Exam 4 Flashcards
Primary dysmenorrhea is related to excessive endometrial production of what
Prostaglandin
A potent myometrial stimulant and vasoconstrictor is what
Prostaglandin
Painful periods produce more what…
Prostaglandin
Uterine hypercontractility caused by when chemical
Prostaglandin
Increased levels of what chemical causes decreased blood flow to uterus
Prostaglandin
Increased levels of what chemical causes increased nerve hypersensitivity in menstruating women
Prostaglandin
What condition is attributed to excessive endometrial prostaglandin production
Primary dysmenorrhea
What condition results from disorders in the presence of pelvic pathologic condition (eg endometriosis)
Secondary dysmenorrhea
Most common cause of secondary dysmenorrhea
Endometriosis
Endometriosis
Endometriosis
Pelvic inflammatory disease
Uterine fibroids- leiomyomas
Polyps
Tumors
Ovarian cysts
IUDs
Causes of what
Secondary dysmenorrhea
Presence of functioning endometrial tissue or implants outside the uterus
What condition
Endometriosis
Three common sites of tissue implantation in endometriosis:
Pelvic peritoneum
Ovaries
Uterosacral ligaments
Like normal endometrial tissue, the ectopic (out of place) endometrium responds to the WHAT of the menstrual cycle
Hormonal fluctuations
Tissue implants can also be found OUTSIDE the pelvic locations including:
(Five examples)
GI tract
Lungs
Diaphragm
Abdomen
Pericardium
Exact cause of endometriosis?
Cause unknown
Clinical manifestations of what reproductive disorder can mimic other disease processes
Endometriosis
Three examples of other disease processes that endometriosis manifestations mimic
PID
Irritable bowel syndrome
Ovarian cysts
Two most common symptoms of endometriosis
Pain
Infertility
Endometriosis symptoms vary in what two things
Frequency
Severity
Progressive dysmenorrhea
Dysuria
Dispareunia
Are symptoms of what
Endometriosis
Constipation
Abnormal vaginal bleeding
Seen in what condition?
Endometriosis
Patients with what condition are at high risk for infertility and cancers (especially ovarian)?
Endometriosis
Patients with endometriosis are at high risk for what two things
Infertility
Cancers (especially ovarian)
PCOS underlying cause?
Unknown
Genetic basis is suspected
No single factor fully accounts for the abnormalities of what reproductive disorder
PCOS
Leading cause of infertility in the US
What disorder?
PCOS
Irregular ovulation
Seen in what disorder?
PCOS
Elevated levels of WHAT seen in PCOS?
Androgens (eg testosterone)
Elevated levels of androgens (testosterone) seen in what reproductive disorder
PCOS
Appearance of polycystic ovaries on US seen in what disorder?
PCOS
True or false
Polycystic ovaries do not have to be present to diagnose PCOS
True
Does presence of polycystic ovaries establish the PCOS diagnosis?
No
What reproductive disorder is attributed to excessive endometrial prostaglandin production?
Primary dysmenorrhea
Painful periods produce more what (hormone)?
Prostaglandins
What substance is a potent myometrial stimulant and vasoconstrictor?
Prostaglandins
Elevated levels of what cause 1) uterine hypercontractility, 2) decreased blood flow to the uterus, and 3) increased nerve sensitivity, resulting in pain?
Prostaglandins
Secondary dysmenorrhea results from what?
Disorders in the presence of pelvic pathological conditions
What is the most common cause of secondary dysmenorrhea?
Endometriosis
What condition? The presence of functioning endometrial tissue or implants outside the uterus
endometriosis
Three common sites of tissue implantation in endometriosis?
1) pelvic peritoneum, 2) ovaries, 3) uterosacral ligaments
Excessive androgens in PCOS affect what type of growth?
follicular growth
What two things are the cardinal features of the patho of PCOS?
Hydroandrogenic state and ovulatory dysfunction
Hyperandrogenic state and ovulatory dysfunction are the two cardinal features of the patho of what condition?
PCOS
Follicule stimulating hormone in PCOS is increased or decreased?
Decreased
What hormone is DECREASED in PCOS?
FSH
Hormone that regulates the menstrual cycle and stimulates egg production in the ovaries
FSH
Glucose intolerance/insulin resistance often run parallel and markedly aggravate what state in PCOS?
Hyperandrogenic state
What factor contributes to the severity of signs and symptomso f PCOS?
Glucose intolerance/insulin resistance
What condition in PCOS worsens/adds to insulin resistance?
Obesity
What condition? An acute inflammatory process caused by infection
pelvic inflammatory disease
Describing what condition? Infection of the upper genital tract leads to inflammatory damage, including scarring, adhesions, and partial or total obstruction of the fallopian tubes
PID
What mechanism increases the risk of a later ectopic pregnancy in PID?
Scarring
Why does scarring increase the risk for a later ectopic pregnancy in PID?
because the motility of an egg through the fallopian tubes is slowed by damaged cilia
Loss of ciliated epithelial cells along the fallopian tube lining results in what?
impaired ovum transport
Scarring and adhesions can also result in what?
Chronic pelvic pain
What type of cancer is at higher risk with PID?
Think PU
Uterine cancer
Gonorrhea and chlamydia are two STIs that can cause what condition?
PID
What two STIs are implicated in PID?
Gonorrhea and chlamydia
What condition? A noninflammatory condition resulting from an overgrowth of anaerobic bacteria
bacterial vaginosis
bacterial vaginosis results from an overgrowth of what type of bacteria?
anaerobic
the overgrowth of anaerobic bacteria causes a shift in the composition of the vaginal flora and produces a malodorous vaginal discharge in what condition?
bacterial vaginosis
Two common clinical manifestations of BV?
Pain and itching
what percentage of PID cases have BV?
0.66
66% of patients with PID have what?
BV
What condition? The descent of one or more of these structures: vaginal wall, uterus, or apex of the vagina (after a hysterectomy)
pelvic organ prolapse
more than (what percentage) of women have some version of POP on physical exam?
more than 50%
do most women have symptoms of POP?
no
what can happen when prolapse becomes severe? (POP)
the function of surrounding organs can be altered
what is thought to cause pelvic organ prolapse?
direct trauma (childbirth), pelvic floor surgery, obesity, constipation, pelvic organ cancers, or damage to the pelvic innervation, particularly the pudendal nerve
what nerve is thought to be damaged to pelvic innervation in pelvic organ prolapse?
pudendal nerve
pelvic floor surgery may lead to what reproductive disorder?
pelvic organ prolapse
occupational activities place nulliparous woman at risk for what disorder?
pelvic organ prolapse
occupational activities that require heavy lifting or chronic medical conditions like chronic lung disease or refractory constipation place a patient at risk of what condition?
pelvic organ prolapse
what are the three most frequently cited risk factors for pelvic organ prolapse?
aging, obesity, and hysterectomy
strong familial tendency (from family and twin studies) and possibly a multifactorial genetic component are involved in what reproductive system disorder?
pelvic organ prolapse
what may occur many years after an initial injury to the supporting structure? (reproductive disorder)
prolapse of the bladder, urethra, rectum, or uterus
what four organs can be affected by pelvic organ prolapse?
bladder, urethra, rectum, uterus
descent of a portion of the posterior bladder wall and trigone into the vaginal canal?
cystocele
cystocele is usually caused by what?
the trauma of childbirth
Usually, symptoms are what in mild to moderate cases of this condition?
cystocele
increased bulging and descent of the anterior vaginal wall and urethra can be aggravated by what?
vigorous activity, prolonged standing, sneezing, coughing, or straining
what activities can relieve a cystocele?
rest or assumption of a recumbent or prone position
three main categories of signs and symptoms of cystocele?
1) urination issues; 2) pelvic discomfort, 3) other symptoms
difficulty starting urination is seen in what reproductive disorder? (Cele)
cystocele
a slow urine stream is seen in what reproductive disorder? (Cele)
cystocele
urinary incontinence is seen in what reproductive disorder?
cystocele
urine leakage (coughing, sneezing, exercise), seen in what reproductive disorder?
cystocele
a feeling of fullness, heaviness, or pain in your pelvic area, or lower back pain, seen in what reproductive disorder?
cystocele
frequent UTIs or discomfort or numbness during sex seen in what reproductive disorder?
cystocele
the bulging of the rectum and posterior vaginal wall into the vaginal canal is called what?
rectocele
childbirth may increase damage in what reproductive disorder? (Cele)
rectocele
lifelong constipation is seen with what reproductive organ disorder? (Cele)
rectocele
herniation of the rectouterine pouch into the rectovaginal septum (between the rectum and posterior vaginal wall). What condition?
enterocele
what pelvic organ disorder is seen in grossly obese and older adults?
enterocele
what two populations of patients are often affected by enteroceles?
grossly obese and older adults
what condition can be complicated by rupture or complete eversion of the vagina with trophic ulceration, edema, and fibrosis?
enterocele
treatment of which ‘cele’ is surgical?
enterocele
what is another name for spermatoceles?
epididymal cysts
another name for epididymal cysts?
spermatoceles?
benign cystic collections of fluid of the epididymis located between the head of the epididymis and testis?
spermatoceles
filled with milky fluid that contains sperm
spermatoceles
what condition is differentiated from a hydrocele in that aspiration of the hydrocele recovers a clear, yellow fluid?
spermatocele
color of aspirate of hydrocele
clear/yellow fluid
color of aspirate of spermatocele?
milky fluid/contains sperm
what condition (hydrocele or spermatocele) does not cover the entire anterior surface of the testis?
spermatocele
what type of reproductive cancer is commonly asymptomatic until the tumors have grown very large?
ovarian cancer
what type of reproductive cancer is most commonly diagnosed after metastasis has occurred?
ovarian cancer
when is ovarian cancer most often diagnosed?
after metastasis has occurred
what type of cancer is termed the “silent killer”?
ovarian cancer
what is the nickname for ovarian cancer?
“silent killer”
describe the pathogenesis of ovarian cancer?
not fully understood
in what percentage of ovarian cancer is a genetic predisposition found?
10-15%
what cancer has an association with the breast cancer susceptibility gene 1?
ovarian cancer
what cancer is associated with a smaller number of mutations of BRCA2?
ovarian cancer
what reproductive cancer is difficult to classify?
ovarian cancer
in what type of cells were ovarian cancers thought to arise from in the past?
epithelial cells
newer evidence suggests that tumors (ovarian cancer) can arise from what three anatomical locations?
fimbriae of fallopian tubes, deposits of endometriosis, or stromal cells
stromal cells may be a place where what type of reproductive cancer can originate?
ovarian cancer
fimbriae of the fallopian tubes are one place where what reproductive cancer can originate?
ovarian cancer
deposits of endometriosis may be involved in the development of what type of cancer?
ovarian cancer
what two procancerous genes are involved in inheritance factors of breast cancer?
BRCA1 and BRCA2
a tumor-suppressor gene involved in development of breast cancer
BRCA1
what gene helps repair damaged DNA and maintain the stability of a cell’s genetic information? (breast cancer)
BRCA2
which BRCA gene mutation is more common in males?
BRCA2 more likely
three environmental risk factors of breast cancer?
smoking, increased alcohol consumption, obesity
what type of tissue secretes leptin that promotes breast cancer cell proliferation by inhibiting cell death signaling pathways?
adipose tissue
what does adipose tissue secrete in breast cancern context?
leptin
what does leptin do in breast cancer?
promotes breast cancer cell proliferation by inhibiting cell death signaling pathways
what are the three consequences of sedentary lifestyle in the context of breast cancer? I I I
decreases immune function
increases insulin resistance
increases inflammation
sedentary lifestyle (breast cancer) results in increased or decreased immune function?
decreased immune function
sedentary lifestyle (breast cancer) results in increased or decreased insulin resistance?
increased insulin resistance
sedentary lifestyle (breast cancer) leads to increased or decreased inflammation?
increased inflammation
what condition results in urinary hesitancy, intermittency, nocturia, and dribbling?
lower urinary tract obstruction in males
symptoms of lower urinary tract obstruction in males may affect what?
quality of life
three conditions associated with lower urinary tract obstruction in males?
urethral stricture, benign prostatic hyperplasia, and prostate cancer
most of what condition result from injury to the urethral mucosa and surrounding tissues?
urethral strictures
urethral strictures are most commonly due to injury of what?
urethral mucosa and surrounding tissues
nodular hyperplasia occurs in what reproductive disorder?
