Exam 2 Flashcards
Peritoneum
Layer of the digestive tract that constitutes the outer wall of the intestine and contains a serous fluid between its two layers.
Crohn Disease
Sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue; cobblestone.
Manifestation: Fistula Formation
Submucosal layer
Layer of digestive tract that consists of nerves, blood vessels, and structures for secreting digestive juices
Treatment of Crohn disease with Sulfasalazine will focus on which aspect of this disease?
Inflammatory suppression
Duodenum
First section of small intestine, where bile from the liver and digestive enzymes from the pancreas aid in the digestion of fats, proteins, and carbohydrates.
Aldosterone
Regulates balance of sodium, potassium, and water in the body
Client diagnosed with Addisons disease will likely experience which abnormal lab result related to the absence of aldosterone?
Serum potassium levels elevated
Urinary Tract Infection (UTI)
Presence of bacteria in the urine (BACTERIURIA)
Creatinine
Waste product produced by muscles during muscle metabolism
Formed from the breakdown of creatine (creatine supplies energy to muscles)
Levels of creatine in the blood and urine is used as an indicator of kidney function because the kidneys filter it out of the blood and excrete it in urine
Disruption of which muscles contraction can lead to the inability to expel urine from the bladder?
Detrusor
What loss of function in the kidney results in anemia of end-stage kidney disease?
Produce erythropoietin
How to collect clean-catch urine specimen
Clean the external urethral opening and then collect the urine in the middle of the stream
Kidneys
Maintain blood volume and pressure, creates stable environment
Ensure balance of SODIUM, CHLORIDE, POTASSIUM, CALCIUM, HYDROGEN, PHOSPHATE & PH
Eliminate products of metabolism, such as urea, uric acid and creatinine
Nephrons
Functional unit of the kidney responsible for filtering blood and forming urine
Each nephron consists of a glomerulus and system of tools.
Glomerulus
High pressure mass of capillaries that filters the blood
Urine formation involves:
Filtration of blood by the glomerulus to form an ultrafiltrative urine
Tubular reabsoprtion of electrolytes and nutrients needed to maintain the constancy of the internal environment
Secretion of waste materials
Urinary Tract Obstruction: Classifying causes
Site:
-upper urinary tract
-lower urinary tract
-bilateral
-unilateral
Degree:
-Partial
-complete
Duration :
-acute
-chronic
Causes of Urinary Tract Obstructions
Calculi
Pregnancy
Tumors
Benign Prostatic hyperplasia (BPH)
Scar Tissue from infections and inflammation
Developmental defects
Neurogenic disorders (spinal cord injury)
Complications of Urinary tract obstructions:
Hydronephrosis, kidney failure, and infection
Renal damage process in Polycystic Kidney Disease
Decrease renal blood flow —> decreased glomerular blood flow —> decreased glomerular filtration rate (GFR)
Tubular cell damage —> increased NaCl delivery to macula densa (specialized group of cells in the kidney), or Tubular obstruction, or back leak of filtrate —> decreased glomerular filtration rate (GFR)
Glomerular damage —> decreased glomerular ultrafiltration —> decreased glomerular filtration rate (GFR)
Autosomal Dominant PKD (polycystic kidney disease)
Most common form
Inherited as an autosomal trait caused by a mutation in PKD1 gene and PKD2 gene, usually presenting in adulthood
Slow to develop & asymptomatic
Manifestations: pain, hematuria, hypertension, nephrolithiasis, hepatic cysts, and aneurysms (later stage)
Subarachnoid hemorrhage is a common cause of death
Kidney becomes enlarged with multiple round cysts in the kidney medulla, cysts may develop in other organs
Autosomal Recessive PKD (polycystic kidney disease)
Inherited disease caused by mutation in the PKHD1 gene.
Usually depend prenatally or within a few weeks after birth, can also appear in older children and adults
Potter fancies and defects associated with oligohydramnios may also be present
Manifestations: severe renal failure, impaired lung development, and liver fibrosis
ARPKD is characterized by the cystic dilation of cortical and medullary collection tubules and bilateral flank masses, causing an enlarged kidney
Nephronophthisis-Medullary Cystic Kidney Disease
Group of disorder that usually begin childhood
Damage occurs in distal tubules with disruption of basement membrane & chronic & progressive tubular atrophy
Manifestations (initial): polydipsia, polyuria, enuresis.
Additional manifestation: salt wasting, growth retardation, anemia, progressive renal insufficiency, ocular motor abnormalities, retinitis pigmentosa, liver fibrosis, cerebellar abnormalities, azotemia, and renal failure.
Kidneys are small and shrunken with cysts in the medullar or cortex, but usually at the corticomedullary junction
Azotemia
Elevated levels of nitrogen-containing compounds (urea and creatinine) in the blood.
These are substances normally removed by the kidneys, so if they are not being removed, that means that azotemia is the kidneys not functioning properly.
Anemia
Condition where you don’t have enough healthy red blood cells to carry adequate oxygen to the body’s tissues.
Can lead to fatigue, weakness, shortness of breath.
BODY ISNT GETTING ENOUGH OXYGEN
Simple Cysts
Commons disorder of the kidneys in OLDER ADULTS
(Sometimes confused with renal cell carcinoma)
Cysts may be single, multiple, unilateral, bilateral and small (less than 1 cm in diameter, though they may grow larger)
Cysts are usually asymptomatic, don’t affect renal function; may cause flank pain, hematuria, infection and hypertension
Hematuria
Presence of blood in the urine.
Acquired Cysts
These cysts are characteristic of End-stage renal disease (ESRD) in individuals who have been on prolonged dialysis
Usually asymptomatic, but may experience hematuria
Adenomas and occasionally adenosarcomas may develop in walls of the cysts
Adenomas
Benign (non cancerous) tumors that form in glandular tissue
Most common cause of endocrine disorders, in epithelial lining in colon, thyroid and pituitary gland
Adenosarcoma
Rare form of malignant tumor that typically affects uterus or retroperitoneal space, though it can occur in other parts of the body
Acute Kidney Injury: Intrinsic
Damage to structures WITHIN the kidney
COMMON CAUSE: Acute Tubular Necrosis
- prolonged renal ischemia
-exposure to nephrotoxic drugs, metals, organic solvents
-intratubular obstruction resulting from hemogloinuria, myoglobin urea, myeloma light chains, or uric acid casts
-acute renal disease
-Acute glomerulonephritis
-Acute Pyelonephritis
-Injury to tubular structures
Signs & Symptoms:
PRIMARY SIGN =
-sharp decrease in glomerular filtration
-stage 3 (moderate damage) is identified with a GFR of 30 to 59 mL/min/1.73 m^2.
Causes of decreased GFR (glomerular filtration rate) and epithelial injury include:
-intrarenal vasoconstriction
-decreased hydrostatic pressure in glomeruli
-changes in arterial tone by tubuloglomerular feedback
-decreased capillary permeability in glomeruli
-increased tubular hydrostatic pressure, secondary to obstruction
-backflow of glomerular filtrate into interstitium
Acute kidney injury: prerenal
Marked decrease in renal blood flow
MOST COMMON CAUSE OF ACUTE KIDNEY INJURY. (Results from Issues above the kidneys!!)
Causes: hypovolemia, decreased vascular filling, heart failure & cardiogenic shock, decreased renal perfusion. Each of these conditions may result from various events
Hypovolemia:
-hemorrhage
-dehydration
-excessive loss of gastrointestinal tract fluids (diarrhea, vomit)
-excessive loss of fluid due to burn injury
Decreased vascular filling (causes vasodilation):
-anaphylactic shock
-septic shock
Heart failure and cardiogenic shock
Decreased renal perfusion
-sepsis
-vasoactive mediators
-drugs (inappropriately given if volume is normal)
-diagnostic agents (radiocontrast dye)
Signs & Symptoms:
-decreased urine output
-abnormal elevation of blood urea nitrogen in relation to serum creatinine levels (normal ration is 10:1; acute kidney injury is indicated by 15:1 to 20:1)
-low fractional excretion of sodium (<1%) suggests reduced urine output is due to decreased renal perfusion
Acute Kidney Injury: Postrenal
Obstruction of urine outflow from the kidney (think: something is happening BEYOND the kidney)
OCCURS IN: ureter, bladder, urethra
MAY RESULT FROM: calculi (stones), scar tissue, tumors, infections, trauma, nerve dysfunction, or prostatic hyperplasia (MOST COMMON CAUSE). urinary tract obstructions usually don’t cause acute kidney injury unless one kidney is already damaged
-bilateral ureteral obstruction
-bladder outlet obstruction
-urethral blockage
Signs & Symptoms
Primary sign to watch for is reduced urinary output, <0.3 mL/kg/h x 24 hours or Andria x 12 hours indicates injury. Other signs and symptoms for risk of injury include those for urinary tract obstruction:
-small and weak stream
-pain and pressure
-abdominal distention
-frequency of urination
-hesitancy
-straining when initiating urination
-feeling of incomplete bladder emptying
-overflowing continence
Acute Kidney Injury: Postrenal
Obstruction of urine outflow from the kidney
Glomerular Filtration Rate (GFR)
Rate of blood flow through the glomerulus
Test used to measure how well your kidneys are functioning by assessing how much blood passes through the glomeruli (tiny filters in the kidneys) per minute.
