Pathophysiology of Disease and Naturopathic Screen Assessment Tools
Excerpts from previous naturopathy assignments HLT60512. Pathophysiology of Disease and Naturopathic screening assessment tool used to determine a treatment approach
| Disease | Pathophysiology | Naturopathic Screening Assessment
Tool |
| Hypertension | Hypertension has multifactorial inputs including genetic predisposition, salt intake, adrenal responses, blood pressure, vascular reactivity, circulatory blood volume, viscosity, cardiac output, blood vessel elasticity and neural stimulation (R Alexander, MD, 2018).
Signs of hypertension include Elevation of systemic arterial blood pressure Systolic blood pressure equal to or greater than 140mmHg |
Hechtman 2012, gives the following examples:
Blood Pressure monitoring regularly Naturopathic observational deficiency signs Can be ‘silent’ no observable signs. Best practice is case taking and |
| Diastolic pressure is 90mmHg or greater.
Results from increased peripheral resistance (vasoconstriction of the arterioles) or an increase in circulating blood volume. Primary hypertension possible causes Immunological factors: oxidation of lipids such as arachidonic acid, that’s initiates T-cell (R Alexander, MD, 2018). Defects in renal sodium haemostasis Increased plasma and extracellular fluid volume Increased natriuretic hormone Increased cardiac output Defect in vascular smooth muscle growth and structure Vascular wall thickness and increased total peripheral resistance (Craft, et al., 2011, p. 610) Hypertension is a comorbidity factor for disease such as: Coronary heart disease. Stroke & Diabetes mellitus Approximately 20 genes are found to contribute to hypertension Only 30% of hypertension is hereditary Secondary hypertension Is caused by an underlying disease process or medication (Craft, et al., 2011, p. 1159) |
blood pressure monitoring Case history
Nutritional intake Exercise Digestive and metabolic function Hormonal status Mental health Environment and comorbidities (Hechtman, 2012, p. 966) |
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| Disease | Pathophysiology | Naturopathic Screening Assessment
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| Anaemia | Anaemia is a reduction in the haemobglobin and erythrocytes in the blood. Inadequate numbers of erythrocytes may result from lack of red cell production or loss of blood in haemorrhage. Inherited defects can cause also cause Anaemia. | Hechtman 2012, gives the following examples:
Biochemical tests for irons status |
| Types of anaemia can occur from iron deficiency, renal disease, and chronic inflammation.
General causes / manifestations/ signs of anemia Haemorrhage Decreased erythropoiesis Increased erythrocyte destruction Decreased red blood cells Decreased Haemobglobin Decreased oxygen carrying capacity (hypoxaemia) Tissue hypoxia ischaemia: ‘weakness and fatigue, skin pallor, respiratory distress, e.g. increased respiratory rate, depth, and exertional dyspnea, and central nervous system problems causing dizziness, fainting, and lethargy’ (Craft, et al., 2011, p. 399) Craft et al states: Increase heart rate, capillary dilation, stroke volume and increase oxygen demands for work of heart, which might cause angina, and increase erythropoietin production which stimulates the bone marrow to make more red blood cells (Craft, et al., 2011, p. 399) Furthermore; Increased stroke volume also leads to: ‘hyper dynamic circulation, cardiac murmurs and high output cardiac failure. The renal compensatory mechanisms are: Increase renin – aldosterone response, increase salt and water retention, and increase extracellular fluid volume, again leading to hyper dynamic circulation and potential for cardiac murmurs and cardiac failure’(depending on severity), (Craft, et al., 2011, p. 399). |
include: Serum iron,
Haemoglobin, Haematocrit, Serum transferrin, Transferrin saturation, Serum ferritin, Total iron binding capacity Transferring receptor Erythrocyte protoporphyrin Zinc and haem ration test Hechtman states: ‘when assisting supplementation from testing, the formula 1mmol iron = 55.8mg iron is used’ (Hechtman, Clinical Naturopathic Medicine, 2012, pp. 398-400) Naturopathic observational deficiency signs Hechtman 2012 gives the following examples: Angular stomatitis, glossitis, Thin and brittle fingernails Spoon nails Pica Pagophagia (the compulsive consumption of iced drinks) |
| Cold intolerance
Palour (Hechtman, 2012, pp. 398-400) |
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| Disease | Pathophysiology | Naturopathic Screening Assessment
Tool |
| Coeliac | Coeliac
