lab midterm Flashcards
urolithiasis
calculus formation at any level of collecting urinary system
supersaturation
-causes stone formation-high conc of stone’s constituents in urine, exceeding their solubility in the urine
75% of stones are made of
calcium oxalate or combo of calcium oxalate and calcium phosphate
10-15% of stones are made of
magnesium ammonium phosphate (aka. struvite)
triple stone
-aka. magnesium ammonium phosphate stone (struvite)-alkaline environment
causes of alkaline urine
-too much mineral water-pure vegetarian diet-gram neg bacilli in urine= UTI (bacterial waste/ enzymes converts urea to alkaline)
most powerful bacteria
proteus vulgaris
6-23% of stones are made of
uric acid salts (hyperuricemia= gout)
radiolucent stones
-pure uric acid stones-stones w/ Ca2+ inclusions are radiopaque
.5-4% of stones are made of
cystine (essential AA)= huge, rare stone
predisposing factors of stones
- urinary obstruction2. epithelial injury3. changes in urine
causes of urinary obstruction that may lead to stone formation
-tap water (Ca2+ salts= clog)-enlarged prostate/ tumors-pregnancy-diverticuli
transitional zone of prostate
-close to urethra-tumor here quickly effects urine output
peripheral zone of the prostate
-far from urethra-tumor here is silent, tumor would have to grow for a long time before it would effect the urethra
70-80% of prostate tumors
-in peripheral zone of prostate-silent
prostatic adenoma
-tumor made of glandular tissue-benign prostatic hyperplasia
prostate tumors may cause
-hesitancy-metastasize in lumbar spine-actively pushing while urinating can lead to herniation (goes where least resistant)
compression of ureter in pregnancy
causes distension of ureter/ renal pelvis due to increased hydrostatic pressure=> pressure atrophy=> hydronephrosis
hydronephrosis
-can be caused by compression of ureter in pregnancy or staghorn calculi-distension of kidney pelvis w/ atrophy of kidney parenchyme due to obstruction of urine outflow
websters technique
used in pregnancy when fetus is compressing ureter
diverticuli
-pouching of wall of any organ -common in gut
aneurysm
diverticuli of blood vesse
diverticuli of ureter
-kink in ureter when a person loses weight too fast and there is no longer a fat capsule to help hold up the kidney-changes path of ureter and hard for urine to get to bladder (urine stays in kidney-can cause nephrotosis
nephrotosis
distension of kidney
epithelial injury of kidney that may lead to stone formation is caused by
-infection (sloughing of cells=> organic nidus)-vit A deficiency-vit B6 deficiency (cells die quicker)-ischemia
changes in urine that may lead to stone formation
dehydration => supersaturation
staghorn calculus
-type of struvite stone (made of magnesium ammonium phosphate-may have Ca2+ phosphate (or oxalate) inclusions-huge, takes shape of renal pelvis and looks like horns
staghorn calculus can cause
-hydronephrosis-thinning of cortex due to hydrostatic pressure-LBP-loss of kidney
factors that can decrease urine flow:
-pregnancy-stricture of ureter (congenital or acquired)-urethral colic
acquired stricture of ureter
-most commonly due to healing of damaged tissue (fibrosis)-contracture of tissue in healing
urethral colic
-severe pain due to empty organ wall spasm-contraction of smooth muscle cells
2 stone manifestations to make dx:
- pain (LBP -> groin/ ipsilateral genitals)2.hematuria (usually micro)
stone treatment
-painkillers and relaxation of smooth muscle cells-surgery if not passed in 8 days-stone formation can reoccur
stones made in bladder
-different shapes and sizes-may look like coral
lithotripsy
-used to break up stones and make easier to pass in urine-no surgery required-US may be used instead
acute cystitis
-inflammation of bladder-more common in females due to anatomy-caused by UTI (gram neg bacilli)
gram neg bacilli that can cause acute cystitis
-e. coli (#1 cause and can cause acute pyelonephritis too)-staph/strep-STDs (chlamidia and gonorrhea)-yeast infection (candidosis or monilliasis)
candidosis
-opportunistic-antibiotics suppress gut flora-60-70%in mouth or vagina-drink buttermilk
predisposing factors of acute cystitis
-exposure of female pelvic organs to cold-catheterization-procrastination in release of urine from bladder
exposure of female pelvic organs to cold
-most common predisposing factors that may lead to acute cystitis-icing or dressing improperly-causes inflammation (ovaries too)
catheterization may lead to acute cystitis because
the catheter brings stuff from urethra into bladder and causes irritation
procrastination in release of urine from bladder may lead to acute cystitis because
distension of bladder from holding in urine => rupture of elastic fibers in bladder wall, and won’t contract as well => retention of urine => bacterial infection from urine sitting => UTI
3 acute cystitis symptoms occurring together that give definite diagnosis:
- dysuria2. increased frequency of urination (due to sensitive/ inflamed bladder= decreased capacity)3. lower abdominal or suprapubic pain(sometimes hematuria)
pepsin
digests proteins in stomach
trypsin
digests proteins in duodenum
trypsinogen
-made in pancreas, travels through pancreatic duct to duodenum-produces trypsin in duodenum
jaundice
-yellowing of skin-caused by accumulation of bilirubin in blood-bile colic or stone can cause accumulation of bile and bilirubin
pancreatonecrosis
-destruction of pancreatic tissue-severe pain-can cause death in young ladies, esp pregnant-must perform cholestomy (removal of gallbladder)