Normal GFR is important sign that kidneys are working well.
Normal GFR
125 mL/min;
90-120 mL/min/1.73m^2 for a healthy adult, it can vary with age
Abnormal GFR - Chronic Kidney Disease (CKD)
GFR below 60 mL/min/1.73m^2 for three months or more could indicate chronic kidney disease (CKD)
What does the Urinary System regulate?
Fluid volume
Blood pressure
Metabolic waste and drug excretion
Vitamin D conversion
Acid-base balance
Hormone synthesis
Ureters
Transport urine from calyces (cup-shaped cavities that collect urine from renal pyramids before it passes into renal pelvis and then into ureter) to bladder
Urinate (micturition)
Voluntary activity; as urine volume in the bladder increased, the urine exerts pressure on the two bladder sphincters (internal & external) and stretch receptors in the bladder
Pressure of 200-300 mL on sphincters and receptors sends nerve impulses to the brain, triggering the urge to urinate
Bladder contracts and external sphincter relaxes, forcing urine out through the urethra
Normal daily urine output is 1500 mL
Each kidney contains 1-2 million nephrons
Renin-Angiotensin-Aldosterone System (RAAS)
Regulates blood pressure, aided by water and electrolyte regulation in the kidneys
-Aldosterone: steroid hormone, part of RAAS, and acts primarily to conserve sodium and water while excreting potassium
Urine waste products
Ammonia is product of delaminating, which strips amino group from amino acid
Urea and uric acid
Erythropoietin
Erythropoietin (EPO) is a glycoprotein hormone primarily produced by the kidneys (and in small amounts by the liver). It plays a crucial role in stimulating red blood cell (erythrocyte) production in the bone marrow.
Kidney Functions:
Convert vit D to its active form
Secrete bicarbonate
Excrete or retain hydrogen
Synthesize atrial natriuretic peptide , erythropoietin and renin
Renin
Renin is an enzyme secreted by the juxtaglomerular (JG) cells of the kidneys in response to low blood pressure, low sodium levels, or sympathetic nervous system activation. It plays a key role in the renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure and fluid balance.
Order of filtrate flow through kidney
Bowman capsule - proximal convoluted tubules - loop of henle - distal convoluted tubes
BPLD (Be careful, pizzas can try lifting hades during crappy times)
Incontinence
Loss of urinary control
Enuresis
Involuntary urination by a child after 4-5 years of age
Nocturnal Enuresis = bed wetting
Stress Incontinence
Loss of urine from pressure exerted on the bladder by coughing, sneezing, laughing, exercising, or lifting something heavy
Occurs when sphincter muscle of the bladder is weakened (PELVIC FLOOR MUSCLES)
Contributing factors: pregnancy , childbirth, menopause, cystocele, prostate removal, obesity , chronic coughing
Overactive Bladder (urge incontinence)
Sudden, intense urge to urinate, followed by an involuntary loss of urine
Causes: UTIs, bladder irritants, bowel conditions, smoking, Parkinson’s disease, Alzheimer’s disease, stroke, injury, nervous system damage (Detruser muscle)
Overactive bladder: urge I continue with no known cause (not a normal part of the aging process)
Reflex incontinence
Caused by trauma or damage to the nervous system
Detrusor Hyperreflexia: increased detrusor muscle contractility that occurs even though there is no sensation to avoid
Urgency is generally absent
Mixed incontinence
Occurs when symptoms of more than one type of urinary incontinence are experienced
Overflow incontinence
Inability to empty the bladder or retention (feels bladder is full but cannot empty)
-dribbling urine (leaking) and a weak urine stream
Causes: bladder damage, urethral blockage, nerve damage, and prostate conditions
CHRONIC OVERDISTENSION occurs because of a perceived inability to interrupt work to void that results in detrusor muscle areflexia and overflow incontintence
Functional Incontinence
Occurs in older adults, especially people in nursing home who have physical or mental impairment that prevents toileting on time
(cannot get to restroom fast enough) !!!!!!
Transient incontinence
Urinary incontinence resulting from a TEMPORARY CONDITION (ex: delirium)
Clinical manifestations of UTI in the ELDERLY
Non-ulcerative Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS)
Constitutes 90% of all cases
Pinpoint hemorrhages in the bladder wall due to inflammation
Ulcerative Interstitial Cystitis/ Bladder Pain Syndrome
5-10% of all cases: Hunner Ulcers/patches: red, bleeding areas on the bladder wall
5% experience symptoms of 2+ years and 5% develop end-stage disease where bladder hardens, capacity is low, and pain worsens
Manifestations of Non-ulcerative and Ulcerative IC/BPS
Pain in urinary tract, (worse with pressure), frequency and nocturia, urgency (often constant, worsened by stress), sexual dysfunction
Diagnosis: history, exam, voiding tests, urodynamic testing, cystoscopy
Curing the condition is rare, but individualized treatment is effective
Urinary Tract Infections: Cystitis
Inflammation of the bladder
If autoimmune —> interstitial cystitis = non-infectious chronic bladder inflammation that causes pain and pressure
Manifestations: UTI Symptoms, abdominal pain. Pelvic pressure (dysuria)
Patient with cystitis is more susceptible to recurrent UTI because of E-Coli
Women sexually active at highest risk ( and at risk true to short urethra, compared to men, and opening or urethra is close to anus )
Interstitial cystitis
Non-infectious chronic bladder inflammation that causes pain and pressure
Dysuria
Painful or difficult urination; pain and stinging when urinating
Causes:
UTI
Interstitial Cystitis
Enlarged prostate (men)
Vaginitis
Kidney stones
STIs
Irritation or inflammation (soaps, etc)
Urosepsis
Sever blood stream infection that originates from UTI and leads to systemic inflammatory respons syndrome (SIRS), potentially causing septic shock and multi-organ failure
Bacterial invasion in urinary tract - ascends to kidneys (pyelonephritis)
Manifestation: dysuria (painful urination), flank pain (pyelopnephritis), fever, chills, nausea, vomiting,
Pyelonephritis
Acute or chronic infection that has reached one or both kidneys due to ascending UTI (E-Coli) usually by direct bacterial invasion of the lower urinary tract
Costovertebral angle tenderness (where last rib meets spine, kidneys are in that spot)
Kidneys become grossly edematous (edema, fluid in interstitial spaces) and fill with exudate (fluid), compressing renal artery and potentially developing abscesses or necrosis
Complications: renal failure, recurrent UTIs and sepsis
Manifestations: UTI symptoms, flank pain, and increased blood pressure
Treatment: usual UTI treatments, long-term antibiotics (4-6 weeks) usually required
Nephrolithiasis
Presence of renal calculi, hard crystals composed of minerals that kidneys normally excrete
Calculi - contain calcium and oxalate or phosphate
Dehydration is main cause of kidney stones!!!!!
Risk factors: pH changes, excessive concentration of insoluble salts in the urine, urinary stasis, family history, obesity, hypertension, and diet
Manifestations: colicky pain in flank area that radiates to the lower abdomen and groin; bloody, cloudy or foul-smelling urine; dysuria, frequency, genital discharge, nausea, vomitting, fever, chills
Ureteral stones: renal colicky pain and hematuria (blood in the urine)
If develops chills and fever (signs of infection) —> notify provider immediately
Treatment: strain all urine, increase fluid intake to 2.5-3.5 L; lithotripsy, percutaneous nephrolithotomy, ureterscopy, surgery, pain management, dietary changes, and physical activity
Hydronephrosis
Abnormal dilation of the renal pelvis and the calyces of one or both kidneys due
-bilateral renal movement indicates an obstruction in one of the ureters!!
