Screening of endocrine and GI system Flashcards
what is included in the Endocrine System Screening Checklist?
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)
what is Diabetes Insipidus?
- 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
what are pituitary gland disorders ?
Diabetes Insipidus
Acromegaly
what is Acromegaly ?
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)
what are adrenal glad disorders
cushings and addisons
what is Addisons disease
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
what is Cushing’s Disease ?
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
what are disorders of the thyroid?
hyperthyroid - graves
hypothyroid
what is graves disease ?
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
what is hyperthyroidism ?
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
Diabetes Mellitus is a condition of what organ?
pancreas
what is Diabetes Mellitus?
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
what are exercise related complications for DM?
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
what are severe hyperglycemia states?
over 400 = Diabetic ketoacidosis (DKA) or Hyperglycemic, hyperosmolar, nonketotic coma (HHNC)
what is included in the GI checklist?
upper: • Swallowing difficulties • Indigestion, heartburn • Food intolerance lower: • Bowel dysfunction • Color of stool • Shape, caliber of stool • Constipation• Diarrhea • Difficulty initiating • Incontinence
what are potential causes of Dysphagia
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
what are clinical manifestations of Dynphagia
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
Indigestion, Heartburn, Dyspepsia are conidtions of the lower or upper GI?
Upper
If you suspect Indigestion, Heartburn, Dyspepsia, what are some Qs to ask?
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)?
how can a pt self mgmt Indigestion, Heartburn, Dyspepsia
- Antacids: Milk of Magnesia, Tums, Maalox
- Histamine (H2) Antagonists: Tagamet, Zantac, Pepcid AC
- Dietary modification; timing, with fluid
what are Common Irritants/Triggers/ food intolerances?
Cheeses Chocolate Citrus fruits Nuts Red Wine
What is melana? what shoudl you do if you suspect?
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
Is bowel dysfxn a lower or upper GI problem?
lower
what are Indicators of Possible Issues of bowel dysfxn?
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?”
what are Potential Causes of Constipation?
Impaired Motility
Inadequate dietary fiber Inactivity Diverticulitis Hypothyroidism Hypercalcemia
Scleroderma
Neurologic Dysfunction
MS, SCI injury
Psychosocial Dysfunction
Depression, situation stress, anxiety
what are potential causes of Diarrhea
Infectious agents Laxative abuse Colon cancer Irritable bowel syndrome (IBS) Crohn’s disease Ulcerative colitis Diabetic enteropathy
what are follow up Questions for Diarrhea ?
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?
what are Possible Manifestations of dehydration?
Rapid breathing Rapid pulse (<100bpm) Headache Capillary refill Confusion Irritability Increased thirst ** Darker urine color Postural hypotension Dizziness Skin turgor Dry mouth
what is Hematochezia ?
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?
what is Colon Carcinoma?
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?
what are possible symps of colon carcinoma ?
Change in bowel habits Constipation Rectal bleeding Blood in toilet Diarrhea Abdominal pain, cramps, gas Weakness Fatigue Unexplained weight loss
