Chapter 7 Other Systems Part 2

Diverticulitis Inflamed or infected diverticula. This occurs in 20-25% of the population that has diverticulosis. Diverticulosis is the condition of having diverticula. These are pouch-like protrusions occurring in the colon. Approximately 10% of the population over 40 years of age develops diverticulosis. Approximately 80% of individuals with diverticulosis are asymptomatic, however, those with symptoms may experience bloating, mild cramping, and both diarrhea and constipation. Treatment includes an increased amount of dietary fiber (______-______ g per day recommended) to avoid diverticulitis. The exact etiology of diverticulitis is unknown, however, a dominant theory is that the disease results from a low _________ diet. Abdominal pain is the primary symptom of diverticulitis. Tenderness over the __________ side of the lower abdomen, cramping, constipation or diarrhea, nausea, fever, chills, and vomiting can also occur. Treatment includes diet modification, controlling the underlying infection, and lower internal colonic pressure through increased fiber intake. In more severe cases, a nasogastric tube may be required for severe obstruction, perforation or necrosis. Complications can include bleeding infections, intestinal blockage, abscess, perforations or tears in the colon, fistulas, or peritonitis.

20-35 g fiber left

It is recommended that desensitization interventions be performed 5 -10 minutes, _____ to ____ times daily. Each session should begin with a sensation that is slightly _______________, but tolerable, and progress to more noxious stimuli. A textural progression ma include feather, cotton ball, chamois cloth, soft terry cloth, corduroy cloth, rough terry cloth, wool.

3 to 4 times daily irritable

Wilson's Disease Rare genetic disorder that is most common in eastern Europeans, Sicilians, and southern Italians, but may occur in any group. Wilson's disease typically appears in people under 40 years old and symptoms can develop in children typically between _______ and ______ years of age. Autosomal recessive inherited trait that produces a defect in the body's ability to metabolize ___________. The copper accumulates over time within the brain, liver, cornea, kidney and other tissues. Symptoms typically appear between the ages of four to sizx and include Kayser-Fleischer rings surrounding the iris of the eyes secondary to copper deposits, degenerative changes in the brain (especially within the _________ _________), hepatitis, cirrhosis of the liver, athetoid movements, and ataxic gait patterns. There may also be emotional and behavioral changes as the copper continues to accumulate. Over time, and with severe disease, there will be deformities of the musculoskeletal system, pathologic fractures, osteomalacia, muscle atrophy, and contractures. Treatment consist of continual pharmacological intervention using vitamin B6 and D-penicillamine as both promote the excretion of excess copper from the body. Treatment will also focus on prevention of __________ disease since a patient will die from a hepatic failure if the condition is left untreated.

4 and 6 years of age copper basal ganglia hepatic

Metabolic acidosis Occurs when there is an accumulation of acids due to an acid gain or bicarbonate loss. As a result, the pH drops below __________. Metabolic acidosis commonly occur with conditions such as renal failure, lactic acidosis, starvation, diabetic or alcoholic ketoacidosis, severe diarrhea or poisoning by certain toxins. Symptoms include compensatory __________ventilation, _________, diarrhea, headache, weakness and malaise, hyperkalemia, and cardiac arrhythmias. If left untreated the continued increase in acid can induce coma and eventual death. Treatment includes managing the underlying cause, correcting any coexisting electrolyte imbalances, and administering sodium bicarbonate.

7.35 hyperventilation vomiting

Diabetes Testing Testing is generally performed on two different occasions to confirm diagnosis of DM. Some of the various testing procedures include: Fasting plasma glucose: Blood glucose testing that occurs at least eight hours after a patient's last intake of food or drink. Testing is positive for DM if the blood glucose level is >_____ mg/dl. (normal is < _______mg/dl). Oral glucose tolerance test: Blood glucose testing that occurs two hours after ingestion of a ____________drink. Testing is positive for DM If the blood glucose level is ______mg/dl or greater (normal is < ________ mg/dl). A1c testing: A blood test based on the attachment of glucose to hemoglobin that measure the patient's average blood glucose level over the past ____-___ months. Testing is positive for DM if the A1c level is 6.5% of greater (normal is < 5.7%). A diagnosis of DM may also be made if a patient has classic signs and symptoms of DM (e.g. polydipsia, polyuria) along with random glucose test of _____mg/dl or greater.

> 125 < 100 sugary 200 < 140 2-3 months 200

Lower GI- Large Intestines (6)

Ascending colon Transverse colon Descending colon Sigmoid colon Rectum Anus

___________ precautions are required for patients with hepatitis _____ and _____.

Enteric A and E

Lower GI - Small intestines (3)

Duodenum Jejunum Ileum

Gland Organs (3)

Gallbladder, Liver, Pancreas

Upper GI (3)

Mouth Esophagus Stomach

Rehab considerations for patients with gastritis 1. Patients with gastritis secondary to chronic _________ use may be asymptomatic 2. Knowledge of blood in the _________ should result in physician referral. 3. Educate patient to take medications with food and avoid certain types of drunk and food 4. The patient should avoid all _________-containing compounds

NSAID stool aspirin

Rehab considerations for patients with acid-base disorders: Recognize that __________________'s sign during blood pressure measurements may indicate ____________ deficiency and the early stages of tetany.

Trousseau's sign calcium

Duodenum: Neutralizes ________ in food from the stomach and mixes _____________ and biliary secretions with food. Jejunum: Absorbs _______, ___________, and nutrients Ileum: Absorbs _____________ and intrinsic factors to be recycled

acid pancreatic water, electrolytes, and nutrients bile

Hormone Replacement Agents These agents restore normal endocrine function when endogenous production of a particular hormone is deficient or absent. Hyperfunction agents These agents manage hyperactive endocrine function to allow for inhibition of hormone function. This is accomplished through negative feedback loops or through hormone ______________.

antagonists

Hypopituitarism: There is a decreased or absent hormonal secretion from the ___________ pituitary gland. Typical disorders may include ___________ stature, delayed growth and puberty, sexual and reproductive disorders, and diabetes insipidus. Treatment is also based on the deficit hormones and usually includes pharmacological replacement therapy. Hyperpituitarism: Excessive secretion of one or more hormones under the pituitary gland's control (frequently growth hormone that produces ________________ in adults). Some disorders include gigantism or acromegaly, hirsutism, galactorrhea (abnormal _____________ in males or females), amenhorrhea, infertility, and impotence. Treatment is hormone and site dependent and can include tumor resection, surgery, radiation therapy, and hormone suppression or replacement. Must demonstrate increased awareness for signs of __________glycemia. Bilateral carpal tunnel syndrome, arthritis, osteophyte formation are common with ___________pituitarism. Bilateral hemianopsia that can occur with ____________pituitarism requires special consideration during treatment.