Causes: urolithiasis, tumors, benign prostatic hyperplasia, strictures, stenosis, and congenital urologic defects
Manifestations: bloody, cloudy or foul smelling urine, dysuria, flank pain, colicky,
Treatment: ureteral stents, nephrostomy tubes, and antibiotics
Colicky Pain
Severe intermittent cramping pain that occurs in waves due to spasms of a hollow organ (intestines, gallbladder, ureters, uterus)
Renal Cell Carcinoma
Most frequently occurring kidney cancer in adults
Risk factors: being male and smoking
-metastasis (spread of cancer cells to distant organs or tissues) to the liver, lungs, bone, or nervous system is common
Manifestations: asymptomatic, painless hematuria, abnormal urine color, dull and achy flank pain, urinary retentions, palpable mass over the affected kidney, (costoverterbral angle), unexplained weight loss, anemia, polycythemia
Bladder cancer
Types: transitional cell carcinoma, squamous cell carcinoma, and adenocarcinoma
Manifestations: PAINLESS HEMATURIA
Benign Prostatic Hyperplasia (BPH)
Common non malignant enlargement of the prostate gland that occurs as men age
Declining testosterone and increasing estrogen levels
As prostate explains, it presses against the urethra and obstructs urine flow
Manifestations: frequency, urgency, retention, difficulty initiating urination, weak urinary stream, dribbling urine, nocturia (frequent urination at night), bladder distension, overflow incontinence, and erectile dysfunction ( due to decrease in testosterone levels)
Patients >50 have higher rises of developing UTI due to enlarged prostate
Recurrent UTI can result in chronic bacterial prostatitis (inflammation or infection of prostate gland)
IMAGINE an enlarge prostate, compresses the urethra (prostate impinging on urethra). “I can’t start a stream, and when I do, I dribble”
Polycystic kidney disease
Genetic disorder; inherited.
NUMEROUS GRAPE-LIKE CLUSTERS (fluid filled cysts) in both kidneys
Glomulerlonephritis
Leading cause of acute renal failure
Bilateral inflammatory disorder of the glomeruli that typically follows a streptococcal infection
Glomeruli
Small filtering units of the kidneys
Kidney injury
Sudden loss of renal function (often critically ill hospitalized patients)
-Pre renal conditions: extremely low BP or blood volume (decreasing renal blood flow); cardiac dysfunction
-Intrarenal conditions: reduced blood supply in kidneys, hemolytic uremic syndrome, renal inflammation, toxic injury (dyes—> intrinsic injury)
-Post renal conditions: ureter obstruction, bilateral kidney stones, bladder obstruction/dysfunction (elderly patients are at a higher risk due to BPH)
Risk factors: advanced age, autoimmune disorders, and liver disease
Less than 400 ccs in 24hrs
Phases:
-Asymptomatic
-Liguria
-Diuretic phase
-Recovery phase
Kidney injury phases
-Asymptomatic
-Oliguric (daily urine output <400 mL): electrolyte disturbances (potassium), fluid volume excess, AZOTEMIA = (excess urea and other nitrogen wastes in the blood), and metabolic acidosis
-Diuretic Phase (daily urine output >5L): electrolyte disturbances, dehydration, and hypotension
-recovery phase: glomerular function gradually returns to normal
Acute kidney injury (AKI) stages:
Early stage —> LOW GFR AND ELEVATED SERUM UREA
Four stages to AKI:
1.) initiation = as the injury is happening
2.) Oliguria = when urine output drops to less than 400 mLs in 24hr period and creatinine and serum urea increase
3.) Diuresis = when an increase urine output indicates glomerular filtration recovery has started
4.) Recovery = when improvement of kidney function occurs (this may take 3-12 months)
Chronic kidney disease
Gradual loss of renal function that is irreversible
Causes: diabetes mellitus, hypertension, sickle cell disease systemic lupus erythematous, smoking, advancing age
Treatment: dialysis is to remove excess fluids and wastes
Erythropoietin is included in the treatment of tend stage renal disease (anemia)
Chronic kidney disease stages
Stage I: kidney damage present but GFR kids >90
Stage II: kidney damage worsens as the GFR falls (60-89)
Stage III: kidney function is significantly impaired as GFR is between 30 and 59
Stage IV: kidney function is barely present with GFR dropping between 15 and 29
Stage V: kidney failure as the GFR drops to less than 15 or the patient begins dialysis
Chyme
Partially digested semi liquid food mixture that forms in the stomach and moves to small intestine for further digestion and absorption
Dysphagia
Difficulty swallowing
Manifestations: choking, coughing, odynophagia —> weight loss
Sensation of food stuck in the throat
Think: malnourishment!!
Epiglottis - affected flap in throat (esophagus)
Vomiting (Emesis)
Involuntary or voluntary forceful ejection of chyme from stomach through espophagus and out mouth
Vomiting (Emesis)
Involuntary or voluntary forceful ejection of chyme from stomach through espophagus and out mouth
Peristalsis
Colon is churning
Involuntary Wave-like contractions that occur along digestive tract to propel foods, liquids and chyme through the system
Aspiration
Inhalation/entry of food, liquid, saliva or other foreign material into airways (trachea and lungs)
Causes serious damage and inflammation when SUPINE (laying flat), unconscious, or the vomiting or cough reflex is suppressed
Hematemesis
Blood in the vomitus
- has a characteristic “COFFEE GROUNDS” appearance resulting from protein in the blood being partially digested
Dark tarry stool = Melena
Yellow or green vomitus = presence of bile; occurs due to GI tract obstruction
Treatment: antiemetic medications (drugs to prevent nausea or vomiting) oral or intravenous fluid replacement, correct electrolyte imbalance, and restore acid-base balance
Frank Blood
Bright red blood
If you see frank blood, it’s closer, higher up!!!
If you see maroon/dark blood, its is further or lower!!!
Occult Blood
Can’t see with naked eye
Overt Blood
Visible
Hemorrhoids
Swollen being in rectum and anus (similar to varicose veins)
Sign of Hemorrhoids: Streaked blood
Hiatal Hernia
Stomach section protrudes upward through opening in diaphragm toward the lung
Causes: weakening of the diaphragm muscles, frequently resulting from increased intrathoracic pressure or increased intra-abdominal pressure
Risk factors: advanced age and smoking
Manifestations: indigestion, heartburn, frequent belching, nausea, chest pain, strictures (abnormal narrowing of a passage or duct in the body,typically in blood vessels ), dysphagia, soft upper abdominal mass (protruding stomach pouch)
GERD (Gastroesophageal Reflux disease)
Chyme or bile periodically backs up from stomach into esophagus, irritating esophageal mucosa
Manifestations: HEARTBURN (due to spasm)
Often confused with angina and may warrant ruling our cardiac disease
Complications: esophagitis, strictures, ulcerations, ESOPHAGEAL CANCER (most serious complication), chronic pulmonary disease
Causes: foods (chocolate, caffeine, carbonated beverages, citrus fruit, tomatoes, spicy, fatty foods, peppermint), alcohol consumption, nicotine, hiatal hernia, obesity, pregnancy, certain medications (corticosteroids, beta blockers, calcium-channel blockers, anticholinergics), nasogastric intubation, and delayed gastric emptying
Treatment: avoid triggers, avoid clothing that is restrictive around waist, eat small frequent meals, high fowler’s positioning 2-3 hours after meals, weight loss, stress reduction elevate the head of bead approx. 6 inches, antacids, acid-reducing agents, mucosal barrier agents, herbal therapies (licorice, slippery elm, chamomile), surgery
Barrett’s Esophagus = caused by GERD; chronic acid reflux, increases risk of developing esophageal adenocarcinoma (cancer)
Acute gastritis
Vomiting and anorexia (loss of appetite)
Gastritis
Inflammation of stomach’s mucosal lining
Helicobacter Pylori
Most common cause of CHRONIC GASTRITIS
Lifestyle behaviors (smoking, stress) may increase susceptibility
Causes: organisms transmitted through food and water contamination, long-term use of nonsteroidal anti-inflammatory drugs, excessive alcohol use, severe stress, autoimmune conditions, and other chronic diseases
Complications of chronic gastritis: peptic ulcers, gastric cancer, and hemorrhage
Peptic Ulcer Disease (PUD)
Lesions affecting stomach lining or duodenum
Develops from imbalance between destructive forces and protective mechanisms
Duodenal cancers = associated with H. Pylori infections
-present with epigastric pain (occurs 30 mins to 2 hours after eating or when the stomach is empty in the middle of the night)
Stress Ulcers
Develop due to major physiological stressor on body due to local tissue ischemia (reduced blood flow to tissue or organ), tissue acidosis, bile slats entering the stomach, and decreased GI motility
Most frequent form in stomach; hemorrhage (hematemesis) is first indicator as ulcer develops rapidly and is masked by primary problem
Complications: GI hemorrhage, obstruction, perforation, and peritonitis
Diagnosis: H. Pylori breath test, and stool analysis (H. Pylori and occult blood)
Cholelithiasis (gallstones)
Common condition that varies based on size, but affects both genders and all ethnic groups relatively equally
- cholecystitis = inflammation or infection in the biliary system cause by calculi (kidney stones)
Manifestations: Upper quadrant pain!!! Nausea, vomiting, jaundice, fever, biliary colic, abdominal distension, leukocytosis
Biliary System
Liver, gallbladder, network of bile ducts that transport bile from liver to gallbladder and small intestine
Hepatitis
Inflammation of liver/biliary system
Causes: infections (usually viral), alcohol, medications (acetaminophen [Tylenol], anti-seizure agents, antibiotics), or autoimmune disease
***Viral hepatitis is CONTAGIOUS but most will recover with sufficient time
Typical Scenario: Pt with flu-like symptoms and abdominal pain. Multiple tattoos, piercings, or IV drug abuse
- jaundice = liver disease —> due to excessive amount of bilirubin in the blood stream
Chronic hepatitis = longer than 6 months
Fulminant hepatitis = uncommon, rapidly progressing form that can lead to liver failure, hepatic encephalopathy, or death within 3 weeks
Cirrhosis
Chronic, progressive, irreversible, diffuse damage to the liver resulting in decreased liver function —> high risk of developing carcinoma
Causes:
-Hepatitis C infection and chronic alcohol abuse, most FREQUENT causes of cirrhosis in U.S.