BPH
Term for ‘increased production of cells’
hyperplasia
development of what male reproductive condition occurs over a prolonged period?
BPH
changes within the urinary tract that are slow and insidious are seen in what male reproductive condition?
BPH
As nodular hyperplasia progresses, tissues that surround the prostatic urethra compress it, usually causing what?
bladder outflow obstruction
most prostate cancers are classified as what type?
adenocarcinomas
what type of tissue does prostate cancer usually develop in?
androgen-dependent epithelium
androgen-dependent epithelium is the tissue usually involved in what type of cancer?
prostate cancer
adenocarcinomas are the most common type of what reproductive cancer?
prostate cancer
more than (what percentage) of prostate neoplasms are adenocarcinomas?
0.95
more than 95% of prostatic neoplasms are what type?
adenocarcinomas
what location do most prostate tumors develop?
in the periphery of the prostate
a heterogeneous group of tumors with a diverse spectrum of molecular and pathologic characteristics?
prostatic adenocarcinoma
why do prostate adenocarcinomas have diverse clinical behaviors and challenges?
because of a diverse spectrum of molecular and pathologic characteristics
where are the cells of origin thought to originate from in prostatic adenocarcinoma?
basal or luminal prostate epithelial cells and genetic mutation
what two types of factors contribute to the risk of prostate cancer?
environmental and genetic
what are the first manifestations of disease in prostate cancer?
those of bladder outlet obstruction
bladder outlet obstruction sx are the first manifestation of disease in what reproductive disorder?
prostate cancer
slow urinary stream, hesitancy, incomplete emptying, frequency, nocturia, and dysuria are symptoms of what
bladder outflow obstruction (prostate cancer)
symptoms of prostate cancer are WHAT compared with BPH?
progressive and do not remit
what male reproductive disorder has progressive symptoms that do not remit?
prostate cancer
what are the two screenings for prostate cancer?
PSA and DRE
evidence is WHAT whether PSA screening or DRE reduces the mortality from prostate cancer or that the benefits outweigh the harms of screening
lacking
what test is commonly used in the diagnosis and management of prostate cancer?
PSA
what may reduce the prostate cancer mortality risk but is associated with false positive results, biopsy complications, and overdiagnosis?
PSA screening
what screening may detect early prostatic carcinomas?
DRE
prostate screening test with low sensitivity and specificity?
DRE
how is prostate cancer diagnosis confirmed?
through tissue bipsy and microscopic examination of tissue
tissue biopsy and microscopic examination of tissue are how what diagnosis is confirmed?
prostate cancer
persons with ED have more damage to what type of tissue?
endothelial damage
erectile dysfunction may be the first symptom of what?
endothelial injury
what process requires a series of coordinated and complex events involving neuronal pathways, vascular response, and psychosomatic stimulation?
penile erection
what type of pathways are involved in erection?
neuronal pathways
what type of stimulation is involved in erection?
psychosomatic
what type of response is involved in erection?
vascular response
what is critical for successful sexual development and normal sexual function?
endocrine regulation
endocrine regulation is critical for what to things (male reproductive)?
successful sexual development and normal sexual function
failure of WHAT GLAND to maintain relative ratio of endogenous levels likely disrupt processes in sexual dysfunction?
pituitary gland
failure of the pituitary gland to maintain relative ratio of endogenous levels likely disrupts what?
processes in sexual function
most important androgen for lipido and spermatogenesis?
testosterone
most important androgen for libido?
testosterone
most important androgen for spermatogenesis?
testosterone
erectile dysfunction may be due to deficiency of what hormone class?
androgen
loss of libido can be caused by that class of hormone deficiency?
androgen deficiency
a decline in reproductive capacity can be caused by what class of hormone deficiency?
androgen deficiency
emotional and psychological response (e.g. anxiety, depression, loss of self esteem) can affect what type of functioning?
sexual functioning
what is the patho mechanism for the emotional and psychological response’s affect on sexual functioning?
not known
what percentage of couples are affected by infertility?
0.15
15% of couples are affected by what?
infertility
the inability to conceive over 1 year of unprotected intercourse?
intertility
how long of a period constitutes infertility?
one year
why might the interfertility rate be increasing?
increased rates of STIs, environmental exposures, delayed child bearing, or lack of previous reporting
increased rates of STIs, environmenal exposures, delayed childbearing, or lack of previous reporting may be resulting in the rate of what?
increasing rate of infertility
ovulatory disorder, abnormal semen, blockage of fallopian tubes, and endometriosis are four causes of what?
infertility
ovulatory disorders can lead to what?
infertility
abnormal semen can lead to what?
infertility
blockage of the fallopian tubes can lead to what?
infertility
endometriosis can lead to what?
infertility
40% of infertility cases are related to what?
ovulatory factors
ovulatory factors account for what percentage of infertility?
0.4
regular ovulation occurs as a result of a functioning what?
hypothalamic pituitary axis
hypothalamic pituitary axis leads to regular what?
ovulation
what is a major factor for infertility because of the regularity of ovulation and the quality of ova?
advancing age
regularity of ovulation and quality of ova WHAT with age?
decrease with age
what percentage of infertility cases are because of abnormalities of the reproductive tract?
0.2
approximately 20% of cases of what are because of abnormalities of the preproductive tract, like tubal pathologies?
infertility
what three conditions are major contributors to blockages within the reproductive tract of persons with a uterus and ovaries?
endometriosis, adhesions, and scarring from PID
endometriosis, adhesions, and scarring from PID are major contributors to what?
blockages within the reproductive tract of persons with a uterus and ovaries
sexually transmitted infection in the past an infection transmitted through sexual intercourse
venereal disease
why was the term venerseal disease replaced?
because of its limited scope
what is the new term for venereal disease?
sexually transmitted infection
many patients infected with STIs do not seek treatment because symptoms are? (3 things)
absent, minor, or transient
what characteristics of the health symptoms lead patients with STI not to seek treatment?
health services are inaccessible, unaffordable, or culturally insensitive
what condition is caused by Neisseria gonorrhoeae?
gonorrhea
gonorrhea is caused by what organism?
Neisseria gonorrhoeae
N. gonorrhea is aerobic or anaerobic?
aerobic
N. gonorrhea is spore forming or non spore forming?
non spore forming
N. gonorrhea is oxidase positive or oxidase negative?
oxidase positive
N. gonorrhea is gram negative or gram positive?
gram negative
Shape of N. gonorrhea
diplocicci
aerobic, non-spore forming, oxidase-positive, gram-negative diplococci
N. gonorrhea
transmission of what STI generally requires direct contact of epithelial (mucosal) surfaces?
gonorrhea
how is gonorrhea transmitted?
direct contact of epithelial (mucosal) surfaces
number of new cases of gonorrhea per CDC
616392
how many undiagnosed cases of gonorrhea per CDC?
1000000
what percentage of men infected with gonorrhea never have signs or symptoms?
5-10%
as many as 5-10% of men infected with what STI never have signs or symptoms?
gonorrhea
more than half of what STI infection in women are initially asymptomatic?
gonorrhea
what percentage of women with gonorrhea are initially asypmtomatic?
more than half
can gonorrhea affect the infant if present during the delivery?
yes
most states require that all infants receive WHAT to prevent gonococcal eye infection (ophthalmia neonatorum)?
prophylactic ophthalmic antibiotics
prophylactic ophthalmic antibiotics are used to prevent what STI complication in infants?
ophthalmia neonatorum (gonorrhea)
ophthalmia neonatorum is seen with what STI?
gonorrhea
topical antibiotics may not be effective in eliminating what in gonorrhea?
neonatal infection
what is indicated for all newborns with known exposure?
systemic treatment
systemic treatment is indicated for all newborns with known exposure to what?
gonorrhea
untreated infection with what STI leads to bilateral corneal ulceration?
gonorrhea
profuse yellow or gray purulent exudate is seen in untreated infection with what (infants)?
gonorrhea
untreated bilateral corneal ulceration is followed by what three things?
necrosis, scarring, and blindness
what condition can lead to necrosis, scarring, and blindness? (STI)
bilateral corneal ulceration (gonorrhea)
C. trachomatis causes what STI
chlamydia
chlamydia is caused by what organism?
C. trachomatis
what organism is responsible for a variety of syndromes, including acute urethral syndrome, nongonococcal urethritis, mucopurulent cervicitis and PID?
C. trachomatis
acute urethral syndrome is associated with what STI?
chlamydia
nongonoccal urethritis (NGU) is associated with what STI?
Chlamydia
mucopurulent cervicitis is associated with what STI?
chlamydia
what is a leading cause of preventable infertility and ectopic pregnancy?
chlamydia
what STI? Because it is often asymptomatic, it is estimated that just over a million unreported infections occur annually
chlamydia
how many chlamydia (unreported) infections are estimated to occur annually?
just over a million
age younger than 26, recent new sexual partner, drug use/other risky behaviors= risks for what STI?
chlamydia
age younger than WHAT are at risk for chlamydia?
age younger than 26
a recent new sexual partner is a risk for what STI?
chlamydia
like gonorrhea, this STI can be transmitted to infant during birth?
chlamydia
can cause eye infections and pneumonia in affected newborns
chlamydia
the most common sexually transmitted virus in the US particularly
HPV
the most common symptomatic viral STI in the US
HPV
the most common symptomatic viral STI in the US in teens and young adults?
HPV
what two populations experience HPV most commonly in the US?
teens and young adults
more than how many cases of HPV are diagnosed yearly?
more than 5.5 million
prevalence of 24 million cases of HPV is considered underestimated because HPV infection is often what?
subclinical
virus is easily transmissable through direct contact with lesions or infected secretions
HPV
how is HPV transmitted?
through direct contact with lesions or infected secretions
prevention of what STI acquisition in young adults is important?
HPV
in young females, the cervix is more vulnerable to what virus?
HPV
why are some people able to clear HPV infection and others cannot?
unknown
most cases of HPV are what?
transient
what percentage of health individuals will spontaneously eliminate the HPV virus?
0.7
70% of healthy individuals will spontaneously eliminate what STI?
HPV
the persistence of the virus and the immune response play a role in the development of WHAT following HPV exposure?
cancer
what two factors affect body’s ability to clear HPV infection?
behaviors and conditions that affect overall health status
three things strongly correlated with persistent HPV infection?
alcohol use, smoking, and HIV infection
alcohol use, smoking, and HIV infection are three things correlated with what persistent infection?
