Download Chapter 29: Additional Health Conditions

Chapter 29: Additional
General Medical Conditions
© 2011 McGraw-Hill Higher Education. All rights reserved.
Role of the Immune System
• Collection of disease fighting cells that
neutralizes foreign substances
– Illness results when immune system does not
neutralize foreign substances (antigens)
– Cell-mediated response, humoral immune
response (B-cells that produce antibodies), or
nonspecific immune response (inflammation)
• Auto-immune response against the body
leads to damage of body’s own tissues
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Viral Infections
• Rhinovirus (Common Cold)
– Etiology
• Over 100 different rhinoviruses
• Transmitted by either direct or indirect contact
(cough, sneeze, speaking, touching
contaminated article)
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– Sign and Symptoms
• Begins w/ scratchy, sore throat, stopped-up
nose, watery discharge and sneezing
• Second batch may produce thick yellow nasal
discharge, watering eyes, mild fever, sore
throat, headache, malaise, myalgia, dry cough
– Secondary - laryngitis, tracheitis, acute bronchitis,
sinusitis, and otitis media
– Management
•
•
•
•
Symptomatic treatment (may last 5-10 days)
Non-prescription cold medications
Eat a balanced diet, consume 64 oz. of water
Avoid emotional stress and extreme fatigue
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• Influenza (Flu)
– Etiology
• Caused by myoviruses (A, B, C)
– Type A is most common
– Virus enters through cell genetic material
• The most recent epidemics have included Type A,
H1N1 (Swine Flu) and A/H5N1 (Avian Flu)
– Sign and Symptoms
• Fever (102-103 degrees F), chills, cough,
headache, malaise, and inflamed respiratory
mucous membrane w/ coryza
• General aches and pains, headache becomes
worse
• Weakness, sweating, fatigue may persist for many
days
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– Management
• Bed rest and supportive care
• Symptomatic care (aspirin) should be avoided by
those under age 18 ( Reye’s syndrome)
• Steam inhalation, cough medicines, and gargles
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• Infectious Mononucleosis
– Etiology
• Epstein-Barr virus (member of herpes group) that has
incubation period of 4-6 weeks
• Transmitted through saliva
– Sign and Symptoms
• First 3-5 days -severe fatigue, headache, loss of appetite
and myalgia
• Days 5-15 - fever, swollen lymph nodes and sore throat
(50% will experience enlarged spleen)
• Possible jaundice, skin rash, puffy eyelids
– Management
• Supportive symptomatic treatment
• Acetaminophen for headache, fever and malaise
• Resume training after 3 weeks after onset if spleen not
markedly enlarged/painful, patient is afebrile, liver function
is normal, and pharyngitis is resolved
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• Rubella (German Measles)
– Etiology
• Highly contagious viral disease (childhood disease)
• Results 13-24 days after exposure
• May cause developmental difficulties for fetus in
pregnant females
– Sign and Symptoms
• Temperature elevation, sore throat, drowsiness,
swollen lymph glands and red spots on palate; rash
– Management
• Prevent by early childhood immunization
– Measles, mumps, rubella vaccine (MMR)
• Antibiotics are ineffective
• Acetaminophen or ibuprofen can be provided to
relieve minor discomfort
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• Rubeola (Measles)
– Etiology
• Childhood disease
• Incubation time of 10 days following
exposure
– Sign and Symptoms
• Sneezing, nasal congestion,
coughing, malaise, photophobia,
spots in mouth, conjunctivitis, and
elevated fever (rash appears causes itching)
Figure 29-2
– Management
• Inoculation w/ MMR vaccine at 1215 months and 4-6 years of age
• Bed rest, isolation in dark room, use
of antipyretic, anti-itching medication
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• Parotitis (Mumps)
– Etiology
• Contagious viral disease that results in
inflammation of parotid and salivary glands
• Appear in 12-25 days following exposure
– Sign and Symptoms
• Malaise, headache, chills and moderate fever
• Pain in neck - swelling of glands may last up to 7
days
• Pain w/ jaw motion and swallowing; increased or
decreased saliva production
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– Management
• Immunization with MMR
should be done in
children
• If mumps occur the
patient should be
isolated while
contagious, confined to
bed and given soft diet
• Analgesics and cold
application should be
used to control swelling
(heat may be used later)
Figure 29-3
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• Varicella (Chicken Pox)
– Etiology
• Caused by varicella-zoster virus (herpes
zoster)
• May occur at any age (more common in
