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Primary Care for the PT > Screening of endocrine and GI system > Flashcards

Screening of endocrine and GI system Flashcards

1
Q

what is included in the Endocrine System Screening Checklist?

A 
General health 
(fatigue, unexplained weight change, weakness)

Psychologic, cognitive (personality changes, memory loss, irritability)

Gastrointestinal (nausea, vomiting, anorexia, dysphagia, diarrhea, constipation)

Urogenital (impotence, intermittent urine stream, straining to void)

Musculoskeletal (muscle weakness, cramps, arthralgias, stiffness, bone pain)

Sensory (paresthesia, numbness)

Dermatologic (foot ulcerations, edema, dry skin, impaired wound healing)

Miscellaneous (temperature intolerance, visual changes, increased bruising, orthostatic hypotension, increased thirst)

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2
Q

what is Diabetes Insipidus?

A
  • lack of secretion of vasopressin (antidiuretichormone, ADH
  • Issue with pituitary gland
- Signs/Symptoms: 
Polyuria, Polydipsia
Dehydration
Fatigue
Irritability
Increased serum sodium
Decreased urine specific gravity
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3
Q

what are pituitary gland disorders ?

A

Diabetes Insipidus

Acromegaly

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4
Q

what is Acromegaly ?

A

hypersecretion of growth hormone (GH), mostoften due to a tumor in the pituitary gland

Signs/Symptoms: 
 Bony enlargement
Amenorrhea
Diabetes mellitus
Profuse sweating, or diaphoresis
Hypertension
CTS, hand pain and stiffness
Back pain (thoraco-lumbar)
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5
Q

what are adrenal glad disorders

A

cushings and addisons

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6
Q

what is Addisons disease

A

hyposecretion by adrenal glands, due to autoimmune response or tumor, treated with cortisol/hormone replacement

Signs/Symptoms: 
Dark pigmentation of skin
Hypotension
Progressive fatigue
Hyperkalemia
GI disturbances
Arthralgias, myalgias
Tendon calcification
Hypoglycemia
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7
Q

what is Cushing’s Disease ?

A

hypersecretion of cortisol by adrenal glands, due to tumor, excessive corticosteroids, or pituitary disfunction

Signs/Symptoms: 
Weight gain
Fatty deposits, especially in the midsection & face (moon-shaped) and between the shoulders and upper back (buffalo hump)
Thinning skin that bruises easily
Skin injuries that are slow to heal
Fatigue
Muscle weakness
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8
Q

what are disorders of the thyroid?

A

hyperthyroid - graves

hypothyroid

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9
Q

what is graves disease ?

A

hyperfunction = too much thyroid hormone

Signs/Symptoms:
Elevation in body metabolism
Three major signs common in adult > 70Tachycardia, fatigue, weight loss

Signs common in adults < 50
Tachycardia, hyperactive reflexes, increased sweating, heat intolerance, fatigue, tremor, nervousness, polydipsia, weakness, increased appetite, dyspnea, and weight loss

Other common signs/sxs Periarthritis (shoulder especially) Proximal muscle weakness and atrophy
Higher incidence of myasthenia gravis

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10
Q

what is hyperthyroidism ?

A

hypofunction = insufficient thyroid hormone

Signs/Symptoms: 
Generalized depression in body metabolism
Constipation
Depression
Dry hair and hair loss
Dry skin
Fatigue
Greater sensitivity to cold
Slow heart rate
Swelling of the thyroid gland (goiter)
Unexplained weight gain or difficulty losing weight
Carpal tunnel syndrome
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11
Q

Diabetes Mellitus is a condition of what organ?

A

pancreas

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12
Q

what is Diabetes Mellitus?

A

deficient or defective insulin

Long Term Sequela
State of hyperglycemia
Disruption in metabolism of carbohydrates, fats, and proteins
Small vessel disease
Large vessel vascular complications
Neuropathies
Signs/Symptoms
Polyuria, polydipsia, polyphagia
Neuropathy, numbness/tingling, feet/hands
Blurred vision, irritability
Hand stiffness
Glycosuria, ketonuria
Fatigue and weakness
Slow healing
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13
Q

what are exercise related complications for DM?

A

Must be planned, executed with caution

  • Monitor glucose before, during, and after exercise
  • Blood glucose > 250 mg/dl – postpone session
  • Blood glucose < 100 mg/dl - Give 10-15 g carbohydrate snack
  • Retinopathy & nephropathy should Avoid high intensity exercise
  • Avoid insulin injection to active extremities within 1 hour of exercise
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14
Q

what are severe hyperglycemia states?

A

over 400 = Diabetic ketoacidosis (DKA) or Hyperglycemic, hyperosmolar, nonketotic coma (HHNC)

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15
Q

what is included in the GI checklist?

