Endocrine, Metabolic and nutritional disorders- chap 9 Flashcards
Quick review
Endocrine glands
Hormones produced one place and sent through blood to other areas of body to the target tissue
***Result of congenital defect or ischemic factors
- Pituitary tumors: benign or malignant
- Trauma at base of skull
- Infection
- Pituitary dwarfism
- Posterior pituitary: diabetes insipidus
- Sheehan’s Syndrome: occurs during childbirth: restricts -blood to pituitary gland
Pituitary Hypofunction
Simmonds disease
Dwarfism
Diabetes insipidus
Pituitary Hypofunction
Weakness, hypotension, weight loss, loss of energy, emaciation
Simmonds disease
Short stature, delayed onset of puberty, headaches, excess thirst, increased urine
Dwarfism
Large amounts of urine (pituitary hypofunction)
Diabetes insipidus
Excess GH (conditions)
gigantism
Acromegaly
Excess GH before puberty
Gigantism
- Broad, heavy bones
- Large hands and feet, thick skull
- Changed facial features
- Large protruding mandible
- Affects glucose metabolism
- Htn and cardiovascular disease
Acromegaly
*Deficit in hormone
- Diabetes insipidus
- HI, surgery, or renal tubules not responding
- Polyuria
- Polydipsea
- Severe dehydration
- Replace ADH
Antidiuretic Hormone
- Excess ADH
- Retain fluid
- Stress, ectopic source
- Symptoms: confusion, irritability
- Treat with diuretics, sodium
Inappropritate ADH syndrome
- TSH secreted by pituitary gland
- Thyroid gland produces T4 and T3
- Can have thyroid or pituitary problem
Thyroid Disorders
-Enlarged thyroid gland
-Endemic: hypothyroid condition due to low iodine level
*****Mountainous area, Great Lakes
*****Goitrogens: cabbage, turnips, lithium, fluoride
-Toxic_________
*****Hyperthyroid condition
goiter
- Graves’ Disease
- Increase in T3 and T4
- Women over 30
- Autoimmune
- Exopthalmos: may lead to vision impairment
- Hypermetabolism
- Toxic goiter
Hyperthyroidism
*****Untreated: visual impairment/optic nerve damage
*****Thyroid storm: uncontrolled hyperthyroidism
-Hyperthermia
-Tachycardia
-Heart failure
-delirium
Hyperthyroidism
*****Treatment for what?
- Radioactive iodine
- Antithyroid meds
- Usually have to treat long term for low thyroid
Hyperthyroidism
-Common
-Mild cases: treat with medication
-Hashimotos thyroiditis
**Autoimmune
-Myxedema
**Non pitting edema
**Leads to hypotension, hypoglycemia, hypothermia,
**LOC
Hypothyroidism
- Congenital hypothyroidism
- Iodine deficiency: thyroid absent or not functioning
- Can lead to mental retardation if not treated
- Impaired growth and development
cretinism
testing for what?
TSH, T3, T4
T3 uptake
Antibodies
Scans
biopsy
Thyroid
**Pheochromocytoma
- Benign tumor
- Secretes epi, norepi
- Produces htn, HA, heart palpitations, sweating, anxiety
Adrenal Glands
-Prognosis is good with appropriate treatment
-MI:
***Pituitary dwarfism: growth hormone
***Simmonds Disease: give deficient hormone
***Diabetes Insipidus: ADH
Pituitary Hypofunction
**Excess glucocorticoids (cortisol)
-Adrenal adenoma
-Pituitary adenoma
-Ectopic carcinoma
-Administered glucocorticoids
**Glucocorticoids
-Responsible for stress response
cushing’s syndrome
- Moon face
- Fat at back of neck
- Thick trunk
- Fragile skin with red streaks, hirsutism
- Osteoporosis
- Delayed healing
- Gluconeogenesis, insulin resistance
- Retain sodium and water
cushings syndrome
-Deficiency of glucocorticoids (cortisol), mineralcorticoids, and androgens
-Etiology:
*Autoimmune
*Tumors
*Infection
Addison’s Disease
- Decreased blood glucose levels
- Poor stress response
- Weight loss
- Frequent infections
- Low sodium
- Hypotension
- Decreased body hair
- Treatment: hormone replacement
Addison’s Disease
May begin at puberty or between 30 and 50
Hyperpiuitarism
Caused by:
Deficit of insulin secretion from pancreas
OR
Lack of response by cells to insulin
Diabetes Mellitus (DM)
- Very common, chronic disorder
- Prevalence increasing rapidly
- 9% of the population over 20 has DM II
- More prevalent in population over age 55
- More prevalent in African Americans, Hispanic -Americans and Native Americans
- It is anticipated that incidence of DM II will increase in the future
diabetes mellitus (DM)
Etiology of what type of diabetes?
