5054 Exam 1

GI System, Tendinopathy Management, Resistance Training, Diabetes, Renal System, Endocrine System, Diabetes Medications

What are the main components of the GI tract?

Mouth, pharynx, esophagus, stomach, small intestine, large intestine/colon, rectum

What are the accessory organs of the GI system?

• Liver

• Gallbladder

• Pancreas

What are the functional processes of the GI system?

• Digestion

• Secretion

• Absorption

• Motility (contractions)

What is the primary function of saliva?

• Lubricates food

• Begins enzymatic digestion

• Kills some bacteria

What role do the pharynx and esophagus play in digestion?

Serve as passageways & move food to the stomach

• don’t contribute to digestion

What is the function of the upper esophageal sphincter?

Prevents air from entering the stomach

What is the function of the lower esophageal sphincter?

Prevents acid reflux into the esophagus

What are the primary functions of the stomach?

• Digestion

• Very little absorption

• Doesn’t contribute to fat digestion (breakdown)

What are the primary functions of the small intestine?

• Most absorption

• End-stage digestion

• Mostly occurs in first ¼ of SI (duodenum & jejunum)

What are the functions of the pancreas?

• Endocrine: secrete hormones (insulin) directly into bloodstream

• Exocrine: secrete pancreatic juice via ducts into duodenum (digestion)

What is the function of the liver?

Secretes bile

What is the main function of the gallbladder?

Makes fat digestible

What are the three mechanisms that accomplish absorption?

• Transport

• Diffusion (fatty acids)

• Osmosis

What components of the SI wall facilitate absorption?

Convolutions, villi, and microvilli maximize surface area

What are the four major GI processes?

Digestion, secretion, absorption, and motility

What is digestion?

The breakdown of macromolecules into smaller components

What is secretion?

The release of substances into the GI lumen

What is absorption?

Movement of nutrients from the GI lumen into blood or lymph

What is motility?

Contractions that move contents through the GI tract

What is chyme?

The partially digested material that leaves the stomach

What structures maximize absorption in the small intestine?

Convolutions, villi, and microvilli

What are the two functions of intestinal motility?

Facilitate nutrient absorption and move materials toward the large intestine

What nerve plays a major role in regulating digestion?

vagus nerve

What are the primary symptoms of GI disorders?

• Nausea

• vomiting

• diarrhea

• anorexia

• constipation

• dysphagia

• heartburn

• abdominal pain

• GI bleeding

What is a hiatal hernia?

Protrusion of the upper stomach through the diaphragm

What causes GERD?

Reduced lower esophageal sphincter pressure or increased gastric pressure

What are common symptoms of GERD?

• Heartburn

• reflux

• dysphagia

• burning sensations in the neck or back

What are esophageal varices?

Dilated veins in the lower third of the esophagus that are at risk of rupture and bleeding

What is gastritis?

Inflammation of the stomach lining

What medications commonly contribute to gastritis?

Aspirin and NSAIDs

What is peptic ulcer disease (PUD)?

Breakdown of the protective stomach or duodenal lining exposing tissue to gastric fluids

What is malabsorption syndrome?

A group of disorders that impair nutrient absorption in the intestines.

What symptoms are associated with malabsorption syndrome?

• Weight loss

• fatigue

• bloating

• diarrhea

• flatulence

• bulky malodorous stools

What two diseases comprise inflammatory bowel disease (IBD)?

Crohn's disease and ulcerative colitis

What are common symptoms of IBD?

• Abdominal pain

• diarrhea

• bloody stools

• anorexia

• weight loss

What is IBS?

A functional GI disorder with abdominal pain, bloating, diarrhea, and/or constipation without detectable inflammation

What commonly triggers IBS symptoms?

Stress, emotions, fatigue, smoking, alcohol, fatty meals, and lactose intolerance

What is diverticulosis?

Presence of diverticula (outpouchings) in the intestinal wall

What is diverticulitis?

Infection and inflammation of diverticula caused by trapped fecal material

What are gallstones (cholelithiasis)?

Stones composed primarily of cholesterol or bile salts that obstruct bile flow

What is pancreatitis?

Inflammation of the pancreas due to autodigestion by pancreatic enzymes

What should a PT assess when screening for GI disorders?

• GI symptoms

• abdominal pain patterns

• bowel habits

• bleeding

• constitutional symptoms

• atypical musculoskeletal presentations

What signs may indicate GI bleeding?

• Pallor

• fatigue

• exercise intolerance

• hematemesis

• bloody stools

• rectal bleeding

What constitutional symptoms should raise concern for serious GI pathology?

• Fatigue

• malaise

• fever

• weakness

• unexplained weight loss

• exercise intolerance

What is diabetes mellitus?

A group of metabolic disorders characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both

What is the primary pathophysiology of Type 1 Diabetes?

Autoimmune destruction of pancreatic β-cells, resulting in absolute insulin deficiency

Which type of diabetes is more prominent?

Type II

What is the primary pathophysiology of Type 2 Diabetes?

Insulin resistance combined with progressive β-cell dysfunction

Which type of diabetes is most associated with Diabetic Ketoacidosis (DKA)?

Type 1 Diabetes

Which type of diabetes is most associated with Hyperosmolar Hyperglycemic State (HHS)?

Type 2 Diabetes

What is insulin resistance?

