TEXT 7. THE ENDOCRINE SYSTEM

The endocrine system is composed of glands located in many different regions of the body, all of which release specific chemical substances directly into the bloodstream. These chemical substances, called hormones, can regulate the many and varied functions of an organism. For example, one hormone stimulates the growth of bones, another causes the maturation of sex organs and reproductive cells, and another controls the metabolic rate (metabolism) within all the individual cells of the body. In addition, one powerful endocrine gland in the brain secretes a wide variety of different hormones which travel through the bloodstream and regulate the activities of other endocrine glands.

All the endocrine glands, no matter which hormones they produce, secrete their hormones directly into the bloodstream rather than into ducts leading to the exterior of the body. Those glands which send their chemical substances into ducts and out of the body are called exocrine glands. Examples of exocrine glands are sweat, mammary, mucous, salivary, and lacrimal (tear) glands.

The ductless, internally secreting endocrine glands are the following: thyroid gland, parathyroid glands (4), adrenal glands (1 pair), pancreas, pituitary gland, ovaries in female (1 pair), testes in male (1 pair), pineal gland, thymus (immune) gland.

The last two glands on this list, the pineal and thymus glands, are included as endocrine glands because they are ductless, although little is known about their endocrine function in the human body. The pineal gland, located in the central portion of the brain, is believed to secrete a substance called melatonin. Melatonin contributes to the process of skin pigmentation. The pineal is also known to regulate the estrus (reproductive) cycle in lower animals. The thymus gland, located behind the sternum and extending into the neck, is large in childhood but shrinks in size in adults. Its structure, although ductless, resembles a lymph gland (contains lymphatic tissue and antibody-producing lymphocytes), and it is thought that the thymus might play a role in the immune process (antibody-antigen reactions) in the body. Although the exact functions of the thymus are not known, it may also be involved in various disease processes; for example, removal of the thymus gland is found to be helpful in treating a muscular-neurological disorder called myasthenia gravis.

V. DIAGNOSIS

Exercise 1.Read and translate the text paying close attention to the expressions in bold.

DISEASE: SIGNS AND SYMPTOMS

Disease may be acute, chronic, malignant, or benign. Of these terms, chronic and acute have to do with the duration of a disease, malignant and benign with its potentiality for causing death.

An acute disease process usually begins abruptly and is over soon. Acute appendicitis, for example, is characterized by vomiting, and pain usually localized in the lower right side. It usually requires immediate surgical treatment, the term chronic refers to a process that often begins very gradually and then persists over a long period. For example, ulcerative colitis is a chronic disease. Its peak incidence is early in the second decade of life. The disease is characterized by relapsing attacks of bloody diarrhea that persist for weeks to months. These attacks alternate with asymptomatic periods that can last from weeks to years.

The terms benign and malignant, most often used to describe tumours, can be used in a more general sense.

Benign diseases are generally without complications, and a good prognosis is usual. A wart on the skin is a benign tumour caused by a virus; it produces no illness and usually disappears spontaneously if given enough time (often many years). Malignancy implies a process that, if left alone, will result in fatal illness. Cancer is the general term for all malignant tumours.

Diseases usually are indicated by signs and symptoms. A sign is defined as an objective manifestation of disease that can be determined by a physician; a symptom is subjective evidence of disease reported by the patient. Each disease entity has a constellation of signs and symptoms; individual signs such as fever, however, may be found in a great number of diseases.

Fever is an abnormal rise in body temperature. It is most often a sign of infection but can be present whenever there is tissue destruction, as, for example, from a severe burn or when large amounts of tissue have died because of lack of blood supply. Fever is a highly significant indicator of disease.

The pulse rate is another easily obtainable and important piece of information. The heart rate varies with the level of physical activity: the heart beats faster during exercise and more slowly during rest. An inappropriate heart rate (or pulse) may be indicative of disease. The heart rate increases in the feverish patient. A weak, rapid pulse rate may be a sign of severe blood loss or of disease within the heart itself. Irregularity of the pulse is an important indicator of heart malfunction.