Genetic component
Autoimmune reaction destroys pancreatic beta cells (insulin producing cells)
Results in an absolute deficit of insulin
type I diabetes
What type of diabetes
-Usually diagnosed in childhood
-Treatment: insulin injections or insulin pump
**Long acting, intermediate acting, short acting
**Must watch diet
-Hard to control in teenage years
-CANNOT CONTROL JUST WITH DIET
DM type 1
what type of diabetes?
- Formerly called noninsulin-dependent diabetes mellitus (NIDDM)
- Decreased effectiveness of insulin or a decrease in Beta cell production of insulin
- Milder form of diabetes
- Usually in older adults
- Increasing incidence in younger adults and children
- Thrifty gene: Pima Indians
type II Diabetes
What type of diabetes?
- Occurs during pregnancy
- Disappears after birth of child
- 5-10% may develop Type 2 diabetes later in life
Gestational diabetes
Pathophysiology of what?
- Insulin deficit results in decreased transportation and use of glucose throughout the body
- Blood glucose levels rise (hyperglycemia)
- Excess glucose spills into the urine
- A large volume of urine to be excreted (polyuria)
- Dehydration occurs
- Dehydration causes thirst (polydipsia)
- Lack of glucose entering cells stimulates appetite (polyphagia)
Initial stage of diabetes
Progression if not diagnosed early
No glucose in cells: catabolism of fats and proteins
Excessive fatty acids and metabolites (ketones)
Body cant process ketones well
Excessive ketones in blood: ketoacidosis
pH in body fluids drops
Ketoacidosis: life threatening
Diabetic ketoacidosis
s/s of what?
- Weight loss
- Fatigue, lethargy
- Nausea and vomiting
-Polyuria, Polydipsia, Polyphagia
diabetes
tests for what?
- Fasting blood glucose level
- Glucose tolerance test (GTT)
- Glycosylated Hemoglobin test (Hgb A1C)
Diabetes Diagnostic tests
fyi
- Fasting blood glucose: > 126 mg/dL on two or more occasions
- Random blood glucose: one reading >200 mg/dL
- Impaired fasting glucose: 100-126 mg/dL
- Normal blood sugar: <100 mg/dL
fyi
fyi
long term management
- Hgb A1C: normal: < 6
- Diabetic patient: <7
wasn’t sure how to put this slide
- Glucometer
- Helps reduce fluctuations in blood glucose
home monitoring
what diabetes is controlled by below?
-Regulating dietary intake
Complex carbs, protein, good fats, fiber
-Weight loss if necessary
-Increasing exercise to use more glucose
-Oral medications
Decrease insulin resistance, stimulate beta cells to produce more insulin
-Sometimes insulin injections are necessary (sub Q) insulin pumps
Long acting, intermediate acting, rapid onset
type II
Hypoglycemia (insulin shock)
diabetes complication- Acute
-Deficit of glucose in the blood
-More frequently occurs with DM I
-Sudden, often following strenuous exercise, vomiting or -missing a meal after taking insulin
-Neurons: cannot use fats or protein
-Poor concentration, slurred speech, lack of coordination, staggering
Increased pulse, pale, moist skin, anxiety, tremors
LOC, seizures and death
-Treat with concentrated carbs (candy, glucose, glucagon)
Hypoglycemia (insulin shock)
Diabetes complications - Acute
-Increased glucose in the blood
-Increased lipid metabolism, increased ketones in the blood
-More frequently occurs with DM I
-Infection, stress, error in dosage, too
much food, alcohol
Diabetic ketoacidosis (DKA)
Symptoms: of what?