anterior short acromegaly lactation hypoglycemi a hyper hypo

Povidone-Iodine Advantages: 1. Broad-spectrum 2. Anti_______ 3. Easily removed with ____________ Disadvantages: 1. Not effect against pseudomonas 2. May impair ____________ function 3. Painful application

anti-fungal water thyroid

Tinea Pedis Commonly referred to as _______________'s foot, is a superficial fungal infection which causes epidermal __________ and a scaly skin appearance. This fungus is opportunistic and will rapidly multiply in a warm and moist environment. Risk factors include wearing closed toe shoes that don't allow airflow, prolonged periods of moisture or wetness, excessive sweating, and possessing small nail or skin abrasion. This infection is contagious through direct contact or when making contact with a surface containing the tinea pedis infection. Signs and symptoms: itching, redness, peeling skin between the toes, pain, odor, and in mores severe cases breaks in skin continuity. Pharmacological intervention includes topical or oral antibiotics depending on the severity of symptoms. Tinea pedis may persist or recur and more long-term management may be required. Prevention includes thorough drying of the feet when bathing or swimming, wearing sandals around public pools or showers, changing socks frequently, proper hygiene, and avoiding shoe wear that creates a moist environment.

athlete's thickening

Gangrene (Wet) Gangrene is referred to as "wet" if there is an associated __________ infection in the affected tissue. Gangrene may develop as a complication of an infected untreated wound. Swelling resulting from a bacterial infection causes a sudden stoppage of _____________ flow. Wet gangrene can develop after a severe burn, frostbite or injury and requires immediate treatment since it tends to spread very quickly and can be __________. There is a cessation of blood flow that starts a chain of events including invasion by bacteria at the affected site. As a result of occluded blood supply, the white blood cells are unable to fight the infection. Swelling and pain at the site of infection, change in skin color from red to brown to black, blisters that produce pus, fever, and general malaise. Wet gangrene is a serious medical condition and requires immediate medical intervention. Surgical debridement of the gangrene and intravenous antibiotic treatment are typical interventions for wet gangrene. Depending on the severity, gangrene is treated by pharmacological intervention, surgery, and hyperbaric oxygen therapy.

bacterial blood fatal

Cellulitis Fast spreading inflammation that occurs as a result of a __________ infection of the skin and ______________ tissues. It can develop anywhere under the skin, but will typically affect the extremities. Caused by particular bacterial infections including streptococci or staphylococci. Predisposing factors to cellulitis include an increased age, immunosuppression, trauma, the presence of wounds, or venous insufficiency. Symptoms include localized redness that may spread quickly, skin that is warm or hot to touch, local abscess or ulceration, tenderness to palpation, chills, fever, and malaise. Treatment: A patient with suspected cellulitis should be immediately referred to a physician for further assessment. Cellulitis requires pharmacological intervention using ________ antibiotics. Differential diagnosis should attempt to rule out deep vein thrombosis and contact dermatitis. Physical therapy may be warranted for wound care. Cellulitis can lead to sepsis or gangrene if not properly treated.

bacterial connective systemic

Peptide Hormones (e.g. insulin) Insulin is a hormone secreted by the _______ cells of the islets of Langerhans within the ___________. Insulin is released when there is an elevation in the level of blood glucose. The insulin produces an increase in cellular uptake of _____________ for metabolism. Insulin also stimulates the skeletal muscle and liver to _____________ the glucose and increases amino acid transport across hepatic, muscle, and adipose tissues. insulin release affects all systems of the body with its primary goal of reducing _________ ___________ levels.

beta pancreas glucose store blood glucose

Metabolic alkalosis Occurs when there is an increase in _________________ accumulation or an abnormal loss of ___________. As a result, the pH rises above ______. Commonly occurs when there has been continuous _____________, ingestion of antacids or other alkaline substances or diuretic therapy. It may also be associated with hypokalemia or nasogastric suctioning. Symptoms include nausea, diarrhea, prolonged vomiting, confusion, muscle fasciculations, muscle cramping, neuromuscular hyperexcitability, convulsions, paresthesias, and hypoventilation. If left untreated the patient can become comatose, experience seizures, and respiratory paralysis. The most important interventions include managing the underlying cause, correcting coexisting electrolyte imbalances, and administering potassium chloride to the patient.

bicarbonate acid 7.45 vomiting

Gallbladder: Stores and releases _____ into the _______________ to assist with digestion. Liver: Bile is produced and is necessary for absorption of ____________ soluble substances, assists with _______ blood cell and vitamin _________ production, regulates serum level of ____________, proteins, and fats. Pancreas: Exocrine- secretes _______________ and digestive enzymes into the ____________; Endocrine - secretes insulin, glucagon, and other hormones into the blood to regulate serum ____________ level.

bile duodenum lipid red vitamin K carbohydrates bicarbonate duodenum glucose

Tay Sachs Disease (lysosomal storage disorder) Absence or deficiency of hexosaminidase A. This produces an accumulation of gangliosides (GM2) within the _________. This disease is an autosomal recessive inherited trait and carried primarily in the Eastern European Jewish population. At approximately ______ months of age, the child will start to miss developmental milestones and will continue to deteriorate in motor and cognitive skills. As symptoms progress, the patient develops significant intellectual disability and paralysis, and will usually die by the age of ________. There is currently no effective treatment for this condition. Genetic testing in high risk populations to identify the carriers prior to pregnancy is importation in order to avoid this disorder.

brain 6 5

Rehab considerations for patient with IBS 1. Emphasize physical activity to assist with bowel function and relieve stress 2. Emphasize breathing techniques to assist in stress reduction and with breath-_________ patients 3. Recognize that _____________ training may be beneficial

breath-holding biofeedback

Hyperparathyroidism: This condition occurs due to excessive levels of hormone production by the parathyroid gland that leads to disruption of ___________, __________, and bone metabolism. Symptoms may include renal stones and kidney damage, depression, memory loss, muscle wasting, bone deformity, and myopathy. Acute treatment include pharmacological intervention that produces an immediate lowering of serum _______________ using diuretics or antiresorptive medications. Surgical intervention is usually required to remove the disease parathyroid gland. Pharamacologial intervention may be used prior to surgery or for long-term management.

calcium phosphate calcium

Endocrine Management: Bone Mineral Regulating Agents Action: Bone mineral regulating agents attempt to enhance and maximize bone mass along with preventing bone loss or rate of bone reabsorption. Typical agents can include estrogens, _________ and vitamin ____, bisphosphonates, calcitonin, and anabolic agents.

calcium vitamin D

Metabolic Bone disease Classification for particular diagnoses where there has been a disruption in normal metabolism within the skeletal system. The skeletal system houses __________ and _________. It also continuously balances the remodeling of the cortical and trabecular bone in order to optimize the structure of the skeleton. Disruption in the homeostasis of skeletal metabolic processes will result in deformity, bone loss, fracture, softening of the bone, arthritis and pain.

calcium and phosphorus

The metabolic system governs the chemical and physical changes that take place within the body enabling it to grow and function. Metabolism involves breakdown of the body's complex organic compounds in order to generate energy for all bodily processes. It also generates energy for the synthesis of complex substances that form tissues and organs. During metabolism, organic compounds are broken down by a process called ______________, while anabolism is the process that combines simple molecule for tissue growth. Many metabolic processes are facilitated by __________. The overall speed at which an organism carries out its metabolic processes is termed its metabolic __________ (or when the organism is at rest, its basal ___________ ____________).

catabolism enzymes rate metabolic rate

Mouth: Initiation of mechanical and ________________ digestion Esophagus: Transports food from the mouth to the ____________ Stomach: Grinding of food, secretion of __________________ ____________ and other exocrine functions, secretion of hormones that release digestive enzymes from the liver, ____________, and ______________ to assist with digestion.

