16. Other systems 1

metabolic syndrome criteria

3 or more of the following: DA, HTN, cholesterol (TG and HDL), obesity

waist circumference: M > 40inches, W: >35inches

triglycerides: >150mg/dL

HDL: M < 40mg/dL, W <50mg/dL

blood pressure: >130 or 85

fasting blood glucose: >100mg/dL

anterior pituitary hormones

“PT FLAG”

• prolactin

• TSH

• FSH

• LH

• ACTH

• GH

hypothalamus

controls and regulates everything especially the pituitary, the pituitary then releases hormones.

ACTH

• adreno corticotrophic hormone

• Stimulates adrenal cortex and releases cortisol and aldosterone

• Cortisol - regulation of BP and stress

• Aldosterone - retains sodium and water and kicks out potassium

• issues = addisons and cushings

TSH

• thyroid stimulating hormone

• Stimulates thyroid which releases T3 and T4

• high TSH = low T3/4 = hypothyroidism

• low TSH = high T3/4 = hyperthyroidism

FSH and LH

Estrogen

Progesterone

Testosterone

prolactin

Milk production in breasts

Posterior pituitary hormones

ADH/vasopressin

• antidiuretic hormone = prevents water from leaving body

• Regulates water and mineral balance, water retention

Oxytocin

• Stimulates uterine contractions during birth

• Ejection of milk from the breast

• Production is prolactin

hypothalamus is responsible for what

regulation of the ANS

homeostasis

Temp

Sweating

Thirst

Sexual behavior

Rage

Fear

Blood pressure

Sleep

Pituitary gland

Secretes endorphins and reduces sensitivity to pain. Creates sex hormones.

Thyroid gland

Produces hormones that act to control rate at which cells burn fuel from food

Parathyroid

Regulate calcium and phosphate metabolism

Adrenal gland

Produces cortisol that will regulate water and sodium balance, the body's response to stress, the immune system, and metabolism

addison's disease

causes: infections, neoplasm, hemorrhage, autoimmune process

adrenal insufficiency - decreased cortisol and aldosterone

decreased BP and dehydration

hyperkalemia

decreased glucose

bronze pigmented skin - increased MSH (melanocyte)

weight loss, anorexia, GI disturbances

generalized weakness (asthenia)

intolerance to cold and stress, anxiety and depression

"Lady named mrs addison, shes a petite brown old lady walking with a stick"

ALL LEVELS ARE GOING DOWN except MSH and K+

cushings disease

causes: pituitary tumor with increased ACTH secretion

elevated cortisol and aldosterone

increased BP, water retention

hypokalemia

increased glucose

ruddy appearance, striae on skin

weight gain, centripetal obesity, round moon face

proximal muscle weakness and atrophy

increased susceptibility to infection, osteoporosis (buffalo hump), poor wound healing

“Mr Santa Clause Cushion: red face, fat, carry bag proximally”

patient comes in with significant weight gain in abdomen and face. lab values show high levels of cortisol and high levels of ACTH secreted by pituitary gland. what is most likely the diagnosis?

cushing's disease

cushing's disease vs syndrome

Disease

Pituitary adenoma → more ACTH secreted by pituitary gland → stimulates adrenal gland → more cortisol is released

Problem in pituitary gland

Syndrome

Adrenal gland tumor → adrenal gland secretes more cortisol → drug toxicity

Problem in adrenal gland

Symptoms common for both

hyperthyroidism

opposite of hypothyroidism

increased T3 and T4, low TSH

increased HR

high BMR

heat intolerance

increased glucose absorption

restlessness, insomnia

diarrhea

silky hair, moist palms

weight loss and increased appetite

increased perspiration

hyperreflexia

exophthalmus (buldging eyes), graves disease

decreased BP

hypothyroidism

LAZY boys love lying on the couch all day watching TV under a comforter

decreased T3 and T4, high TSH

decreased HR

low BMR

cold intolerance

decreased glucose absorption

sleepiness, tiredness, proximal muscle weakness

constipation

brittle nails, dry skin and hair

weight gain and decreased appetite

decreased perspiration

prolonged deep tendon reflex (DTR)

myxedema(EMERGENCY: swellikng hands/feet/face), hashimoto's disease

increased BP (SBP decreased; DBP increased so exam asks overall BP answer as increased)

goiters, exothalmos, frozen shoulder and osteoporosis is seen where

hyperthyroidism

hyperparathyroidism

Elevated PTH = Elevated calcium and decreased serum phosphate (in the blood)

Can demineralize bone

BONES STONES GROANS MOANS SENSORY

Bones - Osteopenia, arthralgia, gout

Stones - Kidney stones, renal insufficiency

Groans - Peptic ulcer

Moans -proximal muscle weakness, fatigue, depression, confusion

Sensory - Glove and stocking loss

hypoparathyroidism

Low PTH = Low calcium and high phosphorus

The CCATS are NUMB!

