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Pathology > Block 12 > Flashcards

Block 12 Flashcards

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1
Q

What is the largest internal organ

A

Liver

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2
Q

What are the functions of the liver

A 
Produce clotting factor, blood proteins, bile, enzymes
Eliminates bilirubin
Detox
Cholesterol metabolism 
Glucose maintenance 
Glycogen storage
Metabolism of steroid hormones
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3
Q

What are some causes of hepatitis

A

Alcohol
Acetaminophen
Viruses (Hepatitis, CMV, EBV)

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4
Q

In Acute viral hepatitis is the virus cleared

A

Yes

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5
Q

What is seen in acute viral hepatitis

A

Increase in LFTs +/- jaundice

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6
Q

In Chronic viral hepatitis is the virus cleared by the immune system

A

NO

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7
Q

Where are AST and ALT found

A

In hepatocytes

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8
Q

What is the most specific liver enzyme

A

ALT

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9
Q

What is found in bile ducts and lining cells

A

ALP

GGT

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10
Q

What is GGT an indicator for?

A

Chronic alcoholism

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11
Q

What is bilirubin

A

recording degradation product

It is cleared by the liver

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12
Q

What enzymes indicate damage

A

ALT increase

AST increase

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13
Q

What are over function enzymes

A

Serum albumin decrease
Prothrombin time increased
Serum bilirubin increased

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14
Q

What are the markers of viral hepatitis

A

High ALT/AST
Slightly increased GGT/ALP/bilirubin

As the damage progresses the bilirubin increases

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15
Q

What are the markers of gallstones that bock hepatica biliary canals

A

High bilirubin

Mildly elevated AST/ALT

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16
Q

How is Hep A transmitted

A

Fecal oral

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17
Q

What are the complications of Hep A

A

Acute and self limiting

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18
Q

Is there a vaccine for Hep A

A

Yes

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19
Q

What can be used to treat Hep A

A

Pooled immune IgG

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20
Q

IgM indicates

A

New acute infection

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21
Q

IgG indicates

A

Old

Chronic infection

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22
Q

How is Hep B transmitted

A

Any body fluid

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23
Q

What does Hep B co-infect with

A

Hep D
Makes the infection very BaD
Increased liver toxicity

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24
Q

What Percent of Hep B infected infants progress to chronic carriers

A

90%

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25
What is the 20% rule of Hep
20% of chronic hepatitis progresses to cirrhosis 20% of cirrhosis progresses to liver cancer
26
T/F HBV carriers develop anti-HBs antigen
False, they do not | The only make surface antigen
27
What diseases can be caused by Hep B
Acute hepatitis Fulminant Hepatitis Chronic hepatitis
28
Hep D
Only occurs with HBV Increases the likelihood of fulminant hepatitis of chronic hepatitis
29
Is there a vaccine for Hep B
Yes
30
What are the treatments for Hep B
Drugs normally fail | Some patents can be cured by seroconversion of HBeAg in 25% of patients
31
What are the symptoms of Hep C
90% are symptomatic
32
How is Hep C transmitted
Through blood mostly
33
What is teh complications of Hep C
Hep C is the #1 cause of chronic hepatitis, cirrhosis, and liver CA 20% rule of Hep
34
Is there a vaccine for Hep C
NO
35
What is cirrhosis
The ed of chronic liver disease
36
What are the signs/symptoms of cirrhosis
