Exam 5 Final Guide Questions Flashcards
What is the difference between oncotic pressure and hydrostatic pressure and how do they contribute to ascites?
Hydrostatic pressure exceeds oncotic pressure which leads to ascites. Hydrostatic pressure will force fluid out into the intersitial tissue leading to edema and ascites.
What happens to PTH in CKD?
In CKD, the kidneys are unable to ‘activate’ vitamin D so less calcium is absorbed and blood calcium levels fall. This triggers the parathyroid glands to overproduce PTH in an attempt to increase the amount of calcium in the blood. This leads to secondary parahyperthyroidism which then leads to osteodystrophy and insulin resistance
What are characteristics of struvite renal stones?
They are the second most common type of kidney stone and are made of magnesium, ammonium, and phophate salts.
They tend to result from chronic UTIs with urease producing bacteria such as proteus and pseudomonas. The ureas produced by these bacteria break down the urine to the salts that comprosie the struvite stones
What is the end product of protein metabolism?
Amino acids are the end product of protein metabolism in humans. When proteins and amino acids are broken down in the body, ammonium is created as a byproduct. Ammonium is dangerous when it remains free in the human body, so something must be done to get rid of it. The major route of removal of ammonium by the body is via urea synthesis in the liver.
What do most testicular cancers secrete?
AFP. Alpha fetoprotein in non-pregnant people is mainly measured as a tumor marker. Tumor markers are substances that are often made by cancer cells or by normal cells in response to cancer. High levels of AFP can be a sign of cancer of the liver, ovaries or testicles.
What are causes of hepatic encephalopathy?
- Accumulation of ammonia
- GI bleed (breakdown of bleed leats of large protein load–> large ammounts of ammonia)
- portal vein thrombosis
- medications with sedating effects
- hyponatremia
- diabetes in an individual with Hepatitis C
- CKD
What are causes of acute tubular necrosis?
Any type of ischemia to the renal tubules at the cellular level can cause ATN
What are characteristics of ATN seen in a UA?
Muddy brown cast cells are seen in the UA of a patient with ATN
How does portal hypertension bleeding most commonly occur?
from esophageal variceal bleeds
What is the pathophysiology behind alcholic cirrhosis?
fatty liver occurs due to hepatic fat accumulation
Alcohol -> acetaldehyde -> liver fibrosis
Mitochondrial fx is impaired decreasing oxidation of fatty acids
Acetaldehyde inhibits export of proteins
What are signs and symptoms of duodenal ulcers?
melena and hematemesis due to it being an “upper GI bleed” located in the duodenum
What is the first sign of small bowel obstruction?
Distention which decreases the intestines ability to absorb water/electrolytes and increased secretions of these things into the lumen which lead to fluid accumulation and gas. This is important to understand because those with SBO need to have their electrolytes/fluids monitored so that they dont become dehydrated
What are signs and symptoms of SBO?
- Hypokalemia due to electrolyte/fluids loss which also causes hypovolemic shock symptoms
- distention
- colicky abdominal pain
- metabolic alkalosis from hydrogen ion loss secondary to vomiting
- obstruction of the pylorus results in profuse vomiting of clear gastric fluid
- a partial SBO results in diarrhea while a complete SBO results in constipation
Where do peptic ulcers occur?
In the duodenum which includes both gastric and duodenal ulcers
What type of pain occurs with gastric ulcers?
The epigastric pain is worse when eating and pain is immediate
What is the age group of those get Crohn’s disase?
Crohn’s is usually diagnosed in young adults between the ages of 15-35
what are signs and symptoms of chron’s disease?
- skip lesions
- malabsorption which causes vitamin deficiencies in B12, vitamin D, calcium, and folic acid
- fistulas (abnormal tracts that develop in the presence of inflammation) which can cause strictures between the intestines, bladder, and vagina
What will screening look like in those with an acute hepatitis B infection?
Acute infection is present when both the hepatitis B core antibody (IgM) and the hepatitis B surface antigen are positive
What will screening look like in those with chronic hepatitis B infection?
chronic infections are present when both the total core antibody and the hepatitis B surface antigen are present
What are prevention methods for hepatitis A?
Handwashing and Hep A vaccine is available to prevent this
How is Hepatitis C transmitted?
transimtted through blood, body fluids, tattoos, and IV drug use
What is the pathophysiology of cholelithiasis?
Cholesterol supersaturation: Normally, bile can dissolve the amount of cholesterol excreted by the liver. But if the liver produces more cholesterol than bile can dissolve, the excess cholesterol may precipitate as crystals. Crystals are trapped in gallbladder mucus, producing gallbladder sludge. With time, the crystals may grow to form stones and occlude the ducts which ultimately produce the gallstone disease.
Excess bilirubin: Bilirubin, a yellow pigment derived from the breakdown of red blood cells, is secreted into bile by liver cells. Certain hematologic conditions cause the liver to make too much bilirubin through the processing of breakdown of hemoglobin. This excess bilirubin may also cause gallstone formation.
Gallbladder hypomotility or impaired contractility: If the gallbladder does not empty effectively, bile may become concentrated and form gallstones.
What is the pathogenesis of pancreatitis?
premature activation of pancreatic enzymes which cause pancreatic destruction and activation of inflammatory cascade which can cause hemorrhaging
Where can pancreatic cancer metastasize to?
metastasizes to the liver
