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Gastrointestinal and Renal Disorders: Symptoms, Diagnosis, and Treatment, Exams of Health sciences

An overview of various gastrointestinal and renal disorders, including their symptoms, diagnosis, and treatment. Topics covered include ulcers (curling's and cushing's), gallbladder disorders (cholelithiasis and cholecystitis), pancreatitis, inflammatory bowel disease, diverticular disease, urinary incontinence, neurogenic bladder, utis, pyelonephritis, nephrolithiasis, polycystic kidney disease, and cancers (kidney and bladder).

Typology: Exams

2023/2024

Available from 03/07/2024

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SUMMARY NUR 2063 / NUR2063: ESSENTIALS OF PATHOPHYSIOLOGY

EXAM 2 BLUEPRINT (LATEST UPDATE) RASMUSSEN

GI disorders

  • Dysphagia Difficulty swallowing o Causes Nero disease: Parkinson’s, dementias, muscular dystrophy, Huntington’s, ALS, MN, Guillain Barre Syndrome. Other: Congenital issues/cerebral palsy, Esophageal stenosis, esophageal diverticula, tumors, stroke, achalasia
  • Vomiting – why and consequences Why: protect against substance, reverse peristalsis, increase intracranial pressure, severe pain. Consequences: lead to fluid, electrolyte, pH imbalance, aspiration o Emesis types and why the emesis would be a problem Hematemesis: blood in vomit (protein), Yellow/green: presence of bile. Deep brown: fecal matter. Undigested food o Treatment of vomiting disorders Antiemetic med., fluid replacement, correct electrolyte imbalance, restore acid-base o Gastritis/gastroenteritis ▪ Acute: Can be mild, transient irritation or can be severe ulceration with hemorrhage ▪ Usually develops suddenly ▪ Likely to also have nausea & epigastric pain ▪ Chronic: Develops gradually ▪ May be asymptomatic but usually accompanied by dull epigastric pain and a sensation of fullness after minimal intake

▪ Complications: peptic ulcer; gastric cancer; hemorrhage

▪ H. pylori: Most common cause of chronic gastritis

▪ Bacteria embeds in mucous layer; activates toxins & enzymes that cause inflammation

▪ Genetic vulnerability & lifestyle behaviors (smoking, stress) may increase susceptible

▪ Other causes: Organisms through food/water contamination, LT NSAID use, Excess alcohol use, Severe stress, Autoimmune conditions ▪ Manifestations of GI bleeding: Indigestion; heart burn, Epigastric pain; abdominal cramping, N/V; anorexia, Fever; malaise, Hematemesis, Dark, tarry stools = ulceration & bleeding

  • Esophageal disorders o Hiatal hernia Stomach section protrudes through diaphragm ▪ Causes: Weakening of diaphragm muscle, trauma, congenital defects. ▪ Manifestation: Indigestion; heartburn; frequent belching; nausea; chest pain; strictures; dysphagia; and soft abdominal mass ▪ diagnosis: H & P; barium swallow; upper GI Xrays; EGD , ▪ treatment: eat small meals, sleep elevated, antacid o GERD ▪ Causes: Certain foods: chocolate, caffeine, carbonated beverages, citrus fruit, tomatoes, spicy or fatty foods, peppermint ▪ Alcohol consumption; nicotine ▪ Hiatal hernia ▪ Obesity; pregnancy ▪ Certain medications – such as corticosteroids; beta blockers; calcium-channel blockers; anticholinergics ▪ NG intubation ▪ Delayed gastric emptying ▪ Manifestations: Heartburn, Epigastric pain, Dysphagia, Dry cough, Laryngitis Pharyngitis, Food regurgitation, Sensation of lump in throat ▪ Treatments: Avoid triggers; avoid restrictive Diagnosis: H & P; barium swallow; EGD; esophageal pH monitoring

▪ clothing ▪ Eat small frequent meals; high Fowler’s positioning, Weight loss; stress reduction; Antacids; acid reducing agent; mucosal barrier agents, Herbal therapies (licorice, chamomile), Surgery ▪ Complications: Esophagitis; strictures; ulcerations; esophageal cancer; chronic pulmonary disease