The respiratory rate (rate of breathing) is modified by disease. Persons with fever have an increased respiratory rate, which serves to lower body temperature (this rapid breathing is analogous to the panting of a dog).

Temperature, pulse, and respiratory rate — called the vital signs — may be important manifestations of disease. The fourth vital sign, blood pressure, is equally significant. Among other things, it indicates the amount of blood in circulation.

Exercise 2.Study the following case notes. What questions might the doctor have asked to obtain the information they contain?

a) SURNAME James FIRST NAMES Robert

AGE 48 SEX M MARITAL STATUS S

OCCUPATION Builder

PRESENT COMPLAINT frontal headache 4/7 following cold. Worse in a.m. and when bending down. Also being ‘off colour’ and feverish.

POINTS OF NOTE analgesics, some relief

b) SURNAME Warner FIRST NAMES Mary Elizabeth

AGE 34 SEX F MARITAL STATUS D

OCCUPATION Teacher

PRESENT COMPLAINT episodic headaches many years, lasting 1-2 days every 3-4 months, pain behind eyes, nausea, ‘tightness’ back of head, depressed pain, interfering work.

c) SURNAME Green FIRST NAMES Peter

AGE 42 SEX M MARITAL STATUS M

OCCUPATION Salesman

PRESENT COMPLAINT severe attack of central chest pain six months ago, lasted 10 minutes, relieved by rest. Recurred several times after exertion. His father died aged 56 of a coronary thrombosis.

POINTS OF NOTE angina

Exercise 3.Work in pairs and try to recreate the consultations. Student A should start.

A: Play the part of the patients. Use the case notes from the Ex. 1 as prompts.

B: Play the part of the doctor. Find out what the patient is complaining of. Do not look at the case notes.

Exercise 4.Read the following case history and find and underline this information about the patient as quickly as you can:

1. previous occupation

2. initial symptoms

3. initial diagnosis

4. condition immediately prior to admission

5. reason for emergency admission

6. duration of increased thirst and nocturia

7. father’s cause of death

8. alcohol consumption

CASE HISTORY

Mr. Wildgoose, a retired bus driver, was unwell and in bed with a cough and general malaise when he called in his general practitioner. A lower respiratory tract infection was diagnosed and erythromycin prescribed. Two days later, at a second home visit, he was found to be a little breathless and complaining that he felt worse. He was advised to drink plenty and to continue with his antibiotic. Another 2 days passed and the general practitioner returned to find the patient barely rousable and breathless at rest. Emergency admission to hospital was arranged on the grounds of ‘severe chest infection’. On arrival in the ward, he was unable to give any history but it was ascertained from his wife that he had been confused and unable to get up for the previous 24h. He had been incontinent of urine on a few occasions during this time. He had been noted to have increased thirst and nocturia for the previous 2 weeks.

His past history included appendicectomy at age 11 years, cervical spondylosis 10 years ago, and hypertension for which he had been taking a thiazide diuretic for 3 years. His father had died at 62 years of myocardial infarction and his mother had had rheumatoid arthritis. His wife kept generally well but had also had a throat infection the previous week. Mr. Wildgoose drank little alcohol and had stopped smoking 2 years previously.

Exercise 5.Study this extract from a case history:

The patient was a 59-year-old man, head of a small engineering firm (1), who complained of central chest pain (2) which occurred on exertion (3) and was sometimes accompanied by sweating (4). He smoked 40 cigarettes a day (5). The pain had first appeared three months previously (6) and was becoming increasingly frequent (7). He had noticed some weight gain recently (4 kg) (8) and also complained that his hair had become very dull and lifeless. He felt the cold much more than he used to. He denied any palpitations (9) or ankle oedema (10).

