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Pathology > Block 12 > Flashcards

Block 12 Flashcards

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
Q

What is the 20% rule of Hep

A

20% of chronic hepatitis progresses to cirrhosis

20% of cirrhosis progresses to liver cancer

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26
Q

T/F HBV carriers develop anti-HBs antigen

A

False, they do not

The only make surface antigen

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27
Q

What diseases can be caused by Hep B

A

Acute hepatitis
Fulminant Hepatitis
Chronic hepatitis

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28
Q

Hep D

A

Only occurs with HBV

Increases the likelihood of fulminant hepatitis of chronic hepatitis

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29
Q

Is there a vaccine for Hep B

A

Yes

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30
Q

What are the treatments for Hep B

A

Drugs normally fail

Some patents can be cured by seroconversion of HBeAg in 25% of patients

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31
Q

What are the symptoms of Hep C

A

90% are symptomatic

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32
Q

How is Hep C transmitted

A

Through blood mostly

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33
Q

What is teh complications of Hep C

A

Hep C is the #1 cause of chronic hepatitis, cirrhosis, and liver CA

20% rule of Hep

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34
Q

Is there a vaccine for Hep C

A

NO

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35
Q

What is cirrhosis

A

The ed of chronic liver disease

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36
Q

What are the signs/symptoms of cirrhosis

A 
No signs until late
Weight loss
Fluid retention
Ascites 
Jaundice 
Confusion
Encephalopathy
Variceal bleeding
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37
Q

What causes cirrhosis

A

Viral hepatitis
Alcohol
Acetaminophen

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38
Q

What is the cirrhosis process

A

Liver swells
Nodules form
Live shrinks

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39
Q

What are teh complications of cirrhosis

A

Portal HTN
GI bleeding
Liver failure

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40
Q

What is jaundice caused by

A

When there is increased blood bilirubin

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41
Q

If there is no urine urobilinogen what does that indicate

A

Bile duct bloackage

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42
Q

What is Wilson’s disease

A

A problem with transporting copper

Copper will accumulate all over and cause oxidative damage

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43
Q

What is the gene mutation responsible for Wilson’s disease

A

ATP7P

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44
Q

What are some complications of Wilson’s Disease

A

Fulminant Hepatitis
Chronic liver disease
Cirrhosis
Psychiatric abnormalities

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45
Q

What are teh ocular manifestations of Wilson’s Disease

A

Kaiser-Fleischer rings in Descemets membrane

Sunflower cataracts

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46
Q

How do you diagnose Wilson’s Disease

A

Serum ceruloplasmin
24 hour urinary copper excretion **
Serum free copper **
Kaiser-Fleischer rings

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47
Q

How do you treat Wilson’s Disease

A

Cheating agent: penicillamine

Blocking intestinal copper absorption: zinc acetate

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48
Q

What is hemochromatosis

A

Iron overload

Iron will accumulate in liver and skin

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49
Q

What is hemachromatosis often confused with

A

Polycythemia Vera

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50
Q

What are the signs and symptoms of hemachromatosis

A

Bronze skin hyperpigmentation

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51
Q

What is the lab test for hemachromatosis

A

High serum iron and ferritin

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52
Q

How do you treat hemochromatosis

A

Phlebotomy

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53
Q

What is cholelithiasis

A

Gall stones

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54
Q

What is cholecystitis

A

Inflammation of the gallbladder

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55
Q

What s cholangitis

A

Inflammation of the common bile duct

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56
Q

What are the signs of cholecystitis

A

Pain
Belching after a fatty meal

The inflammation is usually secondary to cholesteral stone, sludge, infection

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57
Q

What are the lab results for cholecystitis

A

Very high GGT/ALP

Mildly high AST/ALT

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58
Q

What is Murphy’s sign

A

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

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59
Q

How do you cure cholecystitis

A

Cut it out

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60
Q

What are teh endocrine hormones of pancreas

A

Insulin

Glucagon

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61
Q

What are exocrine hormones

A

Proteases
Amylase
Lipase

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62
Q

What is pancreatitis

A

Inflammation of the pancreas

Occurs secondary to alcohol abuse or gallbladder’s

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63
Q

What is the presentation of pancreatitis

A

Abdominal pain that radiates to the back

64
Q

What are the labs for pancreatitis

A

Serum amylase and lipase

65
Q

What are the complications of pancreatitis

A

Pancreatic cancer

66
Q

What is Anura

A

No urine produced

67
Q

What is cystitis

A

Inflammation of bladder

68
Q

What us dysuria

A

Painful urination

69
Q

What is GFR

A

Amount of plasma filtered/unit of time

70
Q

What is he matures

A

Blood in the urine

71
Q

What is oliguria

A

A decrease in the amount of urine that is being passed

72
Q

What is polyuria

A

Too much urine is being excreted

73
Q

What is pyelonephritis

A

Inflammation of the kidney

74
Q

What is retention

A

The bladder does not release urine

75
Q

What s uremia

A

Toxic wastes in the blood

76
Q

How much urine is made per minute

A

1.2 mL

77
Q

What is the functional unit of the kidney

A

Nephron

78
Q

How many nephrons are in the kidney

A

1,000,000

79
Q

What are the functions of the kidney

A 
Excretion of waste products 
Metabolism of select organs
Regulation of water and salt
Maintenance of acid balance 
Secretion of hormones and by-products
80
Q

