Exam 4 Flashcards
Parkinson’s Disease
Chronic neurodegenerative disease
Damage to dopamine production - lack of dopamine
Imbalance of dopamine and acetylcholine
Lewy bodies: Clumps of proteins
Characteristics of Parkinson’s Disease
TRAP
Tremors - pill rolling
Rigidity: - cogwheel rigidity, jerky movements
Akinesia - loss of voluntary movement, bradykinesia
Postural instability - Propulsive gait
Parkinson’s Disease tx
Levodopa carbidopa: Dopamine
Dementia
Slower onset degenerative disease
- Infection, trauma, heart disease
Alzheimer’s Disease patho
Chronic progressive neurodegenerative disease
Build up of (amyloid) plaques and neurofibrillary tangles
Rheumatic Diseases patho
Inflammation from immune systems autoimmune response, mistaking own tissue as harmful stimuli
Degenerates joints, muscles, and soft tissue
Osteoarthritis
Progressive deterioration of cartilage in joints
AKA Degenerative joint disease
Labs that indicate Osteoarthritis
Increased ESR (Sed rate) and C-reactive protein
Rheumatoid Arthritis
Systemic rheumatoid disease
Rheumatoid factors attack healthy tissue
Inflammation in synovial joints
Gout
Systemic inflammatory disease
Malfunction in purine metabolism - uric acid crystals damage joints
Labs that indicate Gout
Increased uric acid
Increased BUN/Creatinine
Foods high in purine
Red meat/poultry
Fish
Alcohol
Soda
Lyme Disease
Spirochete (tick) transmitted by deer tick
Bullseye rash 3-30 days after tick bite
Untreated Lyme Disease s/sx
Heart block
Joint pain/arthritis
CNS - memory loss, numbness/tingling
Fatigue
Lyme Disease tx
Oral Doxycycline
IV Rocephin
Septic Arthritis
Infection in joint or joint replacement
Commonly MRSA
Transmitted through cut/incision
Ankylosing Spondylitis
Chronic inflammation
- Effects joints in spine, hips, knees, shoulders
Psoriatic Arthritis
Starts as Psoriasis
Destruction of joint, tendons, ligaments, nails
Systemic Lupus Erythematosus patho
Autoimmune process that effects DNA/RNA
Can cause organ failure
Systemic Lupus Erythematosus s/sx
Butterfly rash
Fever, malaise
Joint inflammation
Kidney failure
Reynaud’s disease
Pain
Systemic Sclerosis
AKA Scleroderma
Autoimmune disease of connective tissue
- Similar to Lupus
Polymyositis and Dermatomyositis
Autoimmune inflammatory disease that causes symmetrical proximal muscle weakness
Polymyositis and Dermatomyositis s/sx
Butterfly rash (like Lupus)
Difficulty raising head
Difficulty going up stairs
Sjogren’s Syndrome
Systemic autoimmune disorder
Effects lacrimal (eyes) and salivary glands
Goes along with other autoimmune disorders
Fibromyalgia patho
Chronic pain syndrome
CNS ascending and descending pathways increase pain signals
Polymyalgia Rheumatica and Giant Cell Arteritis
Disorders that present together
Proximal muscles of arms and legs are affected
Esophageal sphincters
Upper and lower/cardiac sphincters
Stomach sphincters
Upper = cardiac sphincter
Pyloric sphincter
Parietal cells
Release HCl (hydrochloric acid) which secretes Pepsin (digestive enzyme) production
Releases Intrinsic Factor - required for B12 absorption
Pernicious anemia
Lack of B12
Order of small intestines
Duodenum
Jejunum
Ileum
Pancreatic digestive enzymes
Amylase - carbs
Lipase - fats
Pancreas - proteins
Barium swallow
AKA Upper GI series
Looking for lesions, varices, tumors, obstructions
Barium enema
AKA lower GI series
Looking at large intestine for colorectal cancer or polyps
Esophagogastroduodenoscopy (EGD)
Looking at upper GI looking for inflammation
Video Capsule Endoscopy (VCE)
Looks at small intestine for GI bleed, IBS, celiac
Manometry
Tests the pressure and constriction of muscles in the esophagus as you swallow
Electrophysiologic studies
Looks at GI muscle motility and sphincters for peristalsis or spasms
Gastric analysis
Looks at gastric fluid for gastric irritation
- To see if tx is effective or to dx cause
Laparoscopy
Looks at abdominal organs for peritoneal disease, masses, etc.