  • GI tract disorders o Peptic ulcer disease ▪ Duodenal: Most commonly associated with excess acid or H.pylori infections, Typically present with epigastric pain relieved by food ▪ Gastric: Less frequent; more deadly, Typically associated with malignancy and NSAIDs, Pain worsens with food ▪ Symptoms ▪ Curling’s ulcer from what: associated with burns ▪ Cushing’s ulcer from what: associated with head injuries ▪ Complications of ulcers: GI hemorrhage; obstruction; perforation; peritonitis ▪ Manifestations: Epigastric or abdominal pain, Abdominal cramping, Heartburn; indigestion, N/V ▪ Diagnosis: same as gastritis ▪ Treatment: Same as for gastritis, Surgical repair may be necessary for perforated or bleeding ulcers, Prevention is crucial – may need prophylactic medications (ex: acid- reducers) for at-risk clients o Gallbladder disorders ▪ Cholelithiasis: Gallbladder stones ▪ Cholecystitis: Inflammation or infection in the biliary system caused by calculi ▪ Manifestations: Biliary colic; abdominal distension; N/V; jaundice; fever; leukocytosis ▪ Diagnosis: H & P; abdominal Xray; gallbladder US; laparoscopy ▪ Treatments: Low-fat diet, medications to dissolve calculi, Antibiotic therapy, NG tube with intermittent sxn, Lithotripsy, Choledochostomy, Laparoscopic surgery o Liver disorders

▪ Hepatitis – infectious: A, B, C, D, E vs. noninfectious: Giant cell hepatitis, Ischemic hepatitis, Non-alcoholic fatty liver hepatitis, Autoimmune hepatitis, Toxic & drug- induced hepatitis, Alcoholic hepatitis ▪ Transmission of viral hepatitis: If it’s a Vowel, it comes from the Bowel. All others are blood ▪ Define: acute: Proceeds through 4 stages—asymptomatic stage then 3 symptomatic stages chronic: Characterized by continued liver disease > 6 months ▪ Symptom severity and disease progression vary by degree of liver damage ▪ Can quickly deteriorate with declining liver integrity fulminant: Uncommon, rapidly progressing form that can quickly lead to ▪ Liver failure, hepatic encephalopathy, or death within 3 wks

  • Diagnosis: H & P, Serum hepatitis profile, Liver enzymes, Clotting studies, Liver biopsy, Abdominal US
  • treatment for viral hepatitis: treat with interferon & antiviral mediations ▪ Cirrhosis
  • Common causes: Hepatitis and all factors that can lead to hepatitis, Hep C and chronic alcohol abuse most common cause in U.S.
  • What happens to liver: Leads to fibrosis, nodule formation, impaired blood flow, and bile obstruction  liver failure
  • Manifestations: Portal hypertension, Varicosities, Bleeding –slow or severe, Muscle wasting, Bile accumulation, Clay-colored stools, Dark urine, Ulcers/GI bleeding, Encephalopathy, Spontaneous bacterial peritonitis
  • Diagnosis: H & P; liver biopsy; abdominal Xray; liver enzymes; EGD; clotting studies; stool exam for occult blood
  • Treatments: Avoid alcohol, drugs, hepatotoxic meds, Nutritional imbalances usually treated with TPN; metabolic dysfunction corrected, Bile- acid binding agents can aid bile excretion
  • Hepatic encephalopathy o Pancreatitis ▪ Causes: Cholelithiasis, Alcohol abuse, Biliary dysfunction, Hepatotoxic drugs, Metabolic disorders, Trauma, Renal failure, Endocrine disorders, Pancreatic tumors, Penetrating peptic ulcer ▪ What happens to the pancreas in the disorder? pancreatic enzymes to leak into the pancreatic tissue and initiate autodigestion - -results in edema, vascular damage, hemorrhage & necrosis ▪ Acute pancreatitis importance & complications: Medical emergency, Acute respiratory distress syndrome (ARDS), DM, Infection, Shock, Disseminated intravascular coagulation (DIC), Renal failure, Malnutrition, Pancreatic cancer, Pseudocyst, Abscess
  • Manifestations: Sudden and severe, Upper abdominal pain that radiates to the back, worsens after eating, somewhat relieved by leaning forward or pulling knees to chest, N/V, Mild jaundice, Low-grade fever, BP and pulse changes ▪ Chronic pancreatitis manifestations: Usually insidious, Upper abdominal pain, Indigestion, losing weight without trying, Steatorrhea, Constipation,

