Exam 4 Flashcards
Islet of Langerhans cells
Alpha cells: glucagon
Beta cells: insulin and amylin
Delta cells: somatostatin and gastrin
Glucagon
stimulated by endocrine syst. in low glucose levels (hypoglycemia)
-acts in the liver as glycogen and increased blood glucose concentration by breaking down stored glucose
Insulin
uptakes cellular glucose and through a negative feedback loop
-triggered by hyperglycemia
Amylin
promotes satiety (fullness)
-delays gastric emptying
Somatostatin
regulates alpha and beta cell function by inhibiting the secretion of insulin, glucagon and pancreatic polypeptide
-prevents hypertrophy
-is NECESSARY
Gastrin
secreted gastric (hydrochloric acid) acid which helps to break down food
hormone degradation
when the hormone is deactivated while on the way to it’s target
down regulation
less receptors
Hyperglycemia
-polyuria
-polyphagia
-polydipsia
-fatigue
-weight loss
Hypoglycemia
<40 mg/dl blood glucose
-only glucose is needed
-cold and clammy
-fatigue
-diaphoresis
-tremors
-irritability
stupor/coma
-altered mental state
-seizure
-death
polydypsia
due to excess volume/ urine loss
polyphagia
cells thinking there is not enough sugar to be consumed
polyuria
due to a hyperosmolar state which magnetizes water
Metabolic Syndrome
-triglyceride: > or equal to 150
-Waist circumference: >40 in. in men, > 35 in. in women. (BMI >25)
-Low HDL level: <40 in men, <50 in women
-Hypertension: < 130/85
-Fasting Plasma Glucose: >100mg/dl
what can metabolic syndrome lead to
diabetes, stroke, heart disease
upper urinary system
2 ureters
2 kidneys
lower urinary system
bladder
urethra
nephron
the functional unit of the kidney
Type 1 Diabetes
-cause and information
-idiopathic (unknown cause)
-autoimmune/ genetic
-irreversible
-pancreatic dysfunctioning of cells or the cells are destroyed
-NO insulin production
-no glucose enters the cell –> hyperglycemia
Type II Diabetes risk factors
-age
-obesity
-sedentary lifestyle
-African Americans & native americans
-hypertension
-prediabetes
Type II diabetes and information
Insulin resistance: decreased effectiveness of the cells insulin receptors because of high blood glucose
- leads to hyperglycemia
-pancreatic islet cells become dysfunctional
Macroangiopathy
affects large blood vessels
-leads to tissue necrosis
-in small blood vessels: thickening and hardening of the capillary basement membrane (AKA glycation) and tissue necrosis
Microvascular
Can Cause:
-retinopathy (blindness)
-neuropathy
-nephropathy (damages glomeruli)
Macrovascular
Causes:
-cardiovascular (accelerated atherosclerosis)
-cerebrovascular (increased risk for ischemic/thrombotic stroke)
-peripheral vascular (damaged nerves - gangrene)
-Infection
Hemoglobin A1C
tests the RBCs for how much glucose they have had in the past 90 days
- RBCs live for 120 days
> 6.5%
normal: <5.5%
Eosinophilic Esophagitis
idiopathic chronic inflammatory disease of the esophagus
-WBCs collect in the inner lining causing inflammation and narrowing
Manifestations:
-dysphagia, food impaction, vomiting, stomach pain
Evaluation:
Biopsy
Treatment:
-No cure
Constipation
difficult/ infrequent defecation
-caused by a sedentary lifestyle, low-residue diet, low fluid intake, medication, OPIOIDS, neurogenic disorders
Manifestations:
-straining, lumpy/hard stools, <3 bowel movements a week
Evaluation:
stool diary, description, current medication use
Treatments:
increase fiber intake, moderate exercise, drink more fluids
Diarrhea
-loose/water stools
->3 stools in 24 hours
Manifestations:
dehydration, weight loss, electrolyte imbalance, fever cramping w/ infection
Evaluation:
-abdominal imaging, travel questionnaire
-biopsies
Gi Bleed
-Upper: bleeding in the esophagus (bright red), bleeding from the stomach and duodenum (dark red)
-Lower: bleeding in the jejunum, ileum, colon, or rectum\
most common: hemorrhoids (bright red stool)
Manifestations: changes in HR and BP
Treatment: can resolve on its own depends on where bleed
GERD
reflux of acid from the stomach into esophagitis
-vomiting, coughing, lifting, bending, obesity, can increased abdominal pressure
Manifestations: heartburn, acid regurgitation, dysphagia, laryngitis, upper abdominal pain within 1 hour of eating
Evaluation: biopsy, endoscopy
Treatment: weight reduction, smoking cessation, head elevation, avoiding tight clothing
Pyloric Obstruction
narrowing or blocking of the opening between the stomach and the duodenum
-tumors and ulcers can cause obstruction
Manifestations:
epigastric fullness, nausea, epigastric pain
anorexia, weight loss, distention, vomiting
severe malnutrition, dehydration’
