Block 28 Flashcards
Non modifiable Risk factors for osteoporotic fractures
- age
- white ethnicity
- female sex
- personal or family history of fracture
Stress related mucosal disease
-charactrized by acute gastric mucosal defect that develops in response to sever physiologic stress (eg, shock,extensive burns, sepsis and severe trauma). Pts often have multiple, small , circular lesion in the stomach, ranging from superficial erosion to full thickness ulcers.
Ulcers may perforate or bleed as in this patient.
-the pathogenesis of these ulcers often due to local ischemia caused by hypotention or splanchinc vasoconstriction.
Curling vs cushing ulcers
- ulcers arising in the proximal duodenum in association with severe trauma/ burns are called curlings ulcers.
- ulcers arising in esophagus, stomach or duodenum in patients with intracranial injury are particularly prone to perforation and are called cushing ulcers. (They are the consequence of vagus stimulation -> Ach release and hypersecretion of gastric acid)
Neural tube defect inheritance is
Multifactorial (genetic and envirnomental factors interact to determine phenotypic expression).
Other examples of multifactorial disease inheritance include cleft lip palate, diabetes mellitus, coronary heart disease and hypertension.
Chediak higashi syndrome
- autosomal recessive consist of :
1. Immunodeficiency
2. Albinism
3. Neurologic defect (nystagmus)
4. Peripheral and cranial neuropathies
5. Failure of phagolysosome fusion
DNA polymerase type III function
5’ to 3’ DNA synthesis and 3’ to 5’ exonuclease activity (proofreading (repair ))
Gardeners mydriasis
Due to jimson weed poisining, it produces belladona toxin that have high anticholenergic proporties. (Similar to atropine poisining)
Signs include tachycardia, mydriasis , skin flushing, delayed gastric emptying, decreased intestinal motility and secretion, bronchodilation, dry secretion , hallucination and delerium.
Treatment : physostygmine
Diabetes ketoacidosis changes in ph,hco3 and buffers in “urine”
- Increases HCO3 reabsorption
- Increased H+ secretion(Na/H antiporter in proximal nephron and H atpase and H/K ATPase in a intercalated cells
- Increased acid buffer excretion (HPO4,NH3 —> NH4…)
Gallstone ileus
Uncommon complication of longstanding cholelithiasis that usually occurs in elder women.
- large >2.5 CM gallstone causes formation of cholecystoenteric fistula between gallbladder and adjoining gut due to pressure necorsis and erosion of these tissues.
-stone travels easily until it becomes trapped in the illeum (narrowest portion of intestine)
- patients develops signs of small bowel obstruction, including abdominal pain/ distention, nausea/vomiting, high pitched bowel sounds and tendrness to palpation.
-mmunication may also allow gas to enter the billiary tree ( pneumobilia )
(Not seen in common bile duct occlusion)
Persistence of allantois remnant
Around 3 weeks of gestation the yolk sac forms a protrusion that extends into the urogenital sinus. The upper part of the urogenital sinus gives rise to the bladder. The allantois which originally connected to the urogenital sinus with the yolk sac, becomes the urachus, a duct between bladder and the yolk sac. Failure to obliterate before birth :
- Patent urachus (complete failure of obliteration) , patients presents with straw colored urine discharge from umbilicus, and erythema present.
- Urachal sinus (failure to close the distal part of urachus) present as periumbilical discharge due to persistent and recurrent infection.
- Urachal cyst
Lateral pontine syndrome
Lesion in AICA
Symptoms include.
1. Lateral spinothalmic tract (controlateral loss of pain and temp )
2. Facial nucleus and nerve.-> ipsilateral paralysis, loss of lacrimation and reduced salivation , taste from 2/3 and corneal reflex
3. Spinal trigiminal nerve (ipsilateral loss of pain and temperature sensation from the face)
4. Vesticular nuclei (nystagmus, nausea, vomiting and vertigo
5. Cochlear nuclei (hearing loss- ipsilateral central deafness
6. Middle cerebellar pudencle ( gait ataxia , dysmetria …)
7. Horner syndrome.
Increased blood ammonia levels and orotic acid is seen in
Ornithine transcarbamylase deficiency
Ornithine transcarbamylase deficiency
- MCC urea cycle disorder
- results in excess carbomyl phosphate —> stimulate pyrimidine synthesis —> orotic acid accumulates and result in increased urinary orotic acid.
- hyperammonemia due to imapired ammonia excertion, which is a metabolic emergency.
- Tx :protein restriction, sodium benzoate (scavenger for nitrogen), arginine supplementation
Metabolic acidosis compensation after 12 hours
After 12 hours of metabolic acidosis, the primary respiratory alkalosis will most likely progress to mixed respiratory alkalosis/metabolic acidosis.
- the PH will most likely become normal if compensetory mechanism is working well (no respiratory failure) however the repiratory alkalosis will be lower than predicted due to concurrent primary respiratory alkalosis.
Intususception in young children
Invagination of a portion of intestine into the lumen of the adjacent intestinal segment.
-most typical site is at ileocolic junction. The size differences in the adjacent segments of the intestine allow the small bowel to invaginate into the cecum. Its most common in children younger than 2 years old.
