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patho exam 2 > ch 18 > Flashcards

ch 18 Flashcards

1
Q

what is syndrome of inappropriate ADH secretion (SIADH)

A

high levels of ADH without physiologic stimuli for its release

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2
Q

what must exist in SIADH for diagnosis

A

normal adrenal and thyroid function

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3
Q

clinical manifestation are related to ____,_____,___ in SIADH

A

enhanced renal water retention
hypoatremia (low Na+)
hypo-osmolality (solute loss)

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4
Q

what is the most common cause of SIADH

A

ectopic secretion of ADH by tumor cells

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5
Q

what are the clinical manifestations of SIADH

A 
thirst
dyspnea on exertion (SOB)
fatigue
dulled consciousness progressing to abdominal cramps
vomitting
confusion
seizures
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6
Q

when is SIADH seen

A

in infectious pulmonary diseases

associated with psychiatric disease after treatment with a variety of drugs

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7
Q

what is diabetes insipidus

A

insufficiency of ADH leading to polyuria and polydipsia

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8
Q

what are the 3 types of diabetes insipidus

A

neurogenic
nephrogenic
psychogenic

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9
Q

what is neurogenic of diabetes insipidus

A

-insufficient amounts of ADH

lesion on hypothalamus or posterior pituitary interferes with ADH synthesis, transport or release

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10
Q

what is nephrogenic of diabetes insipidus

A

-inadequate amounts of ADH

insensitivity of renal tubule to ADH

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11
Q

what is psychogenic of diabetes insipidus

A

caused by an extremely large volume of fluid intake which results in a partial resistance to ADH

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12
Q

what are the clinical manifestation related to with diabetes insipidus

A

water excretion
hypematremia
hyper-osmolality

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13
Q

what are the two diseases of posterior pituitary

A

SIADH

diabetes insipidus

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14
Q

what are the 3 disease of the anterior pituitary

A

hypopituitarism
hyperpituitarism
hyper secretion of growth hormone
hyper secretion of prolactin

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15
Q

what is hyperpituitarism caused by

A

a benign slow growing pituitary adenoma

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16
Q

what are the manifestations of hyperpituitarism

A

headache and fatigue
visual changes
hypo secretion of neighboring anterior pituitary hormones

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17
Q

what are the 2 types of hyper secretion of GH

A

acromegaly

gigantism

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18
Q

what is the growth hormone (somatropin)

A

enhances linear bone growth in children, enhances a.a. transport across membranes, increase protein synthesis, increases F.A mobilization and utilization, decrease glucose uptake and use

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19
Q

a deficiency of GH in children often look like and how to treat

A

normal intelligence, short stature, obesity with immature facial features, puberty often delayed

treat with GH

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20
Q

what is acromegaly

A

hyper secretion of GH during adulthood

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21
Q

what is gigantism

A

hyper secretion of GH in children and adolescents

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22
Q

what is prolactinoma

A

most common hormonally active pituitary tumors leading to hyperprolactinemia

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23
Q

increased levels of prolactin in females causes

A

amenorrhea (absence of menstration)
galactorrhea (milky discharge)
hirsutisum (excessive body hair)
osteopenia due to estrogen deficiency (bone loss)

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24
Q

increased levels of prolactin in males cause

A

**hypogonadism (a failure of testes to function properly)
**erectile dysfunction
impaired libido (sexual dysfunction)
oligospermia (low sperm count)
diminished ejaculate volume