chemical stomach hydrochloric acid liver, pancreas, and gallbladder

Contact dermatitis Superficial irritation of the skin resulting from localized irritation (e.g. poison ivy, latex, soap, jewelry sensitivity). This condition can be acute or __________ based on exposure to the precipitating agent. Contact dermatitis is a very common skin disease that can occur at any age. Occurs with exposure to mechanical, chemical, environmental, or biological agents. Nickel, rubber, latex and topical antibiotics are common precipitating agents. Patients experience intense itching, burning, and red skin in areas corresponding to the location of the topical irritation. __________ may also occur in the area of sensitivity and symptoms can ________beyond the initial point of topical irritation. The focus of treatment should be on identifying and removing the source of irritation. Topical ____________ application is commonly employed. Acute lesions should resolve with treatment once exposure to the external irritant has been removed.

chronic edema extend steroids

Hypertrophic scarring is the result of an imbalance between __________ synthesis and lysis during healing, and can occur with any integumentary injury. The development of hypertrophic scarring is particularly common in relation to severe ______ injuries. Complications of hypertrophic scarring may include contracture, adhesions, hypersensitivity, functional limitation, and poor Cosmesis. Scar assessment: Assessment devices, such as a tonometer, and rating scales aid in quantifying scar characteristics. A number of rating scales are available to objectively document observed characteristics. These tend to be more helpful in the assessment and re-assessment of an individual rather than for comparative assessment of a group. General characteristics that should be documented include location, sensation, texture, pigmentation, vascularity, pliability, and height. Scar massage: friction massage is advocated to loosen adhesions between cutaneous scar tissue and underlying structures. Reported benefits include decreased sensitivity and improved pliability. Caution should be taken not to begin scar massage too soon or too aggressively due to the risk of causing re-injury or re-initiating the inflammatory phase of healing. Massage techniques should be slow and firm using perpendicular, parallel, circular, and .ore rolling strokes to mobilize tissue layers. Compression garments: Compression therapy to reduce hypertrophic scarring is typically recommended for burns requiring greater than _____ days to heal. The use of sustained compression from _____-_____ mmHg is believed to create an environment that facilitates the balance of collagen synthesis and lysis, improving scar structure. Compression is applied by custom-made garments worn for 22-23 hours per day until the scar has matured. Silicone or foam inserts may be necessary to provide sufficient pressure over a small areas or concave surfaces. For optimal effect, it is recommended that the use of compression garments begins between __________ weeks and _________ months after wound closure or grafting, continuing for up to ________ years.

collagen burn 14 days to heal 15-35 mmHg two week and two months two years

Gentamicin Advantages: 1. Broad-spectrum 2. May be ________ or left open to air Disadvantages: 1. Has caused resistant strains 2. _________toxic 3. ___________toxic

covered ototoxic nephrotoxic

Metabolic disorders are classified by the particular building block that is affected. An enzyme deficiency leads to accumulation of the substrate and a subsequent deficiency in the intended enzyme's product. There are many different disorders that occur genetically and these are grouped according to the substrate that has been affected (i.e. carbohydrates, amino acids). Inherited metabolic disorders can be diagnosed in utero via amniocentesis or chorionic villus sampling. Many inherited metabolic disorders will produce symptoms in a newborn including lethargy, apnea, poor feeding, tachypnea, vomiting, hypoglycemia, urine changes, and seizures. Symptoms that are immediately apparent indicate a more __________ disorder.

dangerous

Hypothalamus Part of the ______________ located below the thalamus and cerebral hemisphere. The hypothalamus connects to the _________ ________ through the infundibular or pituitary stalk. It is responsible for regulation of the autonomic nervous system (body temperature, appetite, sweating, thirst, sexual behavior, rage, fear, blood pressure, sleep) and other endocrine glands through its impact on the ________ ___________.

diencephalon pituitary gland pituitary gland

Rehab considerations for patients with inherited metabolic disorders: must have an awareness of _________ restrictions.

dietary

Phenylketonuria (amino acid/organic acid metabolic disorder) PKU is a syndrome that consists of intellectual ______________ as well as behavioral and cognitive issues secondary to an elevation of serum phenylalanine. There is a deficiency of phenylalanine hydroxylase. Normally, excessive phenyalanine is converted to tyrosine by phenylalanine hydroxyglase. When this process does not occur and there is an excess of pheylalanine, the _________ is the primary organ that gets affected. Children in the US are tested at birth for PKU and levels greater than _____ mg/dl of phenylalanine requires some form of treatment. This is an autosomal recessive inherited trait and is most common in Caucasian populations. Symptoms will typically present within a few months of birth as the phenylalanine accumulates. If left untreated, severe intellectual disability will occur. These children may also experience gait disturbances, hyperactivity, psychoses, abnormal body odor, and display features that are lighter in coloring when compared to other family members. Phenylketonuria is treated through dietary restriction of phenylalanine throughout the person's lifetime. Adequate prevention will avoid all manifestation of the disease.

disability brain 6

Amine hormones (e.g. catecholamines) Catecholamines (epinephrine, norepinephrine, and _____________) are synthesized from chromaffin cells within the _________ ___________. Sympathetic nervous system stimulation releases the catecholamines into the bloodstream. Epinephrine has one of the largest effects on the sympathetic nervous system and creates the fight of flight response. The target areas for epinephrine are receptor sites in the ___________ and __________________ systems. Other functions of catecholamines including increasing cardiac contraction, constriction of blood vessels, activation of glycogen breakdown, blocking of insulin secretion, increasing metabolic rate, and dilation of the airways within the lungs.

dopamine adrenal medulla cardiovascular metabolic

Key function of the endocrine system The endocrine system consists of endocrine glands (specialized ________ glands) that secrete hormones that travel through the bloodstream to signal specific target ___________ throughout the body. The hormones travel throughout the body to the target organs upon which they act. They will bind selectively to receptor sites on the surface of the receptor cells. The endocrine system and ________system both function to achieve and maintain stability of the internal environment (homeostasis). The systems are capable of working alone or in concert with each other. The endocrine and nervous systems work together to regular metabolism, response to stress, sexual reproduction, blood pressure, and water and salt balances.

ductless cells nervous

Acid-Base Metabolic Disorders: The process of metabolism is regulated by the ___________ and _______________ systems. The rate of metabolism can be influenced by body temperature, exercise, hormone activity, and digestion activity. If proper fluid or acid-base balance is compromised, it can later metabolic function and cause many signs and symptoms of the dysfunction.

endocrine neurologic

Topical agents Silver Sulfadiazine: Advantages: 1. Can be used with or without dressings 2. Painless 3. Can be applied to wound directly 4. Broad spectrum 5. Effective against yeast Disadvantages: 1. Does not penetrate into ___________

eschar

Mafenide Acetate Advantages: 1. Broad-spectrum 2. Penetrates burn __________ 3. May be used with or without occlusive dressings Disadvantages: 1. May cause _________ acidosis 2. May compromise respiratory function 3. May inhibit __________________ 4. _____________ application

eschar metabolic epithelization painful application

Ovaries Provide estrogen and progesterone that contribute to regulation of the menstrual cycle and pregnancy. Estrogen is secreted by the ovarian _______________ and is responsible for the development and maintenance of female sex characteristics such as breast development and the cycles of the female reproductive system. Progesterone is produced by the __________ luteum and functions to maintain the lining of the ________________ at a level necessary for pregnancy. Testes The testes secrete ________________ (most importantly ______________) that regulate body changes associated with _____________ development and support the production of ___________.

