medical conditions exam 2 Flashcards
common causes of PUD
NSAID and h pylori
s/s PUD
burning pain, bloat, heartburn, dark stool
what s/s of a GI disease can mimic MS symptoms
PUD
tx PUD
PPI, H2 blocker, anti/probiotic
esophageal cancer types
SCC and adenocarcinoma
esophageal cancer def
malignant cells in esophagus
who is esophageal cancer more common in
men and older people
additional risk factors for esophageal cancer
barrett esophagus and GERD
s/s esophageal cancer
dysphagia, pain in sternum, indigestion
what organ secretes digestive enzymes
pancreas
what organ does most of the absorption in the GI system
small intestine
hepatitis A who is most effected
men 30-39, white, gay, homeless
which type of hepatitis had a big spike and outbreak in 2017
hep A
is there a vax for hep a
yes, and if you do get the disease you can get the vax and prevent further problems
what type of hepatitis is spread through oral-fecal contact
hep a
what type of hepatitis can be spread through childbirth
hep b
what is the most common cause of chronic hepatitis and liver cancer
hep B
what is the term for passing on a disease during child birth
vertical/perinatal
what type of hepatitis can you be an inactive carrier for
hep b
what is the procedure for pancreatic cancer to treat the tumor
whipple
when do s/s present for pancreatic cancer
after metastases
what is the most deadly and aggressive cancer
pancreatis
2 types of hep C
acute or chronic
how does hep c spread
blood infected and spreads
what can hep c lead to
cancer, cirrhosis, liver disease
what is the most common type of pancreatic cancer
adenocarcinoma
achalasia def
feeling full in the esophagus
cachexia
weight loss due to cancer
constitutional symptoms
fever, malaise, chills, sweats
does the enterric system work with the CNAS
no, it is it’s entirely own system that has its own controls within the body
possible reasons for n/v
chemo, tumor, motion sick, pregnancy, concussion
def diarhea
> 3x stool/ day or abnormal volume
c-diff transmission
oral-fecal route
c-diff effects what part of the body directly
lower intestine
s/s c-diff
foul odor, watery diahrea, cramping, urgency
who is most likely to get nosocomial infection
immunocompromised patient
where is fecal impaction most common
nursing home b/c sedentary and dehydrated so constipation is common
causes of intestinal obstruction
strangulated hernia, IBS, colon cancer
def intestinal obstruction
intestine is blocked to prevent passage of food so stomach contents leak into abdominal cavity
s/s dehydration
poor skin turgo, sunken eyes, orthostatic hypotension
def malnutrition
15-20% ideal body weight
what can cause dysphagia
neuro conditions, obstruction, trauma, muscle damage
hematemesis
upper bleeding caused by gastritis, PUD, or NSAID
def melena
black stool
hematochezia def
fresh blood in stool
s/s GI bleeding
weakness, SOB, anemia, orthostatic hypotension, fatigue
contributing factors of GERD
aging, alcohol, smoking, pregnancy
what can GERD look like
heart attack
drugs for GERD
nexium, peptic acid, prilosac
what side could you recommend your patient with GERD sleeps on
left
hiatal hernia def
upper stomach bulges through diaphragm into chest cavity
what disease is associated w/ esophageal varices
cirrhosis
s/s esophageal varices
black tarry stool, pale, feel faint
what can gastritis lead to
ulcer
what are the 2 types of gastritis
acute or chronic
gastoenteritis def
inflammation of mucosa layer caused by virus, bacteria, parasites
what is the 2nd most common type of illness
gastroenteritis (normal stomach bug)
small intestine disorders
malabsorption: celiac
large intestine disorders
IBD, IBS, colorectal cancer, diverticulitis
what is the job of the pancreas
regulate blood sugar and digestive enzymes
how is IBD diagnosed
blood test, stool sample, colonoscopy
what part of the GI tract does chron’s usually effect
ilium
what part of GI does ulcerative colitis impact
colon
s/s ulcerative colitis
cramp, arthritis, bleeding, liver disease, osteoporosis
how often do adults get colonoscopy
starting at 50 yo, every 10 years after
tx IBD
corticosteroids, sulfalazine, mesalamine, humira
what are some concerns with IBD
have many meds available but they all have side effects so people with IBD have decreased quality of life
colostomy vs colectomy
stool drains into bag at the skin layer, removal of entire colon
what can IBD present as MS
back, thigh, hip, knee pain
where is the liver located
RUQ
what generation are more likely to have hep c
baby boomers b/c they used to share needles
what is the pill for hep c
harvoni
what is the largest gland in the body
liver
where does liver get blood supply from
hepatic artery, portal vein, hepatic vein
functions of liver
fight infection, produce bile, detoxify, decompose RBC, store vitamins, produce urea
s/s liver problem
if the liver is palpable, yellow skin or eyes
what MS pain can indicate liver disease
R shoulder
will someone w/ liver disease need an increase or decrease in dose of mediciation
decrease b/c metabolizes slower and don’t want to create a toxic effect
s/s of cirrhosis
fatigue, weakness, loss of apetite
steps leading up to cirhosis
fatty liver > liver fibrosis > cirrhosis
how to prevent further liver disease
lifestyle changes, vax, no raw shellfish, decrease stress