-Hepatitis A is the type of hepatitis transmitted through fecal-oral route
Treatment: paracentesis (medical procedure used to remove excess fluid from peritoneal cavity, space around abdominal organs, via needle or catheter), avoid alcohol, drugs and hepatotoxic medications
Pancreatitis
Inflammation of pancreas, acute or chronic
Causes: gallstones, cholelithiasis (ACUTE), alcohol abuse (CHRONIC)
-releases insulin, amylase and lipase (these 3 start from digestion)
STOP FEEDING THESE PATIENTS!!! - this will lower their pain
-need artificial nutrition, administer intravenous nutrition
Pancreatic injury = causes pancreatic enzymes to leak into pancreatic tissue, resulting in edema, vascular damage, hemorrhage, and necrosis
Constipation
Stool in large intestine longer than usual, increasing the amount of water removed
Obese patients
Most malnourished patient to care for
Intestinal obstruction
Medical emergency
Complications: perforation, pH imbalances, fluid disturbances, shock, and death
Manifestations: abdominal distension (swelling of abdomen), abdominal cramping, colicky pain, nausea, vomiting, constipation, diarrhea, decreased or absent bowel sounds, restlessness, diaphoresis, tachycardia
Treatment: correcting fluid, electrolyte, and pH imbalances
Appendicitis
Infection
Complications: peritonitis
Manifestations: sharp abdominal pain develops, gradually intensifies (over about 12-24 hrs), and becomes localized to the lower right quadrant of abdomen (McBurney point)
-rebound tenderness
Pain may occur anywhere in abdomen; will temporarily subside if the appendix ruptures, and then pain will return and escalate
Indications of peritonitis = abdominal rigidity, tachycardia, hypotension
Laparoscopy - aids in diagnosis
Peritonitis
Inflammation of peritoneum (thin tissue that lines the abdominal wall and covers most of the abdominal organs)
-thick sticky exudate that bonds nearby structures and temporarily seals them off
-abscesses may form in an attempt to wall off the infections
-peristalsis may slow down in a response to the inflammation, decreasing spread of toxins/bacteria
Manifestations: abdominal rigidity (due to inflammation and abdominal muscle spasm)
FEVER
Celiac disease
Genetic anomaly; gluten-sensitive enteropathy: inherited, autoimmune, malabsorption disorder
Irritable Bowel Dyndrome (IBD)
Chronic inflammation of the GI tract, usually intestines
Thought to be caused by a genetically associated AUTOIMMUNE state that has been activated by an infection
-chiefly seen in women, Caucasian’s, persons of Jewish descent and smokers
Crohn’s disease
COBBLESTONE APPEARANCE
Involves inflammation of Full thickness of intestinal wall and ulcerations
Form fissures divided by nodules
Damaged intestinal wall loses the ability to digest and absorb
Manifestations: right lower quadrant cramping, pain)
Ulcerative Colitis
Chronic inflammatory bowel disease (IBD) that causes inflammation and ulceration of the COLON (large intestine) and RECTUM.
Progressive condition of rectum and colon mucosa (only) not full thickness usually develops in 20s-30s
Manifestations: bloody diarrhea, abdominal pain
Unlike Crohn’s disease, it is typically limited to colon and rectum
Diverticular Disease
Pouches that protrude from wall of colon; Outwardly bulging pouches of the intestinal wall that occur when mucosa sections or large intestine submucosa layers herniate through a weakened muscular layer
Thought to be caused by low-fiber diet and poor bowel habits, resulting in chronic constipation
Diverticulosis: asymptomatic diverticular disease, multiple diverticula present
Diverticulitis
Pouches/sacks burst leading to peritonitis; diverticula become enflamed, usually because of retained fecal matter (often asymptomatic until it becomes serious)
Manifestations: left lower quadrant cramping
Oral cancer
Mouth = gateway
Typical scenario: one or more painless, whitish thickenings that develop into a nodule or an ulcerative lesion that persists, does not heal, and bleeds easily
Risk factors: hygiene, chronic irritation
Esophageal Cancer
Squamous cell carcinoma in distal esophagus
Most common in men
Colorectal Cancer **
Very common and fatal in the U.S. and worldwide; often asymptomatic until advanced; malignant tumor that develops in colon (large intestine)
**Ascending colon —> occult blood in stool
**Descending Colon—> change in shape of stool (narrow stool)
Routine screening can improve prognosis including:
-high sensitivity fecal occult blood test every year
-flexible sigmoidoscopy every 5 years
-colonoscopy every 10 years
Manifestations: lower abdominal pain and tenderness, blood in the stool (occult or frank), diarrhea, constipation, intestinal obstruction, narrow stools, unexplained anemia (iron deficiency), and unintentional weight loss
Treatment: removal during colonoscopy
Liver cancer
Occurs as a secondary tumor that has metastasized from the breast, lung or other GI structures
Causes of primary tumors: chronic cirrhosis and hepatitis
Gastric cancer
Adenocarcinoma (ulcerative lesion)
Other risk factors: low-fiber diet, constipation, family history, H. Pylori infections chronic atrophic gastritis, and gastric polyps
Pancreatic cancer
Adenocarcinoma = malignant tumor that originates from glandular epithelial cells. It is the most common type of cancer in various organs, including colon, lungs, breasts, pancreas, prostate, stomach, and esophagus
Ischemia
Reduced or completely blocked blood flow to a tissue or organ
Acute Kidney Injury (AKI) Treatment
Address underlying cause, manage fluid and electrolyte balance, renal replacement therapy as needed
Patients often need restriction of POTASSIUM AND SODIUM- RICH FOODS
Monitor kidney function, monitor vital signs, monitor urine output, prevent and treat infections, ensure adequate hydration, monitor nephrotoxic drug intake (drugs that can cause kidney damage)
Polycystic Ovarian Syndrome (PCOS)
Multiple cysts in the ovaries —> female 30 years of age —> hirsutism —> amenorrhea —> INFERTILITY
Proteinuria
Abnormal amounts of protein in the urine, sign of kidney dysfunction
Ectopic pregnancy
Pregnancy occurring outside the uterus
Pregnancy induced hypertension =
Weight gain - proteinuria
(Pregnancy induced hypertension is high blood pressure that develops after 20 weeks of pregnancy)
Menopause
Complete cessation (stopping/ending) of the menstruation cycle due to decreased estrogen secretion
Priapism
Prolonged, painful erection, which is a urologic emergency if lasting longer than 4 hours
-not a result of sexual stimulation
Testicular Torsion
Abnormal rotation of the testes on the spermatic cord
MEDICAL EMERGENCY
Manifestations: sudden scrotal edema and pain
Amenorrhea
Absence of menstruation in which the woman experiences 3 or more missed menses
Test used to anticipate: MRI
Dysmenorrhea
Painful menstruation
Endometriosis
Endometrium grows in areas outside the uterus
Most commonly grows in the fallopian tubes, ovaries, and peritoneum, but the tissue can grow anywhere in the body
-the abnormal endometrial tissue continues to act as it normally would during menstruation
-blood becomes trapped and irritates the surrounding tissue
Complications: pain, cysts, scarring, adhesions, infertility
Manifestations: dysmenorrhea, menorrhagia, pelvic pain, infertility, and pain during or after intercourse
Menorrhagia
Abnormally heavy or prolonged menstrual bleeding… more than just heavy period. (May be a sign of an underlying condition)
Candidiasis
Yeast infection caused by the common fungus Candida albicans
Imbalance often occurs in the presence of vaginal pH changes
Causes: antibiotic therapy, bubble baths, feminine products, decreased immune response, and increased glucose in the vaginal secretions
Not sexually transmitted
Manifestations: thick, white vaginal discharge that resembles cottage cheese, vaginal and Labial itching and burning, white patches on the vaginal wall, dysuria, and painful sexual intercourse
Pelvic Inflammatory Disease
Infection of the female reproductive system; bacteria usually ascend from the vagina
Complications: reproductive structure obstructions, peritonitis, abscesses, septicemia, adhesions, strictures, chronic pelvic pain, ectopic pregnancies, infertility
Manifestations: indications of infection, pain or tenderness in the pelvis, lower abdomen or lower back; abnormal vaginal and cervical discharge; bleeding after sexual intercourse; painful sexual intercourse; urinary frequency; dysuria; dysmenorrhea; amenorrhea; AUB; anorexia; and nausea and vomiting
Sexually transmitted infections
Infections that can be contracted through sexual contact
-some can also be transmitted form mother to child during pregnancy and childbirth as well as through blood contact
Chlamydia
Chlamydia trachomatis: intracellular parasite that requires a host cell to reproduce
-the most commonly reported STI in the United States
-can be transmitted through sexual contact and from mother to child during childbirth
Complications: NEONATAL CONJUNCTIVITIS
Treatment: antibiotics, screening, and treating sexual partners
Gonorrhea
Caused by Neisseria gonorrhoeae, an aerobic bacterium with many drug-resistant strains
Transmissible through sexual contact and from mother to infant during childbirth Complications
-is contagious even if they have no outward symptoms!
