final Flashcards
1
Q
aspects that make journals good
A
- published by professional organization
- open source=less good (lower standards)
- impact factor (based on how many articles, quality, citations, etc.)
2
Q
why are long term events particularly challenging for the GI tract?
A
@ elite level, they have to deal with a large calorie input/hour with little to no GI blood flow
3
Q
prevalence of GI symptoms in runners
A
30-90%
4
Q
upper GI tract
A
mouth–>pharynx–>esophogus–>stomach–>duodenum–>jejunum–>ileum
5
Q
lower GI tract
A
cecum–>ascending colon–>transverse colon–>descending colon–>sigmoid colon–>rectum–>anal canal–>anus
6
Q
small intenstine length + function
A
7m long
water, bile, enzymes added to chyme
nutrient absorption
7
Q
liver’s GI role
A
- process nutrients absorbed from SI
- produce bile
- detoxifiction
8
Q
Pancreas GI role
A
- secretes digestive enzymes into duodenum that break down CHO, protein, and fat
- secretes insulin to bloodsteam
9
Q
gallbladder
A
stores and concentrates bile
releases bile for fat digestion
10
Q
large intestine GI role
A
absorbing water
nutrients have been absorbed at this point
11
Q
continence
A
=waste is held in rectum through sphincters and pelvic floor muscles
12
Q
why does exercise cause GI distress?
A
possibly:
aggressive diaphragm movement
abdominal contractions
intenstinal jarring (especially running, rectum is straight)
and blood being redirected to working muscle
13
Q
splachnic hypoperfusion
motility
A
reduced blood flow due to vasoconstriction
motility of esophagus and reduced pyloric sphinctor tone
-reduced gastric emptying
-possibly increased intestinal permeability w/exercise
14
Q
different symptoms in runners and cyclists
A
runners: lower due to pounding
cyclists: upper dues to pressure on abdomen and horizontal esophagus
15
Q
why is delayed gastric emptying an issue?
A
- can lead to bacterial overgrowth
- can increase fluid in the intestine
- potential for toxins to cause symptoms
16
Q
what is recommended CHO for minimal GI symptoms?
A
glucose/fructose mix or maltodextrin/fructose mix
reduce fiber
17
Q
nutrition for GI issues in athletes
A
avoid trigger foods
stay hydrated
avoid fiber before events
18
Q
morning food recommendations
A
low GI if there’s time for digestion
high GI just before racing
19
Q
NSAIDs and GI issues
A
3-5x increased risk GI symptoms
- advil increases risk of intestinal bleeding
- if they cause issues, they shouldn’t be taken
1. reflux, upper GI bleeding in esophagus (common)
2. stomach and duodenum symptoms of gastritis, bleeding, perforation
3. permeability of intestine increased rarely
20
Q
upper GI issues
A
heartburn acid reflux nausea vomiting bloating epigastric pain
21
Q
gastroesophageal reflux likely mechanisms
A
- decreases in esophageal peristaltic activity
- dec. lower sphinctor tone
- inc. transient lower sphincter relaxation
22
Q
GERD causes
A
smoking, obesity, pregnancy, overeating, exercise
23
Q
what can GERD symptoms mimic?
A
asthma
24
Q
stitch
A
likely spasm of diaphragm or gas trapped in colon
avoid solid food before exercise
25
runners diarrhea
more prevalent in competition-ie anxiety may be a factor
cause may be ischemia, increased motility, etc.