Types of enteral nutrition
Short term: Nasoenteric tube (NET) or Nasogastric tube (NGT)
Long term: Percutaneous Endoscopic Gastrostomy (PEG/G tube)
Percutaneous Endoscopic Jejunostomy (J Tube)
Complication of enteral nutrition
Dumping syndrome: Rapid emptying of food from stomach to small intestines
- Avoid by watering down formulas
Parenteral nutrition reasons
If GI tract is inaccessible for more than 7-10 days
- Abd surgery, burn, trauma
Locations of parenteral nutrition
Peripheral (PICC)
or Central line (CVC)
Types of formula/solutions for parenteral nutrition
Partial Parenteral (PPN) or Peripheral Parenteral Nutrition (PPN)
Total Parenteral (TPN) or Total Nutritional Admixture (TNA)
Periapical abscess
Infection/pus at the apex (bottom) of tooth
- Tx with aspiration, tooth extraction, ABX, and saline rinse
Periodontitis
Gum inflammation leading to recession (oral thrush)
Tx: Chlorhexadine rinse
Candidiasis
Caused by Candida Albicans yeast
Parotitis
Swelling of your parotid glands (located between ear and jaw)
Caused by virus (mumps/herpes) or Epstein-Barr
Sialadenitis
Inflammation of salivary glands
- Can remove glands for tx
Salivary calculus
Calcium stone in submandibular gland
Tx: Lithotripsy
Erythroplasia
Red lesion
Earliest sign of CA
Glossectomy
Excision of tongue (partial or total)
Tx for CA
What is used to dx GERD
Endoscopy
Barium swallow study
pH monitoring
Medications commonly used for GERD
Antacids - Mylanta
Histamine blockers - Pepcid, Zantac
Proton Pump Inhibitor - Protonix, Prilosec
Types of Hiatial Hernias
Sliding: Stomach bulges upwards
Rolling: (Para-esophageal): Balloons out
Tx for hiatial hernias
Medications: Antacids, PPI (Prilosec), H2 blockers (Zantac)
Surgical: Laparoscopic repair
S/sx of esophageal CA
Dysphagia, pain, bad breath, hiccups, fear of choking, weight loss
Esophageal diverticula
Outpouching through weak area of esophagus
Dysfunctional sphincter
Esophageal diverticula tx
Diverticulectomy
Achalasia
Absent/ineffective peristalsis of distal esophagus
- Eat slowly
Barrett’s esophagus
Damaged cells in lower esophagus caused by acid reflux
Tissue cells regrow and are cancerous
Reason for neck dissection
When malignant/cancerous cells travel to cervical lymph nodes they respond poorly to chemo and radiation
Radical neck dissection
Removal of cervical lymph nodes, sternocleidomastoid muscle, intrajugular vein, and spinal accessory muscle on one side
Modified radical neck dissection
Removal of cervical lymph nodes only (no muscles or IJ vein)
Selective neck dissection
Tries to save lymph nodes
Reconstructive flap (neck dissection)
Muscle and skin from other areas used at neck dissection surgical site for repair
What is normal JP drainage during the first 24 hours post op
80-120 mL
Neck dissection complication
Neck drop: Prevent with exercise and ROM in shoulder and neck
Most common cause of Peptic Ulcer Disease
H. pylori infection
Tx of PUD
Abx: Flagyl (for H. pylori infection)
PPI: omeprazole
Surgery: Remove diseased portion of stomach
Gastritis
Disruption of mucosal barrier that protects stomach from gastric acid causing inflammation
Pernicious anemia from lack of B12 by stomach
Tx for gastritis
Abx: Flagyl (for H. pylori infection)
Pepcid for acid
B12 to replace
Surgical: Gastric resection (NGT)
GI bleed main cause
PUD
Upper GI bleed s/sx
Vomiting
- Coffee ground = occult blood in stomach
- Bright red = esophageal/oral bleed
Lower GI bleed s/sx
Melena (dark bloody) stool
Bright red = hemorrhoid
Tx for GI bleed