follicles corpus uterus androgens testosterone sexual sperm

Parathyroid gland There are __________ parathyroid glands found on the posterior surface of the thyroid's lateral lobes. These glands produce parathyroid hormone, which functions as an antagonist to calcitonin and is important for the maintenance of normal ___________ levels of ___________ and _______. Parathyroid hormone increases the reabsorption of calcium and phosphate from bones to the ___________. Secretion of parathyroid hormone is stimulated by hypo__________ and inhibited by hypercalcemia. Normal clotting, neuromuscular excitability, and cell membrane permeability are dependent on normal calcium levels.

four blood calcium phosphate blood hypocalcemia

Onychomycosis Refers to a ___________ infection that primarily affects the toenails and nailbeds. Onychomycosis is divided into subtypes, but are typically medically treated in a similar fashion. Acquiring a fungal infection can be a fairly common occurrence. Risk factors include manicures and pedicures with unsterile utensils, possessing nail injuries or deformities, excess skin moisture, wearing closed toe shoes, and an impaired immune response. Yellow or brown nail discoloration, hyperkeratosis and hypertrophy of the nail causing it to partially detach from the nailbed. Manual debridement of the nail and topical antifungal medications are primary interventions. Fungal infections may return to the nailbeds and in some cases, the nails may have permanent damage.

fungal

Catabolism: The metabolic process in which complex materials (e.g. proteins and lipids) are broken down in the body for the purpose of creating and releasing _________ and __________.

heat and energy

DNA (Deoxyribonucleic acid): A double __________ molecule that contains the genes that provide the blueprint for all of the structures and functions of a living being. Gene: A fundamental unit of heredity. Metabolism: The physical and chemical processes of cells burning fuel to produce and use ____________. Examples include digestion, elimination of waste, breathing, thermoregulation, muscular contraction, brain function, and circulation. Mitochondria: The part of the cell that is responsible for ___________ production. The mitochondria are also responsible for converting nutrients into energy and other specialized tasks. Osteopenia: A condition presenting with low bone mass that is not severe enough to qualify as osteoporosis. Individuals with osteopenia may not have actual bone loss, but a naturally lower bone density than established norms. Osteopetrosis: A group of conditions characterized by impaired __________ function which causes bone to become thickened but fragile. Osteopetrosis is an inherited condition that can vary widely in symptoms and severity. pH: A measure of the ______________ ion concentration in body fluid.

helix energy energy osteoclast hydrogen

Endocrine system: Secreting cells send hormones through the bloodstream to signal specific target cells ____________ diffuse into the blood and travel long distances to virtually every area of the body. Endocrine effectors consist of virtually ________ tissues Regulatory effects are _________ and tend to last for long periods

hormones all tissues slow

Cushing's Syndrome A form of adrenal dysfunction that presents with __________function of the adrenal gland, allowing for excessive amount of cortisol (glucocorticoid) production. When the _____________ gland produces excessive adrenocorticotropic hormone (ACTH) with subsequent hypercortisolism, it is termed Cushing's syndrome. Symptoms evolve over years and can include persistent __________glycemia, __________failure, truncal obesity, purple abdominal striae, "moon shaped face", "buffalo hump" posteriorly at the base of the neck, weakness, acne, _________tension, and male gynecomastia. Mental changes can include depression, poor concentration, and memory loss. Treatment may include pharmacological intervention to block the production of the hormones, radiation therapy, chemotherapy, or surgery.

hyperfunction pituitary gland hyperglycemia growth hypertension

Grave's disease The most specific cause of ___________thyroidism. Grave's disease is most common in women over age 20, however, it occurs in men as well and can affect any age group. Grave's disease is caused by an autoimmune disease in which certain antibodies produced by the immune system stimulate the thyroid gland causing it to become overactive. The classic signs of Grave's disease include mild enlargement of the thyroid gland, heat intolerance, nervousness, weight loss, tremor, and palpitations. Management includes pharmacological intervention and/or removal of the thyroid gland using radiation or surgical intervention.

hyperthyroidism

Postpartum thyroiditis refers to a painless inflammation of the thyroid occurring in some women after childbirth. The presentation of this condition is typically defined by two phases. Initially, a state of __________thyroidism will present within the first one to four months following childbirth. This is followed by a shift to ___________thyroidism four to eight months following delivery.

hyperthyroidism hypothyroidism

Parathyroid dysfunction: Hypoparathyroidism: This condition occurs due to hyposecretion of low-level production of parathyroid hormone by the parathyroid gland. Symptoms may include hypo____________, neurological symptoms such as seizures, cognitive defects, short stature, tetany, muscle pain, and cramps. Treatment of acute hypoparathyroidism requires rapid elevation in serum ____________ levels through intravenous calcium. Long-term treatment includes pharmacological management and dietary modifications.

hypocalcemia serum calcium

Adrenal Dysfunction Addison's Disease Presents with ___________function of the adrenal ____________. Subsequently, there is decreased production of both ____________ (glucocorticoid) and ___________ (mineralcorticoid). When the adrenal cortex produces insufficient cortisol and aldosterone hormones it is termed Addison's disease. Symptoms include a widespread metabolic dysfunction secondary to cortisol deficiency as well as fluid and electrolyte imbalances secondary to aldosterone dysfunction. The person may experience _________tension, weakness, anorexia, weight loss, altered pigmentation, and if left untreated this condition will result in shock and possible death. Treatment primarily consists of long-term pharmacological intervention using synthetic corticosteroids and mineralocorticoids.

hypofunction adrenal cortex cortisol aldosterone hypotension

Pituitary gland The size of a pea and is located at the base of the brain just beneath the _____________. The pituitary gland consists of two separate glands, the _________hypophysis (anterior) and the __________hypophysis (posterior). The pituitary gland is considered the most important part of the endocrine system since it releases hormones that regulate several other endocrine glands. This "master gland" is influenced by factors such as seasonal changes or ____________ stress. The pituitary gland secretes ____________ that act on the nervous system and reduce a person's sensitivity to __________. It also controls ovulation and works as a catalyst for the testes and ovaries to create ________ hormones.

hypothalamus adenohypophysis (anterior) neurohypophysis (posterior) emotional endorphins pain sex

In both males and females, the __________________ produces gonadotropin-releasing hormone (GnRH) and the _____________ responds by producing ____________ hormone and ___________-____________ hormone. In males, the Leydig cells of the testes respond to these hormones with the production of ________________. This cycle normally occurs on a daily basis. In females, in the ovaries, LH acts on the theca and interstitial cells to produce progestins and androgens, and FSH acts on granulosa cells to stimulate the precursor steroids to estrogen.

hypothalamus pituitary luteinizing hormone follicle stimulating hormone testosterone

Endocrine system pathology In many instances, it is the ____________ or the ______________ gland that affects the unction of other endocrine glands when they experience direct of indirect dysfunction. Hyperfunction of an endocrine gland: usually secondary to overstimulation of the ____________ ___________. This can also occur due to hyperplasia or neoplasia of the gland itself. Hypofunction of an endocrine gland: usually secondary to understimulation of the _____________ __________. This can also occur from ______________ or ___________ disorders.

