Other systems Flashcards
Function of the endocrine system
HORMONAL REGULATION
endocrine system uses hormones (chemical messengers) to relay info to cells and organs and regular many of the body functions (digestion, use of nutrients, growth and development, electrolyte and water balance and reproduction)
The hypothalamus and pituitary gland, along with the NS, may up the central network that exerts control over many other glands in the body with wide ranging functions.
*also closely linked with immune system
Function of the metabolic system
Normal glucose control: the result of nutrient, neural and hormonal regulation
Hormones: released by islets of Langerhans in the pancreas
- Insulin: allows uptake of glucose from the bloodstream; suppresses hepatic glucose production, lowering plasma glucose levels; secreted by beta cells
- Glucagon: stimulates hepatic glucose production to raise glucose levels, especially in fasting state; secreted by alpha cells
endocrine/metabolic disorders by gland/organ
Adrenal gland:
- Addison’s disease
- Cushing’s syndrome
Thyroid gland:
- hypothyroidism
- hyperthyroidism
Parathyroid:
-hyper and hypo
Pancreas:
-diabetes mellitus
Other metabolic disorders:
- fluid deficit/dehydration
- fluid excess
- metabolic alkalosis
- metabolic acidosis
- Gout
- hemochromatosis
- metabolic bone disease
- obesity
Addison’s disease
“primary adrenal insufficiency”
autoimmune process that causes the adrenal glands to underproduce cortisol and aldosterone
tx: diet high in complex carbs and protein
Difficult to diagnose d/t early symptoms of nonspecific weakness and fatigue
symptoms:
- hyper-pigmentation of the skin and mucous membranes
- progressive fatigue
- GI disturbance
- nausea, vomiting
- weight loss
- tendon calcification
- hypoglycemia
- may cause potassium elevation which can lead to ascending myopathy, causing flaccid paraplegia and polyneuropathy
Cushing’s disease
over secretion of cortisol by the adrenal cortex or by long term use of corticosteroids d/t inflammatory disorders
symptoms:
- moon face appearance
- cervical fat pad
- truncal obesity
- muscle wasting and weakness
- osteoporosis
- HTN
- easy bruising
- depression
- excessive facial hair
- ruddy complexion
- slow wound healing
hypothyroidism
condition resulting from decreased thyroid hormone
- causing generalized depression of metabolism
- diagnosed if TSH level is elevates
Symptoms:
- cold intolerance
- excessive fatigue and lethargy
- headaches
- weight gain
- dry skin
- increasing thinness/brittleness of hair and nails
- peripheral edema
- peripheral neuropathy
- proximal weakness
Red flag:
-can lead to exercise intolerance, weakness, atrophy, exercise induced myalgia, reduced CO
Hyperthyroidism
condition resulting from excessive production of thyroid hormone (Grave’s disease)
- resulting in a generalized elevation of body’s metabolism
- diagnosed if TSH level is depressed
Symptoms:
- tachycardia
- increased sweating
- heat intolerance
- increased appetite
- dyspnea
- weight loss and inability to gain weight
- anxiety
- Goiter- enlargement of thyroid gland
- exophthalmia- hypertrophy of eye muscles and increase in CT in the orbit- eye appears to “bulge out”
parathyroid gland function
releases parathyroid hormone which regulates calcium and phosphorous metabolism
Hyperparathyroidism
excessive PTH leads to elevated calcium level and decreased serum phosphate level
causes demineralization of bone and subsequent loss of bone strength and density
most often discovered as asymptomatic hypercalcemia upon dx
Symptoms:
- proximal weakness
- fatigue
- drowsiness
- arthralgia/myalgia
- depression
- glove/stocking sensory less
- osteopenia/fractures
- confusion/memory loss
- pancreatitis
- gout
Hypoparathyroidism
decreased or absent production of PTG
- most commonly due to removal/injury of the parathyroid gland
- dx with a low serum calcium and high phosphorous and low PTH level
Symptoms: -neck stiffness/muscle cramps -seizures -irritability -depression -skeletal muscle twitching -cardiac arrhythmias -paresthesias -
pancreas function
dual function:
1- acts as an exocrine gland- producing digestive enzymes
2-acts as endocrine gland- producing insulin and glucagons
Diabetes
chronic systemic disorder caused by defective or deficient insulin action in the body and disruption of the metabolism of carbs, fats and proteins
Dx criteria: fasting glucose level of >126 mg/dL OR “casual” blood glucose level of 200 plus symptoms of DM
Symptoms:
- Hypoglycemia: blood glucose 180 mg/dL
- glycosuria: elevated sugar in urine
- polyuria: excessive urination
- polydipsia: excessive thirst
- unexplained weight loss
- fatigue
- blurred vision, headaches
Type I DM