Surgical resection of pylorus or jejunum
Gastric lavage: Withdraws clots
Embolization: Liquid clotting factor stops bleeding artery
IBS
Disorder of motility (increased or decreased)
Nausea, diarrhea, gas, constipation
Tx: Modify lifestyle, Metamucil (fiber) - drink with water to avoid bowel abstruction
Alosetron - med to slow motility
Rifaximin - abx
Appendicitis patho
Opening to appendix is obstructed, leading to infection
Peritonitis
Acute inflammatory bowel disorder
Inflammation of abdominal lining (peritoneum) - rigid abd
- Caused by bowel rupture
- Tx: Abx, IVF
Gastroenteritis
Acute inflammatory bowel disorder
Causes: Norovirus, E. coli, Campylobacter, Shigellosis
Ulcerative Colitis
Chronic inflammatory bowel disorder
- Mainly in rectum and sigmoid colon
Epithelial cells shed (thin) and leads to ulcers
Increased risk of colon CA
Crohn’s disease
Chronic inflammatory bowel disorder
- Caused by hereditary, immune, or environmental factors
Bowel wall thickens - Fissures, fistulas, abscesses
Common in ileum and colon
Complications of Crohn’s disease
Perforation, hemorrhage, obstruction, adhesions, CA, structures
Tx for Crohn’s and Ulceratic Colitis may include
Colostomy for fecal diversion - rest bowels
Low residue diet
For bowel disorders
Reduce fiber, nuts, milk, whole grains, popcorn
Good foods: White bread, cooked vegetables, eggs
Types of bowel obstructions
Partial or total obstruction
1. Mechanical: Adhesions, strictures, fecal impaction, tumors
2. Functional/Paralytic ileus: Decreased peristalyis - possibly neuro disorder
Types of GI tubes
Levin tube: Single lumen, intermittent use only
Salem sump: Dual lumen with blue port for ventilation - so tube tip doesn’t adhere to stomach wall
- Blue vent above waist to bring air in, prevent backflow of stomach acid
Miller Abbott: Weighted balloon (filled with mercury) travels to site of obstruction to irrigate and suction at site of obstruction
Polyps
Small growth protruding from a mucous membrane of the intestine
Hyperplastic = non neoplasm
Adenomatous = neoplastic -> linked to CA
Polyp s/sx
Usually asymptomatic
Polyp tx
Lysis or polypectomy
Colorectal cancer s/sx
Rectal bleeding
Change in stool consistency
Gas pain
Loose/bloody stool
Poor PO intake due to nausea
Types of colostomy (locations)
Ascending colostomy - RLQ *liquid stool
Transverse colostomy - Upper quadrants
Descending/sigmoid colostomy - LLQ *firmer stool
Ileostomy
Surgical opening in ileum or small intestine to redirect fecal matter into a pouch
Proctocolectomy with ileal pouch ( or J ) pouch
Ileum made into pouch/pseudorectum and connected to anus
Continent ileostomy (with Kock pouch)
No external appliance
Stool removed with catheter
High complication risk
Diverticulosis
Presence of pouches without inflammation
- In intestines, mostly colon
Common in older adults, asymptomatic
Tx for diverticulosis
Lots of fluids
High fiber diet
Diverticulitis
Infection/inflammation of diverticuli/pouches
Material trapped and causes infection
Diverticulitis dx
WBC - increased = inflammation
CT Scan
Colonoscopy
Types of hernias
Epigastric
Umbilical
Inguinal (groin - most common)
Femoral
Reducible hernia
Can be placed back with gentle pressure
Irreducible hernia
Requires surgery to be placed back
Strangulated hernia
Blood supply is cut off
- Can lead to necrosis or perforation
Celiac disease
Malabsorption syndrome
Autoimmune response to gluten
Celiac disease dx
Endoscopy with biopsy
Serum IgA (Immunoglobulin A) tests for antibodies
Hemorrhoid