What questions might a doctor ask a patient to obtain the information in italics in the case history? You may ask more than one question for each piece of information. When you have finished, put your questions in the most natural order for a consultation.

Exercise 6.Work in pairs. Student A should start.

A: Play the part of the patient. Base your replies on the information given in the extract above.

B: Play the part of the doctor. Find out what the patient is complaining of.

Exercise 7.What are the main symptoms for these conditions:

a) a cold;

b) flu;

c) hay fever;

d) a hangover;

e) diarrhoea;

f) asthma;

g) appendicitis;

h) chickenpox;

i) bronchitis;

j) tonsillitis;

k) hepatitism;

m) migrain.

Exercise 8.Provide the following symptoms with the correct diagnosis.

1) I've been sick quite a lot. I can't keep anything down. I feel terrible.

2) I feel weak and dizzy. I've got aches and pains all over my body. I can't stop shivering.

3) I can't swallow, and my glands are swollen.

4) I started having a cold a few days ago, and now I've got a rash with small red spots all over my body.

5) I seem to have some sort of stye or infection in my right eye.

6) I keep getting shooting pains in the back and it's difficult to move.

7) I keep getting short of breath.

Exercise 9.This is a section on symptoms, possible diagnosis and remedies. These six exchanges between doctor and patient have been mixed up. Decide which response should follow which question.

Exercise 10.Rearrange these six paragraphs in the same way.

Exercise 11*.Match each of the medical terms for common symptoms in the first column with a term which a patient would easily understand or might use, from the second column:

1. paraesthesia a) swelling, puffiness

2. productive cough b) indigestion

3. anaesthesia c) coughing up phlegm or spit

4. retrosternal chest pain d) trouble holding your water

5. orthopnea e) cramp in the leg muscles which comes and goes

6. stress incontinence f) numbness

7. dysmenorrhoea g) sleeplessness

8. dyspepsia h) out of breath, out of puff, breathlessness

9. oedema i) painful periods

10. intermittent claudication j) pain behind the breast bone

11. insomnia k) pins and needles

12. dyspnoea l) shortness of breath when you lie down

Exercise 12.Retell the dialogue from the third person:

Doctor: Good morning, Mr. Hall. What’s brought you along today?

Patient: Well, you see, doctor, I’ve been having these headaches, you see, and…

D: And how long have they been bothering you?

P: Well, they started about three months ago.

D: I see. And which part of your head is affected?

P: Well, it’s right across the front here.

D: Can you describe the pain?

P: It’s a sort of dull and throbbing kind of pain.

D: Do they come on at any particular time?

P: They seem to be, they’re usually worse in the morning. I notice them when I wake up.

D: Is there anything that makes them better?

P: If I lie down for a while, they seem to go away.

D: Has there been anything else apart from these headaches?

P: My wife says that I seem to be getting a bit deaf.

D: Oh? Well, Mr. Hall, I think at this stage I’ll start by checking your ears to see if there’s any wax…

Exercise 13.Act out the dialogues.

A

D: Good afternoon Mr Priestly, come in and have a seat.

P: Good afternoon, Mr Davidson.

D: Now I’ve had a letter from your doctor saying that you’ve been having problems with your sight.

P: Yes, that’s right, doctor.

D: Could you tell me how long the left eye has been bad for?

P: Oh, going on for about a year now, I suppose.

D: Mm, and what do you do?

P: I’m a postman. I deliver letters and that sort of thing.

D: How is your work being affected?

P: Oh, it’s really bad. I can hardly see the letters let alone the addresses. I have to get my mates to do that sort of thing for me and it’s getting to a stage where I just can’t cope really.

D: I see, yes. I’d just like to examine your eyes and perhaps we could start with the chart. Could you just look at the chart for me? Can you see any letters at all?

P: No, nothing.

D: OK. Well, with the right eye can you see anything?

P: N H T A. That’s about all, I’m afraid.