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25
what are alteration of thyroid function
hyperthyroidism | hypothryoidism
26
what two disease of hyperthyroidism
thryotoxicosis | graves disease
27
what is thyrotoxicosis
higher than normal levels of TH from any source
28
what is graves disease
autoimmune | abnormal stimulation of thyroid gland by IgG antibodies
29
what does graves disease cause
exophthalmos (bulging eyes) irritability weight loss fatigue
30
what is congenital hypothyroidism
appears normal at birth due to maternal TH common cause of preventable mental retardation cretinism- TH essential for normal brain developments and growth
31
what is acquired hypothyroidism
older children and adults slowing down of metabolic processes myxedema- nonpitting mucous edema
32
what is primary and secondary causes of acquire hypothyroidism
primary cause- destruction of thyroid gland ex: hashimotos disease -autoimmune secondary cause- impaired pituitary
33
what are alterations of the parathyroid function
hyperparathyroidism | hypoparathyroidism
34
what is primary hyperparathyroidism
excess secretion of PTH from one or more parathyroid glands
35
what is secondary hyperparathyroidism
increase in PTH secondary to a chronic disease
36
what are clinical manifestations of hyperparathyroidism
hypercalcemia: too much calcium in bone hypercalciuria: kidney stones fatigue depression anorexia
37
what is the most common cause of hypoparathyroidism
damage to PT glands during thyroid surgery
38
what are clinical manifestations of hypoparathyroidism
``` hypocalcemia- muscle spasm hyper-reflexia asphyxiation- deprived of oxygen dry skin hair loss cataracts cone deformities ```
39
what is hypoparathyroidism
abnormally low PTH levels
40
what is diabetes mellitus
chronic hyperglycemia along with disturbances of carbohydrates, fat and protein metabolism
41
what is diagnosis of DM based on
more than one elevated fasting plasma glucose level elevated BG in response to oral glucose tolerance test polys X3 glycoslyated hemoglobin (A1C)
42
what is type 1 diabetes
lack of insulin and relative excess of glucagon | insulin dependent
43
what is the epidemiology of type 1
most commonly diagnosed in those younger than 18
44
what is the etiology of type 1
beta cell destroyed due to autoantibodies
45
what are the clinical manifestations of type 1
polys X3 weight loss fatigue ketoacidosis due to increased metabolism of fats and proteins
46
what is type 2 diabetes
much more common | non insulin dependent
47
what is the epidemiology of type 2
``` native americans hispanics blacks most over 40 obesity ```
48
what is the etiology go type 2
impaired beta cell function peripheral insulin resistance increased hepatic glucose production
49
what are the clinical manifestations of type 2
pruritus (itching) recurrent infections visual changes paresthesias (burning)
50
what goes along with diabetes management type 2
dietary- restriction of calories for overnight individual, balance fat, protein, carbs and high fiber exercise oral antidiabetic agents
51
what are the 3 oral anti diabetic agents for diabetes management in type 2
Sulfonylureas Meglitinides Metformin
52
what is induces risk for gestational diabetes
``` family history of diabetes high risk ethnic group advanced maternal age prior history of gestational diabetes overweight ```
53
what are acute complications of DM
``` hypoglycemia diabetic ketoacidosis (type 1) hypersmolar hyperglycemia nonketotic syndrome(type 2) somogyi effect dawn phenomenon ```
54
what is hypoglycemia
insulin shock | BG 45-60
55
what are clinical manifestations of hypoglycemia
``` pallor tremor anxiety palpitations diaphoresis-sweating tachycardia dizziness fatigue confusion seizures coma ```
56
what is diabetic ketoacidosis - type 1
complication of insulin deficiency and increase of catecholamines, cortisol glucagon, GH glucose production increase and usage decrease fat is mobilized
57
what is hypersomolar hyperglycemia nonketotic syndrome - type 2 and the treatment
high mortality due to high serum glucose (more than 600) leading to severe dehydration treatment: manage fluid/electrolytes and glucose control
58
what is somogyi effect
combination of hypoglycemia followed by rebound hypoglycemia
59
what is dawn phenomenon
early morning risk in BG with no hypoglycemia during the night due to nocturnal elevations of GH
60
what are chronic complications of DM
microvascular marcovscular diabetic neuropathies infection
61
what is microvascular disease
due to capillary basment membrane thickening, ischemia, hypoxia
62
what are the 2 under microvascular disease
retinopathy | nephropathy
63
what is retinopathy