Internal or external
Swollen vein(s) around anus
Caused by strain/pressure
Hemorrhoid tx
High fiber diet
Topical antiseptic
Hemorrhoidectomy
Anal fissure
Tear in lining of anus
Bleeding with defecation
- Stool softener
Anal cancer risk factors
Smokers, women with cervical cancer, HPV positive
Anal fistula
Tunneling from anus to rectum
May extend to outside of the body
Caused by abscess or Crohn’s
Pilonidal cyst
Pilonidal sinus in sacrococcygeal (upper butt) area
If hair grows inward it may lead to infection, cyst, abscess
Tx for abcesses
I&D - incision and drainage
- Packing or surgical closure
Sitz bath
Side lying position
Gynecomastia
Hormonal imbalance causing excessive breast tissue in men
Klinefelter syndrome
Genetic disorder when male has extra X chromosome
- Less testosterone, more risk of male breast cancer
Tx for male breast cancer
Total mastectomy
Sentinel lymph node biospy (SLNB)
Axillary lymph node dissection (ALND)
Chlamydia patho
Bacterial chlamydia trachomatis
Dx for chlamydia
Sample cells from urethral
Tx for chlamydia
Abx: Zithromax or Doxycycline
Gonorrhea patho
Bacteria neisseria gonorrhoeae
Gonorrhea s/sx
Female: May be asymptomatic - untreated leads to pelvic inflammatory disease
Male: Yellow/green discharge, pain and increased urinary frequency
Both: Blisters in throat, sore throat
Tx for gonorrhea
Cephalosporins: Rocephin IM with PO zithromax or doxycycline
Expedited Partner Therapy (EPT)
Trichomoniasis patho
Parasite trichomonas vaginalis
Trichomoniasis s/sx
Female: Vaginal itch, burning with urination, painful intercourse
Male: Burning with ejaculation/urination
Both: May be asymptomatic
Tx for trichomoniasis
Abstinence
Flagyl, Tindamax
EPT
Genital Herpes patho
Incurable, recurrent
Virus Herpes Simplex
Genital herpes s/sx
Asymptomatic
Mild tingling/itching 1-2 days before outbreak
Lesions rupture and leave an erosion
Tx for genital herpes
Antivirals:
Zoverax
Valtrex
IV Acyclovir
HPV
Human papillomavirus
Cause of genital warts (condylomata acuminata)
HPV prevention
Gardasil
HPV tx
Cream or jel Condylox
Chemical ablation/cryotherapy of warts
Syphilis
Treponema Pallidum
Can lead to systemic diseases
Syphilis s/sx
Primary: Chancre
Secondary: Systemic disease
Tertiary: No longer contagious
Flu symptoms
Prostate function
Produces fluids for semen
Function of testis
Produces testosterone and sperm
Meatospermia
Blood in ejaculate
Prostate-Specific Antigen
Increased levels may indicate CA, prostatitis, or urinary retention
Less than 4 ng/mL
Beginning at age 50
Nocturnal penis tumescence status
Sleep study
Measures engorgement/erection
Determines erectile dysfunction cause
Benign Prostatic Hyperplasia
Prostate swells upwards towards bladder and constricts urethra
Caused by aging or increased estrogen or DHT (dihydrotestosterone)
Increased risk for BPH
Smoking, ETOH, HTN, DM, obesity
Tx for BPH
Transurethral Microwave Therapy (TMT): heat to prostate increase necrotic tissue slough
Transurethral Needle Ablation (TUNA): heat to prostate to increase necrotic tissue slough
Transurethral Resection of the Prostate (TURP): removal of inner portion of prostate
Continuous bladder irrigation (CBI)
Irrigates the surgical site after removal of prostate to removes clots/obstruction
Saline irrigates bladder through foley
Monitor for bladder spasms
Transurethral Resection Syndrome
NS in continuous bladder irrigation (CBI) can be absorbed into circulatory system
Leads to fluid and electrolyte imbalance - hyponatremia
Prostate cancer patho
BRCA 1 and 2, DHT
