Chapter 14: systemic disorders Flashcards
Malignancies
- cancer
- occurs when a cell mutates and no longer performed the function for which it was intended
non-hodgkin’s lymphoma
- group of malignancies of the lymphoreticular system
- usually occurs around age 50
NHL signs and symptoms
- nausea
- vomiting
- diarrhea
- night sweats
- unexplained weight loss
- fatigue
- fever
- enlarged lymph nodes
NHL treatment and prognosis
- radiation
- chemo
- combo
- stage 1 = 81.1%
- stage 2 = 70.5%
- stage 3 = 58.5%
Hodgkins lymphoma
- malignant disorder of lymphoreticular origin, different histologically from NHl because of the presence of reed-stenberg cells (giant cells)
- peaks from 25-30 years old
- common in Caucasians
Staging of hodgkins lymphoa
- limited to 1 lymph node region/organ
- two lymph node regions or organ + lymph node
- lymph nodes both above and below the diaphragm
- cancer cells in many portions of one or more organs and tissues
Hodgkins lymphoma s&s
- enlarged lymph nodes
- intense itching
- intermittent fevers
- night sweats
- fatigue
- weight loss
hodgkins lymphoma treatment and prognosis
- radiation
- chemo
- stem cell transplantation
- stage 1 = 90%
- stage 2 = 90%
- stage 3 = 80%
- stage 4 = 65%
Leukemia
- uncontrolled proliferation of white blood cells in the marrow
- most common in children
Leukemia s&s
- fatigue
- loss of appetite
- fever
- enlarged lymph nodes
- frequent nose bleeds
- weight loss
- enlarged liver & spleen
- ecchymosis
- petechiae
leukemia treatment, prog, surv
- radiation
- chemo
- blood and platelet transfusions
- bone marrow transplant
- stem cell transplant
- chronic = 84% (5 year)
- acute = 85% (5 year)
Raynaud’s disorder
- vasospasm of the arteries
- hands, feet, nose, and ears
- cold temps and emotional trauma
- 3-5% of population
raynauds s&s, treatment
- pallor
- cyanosis
- erythema
- symptoms usually resolve over several minutes
- avoid caffeine, tobacco
- meds: calcium channel blockers
Systemic Lupus Erythematosus
- chronic inflammatory autoimmune disorder
- appears as discoid lupus erythematous which affects only the skin
- systemic lupus which affects the entire body
DD for systemic lupus
- rheumatoid arthritis
- vasculitis
- scleroderma
- chronic active hepatitis
- acute drug reactions
- polyarteritis
- drug-induced lupus
American rheumatism association diagnostic criteria
- abnormal titer
- butterfly rash
- discoid rash
- oral or nasopharyngeal ulcerations
- photosensitivity
Incidence of lupus
- primarily a disease of young women
- peak incidence between ages 15-40
- women more affected than men
risk factors for lupus
- family
- physical or mental stress
- strep/viral infections
- exposure to UV light
- immunizations
- pregnancy
- certain drugs: oral contraceptives
Lupus: musculoskeletal
- arthralgia
- arthritis
- fever
- weight loss
- fatigue
Lupus: cutaneous and membranous lesions
- butterfly rash (malar)
- discoid lesions: red, raised, scaling
- peripheral vasculitis
- splinter hemorrhages
- leg ulcers
- raynauds
- painful mouth ulcers
- permanent hair loss from discoid lesions
Lupus: medical management
- NSAIDS
- antimalarial drugs
- corticosteroids
- immunosuppressive drugs
Lupus: mortality
- reasonable good prognosis if respond well to Rx
- if not they suffer from other infections
Fibromyalgia
- chronic widespread musculoskeletal pain syndrome with multiple tender points
- fatigue, headaches, numbness common
- women aged 20-50 years
Fibromyalgia clinical findings
- chronic aching pain and stiffness
- neck shoulders low back and hips
- sleep disorders
- subjective numbness
- IBS
- minor exertion aggravates pain and increases fatigue
DD for Fibromyalgia
- not in people over 50
- not if fever/weight loss
- must rule out arthritis, SLE, CFS
Treatment for Fibromyalgia
- patient education
- support
- stress managent
- psychotherapy
- analgesics, antidepressants
Exercise for Fibromyalgia
- conditioning and aerobic
- aquatic therapy
- short exercise sessions
- reaching a goal of 30 minutes of continuous exercise may take weeks or months
- susceptible to over use
Rheumatoid arthritis
- chronic inflammatory disorder of unknown cause that is typified by polyarticular, symmetrical joint involvement as well as characteristic extra-articular involvement
- shows up in 1% of the population
- 3rd to 4th decade, genetic
- joint lesions
RA etiology
- not really known
- could be infectious
- earliest inflammatory changes involve inflammation and occlusion of small subsynovial blood vessels, suggesting agent is carried into the joint
RA infections agent
- virus like particles are often found in synovial biopsies
- polyarthritis occurs with several bacterial and viral illnesses
RA Epstein-Barr virus
- defect in their ability to regulate B cells infected with EBV
- may aggravate the disease
RA synovial cell interactions