children)
• Incubation time is 13-17 days following
exposure
• Contagious for 11 days, including 5 days prior
to rash
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– Signs and Symptoms
• Slight elevation in temperature followed by
eruption of rash
• Rash progresses (macule, papule, vesicles, and
crusts over for 2-3 days)
• Rash begins on back and chest
• May last 2-3 weeks
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– Management
• Varicella-zoster immune globulin w/in 96 hours
of exposure will prevent clinical symptoms in
normal healthy children
• Acyclovir meds should be administered to
adolescents and adults w/ in 24 hours of
exposure
• Anti-itching medications to prevent scratching
• To prevent, children 12-18 months can be
vaccinated
– Results in significantly lowering chance of getting
chickenpox later in life
– Later in life = shingles
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Respiratory Conditions
• Sinusitis
– Etiology
• Stems from upper respiratory infection caused by a
variety of bacteria
– Sign and Symptoms
• Nasal mucous swell and block ostium of paranasal
sinus
• Painful pressure occurring from accumulation of mucus
• Skin over sinus may be swollen and painful to the touch
• Headache and malaise; purulent nasal discharge
– Management
• If infection is purulent, antibiotics may be warranted
• Steam inhalation and other nasal topical sprays w/
oxymetazoline can produce vasoconstriction and
drainage
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• Tonsillitis
– Etiology
• Acute inflammation and bacterial infection of tonsil
epithelium
– Sign and Symptoms
• Tonsil appear red, swollen, w/ yellow exudate in pits
• Pain w/ swallowing, high fever and chills, headache
and neck pain
• Sinusitis, otitis media, tonsillar abscesses may also
develop
– Management
• Culture to check for streptococcal bacteria and
antibiotics for 10 days
• Gargling w/ saline water, liquid diet, and antipyretic
medication
• Frequent bouts of tonsillitis may necessitate
removal
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• Seasonal Atopic (Allergic) Rhinitis
• Hay fever, pollinosis from airborne pollens
– Etiology
• Reaction to pollen , dust, dander, or mold
– Airborne fungal spores (allergens) resulting in
allergic antibodies causing the release of histamine
– Sign and Symptoms
• Eyes, throat, mouth and nose begin to itch, followed
by watering eyes, sneezing and clear watery
discharge
• Sinus type headache, emotional irritability, difficulty
sleeping, red & swollen eyes and nasal mucus
membranes, and wheezing cough
– Management
• Oral antihistamines and decongestants
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• Pharyngitis (sore throat)
– Etiology
• Caused by virus or streptococcus bacteria
• Transmitted by direct contact of infected person
or one who is a carrier
– Sign and Symptoms
• Pain w/ swallowing, fever, inflamed and swollen
glands, malaise, weakness
• Mucus membrane may be inflamed and
covered w/ purulent matter
– Management
• Throat culture
• Topical gargles and rest
• Antibiotic therapy for streptococcal infection
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• Acute Bronchitis
– Etiology
• Infectious winter disease that follows common cold or
viral infection
• Fatigue, malnutrition or becoming chilled could be
predisposing factors
– Sign and Symptoms
• Upper respiratory infection, nasal inflammation and
profuse discharge, slight fever, sore throat and back
muscle pains
• Fever lasts 3-5 days while cough can last 2-3 weeks
• Yellow mucus indicates infection
• Pneumonia can complicate condition
– Management
• Avoid sleeping in cold environment, avoid exercise in
extreme cold w/out protection
• Rest until fever subsides, drink 3-4 quarts of water
daily, ingest antipyretic analgesic, cough suppressant,
and antibiotic
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• Pneumonia
– Etiology
• Infection of alveoli and bronchioles from viral,
bacterial or fungal microorganisms
• Irritation from chemicals, aspiration of vomitus
• Alveoli fill w/ exudate, inflammatory cells and
fibrin
– Sign and Symptoms
• Bacteria will cause rapid onset
• High fever, chills, pain on inspiration, decreased
breath sounds, rhonchi on auscultation, coughing
of purulent, yellowish sputum
• Viral pneumonia will go on for several days and
up to a few weeks before becoming symptomatic
• Patient will have low grade fever, muscle aches,
fatigue, coughing
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– Signs & Symptoms (continued)
• Certain types of fungus can also cause
pneumonia
• When fungus is inhaled, some individuals will
develop acute pneumonia, others will
experience a form that develops slowly and
lasts for months
– Few symptoms may be experienced
