Exam 3 Flashcards
Hematemesis
vomiting blood
Diverticulosis
out-pouching of the large intestine resulting in materials getting stuck
Hematochezia
- bright red colored blood in stool
- often Occult fecal blood
Gastritis
inflammation of the stomach
megacolon
abnormal stretch of the colon
Hernia
bulging of organ or tissue through abdominal opening
constipation
infrequent and/or difficulty passing stool
diarrhea
abnormally frequent and watery stool
Retching
nonproductive vomiting, also known as dry heaving
Dysphagia
difficulty swallowing
Gastroesophageal Reflux Disease (GERD)
chronic heartburn
signs and symptoms of GI diseases
- ) anorexia
- ) altered motility (vomiting, diarrhea, constipation)
- ) nausea
- ) retching
- ) dysphagia
- ) bleeding in upper or lower GI
gastric analysis
measures amount of stomach acid
Endoscopy
procedure used to look inside GI tract with a camera and a light
Sigmoidscopy
procedure used to look in sigmoid colon with light and camera
colonoscopy
procedure used to look in colon with light and camera
Congenital Pyloric Sphincter
- narrowing of the pyloric sphincter
- idiopathic
- causes projective vomiting 2-4 weeks after birth and no weight gain
- occurs mostly in boys
Hirschsprung disease
- lack of parasympathetic NS ganglia in rectum
- causes defective bowel movements and megacolon
- suspected in infants with chronic constipation and distended abdomen
- surgical removal
Inguinal Hernia
- out-pouching of abdominal content into groin
- danger for bowel strangulation
- more common on men due to testes development in abdominal cavity during utero
types of hernias
- ) inguinal
- ) Hiatal
- ) Epigastric
- ) umbilical
GERD vs LPR
- GERD: acid refluxes into esophagus only
- LPR: acid refluxed into esophagus and spills into pharynx and larynx
pathogenesis/predisposing factors of GERD
- ) alcohol: weakens sphincters
- ) obesity
- ) eating late at night/laying down after eating:
- ) age
- ) Pregnancy
Risk factors for GERD
- ) Burrets esophagus (metaplasia of esophagus cells)
2. ) esophageal cancer
treatment for GERD
- avoid foods increasing reflux
- proton pump inhibitors (decrease amount of acid)
- avoid laying down after meal
symptoms of gastritis
- nausea
- vomiting
- epigastric pain
what causes acute gastritis
- ) Taking non steroidal inflammatories on an empty stomach
2. ) alcohol
what causes chronic gastritis
- ) autoimmune disease attacking parietal cells
2. ) Heliobacter Pylori
Heliobacter Pylori
- bacteria that can survive in the stomachs acidic pH
- risk increases with age
- can cause ulcer and cancer
treatment for Heliobacter Pylori
antibiotics
what occurs in gastritis
acute injury to mucosa caused by agents that compromise protective mucous barrier over epithelial cells
Peptic Ulcer Disease
break or ulceration in mucosal lining of lower esophagus, stomach, or duodenum
what are the leading causes of Peptic Ulcer Disease
- ) H. Pylori
2. ) Ulcers
what are the complications of peptic ulcers?