macrophage - t cell interaction is central to the amplification of the immune response
- b cells are factories for production of rheumatoid factor
- t cells produce cytokines that stimulate production of fibroblast-like lining
- macrophages stimulate endothelial cells to produce capillaries
RA synovial fluid phase
- neutrophil is the predominant cell in the synovial fluid
- releases free radicals and hydrolytic enzymes that destroy cartilage
RA chronic proliferations
- panes accumulates at the margin of the synovial membrane-cartilage border
RA joint destructions
- unpredictable
- swan neck deformity
RA clinical features
- symmetrical, bilateral joint involvement
- MCP, PIP and wrist joints
- DIP spared
- Palmar flexor tendonitis
- rotator cuff tendinitis
- alanto-axial ligament involvement
RA extra-articular involvement
- 20 to 25% of patients
- firm subcutaneous masses found in areas of repetitive trauma
- may appear in the lungs
RA diagnosis
- prolonged morning stiffness. weight loss
- MCP, PIP wrist pain and swelling
- soft tissue swelling
- RA nodules in extensor prominences
American RA criteria for RA
- morning stiffness for at least 1 hour and present for 6 months
- swelling of three or more joints for at least 6 months
- radiographic evidence
- nodules
DD for RA
- non articular disorders (fibro)
- osteoarthritis
- hemochromatosis
RA therapy
- pt education
- protect joints, strengthen weakened muscles
- ADL things
RA pharmacologic therapy
- NSAIDs
- corticosteroids
- immune pathway blockers
RA mortality
- reasonably good if respond to Rx
Chronic Fatigue Syndrome
- usually accompanied by other musculoskeletal problems
- associated with Epstein-barr virus
Diabetes Mellitus
- diabetes = siphon - term used by ancient greeks to describe the large urinary volume excreted
- Mellitus = sweet - distinguish this urine from the people with diabetes insidious
Diabetes: pancreas
- exocrine component
- enzymes flow into ducts eventually into main pancreatic duct which empties into duodenum
Diabetes pancreas & endocrine
- endocrine component
- islets of langerhans = cells within exocrine tissue that secrete insulin, glucagon and somatostatin
- hormones released directly into blood
Diabetes explanation
- hyperglycemia: chronic increase in blood glucose levels
- relative deficiency in insulin from reduced insulin secretion or reduced insulin action or both
Type 1 diabetes
- juvenile-onset diabetes or insulin-dependent diabetes
- characterized by a complete or almost complete lack of insulin production
Type 2 diabetes
- formerly known as adult-onset diabetes or non-insulin dependent
- resistance to insulin in the presence of normal, or slightly increased level of plasma insulin
Diabetes prevalance
- USA = 8.3% of pop, adults = type 2
- world wide = 2.8% of population, 4.4% expected by 2030
Diabetes complications
- 6th leading cause of death/disability in USA
- end-stage renal disease (ESRD)
- amputation
- heart disease
- blindness
- pregnancy complications
Type 1 Diabetes Etiology
- usually appears before age 20
- usually caused by autoimmune destruction of pancreatic beta cells, leading to a failure to produce insulin
- onset is rapid
- no cure
- dietary manipulation, exogenous insulin
- polyuria
- weight loss
- polyphagia
Type 2 diabetes etiology
- mostly in adults
- non caucasian and elderly populations are disproportionately affected
- insulin resistance: tissue don’t respond to insulin
- obesity
- onset is slow
- treatment is weight loss, exercise, diet and oral hypoglycemic drugs
Type 2 Dm risk factors
- age
- men
- GI
- fam hx
- sedentary lifestyle
- obese
Diabetes diagnosis
- fasting = > 126 mg/dl
- oral = >200 mg/dl
- casual = > 200mg/dl
Fasting blood glucose test (FBG)
- gold standard
- hyperglycemia on at least 2 occasions typically means diabetes
Oral glucose tolerance test
- fast
- blood glucose measured 5 times over 3 hours
- glucola drink
Diabetic ketoacidosis
- increase plasma glucose = glucose and ketones are lost in urine
- increased nutrient concentration in kidney tubules leads to osmotic diuresis = decreased plasma volume and decreased blood pressure
- increase ketone production results in blood acidosis = coma and death
Insulin therapy
- goals are to achieve normoglycemia
- delay or prevent late vascular complications
- type 1 = insulin for life
- type 2 = insulin use is reserved for those who actually need it
Thyroid gland disorders
- endocrine gland
- responsible for synthesis of thyroxine and triiodothyronine
Hyperthyroidism
- hyper metabolic state that is caused by the excess production of thyroid hormones from gland
- grave’s disease
- autoimmune caused by diffuse toxic goiter/enlargement of gland
Hypothyroidism
- thyroid hormone deficiency
- more prevalent in women
- usually hashimoto’s thyroiditis
- most frequent cause of goiter
