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Exam In January > Biological Crintal Illnesses > Flashcards

Biological Crintal Illnesses Flashcards

1
Q

What is pH

A

A scale that measures of acidity or alkalinity of a solution

A measure of the concentration of FREE H+

The pH range is from 1-14

The pH of distilled water is 7.0

The body’s pH is rigorously regulated as an excess of H+ or OH can be very destructive

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2
Q

PH of plasma, interstitial fluid and intracellular fluid

A

Cells are constantly producing H+ as a byproduct of their metabolism

Intercellular pH 7.35-7.45

Extracellular space pH 7.35

Cell pH 7.0

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3
Q

What are acids

A

Substances which release hydrogen ions when in solution

The stronger the acid the lower the pH

Hydrochloric acid pH 1.2 = a strong acid

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4
Q

Carbonic acid

A

PH 4.68 a week acid

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5
Q

What are bases

A

Substances which

Accept hydrogen ions or
Donate an hydroxyl group when is solution

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6
Q

What is acid / base balance

A

An individual is in acid/base balance when the production of hydrogen ions in the body is offset by the loss from the body

The normal pH range for arterial blood is

pH 7.35-7.45

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7
Q

Allalotic

A

Too little H+ or too much HCO3

pH >7.45

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8
Q

Acidic

A

Too much H+ or too little HCO3

pH <7.35

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9
Q

Buffers

A

Buffers

Mop up excess H+ within seconds

Consist of a weak acid/alkali and it’s salt

Functions to prevent big changes in body fluid pH

Some buffers remain locally, while others are involved in the transport and excretion of H+

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10
Q

Buffers

A

The main buffering system in the body are

Carbonic acid bicarbonate : bicarbonate is a significant anion in both intracellular and extracellular fluid

Proteins: most abundant in tissue cells and blood

Phosphates: most abundant intracellular space and important for excreting H+ in urine

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11
Q

Excretion of H+

A

Once successfully buffered the H+ is transported around the body and is excreted by the

Lungs (fast excretion of volatile acid)

Kidneys (slow excretion of fixed acid)

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12
Q

Respiratory system and pH

A

The respiratory system can change the amount of carbon dioxide in the blood in minutes

A rise in pCO2 stimulates chemoreceptors in the medulla oblongata leading to an increase in RR this removes co2 and increases the pH

Suppression of the respiratory drive leading to fewer shallower breaths will see a rise in CO2

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13
Q

Respiratory system and pH

A

Respiratory acidosis

When the respiratory system fails to remove all the carbon dioxide generated by the tissues, CO2 accumulates resulting in hypercapnia

Usual cause are CNS depression from stings, injury or disease
Asphyxia
Hypoventilation due to pulmonary, cardiac, musculoskeletal, or neuromuscular disease

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14
Q

Respiratory system and pH

A

Respiratory alkyosis when the respiratory system removes too much carbon dioxide, hypocapnia

Usual causes
Hyperventilating due to anxiety, pain or improper ventilator settings
Respiratory stimulation caused by drugs, disease, hypoxia or fever

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15
Q

Renal excretion of H+

A

The kidney controls pH by controlling the amount of H+ excreted in urine, while retaining bicarbonate ions in the blood

Urine pH 4.5-8.0

Hours to days to take effect

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16
Q

Metabolic alkalosis cause

A

Relatively rare, elevated bicarbonate levels

Repeated vomiting - pyloric stenosis

Ingestion of large quantities of antacids

Salicylate poisoning

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17
Q

Normal child blood gas values

A

PH 7.34-7.45

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18
Q

Reading blood gases

A

Look at pH

Look at the PCO

Look at the bicarbonate level

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19
Q

Summary

A

A if/ base balance is key to all body system

H+ is damaging in higher concentrations

There are buffering systems in the body to protect against increased acidity and to enable H+ to be excreted

Blood gas analysis helps to identify the cause of the problem when there is an acid: base disturbance

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20
Q

What does the cardiovascular system do

A

Delivers oxygen and nutrients to all tissues

Transports waste and co2 away from all tissues

Controls BP

Modifies bloody temp

Transports chemical messengers or hormones

Modifies it’s capacity according to demend

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21
Q

Cardiac output and mean arterial pressure

A

Cardiac output = heart rate x stroke volume

Mean arterial pressure = DBP + 1/3 pulse pressure

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22
Q

The cardiovascular system in children

A

When compared to adults, children have faster testing pulse

Smaller stroke volume

Narrower piles pressure

Lower blood pressure

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23
Q

Shock, cellular hypoxia and acidosis

A

Shock in all it’s forms results in the following cascade of biological events

Hypoxia = ATP production falls

Cells revert to anaerobic metabolism to generate ATP= lactic acidosis builds up

Cell membranes become damage as swell, ionic distribution is deranged

Blood pH falls as buffering systems are overwhelmed

Cells die and releasing contented to ECF

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24
Q

Types of shock

A

Hypovolaemic shock - decreased circulating volume

Cardio genie shock - failure of the heart to pump

Distributive shock - increased peripheral vasodilatation
.septic shock
.anaphylactic shock
.neurogenic shock