insulin dependent DM or juvenile onset
immune mediated, causes beta cell destruction that usually results in absolute insulin deficiency
insulin dependent: requires insulin delivery by injection, insulin pump or inhalation
prone to ketoacidosis: presence of ketone bodies in the urine, the by products of fat metabolism
Type II DM
Non-insulin dependent diabetes or adult onset
characterized by defective insulin production and/or impaired receptor binding of insulin
“insulin resistant”
occurs mainly in adults >30 y/o with a gradual onset and slow progression of symptoms
obesity, family history, race, or women with high birth weight babies can be factors
treatment includes diet and exercise
gestational DM
glucose intolerance (high blood sugar) associated with pregnancy; most likely 3rd trimester
S&S of hypoglycemia
blood glucose
S&S of hyperglycemia
blood glucose >180 mg/dL
skin is dry, flushed fruity odor breath frequent urination-polyuria unusual thirst- polydipsia extreme hunger unusual weight loss (10 lbs in 1 month) extreme fatigue irritability blurred vision fungal infections dizziness
complications of DM
microvascular disease
- retinopathy
- renal disease
- polyneuropathy
- decreased circulation to skin/organs
macrovascular disease- accelerated atherosclerosis
- CVA
- MI
- PAD
- CAD
Integumentary:
- slow healing
- increased risk for ulcers and infections
MS:
- joint stiffness, increased risk of contractures
- increased risk of adhesive capsulitis, tenosynovitis, plantar fasciitis
neuromuscular:
- diabetic polyneuropathy: stock/glove, paresthesias, motor weakness with gait/balance impairments
- diabetic autonomic nerupathy: increased RHR, exercise intolerance with abnormal HR, BP and CO, exercise induced hypoglycemia, postural hypotension
Kidney failure
vision impairments: diabetic retinopathy (associated with chronic hyperglycemia) and diabetic macular edema
fatty liver disease
PT for diabetes
regular exercise improves glucose tolerance and increases insulin sensitivity
exercise produces insulin-like effect on the body by accelerating the movement of glucose out of the bloodstream and into peripheral tissues where it’s needed
-combo of exercise and insulin can lead to hypoglycemia***
don’t exercise 2-4 hours after insulin injection d/t peak concentration in the blood
don’t exercise without eating at least 2 hours before
inject nonexercising limb or body part and don’t exercise that part for at least 1 hour - could result in increased insulin uptake and then hypoglycemia
if BG 250- don’t exercise
- Foot care
- washed daily, not soaked
- moisturize
- clean white socks, no wrinkles
- cut by podiatrist
- alternate wide shoes
Obesity
BMI = weight (kg)/height2 (meters)
- Overweight= 25-29.9
- Obesity = >30
- Morbid obesity >40
fluid deficit/dehydration symptoms
initially: thirst and weight loss
when the condition progresses:
- dryness of mouth, throat and face
- absence of sweat
- increased body temp
- low urine output
- postural hypotension
- increased hematocrit
fluid excess
results in hyponatremia
water shifts into the brain tisues and dilutes sodium in the vascular space, resulting in:
- decreased mental alertness
- sleepiness
- anorexia
- poor motor coordination
- confusion
- convulsions
- sudden weight gain
- warm, moist skin
- hyperventilation
- mild peripheral edema
- low serum sodium
- low hematocrit
- signs of increased intracerebral pressure: slow pulse, increased SBP and decreased DBP
metabolic alkalosis
occurs when either an abnormal loss of acid or excess accumulation of bicarbonate occurs
can be caused by upper GI suctioning, diabetic therapy, and ingestion of large amounts of base substances like antacids
Symptoms:
- nausea, prolonged vomiting
- diarrhea
- confusion
- irritability, agitation
- restlessness
- muscle weakness
- paresthesias
- convulsions
- slow shallow breathing
- eventual coma
symptoms can affect muscular function by causing muscle fasciculation and cramping
metabolic acidosis
occurs when there is an accumulation of acids or a deficit of bases
can be caused by diabetic ketoacidosis, renal failure, severe diarrhea and drug or chemical toxicity
Symptoms:
- headache
- fatigue
- drowsiness
- lethargy
- nausea, vomiting
- diarrhea
- muscular twitching
- convulsions
- coma
- rapid breathing
Gout
excess uric acid in the blood results in the deposition of rate crystals in the joints, soft tissues and kidneys, causing a painful inflammatory response
Symptoms:
- acute monoarticular inflammatory arthritis
- redness
- swelling
- low grade fever
- malaise
- primarily effects peripheral joints of the hand, MTP of great toe, instep, ankle, heel, knee and wrist