amylase
-digests starch in mouth-when swallowed, can continue to work in stomach but not produced there-produced in pancreas
carbs are mainly digested in
duodenum
gastric air bubble
-on xray-L side of film
-aka. fornix-top of stomach-accumulation of gases (from digestion)
fundus
-digestion and storage of food-located in upper left quadrant
stomach
-where majority of peptic ulcers occur-most common location for cancer in stomach
lesser curvature of stomach
-esophageal juction-where reflux can result in heartburn (irritation of esophagus by stomach acidity)
cardiac
metaplasia of mucosa in distal esophagus (pre-cancerous)-replacement of one tissue by another, both normal but not in proper place
baret’s esophagus
gastrointestinal reflux disease (GERD)
-reflux of food in esophagus into pharynx-can lead to aspiration pneumonia (chemical burning of resp tract by stomach enzymes)
antrum of stomach
a cave
-sphincter with many smooth muscle cells-joins stomach and duodenum
pylorus
-very sensitive to acid of stomach-most common place for ulcers
duodenal bulb
pyloric reflex
-lumen depends on acidity of stomach-more acidic= more narrow to protect duodenum (leads to constipation)-low acidity= wider lumen
-folding to increase room in stomach and protect wall
rugae
epithelial cells of stomach
tall columnar w/o goblet mucous producing cells
-single mucous producing cells in duodenum and bronchi-if in stomach => cancer
goblet cells
parietal cells
-normal= 1 billion in stomach-produce HCl= makes stomach acid-produce intrinsic factor
most important functions of stomach acidity:
- conversion of pepsinogen to pepsin2. maintenance of pepsin in active state3. antibacterial action in food (kills bacteria)
3 factors of HCl production by parietal cells:
- parasymp fibers of vagus nerve= neurostimulation of parietal cells => increase in HCl2. amacrine stimulator= gastrin3. local stimulator= histamine => increase in HCl
spicy foods ->
degranulation of mast cells -> release histamine -> stimulates parietal cells -> increase in HCl
intrinsic factor
-carries B12 through GI tract to be absorbed in ileum -w/o= megaloblastic anemia
folic acid deficiency
megaloblastic anemia (affects CNS of fetus)
zymogen/ chief cells
produce pepsin from pepsinogen
MC form of prostatitis
chronic abacterial prostatitis
MC form of cancer in men
adenocarcinoma
MC congenital heart disease
VSD
MC cause of cyanotic heart disease
teratology of fallot
teratology of fallot features
- VSD2. obstruction to R ventricular outflow (pulmonary valve stenosis)3. aorta that overrides the VSD4. R ventricular hypertrophy
MC cause of MI
thrombi
layer that is most at risk to MI
subendocardial
myocardial necrosis caused by ischemia
MI
Most acute MIs are by coronary artery ______
thrombosis
MI typically starts in the ______ region
subendocardial
_______ of MI is determined by sight of vascular occlusion
site
_____ segment occlusion coronary arteries produce large infarcts, smaller/distal arteries cause _____ infarcts
proximal, smaller
3 things in lab evaluation for MI
Creatine Kinase (ck-MB)troponinlactate dehydrogenase
allows free communication between left and right atria from a non complete fugal of the primary and secondary septa
Atria Septal defect
forament ovale is slightly open in ______
atria Septal defect
site where 70% of septal defects occur
basal (membranous) region
VSD is the most _____ congenital heard defect
common
ductus arteriosus allows for blood flow from pulmonary a to the aorta should eventually form the _______
ligamentum arteriosum
machinery murmer is caused by
massive left to right shunt due to VSD and foramen ovale
associated with cyanosis poor O2 from right vent
Right to left shunt
most common cause of cyanosis at birth
tetrology of fallot
4 components of tetrology of fallot
- VSD2. dextraposed aortic root that overrides the VSD3. right ventricular outflow obstruction4. right ventricular hypertrophy
extent of shunting is determined by rate of ventricular outflow ______
obstruction
aorta rises from _____ ventrical
right
pulmonary rises from Left
ventricle
Prostatitis is caused by E-coli and other gram _____ rods
negative
chronic prostatitis is most commonly caused by
chlamydia trachomatis or ureaplasma urealyticum
protatitis features
dysuria,frequency, lbp, suprapubic pain
commonly associated with fever and leukocytosis
protatitis
IBS (2)
chron’s and Ulcerative colitisboth are idiopathis
can affect any portion of GI tract
Chron’s disease
half the cases present with granulomatous inflammation
chron’s disease
Non granulamtous disease that limmited to the colon
Ulcerative colitis
inflammation in both Ulcerative colitis and churns causes
- impaired integrity of mucosal epithelial barrier2. loss of surface epithelial cell abortive function3. activation of crypt epithelial cells secretion
chron’s disease is viewed as a _____ inflammatory disease
systematic
1.white female jew predominance2.diarrhea, cramps and fever3.fistula formation to other loops of bowel, urinary bladder, perianal skin4. abdominal abscess or peritonitis5. interstitial stricture or obstruction
Chron’s disease
Chron’s has a melon appearance of __%
50%
UC
ulceroinflammatory disease affecting the colon, begins in rectum and ends proximally
UC symptoms
1.bloody mucoid diarrhea2.no granules or skin lesions
______ may bring 1st attack of UC
Clostridium difficle
_____ arthritis is common with UC
migratory
cramps, tenderness, and lower ab pain due to ulcerative colitis are relieved by
pooping, weightloss