D: Now does that make any difference?

P: No, nothing.

D: What about that one? Does that have any effect?

P: Not really, I can’t really say it does.

D: Right, OK, thank you very much indeed.

B

D: Hello, Mr. Nicol, I haven’t seen you for a long time. What seems to be the problem?

P: I’ve been having these headaches, doctor.

D: Which part of your head?

P: Mostly along here, along the side.

D: Oh, I see, the left side. How long have they been bothering you?

P: Well, they started about three weeks ago. At first I felt as if I had the flu because my shoulders were aching, you know, pains in the joints and I had a bit of a temperature.

D: I see, and did you take anything for the headaches?

P: I took some aspirin but it didn’t seem to make much difference to me.

D: When do they come on?
P: They seem to be there all day long, and at nigh I just can’t get to sleep.

D: So they’re bad enough to keep you awake?

P: Yes.

D: And how do you feel in yourself?

P: Very weak, and I’m tired of course. I think I’ve lost some weight.

D: Have you had headaches in the past?

P: Just one or two, but never anything like this.

C

General practitioner: Hello, Jim. I wonder if you could see a patient for me?

Consultant: Certainly, John. What’s the story?

GP: Well, it’s a Mr Alan Jameson, a 53-year-old carpenter. He’s been an infrequent attender in the past but he came to see me this morning complaining of pain in his right leg and in his back.

Consultant: And when did this start?

GP: Well, it came on about six weeks ago and it’s become gradually more severe over the past couple of weeks.

Consultant: Was the pain localized?

GP: No, poorly. At first he thought he’d just pulled a muscle. But it’s got so bad that he hasn’t been able to do his work properly. It’s also been getting to the stage where the pain is waking him up at night, it’s been so severe, and he’s also noticed some tingling in his right foot. He’s having difficulty in carrying on with his work. He’s also lost three kilos and has become quite depressed.

Consultant: Has he had anything similar in the past?

GP: No, not exactly, but he has suffered from intermittent pain in back. Paracetamol gave some relief but didn’t solve the problem completely.

Consultant: Apart from that, any other problems with health in the past?

GP: No, perfectly OK.

Consultant: Did you find anything else on examination?

GP: Yes, as well as the pain he has numbness in his toes on the right foot.

D

D: Come in, Mr Green. Come and sit down here. I’ve had a letter from your doctor and she tells me that you’ve been having pain, pain in your chest.

P: Yes, and in my arm, and also tingling in my fingers and…

D: Yes, now when did you first notice this pain?
P: Well, I suppose about six months ago.

D: And can you remember when it first came on?

P: Yes, well I remember, I got a bad pain in my chest when I was shopping. It was so bad I couldn’t breathe.

D: And where, in which part of your chest did you feel the pain?

P: Well, right across my chest.

D: And how long did it last?

P: Ooh, about ten minutes.

D: And what did you do when it happened?

P: I had to stop and wait for it to go away.

D: So, have you had this, the pain again since then?

P: Yes, I often get it when I overdo things.

D: Well, I think at this stage I’d like to examine you, your chest. So if you could strip to your waist.

P: Right. There we go.

D: That’s fine. I’ll just check your pulse first of all. Fine. That’s fine. It’s quite normal, seventy per minute. Now your blood pressure. Fine. That’s quite normal too. 130 over 80.

P: Oh, I’m pleased to hear it.

D: Now I’m going to listen to your heart, so I want you to breathe normally… Mm, your heart sounds quite normal.

P: Well, that’s a relief.

D: Well now, I want you to take deep breaths in and out while I check your lungs. In. Out. In. Out. Fine. They’re completely clear. Well, Mr Green, the pain you’ve been having sounds very much like the pain of what we call angina, and this, well, this occurs when not enough oxygen is getting to the heart. Now I’d like to check a few tests, and, following that I’ll be able to advise some treatment for you…

Date: 2016-01-03; view: 2115