A 
upper:
• Swallowing difficulties
• Indigestion, heartburn
• Food intolerance
lower:
 • Bowel dysfunction
• Color of stool
• Shape, caliber of stool
• Constipation• Diarrhea
• Difficulty initiating
• Incontinence
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16
Q

what are potential causes of Dysphagia

A 
Potential Causes of Dysphasia
Muscle Incoordination
Myasthenia gravis
Myasthenia gravis
ALS 
Parkinsons 
Mechanical Obstruction (these may not have been IDs prior to PT)
Neoplasms
Goiter of thyroid gland
 Cx-spine osteophytes
Aortic aneurysm
17
Q

what are clinical manifestations of Dynphagia

A

motor:
gradual onset
slow progression
equally hard to swallow solid and liquids
- worse symps with cold foods
bolus passage is facilitated by repeated swallowing, valsalva, throwing head/shoulders back

mechanical

  • faster onset and progression
  • harder to swallow solid foods
  • swallowing not affected by cold
  • bolus passage is accompanied by regurgitation
18
Q

Indigestion, Heartburn, Dyspepsia are conidtions of the lower or upper GI?

A

Upper

19
Q

If you suspect Indigestion, Heartburn, Dyspepsia, what are some Qs to ask?

A 
How long have you had these symptoms?
 • Do you know what is causing them? 
• Are they constant or intermittent?
• How are you treating the symptoms? 
• Any associated symptoms (e.g., fatigue, weakness, shortness of breath)?
20
Q

how can a pt self mgmt Indigestion, Heartburn, Dyspepsia

A
  • Antacids: Milk of Magnesia, Tums, Maalox
  • Histamine (H2) Antagonists: Tagamet, Zantac, Pepcid AC
  • Dietary modification; timing, with fluid
21
Q

what are Common Irritants/Triggers/ food intolerances?

A 
Cheeses
Chocolate
Citrus fruits
Nuts
Red Wine
22
Q

What is melana? what shoudl you do if you suspect?

A

Passage of black, tarry stools

•GI bleeding, probably upper GI in origin
-Esophagus,Stomach,Duodenum

  • Follow-up questions:
  • How long have you been having black, tarry stools?
  • Have you felt lightheaded?
  • Any nausea, vomiting, diarrhea, fatigue, lightheadedness, abdominal/back pain, or sweats associated with these stools?•Check HR and BP
23
Q

Is bowel dysfxn a lower or upper GI problem?

A

lower

24
Q

what are Indicators of Possible Issues of bowel dysfxn?

A 
Color of stool
Shape, caliber of stool
Constipation
Diarrhea
Difficulty initiating
Incontinence

Screening:
“Have you recently noticed any problems or difficulties with bowel function?”
“Noticed any changes in bowel habits? Frequency? Type?”

25
Q

what are Potential Causes of Constipation?

A

Impaired Motility
Inadequate dietary fiber Inactivity Diverticulitis Hypothyroidism Hypercalcemia
Scleroderma

Neurologic Dysfunction
MS, SCI injury

Psychosocial Dysfunction
Depression, situation stress, anxiety

26
Q

what are potential causes of Diarrhea

A 
Infectious agents 
Laxative abuse
Colon cancer
Irritable bowel syndrome (IBS)
Crohn’s disease
Ulcerative colitis
Diabetic enteropathy
27
Q

what are follow up Questions for Diarrhea ?

A

How many episodes do you have each day?
How long have you had diarrhea?
Do you ever have periods of diarrhea alternating with periods of constipation
Is the diarrhea worse at certain times of the day?
Do family members or companions have similar symptoms?
Do you have any associated symptoms, such as fever, chills, nausea, vomiting, confusion, or abdominal pain or distention?

28
Q

what are Possible Manifestations of dehydration?

A 
Rapid breathing
Rapid pulse (<100bpm)
Headache
Capillary refill
Confusion
Irritability
Increased thirst **
Darker urine color
Postural hypotension   Dizziness
Skin turgor
Dry mouth
29
Q

what is Hematochezia ?

A

passage of bright blood-red stools
Origin: left side of the colon or anorectal area

Screening questions:
How long have you noticed bright red blood in your stools?
Is the red blood mixed within the stools (red streaks) or not?
Are there any associated symptoms, such as difficulty in initiating bowel movements or a feeling of lightheadedness or fatigue?

30
Q

what is Colon Carcinoma?

A

malignancy in large intestine
Origin: polyps in colon (upper) or rectum (lower)

Screening questions:
Any unusual shape in stool, pencil-like in diameter or flat, ribbon-like?
Any blood in your stool, when you go to the bathroom?

31
Q

what are possible symps of colon carcinoma ?

A 
Change in bowel habits
Constipation
Rectal bleeding
Blood in toilet
Diarrhea
Abdominal pain, cramps, gas
Weakness
Fatigue
Unexplained weight loss

Primary Care for the PT (6 decks)

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