HPV
disorders characterized by infiltration of the lung by inflammatory cells with release of numerous cytokines
obstructive pulmonary diseases
a group of cytokines that are usually pro-inflammatory
interleukins
disorders that contribute to airway damage and mucous production
obstructive pulmonary diseases
these disorders are characterized by infiltration of the lung by inflammatory cells with the release of numerous cytokines that contribute to airway damage and mucous production
obstructive pulmonary diseases
what two things do cytokines contribute to in obstructive pumonary diseases?
airway damage and mucous production
in obstructive pulmonary disease, airway obstruction is worse with inspiration or expiration?
worse with expiration
airway obstruction that is worse with expiration is seen in what type of diseases?
obstructive pulmonary diseases
more force or more time required to expire a given volume of air in what type of diseases?
obstructive pulmonary diseases
more force equates to use of what muscles of expiration?
accessory muscles of expiration
emptying of the lungs is slowed in what type of diseases?
obstructive pulmonary diseases
emptying of the lungs is slowed causing WHAT in obstructive pulmonary diseases?
air-trapping
emptying of the lungs is slowed causing air-trapping thus what happens?
increased residual volume
increased residual volume is a result of what phenomenon in obstructive pulmonary diseases?
air-trapping
subsequent dyspnea, hypoxia, and hypercapnia are a result of what in patients with obstructive pulmonary diseases?
increased work of breathing
what are the three things that result with increased work of breathing in obstructive pumonary diseases?
dyspnea, hypoxia, and hypercapnia
hyper or hypocapnia in obstructive pulmonary disease?
hypercapnia
what are the two most common obstructive pulmonary diseases?
asthma and COPD
what two conditions comprise COPD?
chronic bronchitis and emphysema
asthma and COPD are the two most common what?
obstructive pulmonary diseases
what is the most common type of asthma?
allergic asthma
antigen exposure to the bronchial mucosa- initiates airway hyperresponsiveness. Characterizes which asthmatic response?
early asthmatic response
what initiates airway hyperresponsiveness in the early asthmatic response?
antigen exposure to the bronchial mucosa
in the early asthmatic response, immune activation occurs with antigen presentation to which cells?
T helper cells
immune activation in early asthmatic response involves what two things?
interleukins (cytokines) and IGE production
which immunoglobulin is involved in the early asthmatic response?
igE
what causes mast cell degradation and release of inflammatory mediators in early asthmatic response?
igE
what are the inflammatory mediators released in immune activation of the early asthmatic response? (3)
histamine, prostaglandins, leukotrienes
what mediators cause increased capillary permeability, mucosal edema, bronchial smooth muscle contraction (bronchospasm), and tenacious mucous secretion from mucosal goblet cells with narrowing and obstruction to airway?
inflammatory mediators - histamine, prostaglandins, and leukotrienes
histamine, prostaglandins, and leukotrienes are what?
inflammatory mediators of early asthmatic response
increased capillary permeability is a result of what in the early asthmatic response?
inflammatory mediators
mucosal edema occurs in what asthma phase?
early asthmatic response
what cells produce tenacious mucous secretion in early asthmatic response?
mucosal goblet cells
what asthma phase begins a few hours after the early response?
late asthmatic response
when does the late asthmatic response begin?
a few hours after the early response
release of toxic neuropeptides contribute to increased bronchial hyperresponsiveness in which asthma phase?
late asthmatic response
release of what contribute to increased bronchial hyperresponsiveness in the late asthmatic response?
toxic neuropeptides
what causes air trapping in the late asthmatic response?
impaired expiration
what is impaired in late asthmatic response leading to air trapping?
expiration
in addition to air trapping, what else is caused by impaired expiration in late asthmatic response?
hyperinflation distal to obstructions and increased work of breathing
hyperinflation in late asthmatic response occurs where in respiratory tract?
distal to obstructions
increased work of breathing is seen in which phase of asthmatic response?
late asthmatic response
what further increases hyperventilation through stimulation of the respiratory center in late asthmatic response?
hypoxemia
hypoxemia further increases what in late asthmatic response through stimulation of the respiratory center?
hyperventilation
hypoxemia further increases hyperventilation through stimulation of the respiratory center, thus causing WHAT to decrease?
PaCO2
does PaCO2 increase or decrease in late asthmatic response?**
decrease
does ph increase or decrease in late asthmatic response?
increase
what acid-base imbalance seen in late asthmatic response?
respiratory alkalosis
respiratory alkalosis is seen in what respiratory disorder?
asthma (late asthmatic response)
bronchospasms are becoming more and more severe in what asthma state?
status asthmaticus
with progressive obstruction of expiratory airflow, what becomes more severe in status asthmaticus?
air trapping
lungs and thorax become hyperexpanded in what phase of asthma?
status asthmaticus
what puts the respiratory muscles at a mechanical disadvantage in status asthmaticus?
lungs and thorax become hyperexpanded
fall in tidal volume seen in what asthma condition?
status asthmaticus
what is the effect on tidal volume in status asthmaticus?
decreased
CO2 retention is increased or decreased in status asthmaticus?
increased
respiratory acidosis seen in what phase of asthma?
status asthmaticus
what is the acid-base imbalance associated with status asthmaticus?
respiratory acidosis
what condition signals respiratory failure in status asthmaticus?
respiratory acidosis
ventilation is severely impaired, little air exchange is taking place leading to silent chest in what asthma phase?
status asthmaticus
silent chest is seen in what respiratory disorder?
asthma/status asthmaticus
what are the two common types of COPD?
chronic bronchitis and emphysema
hypersecretion of mucous and chronic productive cough that continues for at least 3 months of the year (usually in the winter months) for at least 2 consecutive years?
chronic bronchitis
what is the time frame for chronic bronchitis diagnosis?
at least three months of the year for at least 2 consecutive years
what months are the most commonly impacted in chronic bronchitis?
winter months
continual bronchial inflammation causes bronchial edema and increases the size and number of mucous glands and goblet cells in the airway epithelium. What condition?
chronic bronchitis
what causes bronchial edema in chronic bronchitis?
continual bronchial inflammation
size and number of mucous glands and goblet cells in airway epithelium are increased/decreased in chronic bronchitis?
increased
thick, tenacious mucous is produced and cannot be cleared because of impaired ciliary function. What condition?
chronic bronchitis
why can the thick tenacious mucous be cleared in chronic bronchitis?
because of impaired ciliary function
function of what is impaired in chronic bronchitis leading to the inability to clear thick tenacious mucous?
ciliary function
compromised lung defense mechanisms lead to increased susceptibility to what in chronic bronchitis?
pulmonary infection
pulmonary infection in chronic bronchitis contributes to what?
airway injury
airway injury is a result of what in chronic bronchitis?
increased susceptibility to pulmonary infection
increase is PaCO2 (term for this)
hypercapnia
hypercapnia means increase or decrease in PaCO2
increase
what happens to PaCO2 related to chronic hypoventilation?
increase (hypercapnia)
chronic hypoventilation in chronic bronchitis is common and results in what?
hypercapnia
characterized by destruction of alveoli walls through the breakdown of elastin within the septa- what condition?
emphysema
breakdown of what in the septa occurs in emphysema?
elastin
destruction of alveoli walls causes abnormal permanent enlargement of the air spaces in the lungs, also known as gas-exchange acini. What condition?
emphysema
gas-exchange acini involves
abnormal permanent enlargement of the air spaces in the lungs
what becomes difficult because loss of elastic recoil reduces the volume of air that can be expired passively, and air is trapped in the lungs
expiration
loss of elastic recoil results in difficulty with what in emphysema?
expiration
loss of elastic recoil reduces the volume of air that can be what in emphysema?
expired passively
what causes hyperexpansion of the chest (barrel chest) in emphysema?
air trapping
what is another name for hyperexpansion of the chest in emphysema?
barrel chest
shape of chest in emphysema
barrel chest
barrel chest puts muscles of what at a mechanical disadvantage in emphysema?
muscles of respiration
what is a common cause of emphysema?
smoking
deficiency of what is suggested in nonsmokers in the context of emphysema?
alpha 1 antitrypsin
deficiency of what is suggested in patients with emphysema before age 40?
alpha 1 antitrypsin
what age group may have alpha 1 antitrypsin deficiency leading to emphysema?
onset before age 40
what is the condition caused by hypoxemia and hypercapnia that leads to pulmonary vasoconstriction and increased pressures in the pulmonary system?
cor pulmonale
hypoxemia and hypercapnia in cor pulmonale lead to what?
pulmonary vasoconstriction
increased pressures in the pulmonary system are seen in what condition?
cor pulmonale
what ventricle is affected in cor pulmonale?
right ventricle
why is the workload increased on right ventricle in cor pulmonale?
increased pulmonary arterial pressure
further hypertrophy and dilation of which ventricle eventually leads to what sided heart failure in cor pulmonale?
right ventricle/right sided heart failure
decreased compliance (Stiffness) meaning it takes more effort to expand the lungs during inspiration
restrictive lung diseases
restrictive lung diseases affect inspiration or expiration
inspiration
examples of restrictive lung diseases?
aspiration, pulmonary edema, ARDS, pneumoconiosis
pneumoconiosis is an example of what type of pulmonary disease?
restrictive lung disease
pulmonary edema is an example of what type of pulmonary disease?
restrictive lung disease
ARDS is restrictive or obstructive pulmonary disease?
restrictive
aspiration is an example of what type of pulmonary disease?
restrictive
aspiration is restrictive or obstructive pulmonary disease?
restrictive
what condition? Any change in the lung caused by inhalation of inorganic dust particles, usually occurs in the workplace
pneumoconiosis
what three dusts are the most common causes of pneumoconiosis?
silica (silicosis), asbestos (asbestosis), and coal (black lung)
silicosis, asbestosis, and coal (black lung) lead to what disorder?
pneumoconiosis
silicosis leads to a restrictive or obstructive lung disorder?
restrictive
is pneumoconiosis reversible?
no
what is the treatment for pneumoconiosis?
palliative and focuses on preventing further exposure
treatment of what respiratory condition is palliative and focuses on preventing further exposure?
pneumoconiosis
pulmonary emboli are an example of what type of pulmonary disease
pulmonary vascular disease
what is the first symptom in 25% of patients with PE?
death
death is the first symptom in what percentage of patients with PE?
0.25
what is the most common cause of PE?
DVT
embolus breaks off and travels through the circulation to a pulmonary vessel. What condition?
PE
what are the three parts of triad of Virchow?
venous stasis (immobility), injury to epithelial cells that line the vessels (trauma, infection like Covid 19), and hypercoagulability (malignancy)
hypercoagulability (malignancy) related to what pulmonary disorder?
PE
venous stasis (immobility) related to what pulmonary disorder?
PE
injury to epithelial cells that line the vessels due to what in PE?
trauma, infection like Covid
injury to epithelial cells that line the vessels is related to what pulmonary disorder?
PE
what are the two main categories of lung cancer?
non-small cell lung cancer and small cell lung carcinoma
what are the three major types of non-small cell lung cancer?
squamous cell carcinoma, adenocarcinoma, large cell carcinoma
what type of cancer is squamous cell carcinoma?
non-small cell lung cancer
adenocarcinoma is what category of lung cancer?
non small-cell lung cancer
large cell carcinomas are what category of lung cancer?
non-small cell lung cancer
what type of cancer accounts for about 30% of bronchogenic carcinomas?
squamous cell carcinoma
tumors are typically located centrally near the hila and project into the bronchi in what type of lung cancer?
squamous cell carcinoma
why is nonproductive cough or hemoptysis common in squamous cell carcinoma?
the central location of the tumors
in squamous cell carcinoma, tumors are typically located centrally near the hila and project into bronchi, this leads to what two common symptoms?
hemoptysis or nonproductive cough
chest pain is a late symptom associated with large tumors- what type of lung cancer?
squamous cell carcinoma
chest pain is early or late symptom of lung cancer? (squamous cell carcinoma)
late symptom
what type of lung cancer tumors can remain fairly well localized and tend not to mestastasize until late in the course of disease?
squamous cell carcinoma
where do adenocarcinoma tumors arise from?
tumor arising from the glands
adenocarcinoma of the lung constitutes what percentage of all bronchogenic carcinomas?
