Lecture 5: Metabolic and Endocrine Pathophysiology

Question 1

key functions of metabolic system

Answer 1

convert food to energy

break food down into protein, lipids, carbs, and nucleic acids

eliminate metabolic waste

Question 2

organs of metabolic system

Answer 2

liver
GI tract
pancreas
adipose tissue
muscles

Question 3

what is catabolism

Answer 3

breaking down large molecules into smaller ones

releases energy

Question 4

what is anabolism

Answer 4

combines small molecules into larger ones

requires energy

Question 5

what is oxidative metabolism

Answer 5

energy produced from O2 and glucose

CO2 and water byproduct

aerobic metabolism

Question 6

what is glycolic metabolism

Answer 6

energy produced from proteins and glucose

lactic acid byproduct

anaerobic metabolism

Question 7

what is Wilson’s disease, common presentation, S&S, and PT implication

Answer 7

abnormal metabolism of capper that leads to build up of copper in the liver, kidneys, CNS, and eyes

most common presentations
- liver disease (younger)
- neurological impairments (older pts)

S&S
- liver failure/cirrhosis
- parkinsonian features
- ataxias
- rigidity
- dysarthria
- premature osteoporosis
- CM
- infertility

PT implication = treat neurological S&S in association with medical management

Question 8

what is Phenylketonuria (PKU)

Answer 8

rare inherited metabolic disorder that causes an amino acid to build up bc of the absence of the enzyme that breaks it down

usually diagnosed within first few months of life

most common presentations = severe developmental/intellectual disability

S&S
- gait impairments
- psychiatric difficulties
- abnormal body odor

PT implications = treat developmental delays

Question 9

what is Paget’s disease: common presentation, S&S, and PT implications

Answer 9

metabolic bone disease caused by high bone reabsorption followed by unrestricted bone formation

common presentation = excessive bone formation lacks structure/strength despite appearing hypertrophic; commonly affects long bones

S&S
- repeated fx
- arthritis
- pain
- MSK deformity

PT implications
- resistance train to build bone density and surrounding mm
- awareness of increased risk of fxs
- weight control and cardiac fitness to manage S&S

Question 10

what is gout/common presentation/incidence

Answer 10

acute inflammatory reaction to high concentration of urate crystals in the synovial space of joints

caused by hyperuricemia or too much uric acid in the blood (uric acid metabolized by the kidneys for excretion)

higher prevalence in pts with CKD, HTN, diabetes, HF, obesity, and other metabolic dysfunctions

20:1 make to female

can be diagnosed via blood test or arthrocentesis

Question 11

symptoms of gout

Answer 11

red, inflamed, swollen joint (sometimes unilateral)

very painful

toes, thumb, elbows, knees most common site

Question 12

PT implications for gout

Answer 12

awareness of increased risk of recurrence with PMH of gout

compensatory strategies based on location

ROM to increase synovial fluid production

weight control and cardiac fitness to manage S& S

encourage medical/pharm treatment and compliance

Question 13

what is osteomalacia, S&S, and PT implications

Answer 13

ineffective bine mineralization causing softening of bone

vitamin D deficiency is main cause in adults and impaired calcium absorption

S&S
- bone pain
- proximal mm weakness
- hip/pelvic pain
- fx sometimes is first presenting symptom

PT implications
- weight bearing exercise, but not high impact
- encourage dietary and medical compliance

Question 14

key functions of endocrine system

Answer 14

maintains homeostasis

communicates with CNS to coordinate and integrate cellular activity at different organs/organ systems

controls, correlates, and integrates
- reproduction
- growth/development
- maintenance of electrolytes, water, and nutritional balance of blood
- regulation of cellular metabolism and energy balance
- mobilization of body defenses

Question 15

components of endocrine system

Answer 15

glands
hormones
receptors

Question 16

what is graves disease

Answer 16

autoimmune disorder that causes HYPERthyroidism and excessive thyroid hormone production

strong family hx

clinical presentation
- heat intolerance
- weight loss
- fatigue
- diaphoresis
- anxiety
- irritability
- tachyarrhythmias
- enlarged thyroid (goiter)
- B ptosis w/ eyelid retraction