What is the function of the nephron

A

Filters blood/plasma

Produces cell/protein free ultrafiltration

81
Q

What are the functions of the nephron

A

Absorption (H2O, Na, glucose)
Secretion (K, H< HCO3)
Formation of osmotic gradient

82
Q

What is the collecting duct responsible for

A

Concentration of urine under control of ADH

83
Q

What are the metabolic waste products that are excreted

A

Urea/creatinine
Bilirubin
Select drugs and toxins

84
Q

What does a dysfunction of excretion

A

Uremia

85
Q

What is uremia

A

Toxic wastes in the blood

Most serious

86
Q

What is azotemia

A

Metabolic wastes in the blood

87
Q

The nephron is responsible for regulation of water and electrolyte balance, what does a dysfunction cause

A

Fluid overload

Hyper/hypokalemia

88
Q

How does the kidney maintain acid-base balance

A

HCO3 regenerated

H is secreted

89
Q

How much urine is produced in a day

A

1-2 L

90
Q

What is the hormone functions of the kidney?

What does a dysfunction cause

A

BP (RAAS)
RBC production (EPO)
Ca/P regulation (Vit D)

HTN, anemia, secondaryhyperparathyroidism
Metabolic bone disease

91
Q

T/F signs and symptoms of renal failure appear after 75% of nephrons fail

A

True

92
Q

What does GFR reflect

A

Kidney function

When a critical mass of nephrons fail then the kidney starts to fail

93
Q

What are the uremia indicators

A

Creatinine
BUN

Both are products of metabolism and are normally excreted
Loss of kidney fxn increases blood levels of both

94
Q

What tests are done to look at renal fxn

A

Urinalysis
Blood test
GFR

95
Q

What blood tests can be done for renal fxn

A

Serum creatinine***

BUN

96
Q

What is the gold standard of GFR tests

A

Inulin clearance
Freely filtered, it is not excreted of reabsorbed

Get inulin via IV infusion

97
Q

What is the most common GFR measure

A

Creatinine clearance

It is based on muscle mass

98
Q

What are som etchings that are looked at in urinalysis

A 
Bilirubin
Blood
Glucose
Ketones
Leukocytes
Nitrate
PH
Protein 
Specific gravity
99
Q

When you look at urine under the microscope what can show up

A

Cells (WBC, RBC, epithelial cells)

Hyaline casts (proteins that congeal n the tubules of the kidneys) (TAMS-horsfall protein)
Crystals
100
Q

What indicates a UTI

A

Blood
Leukocyte esterase**
Proteins
Nitrite

101
Q

What is the significance of bilirubin in urinalysis

A

Bilirubin indicates liver problems

102
Q

What is the starvation indicator

A

Ketones
(Your body is burning fat)
(Not always alarming is someone is on a low carb diet)

103
Q

What is microalbuminemia

A

Low level Albumin in urine

In diabetes this is a sensitive protein check to see if kidney damage is starting to occur

104
Q

What is creatinine a good reflection of

A

GFR

105
Q

What is creatinine

A

It is a product of creatine metabolism in muscles and is proportional to muscle mass

It is eliminated entirely by the kidneys

106
Q

What is the creatinine rule of thumb

A

Renal loss doubles for every doubling of serum creatinine above normal of 1 mg/dL in the average adult

107
Q

What is BUN (blood urea nitrogen)

A

A protein of protein metabolism
It is eliminated by the kidneys
It is less specific for renal failure

108
Q

What underestimates kidney function

A

BUN

109
Q

What over estimates kidney function

A

creatinine

110
Q

T/F in kidney failure there are increases in both BUN and creatinine

A

True

111
Q

T/F BUN is not affected the diet

A

False, it is

112
Q

How do you calculate GFR

A

Th amount of plasma that is cleared of creatinine rung a given time period

Normal is 115-125 mL/min

113
Q

What are some cystic disorders of the kidney

A

Simple cyst
Adult polycystic disease (AD)
Child polycystic disease (AR)

114
Q

What is adult polycystic disease

A

Autosomal dominant
Bilateral
No symptoms until the 4th decade of life
Slowly progressive

115
Q

What are some symptoms of adult polycystic disease

A 
Debilitating pain
Episodic hematuria
HTN
Cardiovascular problems 
Cerebral aneurysm
Cysts on liver and pancreas
116
Q

What is teh most common cause of upper urinalysis tract obstruction

A

Kidney stone
It is very common
Caused by crystallized materials excreted by kidneys
Unilateral