-reduce fiber and anti-diarrheals may be used occasionally (competition)
26
rectal bleeding
athletes may find blood in stool after events
mx unclear
recurrent bleeding=risk for anemia
27
traveler's diarrhea causes
1. bacteria=most common-salmonella, E Coli
2. virus-norovirus, rotavirus
3. parasites-giargia, cyclospora
28
imodium
anti-diarrheal med
slows gut motility (peristalsis) and reduces frequency of stools
only good for certain circumstances (eg when you don't have access to a toilet)
29
protozoal diarrhea
5-10%
from unclean drinking water or person-to-person contact
-initially watery, then foul-smelling and fatty (steatorrhea)
-gradual onset, "relatively tolerable"
-malaise
cramps, bloating, flatulence, nausea, weight loss common
vomiting possible
30
protozoal diarrhea treatment
```
hydration and rest
antiprotozoal medication (prescription)
```
31
bacterial diarrhea
sudden onset, uncomfortable
| -boil, peel, cook, or forget
32
prevention of traveler's diarrhea
- boil water for 3 min or use 2 drops bleach or 5 drops iodine
- ice is not safe
- alcohol does not sterilize water or ice
- look for carbonation to for reassurance of proper processing
- salads are unwise choices
- avoid condiments and steam tables
33
viral gastroenteritis
- stomach and intestines become inflammed-->pain, nausea, diarrhea, vomiting
- sometimes body aches, headaches, and fever, which are only usually w/viral infections
- treatment=oral rehydration and quarentine, hand washing, disinfecting w/chlorine
34
evaporation
1. evaporation (from water to gas) requires heat-cooling effect
- more evaporation when low humidity
- garments play a role
35
radiation
transmission of heat energy from a surface
36
conduction
transfer of thermal energy from one region to another along a temperature gradient
- mesh promotes cooling
- cotton kills
37
convection
two types
- forced convection through blood flow (fluid is moving anyway)
- free convection through the flow of air around the body (heat causes fluid motion)
38
mild hypothermia
```
cold extremities
shivering
tachycardia
tachypnoea
urinary urgency
mild incoordination
```
39
moderate hypothermia
apathy, poor judgement, slurred speech, amnesia
reduced shivering
dehydration
incoordination and clumsiness
40
severe hypothermia
```
inappropriate behavior
loss of shivering
arrhythmias
pulmonary oedema
hypotension, bradycardia
reduced LOC, muscle rigidity
```
41
on-site management of hypothermic condition
- recognition!!! (monitor Tc if possible)
- remove from cold, wind, and wet
- insulation to prevent further loss
- nutritional an fluid support
- passive or active rewarming possible
- transport to medical facility if moderate to severe
42
passive rewarming
remove from cold environment + wet clothing
- replace with dry blankets/clothing
- in a pinch, plastic bag + insulation when no dry clothing is available
- space blankets not super useful cause they're good for radiant, not convective heat loss
43
active rewarming
warm packs on key areas
- groin, axillae, torso
- heat torso to reduce afterdrop
44
superficial frostbite
affecting subcutaneous tissue
45
deep frostbite
affecting bone joint and tissue
46
frostnip
transient numbness with no residual damage
47
frostbite blisters
clear are better and can be drained
cloudy or bloody are worse and usually are not
-blisters contain harmful thromboxanes and prostaglandins
48
frostbite care
ibu
rewarming bath
aloe vera, dry, bulky dressings
eventual surgical management
49
why are elite XC skiers, swimmers, etc more susceptible to asthma?
high ventilatory rate
| +long term training (inc. w/ inc. years of training and dec. after over time after retirement)
50
cold acclimatization
is possible
ideal protocol not studied
some evidence of 4-7 1 hr, 5C cold-air exposures over 14 days having an effect
51
why is exercise complicated in the heat?
- blood is transported to the periphery for cooling
- relative and actual central fluid deficit
- ->smaller SV and larger HR for given intensity
- also, splanchnic vasoconstriction to compensate for peripheral steal leads to GI and kidney adverse effects
52
heat exhaustion sx
- pale, cool, moist skin
- sweating profusely
- mm cramping, pain
- faint or dizzy
- headache, nausea
53
heat stroke sx
- abnormal mental status!
- flushed and hot dry skin
- BP may be elevated initially then reduced
- hyperventilation
54
heat illness risk factors
```
age above 65
alcohol, dehydration
overweight
poor fitness/sedentary
poor acclimatization
recent fever
sunburn or other dry conditions
```
55
what medications would increase heat illness risk?