35-40%
35-40% of all bronchogenic carcinomas are what type of lung tumors?
adenocarcinoma
what are the associated factors with lung adenocarcinoma?
environmental tobacco smoke, occupational carcinogens, viruses, hormones, and positive family history
environmental tobacco smoke occupational carcinogens, viruses, hormones, and positive family history- associated factors for what type of lung cancer?
adenocarcinoma
what type of lung cancer develops in a stepwise fashing through atypical adenmatous hyperplasia, adenocarcinoma in situ, and minimally invasive adenocarcinoma to invasive carcinoma?
adenocarcinoma
what is the first step of adenocarcinoma?
atypical adenomatous hyperplasia
what step of adenocarcinoma happens after atypical adenomatous hyperplasia?
adenocarcinoma in situ
what step of adenocarcinoma happens after adenocarcinoma in situ?
minimally invasive adenocarcinoma
what step of adenocarcinoma happens after minimally invasive adenocarcinoma?
invasive carcinoma
what lung cancer? Tumors are usually smaller than 4 cm
adenocarcinoma
what is the typical tumor size in lung adenocarcinoma?
tumors smaller than 4 cm
where do adenocarcinoma tumors of the lung arise from (what location?)
peripheral regions of the pulmonary parenchyma
peripheral regions of the pulmonary parenchyma are affected in what lung cancer?
adenocarcinoma
patients may be asymptomatic in what lung cancer?
A——A
adenocarcinoma
tumors may be discovered by routine chest imaging in the early stages in what lung cancer?
adenocarcinoma
individual may present with pleuritic chest pain and shortness of breath from pleural involvement by the tumor- what lung cancer?
adenocarcinoma
what percentage of bronchogenic carcinomas are large cell carcinomas?
0.1
10% of bronchogenic carcinomas are what lung cancer?
large cell carcinomas
transformed epithelial cells have lost clear evidence of maturation and are considered an undifferentiated non-small cell carcinoma- what lung cancer?
large cell carcinomas
undifferentiated non-small cell carcinoma- which lung cancer?
large cell carcinomas
clear evidence of WHAT is lost in cells of large cell carcinoma?
maturation
rapid growth and early metastasis that is usually widespread- what lung cancer?
large cell carcinomas
rapid or slow growth in large cell carcinoma?
rapid
early or late metastasis in large cell carcinoma?
early
most common type of neuroendocrine lung tumors?
small cell lung carcinomas
where do most small cell lung carcinomas arise from?
central part of the lung
what part of the lung do most small cell lung carcinomas arise from?
central part of the lung
these tumors show a rapid rate of growth and tend to metastasize early and widely- what type of lung cancer?
small cell lung carcinomas
what type of lung cancer has the worst prognosis?
small cell lung carcinomas
what are the two categories for staging small cell lung carcinomas?
limited disease and extensive disease
staging for what lung cancer involves limited disease and extensive disease?
small cell lung carcinomas
limited disease is a stage of what lung cancer?
small cell lung carcinomas
extensive disease is a stage of what lung cancer?
small cell lung carcinomas
how many chemicals are contained in tobacco smoke?
7000
how many carcinogens are contained in tobacco smoke?
69
aside from tobacco smoke, what two things contain numerous carcinogens?
air pollution and other inhaled toxins
chemicals along with WHAT result in lung tumor development?
inherited genetic predisposition to cancers
lung cancer is initiated by what type of mutations?
carcinogen-induced mutations
what induces mutations in lung cancer?
carcinogens
in addition to carcinogens, tumor development is promoted by additional mutations that alter the production and response to what?
growth factors
altered production and response to growth factors affect what of cells?
cell growth and differentiation
production of inflammatory mediators involved in what cancer?
lung cancer
bronchial mucosa suffers multiple carcinogenic hits because of what?
repetitive exposure to tobacco smoke
repetitive exposure to tobacco smoke and eventually what causes progression from metaplasia to carcinoma in situ?
epithelial cell changes
changes in what types of cells are involved in transition from metaplasia to carcinoma in situ?
epithelial cells
tumor progression includes invasion of surrounding tissues and finally metastasis to distant sites– what lung cancer?
small cell lung carcinomas
what are the sites of metastasis in small cell carcinomas (3)?
brain, bone marrow, liver
brain, bone marrow, and liver are sites of metastasis in what lung cancers?
small cell lung carcinomas
what condition results from partial or complete upper airway obstruction during sleep?
pediatric obstructive sleep apnea syndrome
what part of the airway is affected in pediatric OSAS?
upper airway
incidence of what is higher in obese children?
pediatric OSAS
craniofacial abnormalities (low mandibular plane angle) result in what condition?
pediatric OSAS
low mandibular plane angle is involved in what condition?
pediatric OSAS
obesity increases what in pediatric OSAS?
increases airway collapsibility
increased airway collapsibility is seen in what condition?
obesity
asthma, allergies, adenotonsillary hypertrophy are related to what condition?
pediatric OSAS
asthma is involved in what pediatric respiratory condition?
pediatric OSAS
snoring, labored breathing, oxygen desaturation with hypercapnia are involved in what respiratory condition?
pediatric OSAS
oxygen desaturation with hyper or hypocapnia seen in pediatric OSAS?
hypercapnia
what wakes the child up in OSAS?
oxygen desaturation with hypercapnia
what condition is associated with cognitive and neurobehavioral impairment?
pediatric OSAS
what are two consequences of pediatric OSAS?
cognitive and neurobehavioral impairment
respiratory distress syndrome (pediatric) also known as what?
surfactant deficiency disorder
surfactant deficiency disorder is also known as what?
respiratory distress syndrome
infants less than what age experience surfactant deficiency disorder?
born before 28 weeks gestation
what does surfactant do?
produces a detergent-like effect that separates the liquid molecules in the alveoli to decrease alveolar surface tension
what decreases alveoli surface tension?
surfactant
surfactant increases or decreases alveolar surface tension?
decreases
what expands the alveoli to facilitate gas exchange?
surfactant/effects of surfactant
lungs in the premature infant are what?
underdeveloped
lungs in the premature infant have small what?
alveoli
underdeveloped lungs and small alevoli add to the difficulty of what in surfactant deficiency disorder?
proper alveolar function
autosomal recessive disease with multiorgan involvement
cystic fibrosis
what three body systems are affected in CF?
lungs, digestive tract, and reproductive organs
what gene is mutated in CF?
cystic fibrosis transmembrane conduction regulator (CFTR)
cystic fibrosis transmembrane conduction regulator gets what in CF?
mutated
what does CFTR cause in CF?
abnormal expression of the CFTR protein
without adequate function of what, chloride and water are not transported appropriately across epithelial membrane?
CFTR
what two things are not transported appropriately across epithelial membranes in CF?
chloride and water
what three body systems are affected by cystic fibrosis?
lungs, digestive tract, reproductive organs
lungs, digestive tract, reproductive organs are affected in what pediatric condition?
cystic fibrosis
most common viral respirator tract infection of the small airways in children younger than 2 years of age. What condition?
bronchiolitis
what age group is affected by bronchiolitis?
younger than two years
what is the pathogen of bronchiolitis?
respiratory syncytial virus
RSV causes what condition?
bronchiolitis
viral infections can cause necrosis of the bronchial epithelium and destruction of ciliated epithelial cells. Patho of what condition?
bronchiolitis
viral infections have what effect on the broncial epithelium in bronchiolitis?
necrosis
what type of cells are destroyed in bronchiolitis by viral infection?
ciliated epithelial cells
mucosa becomes edematous along with accumulation of mucus and bronchospasms with narrowing of peripheral airways. What condition?
bronchiolitis
bronchospasms in bronchiolitis happen why?
narrowing of the peripheral airways
what airways are narrowed in bronchiolitis?
peripheral airways
most common cause of sudden unexpected infant death?
SIDS
what is the etiology of SIDS?
remains unknown
what age goup is at the highest risk for SIDS?
2-4 months of age
2-4 month infants are at highest risk for what condition?
SIDS
low birth weight, large family size, lower socioeconomic status, sleeping on soft bedding, and parental smoking are risk factors for what condition?
SIDS
low birth weight is a risk factor for what pediatric condition?
SIDS
large family size is a risk factor for what pediatric condition?
SIDS
sleeping on soft bedding is a risk factor for what pediatric condition?
SIDS
parental smoking is a risk factor for what pediatric condition?
SIDS
lower socioeconomic status is a risk factor for what pediatric condition?
SIDS
what is the key to prevention of SIDS?
education
the reflux of acid and pepsin from the stomach to the esophagus that causes esophagitis. What condition?
GERD
reflux of what two things happens in GERD leading to esophagitis?
acid and pepsin
abnormalities in LES, esophageal motility, and gastric motility or emptying can cause what condition?
GERD
abnormalities in the LES can lead to what condition?
GERD
abnormalities of esophageal motility can lead to what condition?
GERD
abnormalities of gastric motility or emptying can lead to what condition?
GERD
what may trigger spontaneous relaxation of the LES in GERD?
gastric distention after meals
gastric distention after meals may trigger what in GERD?
spontaneous relaxation of the LES
acidic foods may lead to what GI condition?
GERD
obesity may contribute to what GI condition?
GERD
vomiting, coughing, lifting, bending, and pregnancy have what effect on the body?
increase abdominal pressure
increased abdominal pressure leads to development of what?
reflux esophagitis
what is the ph of gastric contents?
highly acidic, low ph=2
bile salts and pancreatic or intestinal enzymes can be problematic in what condition?
GERD
what condition leads to refluxed chyme remaining in the esophagus longer than usual?
weak esophageal peristalsis
weak esophageal peristalsis in GERD leads to what?
refluxed chyme remains in the esophagus longer than usual
what does the refluxate injure in GERD?
mucosa
refluxate in GERD leads to what two effects?
mucosal injury and inflammation
hyperemia is a result of what substance in GERD?
refluxate
increased capillary permeability, edema, tissue fragility, and erosion are consequences of what condition?
GERD
increased/decreased capillary permeability happens in GERD?
increased
edema and tissue fragility are consequences of what condition?
GERD
what is a LONG-TERM consequence of GERD?
precancerous lesions
precancerous lesions are a long-term consequence of what GI condition?
GERD
precancerous lesions of GERD can progress to what cancer?
adenocarcinoma
adenocarcinoma is a potential consequence of what GI condition?
GERD
what type of peptic ulcer disease occurs with greater frequency than other types of peptic ulcers?
duodenal ulcers
what ulcers are generally caused by H. pylori infection and NSAIDS?
duodenal ulcers
NSAIDs generally cause what kind of peptic ulcer disease?
duodenal ulcers
H. pylori generally causes what kind of PUD?
duodenal ulcers
independently or in combination, what two substances increase in duodenal ulcers?
acid and pepsin
what happens when acid and pepsin concentrations increase in the duodenum?
penetrate the mucosal barrier causing ulceration
what promotes metaplasia in the duodenum?
increased duodenal acid
what does the increased duodenal acid favor in duodenum?
H pylori colonization
both H pylori and the increased acid (duodenal ulceration) result in decreased duodenal concentration of what?
bicarbonate
decreased bicarbonate production is seen in what GI condition?
duodenal ulcers
H. pylori infection activates what cells?
immune cells
what three types of immune cells are activated by H. pylori?
T lymphocytes, B lymphocytes, infiltration of neutrophils
T lymphocytes, B lymphocytes, infiltration of neutrophils are part of the patho of what GI condition?
duodenal ulcers
release of what damages the mucosa in duodenal ulceration?
inflammatory cytokines
what do inflammatory cytokines damage in duodenal ulceration?
mucosa
what organism produces a toxin that causes loss of protective mucosal cells, resulting in ulceration?
h pylori
H. pylori produces a toxin that causes loss of what in duodenal ulceration?
protective mucosal cells
H. pylori infection can promote what type of cancer?
gastric cancer
the incidence of gastric cancer with H. pylori is lower/higher for duodenal ulcer than for gastric ulcer?
lower
ulcers of the stomach are called what?
gastric ulcers
what GI condition? The primary defect is an abnormality that increases the mucosal barrier’s permeability to hydrogen ions
gastric ulcers
increased mucosal barrier permeability to WHAT is seen in gastric ulcer?
hydrogen ions
describe gastric secretion in gastric ulcer:
normal or less than normal
decreased mass of parietal cells seen in what GI condition?
gastric ulcer
there may be a decrease mass of what cells in gastric ulcer?
parietal cells
where do gastric ulcers commonly develop?
antral area of the stomach
what ulcers commonly develop in the antral area of the stomach?
gastric ulcers
what condition is often associated with the development of gastric ulcers?
chronic gastritis
what condition may precipitate gastric ulcer formation by limiting the mucosa’s ability to secrete a protective layer of mucous?
chronic gastritis
how does chronic gastritis precipitate ulcer formation?
by limiting the mucosa’s ability to secrete a protective layer of mucous
decreased mucosal synthesis of prostaglandins seen in what GI condition?
gastric ulcers
decreased mucosal synthesis of WHAT happens in gastric ulcers?
prostaglandins
use of NSAIDs decreases synthesis of what
prostaglandins
gastric ulcer age of onset?