if a patient comes to us with liver disease and says they’re tired today what should we do
let them rest, they need to rest
what liver test looks at nutrition
albumin
what do ALT and AST liver tests look at
liver enzymes
what is prothrombin time
clotting test for liver
what does organ donation compatibility depend on
blood type, size, age, when the person died
what are the options for liver transplants
recently died: use entire liver, live donor: can use any part of the liver and it will regenerate on the living person in 6 weeks
how many lives can 1 person save with organ transplants
8 lives
who is not a candidate for liver transplant
HIV, alcohol abuse, cancer, lung disease
endometriosis cause
unknown
tx endometriosis
hysterectomy, oopharectomy, surgery, NSAIDs
what hormone may contribute to endometriosis
estrogen
who’s at risk for endometriosis
mother/sister/daughter has it, low BMI, heavy or early menstrual cycle
renal cell carcinoma
most common type of kidney cancer
what is a specific risk factor for renal cell carcinoma
von hippel lindau
are men or women more likely to get renal cell carcinoma
men 2/3
what is a specific symptom of renal cell carcinoma we should be aware of
constant side pain
what is wilms tumor
childhood tumor kidneys
what race is more at risk for wilms tumor
african americans
what is the most common type of ovarian cancer
epithelial
risk factors for ovarian cancer
BRCA1&2, obesity, FH, hormone therapy, endometriosis
why is ovarian cancer so common and not found early on
older women stop going to the gyno when they get older which is when the cancer is most likely to be found
functions of kidneys
regulate blood water levels, reabsorb useful substances, adjust electrolytes, excrete waste, release renin, EPO, calcitriol
EPO function
create RBC and bone marrow
renin function
regulate BP
calcitriol function
maintain calcium levels for bones
if kidneys aren’t functioning well what would you expect to happen
excessive creatine in the blood
how should we keep BP for someone w/ kidney disease
BP <130/80
at what point is kidney disease a real serious problem
<25% function
SADH
excessive ADH that causes kidneys to retain water
what type of SIADH is most common
SCC
diabetes insipidus has how many types of kinds
4 types
what does diabetes insipidus cause
kidney problems, metastatic lesion, injury to hypothalamus
s/s diabetes insipidus
nocturia, fatigue, dehydration, polydispia
how common is diabetes insipidis
very rare= large amounts of dilute urine
how does diabetes insipdus relate to ADH
insufficient ADH
what does endocrine system regulate
mood, growth and development, metabolism, sexual/reproductive function
what type of glands are endocrine
ductless
how do nervous and endocrine systems work together
glands produce hormones, hormones regulate organs and cells
how do hormones maintain homestasis
feedback loops- keep regulating constantly
what organ is the “brain of the brain”
hypothalamus
what organ regulates body’s homeostasis and is located near the optic nerve
hypothalamus
what organ produces hormones ADH and oxytocin that are released from pituitary gland
hypothalamus
how does pituitary gland secrete hormones
signal to glands to stop or start producing and releasing hormones
what gland controls endocrine glands
pituitary gland
what does the pitutary gland regulate
GH, prolactin, TSH, ACH, LH, FSH
which part of the pituitary gland releases ADH and oxytocin
posterior
what MS pain may be endocrine pathology
shoulder and carpal tunnel symptoms
s/s endocrine pathology PTs may notice
weakness of muscle, atrophy, OA, adhesive capsulitis, synovial fluid
general s/s endocrine dysfunction
changes in urine, hair changes, mental changes, vitals changes
def iatrogenic
HC team did something to medically cause a problem
acromegaly def
hypersecretion of GH in adults
where is GH secreted from
anterior pituitary
what is mostly effected by acromegaly
bones in face, jaw, feet, hands
s/s acromegaly
amenorrhea, DM, profuse sweating, HTN
what is tx for acromegaly
surgery to pituitary gland to decrease secretion of it
gigantism def
overproduction of GH in children that stimulates growth of long bones
diagnosis for pituitary tumor
blood/urine test, brain imaging, vision testing
what 3 hormones are produced by adrenal cortex
aldosterone, cortisol, androgens
what does cortisol do
help regulate body metabolism, has anti-inflammatory effects
what is produced by adrenal medulla
catecholamines
what is cushing’s syndrome
hyperfunction of adrenal gland, increased secretion of ACTH and cortisol by adrenal cortex
2 types of cushing’s syndrome
iatrogenic and ACTH
who is cushing’s disease more common in
women 8: men 1
what does someone w/ cushing’s disease look like
face and torso fat, easily bruising, stretch marks, back hump
cushing’s Pt considerations
muscle weakness, potential for fracture, back pain, poor wound healing
addison’s disease is what type of insufficiency
PRIMARY> hypofunction of adrenal gland
what is addison’s disease
decreased production of cortisol and aldosterone, usually autoimmune
skin condition of addison’s disease
skin darkening due to melanocytes
what is secondary adrenal insufficiency
dysfunction due to lack of pituitary ACTH
adrenal insufficency s/s
dark skin, high potassium in blood, GI problems, loss appetite w/ weight loss
what is a concern with corticosteroids