``` No signs until late Weight loss Fluid retention Ascites Jaundice Confusion Encephalopathy Variceal bleeding ```
37
What causes cirrhosis
Viral hepatitis Alcohol Acetaminophen
38
What is the cirrhosis process
Liver swells Nodules form Live shrinks
39
What are teh complications of cirrhosis
Portal HTN GI bleeding Liver failure
40
What is jaundice caused by
When there is increased blood bilirubin
41
If there is no urine urobilinogen what does that indicate
Bile duct bloackage
42
What is Wilson’s disease
A problem with transporting copper Copper will accumulate all over and cause oxidative damage
43
What is the gene mutation responsible for Wilson’s disease
ATP7P
44
What are some complications of Wilson’s Disease
Fulminant Hepatitis Chronic liver disease Cirrhosis Psychiatric abnormalities
45
What are teh ocular manifestations of Wilson’s Disease
Kaiser-Fleischer rings in Descemets membrane Sunflower cataracts
46
How do you diagnose Wilson’s Disease
Serum ceruloplasmin 24 hour urinary copper excretion ** Serum free copper ** Kaiser-Fleischer rings
47
How do you treat Wilson’s Disease
Cheating agent: penicillamine Blocking intestinal copper absorption: zinc acetate
48
What is hemochromatosis
Iron overload | Iron will accumulate in liver and skin
49
What is hemachromatosis often confused with
Polycythemia Vera
50
What are the signs and symptoms of hemachromatosis
Bronze skin hyperpigmentation
51
What is the lab test for hemachromatosis
High serum iron and ferritin
52
How do you treat hemochromatosis
Phlebotomy
53
What is cholelithiasis
Gall stones
54
What is cholecystitis
Inflammation of the gallbladder
55
What s cholangitis
Inflammation of the common bile duct
56
What are the signs of cholecystitis
Pain Belching after a fatty meal The inflammation is usually secondary to cholesteral stone, sludge, infection
57
What are the lab results for cholecystitis
Very high GGT/ALP | Mildly high AST/ALT
58
What is Murphy’s sign
Have patient lie on their back Push down and slide hand under the rub Have them take a deep breath If they have an inflamed gallbladder it will hurt a LOT
59
How do you cure cholecystitis
Cut it out
60
What are teh endocrine hormones of pancreas
Insulin | Glucagon
61
What are exocrine hormones
Proteases Amylase Lipase
62
What is pancreatitis
Inflammation of the pancreas Occurs secondary to alcohol abuse or gallbladder’s
63
What is the presentation of pancreatitis
Abdominal pain that radiates to the back
64
What are the labs for pancreatitis
Serum amylase and lipase
65
What are the complications of pancreatitis
Pancreatic cancer
66
What is Anura
No urine produced
67
What is cystitis
Inflammation of bladder
68
What us dysuria
Painful urination
69
What is GFR
Amount of plasma filtered/unit of time
70
What is he matures
Blood in the urine
71
What is oliguria
A decrease in the amount of urine that is being passed
72
What is polyuria
Too much urine is being excreted
73
What is pyelonephritis
Inflammation of the kidney
74
What is retention
The bladder does not release urine
75
What s uremia
Toxic wastes in the blood
76
How much urine is made per minute
1.2 mL
77
What is the functional unit of the kidney
Nephron
78
How many nephrons are in the kidney
1,000,000
79
What are the functions of the kidney
``` Excretion of waste products Metabolism of select organs Regulation of water and salt Maintenance of acid balance Secretion of hormones and by-products ```
80
What is the function of the nephron
Filters blood/plasma | Produces cell/protein free ultrafiltration
81
What are the functions of the nephron
Absorption (H2O, Na, glucose) Secretion (K, H< HCO3) Formation of osmotic gradient
82
What is the collecting duct responsible for
Concentration of urine under control of ADH
83
What are the metabolic waste products that are excreted
Urea/creatinine Bilirubin Select drugs and toxins
84
What does a dysfunction of excretion
Uremia
85
What is uremia
Toxic wastes in the blood | Most serious
86
What is azotemia
Metabolic wastes in the blood
87
The nephron is responsible for regulation of water and electrolyte balance, what does a dysfunction cause
Fluid overload | Hyper/hypokalemia
88
How does the kidney maintain acid-base balance
HCO3 regenerated | H is secreted
89
How much urine is produced in a day
1-2 L
90