hypothalamus pituitary gland pituitary gland pituitary gland acquired or congenital

Eczema Also referred to as dermatitis, is used to describe a group of disorders that cause chronic skin inflammation typically due to an _________ system abnormality, allergic reaction or external irritant. Eczema's etiology is based on the particular form of the disorder. Infants and children are at higher risk for eczema, however, many outgrow the condition with age. The geriatric population is also at an increased risk for many forms of eczema. Signs and symptoms: Red or brown-gray, itchy, lichenified skin plaques that may exacerbated by some topical agents such as soaps and lotions. The younger population will also frequently experience oozing and crusting of the patchy areas of irritation. Treatment: Pharmacological interventions are variable ranging from topical or oral corticosteroids to oral antibiotics and antihistamines. Cold compresses and other modalities may assist with reducing the itching. Stress management techniques and avoidance of extreme temperatures should be employed to avoid potential exacerbations of the condition.

immune

Rehab considerations for patients with peptic ulcer disease 1. Asymptomatic patients with history of ulcer should be monitored for signs of bleeding 2. Fatigue level, pallor, and exercise tolerance must be monitored for signs of bleeding 3. Recognize that heart rate ___________ or blood pressure ___________may be signs of bleeding. 4. Recognize that _________ pain is a sign of perforated ulcer located on the posterior wall of the stomach and duodenum 5. Recognize that pain that radiates from the midthoracic area to the __________ upper quadrant and ____________ may signify blood and acid within the peritoneal cavity secondary to a perforated and bleeding ulcer.

increases decreases back right right

Pancreas dysfunction Type 1 Diabetes Mellitus (DM) This form of DM occurs when the pancreas fails to produce enough or any _____. This form of diabetes is normally diagnosed in childhood, but can occur at any age. It is also known as insulin-dependent diabetes or juvenile diabetes. The exact cause is unknown, but genetic predisposition in combination with exposure to a viral or environmental trigger is believed to cause an immune reaction that damages the pancreas with subsequent failure in secretion of endogenous insulin. Symptoms of DM include a rapid onset of symptoms, polyphagia, weight loss, ketoacidosis, polyuria, polydipsia, blurred vision, dehydration, and fatigue. Management includes exogenous insulin injections that are required to maintain proper glucose blood levels and avoid complications. Proper nutritional management is also required for blood glucose control. Insulin pumps may be indicated for continuous administration of insulin. Presently, there is no cure for type 1 DM and as a result, the goal is to control the regulation of blood glucose levels.

insulin

Type 2 Diabetes Mellitus This form of DM typically occurs in the population over the age of 45, however, there has been an increase in children diagnosed with type 2 DM secondary to a rise in childhood obesity. This form of DM typically retains the ability to produce some endogenous ___________. Type 2 DM occurs secondary to an array of dysfunctions resulting from the combination of ____________ to insulin action and inadequate insulin ___________. This disorder is characterized by ___________glycemia when the body cannot properly response to insulin. Obesity is found to contribute to this condition by increasing insulin ____________. Symptoms are relatively the same as type 1, however, ________________ does not occur since insulin is still typically produced. Treatment of type 2 diabetes includes blood glucose control through diet, exercise, oral medications or insulin injections when necessary.

insulin resistance secretion hyperglycemia resistance ketoacidosis

Rehab considerations for patients with diverticular disease 1. Physical activity assists the bowel function is extremely importation during periods of remission 2. Breathing techniques will assist in stress reduction and with breath-holding 3. Avoid any increase in __________-abdominal pressure with exercise or activity 4. Back pain and/or referred hip pain must be examined for possible medical diseases

intra-abdominal

Adrenal glands The two adrenal glands are located on top of each _____________; the outer portion is called the adrenal cortex and the inner portion is called the adrenal medulla. The adrenal cortex and the adrenal medulla secrete different hormones. The adrenal cortex produces __________________ that will regulate __________ and _________ balance, the body's response to stress, the immune system, sexual development and function, and metabolism. The adrenal medulla produces ______________ that increases ________ rate and ___________ _________ when there is an increase in stress.

kidney corticosteroids water and sodium epinephrine heart rate and blood pressure

Pancreas Located in the upper ________ quadrant of the abdominal cavity, extending from the duodenum to the spleen. The pancreas includes both endocrine and exocrine tissues. The islets of Langerhans are the hormone-producing cells of the pancreas. Alpha cells produce _________ and beta cells produce ___________. These hormones work in combination to ensure a consistent level of ____________ within the bloodstream and properly maintain stores of energy within the body.

left glucagon insulin glucose

Intestines Malabsorption Syndrome Characterized by a group of pathologies where there is reduced intestinal absorption and inadequate nutrition. Celiac disease, cystic fibrosis, pancreatic carcinoma, pernicious anemia, AIDS, Crohn's disease, and Addison's disease are a few pathologies that may present with malabsorption syndrome. Malabsorption syndrome occurs secondary to defects in digestion and/or the inability of the intestinal mucosa to absorb the nutrients from digested food. Although each patient's symptoms are based on the root pathology and co-morbidities that may exist, the primary symptoms are weight _________, chronic _____________, and anemia. Other symptoms can include fatigue, abdominal bloating, steatorrhea (oil covered stools), abdominal cramps, indigestion, bone pain, and excessive gas. Once diagnosed, treatment includes avoidance of the underlying cause for the malabsorption, probiotics, antibiotics, dietary modification, and nutritional support including vitamins, minerals, and electrolytes.

loss chronic diarrhea

Aerobic metabolism: The ATP producing metabolic processes that are dependent on oxygen transported via the circulatory system. Aerobic metabolic functions typically provide energy for _______ intensity and/or _________ duration activities. Anabolism: The metabolic process in which simple molecules are combined to create the complex molecules (e.g. proteins) needed for tissue and ___________ growth. Anaerobic metabolism: Metabolic functions that do not require the presence of __________ and produce energy for ____________ intensity, __________ duration activities. Adenosine Triphosphate: The molecular unit within the body which ___________ the chemical compounds used for cellular metabolism.

low longer organ oxygen high short transports

Osteoporosis Osteoporosis is a metabolic condition that presents with a decrease in bone _____________ that subsequently increases the risk for fracture. Osteoporosis primarily affects ___________________ and _______________ bone where the rate of bone ___________ accelerates while the rate of bone formation declines. Declining ____________ function coupled with the loss of calcium and phosphate salts will cause the bones to become brittle. Primary osteoporosis can include idiopathic, post-menopausal or involutional (senile) osteoporosis. Secondary osteoporosis can occur as a result of another primary condition with use of certain medications. Symptoms include compression and other bone fractures, low thoracic or lumbar pain, loss of lumbar lordosis, deformities such as kyphosis, decreased in _________________, dowager's hump, and postural changes. Management of primary osteoporosis includes vitamin and pharmacological intervention, proper nutrition, assistive and adaptive device prescription, and patient education. Surgical intervention may be required for fracture stabilization.