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25
Q

Stages of shock

A

Compensatory stage
Sympathetic nervous system and the renin/angiotensin system helps to maintain blood pressure

Progressive stage : compensation fails, BP falls, perfusion Beyoncé’s grossly inadequate

Irreversible stage
Multi- organ failure and death

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26
Q

Early stages of shock

A

Clinical features
Tachycardia- maintain cardiac output

Tachypnoea- meeting o2 demand and excrete co2

Mottled, pale, cool periphery - peripheral vasoconstriction/ resistance to maintain BP

Wide temperature gradient > 4 °c - cold peripheries due to Lowe peripheral perfusion

High Capillary refill time - low peripheral perfusion

Skin turgor low extracellular fluid

Sunken eyes/ fontanelle - low extracellular fluid

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27
Q

Compensatory phase of shock

A

Cardiac output falls

Release of renin
Release of aldosterone

Disengorgement of spleen

Increased blood volume

Increase cardiac output

28
Q

Shock progressive stage

A

Hypotension = hallmark of progressive stage

Increased work of heart and cardiac output decreases = heart failure

Perfusion yo vital organs insufficient = organ damage and multi organ failure

Acute renal failure = oliguria/ anuria

Barriers in the gut break down= sepsis/ bleeds

Very poor prognosis at this stage

29
Q

Irreversible stage of shock

A

Mass vasodilation : final common pathway for all types of shock

Multi organ failure: heart, hepatic, renal, respiratory, pancreatic, GI, haematological and neurological failure

Organs not responding to treatment

Death is imminent

30
Q

Hypovolaemic shock

A

Primary cause is reduced intravascular volume by 25%

Most common cause of shock in children

Causes
D and V

Haemorrhage

Peritonitis

Bowel obstruction

Burns

31
Q

Treatment of hypovolaemic shock

A

Optimis ventilation and oxygenation

Fluid replacement

  • crystalloid or colloids
  • blood or blood products

Cardiac support drugs
-inotropes

32
Q

Cardio genie shock

A

Heart failure is the primary cause of the shock

Heart ceases to function as an effective pump

Poor prognosis

Congenital heart disease
Heart valve disease
Cardiomyopathy

33
Q

Treatment of cardio genie shock

A

Oxygen administration

Cardiac support drugs

Treat arrhythmias

Diuretics and strict fluid balance

34
Q

Distributive shock

A

Increased peripheral vasodilataion

Three types fall under this am category

Septic shock

Anaphylaxis

Neurogenic shock

35
Q

Septic shock will

A

Due to the overwhelming infection

Immune response results in a cascade of chemical inflammatory mediators leading to mass vasodilation and tissue oedema

Vascular permeability increases, causing leakage of fluid into extra vascular space se

Coagulation can occurs and microthrombi may obstruct blood flow to some organs- called disseminated intravascular coagulation

36
Q

Treatment of septic shock

A

Oxygen mechanical ventilation

Fluid administration

Inotropic support

Antibiotics

Correction of acidosis

Correction of clotting problems

37
Q

Anaphylactic shock h

A

Acute, extensive reaction to allergens

Degranulation of mast cells with
Overwhelming release of histamine

Flushing 
Itching
Facial swelling
Urticaria 
Wheeze
Strider
Abdominal pain 
Diarrhoea
38
Q

Treatment of anaphylaxis

A

Remove or reduce exposure of causative agent

Maintain gaseous exchange, oxygenation, tissue perfusion and cardiac output

Adrenaline 
Antihistamine 
Corticosteroids
Oxygen 
Fluid resuscitations
39
Q

Neurogenic shock

A

Caused by anything that affects vasomotor output
- stimulates parasympathetic activity

Inhibits sympathetic activity

  • spinal injury
  • spinal anaesthesia
  • poisons/depressive drugs
40
Q

Treatment of neurogenic shock

A

Support BP with inotropes

Treat increased intracranial pressure of present

Management of underlying cause

41
Q

Multi-organ failure

A

Final pathway of all forms of shock

GIT vasoconstriction > blood flow diversion away from GI tract > gut is harm is > ulceration and bleeding

Liver hypoxia > cellular dysfunction > metabolic wastes not being detoxified and gluconeogenesis fails

Kidneys acute tubular necrosis > oliguria, then anuria, then polyuria

42
Q

Summary

A

The cardiovascular system in children has differing ranges of normal values based on age

Shock is a syndrome that is seen in a range of conditions

Compensation occurs

Unless shock is adequately treated then it progresse and death my ensue

An understanding of the cause of shock is key to optimal treatment

43
Q

GOT review

A

Oral cavity, teeth, tongue

Salivary glands

Pharynx

Esophagus

Stomach

Liver

Gallbladder

Pancreas

Small intestines

Large intestines

44
Q

GIT review

A

Functions of the digestive system

Ingestion

Mastication

Propulsion

Mixing

Section

Digestion

Absorption

Elimination

45
Q

Gut fluid dynamics

A

Enterocytes

Cell membranes and ion pumps

Secretion

Absorption

Production of faeces

46
Q

Gut defence mechanisms

A

Fluid volume

Gut motility

Anatomical barriers: mucous, glycocaylix

Constant shedding of epithelial cells

Gastric acid barrier

Microbial flora (good bacteria)