– Management
• Treat w/ antibiotics; perform deep breathing
exercises to removal of sputum through heavy
coughing
• Analgesics and antipyretics may be useful for
controlling pain and fever
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• Bronchial Asthma
– Etiology
• Exact cause is unclear
• Metabolic acidosis, postexertional hypocapnia,
stimulation of tracheal receptors, adrenergic
abnormalities and psychological factors have
been suggested
• Can be triggered by viral respiratory tract
infection, emotional upset, changes in barometric
pressure or temperature, exercise, inhalation of
noxious odor or exposure to specific allergen
• Exercise-Induced Asthma
– Bronchial asthma triggered by exercise
– Brought on by exercise w/ exact cause unknown
– Loss of heat and water, sinusitis can also trigger
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– Sign and Symptoms
• Spasm of smooth bronchial musculature,
edema, inflammation of mucus membrane
• Difficulty breathing, may cause hyperventilation
resulting in dizziness, coughing, wheezing,
shortness of breath and fatigue
• Tight chest, breathlessness, coughing,
wheezing, nausea, hypertension, fatigue,
headache, and redness of skin
• May occur w/in 3-8 minutes of exercise
• Patients with chronic inflammatory condition
(bronchiectasis) may have constant bronchi or
bronchioles dilation
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– Management
• Regular exercise, appropriate warm-up and
cool down, w/ intensity graduated
• Using a mask or scarf may be beneficial in
avoiding cold, dry, air
• Exercise in warm, humid environment
• Conditioning tends to reduce bouts of asthma
• Avoid exercising in high levels of pollution or
high pollen counts
• Inhaled bronchodilators may be useful
– B2 agonist – most common is albuterol
– Salmeterol – provides prophylaxis for up to 12 hours
– Medication use prior to activity varies
• Athletes must be sure that the medication they
are using is legal for competition
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• Cystic Fibrosis
– Etiology
• Genetic disorder that can manifest as obstructive
pulmonary disease, pancreatic deficiency, urogenital
dysfunction and increased electrolyte sweating
• Cause of severe lung disease w/ life expectancy of
about
30 years
– Sign and Symptoms
• Bronchitis, pneumonia, respiratory failure, gall bladder
disease, pancreatitis, diabetes and nutritional deficiencies
• High production of mucus
• Susceptible to heat illnesses
– Management
•
•
•
•
Drug therapy to slow progress of disease (ibuprofen)
Antibiotics to control pulmonary disease
Consistent postural drainage to mobilize secretions
High fluid intake to thin secretions and use of humidifier
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Muscular Disorders
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• Duchenne Muscular Dystrophy
– Etiology
• Hereditary disease causing degeneration of skeletal
muscle (gradual replacement of muscle w/ adipose
and connective tissue - decreased circulation which
perpetuates condition)
– Sign and Symptoms
• In children, exhibited by frequent falls, difficulty
standing
• Muscles tend to shorten as they atrophy, causing
scoliosis and other postural abnormalities
– Management
• Cannot be cured; consistent exercise can be used to
retard atrophy
• Ambulation w/ braces until the individual is confined
to a wheelchair
• Death generally occurs by age 20
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• Myasthenia Gravis
– Etiology
• Autoimmune disease where antibodies attack
synaptic junctions
• Deficiency in acetylcholine, producing early fatigue
• Often occurs in females age 20-40
– Sign and Symptoms
• Drooping of upper eyelids and double vision due to
weakness in extraocular muscles
• Difficulty chewing and swallowing, weakness of
extremities and general decrease in muscle
endurance
– Management
• Treat w/ drugs that inhibit breakdown of acetylcholine
• Corticosteroids can be used to suppress immune
system - reducing production of antibodies that
destroy acetylcholine
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Nervous System
Disorders
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• Meningitis
– Etiology
• Inflammation of meninges surrounding spinal cord
and brain
• Caused by infection brought on by meningococcus
bacteria
• While can occur in all ages, commonly seen in
college-aged students living in dorms military
barracks
• Viral vs. Bacterial meningitis
– Sign and Symptoms
• High fever, stiff neck, intense headache, sensitivity
to light and sound
• Progress to vomiting, convulsions and coma
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• Meningitis (continued)
– Management
• Cerebrospinal fluid must be analyzed for
bacteria and WBC’s.