mass trabecular and cortical absorption osteoblast height

Peptic Ulcer Disease A condition where there is a disruption or erosion in the GI ____________. There is an imbalance between the protective mechanisms of the stomach and the secretion of __________ within the septic. Many ulcers are caused by the H. pylori infection and chronic NSAID use. Irritants that increase risk of ulcer include _____________, alcohol, particular medications, foods, and smoking. Symptoms are dependent on the location and severity of ulceration (gastric or duodenal) and can include epigastric pain, burning or heartburn, nausea, vomiting, bleeding, bloody stools, and pain that comes in waves that is relieved by ____________. Symptoms specific to the etiology of H pylori can also include halitosis, rosacea, and flushing. Complications can include hemorrhage, perforation, obstruction (secondary to scarring), and malignancy. Treatment is primarily through pharmacological intervention, however, in more severe cases, surgical intervention may be required.

mucosa acid stress eating

Gastritis Is the inflammation of the gastric ________ or inner layer of the stomach. Symptoms are similar to GERD, however, they tend to have higher ___________. Gastritis is classified as erosive or nonerosive based on the level and zone of injury. Erosive Gastritis: (acute gastritis) Etiology includes ___________ from the gastric mucosa secondary to ___________, NSAIDs, alcohol utilization, viral infection, or direct trauma. Symptoms include dyspepsia, nausea, vomiting, hematemesis. At times, the patient may be asymptomatic. Treatment is supportive with removal of the stimulus of the disease process and pharmacological intervention. Surgical procedures may be required if the bleeding continues. Non-erosive Gastritis: (chronic type _______ gastritis) This condition is typically a result of a H. Pylori infection Signs and Symptoms: The patient is usually asymptomatic but will show symptoms if the gastritis progresses Treatment: H. Pylori is a ______________ and must be treated aggressively. Pharmacological intervention is most common and typically include a proton pump inhibitor and antibiotics.

mucosa intensity bleeding stress B carcinogen

Mitochondrial disorders: There are over one hundred different forms of mitochondrial diseases and each produces a different spectrum of disability and clinical manifestations. Mitochondrial disorders result from genetically inherited or spontaneous ___________ in the DNA that lead to impaired function of proteins found within the mitochondria. Symptoms vary depending on the type of mitochondrial disorder, however, can include loss of muscle coordination, muscle weakness, visual and hearing problems, learning disabilities, heart, liver, and kidney disease, respiratory, neurological, and gastrointestinal disorders, and dementia. These diagnoses are relatively new and treatment is as varied as the symptomatology and presentation of the disease. Treatment is aimed at alleviating the current symptoms and slowing the progression of the disease process.

mutation

Rehabilitation considerations for patients with GI disease: 1. Recognize electrolyte imbalances from diarrhea, vomiting, and weight loss 2. Recognize the potential for __________ ________ secondary to electrolyte imbalances 3. Increased risk for muscle _________ secondary to alteration in the __________-_____________ pumps 4. Potential for difficulty swallowing secondary to _______ protrusion or esophageal pathology. 5. Recognize that back pain and/or __________ pain may be secondary to an acute ulcer or _________ bleed. 6. Observation of Kehr's sign indicates free air or blood within the abdominal cavity.

orthostatic hypotension cramping sodium-potassium disk shoulder GI

Paget's disease: A metabolic condition characterized by heightened _______________ activity. This process of excessive bone formation lacks true structural integrity. The bone appears ____________, but lacks strength due to the high turnover of bone secondary to abnormal osteoclastic proliferation. This disease has a genetic component as well as geographical incidence, and most commonly affects patients over 50 years of age. Symptoms include musculoskeletal pain accompanied by bony deformities (kyphosis, coxa varus, bowing of the long bones, vertebral compression). The skull, clavicle, pelvis, femur, spine, and tibia are common sites that will exhibit bony changes. Symptoms of advanced progression of the disease include continued pain, headache, vertigo, hearing loss, mental deterioration, fatigue, increased cardiac output, and heart failure (secondary to an increased cardiac output). Management relies heavily on pharmacological intervention using bisphosphonates, in order to inhibit bone resorption and improve the quality of the involved bone. Exercise, weight control, and cardiac fitness are all key components in a program to maintain strength and motion.

osteoclast enlarged

Rehab considerations for patients with malabsorption syndrome: 1. Recognize increased risk for _____________ and pathologic fractures 2. Monitor fatigue level, pallor, bone pain, and exercise tolerance 3. Recognize weight loss and abdominal bloating 4. Recognize increased risk for muscle spasms secondary to ______________ imbalances 5. Recognize increased risk for generalized swelling secondary to _________ depletion.

osteoporosis electrolyte protein

Psoriasis-Plaque Chronic autoimmune disease of the skin and is the most common of the five types of psoriasis. T cells trigger inflammation within the skin and produce an accelerated rate of skin cell growth. The skin cells accumulate in raised _______ patches on the surface of the skin. Some patients have a genetic predisposition to plaque psoriasis. Other factors may trigger psoriasis, such as injury to the skin, insufficient or excess sunlight, stress, excessive alcohol, HIV infection, smoking, and certain medications. The primary symptom is red raised blotches that typically present in a bilateral fashion for example over both knees or elbows. These plaques can appear anywhere on the body and will tend to itch and flake. Complications can include arthritis, pain, severe itching, secondary skin infections, and side effects secondary to pharmacological interventions. The primary goal for treatment of plaque psoriasis is to control the symptoms and prevent secondary infection. Treatment varies widely from tropical applications to systemic medications and phototherapy. Plaque psoriasis is a life-long condition that can be effectively managed and controlled through the various stages and exacerbations.

red

Nitrofurazone Advantages: 1. Bacteriocidal 2. Broad-spectrum Disadvantages: 1. May lead to overgrowth of fungus and pseudomonas 2. ____________ application

painful

Silver Nitrate Advantages: 1. Broad-spectrum 2. Non-allergenic 3. Dressing application is painless Disadvantages: 1. Poor ___________ 2. Discolors; making assessment difficult 3. Can cause severe electrolyte imbalances 4. __________ of dressings is painful

poor penetration removal of dressing is painful

Steroid hormones (e.g. _________________) All cells create prostaglandins from the phospholipids of the cell membrane. They are unique from other hormones since they do not circulate in the __________________ and instead exert their effects only where they are produced. Prostaglandins are capable of producing a wide variety of effects; some effects as it pertains to rehab are related to inflammation, pain mechanisms, vasodilation, vasoconstriction, nutrient metabolism, and blood clotting.

prostaglandins blood

Rehab considerations for patients with GERD 1. Avoid certain exercises secondary to an increase in symptoms with activity; _______________ will induce symptoms. 2. Recognize increased incidence of neck and head discomfort secondary to perception of a ______________ in the throat and subsequent compensation. 3. __________ sidelying preferred since __________ sidelying may promote acid flowing into the esophagus. 4. Recognize conditions such as chronic bronchitis, asthma, and pulmonary fibrosis may all present with GERD 5. Recognize that tight clothing, exercise, and constipation may all precipitate GERD 6. Consider that certain positioning during postural drainage may encourage acid to move into the esophagus.