```
those that
reduce sweating
alter skin blood flow
increase heat prod (metabolism)
reduce cardiac contractility
```
56
wet bulb globe temp
index of heat stress that takes humidity into account
57
exertional heat stroke
mental status changes + Tc >40
| -metabolic heat production contributes=difference b/t exertional and classic heat stroke
58
heat stroke causes of death
```
improperly measuring core temp
delayed treatment
-reduce temp below 40 w/in 30 min
-use towels if ice bath unavailable
rapid return to play w/out full determination and elimination of cause
```
59
hyponatremia
serum or plasma sodium below normal reference range (less than 135mmol/L)
60
hyponatremia sx
early: bloating, puffiness, nausea, vomiting, headache
later: altered mental status, obtundation, coma, seizeres, respiratory distress from pulmonary edema
body weight gain in most cases
61
how does hyponatremia happen?
excessive consumption of fluids in excess of total loses
- eg insensible losses from transcutaneous, respiratory, and GI losses
- and sweat and renal fluid losses
62
hyponatremia risk factors
```
excessive drinking
weight gain during exercise
low body weight
-event inexperience
-NSAIDs
-high availability of fluids
-events >4 hours
```
63
hyponatremia treatment
recognition
ABC's
IV access
100mL of 3% NaCl solution and EMS transfer immediately
64
heat illness prevention
ample fluids, sal-containing solutions and salty foods
drink to thirst
replace fluids w/1liter per 2 pounds lost
65
acclimatization to heat
is possible
greater affect in untrained individuals
90min duration in 40 C for 5 days
-60 relative humidity
66
how does heat acclimatization occur?
- improved cutaneous blood flow (from core to periphery)
- lower sweating threshold and increased sweat output
- decreased Na in sweat
- lower skin, core temp, and HR for given intensity
- less CHO metabolism
67
what has the opposite effect to heat acclimatization?
age
68
case: fatigue, poor appetite, hypertension, tachycardia, poor sleep
possible causes: anxiety, anemia, general caloric deficit, exercise induced bronchoconstriction
overtraining
mono or other virus
test for: iron (blood) thyroid hormones, asthma, white blood cells, glucose, look at training volume + nutrition
69
overreaching
accumulation of training stress that leads to short term performance decrements with or without related psychological and physiological signs and symptoms of maladaption
70
overtraining
accumulation of training resulting in long term decrement in performance capacity with or without related physiological and psychological signs and symptoms of maladaption in which restoration may take weeks to months
71
overtraining prevalence
60% of elite runners
also happens in packs sometimes
-like teams with terrible coaches
72
overtraining vs overreaching
spectrum
overreaching has rapid recovery w/rest
-w/in days but at least by 2-3 weeks
73
spectrum of overreaching
functional-recovery in days weeks (training camp for eg)
non-functional-recovery in wks to months-stagnation or dec. in performance capacity
overtraining: months to..., performance decreases
74
how is overtraining diagnosed?
by excluding all other possible causes
- rule out all other phenomena + profile of mood states
- also performance testing if there's baseline data (time trial to exhaustion)
- hormones not super good-variable by lots of other things
75
name 10 other things overtraining symptoms could be due to
```
anxiety
mono
insufficient sleep
dehydration
exercise-induced asthma
iron deficiency
eating disorders
hypothyroidism
upper respiratory infection
```
76
general and physical overtraining symptoms
workouts more difficult
- early fatigue
- faster HR w/less effort
- dec. strength
- dec. coordination
- persistent fatigue
- ongoing mm soreness
- loss of appetite
- inc. aches and pains
- inc. in overuse injuries
- frequent colds or infections
77
what is the subjective psychological evaluation?
- fatigue ratings
- mood states (dec. pos. and inc neg. feelings)
- mm fatigue ratings and inc. recovery time
- perceived exertion during constant exercise load (inc.)
78
cardiovascular factors in OTS
resting moring HR not super useful: sometimes higher, sometimes lower
-HR variability may be useful down the road
79
weight and nutrition in OTS
individual variation, inc. or dec. more than normal
80
OTS risk factors
```
general health
general nutrition
mood state
personality (type A) stressors
intensity of training
volume of training
social, economic, and psychological stressors
environmental conditions
infections travel
```
81
OTS treatment
rest
proper early diagnosis
6-12 wks
possibly address other stress with counseling
*collaboration with athlete, coach, and team or patient's physician
