Clinical Conditions Flashcards
Rhabdomyolysis
Huge breakdown of skeletal muscle leads to release of lots of myoglobin
Plugs renal tubules and causes renal failure
a1 Antitrypsin deficiency
Autosomal recessive
Lack of antitrypsin molecule -> excess trypsin activation
Increased level of elastase release by neutrophils in areas of inflammation -> excessive breakdown of elastin (destroys alveoli -> emphysema)
Hereditary haemochromotosis
Deficiency of hepcidin (iron storage protein)
Fe2+ deposited all over body
Damages pancreas (bronze diabetes) and heart
Bleed to treat
Coal worker’s pneumoconiosis
Microscopic coal dust retained in alveoli and taken up by macrophages
System eventually overwhelmed, immune response causes pulmonary fibrosis - damaging lungs
Reduced air entry -> persistent cough, breathlessness, fainting etc.
Acute alcoholic hepatitis
Result of series binge drinking Toxins badly damage liver Formation Mallory's hyaline Fever, jaundice and tenderness Usually reversible
Cirrhosis
10/15% of alcoholics Irreversible severe damage to liver Shows as micronodules of hepatocytes surrounded by collagen bands Jaundice, fever, sickness Often fatal
Lobar pneumonia
Streptococcus pneumonae
Acute inflammation causes exudate to accumulate in alveoli -> loss of respiratory function
1) Congestion - vascular engorgement, some clear exudate deposition into alveoli
2) Red hepatisation - RBCs leak into exudate, large fibrin deposits formed
3) Grey hepatisation - RBCs have disintegrated -> exudate containing neutrophils and other WBCs remain, thus grey colour
4) Resolution - exudate drained through lymphatics and coughed up
Acute appendicitis
Fecaloma (calcified faeces) block part of the appendix
Causes inflammation, bacteria colonise, stays as abscess until wall of appendix ruptures
Can lead to peritonitis and systemic shock
Bacterial meningitis
Acute inflammation of the meninges of the brain -> rise in intracranial pressure -> blood vessels supplying brain occluded -> brain damage, coning and death Causes.. Neonates - Strep. B Children - Neisseria meningitides Adults - Enterovirus Elderly - Strep. pneumonae
Ascending cholangitis and hepatic abscesses
Gallstone blocks bile duct, bacteria colonise, cause infection, spread to liver, contained as hepatic abscess
Results in jaundice and steatorrhea (lack of bile emulsifying fat)
LFT shows high AST/ALT (hepatocyte lysis has occurred)
Hereditary angio-oedema
Autosomal dominant Mutation of C1 esterase inhibitor Immune system runs out of control Huge generalised oedema throughout body When airways affected - unable to breathe -> death
Chronic granulomatous disease
Neutrophils unable to form O2 radicals (superoxide) to eliminate phagocytosed pathogens, instead take them up by phagocytosis and they stay there
Leads to many chronic infections as huge number of granulomas are formed
Tuberculosis
Chronic infection of lungs - mycobacterium tuberculosis
Bacterium spread by droplet infection
Macrophages phagocytose but cannot destroy due to mycolic acid coat, granulomas form and bacteria multiply within
Primary area of lung infected - ghon focus -> forms ghon complex (calcified hilar lymph node) upon healing
Treated with antibiotics
Can lead to pulmonary fibrosis and eventual death
Can become systemic if untreated -> death via failure of another system
Sarcoidosis
Idiopathic granulomatous disease of the lung
Common in young women
Granuloma formation without caseous necrosis
Symptoms eased with steroids
Associated with hypercalcaemia
Serum ACE can be elevated
Rheumatoid arthritis
Autoimmune attack on synovium of joints
Leads to granuloma formation
Erode the articular surface of bones -> decreased mobility and pain
Affects all joints, common in young people and smaller joints
Treat with steroids to mediate immune function
Chronic gastritis
Aetiologies of note - Heliobacter pylori (irritates stomach lining), use of NSAIDs (retard mucus defence allowing acid to erode mucosa and come into contact with submucosa, impairing function and causing pain)
Treat with antibiotics and acid inhibitors
H. pylori can predispose you to stomach cancer if had for long time
Ulcerative colitis
Intermittent abdominal pain, diarrhoea (sometimes bloody), weight loss
Chronic autoimmune inflammation of colon
Histology - shows crypt abscesses, destruction of mucosa and attack on submucosa
Increases risk of colon cancer
Treated with steroids
Crohn’s disease
Autoimmune chronic inflammation of any part of GI tract
Abdominal pain, diarrhoea (sometimes bloody), and weight loss
Histology - many granulomas and cobblestone bowel
Complications - anal lesions, bowel fistulae
Treat with steroids
Leprosy
Mycobacterium leprae
Chronic inflammation of epidermis, nerves, eyes and respiratory tract
Neuropathy of epidermis, poor eyesight that leads to eventual loss of extremities due to repeated unnoticed injury
Confirm bacteria with acid-fast test then treat with antibiotics
Syphilis
Infectious STD - treponema pallidum
1) Painless ulcer on genitals
2) Untreated infection escapes abscess body develops a rash, fever, malaise, lethargy, joint pains, raised lymph nodes (signs of 2ndary acute inflammatory response)
3) Subdues syphilis into latent stage where symptoms go away
4) Disease causes chronic inflammation in separate areas of body such as brain, liver etc -> leads to death
Wegener’s granulomatosis
Autoimmune chronic inflammation which presents with ELK (ears/nose/throat - lungs - kidney)
Huge autoimmune attack on the epithelia, causing granulomas and fibrosis
Can lead to renal and kidney failure if untreated
Treat with steroids to reduce immune function
Scurvy
Vit C deficiency
Prolyl hydroxylase can’t convert proline -> hydroxyproline
Reduced H bonds, less cross links, weakened structure, wobbly collagen
Commonly presents as bleeding gums
Ehlers-Danlos syndrome
Many types depending on collagen affected
Common feature is inherited defect in collagen gene -> leads to hypermobility of joints, stretchy skin, easily bruised, slow healing wounds
Osteogenesis imperfecta
Type 1 collagen deficiency/deformity (major component in ground substance in bone)
Severe - no conversion of hyaline skeleton, incompatible with life
Most cases - repeated fractures, bowed long bones, can be confused with abuse
Blue sclera due to unknown cause (thinning of cornea due to collagen issues?)