• If bacteria is found isolation is necessary for 24
hours (very contagious), antibiotics must be
administered immediately
• Monitored closely in intensive care unit
• If an individual has come into contact with
someone that is contagious, prophylactic
antibiotics should be administered
• No specific treatment exists for viral meningitis
at this time
– Most recover completely on their own
– Recommended bed rest, fluids, and meds for fever
and headache relief
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• Multiple Sclerosis
– Etiology
• Auto-immune inflammatory disease of CNS that
causes deterioration and damage to myelin sheath,
disrupting nerve conduction
– Sign and Symptoms
• Blurred vision, speech deficits, tremors, muscle
weakness and numbness in extremities
• Tremor spasticity, neurotic behavior, mood swings
• May progress slowly or may be acute attack
followed by partial or complete temporary remission
– Management
• Deal w/ symptoms as they occur
• Avoid over exertion, extreme temperatures, and
stressful situations
• Establish exercise routine
• Drug therapy to slow progression
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• Amyotrophic Lateral Sclerosis (Lou
Gehrig’s Disease)
– Etiology
• Sclerosis of lateral regions of spinal cord along w/
degeneration of motor neurons and significant
atrophy
– Sign and Symptoms
• Difficulty in speaking, swallowing and use of hands
• Sensory and intellectual function remain intact
• Rapid progression of atrophy resulting in paralysis
– Management
• No cure
• Even after incapacitation, normal intellectual
function remains; inability to communicate feelings
and ideas
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• Reflex Sympathetic Dystrophy
– Etiology
• Abnormal excessive response of sympathetic
portion of autonomic nervous system following
injury
– Sign and Symptoms
• Commonly seen in hands and feet following
immobilization of injured part (change to bone,
connective tissue, blood vessels and nerves)
• Develop extreme hypersensitivity to touch,
redness, sweating, burning pain, swelling w/
palpable tightness and shining skin; atrophy
• Possible psychologic depression
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• Reflex Sympathetic Dystrophy
(continued)
– Management
• Early recognition and intervention is critical
• Must direct treatment at disrupting abnormal
sympathetic response
• Use of sympathetic ganglion nerve block is
critical
• AROM exercise through pain free range, use
modalities to modify pain and reduce swelling
• Anti-depressant drugs may be necessary for
chronic conditions
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Blood and Lymph Disorders
• Iron Deficiency Anemia
– Etiology
• Prevalent in menstruating women and males age 7-14
• Three things occur during anemia
– Small erythrocytes
– Decreased hemoglobin
– Low ferritin concentration (compound that contains 23%
iron)
• GI loss of iron in runners is common
• Aspirin and NSAID’s may cause GI bleeding and iron
loss
• Menstruation accounts for most iron lost in women
• Vegetarian athletes may also be deficient in intake
relative to iron loss
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– Sign and Symptoms
• First stage of deficiency, performance declines
• Patient may feel burning thighs and nausea
from becoming anaerobic
• Ice cravings are common
• Serum ferritin levels must be assessed
• Mean corpuscular volume and relative size of
erythrocytes must be checked
– Management
• Eat a proper diet including more red meat or
dark poultry; avoid coffee and tea (hamper iron
absorption)
• Consume vitamin C (enhance absorption)
• Take supplements (dependent on degree of
anemia)
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• Runners’ Anemia (hemolysis)
– Etiology
• Caused by impact of foot as it strikes the
surface
