Pathophysiology Exam 2 Study Guide PDF

Lecture 6 Endocrine System (12) 1) Posterior Pituitary stores and releases ADH and OXY, anterior pituitary produces and releases everything else. 2) Key s/s of endocrine dysfunction: - NMS: myalgia, arthralgia, fatigue, proximal weakness, BL signs - Systemic: swea...

Lecture 6 Endocrine System (12) 1) Posterior Pituitary stores and releases ADH and OXY, anterior pituitary produces and releases everything else. 2) Key s/s of endocrine dysfunction: - NMS: myalgia, arthralgia, fatigue, proximal weakness, BL signs - Systemic: sweating, dehydration 3) Hyperpituitarism: - Oversecrete one or more hormones: → Growth hormone: acromegaly, gigantism → ACTH: Cushing’s Disease → TSH: hyperthyroidism → Prolactin: amenorrhea/galactorrhea/gynecomastia - Typically caused by benign pituitary adenomas that can cause blurred vision as it expands in the skull - Hypopituitarism is the opposite; undersecretion of one or more hormones 4) Excess growth hormone in childhood is pituitary gigantism (develops abruptly), excess growth hormone in adulthood is acromegaly (develops slowly) 5) Hyperthyroidism: - Most common form of Grave’s Disease - Key symptoms include proximal weakness, tachycardia, atrophy, heat intolerance, ocular issues, GI issues, GU issues 6) Hashimoto’s Thyroiditis: - Painless, symmetric or asymmetric enlargement of thyroid - TSH elevated leads to goiter formation 7) Adrenal insufficiency: - Primary: insufficient cortisol and aldosterone release known as Addison’s Disease - Secondary: only cortisol is impacted, suppression of ACTH by steroid therapy - Pathophysiology: decreased production of cortisol & aldosterone = metabolic disturbances, no feedback for pituitary to stop making ACTH = skin pigmentation, aldosterone deficiency = fluid & electrolyte imbalance, hypokalemia 8) Adrenocortical hyperfunction (Cushing) - Cushing Syndrome: adrenal hyperfunction, excess medication - Cushing Disease: pituitary adenoma, excess ACTH stimulation; abnormal fat deposits (face, neck, trunk) 9) Diabetes: - Type 1: decreased utilization of glucose, increased fat mobilization, impaired protein utilization - Type 2: insulin resistance and inadequate insulin secretion 10) Clinical manifestations of diabetes: - Polyuria, polydipsia, polyphagia, weight loss, recurrent blurred vision, ketonuria, weakness/fatigue, asymptomatic (type 2 only) 11) SLIDE 19 12) Diabetes complications: - Retinopathy and nephropathy → exercise may be protective → no high intensity or plyometrics - Atherosclerosis - CV disease - Poor wound healing - Arthritis/osteoporosis - Sensory, motor, and autonomic neuropathies - Pressure injuries - Cognitive decline Metabolic System (5) 1) Osteoporosis: - Most common cause in women is estrogen deficiency - Coughing and sneezing can cause compression fractures - Emphasize neutral and extension postures 2) Paget Disease: - Bone marrow replaced by vascular/fibrous tissue - New bone is irregularly thickened 3) Clinical manifestations of Paget Disease: - Pain, skeletal, neurologic, CV, miscellaneous - Femur most common affected bone of Paget Disease GI System (2) 1) Lying down worsens symptoms of Gastroesophageal Reflux Disease; remain upright for at least 3 hours after meals which can impact PTs plan of care. 2) Extra-esophageal symptoms: asthma, cough, laryngitis Lecture 7 Hepatobiliary System (8) 1) Anatomy is liver (albumin), gallbladder (bile reservoir), pancreas (digestive enzymes). 2) Hepatic disease: - Symptoms: edema/ascites, R upper quadrant and abdominal pain, skin changes, neurologic involvement, MSK pain, hepatic osteodystrophy - Any patient with undiagnosed/untreated jaundice must be referred back to a physician. 3) Jaundice: - Overproduction of bilirubin - Decreased uptake/conjugation in bilirubin - Hepatocyte dysfunction - Impaired bile flow - If treated, resolves in 4-6 weeks. 