• Tetany

• Convulsions

• Cramps

• Arrhythmias

• Twitching of muscles

• Spasm of muscles

• Paresthesia of fingertips/mouth

*fatigue and weakness

*trossea sign and chovstek sign (n/t of facial nerve distribution)

type I diabetes

Diagnosed mostly in childhood

Pancreas produces no insulin → insulin dependent DM

Symptoms:

• Polyphagia - increased hunger

• Weight loss

• Ketoacidosis - use fat cells for energy which releases ketone bodies

• Fruity breath odor

• Polyuria - increased urination

• Polydipsia - increased thirst

• Blurred vision

• Dehydration

type II diabetes

• bodys resistance to insulin → insulin resistance DM

• occurs secondary to other dysfunctions

• similar to type 1 for s/s (NO ketoacidosis)

diagnosis of DM

• >126mg/dL - fasting

• >200mg/dL - random

• HbA1C

  • average of 3 months

    4-6% = normal

    10% + = IMMEDIATE insulin needed

    Anything equal to or > 6.5% = diabetes on two consecutive occasions

hypoglycemia

glucose <70mg/dL

early signs: "TIRED" - tachycardia, irritability, restlessness, excessive hunger, dizziness

• pallor, sweating, shakiness, poor coordination/gait

late signs: slurred speech, drowsiness, confusion, LOC, and coma

"COLD AND CLAMMY GIVE THEM CANDY"

hyperglycemia

glucose >300mg/dL

early signs: weakness, dry mouth, frequent - scant urination, deep and rapid respirations (kassmual respirations), dull senses, confusion, diminished reflexes, excessive thirst

late signs: fruity odor (acetone breath), hyperglycemic coma

"PPP" - polydipsia (excessive thirst), polyuria, polyphagia (excessive hunger)

"HOT AND DRY SUGAR HIGH"

Exercise and diabetes considerations

avoid during peak insulin hours 2-4hrs after insulin given

insulin absorbed much quicker in active extremity, always apply insulin injections in abdomen or non active extremity

insulin dosage should be reduced after exercise

dont exercise in extreme cold or heat (pt needs to be well hydrated)

exercise in AM recommended to avoid hypoglycemia - dont want to become hypo in sleep

safe blood glucose levels to exercise in

100-250mg/dL

if 70-100 can give them a carbohydrate snack and check to make sure level rises to at least 100 prior to exercising

when not to exercise with diabetes

<70mg/dL glucose

>300mg/dL glucose (or >250 with ketones present)

250-300, no ketones are present so proceed with caution

do we want to give sugar or carbs with signs of hypoglyceia

sugar, no carbs only provide carbs before or after exercise

diabetic foot care

• feet screening

• wash feet daily in warm water

• keep toenails cut straight across

• clean white socks and no wrinkles

• alternate shoes

• snug fit with laces/velcro and wide toe box

FITT principle for DM

F - 3-7x a week

I - 11-13 on RPE scale (max 17)

T - 150min/week can be progressed to 300

T - moderate intensity aerobic involving large muscle groups

pelvic floor muscles

• levator ani (pubococcygeus, puborectalis, iliococcygeus)

  • I Literally Pee Pee

• pudenal nerve

stress incontinence

involuntary leakage of urine during cough, sneezing, or exertion

post partum or pelvic floor weakness

urge incontinence

involuntary contraction of detrusor muscle with strong desire to void (urgency) can be seen with infections, parkinsons, UMN

overflow incontinence

caused be acontractile or underactive detrusor muscle. bladder is overdistended, cant empty it completely, urine dribbles or leaks out. can be seen with benign prostatic hyperplasia, DM

functional incontinence

incontinence due to mobility, dexterity, or cognitive deficits. can be seen with dementia or LE weakness

tx for incontinence

stress: strengthen pelvic floor

urge: treat infections, voiding schedule

functional: clear clutter, improve accessibility, prompted voiding

overflow: behavioral modification like double voiding, medication, catheterization