Week 10 Flashcards
List the five functions of the kidney
1) removes waste
2) maintains homeostasis
3) urine formation
4) erythropoietin
5) Ca homeostasis
List some signs and symptoms of kidney and urologic disease
Urinary frequency, urgency, incontinence
Pain - Costovertebral Tenderness - Flank Pain - Inguinal Pain
Fever
Dysuria - Hematuria - Proteinuria
Systemic Manifestations of Kidney Failure
Anemia - Elevated BUN and Creatinine
Myopathy - Neuropathy - Osteodystrophy
What are some common urinary system pathologies?
1) Cystitis: infection of the bladder that almost always follows (is secondary to) bacterial infection in the urine. It is the most common type of urinary tract infection (UTI), particularly in women.
2) Pyelonephritis: (kidney infection) it affects the kidneys. It occurs when bacteria, usually from the bladder, travel up the ureters and infect one or both kidneys. Symptoms often include fever, chills, flank pain (pain in the back or side), nausea, vomiting, and frequent or painful urination. If left untreated, pyelonephritis can lead to serious complications, such as kidney damage or sepsis. It typically requires antibiotics for treatment, and severe cases may need hospitalization.
List some chronic kidney disease
Diabetes -> Glomerulonephritis -> end stage renal disease
Hypertension -> polycystic kidney disease -> end stage renal disease
What is the hypothalamus responsible for?
maintains the body’s internal balance, or homeostasis. It regulates a wide range of bodily functions, including body temperature, hunger, thirst, sleep, emotional responses, and sexual behavior.
The hypothalamus also plays a key role in controlling the release of hormones by the pituitary gland, influencing growth, metabolism, stress responses, and reproductive functions. It essentially acts as a control center, linking the nervous system to the endocrine system and helping the body respond to both internal and external changes.
Can pathology occur at any point in the feedback loop?
yes, and it will affect all other factors of the feedback loop
ex: inflammation or tumor in the hypothalamus can cause dysfunction in the endocrine and nervous systems
What does the thyroid gland release and what is its role?
1) Thyroxine (T4)
2) Triiodothyronine (T3)
It regulates:
1) oxidation of body cells and growth metabolism
2) influences glucose genesis
3) mobilization of fats
4) exchange of water, electrolytes, and protein synthesis
5) Increase basal metabolic rate and sensitivity to catecholamines (epinephrine and norepinephrine) “fight or flight”
A) Thyroid dysfunction is more common in women
B) Monitor heart rate if there is thyroid dysfunction
List order of events leading to the release of T3 and T4
1) Metabolic rate and/or T3 and T4 concentration in blood
If it’s low: hypothalamus releases TRH which triggers TSH release by the pituitary
If it’s high: Hypothalamus stops TRH release and the anterior pituitary stops TSH release
2) effects of TSH release: triggers the release of T3 and T4 by thyroid follicle cells
3) effects of T3 and T4 release: increased basal metabolic rate of body cells
Rise in body temperature
4) Negative feedback: Elevated T3 and T4 levels inhibit the release of TRH and TSH
What is the anterior and posterior pituitary responsible for?
- Anterior Pituitary (hypothalamic pituitary):
The anterior pituitary produces and releases several key hormones that regulate various bodily functions.
Ex: TSH, GH - Posterior Pituitary:
The posterior pituitary stores and releases hormones produced by the hypothalamus.
Ex: ADH, oxytocin
List the etiology, pathogenesis, clinical presentation (signs and symptoms) of hypothyroidism
Etiology:
* Primary causes: Hashimoto’s thyroiditis (autoimmune) -> Goiter, iodine deficiency -> Goiter, thyroid surgery, cancer.
* Autoimmune inflammatory disorder where there is reduced production of thyroid hormones
Pathogenesis:
* Reduced production of thyroid hormones (T3 and T4) leads to decreased metabolic rate.
* Primarily affects cellular energy production and tissue repair processes.
Clinical Presentation (Signs & Symptoms):
* Bradycardia, low metabolic rate, lethargy, weight gain, cold intolerance.
* Enlargement of thyroid from too much TCH
Diagnostics:
* Lab Values: Elevated TSH (primary hypothyroidism), low T3 and T4 levels.
* Imaging: Thyroid ultrasound or radioactive iodine uptake scan for structural assessment.
* Other Tests: Antithyroid antibodies (e.g., anti-TPO) to detect autoimmune thyroiditis.
List the diagnostics (labs values, imaging, other tests), medical/surgical management/medication, precautions and/or red flags, and physical therapy management of hypothyroidism
Diagnostics:
* Lab Values: Elevated TSH (primary hypothyroidism), low T3 and T4 levels.
* Imaging: Thyroid ultrasound or radioactive iodine uptake scan for structural assessment.
* Other Tests: Antithyroid antibodies (e.g., anti-TPO) to detect autoimmune thyroiditis.
Medical/Surgical Management/Medication:
* Medications: Levothyroxine (synthetic T4) as the primary treatment.
* Surgery: Rarely indicated unless large goiter causing compressive symptoms.
* Regular monitoring of TSH levels to adjust medication dosage.
Precautions and/or Red Flags:
* Watch for signs of myxedema coma (severe form) - altered mental status, hypothermia, bradycardia.
* Medication overdose can cause hyperthyroid symptoms (tachycardia, anxiety).
Physical Therapy Management:
* Focus on: Energy conservation techniques, low-intensity exercise, gradual progression.
* Address: Muscle weakness, joint stiffness, balance and coordination.
* Monitor: Fatigue levels, cardiovascular response during exercise. Adjust activity as needed to prevent overexertion.