- internal bleeding (due to iron deficiency anemia)
- penetration of pancreas leading to inflammation of it
- perforation leading to infection
Dental caries
- cavities
- caused by the breakdown of protective enamel letting bacteria to enter tooth
Gingivitis
- inflammation of the gums
- main cause bacteria
- causes redness, bleeding, and swelling
Leukoplakia
white spots/patches on tongue that are used to detect mouth cancer
Otitis media
middle ear infection
Presbycusis
hearing loss that occurs with age
Aphthous Stomatitis
Canker sores
Oral cavity structure and function
- teeth, tongue, and walls of mouth
- salivary glands
- allows for speech
- digestion, respiratory, and sensory
amylase
enzyme secreted in mouth that breaks down carbs
Nose function and structure
- moisturizes and filters inhaled air
- used for smell
Sinuses structure and function
- hollow cavities within cranial bones
- produce mucus
Larynx structure and function
- major passageway to lungs
- holds vocal cords
Epiglotis
flap folding over larynx during swallowing to prevent aspiration into trachea
ear structure and function
- detects sounds and aids in equilibrium
- vestibular apparatus: balance and knowing where you are in space
- ossicles (middle ear bones)
- Tympanic membrane (ear drum)
- Cochlea
degultition
act of swallowing
phases of deglutition
- ) orophasyngeal (voluntary): push bolus to back of mouth
- ) Esophageal (involuntary): foods going down esophagus
- ) Gastroesophageal (involuntary): food entering stomach from esophagus
Cleft lip and palate
- multifactorial: environment and genetics
- complications: cosmetic, speech, dental, hearing, eating, facial growth
- treatment: surgery
Peridontitis
- inflammation of peridontium which holds teeth in place
- causes a pocket for bacteria to go
- can lead to tooth or bone loss
plaque
- bacteria accumulation
- prevented by flossing and brushing
tarar
- calcified plaque
- cannot be physically removed with flossing and brushing
cold sore
- blister like lesions on face or inside mouth
- contagious
- painful
what causes cold sores
- herpes simplex virus 1
- latent (stays in body, but not always activated)
- reactivation occurs under stress mostly
Canker sores
- painful open sores in mouth
- idiopathic
- heals within 7-10 days
- not contagious
what is the main thing that causes upper respiratory tract infection? and how are they spread?
- viruses
- coughing and sneezing
symptoms of upper respiratory tract infection
- sore throat (pharyngitis)
- nasal discharge (rhinitis)
- headache
- fever
- fatigue
complication of upper respiratory tract infection
- otitis media in children (shorter Eustachian tube)
- pneumonia in elderly
- enlarged tonsils can obstruct breathing
sinusitis
- inflammation of sinuses
- can be become blocked and filled with fluid/mucus
symptoms of sinusitis
- nasal congestion
- headache
- facial pain
- thick and discolored mucus (green or pussy)
- postnasal drip
Acute sinusitis
if it lasts for less than a month and is self limiting
Chronic sinusitis
if it persists or is recurrent
-can be difficult to treat
treatment of chronic sinusitis
- antibiotics/antifungals can’t always clear infection if its a virus
- steroid therapy to reduce inflammation (corticosteroids)
- surgery
Allergic Rhinitis (hay fever)
- allergic response to environmental antigens
- pollen, dander, dust, etc.
- symptoms like common cold: runny nose, scratchy throat, watery eyes
- treatment: antihistamines, decongestons, eye drops, shots
what group is otitis media most common in
infants and children because they have a Eustachian tube
what causes an otitis medua
-fluid accumulation in middle ear provides fertile culture medium for bacteria
sensorineual hearing loss
hearing loss due to damaged cochlea and/or auditory nerve
conductive hearing loss
hearing loss due to damaged ear canal
characteristics of presbycusis
- begins with high frequencies
- symmetrical
- assocaited with tinitus (ringing in ears)
main risk of prebycusis
loud noises
hearing aids
- amplify soundwaves
- avoided by patients because they are uncomfrotable, costly, and fill with ear wax
cochlear implants
- conduct sound through skull bone
- safe and rarely complicated by infection
- only used in serious hearing loss
what is the most common neoplasm of the head and neck
squamous cell carcinoma
what is the main risk factor of squamous cell carcinoma
alcohol and tobacco
symptoms of squamous cell carcinoma
- loss of function
- hoarseness, pain, or difficulty swallowing
- obstruction of nasopharyngeal passages
Obstructive Sleep Apnea
- patient repeatdly stops breathing during sleep
- causes CO2 to build up snd cause acidosis
- makes patient tired and can cause heart problems
- collapse of pharyngeal passages when patient is relaxed and supine
Atelectasis
collapse of the lung
Bronchiectasis
dilation of the bronchi
Pneumothorax
presence of air in the pleural cavity leading to collapse of the lungs
Dyspnea