• Impact destroys normal erythrocytes w/in
vascular system
– Sign and Symptoms
• Mildly enlarge cells, increase in circulatory
reticulocytes and decreased haptoglobin
(bound to hemoglobin)
• Varies according to training
– Management
• Reduce distance or mileage
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• Sickle-Cell Anemia
– Etiology
• Hereditary hemolytic anemia - RBC’s are sickle or
crescent shaped (irregular hemoglobin)
• Less ability to carry oxygen, limited ability to pass
through vessels, causing clustering and clogging of
vessels (thrombi)
• Severe cases can result in death if embolus
develops and travels to lungs
• Exercise factors that can cause sickle cell anemia 1)acidosis, 2) hyperthermia, 3)dehydration, 4)
severe hypoxemia
• Can be brought on by high altitudes
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• Sickle Cell Anemia (continued)
– Sign and Symptoms
• Fever, pallor, muscle weakness, pain in limbs
• Pain in upper right quadrant indicating possible
splenic infarction
• Headaches and convulsions are also possible
– Management
• Provide anticoagulants and analgesics for pain
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• Hemophilia
– Etiology
• Hereditary disease caused by absence of clotting
factors
• Prolonged coagulation time, failure of blood to clot
and abnormal bleeding
– Sign and Symptoms
• Physical exertion can cause bleeding into muscles
and joints -- may be extremely painful
• Joints may become immobilized
– Management
• If bleeding occurs, athlete should be taken to a
medical care facility
• No cure
• Clotting factors have been developed to control
bleeding for several days
• Avoid trauma and wear medical alert bracelet
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• Lymphangitis
– Etiology
• Inflammation of lymphatic channels
• Caused by streptococcal bacteria
– Sign and Symptoms
• Usually occurs in extremities
• Deep reddening of the skin, warmth, lymphadenitis and
raised border over affected area (particularly in case of
infection)
• Chills and high fever w/ moderate pain and swelling
– Management
• Patient should be hospitalized and vital signs
monitored
• Following evaluation warm compresses should be
applied to the extremity
• Antibiotic administration and fluid intake (restore fluid
balance) is encouraged
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Diabetes Mellitus
– Most common forms are Type I (insulindependent diabetes mellitus) and Type II
(non-insulin-dependent diabetes mellitus)
– Etiology
• Result of interaction between physical and
environmental factors
• Involves a complete or partial decrease in insulin
secretion
• Type I – typically occurs in individuals under age 35
• Type II – occurs in all ages, becoming increasingly
prevalent in younger individuals due to childhood
obesity
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– Sign and Symptoms
• IDDM - sudden symptoms of frequent urination,
constant thirst, weight loss, constant hunger,
tiredness, weakness, itchy dry skin and blurred vision
• Diagnosed through measurements of blood glucose
levels
• Both forms can be a threat to heart, kidney, blood
vessel and eye function
– Management
• Monitor and control glucose levels
• Diet, doses of insulin
• Vigorous exercise increases peripheral insulin action
and enhances glucose tolerance
• AT must be aware that extreme temperatures and
unpredictable activity levels may require the
administration of rapid-acting carbohydrates
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• Diabetic Coma
– Etiology
• Loss of sodium, potassium and ketone bodies
through excessive urination (ketoacidosis)
– Sign and Symptoms
• Labored breathing, fruity smelling breath (due
to acetone), nausea, vomiting, thirst, dry
mucous membranes, flushed skin, mental
confusion or unconsciousness followed by
coma.