Flatulence ▪ Pancreatitis diagnosis: H & P, Serum amylase & lipase, Serum calcium level, CBC, Liver enzymes, Serum bilirubin level, ABG, Stool analysis (lipid & trypsin levels), Abdominal Xray, CT/MRI, Abdominal US, ERCP (endoscopic retrograde cholangiopancreatography) ▪ Treatment: fasting; administer IV nutrition; gradually advance diet from clears as tolerated to low fat, Pancreatic enzyme supplements when diet resumed, Maintain hydration with IVF, NG to intermittent suction, Antiemetic agents, Pain management, Antacids/acid-reducing agents, Anticholinergic meds, Antibiotics, Insulin

  • Bowel disorders o Diarrhea – acute: Often d/t bacterial or viral infections ■ Chronic: Lasts longer than 4 weeks, inflammatory bowel diseases, Malabsorption syndromes, Endocrine disorders, Chemo/radiation ■ Causes: ▪ Manifestations ▪ Diagnosis/Bristol stool chart ▪ Treatment o Constipation ▪ Causes ▪ Manifestations & complications

▪ Diagnosis & treatment o Intestinal obstructions ▪ Mechanical: Foreign bodies, Tumor, Adhesion, Hernia, Intussusception or volvulus, Strictures, Crohn’s disease, Diverticulitis, Hirschsprung’s disease, Fecal impaction ▪ Functional: (aka paralytic ileus): Neuro impairment, Intra-abdominal surgery complications, Chemical, electrolyte, mineral disturbances, Intra-abdominal infections, Abdominal blood supply impairment, Renal and lung disease, Use of certain medications (ex: opiates) ▪ The problem with obstructions: Can develop suddenly or gradually and can be partial or incomplete, Chyme and gas accumulate at the site of the blockage, Saliva, gastric juices, bile, and pancreatic secretions begin to collect as blockage lingers, Serum electrolytes and protein increase, causing abdominal distention and pain, Intestinal blood flow can become impaired, leading to strangulation and necrosis, Intestinal contents can seep into the abdomen as pressure increases ▪ Manifestations: Abdominal distension, Abdominal cramping, Colicky pain, N/V, Constipation/diarrhea, Borborygmi, Intestinal rushes, Decreased or absent bowel sounds ▪ Diagnosis: H & P ( including bowel patterns), Blood chemistry, ABG, CBC, CT, Abdominal Xray/US, Sigmoidoscopy, Colonoscopy ▪ Treatment: Strategies depend on underlying cause, Correct fluid, electrolyte, pH imbalances, NG tube to intermittent sxn, Fasting & TPN until bowel function restored, Ambulation, Avoid laxatives until obstruction resolved, Surgery o Appendicitis ▪ What it is ▪ Complications: Abscess, Peritonitis, Gangrene, Death ▪ Manifestations & McBurney’s point: Sharp pain develops and gradually intensifies over 12-24 hrs and localized to RLQ (McBurney point)

▪ Treatment o Peritonitis! ▪ Causes: Chemical irritation (ex: ruptured gallbladder or spleen) ▪ Direct organism invasion (ex: appendicitis or peritoneal dialysis) ▪ Manifestations: Usually sudden & severe, Abdominal rigidity (classic), Abdominal tenderness & pain, Large volumes of fluid leak into peritoneal cavity, N/V, Decreased peristalsis, Intestinal obstruction, Indications of infection, Indications of sepsis ▪ Diagnosis: H & P, CBC, Abdominal Xray, Abdominal US, Abdominal CT, Paracentesis with peritoneal fluid analysis, Laparoscopy ▪ Treatments: Surgery, LT antibiotics, Correcting fluid & electrolytes, NG tube with low intermittent sxn, TPN o Celiac disease ▪ What is this disorder? ▪ Complications ▪ Manifestations ▪ Diagnosis & treatment o Inflammatory bowel diseases ▪ Crohn’s

