radiation: to treat adenomas causing excessive secretions
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6
Q

Insulin

A

From pancreas

  • controls amount of blood sugar
  • controls cellular uptake of glucose and liver glycogensis
  • assists in synthesis of proteins and fats
  • deficient insulin results in abnormal carbohydrate/protein/fat metabolism d/t the impaired transport of glucose and amino acids into cells
  • adversely affects many tissues/organs
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7
Q

Diabetes mellitus

A
  • blood sugar (glucose) levels are abnormally high
  • the body does not produce enough insulin to meet its needs
  • adversely affects many tissues and organs
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8
Q

Type 1

A

Insulin dependent (more severe form)

  • the body does not produce insulin (autoimmune)
  • typically diagnosed in children and young adults
  • typically occurs around age 12
  • autoimmune: body destroys B cells from islets of langerhans
  • pathogensis: sudden onset
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9
Q

Type 2

A

Non-insulin dependent (more common)

  • either thebody does not produce enough insulin or the cells ignore the insulin
  • d/t decreased production of insulin and decreased cellular sensitivity
  • a milder form of diabetes
  • gradual onset in older adults
  • majority of these adults are overweight
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10
Q

Initial stage type 1

A
  • decreased transport and use of glucose in many cells
  • blood glucose levels rise (hyperglycemia)
  • excess glucose spills into the urine as glucose level exceeds absorption capacity of the renal system
  • increased urin production = loss of fluid from body tissues, leading to dehydration and thirst
  • leach of nutrients entering cells stimulates appetite
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11
Q

Later stage type 1

A
  • lack of glucose in cells results in catabolism of fats and proteins, leading to excessive fatty acids and ketones in the blood
  • some diabetic patients test their urine for ketones
  • as dehydration develops, excretion of acids becomes more limited which may lead to a diabetic coma
  • occur more frequently in persons with type 1 diabetes
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12
Q

Signs of diabetes

A
  • weight gain
  • glycosuria
  • polyuria
  • weight loss
  • fluid loss
  • non-healing infections
  • neuropathy
  • gastroparesis
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13
Q

Symptoms of diabetes

A
  • frequent urination
  • constant thirst
  • increased hunger
  • fatigue
  • tingling toes
  • blurred vision
  • dry mouth
  • N&V
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14
Q

Diagnostic tests diabetes

A
  • fasting blood glucose level: >126 mg/dL taken on > one occasion confirms diagnosis of diabetes
  • glucose tolerance test
  • glycosylated hemoglobin test (HA1c): monitors long term control of blood glucose levels (normal 5-6%)
  • urine tests
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15
Q

Treatment diabetes

A
  • goal: 70-130 mg/DL * blood glucose levels before meals (normal range)
  • 3 levels of control
    1. Diet and exercise
    2. Oral medication to increase insulin secretion or reduce insulin resistance
    3. Insulin replacement
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16
Q

Diet and exercise diabetes

A
  1. Diet: based on maintaining optimum body weight - control of blood glucose levels - important for both types of diabetes - meal planning
  2. Exercise benies: increases muscle glucose uptake without increasing insulin utilization - weight control - reduces stress - improves fitness
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17
Q

Exercise prescription in DM

A
  • low to moderate intensity 3-5x/wk including resistance and aerobic exercise is recommended
  • at least 170 min/wk (40-80% vo2 max) increased cell sensitivity to glucose
  • 180 min/wk including cycle ergo entry, treadmill, resistance exercises (leg press, seated abs, etc) improved vascular function
  • ACSM: type 1: aerobic health and weight loss
18
Q

Oral meds diabetes

A
  • anti-diabetic agents or oral hypoglycemic drugs are useful in the treatment of type 2 diabetes
  • certain drugs may help to reduce insulin resistance
  • metformin, glucophage
19
Q

Insulin replacement therapy

A
  1. injected subcutaneously
  2. biosynthetic form of insulin most frequently used
  3. continuous monitoring to prevent complications
    - large fluctuation in blood glucose levels
    - d/t variations in diet, physical activity level, the presence of infection, or alcohol use
    - stable blood glucose levels reduce the risk
    - complications may be acute or chronic
20
Q

Hypoglycemia

A

Insulin shock

  • acute complication d/t excess of insulin, causes deficit of glucose in the blood
  • type 1 diabetes pats are most often affected
  • occurs suddenly following: strenuous exercise, dosage error, vomiting, skipping a meal after taking insulin
  • lack of glucose quickly affects nervous system
21
Q

What to look for (diabetes)

A
  1. Impaired CNS: slurred speech - poor/lack of coordination - staggering gait
  2. Sympathetic system: increased pulse - pale/moist skin, anxiety, tremors
22
Q