– Management
• Early detection is critical as this is a lifethreatening condition
– Monitor blood glucose levels
• Insulin injections may help to prevent coma
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• Insulin Shock
– Etiology
• Occurs when the body has too much insulin
and too little blood sugar
– Sign and Symptoms
• Tingling in mouth, hands, or other parts of the
body, physical weakness, headaches,
abdominal pain
• Normal or shallow respiration, rapid heart rate,
tremors along with irritability and drowsiness
– Management
• Adhere to a carefully planned diet including
snacks before exercise
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• Thyroid Gland Disorders
– Etiology
• Thyroid produces two hormones (thyroxine and
triiodothyronine)
• Disorders include hyperthyroidism and
hypothyroidism
– Signs & Symptoms
• Hyperthyroidism
– Over-production of thyroxine resulting in impaired glucose
metabolism, increased metabolism, rapid fatigue, weight
loss, and hyperthermia during exercise
– Graves’ disease is a form of hyperthyroidism and may
include additional symptoms (weakness, tremors, difficulty
swallowing/speaking
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– Signs & Symptoms
• Hypothyroidism
– Low metabolism, poor circulation, dry skin, low blood
pressure, slow pulse, decreased muscle activity,
increasing obesity, goiter development
– Management
• If signs and symptoms of either develop patient
should be referred to a physician
• Hyperthyroidism treatment usually involves the
use of medication to slow thyroxine production
or partial removal of thyroid
• Hypothyroidism often requires hormone
replacement therapy
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Seizure Disorders: Epilepsy
– Defined as recurrent paroxysmal disorder
of cerebral function characterized by
periods of altered consciousness, motor
activity, sensory phenomena or
inappropriate behavior caused by
abnormal cerebral neuron discharge
– Etiology
• For some forms of epilepsy there is genetic
predisposition
• Brain injury or altered brain metabolism
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– Sign and Symptoms
• Periods of altered consciousness, motor activity,
sensory phenomena or inappropriate behavior
caused
• May last 5-15 seconds (petit mal seizure) or longer
(grand mal seizure)
• Includes unconsciousness and uncontrolled tonicclonic muscle contractions
– Management
• Individuals that experience daily or weekly seizures
should be prohibited from participating in collision
sports (blow resulting in unconsciousness could
result in serious injury)
• Must be careful with activities involving changes in
pressure
• Can be managed with medication
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Hypertension
– Etiology
• Primary hypertension accounts for 90% of all
cases with no other disease association
• Secondary hypertension is associated with
kidney disorder, overactive adrenal glands,
hormone-producing tumor, narrowing of aorta,
pregnancy and medications
• Long term cases increase the chances of
premature mortality and morbidity due to
coronary artery disease, congestive heart
failure and stroke
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– Sign and Symptoms
• Primary hypertension is generally
asymptomatic until complications arise
• May cause dizziness, flushed appearance,
headache, fatigue, epistaxis and nervousness
– Management
• Thorough examination must be performed to
determine type of hypertension and extent of
hypertension
• Medication is not recommended for those with
pre-hypertension (120-139/80-89) unless linked
with other conditions
• If pre-hypertension is an issue - lifestyle
changes should be made
• Individuals with stage 1 and 2 hypertension
should be medicated
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Cancer
– Etiology
• Condition where cellular activity becomes
abnormal and cells no longer perform normal
function
• Cells do not multiply at increased rate but
continue to develop ultimately taking over
normal tissue
• Tumors may be benign or malignant
• Malignancies are classified based on the types
of tissue they invade
• Variety of causes including, ultraviolet radiation,
chemicals (tobacco), alcohol, fatty diet,
combination of heredity and environmental
factors
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– Sign and Symptoms
• Vary tremendously depending on type of
cancer
• Warning signs include change in bowel and
bladder habits, sore throat that does not heal,
unusual bleeding or discharge, development of
lump in breast or elsewhere, indigestion,
change in wart or mole
– Management
• Early detection is critical
• Effective forms of treatment include surgery,
radiation and chemotherapy
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Sexually Transmitted
Infections (STI’s)
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• Chlamydia
– Etiology
• Caused by bacterial organism
– Sign and Symptoms
• May result in pelvic inflammation and is
important cause of infertility and ectopic
pregnancy in females
• In males, inflammation occurs along with
purulent discharge 7-28 days after intercourse
• Painful urination and traces of blood in urine,
vaginal discharge
• Can cause conjunctivitis and pneumonia in
newborns
– Management
• Identify infection and exact organism present
• Treat with antibiotics
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• Genital Herpes
– Etiology
• Caused by type 2 herpes simplex virus
– Sign and Symptoms
• Develops 4-7 days following sexual contact
• Begins to crust 14-17 days in primary genital
herpes and 10 days in secondary
• Females may be asymptomatic while males will
experience itching and soreness
• Development of lesions
– Management
• Herpes and pregnancy
• No cure, just systemic medication (antiviral
medications) to lessen early symptoms or the
disease
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• Trichomoniasis
– Etiology
• Caused by the flagellate protozoan Trichomonas
vaginalis
– Sign and Symptoms
•
•
•
•
Vaginal discharge that is greenish yellow and frothy
Causes irritation of the vulva, perineum and thighs
Painful urination
Males tend to be asymptomatic but may experience
purulent urethral discharge
– Management
• 2 grams of metronidazole cures up to 95% of cases
in women
• Males require 500mg twice daily for 7 days
• Complete cure is required before engaging in
intercourse
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• Genital Candidiasis
– Etiology
• Transmitted through sexual activity and appear
as warts on the glans penis, vulva or anus
– Sign and Symptoms
• Cauliflower-like wart or can be singular
• Soft, moist pink or red swellings that develop
cauliflower-like head
• May be mistaken as secondary syphilis or
carcinoma
– Management
• When moist - 20-25% polophyllin
• Dry warts - may be frozen with liquid nitrogen
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© 2011 McGraw-Hill Higher Education. All rights reserved.