50-70 years
50-70 year old age of onset for what GI condition?
Ulcer type
gastric uler
describe family history with gastric ulcer?
usually negative
family history is usually negative- which PUD?
gastric ulcer
family history is usually positive- which PUD?
duodenal ulcer
describe family history of duodenal ulcer?
positive
describe family history of gastric ulcer?
usually negative
describe cancer risk with gastric ulcer?
increased
describe cancer risk with duodenal ulcer?
not increased
H. pylori infection present/not present in gastric ulcer?
often present
h. pylori infection present/not present in duodenal ulcer?
often present
pain with gastric ulcer occurs when?
immediately after eating
pain immediately after eating is seen with which PUD?
gastric ulcer
pain 2-3 hours after eating is seen with which PUD?
duodenal ulcer
when is pain seen with duodenal ulcer?
2-3 hours after eating
what disease begins in the rectum (proctitis) and may extend proximally to the entire colon (pancolitis)?
ulcerative colitis
where does ulcerative colitis begin?
in the rectum (proctitis)
describe where ulcerative colitis may extend?
proximally to the entire colon
pancolitis seen with which GI condition?
ulcerative colitis
decreased secretion of mucin seen in what GI condition?
ulcerative colitis
what substance is antimicrobial and provides a protective layer against pathogens?
mucin
what does mucin protect against?
pathogens
loss of mucin protection leads to what (UC)?
increased permeability of the mucosa
stimulation of the gut immune system with an inflammatory response is related to loss of what in UC?
mucin
what two cells activate proinflammatory cytokines and chemokines in UC?
T cells and dendritic cells
T cells and dendrtic cells activate what in UC?
proinflammatory cytokines and chemokines
TNF alpha, interleukin 12, interleukin 23, toxic oxygen free radicals, and interferon gamma produce damage to intestinal epithelium in what condition?
ulcerative colitis
what are the two interleukins involved in UC?
IL12 and IL23
mucosa inflamed and involved in a continuous fashion- what GI condition?
ulcerative colitis
with milder inflammation, the mucosa is hyperemic and edematous and may appear dark red. What GI condition?
ulcerative colitis
with severe inflammation, the mucosa becomes hemorrhagic and small erosions form and coalesce into ulcers. What condition?
ulcerative colitis
abscess formation, necrosis, and ragged ulceration of the mucosa ensue in what GI condition?
ulcerative colitis
what narrows the lumen of the involved colon in ulcerative colitis?
edema and thickening of the muscularis mucosae
what becomes edematous and thickened in UC?
muscularis mucosae
what causes bleeding, cramping pain, and an urge to defecate in UC?
mucusal destruction and inflammation
mucosal destruction and inflammation cause what three symptoms in UC?
bleeding, cramping pain, and urge to defecate
frequent diarrhea with passage of small amounts of blood and purulent mucous common in what condition?
ulcerative colitis
frequent diarrhea, what GI condition?
ulcerative colitis
what two things cause large volumes of watery diarrhea in UC?
loss of absorptive mucosal surgace and rapid colonic transit time
large volumes of watery diarrhea- what condition?
ulcerative colitis
loss of the absorptive mucosal surface causes what symptom in UC?
large volumes of watery diarrhea
rapid colonic transit time causes what symptom in UC?
large volumes of watery diarrhea
inflammation begins in the intestinal submucosa and spreads with discontinuous transmural involvement or “skip lesions” that can involve any part of the GI tract from the mouth to the perianal area. What condition?
crohn’s disease
transmural involvement- what GI condition?
chrohn’s disease
where can crohn’s lesions affect?
any part of the GIT from mouth to perianal area
what lesions are distinguished by inflamed areas mixed with uninflamed areas, noncaseating granulomas, fistulas, and deep penetrating ulcers?
skip lesions
noncaseating granulomas involved in what GI condition?
crohn’s disease
deep penetrating ulcers involved with what GI condition?
crohn’s disease
sip lesions- what GI condition?
crohn’s disease
fistulas are involved in what GI condition?
crohn’s disease
typical lesion associated with what condition is a granuloma or mass of inflammatory tissue with a cobblestone appearance of inflamed tissue surrounded by ulceration?
crohn’s disease
granuloma- what GI condition?
crohn’s disease
cobblestone appearance of inflamed tissue surrounded by ulceration- what GI condition?
crohn’s disease
where does fistula form in crohn’s disease?
perianal area (between loops of intestine)
where may fistula extend to in crohn’s disease?
bladder, rectum, or vagina and form intra-abdominal abscesses
intra-abdominal abscesses possible in what GI disease?
crohn’s disease
strictures may develop, promoting obstruction in what GI disease?
crohn’s disease
what may develop, promoting obstruction in crohn’s disease?
strictures
small intestine malabsorption is common in what GI disease?
crohn’s disease
where does malabsorption happen in crohn’s disease?
small intestine
most common age group for UC?
10-40 years
possible age group for UC?
any age
most common age group for crohn’s disease?
10-30 years
10-30 years- most common age group for what GI condition?
Crowns orUC
crohn’s disease
10-40 years- most common age group for what GI condition?
ulcerative colitis
family history- more or less common in UC?
less common
family history- more or less common in crohn’s disease?
more common
family history is more common in what GI disease?
crohn’s disease
family history is less common in what GI disease?
ulcerative colitis
location of lesions in ulcerative colitis?
colon and rectum
lesions are continuous and involve no “skip” lesions- what condition?
ulcerative colitis
where are lesions located in crohn’s disease?
all of GI tract- mouth to anus
skip lesions are common in what GI disease?
crohn’s disease
ulcerative colitis affects what area of intestinal wall?
mucosal layer involved
mucosal layer involved in what GI condition?
ulcerative colitis
entire intestinal wall involved in what GI condition?
crohn’s disease
what part of intestinal wall is affected in crohn’s disease?
entire intestinal wall
strictures and possible obstruction are rare in what GI disease?
ulcerative colitis
strictures and possible obstruction are common in what GI disease?
crohn’s disease
abdominal pain in ulcerative colitis occurs how often?
occasionally
abdominal pain in crohn’s disease? Frequency
common
GI disease with occasional abdominal pain
ulcerative colitis
GI disease with common abdominal pain
crohn’s disease
diarrhea is common in what GI diseases?
crohn’s and ulcerative colitis
bloody stools are common/less common in ulcerative colitis?
common
bloody stools are common/less common in crohn’s disease?
less common
small intestinal malabsorption is common in what GI condition?
crohn’s disease
small intestinal malabsorption is rare in what GI condition?
ulcerative colitis
where can diverticula develop?
anywhere in the GIT
where do diverticula particularly develop?
at weak points in the colon wall
what are the most common sites for diverticula to develop?
left sigmoid colon (large intestine)
left sigmoid colon is part of what anatomical part?
large intestine
diverticula are associated with thickening of what?
muscle
muscle thickening seen in what GI condition?
diverticular disease
muscle thickening in diverticular disease contributes to what two things?
increased intraluminal pressure and herniation
increased intraluminal pressure and herniation seen in what GI condition?
diverticular disease
pressure within the narrow lumen can increase enough to rupture what in diverticular disease?
diverticula
what causes inflammation and diverticulitis in diverticular disease?
pressure within the narrow lumen
what are contributing factors to diverticulitis? (two)
bacteria and local ischemia
bacteria and local ischemia are involved in what GI disease
diverticular disease
abscess, fistula, obstruction, bleeding, perforation are complications of what?
diverticular disease
what condition involves the replacement of normal healthy liver tissue with scar tissue?
cirrhosis
what condition? An irreversible inflammatory, fibrotic liver disease
cirrhosis
chaotic fibrosis alters or obstructs biliary channels and blood flow. What condition?
cirrhosis
blood from the portal vein bypasses what in cirrhosis?
the liver
new vascular channels form shunts in what condition?
cirrhosis
in cirrhosis, new vascular channels form shunts and blood from portal vein by passes the liver, contributes to what three things?
portal hypertension, metabolic alterations, toxin accumulation
portal hypertension, metabolic alterations, toxin accumulation- patho of what condition?
cirrhosis
what condition is caused by the toxic effects of alcohol metabolism in the liver
alcoholic cirrhosis
oxidative stress from lipid peroxidation is involved in what condition?
alcoholic cirrhosis
lipid peroxidation is caued by what in alcoholic cirrhosis?
oxidative stress
immunologic alterations, inflammatory cytokines, oxidative stress from lipid peroxidation, malnutrition are involved in what condition?
alcoholic cirrhosis
an ongoing cycle of liver injury and regeneration- what condition?
alcoholic cirrhosis
alcohol is transformed into what?
acetaldehyde
excessive amounts of WHAT are toxic and significantly alter hepatocyte function and activate hepatic stellate cells?
acetaldehyde
what activates hepatic stellate cells?
acetaldehyde
a primary cell involved in liver fibrosis?
hepatic stellate cells
what two things may be depressed or altered in alcoholic cirrhosis?
enzyme and protein synthesis
enzyme and protein synthesis may be depressed or altered and hormone and ammonia degradation is diminished- what condition?
alcoholic cirrhosis
degradation of what two things are diminished in alcoholic cirrhosis?
hormone and ammonia degradation
hormone and ammonia degradation are diminished in what condition?
alcoholic cirrhosis
what inhibits protein synthesis and export of proteins from the liver?
acetaldehyde
what alters metabolism of vitamins and minerals in alcoholic cirrhosis?
acetaldehyde
what induces malnutrition in alcoholic cirrhosis?
acetaldehyde
fibrosis and scarring interspersed with regenerating nodules alter the structure of what organ?
the liver
fibrosis and scarring interspersed with regenerating nodules alter the structure of the liver- what condition?
alcoholic cirrhosis
obstruction of biliary and vascular channels is caused by what in alcoholic cirrhosis?
fibrosis and scarring
eventually hepatocytes lose their ability to regenerate with progression to liver failure- what condition?
alcoholic cirrhosis
what do hepatocytes eventually lose with alcoholic cirrhosis?
ability to regenerate
infiltration of hepatoctes with fat- what condition?
nonalcoholic fatty liver disease
infiltration of hepatocytes with fat, primarily in the form of triglycerides- whata condition?
nonalcoholic fatty liver disease
what type of fats are involved in NAFLD?
triglycerides
NAFLD occurs in the absence of what two things/variables?
alcohol intake and inflammation
what condition- associated with obesity (including obese children), insulin resistance, high levels of cholesterol and triglycerides that exceed metabolic capacity, metabolic syndrome, type II dm?
nonalcoholic fatty liver disease
what is the most common chrnoic liver disease in the US?
nonalcoholic fatty liver disease
NAFLD is the most common what?
chronic liver disease in the US
what condition is caused by disorders that cause resistance to flow in the portal venous system?
portal hypertension
portal hypertension is caued by disorders that cause what?
resistance to flow in the portal venous system
intrahepatic causes of portal hypertension result from?
vascular remodeling with shunts
vascular remodeling with shunts are associated with what type of causes of portal hypertension?
intrahepatic
vascular remodeling with shunts- what condition?
portal hypertension
most common intrahepatic cause of portal hypertension?
cirrhosis
post hepatic causes of portal hypertension are associated with what type of disorders?