Is a disease whereby the digestive system can’t metabolise gluten, adverse health effects occur from gluten consumption. Signs and symptoms Atrophy and flattening of villi in the duodenum and jejunum of the SI Malabsorption nutrients T-cell antibody and complement activators Primary and Secondary effects of injury to villi and mucosal damage to the small intestine, Decreased surface area absorption and decreased intestinal hormones which results in inflammatory enteritis, decreased pancreatic function, decreased carbohydrate protein absorption, and fat absorption. Diarrhoea occurs due to malabsorption of food, decreased electrolytes and proteins are a result, which causes a vicious cycle of carb, protein, and fat malabsorption, ending in malnutrition (Craft, et al., 2011, p. 826) Research A study by Goebel 2017 reports: ‘A strong association exists between celiac disease and two human leukocyte antigen (HLA) haplotypes (DQ2 and DQ8). Damage to the intestinal mucosa occurs with the presentation of gluten-derived |
Hechtman 2012, gives the following examples:
Organic acid profile IgG, IgE Food antibodies profile Coeliac profile and Gene screen Amino acid profile Nutrient and Toxic Elements (Hair, Blood) Adrenal Stress profile GI Function profile Secretory IgA Vitamin D Red cell or serum zinc and copper Urinary iodine (Hechtman, Clinical Naturopathic Medicine, 2012)
Naturopathic observational signs Diarrhea Bloating |
| peptide gliadin, consisting of 33 amino acids, by the HLA molecules to helper T cells. Helper T cells mediate the inflammatory response. Endogenous tissue transglutaminase deamidates gliadin into a negatively charged protein, increasing its immunogenicity. Absence of intestinal villi and lengthening of intestinal crypts characterize the mucosal lesions in untreated celiac disease. More lymphocytes infiltrate the epithelium (intraepithelial lymphocytes). Destruction of the absorptive surface of the intestine leads to a maldigestive and malabsorption syndrome. Celiac disease has a strong hereditary component. The prevalence of the condition in firstdegree relatives is approximately 10%’ (Goebel, 2017 ).
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Gas
Fatigue Weight Loss Iron-Deficiency Anemia Constipation Depression (Healthline, 2018) |
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| Disease | Pathophysiology | Naturopathic Screening Assessment
Tool |
| Cystitis | Craft Gordon and Tiziani states:
Acute cystitis is an inflammation of the bladder and is the most common site of UTI. Factors which can influence UTI’s • Escherichia coli • Klebsiella, proteus • Pseudomonas • Staphylococcus • Fungi • Viruses • Parasites • Tubercular bacilli Hechtman states: ‘Bladder insult results from, infection, bladder trauma, bladder over distention, |
Hechtman 2012, gives the following examples: Pyuria (white cell count greater than 10 000/ml and bacteriuria on urinalysis Urinalysis/dipstick testing Referral Physical examination: Pelvic exam Urinalysis Naturopathic observational deficiency signs |
| primary neurogenic inflammation, bacterial cystitis, autoimmune disorder, pelvic floor dysfunction. This results in damage to the bladder epithelium and anti-proliferative factor secreted by epithelial cells and the bladder fails to repair damage initially, therefore there is a leak of urine constituents (potassium) into interstitium. There is subsequent mast cell activation and histamine release, c-fibre activation, substance P release, and immunogenic and allergic responses are possible. If not treated and cleared this can lead to progressive bladder injury, spinal cord changes and possibility of chronic neuropathic pain (Hechtman, 2012, p. 709) | Burning pain on urination
Increased frequency of urination Lower abdominal pain Urine that is dark coloured and has a strong odour Cloudy urine Haematuria Questions Washing detergents Toiletries Cleaning products Toilet paper Sanitary products Menstrual timing and menstrual history STI possibility (Hechtman, 2012, pp. 708-10) |
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| Disease | Pathophysiology | Naturopathic Screening Assessment
Tool |
| Hyperthyroidism | Craft et al states: ‘Disturbances of the normal homeostatic mechanism can occur at the level of the pituitary gland, the thyroid gland, or in the periphery. Regardless of etiology, the result is an increase in transcription in cellular proteins, causing an increase in the basal metabolic rate. In many ways, signs and symptoms of hyperthyroidism resemble a state of catecholamine excess, and adrenergic blockade can improve these symptoms’ | Hechtman, 2012 gives the following examples:
TSH assay will show low levels unless in rare cases Thyroglobulin antibodies (Tg-Ab) or thyrotropin (TSH) receptor |
| More than 99.9% of T4 and T3 in the peripheral circulation is bound to plasma proteins and is inactive
Free T3 is 20-100 times more biologically active than free T4. Free T3 acts by binding to nuclear receptors (DNA-binding proteins in cell nuclei), regulating the transcription of various cellular proteins. Hyperthyroidism Graves’ disease 1. Lag of the eyeball on upward gaze and of the upper lid on downward gaze, 2. Enlargement of the ocular muscles resulting in eyeball protrusion, paralysis of extra ocular muscles and damage to the retina and optic nerve 3. Irritation, pain, photophobia, blurred vision 4. Increased metabolism and weight loss (Craft, et al., 2011, pp. 258-60) |