• Gonorrhea (clap)
– Etiology
• Caused by organism infection - gonococcal
bacteria which is spread through intercourse
– Sign and Symptoms
• In men - experience tingling of urethra followed
by 2-3 hours of greenish yellow discharge and
painful urination
• 60% of women are asymptomatic
• Females will experience vaginal discharge
• May result in sterility if not treated or arthritis
– Management
• Penicillin
• Avoid sexual contact until it is known that the
disease is no longer active
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• Condyloma Acuminata (Venereal Warts)
– Etiology
• Transmitted through sexual activity
• Form of wart virus
– Signs & Symptoms
•
•
•
•
•
Appear on glans penis, vulva or anus
Nodule, cauliflower-like lesion or can be singular
Start out soft, moist, pink or red swelling
Develops a stem rapidly
May be mistaken for syphilis or carcinoma
– Management
• When moist – treated with podophyllin
• Dry warts may be treated with freezing process
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• Syphilis
– Etiology
• A spirochete bacteria is the organism related to
syphilis and enters body through mucous
membranes or skin lesions
– Sign and Symptoms
• 4 stages
– Incubation is usually 3-4 weeks but could be anywhere
from 1-13 weeks; painless chancre or ulcer forms that
health w/in 4-8 weeks (can occur on penis, urethra,
vagina, cervix, mouth, hand, foot or around eye)
– Secondary stage occurs 6-12 weeks after initial infection
and is characterized by a rash, lymph swelling, body
aches, mild flu-like symptoms and possible hair loss
– Latent syphilis is characterized by no or few symptoms but if untreated it may result in tertiary syphilis
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– Sign and Symptoms
– Late stage is characterized by deep penetration of
spirochetes that damage skin, bone, cardiovascular
system and nervous system
– Late stage may develop w/in 3-10 years of infection
and cause neurosyphilis - muscle weakness,
paralysis and various types of psychoses
– Management
• Penicillin is used for all stages
• Other drugs may be required due to increased
resistance
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Menstrual Irregularities and
the Female Reproductive
System
• Physiology of the Menstrual Cycle
– Menarche
• Onset of menses and puberty normally occur
between ages 9-17
• Female becomes capable of reproduction
• May be delayed through strenuous sports
training
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– Menstruation
• 28 day cycle that consist of follicular and luteal
phases (each lasting ~14 days)
• Result of cyclic hormone pattern
– Follicle stimulating hormone stimulates
maturation of ovarian follicle while luteinizing
hormone (LH) stimulates development of
corpus luteum and encourages secretion of
progesterone and estrogens
– Control and inhibition of production of FSH
when follicle reaches maturity caused by
estrogenic steroids
– Progesterone will ultimately inhibit LH
– Before onset of new menstrual period, FSH
levels are already rising = maturation of new
follicle for next cycle
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Figure 29-6
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– Menstrual Cycle Irregularities
• Strenuous training may alter cycle (25-38 day
long cycles)
• Oligomenorrhea - diminished flow (refers to
fewer than 3-6 cycles per year)
• Amenorrhea is the complete cessation of the
cycle
– Ovulation is seldom or not at all due to low levels of
estrogen circulation
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• Amenorrhea
– Etiology
• Primary
– Female has not had menstrual periods by age 16
• Secondary
–
–
–
–
Occurs when menstrual periods stop for 3-6 months
Often a hypothalamic dysfunction
Gonadotropin-releasing hormone is often deficient
Must rule out pregnancy, abnormal reproductive or
genital tract as well as ovarian failure and pituitary
tumors
– Sign and Symptoms
• Complete cessation of menstrual cycle
• Depending on the cause, female may also
experience headache, vision changes, hair
loss, excess facial hair, milky nipple discharge
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– Management
• Re-establishment of normal hormone levels
• Thorough medical examination, nutritional
counseling, reduction of exercise intensity and
emotional stress
• Estrogen replacement may be considered
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• Dysmenorrhea