cardiac disorders
disorders that impair the pumping ability of the right side of the heart reflect what type of cause of portal hypertension?
posthepatic causes
impaired pumping ability of which side of the heart is affected in portal hypertension?
right side of heart
three complications of portal hypertension?
esophageal varices, ascites, hepatic encephalopathy
esophageal varices, ascites, hepatic encephalopathy are three complications of what?
portal hypertension
distended, tortuous collateral veins are what?
varices
prolonged elevation of pressure in the portal vein causes collateral veins to open between the portal vein and systemic vein- patho of what condition?
esophageal varices
what process results in transformation into varices?
prolonged pressure distributed throughout the GI tract
in particular, what two areas are affected by transformation with esophageal varices?
lower esophagus and stomach
what is it called- accumulation of fluid in the peritoneal cavity?
ascites
in ascites, where does fluid accumulate?
peritoneal cavity
where is body fluid trapped in ascites?
peritoneal space
can fluid escape from the peritoneal space?
no
what condition reduces the amount of body fluid available for normal physiologic functions?
ascites
ascites reduces the amount of WHAT available for normal physiologic functions?
body fluid
portal hypertension causes capillary hydrostatic pressure to exceed what?
capillary oncotic pressure
what happens when portal hypertension causes capillary hydrostatic pressure to exceed capillary oncotic pressure?
pushes water into the peritoneal cavity
reduced serum albumin levels reduce WHAT adding to fluid shift in ascites?
capillary oncotic pressure
serum levels of what are reduced in ascites?
albumin
what condition results from a combination of biochemical alterations that affect neurotransmission and brain function?
hepatic encephalopathy
liver dysfunction and the development of collateral vessels that shunt blood around the liver to the systemic circulation permit toxins to accumulate- what condition?
hepatic encephalopathy
toxin accumulation- what condition?
hepatic encephalopathy
accumulated toxins in heaptic encephalopathy alter WHAT?
cerebral energy metabolism
alteration of cerebral energy metabolism happens in what condition?
hepatic encephalopathy
what three things happen with accumulated toxins in hepatic encephalopathy?
cerebral energy metabolism altered, interference with neurotransmission, cause edema
cerebral energy metabolism altered, interference with neurotransmission, and edema are caused by what in hepatic encephalopathy?
accumulation of toxins
what are the most hazardous substances involved in hepatic encephalopathy?
end products of intestinal protein digestion
what is ammonia?
end product of intestinal protein digestion
ammonia cannot be converted to WHAT by the liver?
urea
ammonia cannot be converterted to WHAT by the diseased liver?
urea
example of end products of intestinal protein digestion?
ammonia
presence of gallstones- term for this condition?
cholelithiasis
what forms in the biliary tract as a result of impaired metabolism of cholesterol, bilirubin, and bile acid and hypomotility of the gallbladder?
gallstones
hypomotility of the gallbladder involved in what condition?
cholelithiasis
hyper or hypomotility of the gallbladder in cholelithiasis?
hypomotility
what three substances have impaired metabolism in cholelithiasis?
BBC
bilirubin, and bile acid, cholesterol
cholesterol, bilirubin, and bile acid- impaired WHAT of these in cholelithiasis?
metabolism
what process causes “microstones” in cholelithiasis?
cholesterol nucleation
another name for cholesterol crystal formation?
cholesterol nucleation
what sets the stage for cholesterol crystal formation or formation of “microstones”?
supersaturation
what is formed when more crystals aggregate on the microstones?
macrostones
macrostones form when what happens?
more crystals aggregate on the microstones
macrostone formation more commonly occurs in what organ?
gallbladder
prolonged exposure to WHAT can decrease gallbladder motility?
supersaturated bile
prolonged exposure to supersaturated bile can decrease WHAT?
gallbladder motility
what process occurs alongisde reduced gallbladder motility in cholelithiasis?
incomplete postprandial emptying
what does jaundice mean in cholelithiasis?
that the stone is located in the common bile duct
a stone located in the common bile duct produces what sign?
jaundice
jaundice means a stone is located where?
common bile duct
incomplete postprandial emptying is seen in what condition?
cholelithiasis
reflux of bile acid into the pancreatic duct from gallstone obstruction of the common bile duct and ethanol metabolites within the pancreas- what condition?
acute pancreatitis
gallstone obstruction of common bile duct and ethanol metabolites promote what type of injury?
intracellular pancreatic injury
obstruction of what increases with recruitment of neutrophils in acute pancreatitis?
bile duct obstruction
cellular injury in acute pancreatitis leads to recruitment of what?
neutrophils
bile duct obstruction increases with recruitment of what?
neutrophils
in acute pancreatitis, what two responses are promoted?
pancreatic and systemic inflammatory response
what state increases the content of calcium in the pancreatic secretions resulting in an accelerated transformation of trypsinogen to trypsin?
sustained hypercalcemia
sustained hypercalcemia occurs in what condition?
acute pancreatitis
trypsin activation causes what in acute pancreatitis?
autodigestion
calcium content in the pancreatic secretions occurs because of what?
sustained hypercalcemia
accelerated transformation of trypsinogen to trypsin leads to what three consequences?
CIN
cell injury, inflammation, and necrosis
what are the two most common craniofacial malformations in the newborn?
cleft lip and cleft palate
what condition is caused by the incomplete fusion of the nasomedial or intermaxillary process beginning the fourth week of embryonic development?
cleft lip
during what time of embryonic development does cleft lip form?
beginning the fourth week of embryonic development
a period of rapid embryonic development
fourth week of embryonic development
cleft causes what to structures to develop without the normal restraints of encircling lip muscles?
face and mouth
what other four anatomical parts may be affected by facial cleff?
external nose, nasal cartilages, nasal septum, alveolar processes
external nose, nasal cartilages, nasal septum, and alveolar processes may also be affected by what condition?
facial cleft
where is the cleft usually located in cleft lip?
just beneath the center of one nostril
what condition may occur bilaterally and may be symmetrical or asymmetrical?
cleft lip
the more complete the cleft lip, the greater the chance that teeth in the line of the cleft will be WHAT?
missing or malformed
the more omplete the cleft lip, the greater the chance that WHAT in the line of the cleft will be missing or malformed?
the teeth
cleft palate is often associated with WHAT but may occur without it?
cleft lip
fissure in cleft palate may only affect the what? (two things)
uvula and soft palate
fissure in cleft palate may extend forward to the nostril and involve what? (two things)
hard palate and maxillary alveolar ridge
cleft palate can be either—-
unilateral or bilateral
cleft may occupy the midline posteriorly– what condition?
cleft palate
what is the alveolar process?
the ridge of bone that holds the teeth
the ridge of bone that holds the teeth is called what?
alveolar process
cleft palate may extend as far forward as what? (anatomical location)
alveolar process
where does cleft palate deviate to at the alverolar process?
the involved side
clefts involving only the WHAT are usually, but not necessarily in the midline?
palate
small, thin bone separating the left and right nasal cavities?
vomer
vomer is a small, thin bone that separates what?
left and right nasal cavities
what bone may be partly or completely undeveloped in cleft palate?
vomer
what tissue may be partly or completely undeveloped in cleft palate?
nasal septum
what two anatomical structures may be partly or completely undeveloped in cleft palate?
vomer and nasal septum
when facial bones are involved in cleft palate, the nasal cavity may WHAT with the oral cavity?
communicate freely
when facial bones are involved in cleft palate, what two anatomical parts may communicate freely?
nasal cavity and oral cavity
parents with a WHAT of cleft lip or cleft palate face a higher risk of having a baby with a cleft?
family history
exposure to what three substances during pregnancy may lead to cleft lip/palate?
CAC
cigarettes, alcohol, certain medications
obesity and/or diabetes are risk factors for what abnormality in kids?
cleft lip and cleft palate
acquired narrowing and distal obstruction of the pylorus and a common cause of postprandial vomiting
infantile hypertrophic pyloric stenosis
what is the term for ‘after a meal’?
postprandial
what does postprandial mean?
after a meal
distal obstruction of the pylorus- what condition?
infantile hypertrophic pyloric stenosis
most common cause of intestinal obstruction in infance?
infantile hypertrophic pyloric stenosis
what is the etiology of IHPS?
unknown
genetic and environmental factors, bottle feeding, younger maternal age, maternal smoking, and erythryomycin administration in the first two weeks of life- risk factors for what condition?
infantile hypertrophic pyloric stenosis
bottle feeding is associated with what condition?
infantile hypertrophic pyloric stenosis
erythromycin administration in the first two weeks of life- associated with what condition?
infantile hypertrophic pyloric stenosis
younger maternal age is associated with what condition?
infantile hypertrophic pyloric stenosis
individual muscle fibers of the longitudinal and circular muscles thicken- patho of what condition?
infantile hypertrophic pyloric stenosis
entire pyloric sphincter becomes enlarged and inflexible- what condition?
infantile hypertrophic pyloric stenosis
muscle fibers thicken and the opening of the pyloric sphincter becomes narrow- what condition?
infantile hypertrophic pyloric stenosis
the mucosal lining of the pyloric opening is folded and narrowed by the encroaching muscle?
infantile hypertrophic pyloric stenosis
the mucosal lining of the pyloric opening is WHAT and narrowed?
folded
encroaching muscle leads to narrowing of what?
mucosal lining of the pyloric opening
why may the muscles of the stomach become hypertrophied in IHPS?
because the extra peristaltic effort necessary to force the gastric contents through the narrow opening
congenital malformation results from failure of neural crest cells to migrate into the GI tract- what condition?
hirschprung disease
absence of parasympathetic plexuses along variable lengths of the colon (located in the large intestines)- what condition?
hirschprung disease
failure of what cells to migrate in the GIT in Hirschsprung disease?
neural crest cells
what are the two parasympathetic plexuses involved in hirschsprung disease?
Meissner and Auerbach plexuses
Meissner and Auerbach plexuses are involved in what disease?
hirschprung disease
lacking neural stimulation in muscle layers of the colon happens in what condition?
hirschprung disease
failure to propel feces through the colon and functional obstruction- what condition?
hirschprung disease
what causes failure to propel feces through the colon leading to functional obstruction in hirschsprung disease?
lacking neural stimulation in the muscle layers of the colon
functional obstruction seen in what GI condition?
hirschprung disease
functional obstruction in hirschsprung disease leads to distention of what part of the colon?
proximal colon
proximal colon distention happens in what GI condition?
hirschprung disease
megacolon happens in what condition?
hirschprung disease
why is the term megacolon used?
because of proximal colon distention in hirschsprung disease
abdominal distention and poor feeding are common in what GI condition?
hirschprung disease
what are two common presentations with hirschsprung disease?
abdominal distention and poor feeding
ileum commonly telescopes into the cecum and part of the ascending colon by collapsing through the ileocecal valve- what condition?
intussusception
where can intussusception occur?
DR
anywhere from the duodenum to the rectum
proximal portion of the intestine (the intussusceptum) telescopes into WHAT portion?
distal portion (intussuscipiens)
what direction does intussusception occur?
direction of peristaltic flow
compression leads to what five things in intussusception?
venous stasis, engorgement, edema, exudation, and further vascular compression (within hours)
venous stasis, engorgement, edema, exudation, and further vascular compression within hours? As a result of what?
compression with intussusception
edema and compression in intussusception obstruct the flow of WHAT through the intestine?
chyme
what two things obstruct the flow of chyme through the intestine in intussusception?
edema and compression
bleeding, necrosis, and bowel perforation occur if what condition goes untreated?
intussusception
three serious complications of untreated intussusception?
BNB
bleeding, necrosis, bowel perforation
what are the two common clinical manifestations of UTI in older adult?
confusion and poorly localized abdominal discomfort
what is very difficult to diagnose in older adults due to vague symptoms?
UTI
UTIs in older adults have symptoms described as what?
vague
what are the two common factors that account for UTI?
virulence of the pathogen and the efficiency of the immune response
virulence of the pathogen and efficiency of the immune response are two common factors that account for what condition?