shortness of breath
Apnea
temporary stoppage of breathing
Emphysema
destruction of alveoli causing them to be deflated
Chronic Bronchitis
- inflammation of bronchioles
- cough lasting for at least 3 months for 2 consecutive years
- excessive mucus
- frequent respiratory infections
Bronchiscopy
endoscopic technique used to look at the inside of the airways
spirometry
measurement of lung volumes and capacities
Forced Vital Capacity (FVC)
amount of air you can inhale and forcefully exhale
Forced Expiratory Volume 1 (FEV1)
amount of air you can inhale and forcefully exhale in 1 second
Surfactant
material secreted by type 2 cells in alveoli that reduces surface tension
mucociliary escalator
specalized epithelial lining of bronchiol trees that traps inhaled bacteria in mucus and cilia move it up to mouth for it to be swallowed
Orthopnea
discomfort breathing when lying down flat
Hemopysis
coughing up blood
factors needed for efficient gas exchange
- ) large capillary surfacw area in contact with alveolar membrane
- ) unimpeded diffusion across alveolar membrane
- ) normal pulmonary blood flow
- ) normal pulonmary alveoli
signs and symptoms of respiratory disorders
- ) dyspnea
- ) apnea
- ) tachypnea
- ) cough
- ) cynaosis
tachypnea
increased breathing rate
tests for respiratory diseases
- ) percussion (tapping)
- ) Ausculation: listening for crackles
- ) radiography
- ) spirometry
- ) bronchoscopy
Neonatal Respiratory Distress Syndrome
- alveoli don’t make enough surfactant causing them to not expand normally in inhalation and collapse in expiration
- etiology: babies are born before lungs can fully develop
what groups are at risk for neonatal respiratory distress syndrome
- ) premature infants
- ) infants delivered via C section
- ) infants born to mothers with diabetes
treatment of neonatal respiratory distress syndrome
supplemental oxygen and surfactant
obstructive lung disease
obstruction of exhaling causing retention of CO2 and decreased O2 in RBC
Types of obstructive lung disease
- ) Asthma
2. ) Chronic Obstructive Pulmonary Disease
Types of Chronic Obstructive Pulmonary Disease
- ) Chronic Bronchitis
2. ) emphysema
COPD
- group of disorders characterized by reducing air flow and impairing gas exchange
- age related
- progressive
- poor reversability
- associated with smoking
symptoms of COPD
- lots of mucus
- coughing (more common in morning)
- dyspnea
- chest tightness
- barrel chest: increase in volume of thoracic cavity
Treatment of COPD
- stop smoking
- steroid and bronchodilators
- supplmental oxygen with caution
- antibiotics
Asthma
- not COPD because its reversible
- assocaited with bronchospams (wheezing)
- most cases are allergic based (occurs when exposed to allergn)
treatment of asthma
- Drugs that dilate bronchioli walls (epinephrine and beta agonist inhalers)
- reducing inflammation via corticosteroid inhalers
- drugs that block the release of mediators form mast cells
complications of COPD
- respiratory failure (acidosis or arrythmia)
- right sided heart failure
- infections
- acute respiratory failure
- lung cancer
Acute Respiratory Disease Syndrome
- diffuse alveolar damage to alveolar epithelium and vascular endothelium
- medical emergency
- results in hypoxemia
- can lead to organ failure
pulmonary embolism
- Starts with DVT and part breaks off traveling through the heart to the lungs
- fatal
Pulmonary hypertension
- high blood pressure in the lung vessels
- causes increased pulmonary edema
- can lead to right sided heart failure
- can only be treated by removing fluid from lungs
- 10 year survival rate after diagnosis
Small cell Lung cancer
- typically smokers
- 15% of lung cancers
- detected after it has metasasized
- 3-5% survival rate
Non-small cell lung cancer
- more localized
- 5-12% survival rate
what can cause lung cancer
- ) smoking
- ) genetics
- ) asbestos
- ) pollution
- ) radon gas
why is lung cancer the most deadly cancer?
there are not screening tests
symptoms of lung cancer
- ) unexplained cough
- ) weight loss
- ) coughing up blood
- ) loss of appetite
whats one of the leading cause of death in US involving respiratory?
chronic lower respiratory disease
whats one of the leading causes of death in the world involving respiratroy?
Chronic Obstructive Pulmonary Disease
Hemostasis
stoppage of bleeding
Thrombosis
abnormal blood clot
Stages of Hematosis
- ) Vasoconstriction
- ) Platelet plug
- ) Clot by Coagulation
what occurs in vasoconstriction
- narrowing of the lumen of vessel to minimize blood loss
- brings hemostatic components of blood closer to the site of injury in vessel
what occurs in the platelet plug
-thrombocytes need to be activated because at rest there is minimal interaction of thromobytes and blood vessel wall
how are thombocytes activated in platelet plus?
activated when it is stimulated by exposure to collagen
- ) plug defect become rounf and sticky
- ) secrete granules
what granules do platelets secrete?