TX: urate lowering drugs (colchicine, NSAIDs or steroids, allopurinol to reduce hyperuricemia)
RICE and joint protection during acute phase
metabolic bone disease
Osteoporosis:
-combo of decreased bone mass and microdamage to the bone structure resulting in susceptibility to fractures
Osteomalacia:
- softening of bone without loss of bone matrix, caused by vitamin D deficiency in adults
- decalcification of bones takes place primarily in spine, pelvis and LEs
Paget’s disease:
- characterized by excessive bone resorption and formation in a haphazard fashion, producing bone that is larger, less compact, more vascular, and more susceptible to fractures
- bones commonly effected: skull, pelvis, spine, sacrum, femur and tibia
- bowing of the long bones, periosteal tenderness
cancer
cancer tx pros and cons
rapidly proliferating cellular malignancy that results in unregulated cell growth, lack of differentiation, and the ability to invade local tissues and metastasize
Surgery:
- often used in combo with radiation and chemo
- either curative, by removing a tumor; or palliative by relieving pain or correcting an obstruction
Radiation:
- destroys cancer cells and inhibits cell growth
- also used post-op to shrink tumors and prevent spread of cancer cells
- side effects: radiation sickness, immunosuppression, fibrosis, decreased ROM, burns, delayed wound healing, edema, hair loss, CNS effects
Chemotherapy:
- uses chemicals to kill cancer cells by attacking rapidly dividing cells and affecting both cancerous and noncancerous cells
- the bone marrow contains rapidly dividing cells that form the blood elements and is affected by chemo
- can result in immunosuppression, thombocytopenia, (refrain from performing heavy resistance exercises d/t potential increased bleeding), anemia, alopecia, GI impact (nausea, vomiting, diarrhea, ulcers, or hemorrhage), and neuropathies
carcinoma
malignant tumor originating in the epithelial tissues
-stomach, skin, colon, breast, rectum
sarcoma
a malignant tumor originating in connective and mesodermal tissues - muscle, bone, fat
lymphoma
affecting the lymphatic system
-hodgkin’s disease, lymphatic leukemia
leukemias and myelomas
affecting the blood (unrestrained growth of leukocytes) and blood forming organs (bone marrow)
cancer staging
0= carcinoma in situ
1= tumor is localized,
PT concerns for cancer
pain at distal side to initial tumor sit may suggest metastasis
lung, breast, prostate, thyroid, and lymphatic cancers commonly metastasize to bone
-pathological fractures, pain and muscle spasms may result
fatigue-most common symptom
muscular atrophy and weakness with chemo
ROM deficits particularly with radiation therapy
hematological disruptions:
- WBC suppression (leukopenia)- increased risk of infection
- platelet suppression (thrombocytopenia)- increased bleeding
- RBC suppression (anemia)- diminished aerobic capacity
RED FLAG:
- patients with significant bony metastases, osteoporosis or low platelets (100
- severe nausea, vomiting, diarrhea within 24-35 hours, dehydration, poor nutrition
- unusual or extreme fatigue, muscular weakness, recent bone pain
- chest pain, rapid or slow HR, elevated BP, swelling of ankles
- severe dyspnea, pain on deep breath, cough/wheezing
- dizzy, disoriented, confused, blurred vision, ataxia
specific considerations for exercise programs for cancer patients
Postmastectomy:
- focus on restoring pain free full ROM of shoulder
- prevent/reduce edema
- restore function
- early post-op day 1
Post bone marrow transplant
- 30 day inactivity, strict isolation
- focus on restoring function, re-conditioning
- exercise contraindicated if platelets
Exercise guidelines based on platelet count
normal: 150,000 -450,000
Exercise guidelines based on WBC
normal: 4800-10,800
5000 light or regular exercise
Exercise guidelines based on hemoglobin
normal:
- women: 12-16 g/dL
- men: 13-18 g/dL
10 - regular exercise
Exercise guidelines based on hematocrit
% of RBC of whole blood
normal:
-women: 37-48%
-men: 45-52%
25% light or regular exercise
functions of the liver
excretes bilirubin produces 500-1500 mg of bile daily produces clotting factors stores vitamins produces albumin and plasma proteins contributes to the immune system by reducing the amount of toxins and filtering the blood of our digestive system
symptoms of liver disease
can cause GI symptoms:
- edema/ascites
- dark urine
- light colored or clay colored feces
- anorexia
- skin changes- jaundice, spider angiomas, bruising, palmar erythema
- R upper quadrant abdominal pain
MS pain associated with liver disease includes:
- thoracic pain between scapula, R shoulder, R upper trap, R interscapular area, R subscapular areas