Question 17

graves disease treatment

Answer 17

radioactive iodine to destroy cells that produce thyroid hormones

antithyroid drugs

Thyroidectomy

Question 18

PT implications for graves disease

Answer 18

tachyarrhythmias, dyspnea on exertion

decreased peripheral mm oxygen extraction

myopathies, proximal mm weakness

heat intolerance

meds/sx management can cause pt to fluctuate between hypothyroidism and hyperthyroidism

Question 19

what is hypothyroidism

Answer 19

low levels of thyroid hormones which control most metabolic functions in body

iodine deficiency is main cause in developing nations

autoimmune disorders are main causes in developed nations (i.e. Hashimotos)

clinical presentation
- fatigue
- weight gain
- decreased metabolism
- hair loss
- dry skin
- cold sensitivity
- constipation

Question 20

medical management of hypothyroidism

Answer 20

hormone replacement therapy (lifelong)

treatment of side effects if needed once thyroid levels are normal

Question 21

PT implications for hypothyroidism

Answer 21

improve activity tolerance and mm strength/endurance

can only make impact once pt is properly medically managed

increased activity will help negate constipation

edu on management of other S&S and medical compliance

Question 22

what is syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer 22

too much ADH released by pituitary

kidneys abnormally retain too much water

causes
- medications
- response to GA
- neuro insult
- pituitary tumor
- infections

presentation
- hyponatremia
- hypervolemic but highly concentrated urine
- N&V
- HA
- Vision changes
- balance impairments
- AMS
- other neuro S&S
- seizures

Question 23

PT implications of SIADH

Answer 23

awareness of hypoNa

HTN awareness

may need to wait until pt is no longer symptomatic form their hypoNa

edu to pt/family on looking out for worsening S&S

Question 24

what is diabetes insipidus

Answer 24

pituitary gland doesn’t release enough ADH

kidneys abnormally produce too much urine w/o ADH signaling to retain normal levels of water

no connection to diabetes mellitus and does not affect blood sugar in any way

causes:
- genetics
- pituitary/other brain tumor
- severe TBI
- hormones with pregnancy
- type of kidney disorders

Question 25

clinical presentation of diabetes insipidus

Answer 25

extreme levels of urine production

excessive thirst regardless of intake

hyperatremia

hypovolemic

Question 26

PT implications of diabetes insipidus

Answer 26

impairment based treatment approach

hypotension awareness

encourage rehydration

Question 27

what is Addisons disease

Answer 27

adrenal insufficiency; reduced production of cortisol and aldosterone

autoimmune disorder that causes progressive destruction of adrenal cortex

TB is most common cause

adrenal insufficiency from long term corticosteroid use is NOT the same as Addisons

presentation:
- slow developing weakness/fatigue/back and leg pain
- GI distress
- weight loss
- poor appetite
- crave salt
- hypoglycemia
- hypovolemia
- hyponatremia with hyperkalemia
- skin hyperpigmentation

Question 28

associated comorbidities with addisons disease

Answer 28

hypothyroidism
DM 1
chronic hepatitis
osteoporosis

Question 29

PT implications with addisons disease

Answer 29

chronic steroid replacement and accompanying side effects

symptomatic treatment of back and leg pain

postural control and core strengthening

encourage medical compliance

Question 30

what is Cushing’s syndrome

Answer 30

over secretion of cortisol by adrenal cortex OR long term use of corticosteroids

mist commonly results from long term steroid use seen in pts with cancer, lung diseases, autoimmune diseases, or MS

clinical presentation:
- moon face
- buffalo hump
- abdominal obesity
- mm wasting/weakness
- bone density impairments
- skin changes (red cheeks, poor wound healing)

Question 31

PT implications for Cushing’s disease

Answer 31

weight bearing exercises, not high impact

posture control/core strengthening

reduce fall risk

wound prevention/healing

awareness of side effects of chronic steroid use

Question 32

normal physiology of pancreas

Answer 32

Islets of langerhans in pancreas produce insulin and glucagon

insulin ( B cells) suppress glucose production

glucagon (a cells) stimulate glucose production

lack of insulin results in inability to use glucose as fuel and impaired protein metabolism