- Thirst, dry mouth, warm dry skin, rapid pulse, fruity breath
- Lethargy, decreased responsiveness
- LOC
- Abdominal cramps, nausea vomiting
Diabetic ketoacidosis (DKA)
- Ketoacidosis
- Administer insulin
- Fluid replacement
- Electrolyte replacement
Diabetes Complications- acute
- See in DM II
- Infection, overindulge in carbs (holidays!!)
- Uses more insulin
- Hyperglycemia, dehydration
- Some insulin still available so no ketoacidosis
- Muscle weakness, difficulty with speech, abnormal reflexes
hyperosmolar hyperglycemic nonketotic coma
- Due to changes in metabolic pathways
- Vascular problems
- Large and small vessels
- Capillaries obstruct or rupture: tissue necrosis
diabetes complications- chronic
- Capillary BM becomes thick
- Ruptures small arteries and capillaries
- Is the cause of retinopathy and nephropathy in diabetics
- Can lead to end stage renal failure
microangiopathy
- Affects large arteries
- Increases incidence of MI, CVA and PVD
- Increases incidence of ulcers in legs and feet
macroangiopathy
- Peripheral neuropathy
- Common
- Impaired sensation, numbness, tingling, weakness, muscle wasting
- Also can effect autonomic nerves; bladder incontinence, impotence, diarrhea
diabetes complication- chronic
- Infections
- More severe, common
- May be due to vascular impairment
- Delay in healing
- Increased glucose
- Slow healing
- Fungal infections
- Urinary infections
- Periodontal disease
diabetes coplications- chronic
- Cataracts
- Affected by glucose metabolism
- Water and sorbitol destroys transparency
Pregnancy:
may become more severe
spontaneous abortions
Newborn: large
diabetes complications- chronic
- Emphasize healthy habits to your patients
- Good hydration during treatment
nutritional disorders
- Becoming an epidemic
- 33.8% of adults and 17% of children and adolescents are obese
- 70-85% of those children will be obese as adults
- High fat and protein diets
- 9% of all medical spending is on obesity
- 20% of adults in US are morbidly obese
obesity
- Multiple factors
- S/S: excess weight
- High waist measurement and BMI: increased risk of obesity related diseases
- Hypertension
- cholesterolemia
- Type 2 diabetes
- Coronary artery disease
- CVA
- Gall bladder disease
- Osteoarthritis
- sleep apnea
- Certain cancers
obesity
fyi
In 1990, among states participating in the Behavioral Risk Factor Surveillance System, 10 states had a prevalence of obesity less than 10% and no state had prevalence equal to or greater than 15%.
By 2000, no state had a prevalence of obesity less than 10%, 23 states had a prevalence between 20–24%, and no state had prevalence equal to or greater than 25%.
In 2010, no state had a prevalence of obesity less than 20%. Thirty-six states had a prevalence equal to or greater than 25%; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence equal to or greater than 30%.
fyi
- Physical therapy
* Can help with behavior modification
Increase daily activity
Exercise instruction to young children
Encourage physical education classes
obesity
- Anorexia nervosa
- Bulimia nervosa
- Both can cause lack of nutrition and further problems
Impaired muscluloskeletal system
Cognitive dysfunction
Organ disease
eating disorders
- 95% are female
- Approx 1in 100 adol females
- Caucasian, middle and upper socioeconomic class
- Etiology: unknown
- Hormones assoc with appetite
- Social, psychological and endocrine
anorexia
- Fear of being overweight
- 85% or less of expected body weight
- Obsessed with body image
- Menstruation ceases, malnutrition, osteoporosis, depression, hypoglycemic coma, renal failure
* With treatment 50% of people recover - 20% chronic issues
- 6-10% die as a result
anorexia
- Treatment
- Whole family
- Multiple members of team
- May need hospitalization
- PT
- Be aware of implications: fatigue easily, overexercise to lose more weight
anorexia
- More common in females
- Strong psychological component, impulsive, possible hereditary tendency
- Low self worth, pressures to be thin
- Can be associated with anorexia
- Eat large quantities and purge
- Self induced vomiting
- laxatives
bulimia nervosa
- Weight may not be as low as anorexics
- Decreased nutritional status and can affect GI tract, teeth, esophagus, electrolyte imbalance
- Usually not life threatening
- May reoccur through life
- Treat: antidepressants and therapy
- PT: may need to encourage someone to get medical attention
Bulimia Nervosa