- Bilateral carpal tunnel syndrome requires thorough exam since it can be caused by the lack of detoxification of ammonia by the liver- resulting in numbness and tingling bilaterally
- Rhabdomyolysis
Neuromuscular symptoms can include: -confusion sleep dirsturbances -hyperactive reflexes -asterixis (flapping tremor usually of the hands)
rhabdomyolysis
a potentially fatal condition involving the breakdown of muscle tissue
presents with muscle aches, cramps, weakness and soreness
can be caused by liver failure due to statin use (cholesterol-lowering drugs like zocor, lipitor, crestor)
Hepatitis
acute or chronic inflammation of the liver due to viral or chemical cause, drug reaction or alcohol abuse
Viral hepatitis: types A, B, C, D, E and G
A&E primarily transmitted via fecal-oral route (contaminated food/water)
B,C, D, G- primarily bloodborne pathogens
3 stages:
1-initial/preicteric (1-3 weeks)
2- icteric/jaundiced (peaks in 1-2 weeks, lasts 6-8 weeks)
3- recovery (3-4 months)
cirrhosis
chronic hepatic disease characterized by the destruction of the liver and replacement of CT by fibrous bands, resulting in obstruction of blood and lymph flow
-mostly caused by alcohol abuse
symptoms:
- mild R upper quadrant pain
- GI symptoms- anorexia, indigestion, weight loss, nausea, vomiting, diarrhea, constipation
- dull abdominal ache
- weakness
- quick fatigue
progression will lead to portal hypertension (elevated pressure in the portal vein), causing the blood to bypass the liver through collateral vessels. Symptoms:
- ascites
- dilated collateral veins
- esophageal varices (upper GI)
- hemorrhoids (lower GI)
- splenomegaly
- thrombocytopenia (decreased platelets)
gallbladder function
stores bile, which assists in emulsification, absorption and digestion of fat
symptoms of gallbladder disease
R upper quadrant pain jaundice -blocking of bile duct low grade fever and chills indigestion nausea excessive belching and flatulence intolerance of fatty foods persistent pruritus (itching) sudden excruciating pain mid epigastrium with referral to back and R shoulder (acute cholecystitis)
sudden exacerbation of symptoms after eating indicates gallbladder inflammation
pain and nausea 1-3 hours after eating indicate the presence of gallstones
cholelithiasis
the presence or formation of gallstones
-a leading cause of hospitalization among adults
mostly asymptomatic, detected incidentally during medical imaging
problems arise when the gallstones leave the gallbladder, causing obstruction somewhere in the biliary system
Biliary colic: gallstone gets lodged in the neck of the gallbladder
-presents with R upper abdominal pain that comes and goes in waves
Cholecystitis: blockage of gallstones in the cystic duct causing infection or inflammation of the gallbladder
- presents as steady severe pain in R upper quadrant that increases rapidly, lasting several minutes to hours.
- nausea, vomiting, fever, jaundice, GI symptoms, chills, tenderness over gallbladder and 10th R rib anteriorly may be present
Cholangitis: gallstones lodged in the common bile duct
-leads to jaundice, and possible liver infection
GI anatomy and function
Upper GI: mouth, esophagus and stomach
-functions for ingestion and initial digestion of food
Middle GI: small intestine (duodenum, jejunum, and ileum)
-major digestive and absorption processes occur here
Lower GI: large intestine (cecum, colon and rectum)
-primar functions include absorption of water and electrolytes, stores and elimination of waste
accessory organs aid in digestion by producing digestive secretions and include the salivary glands, liver and pancreas
GI motility propels food and fluids through the GI system and is provided by rhythmic, intermittent contractions (peristaltic movements) of smooth muscle
Neural control is achieved by the ANS. both sympathetic and parasympathetic plexuses extend along the GI wall.
-Vasovagal (mediated by vagal nerve) reflexes control the secretions and motility of the GI tract
common S&S to many types of GI disorders
nausea and vomiting
-triggered by foods, drugs, hypoxia, shock, inflammation of abdominal organs, distention, irritation of the GI tract and motion sickness
diarrhea
-triggered by: infectious organisms, dysentery, diabetic enteropathy, irritable bowel syndrome, hyperthyroidism, neoplasm and diverticulitis
constipation
- triggered by lack of diet, lack of fiber, inadequate fluids, sedentary lifestyle, increasing age and drugs
- obstipation= intractable constipation with facal impaction and obstruction
- can refer pain to ant hip, groin or thigh
- may also result with muscle guarding and splinting (LBP)
anorexia
dysphagia
heartburn
abdominal pain
-result of inflammation, ischemia and mechanical stretching