Complications: neonatal conjunctivitis
Treatment: antibiotic therapy (patients are not restricted from engaging in sexual activity after their blood tests and genital swabs are negative)
Manifestations: white blisters that darken and disappear…
Syphilis
Ulcerative infection caused by treponema pallidum, a spirochete that requires a warm, moist environment to survive
- transmitted from skin or mucous membrane contact with chancres and from the mother to child through the plancental barrier
Syphilis Stages
Stage 1: primary syphilis
-1+ painless chancres form at site 2-3 weeks AFTER infection
-often go unnoticed and disappear about 4-6 weeks later, even without treatment
-bacteria become dormant and no other symptoms are present
-CONTAGIOUS, but may not test positive, testing should be repeated at a later date
Stage 2: secondary syphilis
-occurs about 2-8 weeks after the first chancres form
-manifestations: GENERALIZED, nonpruritic, brown-red; malaise; fever and patchy hair loss
-will test positive (if untreated), and is CONTAGIOUS, especially with direct contact with the rash
Stage 3: latent or tertiary syphilis
-begins when secondary symptoms disappear and lasts 1-4 years
-infection spread to brain, nervous system, heart, skin and bones; can last for years
-complications: blindness, paralysis, dementia, cardiovascular disease, pathologic fractures, and death
-in utero, fetuses are protected by Langhans layer for first 4 months, so screening and treating the mother prior can decrease likelihood of fetus contracting the infection
-untreated, may lead to fetal demise or defect affecting the bone, liver, lungs, and nerves
-antibiotic therapy
Genital herpes (herpes simplex virus, HSV)
Two forms:
HSV type 1: typically occurs above the waist and manifests as a cold sore
HSV type 2: typically occurs below the waist
Complications: spontaneous abortions, encephalitis, brain damage
Both types are characterized by recurrent episodes of lesions
The virus causes an initial infection at the entry site and then the virus travels along the dermatome to the nerve root where it remains protected and DORMANT until the next outbreak, which will occur at the same site (patients do not develop immunity after the first infection)
The lesions first appear as a vesicle surrounded by erythema
Vesicles rupture, leaving a painful ulcerative lesion with watery exudate
Crust forms over the ulcer, and it heals spontaneously in 3-4 weeks
Recurrent heroes genitals: reactivation of the virus and manifestations
Trichomoniasis
In men, the organism primarily resides in the urethra and causes no symptoms
In women, the organism in the vagina and becomes symptomatic when vaginal microbial imbalance occurs
Manifestations: excessive odorous, frothy, white or yellow-green vaginal discharge; vagina and vulva irritation; itching; painful intercourse; and dysuria
Breast Cancer
Most common malignancy in women, second leading cause of cancer death in women
BRCA1 and BRCA2 genes
Manifestations: asymptomatic; mass in the breast or axillary that is hard, has uneven edges, and is usually painless (painless lump in the first clinical manifestations)
Diagnosis: monthly self-breast examinations, mammogram, biopsy
Cervical cancer
Almost all cervical cancers are caused by HPV = genital warts
Manifestations: asymptomatic; continuous vaginal discharge; AUB between menstruation, after intercourse, or after menopause
Endometrial cancer
Cancer in the uterus; Exact cause is unknown
Manifestations: abnormal painless vaginal bleeding, no bloody vaginal discharge, Pelvic pain, weight loss, palpable abdominal mass, pain during sexually intercourse
Ovarian cancer
Ninth most frequent cancer in women and fifth leading cause of cancer death
Risk factors: defects on BRCA1 and BRCA2 genes
Diagnosis: CA 125 levels and biopsy
Hypothalamus
Regulates emotion, pain, and body temp
It acts as a signal relaying bridge between endocrine and nervous system (multiple body systems and pituitary gland)
Controls release of hormones from the pituitary gland and influences several vital processes.
Acromegaly
Excess of growth hormone (ADH), usually due to benign tumor (adenocarcinoma) of the pituitary gland
Leads to abnormal growth of bones and tissues (hands, feet, facial features)
Abnormally large hands and feet, bulbous nose, broad face, and a protruding jaw
Paraffins Signaling or Action
Signaling molecules or hormones that act locally on cells other than those that produce the hormone
Anterior Pituitary Gland
Secretes 6 main hormones ( GH, TSH, ACTH, FSH, LH, prolactin)
Luteinizing Hormone (LH) & Follicle-Stimulating hormone (FSH) are gonadotropins produced by the anterior pituitary gland
Play crucial roles in reproductive system
What regulates hormone levels?
The hypothalamic-pituitary- target cell system
Stimulation testing
Used to asses functionality of endocrine glands by measuring how they respond to stimulation
Evaluates whether an endocrine glands is capable of producing the appropriate hormones when prompted by a specific stimulus
Why do you have to collect a 24hr urine sample for cortisol levels?
Because cortisol levels fluctuate, collecting a sample over time will be the most accurate
Positive feedback loop
Physiological process where output of a system amplifies or enhances the original stimulus, leading to an increased response (escalating effect)
Example: increase in prolactin secretion that occurs with more frequent breastfeeding
Negative feedback loop
Regulatory mechanism in which change in a variable triggers a response that counteracts the initial change, ultimately bringing the system back to a state of balance or homeostasis.
Essential for maintenance of stable conditions in the body (regulating body temp, hormone levels, and other vital functions)
Cretinism
Results from severe untreatedcongenital hypothyroidism (deficiency in T3 and T4, which are essential for normal growth, development and metabolism)
Developmental delays and various physical and mental impairments (dwarfism, broad flat nose, thick tongue, large protruding abdomen)
Causes: iodine deficiency,
What facilitates breast milk production?
Prolactin
What cells do paraffins actions affect?
Local.
Paracrine hormones or signaling molecules are released by a cell and affect nearby cells within the same tissue or organ;
travel short distances (local) to target cells in the same tissue or surrounding areas. Act locally without entering the blood stream
Autocrine signaling
When the cell secretes signaling molecules that bind to receptors on its own surface, affecting the same cell that released the signal
The immune suppressive and anti-inflammatory effects of cortisol cause..?