A decreased ability of cells to respond to insulin, causing elevated blood glucose levels

Compare insulin levels in Type 1 and Type 2 diabetes.

• Type 1: Little to no insulin production

• Type 2: Insulin present initially, but tissues become resistant

Which type of diabetes is more strongly associated with obesity?

Type 2 Diabetes

Which type of diabetes requires insulin for survival?

Type 1

What is hyperglycemia?

Elevated blood glucose levels

What are the classic symptoms of hyperglycemia?

• Polyuria

• Polydipsia

• Polyphagia

• Fatigue

• Blurred vision

• Weight loss

What are the three "P's" of hyperglycemia?

• Polyuria

• Polydipsia

• Polyphagia

What is the PT response if a patient demonstrates severe hyperglycemia symptoms?

Stop exercise, assess blood glucose, and refer for medical evaluation if necessary

What is hypoglycemia?

Blood glucose less than 70 mg/dL

What are common symptoms of hypoglycemia?

• Sweating

• Shaking

• Hunger

• Dizziness

• Confusion

• Anxiety

• Tachycardia

Why is hypoglycemia dangerous?

It can progress to seizures, loss of consciousness, coma, or death if untreated

Which diabetes medications increase risk of hypoglycemia?

• Insulin

• Sulfonylureas

• Meglitinides

When is the 15–15 Rule used?

When blood glucose is below 70 mg/dL and the patient is conscious

What are the steps of the 15-15 Rule?

• Consume 15 grams of fast-acting carbohydrates

• Wait 15 minutes

• Recheck blood glucose

• Repeat if glucose is still below 70

What is diabetic neuropathy?

Nerve damage caused by chronic hyperglycemia

What symptoms are associated with diabetic peripheral neuropathy?

• Numbness

• Burning

• Tingling

• Loss of protective sensation

What is diabetic retinopathy?

Damage to retinal blood vessels caused by diabetes

What exercise precaution is necessary with diabetic retinopathy?

Avoid high-intensity exercise that may increase intraocular pressure

How often should a diabetic foot screen be performed?

At least annually

What skin abnormalities should be inspected during a diabetic foot screen?

• Blisters

• Splits

• Calluses

What deformities should be assessed during a diabetic foot screen?

• Hallux valgus

• Hammer toes

• Charcot foot

What nail changes may indicate diabetic complications?

• Thickening

• Splitting

• Yellowing

• Hardening

What pulses should be assessed during a diabetic foot screen?

• Dorsalis pedis

• Posterior tibial

What tool is used to test protective sensation?

10-g monofilament

What is protective sensation?

The ability to detect pain, pressure, and temperature to prevent injury

What footwear characteristics are recommended for patients with diabetes?

• Wide toe box

• Arch support

• Tall toe box

• Cotton socks

What is CAN (cardiovascular autonomic neuropathy)?

Damage to autonomic nerves controlling cardiovascular function

What are common signs of CAN?

• Resting tachycardia

• Orthostatic hypotension

• Exercise intolerance

• Dizziness upon standing

How should PTs assess patients for CAN?

Monitor blood pressure response during changes in position and activity

Name three PT interventions for CAN.

• Compression garments

• Gradual ascent against gravity

• Deep breathing

Name three counter-maneuvers used for CAN.

• Leg crossing

• Static squats

• Isometric quad/glute contractions

What is a hypertensive response to exercise?

An exaggerated increase in systolic blood pressure during exercise

What systolic BP defines a hypertensive response in males?

Greater than 210 mmHg

What systolic BP defines a hypertensive response in females?

Greater than 190 mmHg

What is post-exercise hypotension (PEH)?

A prolonged decrease in resting blood pressure following exercise

What causes PEH?

Sustained vasodilation and reduced sympathetic tone after exercise

What is the aerobic exercise goal for individuals with diabetes?

200–300 minutes per week

What is the resistance training recommendation for diabetes?

At least 2 days per week involving major muscle groups

What is a tendon?

A dense connective tissue structure that connects muscle to bone and transmits muscular force to create movement

What is the primary structural protein in tendons?

Type I collagen

What is the primary function of a tendon?

To transmit force from muscle to bone and store/release elastic energy during movement

Are tendons highly vascularized?

No. Tendons have relatively poor blood supply, which contributes to slower healing

What is tendinopathy?

A clinical condition characterized by tendon pain, impaired function, and structural changes within the tendon

What are common tendon changes seen in tendinopathy?

• Collagen disorganization

• Increased ground substance

• Tendon thickening

• Neovascularization

• Reduced mechanical properties

What factors contribute to pain in tendinopathy?

• Mechanical loading

• Neural sensitization

• Biochemical changes

• Tendon pathology

What is the most common cause of tendinopathy?

Load that exceeds the tendon's capacity

What training errors increase tendinopathy risk?

• Sudden increase in intensity

• Sudden increase in volume

• Sudden increase in frequency

• Rapid return to activity

What biomechanical factors may contribute to tendinopathy?

• Muscle weakness

• Poor movement mechanics

• Altered joint loading

• Poor force distribution

What is optimal loading?

Applying enough load to stimulate adaptation without exceeding tendon tolerance

Why is complete rest usually not recommended with tendinopathy?

Tendons require loading to maintain and improve capacity. Underloading can worsen tendon health