Treatment of diabetes

A
  • immediate administration of concentrated carbohydrate

- hypoglycemia can be life threatening if it is not treated promptly

23
Q

Diabetic ketoacidosis

A

Insufficient insulin

  • high blood glucose levels and mobilization of lipids
  • more common in type 1
  • develops over a few days
  • may be initiated by an infection or stress
24
Q

Diabetic ketoacidosis S&S

A
  • rapid, deep respiration’s
  • an acetone breath (sweet, fruity smell)
  • thirst N&V
  • decreased urine output related to dehydration, metabolic acidosis, and electrolyte imbalances
25
Q

Electrolyte imbalances

A
  • includes imbalances of sodium, potassium, and chloride
  • signs include primarily abdominal cramping, nausea and vomiting
  • the individual may also experience lethargy and weakness
  • treatment: administration of insulin and replacement of fluid/electrolytes
26
Q

Chronic complications

A
  1. degenerative changes occur in many tissues with both types of diabetes
  2. several of the more common chronic complications associated with diabetes
    - vascular problems
    - neuropathy
    - infections
    - cataracts
27
Q

Pic

A

Pic

28
Q

Neuropathy

A
  • impaired sensation, numbness, tingling, weakness, and mm wasting
  • symptoms dont follow typical dermatomes or myotome patterns (glove and stocking)
  • results from ischemia and altered metabolic processes
  • degenerative changes occur in both myelinated and unmyelinated nerve fibers
  • increased risk of tissue trauma and infection
29
Q

Infections

A
  • due to vascular impairment, infections tend to be more common in this pt population
  • healing is delayed due to the insulin deficit - increased glucose levels support infection
30
Q

PT intervention

A
  1. Foot care: inspect feet, show wear, educate patient
  2. Balance training: proprioception, vestibular, and vision
  3. Cardiovascular exercise
  4. time of treatment will be important
31
Q

CV exercise

A
  1. Short term:
    - increased glucose uptake into skeletal muscles
    - lower level of glucose in the blood for 48 hrs after exercise
  2. Long term:
    - increased insulin receptors on target cells
    - increased affinity of receptors for insulin
    - decrease CV complications
32
Q

Pituitary hormones

A
  • growth hormone (tissue growth)
  • TSH: stimulates thyroid gland to produce T3 and T4 (tri-iodothyronine and thyroxine: protein synthesis and metabolic regulation)
  • calcitonin: calcium and phosphorus balance
  • need to determine the source of the imbalance in hormaones controlled by the pituitary
  • benign adenomas are most common cause of pituitary disorder
33
Q

Pituitary mass

A
  • enlarges and causes pressure on skull
  • signs of pressure include increasing headaches, seizures, and drowsiness
  • visual defects are also common
  • tumor cells may secrete an excessive amount of a particular hormone
  • the adenomas may destroy an area of pituitary cells, causing a deficit of a particular hormone
  • tumors usually removed by surgery or radiation therapy
34
Q

Growth hormone

A
  • dwarfism: may be caused by deficit of growth hormone
  • gigantism: results from excess growth hormone prior to puberty and fusion of the epiphyses
  • acromegaly: the effects of excess growth hormone secretion in the adult, usually by an adenoma
35
Q

Thyroid disorders

A
  • disorders may result from pituitarty thyroid gland dysfunction
  • goiter
  • hyperthyroidism (grave’s disease)
  • hypothyroidism
36
Q

Hyperthyroidism

A
  • autoimmune condition in which the thyroid gland makes too much thyroid hormone
  • antibodies: an overproduction of thyroid hormones (T3 and T4)
  • the condition is often referred to as an overactive thyroid
  • related to an autoimmune factor
37
Q

Graves

A
  • hyperthyroidism
  • autoimmune and genetic
  • goiter, nervousness, heat intolerance, palpitations, diarrhea, decrease weight, eye protrusion
  • Rx: meds, radioactive iodine, surgery
38
Q

Goiter

A
  • enlargement of thyroid gland
  • often visible on the anterior neck
  • caused by various hypothyroid and hyperthyroid conditions
  • can become very large, compressing the esophagus and interfering with swallowing, or it can cause pressure on the trachea
39
Q

Hypothyroidism

A
  • hormone resistant or hormone deficit
  • slows basal metabolic rate, bradycardia, decreased heat production, slowed neurological function
  • Rx: meds (synthryoid)
  • hashimotos’ disease
  • thyroid inflammation
  • decrease thyroid hormone
  • fatigue, increased weight, cold sensitivity, difficulty with concentration, dry skin/hair/nails, muscle soreness, drowsiness
40
Q

Adrenal dysfunctions

A

Idiopathic or autoimmune

  1. Hypercortisolism: cushing’s, excessive cortisol. -etiology meds or adenoma. - S&S hyperglycemia, HTN
  2. Adrenal insufficiency: addison’s, decreased cortisol. - etiology autoimmune or idiopathic. - S&S hypoglycemia, low BP

S2 PTA 104 disease (15 decks)

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