Inhibition of prostaglandin synthesis.
Cortisol involves immune suppression (reduced inflammation and immune response),
-anti inflammatory effects = inhibition of prostaglandin synthesis; prostaglandins are lipid compounds involved in inflammation, and by inhibiting their production, cortisol helps reduce inflammation.
-moderate insulin resistance
Hormones (including growth hormone, GH, and thyrotropin-releasing hormone, TRH) are bound to and carried by which substance?
Proteins
Myxedema
Severe form of hypothyroidism (under active thyroid)
Symptoms: enlarged tongue, Bradycardia (slow heart rate), voice changes
Treatment: synthetic thyroid hormone replacement in form of T3 and T4
Hyperthyroidism
Excess T3 and T4 produced
Increased metabolism
Symptoms: increased appetite, weight loss
Pituitary Gland
Master gland;
Secretes Several Hormones: TSH, growth hormone, adrenocorticotropic hormone (ACTH), follicle-stimulating hormone, luteinizing hormone, prolactin melanocyte-stimulating hormone, antidiuretic hormone, and oxytocin
Hypothalamus
Basal (base) part of diencephalon (part of brain located between cerebrum and brain stem), regulating the pituitary gland and connects the nervous and endocrine systems
Monitor hormone, nutrient, and ion levels
Regulates the hormones produced by the anterior pituitary gland (hypothalamic-pituitary axis)
Islets of Langerhans: cell types
(Location: pancreas)
Alpha cells = secrete glucagon when serum glucose levels fall
Beta Cells = secrete insulin when serum glucose levels increase and amylin to enhance insulin
Delta Cells = secrete somatostatin, which regulates insulin and glucagon
PP (pancreatic polypeptide) cells = secrete pancreatic polypeptide which regulates pancreatic enzyme secretion and influences appetite.
Epsilon cells = secrete ghrelin, which stimulates hunger
Thyroid Gland
Produce: T3 (Triiodothyronine) T4 (Thyroxine), & calcitonin
T3, T4 - regulate cellular metabolism and growth/development
Hypothalamus stimulates pituitary gland to produce thyroid-stimulation hormone (TSH), which stimulates T3 and T4. - iodine is required to synthesize thyroid hormones
Calcitonin - regulates serum calcium levels, inhibiting osteoclast activity (decreases calcium release from the bone) and stimulating osteoblast activity (increase calcium deposits in the bone)
Parathyroid Glands
Location: Posterior surface of thyroid
Secretes PTH (parathyroid hormone) = regulates serum calcium levels (works opposite of calcitonin); it is secreted when calcium levels drop
-PTH INCREASES serum calcium levels by increasing OSTEOCLAST activity (increases calcium release from the bone) as well as increasing absorption of calcium in the gastrointestinal tract and kidneys
Adrenal Glands
Locations: each kidney
Medulla: inner portion that produces epinephrine and norepinephrine
Cortex: outer portion that produces steroids -
-Mineralocorticoids = aldosterone, which acts to conserve sodium and water
-Glucocorticoids = cortisol, which increases serum glucose levels
-Gonadocorticoids = sex hormones, secreted in minimal amounts in both sexes
Hypopituitarism
Pituitary gland does not produce sufficient amounts of some or all of its hormones
Causes:
-DWARFISM (deficient levels of growth hormone, somatotropin)
-Diabetes insipidus = excessive fluid excretion in the kidneys (increased urination) caused by deficient antidiuretic hormone levels (ADH)
Hyperpituitarism
Pituitary gland secretes excessive amounts of one or all of the pituitary hormones, most commonly caused by tumors secreting hormone or hormone-like substances
Causes:
-GH is an anabolic agent
-GIGANTISM = tall stature caused by excessive growth hormone prior to puberty
-ACROMEGALY = increased bone size caused by excessive growth hormone in adulthood after fusion of epiphyseal plates of long bones (Pituitary Adenoma)
-Syndrome of inappropriate antidiuretic hormone = increased renal water retention caused by excessive antidiuretic hormone (hyponatremia) dt increase Na secretion and fluid retention
-Hyperprolactinemia = excessive prolactin that results in menstrual dysfunction and galactorrhea
-Cushing’s syndrome = excessive cortisol that results from the increased ACTH levels
-Hyperthyroidism = hypermetabolic state caused by excessive thyroid hormones from increased TSH
Diabetes Mellitus
Group of conditions characterized by hyperglycemia from defects in insulin production, insulin action or both
-impaired insulin production or actions result in abnormal carbohydrate, protein, and fat metabolism because of the glucose transportation issue
Complications: hyperglycemia, diabetic ketoacidosis (metabolic) (dt the breakdown of fats) —> ketones in urine, acetone breath, flushing, rapid deep breathing, tachycardia), hypoglycemia —-> diaphoresis, parlor, tremors, heart disease, stroke, hypertension, diabetic retinopathy, blindness, kidney disease, nephropathy, amputation, delayed healing, pregnancy complications, and peripheral neuropathy
Manifestations: hyperglycemia, polyuria, polyphagia, polydipsia, weight loss, fatigue,
Diagnosis: history, physical examination, urinalysis, fasting blood glucose test, oral glucose tolerance test, random blood glucose test, hemoglobin A I C (over past 2-3 months), blood pressure measurement, and cholesterol panel
Polydipsia
Excessive thirst
(Diabetes mellitus)
Polyphagia
Excessive hunger or increased appetite
(Diabetes mellitus)
Type I Diabetes
Previously called insulin-dependent and juvenile onset; it develops when the body’s immune system destroys pancreatic beta cells (Autoimmune)
-MUST HAVE INSULIN
-usually strikes CHILDREN (although disease can occur at any age)
-Stress: increases glucocorticoids —> counteracts insulin function —> increase blood glucose levels
CANNOT BE PREVENTED
MORE SUSCEPTIBLE TO INFECTION (SKIN, UTI, VAGINAL INFECTION)
***GLUCAGON (increases blood glucose by facilitating the conversion of glycogen to glucose in the liver) vs INSULIN (decreases blood glucose)
Type II Diabetes
Previously called non-insulin dependent adult-onset
In adults, type 2 accounts for 90-95% of all newly diagnosed cases
Usually begins as INSULIN RESISTANCE
Risk Factors: advancing age, obesity, family history of DM, history of gestational diabetes, impaired glucose metabolism, physical inactivity, African Americans, Hispanics, Native Americans, Asians, Native Hawaiians, other Pacific Islanders.
-As condition progresses, supplemental insulin is often necessary as pancreatic production declines
Gestational Diabetes
Glucose intolerance during pregnancy
Metabolic Syndrome
-cluster of risk factors occurring together: hyperglycemia, high blood pressure, hypercholesterolemia, and increased waist circumference
Not a form of diabetes, but is related because it increases the risk of cardiovascular disease, diabetes, and stroke
Goiter and Thyroid Nodules
Visible enlargement of the thyroid gland
-usually painless, but may affect respiratory and gastrointestinal systems
-can occur in hyperthyroidism, hypothyroidism, and normal thyroid stress
-iodine deficiency is the most common cause
Hypothyroidism
Condition in which the thyroid does not produce sufficient amounts of the thyroid hormones (TH) = T3 & T4 —> (TSH Elevated)
CONSTIPATION, DRY SKIN, WEIGHT GAIN, COLD INTOLERANCE
-Relatively COMMON (1 out of 500 Americans has the condition)
Risk factor: advancing age
Causes: autoimmune thyroiditis (also called HASHIMOTO’S THYROIDITIS) and Iatrogenic
Manifestations: low heart rate, fatigue, sluggishness, increased sensitivity to cold, constipation, pale and dry skin, hypercholesterolemia, unexplained weight gain, muscle weakness, heavier than normal menstrual periods, brittle finger nails, hair loss or thinning, Bradycardia, hypotension, depression
MYXEDEMA = rare and life-threatening advanced hypothyroidism
-manifestations: marked hypotension, respiratory depression, hypothermia, lethargy, non-pitting edema, and coma
Diagnosis: serum thyroid hormone levels (decrease T3 and T4), increased serum TSH
Hyperthyroidism
Condition of excessive levels of thyroid hormones, resulting in a hypermetabolic state
Causes: excessive iodine, GRAVES DISEASE (exophthalmos & tachycardia), nonmalignant tumors, thyroid inflammation, taking large amounts of thyroid hormone replacement
Manifestations: sudden weight loss, tachycardia/palpitation, hypertension, increased appetite, nervousness, anxiety attacks or anxiety, irritability, tremor, diaphoresis, changes in menstrual patterns, increased sensitivity to heat, diarrhea, goiter, difficulty sleeping, exophthalmos
Thyrotoxicosis (thyroid storm) is a medical emergency
-worsening of hyperthyroidism that may occur with infection or stress
-fever, decreased mental alertness, abdominal pain
Additional complications: dysrhythmias, heart failure, osteoporosis
Treatment: radioactive iodine, anti thyroid agents, beta blockers, surgery, strategies for exophthalmos (e.g. cool compresses, wearing sunglasses, eye lubricants, and elevating the head of the bed), increasing caloric and calcium intake
Oliguria
Decreased urine output
Anuria
Absent urine production
Hypoparathyroidism
Parathyroid gland does not produce sufficient amounts of PTH (regulate calcium levels)
Causes: congenital defects ( lack of one or more of the four parathyroid glands) and damage (e.g. surgery, radiation, or autoimmune conditions)
Manifestations: muscle twitching or spasms (tetany) dysrhythmias, dry/coarse/brittle skin and nails.