What is the hormone functions of the kidney? What does a dysfunction cause
BP (RAAS) RBC production (EPO) Ca/P regulation (Vit D) HTN, anemia, secondaryhyperparathyroidism Metabolic bone disease
91
T/F signs and symptoms of renal failure appear after 75% of nephrons fail
True
92
What does GFR reflect
Kidney function When a critical mass of nephrons fail then the kidney starts to fail
93
What are the uremia indicators
Creatinine BUN Both are products of metabolism and are normally excreted Loss of kidney fxn increases blood levels of both
94
What tests are done to look at renal fxn
Urinalysis Blood test GFR
95
What blood tests can be done for renal fxn
Serum creatinine*** | BUN
96
What is the gold standard of GFR tests
Inulin clearance Freely filtered, it is not excreted of reabsorbed Get inulin via IV infusion
97
What is the most common GFR measure
Creatinine clearance It is based on muscle mass
98
What are som etchings that are looked at in urinalysis
``` Bilirubin Blood Glucose Ketones Leukocytes Nitrate PH Protein Specific gravity ```
99
When you look at urine under the microscope what can show up
Cells (WBC, RBC, epithelial cells) ``` Hyaline casts (proteins that congeal n the tubules of the kidneys) (TAMS-horsfall protein) Crystals ```
100
What indicates a UTI
Blood Leukocyte esterase** Proteins Nitrite
101
What is the significance of bilirubin in urinalysis
Bilirubin indicates liver problems
102
What is the starvation indicator
Ketones (Your body is burning fat) (Not always alarming is someone is on a low carb diet)
103
What is microalbuminemia
Low level Albumin in urine | In diabetes this is a sensitive protein check to see if kidney damage is starting to occur
104
What is creatinine a good reflection of
GFR
105
What is creatinine
It is a product of creatine metabolism in muscles and is proportional to muscle mass It is eliminated entirely by the kidneys
106
What is the creatinine rule of thumb
Renal loss doubles for every doubling of serum creatinine above normal of 1 mg/dL in the average adult
107
What is BUN (blood urea nitrogen)
A protein of protein metabolism It is eliminated by the kidneys It is less specific for renal failure
108
What underestimates kidney function
BUN
109
What over estimates kidney function
creatinine
110
T/F in kidney failure there are increases in both BUN and creatinine
True
111
T/F BUN is not affected the diet
False, it is
112
How do you calculate GFR
Th amount of plasma that is cleared of creatinine rung a given time period Normal is 115-125 mL/min
113
What are some cystic disorders of the kidney
Simple cyst Adult polycystic disease (AD) Child polycystic disease (AR)
114
What is adult polycystic disease
Autosomal dominant Bilateral No symptoms until the 4th decade of life Slowly progressive
115
What are some symptoms of adult polycystic disease
``` Debilitating pain Episodic hematuria HTN Cardiovascular problems Cerebral aneurysm Cysts on liver and pancreas ```
116
What is teh most common cause of upper urinalysis tract obstruction
Kidney stone It is very common Caused by crystallized materials excreted by kidneys Unilateral
117
What are the types of stones that can occur
Calcium (calcium oxalate) Mg/NH4/P Amino acids
118
What are the signs and symptoms of Kidney stones
``` Dull deep pain in back Server flank pain Cool clammy skin N/V Hematuria ```
119
How do you treat kidney stones
Pain relief Fluids Ab Remove stone
120
What is the 2nd most common type of bacterial infection seen by health Care providers
UTI
121
What is teh #1 causative agent of UTI
E.coli
122
What are the signs and symptoms of lower UTI
``` Urinary frequency Lower abdominal or back discomfort Burning and pain when peeing Cloudy urine Could smelling urine Efebrile Leukocyte esterase ```
123
What are the signs of upper UTI
``` Abrupt onset of shaking chills Moderate-high fever Constant flank pain Lower UTI symptoms Looks/feels ill N/V ```
124
How do you diagnose UTI
Symptoms Urinalysis (leukocyte esterase, nitrites) Culture and sensitivity
125
What are nephritic syndromes
Caused by disease that produce proliferation inflammation responses that allow loss of blood into urine
126
What are nephrotic syndromes
Caused by disorders that increase permeability of the glomerular capillary membrane, causing massive loss of protein in the urine
127