  • Characteristics: patchy areas of inflammation involving full thickness of the intestinal wall and ulcerations
  • Complications: Malnutrition, Anemia (esp. iron deficiency), Fistula/perforation
  • Adhesion, Abscesses, Intestinal obstruction, Anal fissure, Fluid, electrolyte, and pH imbalances
  • Manifestations: Abdominal cramping & pain (RLQ), Diarrhea/steatorrhea, Constipation, Palpable abdominal mass, Melena, Anorexia, weight loss, Indications of inflammatory reaction
  • Diagnosis: H & P, stool analysis, CBC, blood chemistry, Abdominal Xray, abdominal CT/MRI, Barium studies, Sigmoidoscopy, Colonoscopy, Biopsy
  • Treatment: Low-residue, high-calorie, high-protein diet, Oral supplements & multivitamins, TPN, Antidiarrheal agents, Medications, Surgical intestine resection, Stress management & support ▪ Ulcerative colitis
  • Characteristics
  • Complications: Malnutrition, anemia, Hemorrhage, perforation, Strictures, fistulas, Pseudo polyps, Toxic megacolon, Colorectal cancer, Liver disease
  • Manifestations: Diarrhea –frequent, up to 20/day, Watery stools with blood and mucus, Vomiting, weight loss, Indications of inflammatory process
  • Diagnosis: Similar to Crohn’s, Differences: barium enema, colonoscopy
  • Treatment: Similar to Crohn’s , Surgical intervention = ileostomy or colostomy ▪ IBS
  • Characteristics: Chronic, noninflammatory GI condition characteristics by exacerbations associated with stress
  • Complications: Hemorrhoids, nutritional deficits, social issues, sexual discomfort
  • Manifestations: Stress, mood disorders, some foods, and hormone changes often worsen symptoms, Abdominal distension, fullness, flatus, bloating, Intermittent abdominal pain exacerbated by eating and relieved by defecation, Chronic & frequent constipation or diarrhea, usually with pain, Non-bloody stool which may have mucus, Bowel urgency, Intolerance to certain foods (gas-forming foods, those containing sorbitol, lactose or gluten), Emotional distress, Anorexia
  • Diagnosis (Rome III): H & P, including bowel pattern & Rome III criteria
  • Stool analysis, abdominal CT/MRI/Xray, Barium studies, Sigmoidoscopy/colonoscopy, Biopsy.
  • Treatment: Antidiarrheal agents, Laxatives, Antispasmodics, Antidepressants, Avoid triggers, Maintain adequate fiber intake, Stress management, Support ▪ Diverticular disease
  • What it is: Conditions related to outpouching (diverticula) of intestinal wall layer that occur when mucosa sections or large intestine submucosa layers herniate through a weakened muscular layer
  • Diverticulosis: asymptomatic disease with multiple diverticula
  • Diverticulitis: diverticula are inflamed usually d/t retained fecal matter
  • Manifestations: Abdominal cramping followed by passing large quantity of frank blood, Low-grade fever, Abdominal tenderness (usually LLQ), Abdominal distension, Constipation/ obstipation, N/V, Palpable abdominal mass, Leukocytosis
  • Diagnosis: H & P
  • Stool analysis (including for occult blood), Abdominal CT/MRI, Colonoscopy, Barium enema, Biopsy
  • Treatment: High-fiber diet, Omitting foods with seeds, Decrease food intake during active bleeding, Adequate hydration, Colon resection, Proper bowel habits, Antibiotics, Analgesics
  • GI cancers o Oral cancer ▪ Risk factors, manifestations, treatment o Esophageal cancer ▪ Complications ▪ Manifestations ▪ Treatment o Stomach cancer ▪ Risk factors ▪ Manifestations & treatment o Liver cancer ▪ Manifestations ▪ Treatment o Pancreatic cancer ▪ Risk factors ▪ Manifestations ▪ Treatment o Colorectal cancer ▪ Risk factors ▪ Manifestations & treatment Urinary system disorders
  • What is GFR and why is it important? Glomerular filtration rate, Best indicator of renal function
  • Normal = 125mL/min
  • Kidney hormone function – what hormones, what do they do? Antidiuretic hormone (ADH): water is reabsorbed into the blood, causes arteries to constrict. Aldosterone: reabsorbs more sodium and water,