Treatment: nasogastric suctioning to relieve distention, surgery
Evaluation: abdominal ultrasound, endoscopy, blood test
Intestinal Obstruction
caused by anything that prevents the normal flow of chyme through the intestinal lumen
-small bowel obstructions are caused by postop adhesions, tumors, crohn’s disease, hernias
Manifestations: colicky pains, nausea and vomiting, sweating, tachycardia, rebound tenderness
Treatment: early identification, replace fluid and electrolytes, decompression of lumen with suction, surgery
Evaluation: CT, X ray, enhanced imaging
Duodenal Ulcers
commonly caused by H. pylori infections
Manifestations:
chronic epigastric pain, pain begin 2/3 hours after eating, pain is rapidly relieved by antacids or food ingestion, bleeding
Treatment: the aim is to relieve causes and effects of hyperacidity, antacids neutralize gastric contents and relieve pain, surgery
Evaluation: endoscopy, biopsy
Kidney Stones
masses of crystals, protein or other substances that are common urinary tract obstruction
-common stone types are CALCIUM oxalate or phosphate
Manifestations: moderate to severe pain that is radiating
lower urinary tract symptoms (urgency/frequency/incontinence) indicate obstruction of the lower ureter
Treatment: manage acute pain, promote stone passage, reduce the size of stones that are already formed, prevent new stone formation
Evaluation: urinalysis , imaging studies, history
Renal Carcinoma
usually occurs in men between the ages of 50 and 60
-risk factors: obesity, cigarette smoking, uncontrolled hypertension
Manifestations: hematuria, dull aching flank pain, weight loss
Treatment: removal of infected kidney, chemotherapy, radiation, immunotherapy
Evaluation: tumor staging, imaging, lab tests
Bladder Tumors
bladder cancer is most common in men >60 years
risks: people who smoke
Manifestations: gross painless hematuria
Treatment: cystoscopy with tissue resection, biopsy, chemotherapy, immunotherapy
Evaluation: uring cytologic study for screening, imaging, lab tests
UTI Cystitis
inflammation of the bladder
-infection organisms is most commonly E. coli
Manifestation:
common- frequency, urgency, dysuria, painful , lower back pain, suprapubic pain
severe- hematuria, cloudy urine, back pain - more serious
elderly- confusion, abdominal discomfort
Evaluation: urine culture
Treatment: antibiotics
Regeneration
when damaged tissue is replaced with healthy tissue of the original type
-by mitoses??
Restoration also called resolution (or maturation)
restoration of function and complete healing if the damage is minor with no complications
Repair
the replacement of destroyed tissue with scar tissue
Scar tissue
composed primarily of collagen - its a substance that fills in the lesion, restoring tissue integrity and strength
-results in a LOSS of FUNCTION
Wound Healing Phases
- Inflammation/ Hemostasis
- Proliferative/ Granulation
- Remodeling/ Maturation
Inflammation/ Hemostasis
-coagulation (blood clot/ scab)
-platelets & macrophages & neutrophils
3 to 5 days
Proliferation/ Granulation
-angiogenesis (formation of new blood vessels)
-epithelialization (sealing of the wound)
-fibroblast and collagen formation
-wound contraction (shrinking of wound)
-lymphocytes
Remodeling/ Maturation
-weeks to months (2years?)
-continuation of cellular differentiation
-scar tissue formation (no function)
-scar remodeling
-contraction can occur by myofibroblasts
Primary Intention
-margins are well approximated - abrasions
-3 to 5 days
-surgical incision and clean incision
most rapid healing
minimal tissue loss
-suture, staples, butterfly, and glue
high risk of getting infection
Secondary Intention
would margins are not well approximated
-larger wound area requres granulation tissue to fill the gap
gaping would
open wound and requires alot of tissue replacement
longer period of time needed to heal
Tertiary Intention
would healing is DELAYED
-a would that was open and is now closed
large infected or contaminated wound
increased granulation and late suturing with the wide scar
(dog or human bite)
Dysfunctional Wound Healing
can occur at any stage
-ischemia
excessive bleeding
excessing fibrin deposition
predisposing disorders :
-diabetes
-obesity
-wound infection
-tobacco smoking
Dysfunctional Wound Healing: reconstructive phase
Dysfunctional collagen synthesis leads to keloid or hypertrophic scar
Dysfunctional Wound Healing: wound disruption
dehiscence (wound splitting open)
increases risk of infection
Dysfunctional Wound Healing: impaired contraction
contracture (usually at joints and causes a loss of joint function)
fasting plasma glucose
> 126 md/dl
normal : <100