UTI
what is the most common causative organism of UTI?
e coli
what organism has fingerlike projections that cling to/bind to the uroepithelium and resist flushing by flow of urine?
e coli
why is ecoli more problematic in women?
anatomical structure
what is considered a chronic bladder pain disorder?
interstitial cystitis
what urinary condition is difficult to diagnose so need to r/o other causes?
interstitial cystitis
painful bladder syndrome is another name for what condition?
interstitial cystitis
interstitial cystitis is another name for what condition?
painful bladder syndrome
fibromyalgia, irritable bowel disease, and chronic fatigue syndrome are often associated with what urinary condition?
interstitial cystitis
what is the cause of interstitial cystitis?
exact cause unknown
an autoimmune reaction may be responsible for the inflammatory response, contributing to what urinary condition?
interstitial cystitis
mast cell activation, altered epithelial permeability, neuroinflammation and increased sensory nerve sensitivity are involved in what urinary condition?
interstitial cystitis
chronic condition that causes bladder pain and pressure?
interstitial cystitis
a frequent or urgent need to urinate- what chronic condition?
interstitial cystitis
pain and pressure in the bladder, pelvic pain, frequent or urgent need to urinate- symptoms of what condition?
interstitial cystitis
symptoms of interstitial cystitis can range from what to what?
mild to severe
frequency of symptoms of interstitial cystitis?
intermittent or persistent
what chronic urinary condition can significantly impact quality of life?
interstitial cystitis
what chronic urinary condition can lead to other health problems like depression?
interstitial cystitis
where can kidney stones be located? (three places)
Think KUB
kidneys, ureters, bladder
kidneys, ureters, bladder- three possible locations of what?
kidney stones
what is the most common type of kidney stone?
calcium oxalate
calcium oxalate is the most common type of what?
kidney stone
supersaturation of the mineral in the urine- patho of what condition?
kidney stone
by what two processes can kidney stones grow?
agglomeration (aggregation) or crystallization
agglomeration/aggregation or crystallization are what?
two ways kidney stones can grow
uromodulin is a what?
stone inhibitor
lack of WHAT can result in kidney stones?
stone ibhibitors
what is an example of a stone inhibitor?
uromodulin
what are the three microorganisms usually associated with acute pyelonephritis?
Epp
e. coli, proteus, or pseudomonas
e. coli, proteus, or pseudomonas are organisms usually associated with what condition?
acute pyelonephritis
the microorganisms involved in acute pyelonephtiris split urea into WHAT?
ammonia
alkaline urine increases the risk of what?
stone formation
e. coli, proteus, or pesudeomonas are organisms that split what into ammonia?
urea
infection, ischemia, free radicals, drugs, toxins, vascular disorders are common causes of what urinary issue?
acute glomerulonephritis
renal diseases in which glomerular inflammation is caused by immune mechanisms- can lead to what condition?
acute glomerulonephritis
the most common type of immune injury is related to WHAT in the glomerulus? (context of glomerulonephritis)
antigen-antibody complexes
where do antigen-antibody complexes form in acute glomerulonephritis?
the glomerulus
what do antigen-antibody complexes damage?
glomerular capillary filtration membrane
what does the glomerular capillary filtration membrane include?
endothelium, basement, membrane, and epithelium
endothelium, basement membrane, and epithelium comprise the what?
glomerular capillary filtration membrane
sudden onset of hematuria, red blood cell casts and proteinuria (much milder than nephrotic syndrome) are symptoms of severe what?
acute glomerulonephritis
proteinuria that is much milder than nephrotic syndrome- seen in what condition?
acute glomerulonephritis
edema, hypertension, and impaired renal function- seen in what condition?
acute glomerulonephritis
may be acute and rapidly progressive (within hours)- what renal condition?
acute kidney injury
process of what renal condition may be reversible?
acute kidney injury
refers to a decline in renal function to about 25% of normal or eGFR of 25-30 ml/minute- refers to what?
renal insufficiency
what lab/measure is extremely useful in determining improvement or decline in kidney function?
EGFR
levels of what are mildly elevated in acute kidney injury?
serum creatinine and urea
changes in serum creatinine level occur only if more than WHAT PERCENT of glomerular filtration is lost?
0.5
changes in WHAT only occur if more than 50% of glomerular filtration is lost?
serum creatinine
what is the most common reason for AKI?
inadequate kidney perfusion
hypovolemia- such as blood loss- is what kind of AKI?
prerenal
reduced cardiac output- heart failure with reduced EF- what AKI?
prerenal
systemic hypotension or hypoperfusion- what AKI?
prerenal
acute MI- what AKI?
prerenal
renal vein thrombosis- what AKI?
intrarenal
renal artery stenosis- what AKI?
intrarenal
acute tubular necrosis (postischemic or nephrotoxic)- what AKI?
intrarenal
glomerular- immune-complex diseases such as lupus nephritis- what AKI?
intrarenal
disorders associated with urinary tract obstruction- what AKI?
postrenal
bladder outlet- benign prostatic hypertrophy- what AKI?
postrenal
ureteral obstruction destruction (tumors, stones, clots)- what AKI?
postrenal
neurogenic bladder- what AKI?
postrenal
factors that contribute to the pathogenesis of WHAT are complex and involve the interaction of many cells, cytokines, and structural alterations?
chronic kidney failure
the progressive and irreversible loss of renal function indicated by a decline in GFR- what condition?
chronic kidney failure
what condition is associated with systemic diseases, like diabetes mellitus (most significant risk factor), hypertension, and SLE?
chronic kidney failure
what is the most significant risk factor for chronic kidney failure?
diabetes mellitus
what condition is also associated with intrinsic kidney disease?
chronic kidney failure
AKI, chronic glomerulonephritis, or vascular disorders (intrinsic kidney disease) are all associated with what condition?
chronic kidney failure
progression phase of what disease is characterized by a persistent state of inflammation and hypoxia and oxidative stress that contribute to the development of renal fibrosis?
chronic kidney failure
persistent state of inflammation and hypoxia and oxidative stress- what phase of chronic kidney failure?
progressive phase
persistent state of inflammation, hypoxia, and oxidative stress in chronic kidney failure contribute to the development of what?
renal fibrosis
the kidneys have a remarkable ability to adapt to the loss of what?
nephron mass
symptomatic changes in chronic kidney failure result from increase of what three things?
CUP
plasma creatinine, urea, and potassium
increased plasma levels of creatinine, urea, and potassium- what condition?
chronic kidney failure
alterations of what two things in chronic kidney failure do not usually become apparent until renal function declines to less than 25% of normal when adaptive renal reserves have been exhausted?
salt and water
when do renal function reserves become exhausted?
renal function <25% of normal
what are the two factors that have consistently been recognized to advance renal disease?
proteinuria and angiotensin II
proteinuria and angiotensin II are consistently recognized for the ability to what?
advance renal disease
glomerular hyperfiltration, increased glomerular capillary permeability, and loss of negative charge may lead to what?
proteinuria (chronic kidney failure)
proteinuria contributes to WHAT type of injury by accumulating in the interstitial space of nephron tubules?
tubulointerstitial injury
what becomes activated in chronic renal failure that promote inflammation and progressive fibrosis?
complement proteins and other mediators and cells like macrophages
WHAT causes efferent arteriolar vasoconstriction that promotes glomerular hypertension?
angiotensin II
angiotensin II promotes what three things (chronic kidney failure)
efferent arteriolar vasoconstrction that promotes glomerular hypertension, systemic hypertension, and hyperfiltration
what promotes hyperfiltration (chronic kidney failure)?
angiotensin II
what causes efferent arteriolar vasoconstriction?
angiotensin II
what are two examples of renal regulatory mechanisms?
tubular glomerular feedback; RAAS
tubular glomerular feedback and RAAS are two examples of what?
renal regulatory mechanisms
what makes it impossible for the kidney to compensate for water-electrolyte and acid-base disturbances in chronic kidney failure?
adverse effects on renal regulatory mechanisms
what organs are spared from progressively declining kidney function?
no organs
what is the primary site in the body for production of EPO?
kidneys
a hormone that stimulates the bone marrow to produce red blood cells?
EPO
what hormone is primarily produced in the kidneys?
EPO
there is increased/decreased secretion of EPO in chronic kidney disease?
reduced
red blood cell production is increased or decreased in CKD?
decreased
why is red blood cell production decreased in CKD?
reduced EPO
what shortens the lifespan of the RBC in the context of CKD?
uremic environment
what effect does the uremic environment of CKD have on RBCs?
shortens lifespan
what electrolyte imbalance in CKD is accelerated by impaired renal synthesis of 1,25-dihydroxy-vitamin D?
hypocalcemia
renal excretion of what is diminished in CKD?
phosphate
phosphate binds to WHAT in CKD?
calcium
phosphate binds to calcium in CKD- contributing further to what?
hypocalcemia
hyper or hypocalcemia in CKD?
hypocalcemia
hyper or hypophosphatemia in CKD?
hyperphosphatemia
what is the phosphate electrolyte imbalance in CKD?
hyperphosphatemia
what kind of relationship do calcium and phosphorus have?
reciprocal relationship
what two electrolytes have a reciprocal relationship in the context of CKD?
calcium and phosphorus
decreased serum calcium levels triggers WHAT GLAND to secrete PTH?
parathyroid gland
what gland secretes parathyroid hormone?
parathyroid gland
what is the trigger for secretion of PTH?
decreased serum calcium levels
secondary hyperparathyroidism is seen in what renal condition?
CKD
vitamin D deficiency is seen in what renal condition?
CKD
renal osteodystrophy is caused by what in CKD?
hyperparathyroidism with vitamin D deficiency
increased risk of skeletal fractures- involved with what renal condition?
CKD
why is there an increased risk of skeletal fractures in CKD?
secondary hyperparathyroidism and vitamin D deficiency
what acid-base imbalance develops in ESRF?
metabolic acidosis
when does metabolic acidosis develop in ESRF?
when GFR decreases to less than 20-30% of normal
when GFR decreases to WHAT does metabolic acidosis develop in ESRF?
to less than 20-20% of normal
what may be severe enough in ESRF to require alkali therapy and dialysis?
metabolic acidosis
severe metabolic acidosis in ESRF may require what two treatments?
alkali therapy and dialysis
what should bicarb levels be maintained at in ESRF (metabolic acidosis)?
22 meql/l
hyper or hypokalemia in ESRF?
hyperkalemia
what is the potassium imbalance in ESRF?
hyperkalemia
what is the life threatening electrolyte imbalance in ESRF?
hyperkalemia
hyperkalemia occurs in what renal condition?
progressive ESRF
the condition when the urethral meatus is located on the ventral portion or undersurface of the penis?
hypospadias
where is the urethral meatus located in hypospadias?
ventral portion/undersurface of the penis
dorsal urethra characterizes what condition?
epispadias
what characterizes epispadias?
dorsal urethra that has not fused and has failed to form a tube
dorsal urethra that has not fused and failed to form a tube- what condition?
epispadias
what percentage of children younger than 5 years old who develop a UTI have VUR?
30-40%
VUR stands for what?
vesicoureteral reflux
urine sweeps up into the ureter and flows back into the bladder- what condition?
primary VUR
abnormally short submucosal tunnel and ureter that permits reflux by the rising pressure of the filling bladder?
primary VUR
the combination of reflux lower UTI is an important cause of what?
pyelonephritis
an estimated 30-40% of children younger than 5 years old who develop WHAT have VUR?
UTI
rising pressure of the filling bladder permits what?
reflux
renal parenchymal injury, scarring, hypertension, and CKD can occur many years after what?
VUR
early diagnosis and treatment is important in VUR to prevent what complications?
renal parenchymal injury, scarring, hypertension, and CKD
renal parenchymal injury can occur as a complication of what condition?