due to blood vessel changes and RBC aggregation | more likely to occur in type 2 as a result of long standing hyperglycemia before diagnosis
64
what is nephropathy
most common cause of end stage renal disease | death from renal failures more common in type 1 as a result of proteinuria
65
what is marcovascular complication
cause morbidity and mortality especially in type 2
66
what are the 3 under microvascular complications
CAD stroke peripheral vascular disease
67
what is CAD
most common cause of death in type 2
68
what is stroke
2 x as common with diabetics
69
what is peripheral vascular disease
due to occlusion of small vessels which may results in gangrene of the lower extremities
70
what are the 2 types of neuropathies
somatic | autonomic
71
what are infections associated with chronic complicatons
increased risk due to senses impairment, hypoxia, proliferation of pathogens, decreased blood supply WBC impairment
72
what are the disorders of the adrenal cortex
cushings syndrome congential adrenal hyperplasia cushing disease
73
what is cushing syndrome
glucocorticoid hormone excess | excessive anterior pituitary secretion of ATCH
74
what causes cushing syndrome
excess production of ACTH due to pituitary tumor benign or malignant adrenal tumor non pituitary ACTH secreting tumor
75
what are the manifestation of cushing syndrome
altered fat metabolism -moon face and buffalo hump muscle weakness due to protein breakdown deranged glucose metabolism susceptibility to infection
76
what is the treatment for cushing syndrom
surgery irradiation medication
77
what is congenital adrenal hyperplasia
deficient production cortisol leads to increased ACTH
78
what happens with males in CAH
seldom diagnosed at birth unless have enlarged genitals or lose salt
79
what happens with females with CAH
ambiguous genitalia due to increase in androgens
80
what is the treatment for CAH
cortisol replacement | recontructive surgery
81
what is primary for adrenal cortical insuffciency
addison disease increased ACTH and decreased cortical hormones lifetime replacement therapy
82
what are the clinical manifestations of adrenal cortical insufficiency
deficiency mineral- glcocorticoids hyperpigmentation due to increased ACTH sparse pubic- axially hair in women
83
what is secondary adrenal cortical insufficiency
hypopituirarism or due to removal of pituitary gland | more common due to rapid removal of glucocoritcoids and adrenal cortical atrophy
84
Mr. Metzner has polyuria with a urine volume of 8 L/day. His urine specific gravity is 1.02. His serum sodium (Na+) is 150 mEq/L, and his plasma osmolality is 300 mOsm/kg. He is always asking for more cold liquids to drink. What type of hormonal alteration is Mr. Metzner exhibiting? What are some possible causes of this alteration?
Mr. Jones has diabetes insipidus, which has three forms: neurogenic, nephrogenic, and psychogenic. The neurogenic form is caused by a hypothalamic, infundibular stem, or posterior pituitary problem, that decreases or inhibits antidiuretic hormone (ADH) synthesis, transport, or release. This may be caused by pituitary tumors, brain tumors, infections, immunologic problems, or thrombotic problems. - The nephrogenic form of diabetes insipidus may be acquired, permanent, or reversible. It is caused by renal tubule insensitivity to ADH. In this form the amounts of ADH are normal but the tubules are no longer able to respond to the hormone. Examples of renal problems that can lead to diabetes insipidus include pyelonephritis, amyloidosis, destructive uropathies, and polycystic kidney disease. It may also be secondary to anesthetic drug use and the use of lithium carbonate. - The psychogenic form of diabetes insipidus is caused by compulsive water drinking by individuals with psychiatric disorders. In this form the individual has periodic polyuria, high urine volume, and plasma osmolarity of less than 285 mOsm/kg.
85
Mrs. Johnson is admitted to your unit with tachycardia, fever, agitation, and diarrhea. Her medical history is nonsignificant except for a history of recent pneumonia, and she takes no regular prescription or over-the-counter medication. She also reports that she has been very upset at the recent death of her mother. Her diagnosis is thyrotoxic crisis. She asks you to explain what is happening to her.
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86
John is a 40-year-old recently diagnosed with Addison disease. He asks you to explain what happened to him and explain how he can live a normal life.
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patho exam 2 (2 decks)

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