WBC don’t turn off production and causes damage to tissue
thyroid cancer 4 types
papillary, follicular, medullary, anaplastic
most common type of thyroid cancer
papillary
is thyroid cancer inherited
yes, genetic influence, most common for asian women
s/s thyroid cancer
change in voice, difficulty swallowing, lump on neck
how has the rate of thyroid cancer changed
increase in number of cases but death rate stayed very low
osteoporosis def
bone disease that causes weakness
are men or women more at risk for osteoporosis
women
can osteoporosis be stopped
yes, if caught soon enough it can be stopped
what’s a main concern for patients with osteoporosis
hip fracture
what does thyroid gland do
releases hormones to control metabolism
what do thyroid hormones do
respiration, HR, body weight, muscle strength, body temp, cholesterol
3 main thyroid hormones
thyroxine 4 and 3, calcitonin
too much thyroid hormone does what
speeds up metabolic functions, too little do the opposite
who’s more likely to have thyroid dysfunction
women more likely 5-8x
why is thyroid disease difficult to diagnose
strong family history component and symptoms usually develop slowly over time
what kind of hormone is TSH
tropic so it sends message to release other hormones
if a patient has low TSH what does that mean about their thyroid function
likely hyperthyroidism, will be confirmed if FT3&4 are high
if a patient has high TSH what does that mean for thyroid function
hypothyroidism, will be confirmed if FT3 and 4 are low
what is the most common hyperthyroidism disease
grave’s
what is goiter caused by around the world compared to in the US
iodine deficiency vs overproduction of thyroid hormone in glands
what are T3 and T4 responsible for
regulating basal metabolism and increasing metabolic rate and protein synthesis
what type of disease is grave’s
autoimmune
hyperthyroid complications we may see
pain at shoulder, frozen shoulder, muscle weakness, tachycardia, bulging eyes, skin lesions
what is an explicit sign of graves disease
exophthalmos: bulging eyes
what drug is common for hyperthyroidism
tapazole and propranolol
is hyperthyroidism or hypothyroidism easier to treat
hypo b/c can give hormones to increase levels
what can radioactive iodine do for thyroid cancer
gradual shrink tumor which will destroy the thyroid gland
what are 2 parts of PT CI for someone w/ thyroid disease
hot pool/hot pack (be careful), strenuous exercise b/c risk for heart problems
what is a major risk factor for graves disease
hip fracture
what is the most common type of hypothyroidism
hashimoto’s thyroidits
what happens to someone w/ hashimoto’s
thyroid is inflammted, auto-immune response, progresses slowly and is chronic
what is myxedema
untreated hypothyroidism that can cause swelling of the face
primary causes of hypothyroidism
hormone insufficiency, auto-immune disease, medications, congenital or iodine deficient
secondary cause of hypothyroidism
pituitary gland disease
where may someone w/ hypothyroidism experience pain
big toe= pseudo gout
what does parathyroid gland regulate
calcium and phosphorus
how many parathyroid glands do we have
4 glands located in the thyroid
secondary causes of hyperparathyroidism
kidney failure, not enough calcium, vit D disorder
s/s hyperparathyroidism
painful bones, renal stones, psychic moans
primary cause of hypoparathyroidism
insufficient secretion of PTH or accidental removal of gland during surgery
what can hypoparapthyroidism appear as
muscle weakness and pain, muscle spasm, cardiac arrhythmias
treatment for hypoparathyroidsm
IV or oral calcium w/ vitamin D
fasting glucose test levels
pre: <126, diabetes>126, normal <100
not fasted glucose test results
pre=<200, <140 normal, >200 diabetes
what type of diabetes produces more ketoacidosis
type 1
what is the job of insulin in cells
gets glucose into cells and inhibits glycolysis
average hypoglycemia level
<70 mg/dl
dangerous level of hypoglycemia
<45 mg/dl
is feeling sleepy associated w/ hyperglycemia or hypoglycemia
hyper
systemic related conditions of diabetes
artherosclerosis, infection, poor wound healing, alzheimer’s
what is a contraindication for someone w/ diabetic reinopathy
vigorous activity
what is a concern with charcot joint
increase weight bearing where it’s not used to being
anatomical and neurological changes with diabetes
thicker and stiffer tissue, increase in pain at low back, shoulder, neck, extremity, change in gait, change in pressure
goal A1C for patients
<7%
what med can mask hypoglycemia symptoms
beta blockers
what types of drugs can help control sugar by increasing the insulin in the blood
sylfonylureas, insulin, meglitinides
high intensity exercise for someone with diabetes
plasma glucose rises, less likely to have hypoglycemia during exercise, recovery is more challenging
how often should someone w/ diabetes aerobically exercise
<2 days b/w activity
what type of training should be performed first to prevent hypoglycemia
resistance training of all muscle groups
what needs to be combined to help manage glucose of patient w/ exercise
balance of medications and carb intake
if a patient doesn’t have ketones can they exercise
yes, they can do moderate exercise as long as they don’t have ketones
what is a good range of pre-exercise glucose level to get started
90-250 mg/dl