increases blood volume Renin-angiotensin-aldosterone: regulate blood pressure

  • Urinary incontinence o Difference between types: Enuresis: AKA bedwetting after 4-5 yrs old, Transient: Temporary condition, Causes: Delirium, infection, Certain meds such as diuretics, sedatives, Psychologic factors, High urine output, restricted mobility, Fecal impaction, Alcohol/caffeine use o Risk factors: Female, Advanced age, Overweight, Smoking, Other diseases o Complications: Skin problems, Recurrent UTIs, Negative psychological consequences, Interruption of normal activities o Diagnosis: H & P, Bladder diary, UA/UC, Cystourethrogram, Cystoscopy, Pelvic ultrasound, Postvoid residual measurement, Urodynamic testing o Treatment—simple to invasive
  • Neurogenic bladder o Causes: Brain or spinal cord injury/infections, Nervous system tumors, Dementia/Parkinson disease, Spinal bifida, Diabetes mellitus, Stroke, Medications, Vaginal childbirth, Multiple sclerosis, Chronic alcoholism, SLE, Heavy metal poisoning, Herpes zoster o Manifestations: Symptoms of an over- or underactive bladder

o Diagnosis: H & P, Bladder diary, UA/UC, Cystourethrogram, Cystoscopy, Pelvic ultrasound, Postvoid residual measurement, Urodynamic testing o Treatment: varies

  • UTIs o Risk factors: Female, BPH, Immobility, Urinary or bowel incontinence, Kidney stones (renal calculi), Urinary catheters, Decreased cognition, Pregnancy, Impaired immune response, Improper personal hygiene o Manifestations: May be asymptomatic, Urgency, Dysuria, Frequency, Hematuria, Bacteruria, Cloud/foul-smelling urine, Symptoms of infection o Diagnosis: H & P, UA/UC, Cystoscopy, CBC o Treatments: Antibiotics, Increased hydration, Proper perineal care, Cotton undergarments, Do not delay urination, Adequately empty bladder, Proper urinary catheter care, Cystitis
  • Pyelonephritis o What it is: Kidney infection located in both kidneys o Complications: Renal failure, Recurrent UTIs, Sepsis
  • Nephrolithiasis: Kidney Stones o Risk factors: pH changes, Excessive concentration of insoluble salts in urine, Urinary stasis, Family history, Obesity, Hypertension, Diet o Manifestations o Diagnosis & treatment
  • Polycystic kidney disease (remember, this is genetic) o Manifestations: Hematuria, Nocturia, Drowsiness, Hypertension, Lumbar pain, Increased abdominal girth, Swollen, tender abdomen, Grossly enlarged, palpable kidneys o Diagnosis: H & P, UA, Blood chemistry, US, CT/MRI, IV pyelogram o Treatment: Antibiotics, Analgesics, Antihypertensive agents, Adequate hydration, Low-salt diet, Surgical drainage of cyst abscesses or retroperitoneal bleeding, Dialysis, Kidney transplant
  • Cancers o Kidney (renal) cancer ▪ Manifestations ▪ Diagnosis & treatment

o Bladder cancer ▪ Risk factors ▪ Manifestations ▪ Diagnosis & treatment

  • Intrarenal disorders o Glomerulonephritis – what it is: Bilateral inflammatory disorder of glomeruli typically after strep infection ▪ Diagnosis ▪ Treatment o Nephrotic syndrome antibody-antigen complexes lodging in glomerular membrane o nephritic syndrome: Inflammatory injury to glomeruli that may occur d/t antibodies interacting with normally occurring antigens in the glomeruli ▪ Causes, complications ▪ Manifestations
  • Renal failure o Acute vs. chronic