– Etiology
• Painful menstruation prevalent in active women
• May be caused by hormonal imbalance,
ischemia of the pelvic organs, endometriosis
• Most common menstrual disorder
– Sign and Symptoms
• Cramps, nausea, lower abdominal pain,
headache, occasionally emotional variability
– Management
• Mild to vigorous exercise that help to ameliorate
dysmenorrhea are usually prescribed
• Continued activity as long as performance levels
do not drop
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• Ovarian Cyst
– Etiology
• Occurs when follicular cyst fails to open and
release egg
• Forms within one of the ovaries
• Small fluid filled sac, most are benign
• May cause bleeding and pain and grow quite large
• Causes may include early menstruation, irregular
menstrual cycles, increased upper body fat
distribution, hormonal imbalances, ovarian cancer,
and cancer spreading outside of ovary
– Signs & Symptoms
• Some may have no symptoms
• May experience dull ache in low back and thighs;
problems with urination
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– Signs & Symptoms
•
•
•
•
•
Pressure, breast tenderness
Nausea, vomiting feeling or fullness, pain in abdomen
Weight gain
Painful menstrual periods and abnormal bleeding
Pain during intercourse
– Management
• Pain relievers, NSAID’s
• Oral contraceptives to regulate menstrual cycle
– Prevents follicles formation and cyst development
• Limiting strenuous activity to avoid cyst rupture/torsion
• If pain, fever, vomiting, faintness, dizziness, weakness, or
rapid breathing develop a physician should be consulted
immediately
• Laparoscopic surgery may be necessary to remove or
correct torsion
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Bone Health
– Etiology
• Decrease in bone is seen commonly in older
women and is linked to declines in FSH, LH,
progesterone, and estrogen
• Physically active women with irregular menses
– Sign and Symptoms
• Increased risk of stress fractures
• Decreased bone mineral density
– Management
• Decrease training volume, increase total caloric
intake and increase calcium supplementation
• Estrogen replacement therapy
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The Female Athlete Triad
– Etiology
• Relationship between disordered eating,
amenorrhea and osteoporosis
• Often seen in females driven to meet standards of
sport or to meet a specific athletic image to attain
goals
– Sign and Symptoms
• Disordered eating - bulimia and anorexia
• Osteoporosis - premature bone loss in young
women, inadequate bone development
– Management
• Prevention is key; identify and educate
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Contraceptives & Reproduction
• Oral contraceptives
– Should not be used to delay menstruation
during competition
• May result in nausea, vomiting, fluid retention,
amenorrhea, hypertension, double vision and
thrombophlebitis
– Use under supervision of a physician
– Low dose preparations (<50mg of estrogen)
provide little risk to healthy women
• Intrauterine devices
– Not recommended for adolescents that have
not given birth
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Pregnancy
• Physical activity and competition can be
engaged in up to the 3rd month unless
complications present
• May even be able to continue up through the
seventh month
• Many women do not continue past third month
due to drop in performance
• No indication that exercise is harmful to the
fetal growth patterns
• Extreme exercise may result in low birth weight
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• Should avoid activities that involve severe
body contact, jarring or falls
• Contraindications include
– Pregnancy induced hypertension
– Pre-term rupture of membranes
– Pre-term labor during the prior or current
pregnancy or both
– Incompetent cervix or cerclage
– Persistent second or third trimester bleeding
– Intrauterine growth retardation
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• Ectopic Pregnancy
– Etiology
• Fertilized egg implants outside the uterine
cavity due to inflammation of fallopian tubes or
mechanical blockage
– Sign and Symptoms
• Amenorrhea, tenderness and soreness on
affected side, referred pain to shoulder, pallor,
possible shock and/or hemorrhaging
– Management
• Operative treatment is necessary to terminate
nonviable pregnancy and control hemorrhaging
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