VUR
primary or secondary VUR- develops in association with acquired conditions like neurogenic bladder dysfunction or ureteral obstructions?
secondary VUR
what condition- develops in association with acquired conditions like neurogenic bladder dysfunction or ureteral obstructions?
secondary VUR
what urinary condition is more common in children than adults?
nephrotic syndrome
what condition- characterized by the excretion of 3.0 g or more protein (massive proteinuria) in the urine per day?
nephrotic syndrome
hypoalbuminemia (<3.0 g/dl) characterizes what condition?
nephrotic syndrome
hyperlipidemia is involved in what renal condition?
nephrotic syndrome
peripheral edema is involved in what renal condition?
nephrotic syndrome
what renal condition is characteristic of glomerular injury?
nephrotic syndrome
what renal condition occurs when the basement membrane in the kidney’s glomerulus becomes abnormally permeable?
nephrotic syndrome
low protein in the blood is called what?
hypoalbuminemia
what is hypoalbuminemia?
low protein in the blood
proteinuria means what?
high levels of protein escaping in the urine
high levels of protein escaping in the urine is called what?
proteinuria
what membrane in glomerulus becomes abnormally permeable in nephrotic syndrome?
basement membrane
why is there too much protein released in the urine in nephrotic sndrome?
because the basement membrane in the kidney’s glomerulus becomes abnormally permeable
decreased catabolism of lipids is part of what renal condition?
nephrotic syndrome
reduced concentration of lipoprotein lipase in the blood- part of what renal condition?
nephrotic syndrome
what is a primary enzyme involved in hyperlipidemia of nephrotic syndrome?
lipoprotein lipase
decreased serum what in nephrotic syndrome leads to edema?
protein
increased or decreased oncotic pressure in nephrotic syndrome?
decreased
what happens to oncotic pressure in nephrotic syndrome?
decreased
why is there edema in nephrotic syndrome?
decreased serum protein and decreased oncotic pressure
membranous glomerulonephritis and minimal change disease- primary causes of what renal condition?
nephrotic syndrome
minimal change disease is a primary cause of what?
nephrotic syndrome
membranous glomerulonephritis is a primary cause of what condition?
nephrotic syndrome
secondary forms of what condition occur in systemic diseases including diabetes mellitus, amyloidosis, and systemic lupus erythematosus?
nephrotic syndrome
what renal disorder is also seen with certain drugs, infections, malignancies, and vascular disorders?
nephrotic syndrome
amyloidosis is a cause of secondary what?
nephrotic syndrome
secondary forms of nephrotic syndrome occur in what types of diseases?
systemic diseases
rest or assumption of a recumbent or prone position can relieve what condition?
cystocele
genetic basis is suspected as an underlying cause of what reproductive condition?
PCOS
endometriosis places patients at high risk for what type of cancer?
ovarian
GI tract, lungs, diaphragm, abdomen, pericardium are sites of what in endometriosis?
tissue implants
lower back pain is associated with what pelvic organ prolapse? (cele)
cystocele
a feeling of fullness, heaviness- associated with what ‘cele’?
cystocele
pelvic peritoneum is a common site of WHAT in endometriosis?
tissue implantation
uterosacral ligaments are a common site of what in endometriosis?
tissue implantation
function of surrounding organs can be altered in severe WHAT?
pelvic organ prolapse
urination issues, pelvic discomfort, and other symptoms are the three main categories of symptoms in what?
cystocele
aging, obesity, and hysterectomy are the three most frequently cited risk factors for what condition?
pelvic organ prolapse
impaired ovum transport increases the risk for what two things?
infertility and ectopic pregnancy
loss of ciliated epithelial cells along the fallopian tube lining results in impaired transport of what?
ovum
vigorous activity, prolonged standing, sneezing, coughing, or straining can aggravate what?
increased bulging and descent of the anterior vaginal wall and urethra
glucose intolerance and insulin resistance are a part of the patho of what reproductive condition?
PCOS
pain and itching are two common clinical manifestations of what condition?
bacterial vaginosis
grossly obese and older adults patients are often affected by what ‘cele’ condition?
enterocele
hyperandrogenic state in PCOS is markedly aggravated by what?
glucose intolerance/insulin resistance
PID, irritable bowel syndrome, and ovarian cysts have clinical manifestations that mimic what condition?
endometriosis
bladder, urethra, rectum, and uterus can all be affected by what condition?
pelvic organ prolapse
childbirth may increase damage in what ‘cele’ disorder?
rectocele
pain and infertility are the two most common symptoms of what condition?
endometriosis
frequent UTIs are seen in what ‘cele’ disorder?
cystocele
discomfort or numbness during sex is seen in what ‘cele’ disorder?
cystocele
herniation of the rectouterine pouch into the rectovaginal septum? What reproductive condition?
enterocele
where is the rectovaginal septum located?
between the rectum and the posterior vaginal wall
constipation is seen in what reproductive condition?
endometriosis
abnormal vaginal bleeding is seen in what reproductive condition?
endometriosis
hyperandrogenic state is a cardinal feature of the patho of what condition?
PCOS
ovulatory dysfunction is a cardinal feature of the patho of what condition?
PCOS
endometriosis and endometritis are examples of causes of what disorder?
secondary dysmenorrhea
what portion of the bladder descends into the vaginal canal in cystocele?
posterior bladder wall
pelvic floor surgery is a cause of what condition?
pelvic organ prolapse
direct trauma (childbirth) is a cause of what condition?
pelvic organ prolapse
pelvic organ cancers can contribute to what condition?
pelvic organ prolapse
damage to pelvic innervation can contribute to what condition?
pelvic organ prolapse
pudendal nerve damage can contribute to what condition?
pelvic organ prolapse
refractory constipation is a risk factor for what reproductive condition?
pelvic organ prolapse
chronic medical conditions like chronic lung disease are a risk factor for what reproductive condition?
pelvic organ prolapse
motility of an egg through the fallopian tube is slowed by damaged cilia in PID leading to an increased risk of what?
ectopic pregnancy
pelvic peritoneum, ovaries, uterosacral ligaments are sites of what?
three common sites of tissue implantation in endometriosis
excess production of what happens in primary dysmenorrhea?
prostaglandin
chronic pelvic pain is a result of what two things in PID?
scarring and adhesions
trauma of childbirth causes which ‘cele’ condition?
cystocele
obesity in PCOS worsens/adds to what state?
insulin resistance
decreased blood flow to the uterus is caused by what hormones?
prostaglandins
where are fluid collections located in spermatoceles?
between the head of the epididymis and testis
what is the treatment for enterocele?
surgical treatment
dyspareunia is seen in what reproductive disorder?
endometriosis
progressive dysmenorrhea is seen in what reproductive disorder?
endometriosis
what position can relieve a cystocele?
recumbent or prone position
scarring in PID increases the risk of later what?
ectopic pregnancy
what type of cancer is seen with endometriosis patients?
ovarian
uterine fibroids (leiomyomas) are a cause of what reproductive disorder?
secondary dysmenorrhea
when is ovarian cancer most commonly diagnosed?
after metastasis has occurred
nickname for ovarian cancer?
“silent killer”
fimbriae of the fallopian tubes is a site from which what type of cancer can arise?
ovarian cancer
deposits of endometriosis can be the source of what type of cancer?
ovarian cancer
stromal cells can be the source of what type of cancer?
ovarian cancer
BRCA2 gene mutation is more common in males or females?
males
smoking, increased alcohol consumption, and obesity are three environmental risk factors for what reproductive cancer?
breast cancer
adipose tissue secretes WHAT that promotes breast cancer cell proliferation by inhibiting cell death signaling pathways?
leptin
adipose tissue secretes leptin that promotes breast cancer cell proliferation by inhibiting what?
cell death signaling pathways
urethral stricture is a cause of what condition in males?
lower urinary tract obstruction
benign prostatic hyperplasia is a cause of what condition in males?
lower urinary tract obstruction
what primarily causes urethral stricture?
injury to the urethral mucosa and surrounding tissues
what kind of hyperplasia is seen in BPH?
nodular hyperplasia
what type of obstruction is seen with nodular hyperplasia?
bladder outflow obstruction
adenocarcinomas are the most common classification of what type of reproductive cancer?
prostate cancer
androgen-dependent epithelium is the type of tissue that WHAT reproductive cancer usually develops in?
prostate cancer
androgen-dependent epithelium is associated with what reproductive cancer?
prostate cancer
more than 95% of what reproductive cancer are adenocarcinomas?
prostate cancer
prostatic adenocarcinoma originates in what type of epithelial cells?
basal or luminal prostate epithelial cells
basal or luminal epithelial cells are involved in what type of reproductive cancer?
prostate adenocarcinoma
first manifestations of what reproductive cancer are those of bladder outlet obstruction?
prostate cancer
frequency, nocturia, and dysuria are symptoms of what feature of prostate cancer?
bladder outflow obstruction
endothelial damage is prevalent in patients with what reproductive disorder?
erectile dysfunction
what gland causes problems in sexual dysfunction?
pituitary gland
testosterone is the most important androgen for what two things?
libido and spermatogenesis
what is the most important hormone for spermatogenesis?
testosterone
what is the most important hormone for libido?
testosterone
what type of hormone is testosterone?
androgen
increased rates of STIs may be associated with the increasing rate of what?
infertility
ovulatory factors account for what percentage of infertility cases?
0.4
interleukins are a type of what?
cytokine
infiltration of the lung with inflammatory cells- patho of what type of condition?
obstructive pulmonary diseases
CO2 issue in obstructive pulmonary disease?
hypercapnia
asthma and COPD are the two most common type of what pulmonary diseases?
obstructive pulmonary diseases
two examples of obstructive pulmonary diseases?
asthma and COPD
initiation of airway hyperresponsiveness occurs in what phase of asthma?
early asthmatic response
antigen exposure to the bronchial mucosa occurs in what phase of asthma?
early asthmatic response
IgE is involved in what phase of asthma?
early asthmatic response
mast cell degradation in early asthmatic response is caused by what immunoglobulin?
IgE
histamine, prostaglandins, and leukotrienes are inflammatory mediators released in what phase of asthma?
early asthmatic response
tenacious mucous secretions from mucosal goblet cells occurs in what phase of asthma?
early asthmatic response
when does the late asthmatic response begin relative to the early asthmatic response?
a few hours after
toxic neuropeptides contribute to what in the late asthmatic response?
increased bronchial hyperresponsiveness
impaired expiration causes what phenomenon in the late asthmatic response?
air trapping
inspiration or expiration is involved in air trapping?
impaired expiration
what happens to PH in the late asthmatic response?
increases
respiratory acidosis or alkalosis is seen in late asthmatic response?
alkalosis
increasingly severe bronchospasms are seen in what asthma state?
status asthmaticus
there is increased retention of what in status asthmaticus?
CO2
how long does the productive cough last to constitute chronic bronchitis?
at least 3 months
how many years must symptoms be present for chronic bronchitis diagnosis?
an inflammatory mediator that causes pain
prostaglandin
corpus lutem forms where during the menstrual cycle?
on the ovary
what is the job of the corpus luteum?
make healthy place for the fetus to grow
progesterone does what?
make uterus a great environment for embryo to grow
what gland produces and releases FSH?
anterior pituitary
chronically increased intraabdominal pressure- what condition?
pelvic organ prolapse
which celes have a tendency to rupture?
enteroceles
bloating that doesn’t come and go- what reproductive disorder?
ovarian cancer
BEAT acronym- what reproductive disorder?
ovarian cancer
leptin increases what?
uncontrolled cellular proliferation
leptin inhibits what?
apoptosis
leptin plays an important role in what reproductive cancer?
breast cancer
what type of medications can contribute to or cause ED?
blood pressure medications
gram negative or gram positive organisms cause morbidity and mortality?
gram negative
Nephrotic Syndrome Acronym
HELP
hypoalbuminemia
Edema
Lipid abnormalities
Proteinuria
Gonorrhea
Gram negative or positive
Gram negative