▪ Acute: Sudden loss of renal function

  • Causes: Extremely low BP or blood volume
  • Heart dysfunction, Reduced blood supply to kidneys, Hemolytic uremic syndrome, Renal inflammation, Toxic injury, Ureter obstruction, Bladder obstruction/dysfunction
  • Risk factors: Advanced age, Autoimmune disorders, Liver disease o Manifestations: Oliguric phase: Decreasing urine output, Electrolyte disturbances ( K), Fluid volume excess, Azotemia (BUN:Cr ratios abnormal), Metabolic acidosis, Diuretic phase: Increased urine output, Electrolyte disturbances, Dehydration, Hypotension, Recovery phase: Symptoms begin to resolve
  • Diagnosis:
  • Treatment: Correct fluid/electrolyte imbalances, Diet high in calories, Restricted, Protein, Sodium, Potassium, Phosphates, Hypertension management, Infection prevention strategies, ST dialysis, Treat anemia with Epogen ▪ Chronic: Gradual loss of renal function that is irreversible
  • Causes (most common causes!): Diabetes mellitus, HTN, Urine obstructions, Renal disease, Renal artery stenosis, Ongoing exposure to toxins & nephrotoxic medications, Sickle cell disease, SLE, Smoking, Older age
  • Stages and associated GFR: Stage 1 : Kidney damage but GFR normal or increased (>90) Stage 2: Mildly decreased GFR (60-89) Stage 3: Moderately decreased GFR (30-59) Stage 4: Severely decreased GFR (15-29) Stage 5: ESRD (<15); need dialysis
  • Manifestations
  • Diagnosis & treatment
  • Dialysis vowels Reproductive disorders
  • Male alterations

o Epispadias vs hypospadias ▪ Diagnosis & treatment o Testicle disorders ▪ Cryptorchidism

  • Risk factors
  • Diagnosis
  • Treatment o Erectile dysfunction ▪ Causes ▪ Diagnosis & treatment o Priapism ▪ Causes, diagnosis, treatment o Phimosis (review in book) & paraphimosis o Testicular torsion ▪ What is it, diagnosis & treatment o Hydrocele/spermatocele

▪ What these are ▪ Diagnosis & treatment o Varicocele ▪ What it is, causes, manifestations, treatment o Prostate disorders ▪ Prostatitis

  • Causes, diagnosis
  • Manifestations & treatment
  • Female alterations o Menstrual disorders – causes, diagnosis, manifestations, treatment ▪ Amenorrrhea ▪ Dysmenorrhea ▪ Menorrhagia, metrorrhagia, polymenorrhea, oligomenorrhea o Premenstrual syndrome ▪ Manifestations ▪ Premenstrual dysphoric syndrome ▪ Diagnosis, treatment o Pelvic support disorders - causes, manifestations, treatment ▪ Cystocele ▪ Rectocele ▪ Uterine prolapse o Uterine disorders ▪ Endometriosis
  • Complications, manifestations
  • Treatment ▪ Leiomyoma
  • Cause, manifestations, diagnosis, treatment o Ovarian cysts ▪ Manifestations, diagnosis, treatment o Polycystic ovary syndrome

▪ Manifestations o Breast disorders ▪ Fibrocystic breast condition

  • What it is
  • What causes this to happen
  • Manifestations
  • Diagnosis & treatment ▪ Mastitis
  • What it is – why is this happening?
  • Manifestations
  • Treatment o Candidiasis (yeast infection) ▪ Cause ▪ Manifestations ▪ Treatment o Pelvic inflammatory disease – either acute or chronic ▪ Causes

▪ Complications ▪ Manifestations/diagnosis/treatment Sexually transmitted diseases

  • Bacterial o Which are reportable to CDC? o Chlamydia ▪ Transmission ▪ Complications ▪ Manifestations, diagnosis, treatment o Gonorrhea ▪ Transmission ▪ Complications ▪ Manifestations, diagnosis, treatment o Syphilis ▪ Transmission ▪ Stages ▪ Complications ▪ Manifestations, diagnosis, treatment
  • Viral o Herpes simplex 1 & 2 (how do these present—meaning what triggers this infection?) ▪ Transmission ▪ Complications ▪ Manifestations, diagnosis, treatment o Human papilloma virus (HPV) ▪ Complications of HPV ▪ Transmission ▪ Manifestations, diagnosis, treatment
  • Trichomonas vaginalis (good to know info)