Question 33

actions of insulin

Answer 33

facilitates glucose transport across cell membrane for cell metabolism; both oxidative/aerobic and glycolytic/anaerobic

enhances cellular utilization and storage of glucose

promotes adipose synthesis into amino acids (free fatty acids)

enhances utilization of amino acids in liver and throughout body

Question 34

describe type 1 diabetes

Answer 34

progressive destruction of insulin secreting B cells in islets of L

result = complete lack of systemic insulin; needs to be replaced pharmacologically

5-10% of DM cases

usually diagnosed in 1st 10 years

insulin dependent diabetes mellitus = IDDM

Question 35

describe type 2 diabetes

Answer 35

decreased sensitivity to circulating insulin

glucose doesn’t get transported through cell membranes to be stored for energy in mm/liver/fat = too much blood glucose

90-95% DM cases

usually happens in adulthood, but trending younger ages now

non-insulin dependent diabetes mellitus = NIDDM

Question 36

S&S of DM type 1 vs type 2 that are DIFFERENT

Answer 36

DM 1
- N&V
- constant hunger
- sweet breath

DM 2
- yeast infections
- slow wound healing

Question 37

CVP complications from DM

Answer 37

increased risk for:
- CAD/HF/HTN (5x greater risk for some type of heart disease)
- PAD
- SVA
- autonomic dysfunction
- thickened alveolar membrane
- systemic microvascular disease, common in kidneys and eyes

indirect relation to:
- reduced peripheral O2 extraction
- higher CV fitness needed for some tasks
- increased blood viscosity

Question 38

microvascular diseases that can be of diabetic origin

Answer 38

diabetic:
- CM
- neuropathy
- retinopathy
- encephalopathy
- neuropathy

Question 39

blood glucose lab values

Answer 39

immediate reading of blood sugar

normal = 70-100 mg/dL

140-199 = pre diabetes

> 200 = diabetes

Question 40

hemoglobin A1c lab values

Answer 40

glucose adheres to RBCs for 3 month lifespan; HgbA1c = average measurement of BS over 3 month period

normal = <5.7%

5.7-6.4% = prediabetes

> 6.5% = diabetes

Question 41

what is hypoglycemia

Answer 41

too much insulin, not enough glucose

BS <70

SNS activation

S&S
- tremors
- anxiety
- tachycardia
- diaphoresis
- AMS
- dizziness
- blurred vision
- hunger
- seizures

need easily absorbed glucose ASAP

Question 42

what is hyperglycemia

Answer 42

too much glucose, not enough insulin

BS > 300

inadequate insulin levels

more common in DM2

S&S
- frequent urination w high glucose content
- dehydration
- thirst/hunger
- HA
- blurred vision
- N&V
- SOB
- dry mouth
- AMS

Question 43

what is diabetic ketoacidosis (DKA)

Answer 43

insufficient insulin to allow blood glucose from entering cells

alternative source = liver breaks down fat and produces ketones

ketones build up in blood = high glucose and low insulin

more common with DM1 or uncontrolled DM 2

S&S
- tachycardia
- HTN
- severe SOB
- dehydration
- uncontrolled vomitting
- abdominal pain
- sweet breath
- electrolyte abnormalities

medical emergency requiring insulin infusion

Question 44

exercise impact on DM

Answer 44

PA reduces insulin secretion

compensated for by increased peripheral sensitivity = more rapid glucose uptake by mm

helps decrease BS and HgbA1c

resistance training more effective when targeting major mm groups with high intensity strength training (3 sets, 8-10 reps, weight near fatigue, 3x/wk)

Question 45

what type of exercise causes mm to have increased glucose uptake for energy production as well as reduces hyperglycemia in DM pts

Answer 45

low-moderate intensity

Question 46

best exercise type to provide benefits on HgbA1c

Answer 46

combined aerobic and resistance