Transcript Chapter 29: Additional Health Conditions

Chapter 29: Additional General
Medical Conditions
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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
•
•
•
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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
– 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 ( 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)
– 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
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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
– 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)
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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
– 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/
oxymetazalone 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, 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
• 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
• 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
• 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 collegeaged 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 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
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• Amyotropic 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 anemai 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, 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
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Diabetes Mellitus
– Most common forms are Type I (insulindependent diabetes mellitus) and Type II (noninsulin-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
• ATC 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 life-threatening
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
• Hypothyroidism
– Low metabolism, poor circulation, dry skin, low blood
pressure, slow pulse, decreased muscle activity, increasing
obesity, goiter development
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– 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 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
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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, hormoneproducing 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 prehypertension (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
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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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• 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 29-3
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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
• Laparascopic 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 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 (<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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