Reproductive system cancers

  • Those with high rates of treatment vs. those with high mortality rates
  • Prostate cancer o Diagnosis o Manifestations o Complications o Treatment
  • Testicular cancer o Diagnosis o Manifestations o Complications o Treatment
  • Breast cancer o Diagnosis (genetics?) o Manifestations

o Complications o Treatment

  • Cervical cancer o Causes o Diagnosis o Manifestations o Complications o Treatment
  • Endometrial (uterine) cancer o Diagnosis o Manifestations o Complications o Treatment
  • Ovarian cancer o Diagnosis o Manifestations o Complications o Treatment Endocrine disorders
  • Pituitary disorders ▪ Manifestations: Sudden weight loss/increased appetite, Tachycardia/hypertension, Nervousness, anxiety or anxiety attacks, Irritability/difficulty sleeping, Diaphoresis, Sensitivity to heat, Goiter, Sensitivity to heat, Exophthalmos ▪ Complications: Hypercalcemia /hypophosphatemia, Hypermagnesemia, Metabolic acidosis ▪ Treatment: Radioactive iodine/antithyroid agents, Beta blockers, Surgery, Strategies for exophthalmos, Increased caloric and calcium intake
  • Adrenocortical disorders

o Cushing’s syndrome (excessive cortisol) Too much cortisol_! That’s the stress hormone_ ▪ Diagnosis ▪ Manifestations ▪ Complications ▪ Treatment o Addison’s disease (deficiency of cortisol) Deficiency of adrenal cortex hormones (glucocorticoids, mineralocorticoids, androgens) ▪ Diagnosis ▪ Manifestations ▪ Complications ▪ Treatment o Hypopituitarism: Condition which pituitary does not produce some or all of hormones ▪ Dwarfism: Short stature d/t deficient levels of growth hormone, somatotropin or somatotropin-releasing hormone ▪ Diabetes insipidus: Excess fluid excretion (water!) in kidneys caused by insufficient ADH levels o Hyperpituitarism: Secretion of excess amounts of one or all pituitary hormones ▪ Gigantism ▪ Acromegaly ▪ SIADH (syndrome of inappropriate antidiuretic hormone) ▪ Cushing’s syndrome ▪ Hyperthyroidism o Causes o Manifestations: Headache; vision changes; excess sweating; sleep apnea; joint pain and stiffness; muscle weakness; paresthesia o treatment (over-arching concepts for pituitary) Depends on underlying cause, Tumors usually require surgery, radiation/chemo

  • Thyroid disorders o Hypothyroidism: Thyroid under-produces sufficient thyroid hormones (Hashimoto’s vs. iatrogenic)

▪ Diagnosis: Serum thyroid hormone levels, Serum TSH (thyroid-stimulating hormone), Cholesterol panel ▪ Manifestations: Fatigue, sluggishness, Sensitivity to cold, unexplained weight gain, high cholesterol ▪ Complications

▪ Treatment: Thyroid hormone replacement (ex: levothyroxine), Weight management, Constipation measures, Avoid cold temperatures o Hyperthyroidism: Excess levels of thyroid hormones = hypermetabolic state ▪ Diagnosis

  • Adrenal medulla disorders o Pheochromocytoma ▪ Release of catecholamines (epi/norepi) ▪ Manifestations: Hypertension, tachycardia, forceful heartbeat, Profound diaphoresis, Sudden onset of severe headaches, Anxiety, feeling of extreme fright, pallor, weight loss, Abdominal pain ▪ Can be life-threatening/complications: Hypertensive crisis; stroke; renal failure; psychosis; seizures ▪ Diagnosis: H & P; serum levels of epinephrine & norepinephrine ▪ Abdominal CT/MRI; biopsy ▪ Treatment: Surgery and antihypertensive medications
  • Parathyroid disorders o Calcium regulation
  • Antidiuretic hormone disorders o Diabetes insipidus o SIADH Diabetes
  • Type I diabetes o Cause o Complications o Manifestations

o Diagnosis o Treatment

  • Type II diabetes o Cause o Complications o Manifestations o Diagnosis o Treatment
  • Gestational diabetes o Risk factors o Treatment
  • Metabolic syndrome o What is it? o Diagnosis o Treatment Medications: (Therapeutic Effect) Medication Levothyroxine Medication Insulin-type 1 diabetes Medication - Glyburide Type 2 - Metformin Type 2 Medication: - PPIs (Omeprazole) - H2 blockers (ranitidine)