Hyperparathyroidism
Condition of excessive PTH production by the parathyroid glands
Manifestations: osteoporosis, renal calculi, polyuria, abdominal pain, constipation, fatigue, weakness, flaccid muscles, dysrhythmias, hypertension, depression, forgetfulness, bone and joint pain, nausea, vomiting, anorexia
Cushing syndrome
Excess cortisol; Excessive amounts of glucocorticoids (Adrenoctorticotropic hormone = ACTH)
Causes: Iatrogenic from ingestion of glucocorticoid medications, adrenal tumors that secrete glucocorticoids, pituitary tumors that secrete ACTH and cortisol, and paraneoplastic syndrome (body’s immune system mistakenly attacks normal tissues in response to cancer, rather than just targeting the tumor itself)
Manifestations: obesity (especially around the trunk), “moon face”, “buffalo hump” = fatty pad between the shoulders, thin skin, that bruises easily, delayed wound healing, osteoporosis, hirsutism, insulin resistance, hypertension, edema, hypokalemia, mood changes, immunosuppression
Treatment: GRADUAL tapering of any glucocorticoids
Addison’s Disease
Deficiency of adrenal cortex hormones (glucocorticoids)
Causes: autoimmune conditions
Manifestations: hyperpigmentation!!!!!
Treatment: lifelong hormone replacement therapy
Cortisol low = Addison’s
What is the most common mechanism of hormone control?
Negative feedback;
It initiates actions to counteract changes in hormone levels, maintaining homeostasis
Insulin
Peptide hormone; synthesized in the rough endoplasmic reticulum of endocrine cells
After synthesis, it moves into the golgi complex (post office of cell) where it is packaged into vesicles
Small Cell Carcinoma Lung cancer (as relating to Cushing syndrome)
Secretes adrenocorticotropic hormone (ACTH), which can lead to an ectopic form of Cushing Syndrome — causes overproduction of cortisol by the adrenal glands leading to symptoms of Cushing syndrome
Addison’s Disease
Increased levels of ACTH (adrenocorticotropic hormone); adrenal insufficiency
Symptoms: muscle weakness, diarrhea, bronze skin tone, bluish-black mucous membranes.
Diabetes insipidus
Affects the body’s ability to regulate fluid balance;
Excessive urination and DEHYDRATION/THIRST if left untreated.
Cortisol
Elevated cortisol levels increase the mobilization of fatty acids for energy, along with other metabolic effects
SIADH (syndrome of inappropriate antidiuretic hormone secretion) Diagnosis:
Based on hyponatremia (low sodium levels) and other signs of bladder retention
Posterior pituitary
Stores and releases ADH (water balance) and oxytocin (labor, milk)
Releases hormones directly into the blood stream
Autocrine pathway
Hormone acts on same cell that produced it, as well as nearby cells
Paracrine pathways
Cell signaling where a cell releases molecules to change the behavior of nearby cells
Exophthalmos (bulging eyes)
Hallmark symptom of Graves’ disease, condition related to hyperthyroidism
Ovarian interstitial cells
Responsible for producing estrogen in the ovaries
Progesterone
Levels rise during pregnancy, causes constipation, swelling, nausea, headaches.
Melena
Blood in the stool
Myenteric plexus
Located between circular and longitudinal muscle layers of the intestines and plays a key role in controlling gastrointestinal motility
Ascending colon
Majority of water is absorbed in the ascending colon, where moist of the fluid is reabsorbed from the chyme as it moves through the large intestine
Mass movement
Strong coordinated contractions that push fecal contents into the rectum, signaling the urge to defecate
Average amount of urine released
1500 mL
External sphincter
Under voluntary control; ureteral sphincter that is made of skeletal muscle
GFR RANGE (normal)
Normal = 90-120
Diabetic Ketoacidosis (DKA)
Body produces too many ketones and doesn’t produce enough insulin. It can lead to coma, cerebral edema and death
Ketone
Type of chemical that your liver produces when it breaks down fat.
Body uses ketones for energy typically during fasting or long periods or exercise or when you don’t have as many carbohydrates
HbA1c (glycated hemoglobin)
Blood test that measures the average blood sugar (glucose) level over the past 2-3 months; key indicator of glycemic control in people with diabetes and prediabete
Tells you whether or not pancreas is producing enough insulin
Neuropathy
Nerve condition that causes pain, numbness, tingling, weakness in hands, feet, legs, arms
Usually shown in patients with diabetes
Somogyi Effect
Hypoglycemic.
Somogyi Effect
Hypoglycemic episode (low blood sugar) during the night, which prompts the body to release stress hormones (like cortisol and adrenaline) to raise blood sugar levels. This rebound effect causes high blood sugar by the morning.
• Timing: Occurs after a hypoglycemic episode at night, typically between 2-3 a.m.
• Key Point: The underlying cause is a drop in blood sugar, and the body’s response to correct it leads to high blood sugar in the morning.
Dawn Phenomenon
Cause: Natural increase in hormones like growth hormone, cortisol, and glucagon during the early morning hours (usually between 4-8 a.m.), which can lead to increased glucose production by the liver and higher blood sugar levels in the morning.
• Timing: Occurs in the early morning hours, typically between 4-8 a.m.
• Key Point: The underlying cause is a physiological increase in hormones that occurs naturally, leading to elevated blood sugar levels upon waking.
What is the difference between somogyi and dawn phenomenon
• Somogyi Effect: Caused by a low blood sugar episode leading to high blood sugar as the body rebounds.
• Dawn Phenomenon: Caused by a natural increase in hormones in the early morning, leading to higher blood sugar.
Alpha, beta, delta cells of pancreas
Responsible for secreting glucagon, which raises blood glucose levels
Alpha Cells:
• Function: Secrete glucagon, which increases blood glucose levels.
• Role: Stimulates the liver to release stored glucose (glycogen) into the bloodstream during periods of low blood sugar (hypoglycemia).
• Location: Found in the outer portion of the islets of Langerhans.
• Mnemonic: Alpha → Glucagon → Increases blood sugar.
- Beta Cells:
• Function: Secrete insulin, which lowers blood glucose levels.
• Role: Facilitates glucose uptake by cells for energy or storage (as glycogen in the liver and muscles).
• Location: Found in the center of the islets of Langerhans.
• Mnemonic: Beta → Insulin → Decreases blood sugar. - Delta Cells:
• Function: Secrete somatostatin, which inhibits the release of both insulin and glucagon.
• Role: Helps regulate the balance between insulin and glucagon secretion, preventing excessive fluctuations in blood sugar.
• Location: Found in the inner portion of the islets of Langerhans.
• Mnemonic: Delta → Somatostatin → Inhibits insulin and glucagon.
Summary of Key Differences:
• Alpha cells: Secrete glucagon (raises blood sugar).
• Beta cells: Secrete insulin (lowers blood sugar).
• Delta cells: Secrete somatostatin (inhibits insulin and glucagon).
Seminal vesicles
Secrete fructose Responsible for sperm motility
Erectile Dysfunction
Issues with endocrine system and cardiovascular
-often linked to underlying cardiovascular conditions
Polycystic ovarian system PCOS
Caused by elevated LH (Leuteinizing hormone)
Hormonal imbalances, insulin resistance
Elevated androgens, disrupts normal functioning of ovaries.
What is the physiologic process caused by estrogens?