List the etiology, pathogenesis, clinical presentation (signs and symptoms) of hyperthyroidism
Etiology:
* Primary causes: Graves’ disease (autoimmune) -> goiter
(Presence of TSI antibody indicating Graves’ disease)
Pathogenesis:
* Excessive production of thyroid hormones (T3 and T4) increases metabolic rate.
* Affects nearly all body systems, with heightened cellular activity and energy use.
Clinical Presentation (Signs & Symptoms):
* Weight loss despite increased appetite, heat intolerance, eyes protruding, exophthalmos, restless, tremors, tachycardia, high metabolic rate.
List the diagnostics (labs values, imaging, other tests), medical/surgical management/medication, precautions and/or red flags, and physical therapy management of hyperthyroidism
Diagnostics:
* Lab Values: Low TSH (primary hyperthyroidism), elevated T3 and T4 levels.
* Imaging: Thyroid ultrasound or radioactive iodine uptake scan to assess for nodules and uptake patterns.
* Other Tests: Thyroid-stimulating immunoglobulins (TSI) for Graves’ disease confirmation.
Medical/Surgical Management/Medication:
* Medications: synthyroid after procedure to replace hormone production
* Radioactive Iodine Therapy: To reduce thyroid hormone production.
* Surgery: Thyroidectomy in cases resistant to other treatments or when goiter is compressive.
Precautions and/or Red Flags:
* Watch for signs of thyroid storm (severe form) - high fever, tachycardia, confusion, dehydration.
* Avoid stimulants (e.g., caffeine) that can exacerbate symptoms.
Physical Therapy Management:
* Focus on: Energy conservation, managing cardiovascular symptoms.
* Address: Muscle weakness, improving endurance, and joint stability.
* Monitor: Heart rate and blood pressure during exercise, with gradual progression and avoidance of high-intensity activities to prevent exacerbation of symptoms.
why someone with hypothyroid would be linked with cold intolerance?
Low metabolism, low t3 and t4, the connection is that low t3 and 4 blunts (less) the response / sensitivity to epinephrine and norepinephrine which increase hr and metabolic rate. So when those are lower, less energy and heat is generated.
Hyperthyroidism is opposite of the above
Which hormones are from the adrenal cortex?
1) Mineralocorticoids (aldosterone):
A) widespread, primarily kidney
B) maintains fluid/electrolyte balance, resorbs sodium chloride, secretes potassium, increases blood volume and BP
2) glucocorticoids (cortisol) “stress hormone”:
A) widespread
B) body response to stress, concerned with food metabolism, preserves carbs and mobilizes amino acids, promotes gluconeogenesis, suppresses inflammation and immune function (Results in less wound healing and increased susceptibility to infection), vasoconstriction in the periphery, energy mobilized for body tissue
3) sex hormone (testosterone, estrogen, progesterone):
A) gonads
B) ability to influence secondary sex characteristics
Which hormones are from the adrenal medulla?
1) Epinephrine (adrenaline):
A) widespread
B) fight or flight, cardiac myocardial stimulation, higher HR, dysrhythmias, vasoconstriction with increased BP, increased blood glucose via glycolysis, stimulates ACTH production
2) Norepinephrine:
A) widespread
B) vasoconstriction, other effects similar to epinephrine
What are long term effects of glucocorticoid therapy?
Adrenal suppression where the hypothalamic pituitary ACTH secretion is inhibited resulting in non cortisol secretion
List the etiology, pathogenesis, clinical presentation (signs and symptoms) of Cushing syndrome
Etiology:
* **excess of glucocorticoid from A) adrenal or pituitary adenoma, B) large amounts of glucocorticoid
Pathogenesis:
* Excess cortisol production leading to metabolic, endocrine, and psychological disturbances.
Clinical Presentation:
* Classic triad: Central “truncal” obesity, moon face, and buffalo hump
* Other signs and symptoms:
* osteoporosis
* mood swings
* insomnia
* delayed wound healing and bruising
List the diagnostics (labs values, imaging, other tests), medical/surgical management/medication, precautions and/or red flags, and physical therapy management of Cushing Disease
Diagnostics:
* Laboratory tests:
* 24-hour urine free cortisol
* Late-night salivary cortisol
* Dexamethasone suppression test
* ACTH level
* Imaging:
* CT scan of the abdomen and chest
* MRI of the pituitary gland
Medical/Surgical Management:
* Iatrogenic Cushing’s: Gradual tapering of glucocorticoids
* Endogenous Cushing’s:
* Pituitary adenoma: Transsphenoidal surgery or medical therapy (e.g., dopamine agonists)
* Adrenal adenoma or carcinoma: Adrenalectomy
* Ectopic ACTH-producing tumors: Surgical resection or medical therapy (e.g., ketoconazole, mitotane)
Precautions and Red Flags:
* Monitor for complications such as infection, osteoporosis, and cardiovascular events.
* Be aware of the risk of adrenal insufficiency during and after treatment.
Physical Therapy Management:
* Exercise: Low-impact exercises like swimming, walking, or yoga to improve muscle strength and flexibility.
* Education: Educate patients about the importance of regular exercise and weight management.
* Pain management: Address musculoskeletal pain associated with osteoporosis or muscle weakness.
* Post-surgical rehabilitation: Assist with regaining strength and mobility after surgery.
List the etiology, pathogenesis, clinical presentation (signs and symptoms) of Addison’s disease
Etiology:
-
Autoimmune: Most common cause, body attacks adrenal glands
(Also meningococcal, viral infection, tumor) - **deficiency of adrenocortical secretions
Pathogenesis:
- Adrenal glands produce insufficient cortisol and aldosterone.
Clinical Presentation:
- Fatigue
- **low blood glucose
- **Weight loss and decreased appetite
- **frequent infections
- Low blood pressure