recumbency lump left right

Cholecystitis and Cholelithiasis Refers to inflammation of the gallbladder that may be acute or chronic The most common etiology is gallstones (cholelithiasis) that have become impacted within the cystic duct. Gallstones develop from hypomobility of the gallbladder, supersaturation of the bile with cholesterol or crystal formation from bilirubin salts. These stones can also cause infection which exacerbate the condition. Many times gallstones are asymptomatic, however, the most common symptom is ________ upper quadrant pain. If the gallstone becomes lodged within the cystic duct., then the patient can experience many problems including severe right upper quadrant pain with muscle guarding, tenderness, and rebound pain. These symptoms can radiate to the _________________ region. Other symptoms include jaundice, fever, nausea, vomiting, anorexia, and abdominal rigidity. Treatment is not recommend for the patient with _____________ gallstones, but a low fat diet can decrease gallbladder stimulation if mild symptoms are present. If patients are symptomatic, a lithotripsy procedure can be used in an attempt to break up and dissolve the stones. Primary treatment is a laparoscopic cholecystectomy to remove the gallbladder and the lodges stones from the ducts. Acute cholecystitis should resolve itself within a week with analgesics, antibiotics, and intravenous alimentary feedings.

right interscapular asymptomatic

Cirrhosis of the liver healthy tissue of the liver is replaced with ________ tissue that blocks the flow of ________ through the organ and prevents the liver from functioning properly. The etiology is usually alcoholism or hepatitis ______. Alcohol tends to block the normal metabolism of protein, fats, and carbohydrates. This condition will normally occur after a patient has been heavily drinking for more than a _________. Inflammation of the liver secondary to hepatitis C is also a large causative factor for cirrhosis. Persistent inflammation and slow damage to the liver will result in cirrhosis of the liver after several decades of infection. Other causes include hepatitis ___ and ___, certain drugs, infections, and toxins, specific hereditary diseases, nonalcoholic steatohepatitis, and blocked bile ducts. Symptoms include fatigue, decreased appetite, nausea, weakness, abdominal pain, spider angiomas, and weight loss. Common complications from cirrhosis include ascites (water accumulation in the abdomen secondary to decreased production of albumin by the liver), edema in the lower extremities, jaundice, gallstones, increased itching, ecchymosis, bleeding, an increase in sensitivity to medications, accumulation of toxins in the brain, portal vein hypertension, development of varices (enlarged blood vessels in the stomach and esophagus), immune system dysfunction, encephalopathy, and liver cancer. Treatment cannot reverse the process or damage, but can slow the process. Treatment is based on the causative factors and is implemented until symptoms cannot be controlled. A liver transplant may be necessary to sustain life.

scar blood C decade B and D

Female hypogonadism Primary hypogonadism results if the gonad does not produced the amount of sex steroid sufficient to suppress secretion of LH and FSH at normal levels. The most common cause of primary hypogonadism is Turner syndrome. Secondary hypogonadism occurs when there is a failure of the hypothalamus or pituitary to produce the hormones that subsequently stimulate the production of estrogen. If a female experiences this prior to puberty symptoms will include gonadal dysgenesis, a ________ stature, failure to progress through puberty or primary amenorrhea, and premature gonadal failure. When hypogonadism occurs in postpubescent females, secondary amenorrhea is the primary symptom. Treatment includes hormone replacement pharmacological intervention.

short

Osteomalacia Is a metabolic condition where bones become ____________ secondary to a calcium or ___________ deficiency. There is adequate bone ____________, however, there is insufficient ________________ of the matrix due to the deficiency. Calcium is typically lost secondary to inadequate intestinal absorption and the phosphorus is lost secondary to an increase in _________ excretion. A deficiency in vitamin ___ will also cause osteomalacia. Osteomalacia can include a vague presentation of aching, fatigue, and weight loss. Myopathy and sensory polyneuropathy may also occur along with periarticular tenderness and pain, thoracic __________ deformity, and __________ of the lower extremities. The patient may also struggle to perform transfers and assume a standing position. Specific intervention will focus on the underlying etiology. Increased nutrition is recommended and pharmacological intervention may include vitamin ______ or __________ supplements.

soft phosphorous matrix calcification renal D

Diarrhea/Constipation: An abnormal frequency of volume of stool and can appear as a symptom of certain GI pathologies. Constipation is defined as the infrequent or difficult passage of ___________, secondary to an increase in the hardness of the stool, and can also appear as a symptom of certain GI pathologies.

stool

Nervous system Neurons secrete neurotransmitters to signal nearby cells that have an appropriate receptor site Neurotransmitters are sent very short distances across a ___________ Nervous effectors are limited to muscle and ____________ tissue Regulatory effects appear ________ and are often short lived

synapse glandular rapidly

Allograft: A _________ skin graft taken from another ___________, usually a cadaver, in order to cover a __________ burned area. Autograft: A _____________ skin graft taken from a donor site on the patient's own body. Donor site: A site where health skin is taken and used as a graft. Escharotomy: A surgical procedure that opens or removes eschar from a burn site to reduce tension on a surrounding structure, relieve pressure form interstitial ___________, and subsequently enhance _______. Full-thickness graft: A skin graft that contains the _______ and ____________. Heterograft (xenograft): A _______________ skin graft taken from another species. Mesh graft: A skin graft that is altered to create a mesh-like pattern in order to cover a larger surface area. Recipient site: A site that has been burned and requires a graft. Sheet graft: a skin graft that is transferred directly from the unburned donor site to the prepared recipient site. Split-thickness graft; A skin graft that contains only a ___________ layer of the dermis in addition to the epidermis. Z-plasty: A surgical procedure to eliminate a scar ____________. An incision in the shape of a "z" allows the contracture to change configuration and lengthen the scar.

temporary human large permanent edema circulation dermis epidermis temporary superficial contracture

Male hypogonadism: Defined as a deficiency of _____________ secondary to failure of the testes to respond to __________ and _______ (produced by the pituitary and hypothalamus). the most common cause of primary hypogonadism is Klinefelter's syndrome (CALVIN KLIEN underwear). Secondary hypogonadism occurs when there is a failure of the hypothalamus or pituitary to produce hormones that will subsequently stimulate the production of testosterone. If a male experiences this prior to puberty, symptoms will include sparse body hair, underdevelopment of skeletal muscles, and ________ arms and legs secondary to a delay in the closure of the epiphyseal growth plates. Adult-onset testosterone deficiency will present with a decreased libido, erectile dysfunction, infertility, decreased cognitive skills, mood changes, and sleep disturbances. Treatment includes hormone replacement pharmacological intervention.

testosterone FSH and LH long

Hyperglycemia Early signs of hyperglycemia that can occur when blood glucose is > 180-200 mg/dl include increased _________ and frequent urination. Recognition of these early signs is crucial in preventing the dangerous onset of ketoacidosis, often referred to as "diabetic _________". Most commonly occurring in patients with type 1 DM, ketoacidosis is a life-threatening condition requiring immediate medical attention. Symptoms include dyspnea, a fruity breath order, dry mouth, nausea, vomiting, confusion, and an eventual loss of consciousness. Hypoglycemia Early signs of hypoglycemia that may occur when blood glucose is <____ mg/dl include hunger, sweating, shaking, dizziness, clumsiness, and headache. If unaddressed, patients who become hypoglycemic may lose consciousness at which point immediate medical attention is necessary . Hypoglycemia is often counteracted simply by ingestion of a glucose or carbohydrate-rich substance. Patients with significant hypoglycemia issues may be advised by their physician to carry a glucose source or injectable glucagon with them at all times.

thirst coma 70

Thyroid gland The thyroid gland is located on the anterior and lateral surfaces of the _____________ immediately below the larynx and is shaped like a "bow tie" or "butterfly" with two halves (lobes); a right lobe and a left lobe joined by an isthmus. The thyroid produces thyroxine and triiodothyronine that act to control the rate at which cells burn the fuel from ____________. An increase in thyroid hormones will increase the rate of the chemical reactions within the body.