- ) ADP
- ) Thromboxane 2
- ) Vasoactive amines
- ) Coagulation factors
ADP
stimulates shape change of platelets and the released of thomboxane 2
thromboxane 2
amplifies the initial clumping of platelets into a large mass
vascoactive amines
epinephrine helps maintain vasoconstriction
what occurs in clot by coagulation
cascade of events
-thrombin stimulates fibrinogen which stimulates fibrin
extrinsic vs intrinsic
Extrinsic/Tissue factor
- occurs due to trauma
- activated by tissue factor released by endothelial cells after external damage
Intrinsic/Contact coagulation
-activated through exposed endothelial collagen
what are the primary layers in hemostasis
- ) blood vessels
- ) platelets
- ) coagulation factors
where are coagulation factors made
the liver
function of coagulation inhibitors
they counterbalance coagulation factors
plasminogen
- coagulation inhibitor
- secreted by liver in inactive form
- activated when endothelial cells secrete tissue plasminogen activator
- result: plasminogen turns to plasmin and dissolves fibrin
epistaxis
excessive nose bleeds
menorrhagia
excessive heavy periods
Hematuria
blood in urine
Hematochezia
blood in upper Gi tract
petechiae
little pin point hemorrhages
Hematoma
big hemorrhage
Tests for bleeding and clotting
- ) CBC for platelete level
- ) fibrinogen assay: measures amount of fibringoen in blood
- ) prothrombin time: tests how long the estrinsic pathway takes to work
- ) activated parial theomboplastin time: tests for instrinsic pathway
Thrombocytopenia
- abnormally low platelet level
- cause: genetic, acquired, disease (leukemia), autoimmune, hypersplenism
- can lead to petechiae
hypersplenism
enlarged spleen causes early removal of platelets
-associated with thrombocytopenia
Thrombocytosis
- abnormally high plalete level
- cause: trauma, surgery, or childbirth
- risk for thrombus
Virchows Triangle
inappropriate coagulation
thrombosis
inappropriate activation of blood coagulation
what triggers Virchows Traingle?
- ) endothelial cell injury: turbulant blood flow or atheroscelerosis
- ) altered blood flow: stasis of turbulent
- ) hyper coagulability: can be caused by thrombocytosis
what condition can lead to Virchows triangle?
- taking oral contraceptive
- increases estrogen levels which can increase coagulation factors
warfarin
- anti-coagulation drug
- reduces amount of vitamin K available to reduce coagulation
Heparin
- anti-coagulation drug
- inactivates thrombin to reduce activity of coagulation cascade
Aspirin
- anti-platelet drug
- inhibits thromboxane A2 formation to decrease platelet number
what can cause someone to have too little coagulation?
- genetic: hemophilia
- acquired via liver disease of lack of vitamin K
Hemophilia
- lack of coagulation factor
- symptoms: subcutaneous bleeding, blood in urine, bleeding in mouth, lips, or tongue, and bleeding in joints, CNS, or GI
- treatment: treat with missing coagulation factor
- X-linked disease, men more likely
Disseminated Intravascular Coagulation (DIC)
- increases clotting by releasing thromboplastic material in circulation
- causes: snake bite
Fibrinogen
protein that stimulates fibrin
fibrin
protein that initates clotting
stasis
stationary blood flow in veins
Tissue PLasminogen Activator
activates plasminogen into plasmin
composition of blood
- ) plasma: 55%
- ) red blood cells: 45%
- ) white blood cells: less than 1%
- ) platelets: less than 1%
function of blood
- ) transport O2
- ) fight infection
- ) carry hormones
- ) form clots
hematopoiesis
- formation of blood cellular components in the bone marrow
- lymphoid or myeloid progenitor
classification of anemia
based on size size of RBC and amount of hemoglobin level (morphologic classification)
microcytic
smaller than normal RBC
hypochromic anemia
RBC have reduced hemoglobin count
normocytic anemia
normal size and appearance of RBC
macrocytic anemia
cells larger than normal can be due to deficient in folic acid or B12
Hypochromic microcytic anemia
- RBC smaller than normal and have low hemoglobin level
- iron deficient anemia
Cause and treatment of hypochromic microcytic anemia
-low iron intake
-chronic blood loss