Mucosal and luminal IgA

Lymphatic

47
Q

Immature GI tract in children

A

Reduced gut acidity

Reduced gut motility

Reduced IgA secretion

Increased permeability of mucosa

Prone to gastro oesophageal reflux

48
Q

Breast milk and gut production

A

Enhances gut maturation

Provision of white blood cells

Bacteriocidal

Bacteriostatic

49
Q

Gastroenteritis

A

Inflammation of the mucous membranes of the GIT, chnaracterisednby vomiting and or diarrhoea

Dehydration, electrolyte imbalance and metabolic acidosis are accompanying features of gastroenteritis

50
Q

Common causative agent

A

Bacteria
•escherichia coli
•salmonella
•shigella sonnei

Viruses 
•rotavirus
•adenovirus 
•hepatitis A 
•small round structured virus’s (SRVs) eg norovirus
51
Q

Modes of transmission

A

Water

Food

Person to person

 vector
Finger 
Flies
Food
Fluid
Faeces
52
Q

Microbial pathogensis

A

Microbe gains entry to gut

Survives non specific defences

Adheres and attached to gut wall

Multiplies, indueces pathology

53
Q

The onset of diarrhoea

A

Normal absorption in the GI tract abruptly stops

Vomiting and diarrhoea starts

Loss of undigested food and fluids

Loss of GI tract secretions

Loss of large quantities of water from bowel walls

Dehydration

Electrolyte imbalance

Metabolic acidosis

54
Q

Diarrhoea

A

Defined as a change in bowel habit for the individual child resulting in substantially more frequent and or looser stools

Acute diarrhoea is usually caused by GI infection

Profuse, liquid/watery consistency

Pea green

Abdominal pain

Blood

Mucous

55
Q

Other conditions which may present as suspected gastroenteritis

A

Systemic infection : septicaemia

Local infection : RTI, otitis media, uti, hepatitis a

Surgical disorders : pyloric stenosis, appendicitis

Diabetic ketoacidsis

Other allergy’s

56
Q

Water diarrhoea viruses

A

Gain access into gut wall

multiply inside enterocytes

Destroy or shorten villi

disrupt fluid and electrolytes balance

Cause excessive secretions

Reduce re absorption

57
Q

Bloody diarrhoea

A

Invade and adhere to gut wall

Replicate in abundance

Produce enterotxins

Activate gut secretion

Cause intestinal hurt

Hinders re absorption

Inflammation and haemolysis

58
Q

Incubation periods

A

Salmonella 12-3 days

Clostridium botulinum 12 hours -1 1/2 days

Rotavirus 1-2!days

59
Q

Investigations

A

Stool MC&S inculcated when

Blood or mucus is present in the stools

Septicaemia is suspected

The child is immunocompromised

Consider when

Child has recently been abroad

Has prolonged barrows more than7 days

Unsure of diagnosis

Bloods

U&Es in severe dehydration

60
Q

Dehydration

A

Negative fluid balance

Loss of 3% body weight

Levels of dehydration based on loss of body weight

-mils 3-5%

Moderate 5-10% loss

Severe 10%loss

61
Q

Signs of dehydration in children

A

Prolonged capillary refill

Abnormal skin turgor

Abnormal respiratory pattern

Cold extremities

Absent tears

Sunken fontanelle

Sunken eyes

Dry mucous membranes

Weak pulse

Tiredness and lethargy

62
Q

Investigation in dehydration

A

If clinically dehydrated, consider

Blood for urea and electrolytes

Blood for culture

Full blood count

63
Q

Oral rehydration solution

A

A dioralyte sachet contains

Glucose

Sodium chloride

Potassium chloride

Disodium hydrogen citrate

ORS to have equal efficacy to IVIs

ORS reduces stool output and need for IVIs

64
Q

Intravenous fluid thearapy

A

Usually only recommended for children with severe dehydration

I’ve fluid regime is calculated according to the child weight and electrolyte levels

A fluid boils may be needed for fluid resuscitation

20ml/kg

65
Q

Return to normal diet

A

Rapid reintroduction of normal feeding of previously consumed diet after oral rehydration

Breastfeeds

Full strength milk and formula normal lactose containing diet

66
Q

Evidence based theory

A

Good evidence

Hand washing
Breathing
Parent education

Less evidence

Anti diarrhoea drugs

Antibiotics

Zinc

67
Q

Summary

A

Gastroenteritis is a significant golabal problem

Good public health measures have a significant impact on reducing gastroenteritis

Simple measure such as a good hygiene are key

Fluid replacement therapy is the mainstay of treatment for dehydration

ORS for a short period of time is usually all that is required while the D and V settle then the normal diet can be reintroduced

Exam In January (11 decks)

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