117
Q

What are the types of stones that can occur

A

Calcium (calcium oxalate)
Mg/NH4/P
Amino acids

118
Q

What are the signs and symptoms of Kidney stones

A 
Dull deep pain in back
Server flank pain
Cool clammy skin
N/V
Hematuria
119
Q

How do you treat kidney stones

A

Pain relief
Fluids
Ab
Remove stone

120
Q

What is the 2nd most common type of bacterial infection seen by health Care providers

A

UTI

121
Q

What is teh #1 causative agent of UTI

A

E.coli

122
Q

What are the signs and symptoms of lower UTI

A 
Urinary frequency 
Lower abdominal or back discomfort
Burning and pain when peeing
Cloudy urine
Could smelling urine
Efebrile 
Leukocyte esterase
123
Q

What are the signs of upper UTI

A 
Abrupt onset of shaking chills
Moderate-high fever 
Constant flank pain 
Lower UTI symptoms 
Looks/feels ill
N/V
124
Q

How do you diagnose UTI

A

Symptoms
Urinalysis (leukocyte esterase, nitrites)
Culture and sensitivity

125
Q

What are nephritic syndromes

A

Caused by disease that produce proliferation inflammation responses that allow loss of blood into urine

126
Q

What are nephrotic syndromes

A

Caused by disorders that increase permeability of the glomerular capillary membrane, causing massive loss of protein in the urine

127
Q

What is glomerulonephritis

A

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
Q

What are the characters of glomerulonephritis

A 
Hematuria
Diminished GFR
Uremia
Oliguria
HTN
129
Q

What is nephritis syndrome

A

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
Q

What is acute glomerulonephritis

A

Most common form is post streptococcal glomerulonephritis

Symptoms last 7-12 days post infection

Caused by an immune reaction

131
Q

What are the signs and symptoms of acute glomerulonephritis

A 
Oliguria (decreases GFR)
Proteinuria
Hematuria
Edema of face and hands
HTN
RBCs in urine
132
Q

What are the treatments of acute glomerulonephritis

A

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
Q

What is nephrotic syndrome

A

Glomerular disorder that leaks large amounts of protein

Ex. Hypoalbuminemia, hypogammaglobulinemia, hypercoagulable, hyperlipidemia, and hypercholesterolemia

134
Q

What is the diabetic glomerulosclerosis

A

Diabetic nephropathy

Microvasular damage to the glomeruli

135
Q

What are teh 3 pathy’s of DM

A

Retinopathy
Nephropathy
Neuropathy

136
Q

Diabetic nephropathy affects __% of go Type 1 DM Patients

A

30

137
Q

What serves as an important predictor of future diabetic nephropathies

A

Microalbuminuria

138
Q

Pyelonephritis

A

Inflammation of the kidney

139
Q

What causes acute pyelonephritis

A

UTI’s so E.coli

140
Q

What is chronic pyelonephritis

A

A slowly progressive process-scar/deforms
Unilateral or bilateral
Significant of renal failure
Responsible for 20% of ESRD

141
Q

What are the signs and symptoms of chronic pyelonephritis

A 
You cant concentrate urine
Polyuria
Nocturia
Mild proteinuria
Severe HTN
142
Q

How can drugs and toxins damage the kidneys

A

Decrease renal blood flow
Obstruct urine flow
Damage tubulointerstitial structures
Producing hypersensitivity reactions

143
Q

What does tolerance to damage (in drug related nephropathies) depend on

A

Renal functio
State of hydration
Blood pressure
PH of urine

144
Q

What are the causes of acute renal failure

A

Decreases blood flow to kidney
Disorders that disrupt the structures in the kidney
Disorders that interfere with the elimination of urine from kidney

145
Q

What is uremia

A

Accumulation of waste products normally cleared by the kidney

Urea nitrogen and creatinine
Reversible if the cause can be corrected

146
Q

What is Acute tubular necrosis

A

Destruction of tubular epithelial cells with acute loss of renal function

147
Q

What are the causes of acute tubular necrosis

A

Ischemia
Toxins
Tubular obstruction
The injury is typically reversible

148
Q

What is chronic renal failure

A

Progressive irreversible destruction of kidney structures

149
Q

What are the causes of chronic renal failure

A

Diabetes #1
HTN
Glomerulonephritis
Polycystic kidney disease

150
Q

What are the stages of progression fo chronic renal failure

A

Diminished renal reserve
Renal insufficiency
Renal failure
End-stage Renal disease

151
Q

What is renal insufficiency

A 
GFR is reduced 20-50%
Uninsured nephrons must filter more soluble particles from the blood
Uremia
Anemia
HTN
152
Q

What is renal failure

A 
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
Q

What is end stage renal disease

A 
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
Q

What are the clinical manifestations of chronic renal failure

A 
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
Q

How are drugs eliminated

A

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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