(iron-dediciency anemia)
-treatment: iron supplements or treat cause of anemia
cause and treatment of macrocytic anemia
- deficency in B12 or folic acif
- treatment: increase intake of B12 (animal products) and folic acid (leafy greens)
Pernicious anemia
- RBC can’t absorb enough B12 due to lack of instrinsic facotr
- macrocytic anemia
what can cause perniciosu anemia
- gastric bypass or resection
- distal bowel resection or disease
- elderly
- autoimmune
leukemia
malignant disease involving WBC precurser in BM
signs and symptoms of leukemia
- anemia
- weakness
- bleeding
- common infections
- bone pain
what is the most common leukemia in kids
acute lymphocytic leukemia
lymphoma
cancer affecting the T and B cells
-present in the lymph nodes
Non-Hodgkin’s lymphoma
- producing too many lymphocytes
- risk increases with age
- involves lymph nodes, bone marrow, spleen, thymus
- can be outside of the lymph nodes
Hodgkin’s lymphoma
- most common caner in US of 10-30 year olds
- characterized by Reed-Sternberg cells
reed sternberg cells
- large abnormal B lymphocytes
- can be associated with epstein-barr virus
myeloma
- malignant disease of plasma cells
- patient usually 45 years or older
pathophysiology of myeloma
- functionally useless antibodies
- impaired immunity
- anemia
- death is due to infection or renal failure
hypogammaglobulinemia
low antibodies in blood
treatment of leukemia and lymphoma
- first chemo
- HSC stem cell transplant
HSC stem cell transplant
replaces HSC with new to “reset” bone marrow
leukocytosis
- WBC count higher than normal
- can be normal is infection
- if no infection due to malignancy in lymph nodes or bone marrow
Leukopenia
- WBC count lower than normal
- always pathological
- predisposes to infection
Infectious Mononucleosis (MONO)
- infection of B lymphocytes
- caused by epstein-barr virus
- swollen lymph nodes, sore throat, tired/weak
Polycythemia
too many RBC
primary polycythemia
cause of polycythemia is because of the disease
-EXs: bone marrow malignancy, pverproduction of RBC, WBC, or platelet
secondary polycythemua
cause of polycythemia is second to another disease
complications of polycythemia
makes blood thick which can causes the heart to work harder increasing risk for stroke
what causes primary thrombocytopenia
idiopathic thrombocytopenia purpura
idiopathic thrombocytopenia purpura
platelets antibodies attack platelets
what causes secondary thrombocytopenia
damage to bone marrow from drugs or chemicalas
Erythropoiesis
the formation and development of RBC
what is needed for erythropoiesis
- protein
- folic acid
- vitamin B12
- iron
Erythropoietin (EPO)
hormone produced primarly by kidneys that stimulates RBC production
hematocrit
volume % of RBC in blood (normal 12-16)
Mean Corpuscular hemoglobin concentraion (MCHC)
checks average amount of hemoglobin in group of red blood cells
Means corpuscular volume (MCV)
measures average size of red blood cells,
thrombocytes
- platelets
- not cells
- fragments of megakarocytes
erythrocytes
red blood cells
leukocytes
white blood cells
myelopthisic anemia
bone marrow infiltration by tumor or replaced by fibrous tissue
hemolytic anemia
- premature destruction of RBC
- results in increase EPO, reticulocytes, and active bone marrow
reticulocytes
premature RBC
what can caise hemolytic anemia
- sickle cell
- thalassemia (affects syntheis of adult hemoglobin)
- autoimmune
diagnosis of anemia
- complete blood count
- blood smear
- hematocrit
left sided heart failure
left ventricle fails to pump to body so blood backs up into the lungs and they become full of fluid
symptoms of left sided heart failure
- difficulty breathing
- increased hydrostatic pressure
right sided heart failure
- right ventricle fails to pump blood adequately
- blood isn’t fully adjected so blood will back up into right atrium then the veins, then organs, then veins in neck
symptoms of right sided heart failure
- swelling in liver, spleen, ankles
- swollen neck due to blood in it
sudden cardiac death
natural death from cardiac causes within one hour of acute symptoms
-due to: arrhythmia, myocardial infarct, aortic aneurysm, electrocution, drugs