Alport syndrome
X linked dominant
Defect in type 4 collagen -> major issues with basement membranes of kidney, ear and eye
Leads to nephritis, haematuria and eventual renal failure along with progressive hearing loss and varied ocular conditions
Keloid scars
Scars that deposit a large amount of granulation tissue (mainly type 3 collagen)
They extend the boundaries of the original wound (also raised)
Much more common in dark skinned races than caucasians
Oesophageal strictures
Persistent acid reflux can damage collagen framework of oesophagus
Leads to scar tissue formation (inflexible, contraction of myofibrils impacts function)
Dysphagia (difficulty swallowing) primary presenting symptom
Contractures
After 2nd/3rd degree burn, basal layer permanently damaged
Leads to granulation formation (less elastin - less flexible) -> permanent shortening of skin
Can occur over a joint -> fixed flexion of joint
Can be minimised to ensure full extension of joint but this isn’t always feasible
Marfan’s syndrome
Autosomal dominant
Misfolding of fibrillin -> more elastic connective tissue
Parts of body will stretch abnormally when under pressure
Very tall, arachnodactyly (long fingers/toes), death usually around 40 from aortic rupture
Deep vein thrombosis
Formation of thrombus within a deep vein, usually in lower limb
Risk factors - inactivity, obesity, the pill, heart conditions
Prevention - subcutaneous heparin and TED stockings
Treatment - IV heparin/oral warfarin
Thrombus can break and migrate to lungs (PE)
Pulmonary embolism
Embolism that migrates to the pulmonary arteries, occluding the vessels and causing respiratory symptoms
>60% reduction in lung function always fatal
Major - shortness of breath, blood in sputum
Minor - shortness of breath or asymptomatic
Treatment - clot busters (streptokinase)
Cause of death…
1) Right sided heart failure - due to severe pulmonary hypertension
2) Mechanical shock - severely decreased preload of left heart
3) Critical hypoxaemia - ischaemia of huge part of lungs
Air embolism
Air bubble becomes trapped in blood vessel
Result of care provider error (cannulation etc.), barotrauma (diver holds breath as they come up rapidly, bursting alveoli), or decompression sickness
> 150ml air into heart = fatal
Risk of stroke, ischaemic limb etc. due to occlusion of artery
Treatment - hyperbaric chamber (bring to high pressure to dissolve air and then let pressure down slowly)
Fat embolism
Embolism as result of long bone breaking, releasing yellow marrow into bloodstream
Same risks as other embolisms
Not easily treated, wait for body to remove fat, fix bone ASAP
Haemophilia A
Recessive X linked
No/reduced factor VIII production -> blood can’t clot as well (factor Xa production down 50%)
Treatment - recombinant factor VIII, avoid thrombolytics/blood thinners
Disseminated intravascular coagulation
Widespread overactivation of clotting cascade
Formation of many thrombi
Can lead to multiple organ damage and death
Consumes platelets and clotting factors, making clotting less likely where it is actually needed
Treatment - platelet transfusion to prevent haemorrhage (limited extent)
Thrombocytopenia
Lack of thrombocytes (platelets) in blood
Result of decreased production (folic acid deficiency, bone cancer, infection) or increased destruction (autoimmune)
Can be caused by medications eg. methotrexate
Treat cause of give platelet transfusion
Thrombophilia
Excessive clotting throughout body as result of various genetic disorders
Overactivation of clotting cascade
Not as severe as disseminated intravascular coagulation
> risk of DVT
Amniotic fluid embolism
Embolism as result of traumatic birth
Amniotic fluid find its way into blood vessels through female reproductive system
Same risks as other embolisms
Treatment - supportive as amniotic fluid can’t be removed, body must do it
Bowel infarction
Death of bowel due to occlusion of one of the mesenteric arteries (superior or inferior)
Usually due to thrombus coming from left side of heart (result of a left -> right shunt ASD/VSD)
Can also be due to atherosclerosis