trachea food

Gastroesophageal reflux disease The result of an incompetent lower esophageal sphincter (LES) that allows reflux of gastric contents. This backwards movement of stomach acids and contents can cause esophageal tissue injury over time as well as other pathology. GERD is estimated to occur in 20-30% of adults and can be found in some newborns or infants. The etiologies of GERD include _____________ of the LES, intermittent relaxation of the LES, direct damage of the LES through NSAIDs, alcohol, infectious agents, smoking, and certain prescription medications. Clinical symptoms include heartburn, regurgitation of gastric contents, belching, chest pain, hoarseness and coughing, esophagitis, and hematemesis. If GERD is left untreated, the patient may develop esophageal strictures, esophagitis, aspiration pneumonia, asthma, Barrett's esophagitis, and esophageal adenocarcinoma. Treatment: Primarily through pharmacological intervention.

weakness

Gestational diabetes Condition characterized by an increase in insulin resistance and therefore an increase in blood glucose levels that occurs during pregnancy. This condition generally develops in the last ___________. The etiology of the condition is not known, but it is thought that hormones that assist the fetus to grow and develop also lead to insulin resistance. Gestational diabetes occurs in about 4% of all pregnancies. The large majority of women with gestational diabetes return to normal glucose metabolism after the pregnancy. If glucose intolerance persists for more than six weeks after childbirth, the patient should be reclassified to another form of diabetes mellitus. babies born to women with gestational diabetes have increased glucose levels and are at an increased risk for macrosomia (i.e. larger than average size), which makes delivery more difficult and potentially more dangerous. The baby may also experience ___________ difficulties, jaundice, and __________glycemia following birth. In childhood and adolescence, these children are more likely to experience insulin resistance, obesity, behavior health issues such as hyperactivity disorders, and delays in gross and fine motor skills.

trimester breathing hypoglycemia

Irritable Bowel Syndrome Consists of recurrent symptoms of the ____________ and ________ GI system that interfere with the normal functioning of the ______________. The etiology is unknown, but the one theory believes that the colon or large intestine may be sensitive to certain foods or stress. Other theories hypothesize the immune system, serotonin, and bacterial infections may all be causative factors. IBS typically occurs in as many as 20% of adults, more commonly in females, and begins prior to the age of 30 in 50% of patients. Females have a slightly higher rate of incidence which may be triggered by food sensitivities, stress, anxiety, caffeine, smoking, alcohol or high fat intake. Symptoms can include abdominal pain, bloating, or distention or the abdomen, nausea, vomiting, anorexia, changes in form and frequency of stool, and passing of mucus in stool. IBS is normally a diagnosis of exclusion from other GI diagnoses and treatment is usually multifactorial. Symptoms can be typically controlled by diet, pharmacological intervention, and _____________ management.

upper and lower GI system colon stress

Gangrene (Dry) Gangrene is referred to as dry when there is a loss of _________ supply resulting in local tissue death. Fingers, toes, and limbs are most often affected. The hardened tissue is not painful, however, there may be significant pain at the line of demarcation. Dry gangrene typically develops slowly and in some cases results in _______-amputation. Dry gangrene occurs most commonly in blood vessel disease, such as diabetes mellitus or atherosclerosis. It develops when blood flow to an affected area is impaired, typically as a result of poor circulation. Infection is typically not present in dry gangrene, however, dry gangrene can progress to ________ gangrene if infection occurs. Dry gangrene presents as dark brown or black nonviable tissue that eventually becomes a hardened mass (mummified). The patient may complain of cold or numb skin and they may present with _______. Gangrene is a serious medical condition and requires immediate medical intervention. Depending on the severity, gangrene is treated by pharmacological intervention, surgery, and hyperbaric oxygen therapy.

vascular auto-amputation

Liver Hepatitis An inflammatory process within the liver. Viral hepatitis is the most common and is classified as hepatitis A, B, C, D, E, or G. Hepatitis A, B, and C are the most common. Many instances of hepatitis are __________ in nature. Other etiologies include a ___________ reaction, ________ reaction , or alcohol abuse. Other viruses that can cause hepatitis include Epstein-Barr virus, herpes virus I and II, varicella-zoster virus, and measles. Symptoms of hepatitis include fever, flu symptoms, abrupt onset of fatigue, anorexia, headache, jaundice, darkened urine, lighter stool, enlarged spleen and liver, and intermittent pruritus. Treatment: Acute viral hepatitis usually resolves with medical treatment, but can be become chronic in some cases. Chronic hepatitis may result in the need for a liver ____________. Hepatitis A: Transmission occurs by close personal contact with someone that has the infection or through the fecal-oral route (i.e. contaminated water and food sources). The flu-like symptoms represent an acute infection; this form does not progress to chronic disease or cirrhosis of the liver. Patients usually recover in _____ to ____ weeks. Treatment is supportive and the virus is self-limiting. Hepatitis B: Transmission of this virus occurs through the sharing of needles, intercourse with an infected person, exposure to an infected person's blood, semen or maternal-fetal exposure. Approximately 10% of cases progress to chronic hepatitis since the body cannot always rid itself of HBV. Treatment includes hepatitis B immunoglobulin for the unvaccinated patient within 24 hours of exposure. The patient should then receive the vaccination series at one and six months. If the patient is already vaccinated, they may require another dose of the HBV vaccine. Chronic hepatitis is now being treated with interferon alfa-2b, providing remission for some patients. Hepatitis C: It is one of the primary etiologies for chronic liver disease and eventual liver failure. Transmission of this virus occurs through the sharing of needles, intercourse with an infected person, exposure to an infected person's blood, semen, body fluids or maternal-fetal exposure. The virus accounts for 90% of post transfusion hepatitis cases. Like hepatitis B, this virus is often ________________ and the acute infection can be mild. Patients with hepatitis C have an increased frequency of manifesting conditions such as Hashimoto's thyroiditis, diabetes mellitus, and corneal ulceration. Treatment may include the use of interferon alfa-2b to reduce the inflammation and liver damage but only a small percentage but only a small percentage of patients with hepatitis C benefit from medication. There is no vaccine to prevent this virus and no immunoglobulin fully effective tin treating the infection. Chronic hepatitis occurs in 50% of cases and 20% of those cases progress to cirrhosis of the liver.

viral chemical drug transplant 6 to 10 weeks asymptomatic

Lower GI- Large Intestine: Continues to absorb __________ and ___________, stores and eliminates undigested food as feces.

water and electrolyte

Bone Mineral Density is measured via dual-energy ___________ absorptiometry and expressed in terms of ______-score and ______-score. T-score refers to how many ______________ ________ above or below average healthy young adult norms an individual's BMD is. Z-score refers to how many __________ _____________ above or below average ________ and __________ adjusted norms an individual's BMD is. The WHO reports that in women, a T-score lower than ____ SD but greater than _______ SB is indicative of osteopenia. A score that is _____ SB or lower is indicative of osteoporosis. A score that is at or below ________ SD with _________ or more related fractures is considered ___________ osteoporosis.

x-ray Z-score T-score standard deviations standard deviations age and gender -1 -2.5 -2.5 -2.5 one severe