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Chapter 29: General Medical Conditions

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Title: Chapter 29: General Medical Conditions


1
Chapter 29 General Medical Conditions
2
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 bodys own tissues

3
Viral Infections
  • Rhinovirus (Common Cold)
  • Etiology
  • Over 100 different rhinoviruses
  • Transmitted by either direct or indirect contact
    (cough, sneeze, speaking, touching contaminated
    article)

4
  • 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

5
  • Influenza (Flu)
  • Etiology
  • Caused by myoviruses (A, B, C)
  • Type A is most common
  • Virus enters through cell genetic material
  • 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
  • Management
  • Bed rest and supportive care
  • Symptomatic care (aspirin) should be avoided by
    those under age 18 ( Reyes syndrome)
  • Steam inhalation, cough medicines, and gargles

6
  • 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, athlete is
    afebrile, liver function is normal, and
    pharyngitis is resolved

7
  • 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)

8
  • 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)
  • Management
  • Inoculation w/ MMR vaccine at 12-15 months and
    4-6 years of age
  • Bed rest, isolation in dark room and use of
    antipyretic and anti-itching medication

9
  • Mumps (Parotitis)
  • 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
  • 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)

10
  • 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
  • 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

11
  • 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

12
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/ oxymetazalone can produce vasoconstriction and
    drainage

13
  • 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

14
  • Seasonal Atopic (Allergic) Rhinitis
  • Hay fever, pollinosis from airborne pollens
  • Etiology
  • Reaction to pollen - 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

15
  • 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 and anorexia
  • Mucus membrane may be inflamed and covered w/
    purulent matter
  • Management
  • Throat culture
  • Topical gargles and rest
  • Antibiotic therapy for streptococcal infection

16
  • 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/ protection
  • Rest until fever subsides, drink 3-4 quarts of
    water daily, ingest antipyretic analgesic, cough
    suppressant, and antibiotic

17
  • 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
  • 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

18
  • Bronchial Asthma
  • Etiology
  • Caused by viral respiratory tract infection,
    emotional upset, changes in barometric pressure
    or temperature, exercise, inhalation of noxious
    odor or exposure to specific allergen
  • 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

19
  • Exercise-Induced Bronchial Obstruction (Asthma)
  • Etiology
  • Brought on by exercise w/ exact cause unknown
  • Metabolic acidosis, post-exertional hypocapnia,
    stimulation of tracheal irritant receptor,
    adrenergic abnormalities, defective catecholamine
    metabolism and psychological factors, loss of
    heat and water, sinusitis can also trigger
  • Sign and Symptoms
  • Airway narrowing due to spasm and excess mucus
    production
  • Tight chest, breathlessness, coughing, wheezing,
    nausea, hypertension, fatigue, headache, and
    redness of skin
  • May occur w/in 3-8 minutes of exercise

20
  • EIA (continued)
  • Management
  • Regular exercise, appropriate warm-up and cool
    down, w/ intensity graduated
  • Inhaled bronchodilators may be useful
  • Exercise in warm, humid environment

21
  • Cystic Fibrosis
  • Etiology
  • Genetic disorder that can manifest as obstructive
    pulmonary disease, pancreatic deficiency,
    urogential 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
  • 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

22
Muscular Disorders
  • 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

23
  • 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

24
Nervous System Disorders
  • Meningitis
  • Etiology
  • Inflammation of meninges surrounding spinal cord
    and brain
  • Caused by infection brought on by meningococcus
    bacteria
  • Sign and Symptoms
  • High fever, stiff neck, intense headache,
    sensitivity to light and sound
  • Progress to vomiting, convulsions and coma

25
  • Meningitis (continued)
  • Management
  • Cerebrospinal fluid must be analyzed for bacteria
    and WBCs.
  • If bacteria is found isolation is necessary for
    24 hours (very contagious), antibiotics must be
    administered immediately
  • Monitored closely in intensive care unit

26
  • 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 and 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

27
  • Amyotropic Lateral Sclerosis (Lou Gehrigs
    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

28
  • 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

29
  • 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

30
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 NSAIDs 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

31
  • Sign and Symptoms
  • First stage of deficiency, performance declines
  • Athlete 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)

32
  • 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
  • Run on soft surfaces, wear well cushioned shoes
    and run w/ light feet

33
  • Sickle-Cell Anemia
  • Etiology
  • Hereditary hemolytic anemia - RBCs 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
    anemai - 1)acidosis, 2) hyperthermia,
    3)dehydration, 4) severe hypoxemia
  • Can be brought on by high altitudes

34
  • 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

35
  • 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

36
  • Lymphangitis
  • Etiology
  • Inflammation of lymphatic channels
  • Caused by streptococcal bacteria
  • Sign and Symptoms
  • Usually occurs in extremities
  • Deep reddening of the skin, warmth,
    lymphandentitis 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

37
Diabetes Mellitus
  • Most common forms are Type I (insulin-dependent
    diabetes mellitus) and Type II (non-insulin-depend
    ent diabetes mellitus)
  • Etiology
  • Result of interaction between physical and
    environmental factors
  • Involves a complete or partial decrease in
    insulin secretion

38
  • Sign and Symptoms
  • IDDM is most commonly seen in childhood with
    sudden symptoms of frequent urination, constant
    thirst, weight loss, constant hunger, tiredness,
    weakness, itchy dry skin and blurred vision
  • NIDDM occurs later in life and is usually
    associated with being overweight
  • Body either does not produce enough insulin or
    resists insulin that is being produced
  • Management
  • Monitor and control glucose levels
  • Diet, doses of insulin
  • Vigorous exercise increases peripheral insulin
    action and enhances glucose tolerance
  • ATC must be aware that extreme temperatures and
    unpredictable activity levels may require the
    administration of rapid-acting carbohydrates

39
  • 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
    life-threatening condition
  • Insulin injections may help to prevent coma

40
  • 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

41
Seizure Disorders
  • 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

42
  • 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
    tonic-clonic 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

43
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

44
  • 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

45
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

46
  • 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

47
Sexually Transmitted Infections (STIs)
48
  • 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

49
  • 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 of the
    disease

50
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51
  • 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 by 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

52
  • 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

53
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54
  • 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

55
  • 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

56
  • 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

57
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

58
  • 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

59
  • 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

60
  • Amenorrhea
  • Etiology
  • Exercise related is 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
  • 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 lability
  • 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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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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Bone Health
  • Etiology
  • Decrease in bone is seen commonly in older women
    and is linked to declines in FSH, LH,
    progesterone, and estrogen
  • Athletic 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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Contraceptives and 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 (lt50mg 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
  • Impact on 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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