What is glomerulonephritis
Inflammation process of the glomerulus It is the leading cause of chronic renal failure in US It is the cause of 50% of all end-stage renal disease
128
What are the characters of glomerulonephritis
``` Hematuria Diminished GFR Uremia Oliguria HTN ```
129
What is nephritis syndrome
Glomerular disorder characterized by inflammation and bleeding ``` There is limited proteinuria Oliguria and azotemia Salt Retention Periorbital anemia HTN RBC and casts in urine ```
130
What is acute glomerulonephritis
Most common form is post streptococcal glomerulonephritis Symptoms last 7-12 days post infection Caused by an immune reaction
131
What are the signs and symptoms of acute glomerulonephritis
``` Oliguria (decreases GFR) Proteinuria Hematuria Edema of face and hands HTN RBCs in urine ```
132
What are the treatments of acute glomerulonephritis
Largely symptomatic to decrease salt, fluid, diuretics, dialysis Can subside within 10-14 days 95% of children recover completely 60% of adults recover completely, some have permanent kidney damage
133
What is nephrotic syndrome
Glomerular disorder that leaks large amounts of protein Ex. Hypoalbuminemia, hypogammaglobulinemia, hypercoagulable, hyperlipidemia, and hypercholesterolemia
134
What is the diabetic glomerulosclerosis
Diabetic nephropathy | Microvasular damage to the glomeruli
135
What are teh 3 pathy’s of DM
Retinopathy Nephropathy Neuropathy
136
Diabetic nephropathy affects __% of go Type 1 DM Patients
30
137
What serves as an important predictor of future diabetic nephropathies
Microalbuminuria
138
Pyelonephritis
Inflammation of the kidney
139
What causes acute pyelonephritis
UTI’s so E.coli
140
What is chronic pyelonephritis
A slowly progressive process-scar/deforms Unilateral or bilateral Significant of renal failure Responsible for 20% of ESRD
141
What are the signs and symptoms of chronic pyelonephritis
``` You cant concentrate urine Polyuria Nocturia Mild proteinuria Severe HTN ```
142
How can drugs and toxins damage the kidneys
Decrease renal blood flow Obstruct urine flow Damage tubulointerstitial structures Producing hypersensitivity reactions
143
What does tolerance to damage (in drug related nephropathies) depend on
Renal functio State of hydration Blood pressure PH of urine
144
What are the causes of acute renal failure
Decreases blood flow to kidney Disorders that disrupt the structures in the kidney Disorders that interfere with the elimination of urine from kidney
145
What is uremia
Accumulation of waste products normally cleared by the kidney Urea nitrogen and creatinine Reversible if the cause can be corrected
146
What is Acute tubular necrosis
Destruction of tubular epithelial cells with acute loss of renal function
147
What are the causes of acute tubular necrosis
Ischemia Toxins Tubular obstruction The injury is typically reversible
148
What is chronic renal failure
Progressive irreversible destruction of kidney structures
149
What are the causes of chronic renal failure
Diabetes #1 HTN Glomerulonephritis Polycystic kidney disease
150
What are the stages of progression fo chronic renal failure
Diminished renal reserve Renal insufficiency Renal failure End-stage Renal disease
151
What is renal insufficiency
``` GFR is reduced 20-50% Uninsured nephrons must filter more soluble particles from the blood Uremia Anemia HTN ```
152
What is renal failure
``` GFR reduced 5-15% Signs and symptoms of uremia Kidneys cannot regular volume and solute composition Uremia may develop Anemia and other manifestations develop ```
153
What is end stage renal disease
``` GFR less than 5% Reduced capillaries and scarring glomeruli Atrophy and fibrosis of tubules Decreased renal mass Dialysis or transplant is needed to live ```
154
What are the clinical manifestations of chronic renal failure
``` Uremia Alterations n water, electrolyte, and acid-base balance Mineral and skeletal disorders Anemia HTN Gastrointestinal disorders Neurological complications Disorders of skin integrity Immunologic disorders ```
155
How are drugs eliminated
By the kidneys Some are harmful to the kidney Intermediate metabolites are often toxic Renal failure patient must not take OTC drugs without consulting doctor

Pathology (4 decks)

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