4) Ascites: - Accumulation of fluid in abdominal cavity - Semi to high Fowler’s position are usually well tolerated - Edema can mask muscle wasting 5) Cirrhosis: - Progressive inflammation of liver - Main cause is viral hepatitis and is IRREVERSIBLE - Aerobic and resistance training is recommended - Check for following integumentary signs: spider angiomas, nailbed changes, Dupuytren’s contracture 6) Portal Hypertension: - Pressure increases when pressure in portal vein is higher than pressure in inferior vena cava - Blood backs up on the stomach, esophagus, umbilicus, and rectum which lead to engorged vessels, varices, and bleeding - AVOID isometric exercises as they likely increase IAP - Gastroesophogeal varices are very serious - Interventions to reduce abdominal pressure 7) SLIDE 37 Oncology (8) 1) Oncology: - In malignant cells, differentiation is altered - Dysplasia can reverse itself to progress to cancer - Metaplasia is first level of dysplasia, reversible and benign but can progress 2) Cancer staging and grading: - Stage 0: carcinoma in situ - Stage 1: Early stage, cancer is usually localized - Stage 2: Increased risk of regional spread because of tumor size or grade - Stage 3: local cancer has spread regionally - Stage 4:cancer has spread and disseminated to distant cites - Grade 1 (low): well differentiated; tumor looks like normal tissue - Grade 2: moderately differentiated; somewhat abnormal - Grade 3: poorly differentiated; most cells look abnormal - Grade 4 (high): undifferentiated; all/most cells are abnormal 3) Cancer Metastases: - Lungs: dry, persistent cough, pleural pain, SOB, pleural effusion, hemoptysis - Liver: abdominal and/or RUQ pain, general malaise and fatigue, anorexia, early satiety, weight loss, low grade fevers - Bone: deep pain worse with activity, neurologic symptoms, pathologic fratcures - Brain: increased ICP, obstruction of CSF, change mentation, reduced sensory/motor function - Spinal cord: nerve issues - Lymphatic system: lymphedema 4) Exercise precautions for cancer survivors: - Delay exercise until medical evaluation for survivors with anemia - Avoid public gyms for survivors with compromised immune function or marrow transplant - Severe fatigue may prevent exercise; exercise in 5-min increments - Avoid exposure of irradiated skin to chlorine - Avoid water or other microbial exposure for survivors with catheters - Recumbent bike may be better than treadmill for survivors with peripheral neuropathies or gait disturbances 5) Lung cancer: - Most frequent cause of cancer death in the US - Small cell: rapid growth, early mets, and poor prognosis - Non-small cell: → Squamous cell- slow growth, rare mets, curative treatment → Adenocarcinoma- slow to moderate growth, early mets → Large cell- rapid growth, early and widespread mets - Risk factors: → environment → nutrition → genetics → age → family history  → medical history 6) Clinical presentation: - Pancoast tumors invade brachial plexus and phrenic nerve 7) PT implications: - Pancoast tumors present like thoracic outlet syndrome and subacromial bursitis, with sharp pleuritic pain in axilla and shoulder 8) Breast cancer: - Types: → Ductal carcinoma in situ: confined to duct and may not need treatment → Invasive ductile carcinoma: invades through duct wall into stromal tissue → Invasive lobular carcinoma: grows through lobule and spreads(poorly visualized on mammogram) → Inflammatory breast cancer: very aggresive (rapidly progressive), causes swelling from cancer cells obstructing lymphatics → Paget Disease of Breast: rare form of ductal carcinoma with itching, tingling, pain and rash - Estrogen is likely the promoter of most breast cancers - Bone mets occur in up to 70% of women with advanced breast cancer - Aerobic and resistive exercise is beneficial 9) Colorectal cancer: - Types: → Adenocarcinoma: begin in cells that make/release mucus and other fluids (most common type) → Carcinoid: begin in the hormone producing cells of the intestine → GI stromal: begin on colon cell walls → Lymphomas: cancers of immune cells that start in lymph nodes → Sarcomas: start in muscle and CT in wall of colon - Impaired posture due to adaptive shortening of abdominals after surgery - Removal of lymph nodes can cause lymphedema 10) SLIDE 50  Pop-Up Physios Endocrine related muscle weakness is typically