antibodies
Conduct laboratory TSH T3, T4, and thyroid antibody assessments for all suspected presentations Antioxidant status Environmental toxins Stress profile and cortisol levels Naturopathic observational signs Fatigue Frequent loose stools Heat intolerance Insomnia Nervousness Irritability Nervousness Palpitations and tachycardia Stare Sweating Tremor Weakness Weight loss despite a good appetite Physical assessment Serum T3, T4, Thyroid resin uptake, and free thyroxine (T4) and free T4 index are usually all elevated in TSH |
| test
(Hechtman, Clinical Naturopathic Medicine, 2012) |
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| Disease | Pathophysiology | Naturopathic Screening Assessment Tool |
| GORD | In Oesophagitis the upper oesophageal sphincter tone tends is lower than normal. The severity depends on the composition of the gastric contents and length of time they are in contact with the oesophageal mucosa (Craft, et al., 2011, p. 830).
The lining of the oesophagus is not protected from acid in the same way as the stomach mucosa and acidic chime can be damaging. In individuals with weak oesophageal peristalsis, refluxed chime remains in the oesophagus longer than usual (Craft, et al., 2011, p. 830).
Delayed gastric emptying contributes to reflux. Disorders that delay emptying include gastric duodenal ulcers, and hiatal hernia, which can weaken the lower oesophageal sphincter (Craft, et al., 2011, p. 830) |
Hechtman, 2012 gives the following examples:
Barium oesophagram Endoscopy Oesophogeal mucosal biopsy Empirical trial of proton pump inhibitors Hydrogen breath test Naturopathic observational deficiency signs Sensation of burning in the oesophogeal region, feeling of chest pain Chronic cough Chronic hoarseness Teeth erosion Angina like pain Belching Queasiness Asymptomatic |
| Dysphagia
Weight Anaemia Bleeding (Hechtman, 2012, p. 197) |
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| Disease | Pathophysiology | Naturopathic Screening Assessment
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| PCOS | PCOS derives from abnormalities in metabolism of androgens and estrogen, and androgen production. PCOS can also result from abnormal function of the hypothalamic-pituitary-ovarian (HPO) axis. Features of PCOS may include the following: Hirsutism
• Infertility • Obesity and metabolic syndrome • Diabetes • Obstructive sleep apnea • Hypertension • Enlarged ovaries: May or may not be present; evaluate for an ovarian mass Testing • Exclude all other disorders of menstrual irregularity: • Hyperandrogenism • Adrenal or ovarian tumors • Thyroid dysfunction • Congenital adrenal hyperplasia • Hyperprolactinemia |
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Blood sugar
Waist to hip ratio Body mass index Naturopath tests Lipid profile Cardiovascular risk Hepatobiliary health Female hormone profile LH FSH oestradiol Progesterone Prolactin BhCG Androgen Profile Fee and bound testosterone Free Metabolic profile Fasting GTT Insulin Fasting glucose |
| Acromegaly
Cushing syndrome. |
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HbA1c
Lipid profile |
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| Triglycerides | ||||
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HDL, LDL, VLDL, total cholesterol,
Apo lipoproteins, lipoproteins |
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| Thyroid panel: TSH, T3, t4, reverse T3, thyroid antibodies, urinary iodine or spot iodine. | ||||
| Transvaginal and transabdominal ultrasound | ||||
| (Hechtman, 2012, pp. 785,86) | ||||
| Doctor tests | ||||
| Thyroid function tests (e.g., TSH, free thyroxine) | ||||
| Serum prolactin level | ||||
| Total and free testosterone levels | ||||
| Free androgen index | ||||
| Serum hCG level | ||||
| Cosyntropin stimulation test | ||||
| Serum 17-hydroxyprogesterone (17-
OHPG) level |
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| Urinary free cortisol (UFC) and creatinine levels | ||||
| Low-dose dexamethasone suppression test |
| • Serum insulin-like growth factor
(IGF)–1 level Other Androstenedione level FSH and LH levels GnRH stimulation testing Glucose level Insulin level Lipid panel Imaging tests The following imaging studies may be used in the evaluation of PCOS: Ovarian ultrasonography, preferably using transvaginal approach Pelvic CT scan or MRI to visualize the adrenals and ovaries |
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| Disease | Pathophysiology | Naturopathic Screening Assessment Tool |
| Osteoporosis | Osteoporosis is loss of bone mineral density (BMD) to a significant extent that the bones become at risk of fracture from accidents, injuries, and falls depending on level of BMD. Three major factors are Oestrogen deficiency, ageing, and malnutrition.