Promotion of ovarian follicle growth
Physiologic process caused by estrogen
Promotion of ovarian follicle growth
What is the goal of pharmacologic treatment for breast cancer
Blocking effects of estrogen on growth of malignant cells
Cryptorchidism
A condition where one or both of the testes fail to descend into the scrotum during fetal development or infancy
-increased a clients risk for development of testicular cancer
Benign Prostatic hyperplasia BPH
Non cancerous enlargement of the prostate gland, commonly occurs as men age
As prostate enlarges it can press against urethra, obstructing the flow of urine
This can lead to urinary retention, where bladder is unable to fully empty, resulting in discomfort, difficulty urinating and urinary tract infections
-causes: dihydrotestosterone (DHT) proliferates the growth of prostatic stromal cells, leading to a reduction in the death of the epithelial cells
Inguinal Hernia
When a portion of the intestine or fat pushes through a weak spot in abdominal muscles into the groin area.
-nurse’s top priority in this situation is to prevent intestinal ischemia (reduced blood flow)
Laparoscopy
Minimally invasive surgical procedure in which a camera is inserted into the abdominal cavity, allowing the physician to directly visualize the internal organs, including presence of endometrial tissue outside the uterus (hallmark of endometriosis)
-procedure that provides a definitive diagnosis of endometriosis
Epididymitis
Manifestations: unilateral pain, swelling, redness in scrotal area
Inflammation of the epididymis (tube carrying sperm from testicles)
Causes: STIs, chlamydia or gonorrhea, UTIs
Gonadotropin-Releasing Hormone (GnRH)
Produced by hypothalamus
-stimulates the pituitary gland to release LH and FSH
Luteinizing Hormone (LH)
Produced by pituitary gland
Females: triggers ovulation (release of the egg) and supports corpus luteum
Corpus luteum = secretes the progesterone, crucial for preparing the uterine lining (endometrium) for a possible pregnancy.
Males: stimulates testosterone production in testes
Follicle-Stimulating Hormone (FSH)
Produced by pituitary gland Females
Females: stimulated the growth of ovarian follicles and the production of estrogen
Males: stimulates sperm production in testes
-crucial in spermatogenesis
Leiomyomas
Smooth-muscle fibroid tumors that usually develop in the corpus (body) of the uterus
Why can’t a biopsy of the tumor be taken instead of removing the entire testicle?
A biopsy is not recommended because it may result in cancer cells spreading into the scrotum and lymph nodes
Invasive penile cancer
Treatment: Surgical removal of affected area
Inguinal area
Lower abdomen, near where the thigh meets the torso
Inguin- = groin
-al = pertaining to or related to
If a patient has severer pain in the Inguinal area and nausea, the nurse should inspect the clients genitalia
Vasectomy
Male sterilization; Involves cutting and sealing the ductus deferens (vas deferens), which are the tubes that carry sperm from the testes to the urethra.
Premature ovarian failure
Primary ovarian insufficiency; occurs when woman’s ovaries stop functioning properly before the age of 40, leading to a cessation of menstruation (amenorrhea)
Can result in loss of egg production and decreased levels of estrogen
Thyroid Stimulating Hormone (TSH)
Produced by anterior pituitary
Stimulates the thyroid gland to produced thyroid hormones T3 and T4
-influences metabolism and energy production
Low TSH = hyperthyroidism (overactive thyroid)
High TSH = hypothyroidism (underactive thyroid), thyroid isn’t producing a enough hormones so the pituitary produces more TSH to try to stimulate the thyroid
Adrenocorticotropic Hormone (ACTH)
Produced by anterior pituitary
Stimulates the adrenal glands (specifically the adrenal cortex) to produced thyroid hormones cortisol and other glucocorticoids
Effect: cortisol helps the body respond to stress, regulates metabolism and supports immune function
High ACTH = can lead to Cushing’s disease, where too much cortisol is produced, causing symptoms like weight gain, high blood pressure, and thinning skin
Low ACTH = can be seen in Addison’s Disease, where the adrenal glands don’t produce enough cortisol, leading to fatigue, weight loss, and low blood pressure
Thyrotropin-Releasing Hormone (TRH)
Produced by the hypothalamus
Function: TRH stimulates the anterior pituitary to release TSH (Thyroid stimulation hormone)
By stimulating TSH release, TRH helps regulate the thyroid gland’s production of T3 and T4, which are crucial for regulating metabolism, growth, and energy production in the body
Low TRH = indicates problem with hypothalamus, possibly leading to hypothyroidism or low TSH levels
High TRH = suggests the body is trying to stimulate the thyroid when there is insufficient thyroid hormone (e.g., in cases of hypothyroidism). It can also be a part of the feedback mechanism in response to low thyroid hormone levels
TRH is an important part of the Hypothalamic-pituitary axis
Penile erection: physiologic process
Nitric oxide is released to facility smooth muscle relaxation and shunting of blood into the sinusoids
Oliguria
Low urine output
Less than 400 mL per day or less than 0.5 mL/kg/hr
Diuresis
Increased urine production, often exceeding the normal range of 800-2000 mL per day in adults
It is the opposite of Oliguria
Glomerulonephritis
Inflammation of the glomerular capillaries, possibly from a strep infection
Nephrotic Syndrome
Increased glomerular Permeability leads to proteinuria
Serum creatinine
Evaluates the effectiveness of kidney function and is expected to be between 0.6-1.2 mg/dL
Think: 0.6 + 0.6 =1.2
Chronic Kidney Disease (CKD) and End-Stage Kidney Disease (ESKD)
CKD =
Long term, progressive condition where kidneys slowly lose function over time
Causes: diabetes, high blood pressure, long-term kidney damage
Symptoms: fatigue, swelling, trouble urinating
Kidneys are still working, but not as well as they should be
ESKD =
Final, most severe stage of CKD, kidneys are no longer functioning enough to sustain life
Causes: occurs when CKD has progressed and kidney function is less than 15% of normal
Symptoms: severe fluid retention, electrolyte imbalance, waste buildup in the blood
Treatment: dialysis (filtering of waste/excess fluids and toxins from blood) or kidney transplant
Kidneys fail completely and require dialysis or transplant
Polyphagia, polyuria, polydipsia
All associated with diabetes mellitus
Treatment: exogenous insulin injections
Paracrine action/paracrine signaling
Act locally on cells other than those that produce the hormone
It is a type of cell signaling in which a cell produces a signaling molecule that affects nearby target cells within the same tissue or organ
Endocrine signaling
Where hormones travel through the bloodstream to act on distant target cells
Autocrine signaling
When a cell affects itself by responding to signals it has released
Which blood test reflects the glomerular filtration rate and is used to estimate renal function
Serum creatinine
Glycoslyated hemoglobin, hemoglobin A1C (HbA1C)
HbA1C provides an average of the clients blood glucose levels over the past 2-3 months, reflecting long-term management and control of blood sugar levels
Aldosterone
Produced by the adrenal gland - plays a key role in regulating sodium and potassium levels due to adrenal gland impairment
A nurse is caring for a client with a tumor of the hypothalamus, for which complication should the nurse monitor?
Sex hormone alterations
Normal A1C Level for blood glucose levels (type 2 diabetes)
Less than 5.7%
Somogyi Effect
Cycle of insulin-induced posthypoglycemic (symptoms that office after hypoglycemia, low blood sugar, has taken place)
- this can happen in individuals with diabetes, when too much insulin is administered or if insulin is not properly adjusted.
The body responds to the hypoglycemia by releasing the counter-regulatory hormones such as glucagon, epinephrine, and cortisol, which cause an increase in blood glucose levels
THIS PHENOMENON OCCURS OVERNIGHT
Acini cells of exocrine pancreas
Responsible for synthesis, storage and secretion of digestive enzymes
Diabetic Ketoacidosis DKA
Symptoms: polyuria, polydipsia, polyphagia, nocturia, weight loss, fatigue
PH of 7.22
Complication of diabetes usually occurring in individuals with type 1 diabetes, when there is insufficient insulin, leading to hyperglycemia without significant ketosis or acidosis
Insulin is a hormone that helps lower blood glucose levels by promoting the UPTAKE OF GLUCOSE BY TARGET CELLS
REMEMBER
LIVER
Liver plays a central role in glucose metabolism
When there is excess glucose in the bloodstream, the liver converts it into glycogen through a process called GLYCOGENESIS and stores it for later use
Diabetics are at a higher risk than are the majority of the population for injured to organ systems in the body. Which ones?
Kidneys and eyes