proximal. Always be on alert for patients with bilateral Carpal Tunnel, atypical Rheumatoid Arthritis, or adhesive capsulitis. Pituitary tumors will produce symptoms as they expand within the skull. Visual field abnormalities: headache and somnolence. Post-op precautions following hypophysectomy: no coughing, no sneezing, no nose blowing. Watch for signs of reduced consciousness or visual acuity, falling pulse rate, or rising BP. Observe for signs of meningitis. Screen for weakness, changes in ROM, and poor exercise tolerance in patients with acromegaly. Role of PT in care for patients with acromegaly: joint mobz, soft tissue ROM, muscle strengthening, functional skills and ADL training. When goiter gets extremely large, pressure on trachea and esophagus leads to difficulty breathing, dysphagia, and hoarseness. Upper airway compression can be fatal and can occlude carotid arteries. During early treatments of hypothyroidism, patients may have pseudogout. Some studies have shown a connection between hypothyroidism and fibromyalgia. Take caution with manual techniques due to fragile skin. If cardiac symptoms have occurred, thyroid hormone dosage must start low and increase slowly. Exercise tolerance may be poor. In patients with Addison’s Disease, exercise tolerance is very poor but progresses gradually. Aquatic therapy is CONTRAINDICATED due to demand for cortisol. Vitals need to be monitored closely. Medications may lead to steroid induced psychosis. Metabolic syndrome: - Abdominal adiposity: waist > 40 in men, waist >35 in women - High triglycerides: >150 mg/dL - Low HDLs: 130/85 mmHg When treating an individual who is obese, the PT has to be extremely aware of body mechanics, carefully planning transfers, and getting extra assistance as needed. Patients can have symptoms of hypoglycemia when glucose drops quickly even if the level is still elevated. Keep easy to administer sugar sources in your clinic such as orange juice or canned frosting. When treating individuals with osteoporosis, provide exercises that optimally load the spine emphasizing neutral or extension postures and avoiding flexion. Practice Questions 1) A physical therapist is evaluating a patient with chronic hand and wrist pain, numbness, and tingling. The patient reports they are right hand dominant, but the symptoms are bilateral and symmetrical. They also cannot pinpoint when or how the symptoms started. What about this clinical presentation is a RED FLAG for endocrine dysfunction? A. Location of pain B. Bilateral symptoms C. Nerve symptoms D. Atrophy 2) An excess of which hormone is associated with the development of Cushing Syndrome? A. Thyroid Stimulating Hormone B. Prolactin C. Adrenocorticotropic Hormone D. Luteinizing Hormone 3) For individuals with a long history of Diabetes, what aspect of the pathogenesis significantly increases fall risk? A. Neuropathy B. Retinopathy C. Nephropathy D. Coagulopathy 4) As the body ages, the impact on the hepatobiliary system will do what to a person's medication needs? A. Require dosage adjustments B. Decrease medication tolerance C. Increase drug interactions D. No age-related change is expected 5) What is the most common secondary complication seen in individuals with osteoporosis?  A. Compression fractures B. Bruising C. Scoliosis D. Vertebral subluxation 6) A physical therapist is evaluating a patient who is 1 week post-op from a right total knee replacement. The patient reports a dull ache in the right calf, and the therapist notes redness and swelling in the calf. What is this patient's MOST LIKELY diagnosis? A. Venous insufficiency B. Arterial insufficiency C. Deep vein thrombosis D. Lymphedema 7) A physical therapist is called to the emergency room to evaluate an 86 year old patient presenting with sudden onset of altered mental status. The patient's daughter reports that their parent was in their usual state of health until the night before when they began to appear confused. The patient also reported abdominal pain. What is the patient's MOST LIKELY diagnosis? A. Urinary tract infection B. Stroke C. Aortic aneurysm D. Appendicitis