Markers of Bone mineral density are given from DEXA testing as follows: • T-score-1.0 to -2.5 • Above-1.0 is low risk Requires observations |
Doctor tests
Dual energy X-ray absorptiometry (DEXA) Naturopathic tests Osteoporosis risk assessment (ntX) Female Hormonal Profile (Saliva) 2 and 16 urinary Oestrogen |
| Calcium
Vitamin D Exercise Repeated BMD in 2-5 years. Below -2.5 is high risk. it requires Evaluation of secondary causes, and treatment for secondary causes Calcium, vitamin D, exercise, and antiresorptive therapy Repeat BMD in 1-2 years (bone markers in 3-6) months Monitor for side effects incase changes to antiresorptive therapy are required (Hechtman, 2012, p. 576)
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Metabolites
Bone Resorption Assay (Urine) Fat Soluble Vitamin Profile (Hechtman, 2012, pp. 576-79)
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| Disease | Pathophysiology | Naturopathic Screening Assessment
Tool |
| Allergic Rhinitis | Allergic rhinitis comprises inflammation of the mucous membranes of nose, eyes, Eustachian tubes, middle ear, sinuses, and pharynx. Possible causes
IgE mediated response to an extrinsic protein e.g. a specific pollen grain Mediators release histamine, tryptase, kinins, and heparin Mast cells synthesise leukotrienes and prostaglandin Vascular permeability is increased, leading to plasma exudation. Vasodilation occurs, leading to congestion and pressure. Sensory nerves are stimulated, leading to sneezing and itching Systemic effects, including fatigue, sleepiness, and malaise, can occur from |
Dental hygiene
Allergy Full dietary review Recent immunisations Potential occupation hazards Exposure to chemical Headache migraines Ct scan Allergy testing Nasal smear |
| the inflammatory response. These symptoms often contribute to impaired quality of life
(Sheikh, MD, 2018) |
Radiographic studies (Hechtman, 2012, pp.
455,56)
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| Disease | Pathophysiology | Naturopathic Screening Assessment
Tool |
| Chronic Fatigue | Immune system is upregulated in CFS, antibodies and antigens are increased. Patients with a possible diagnosis of CFS are found to have elevated levels of immunoglobulin G (IgG) viral capsid antigen (VCA) & EBV (Cunha, MD, 2017).
Cunha MD states: ‘Most patients with CFS demonstrate elevated IgG, coxsackievirus B, human herpesvirus 6 (HHV-6), and/or C pneumonia titers. Patients with CFS also commonly have a decreased percentage of natural killer (NK) cells. Most patients with CFS have 2 of the 3 above-mentioned immunological abnormalities’ (Cunha, MD, 2017) Signs and symptoms Hechtman Four or more of the following symptoms are concurrently present for 6 months or longer Impaired memory or concentration Sore throat Tender cervical or axillary lymph nodes Muscle pain Multi joint pain without swelling or redness New headaches Unrefreshing sleep Post exertion malaise (lasting more than 24 hours) |
History and Naturopathic Test
Mental exam Physical exam Full blood count Erythrocyte sedimentation rate Liver function tests Enzyme levels Alanine Aminotransferase (ALT) alkaline phosphatase (ALP) with follow up tests for hepatitis if necessary Blood proteins Total albumin, globulin Blood glucose Blood urea nitrogen and serum creatinine Serum electrolytes Calcium phosphorus Thyroid function tests Iron studies |
| (Hechtman, 2012, p. 1183) | Vitamin D
Red cell folate and B12 IgE, IgA, IgG Sensitivity (Hechtman, 2012, pp. 1191,92) |
Heather Indiana Rose
Copyright 2019