Endocrine Cases DSA 1/6 Flashcards
how are length and height measured in infants and toddelrs
firm box
then against wall
the nearest 0.1 cm and measured twice, with results of the 2 measurements falling within a 4-mm range.6 If the difference between the 2 values is >4 mm, then a third measurement should be obtained
do children in different countries growth differently
no
The MGRS was based on the hypothesis, later proven, that young children have similar growth potential independent of ethnicity and place of birth.
rule of 5s for height velocity
25 cm/ year from birth to 1y.o
10 cm/yr 1-4 years old
5-7 cm/year from 4-8
second peak of height velocity in adolescence
- 5 y.o girls
13. 5 y.o boys
when is it best to obtain HV measurements
9-12 mo intervals after age 2
formulations for target height in girls
fathers height - 13 cm + moms height /2
formulations for target height in boys
mothers height + 13 + fathers height/2
important parts of exam if child has abnormal growth pattern (could suggest a slow in growth)
PMH (including in utero Hx)
FMH: genetics and including mothers pregnancy
Soc Hx: depression, stress, anxiety
how to tell is short stature is proportionate
arm span, sitting height to standing height
upper to lower segment ratios
BMI
head circumference if <3-4 years old
labs to order for screening of growth failure
CBC with SED rate
CRP
CMP
infant born SGA, when will growth catch up
usually in 2 years
how do glucocorticoids decrease bone growth
reduced E levels, inhibited IGF-1 production and R to IGF-1
growth impairedment from CF or celiacs is best detected when recording what
weight trajections
3 principal uses of chapmans reflexes
Dx
influencing motion of fluids
inflencing visceral function through nervous system
how do posterior chapmans feel
edematous with string feel deeper
endocrine group of chapmans includes what
prostate, broad ligament, uterus, gonads, thyroid and adnrelas
the GI group of chapmans includes what
colon, thyroid, pancreas, duodenum, small intestine on L liver, small intestine on R
infectious group for chapmans
liver, spleen and adrenals
anterior and posterior points for thyroiditis
ant: intercostal space between 2nd and 3rd ribs close to sternum
post: across face of transverse process of second dorsal vertebra, midway between the spinous process and tip of transverse process
Ant and post points for kidneys
ant: laterally inch either side of median of abdomen and inch above umbilicus
post: intertransverse space 12th dorsal and 1st lumbar vertebrae
midway between the spins and tips of transverse processes
points for adrenals
ant: 2 -2.5 inches above umbilicus and 1 inch lateral
post: intertransverse spaces on both sides 11th and 12th dorsal vertebra
midway between spinous processes and tips of transverse
points for pancreas
ant: intercostal space 7th and 8th ribs on R side close to approximation of cartilages
post: between transverse processes of 7th and 8th dorsal vertebra midway between spinous and transverse processes on R side
points for congestion of liver and gall bladder
Ant: intercostal space mid mamillary line up to sternum on R side between 6th and 7th ribs
post: between transverse processes of 6th and 7th vertebrae between spinous and transverse on R side
45 y.o F with weight loss, fatigue, vomiting, diarrhea, dec cold tolerance and salt craving
ddx?
adrenal fatigue
addisons
labs to order for addisons
basal plasma cortisol and ACTH
ACTH stimulation test
what will basal plasma cortisol and ACTH be in addisons
low cortisol and high ACTH
what will ACTH stimulation test show in addisons
low to normal cortisol levels that do not rise after ACTH administration
what are the 5 Ss to manage in adrenal crisis
salt, sugar, steroids, support and search for precipitating illness
arterial supply to adrenal gland
superior middle and inferior suprarenal aa
venous drainage adnreal gland
suprarenal vv
lymph drainage for adrenals
para-aortic nodes
driven by resp diaphragm
sympathetics to adrenals
T6-L2
T8-T10 NBOME
PArasympathetic control to adrenals
vagus
OMT areas for addisons
lymph- thoracic inlet, resp diaphragm
sympathetics:T6-L2
PANS: vagal function (temporal bone, occipitomastoid suture, OA AA C2
48 y.o M with fatigue, cold intolerance, constipation, migrating muscle aches, weight gain, course dry skin
dec DTRs
dx?
hypothyroidism
labs to order if suspect hypothyroidism
TSH T3 T4
TSH would be increased and free T4 dec in primary
both dec in central
TSH elevated and T4 normal in subclinical
medical management of hypothyroidism
levothyroxine
if levo not working in hypothyroid patient what drug can you try
liothyronine
arterial supply thyroid gland
superior and inferior thyroid aa
venous drainage of thyroid gland
superior middle and inferior thyroid vv
lymphatic drainage of thyroid gland
prelaryngeal, pre tracheal and paratracheal
what drive lymph flow from thyroid
resp diaphragm
SAN to thyroid
upper thoracic T1
contributions from C3 C2 and C6
role of sympathetic fibers to thyroid
vasomotor
OMT for thyroid dysfunction
lymph: thoracic inlet, resp diaphragm SAN: T1 (flexed segment) compensatory segments T3-4 1st ribe (elevated) to Tx the inferior cervical stellate ganglion cervical spine cranial
65 y.o F HTN HLD DM II
atorvastatin, ramipril and metformin
overweight
dx?
metabolic syndrome
what is metabolic syndrome
constellation of altered function: abdominal obesity
dyslipidemia, HTN and insuline R
possible impaired glucose tolerance
What organs contribute to metabolic syndrome
thyroid, adrenals, pancreas, liver kidneys
arterial supply to pancreas
superior and inferior pancreaticoduodenal aa
venous drainage of pancreas
superior and inferior pancreaticoduodenal vv
lymph drainage of pancreas
pancreaticosplenic and pre-aortic nodes
SAN to pancreas
T6-9
vasomotor
PAN to pancreas
vagus- secretomotor
results in secretion insulin, bicarb, somatostatin and glucagon
functions of liver
metabolizes, detoxifies and inactivates substances
stores carbs, lipids, vitamins and minerals
liver activates what
hormones T4 to T3 and vitamines
liver synthesizes
albumin, glucose, cholesterol, phospholipids and fatty acids for TG
arterial supply to liver
hepatic artery
venous drainage liver
portal venous system and hepatic vv
lymph drainage of liver
nodes above and below diaphragm
SAN liver
T6-9
stimulation inc breakdown of glycogen to glucose
PAN liver
vagus
stimulation dec breakdown glycogen to glucose
arterial supply to kidney
renal aa
venous drainage kidney
renal vv
lymph drainage kidney
renal v to drain to lateral aortic nodes
SAN kidney
T10-L1
vasomotor
(frequently flexed at thoracolumbar)
PAN kidney
vagus most likely
SAN does what to kdiney
vasoconstriction
enhanced Na reabsorption from prox tubule
increased renin secretion
increased fluid retention inc BP
OMT metabolic syndrome
lymph
autonomics
myofascial restrictions of involved organs
chapmans
