Medical Illnesses Flashcards
What are the Canadian statistics on Diabetes
One in three Canadians is living with diabetes or prediabetes, yet knowledge of the risk and complications of the disease remains low
What must the body maintain a constant level of?
blood glucose
- GI tract- food
- liver - glycogen, gluconeogenesis
What is blood glucose homeostasis regulated by?
Insulin
Glucagon
Epinephrine
Insulin?
responds to a rise in blood sugar
promotes uptake and/or storage of glucose by cells
Glucagon?
responds to a drop in blood sugar
brings glucose out of storage
Epinephrine?
helps to raise blood glucose
“fight or flight
What is normal fasting blood glucose?
4.0-6.0 mmol/L
What is diabetes?
complex metabolic disorder
- insufficient production or utilization of insulin
- inability to absorb, transport and utilize glucose
- glucose builds up in the bloodstream instead of being used for energy
What is the diagnosis of diabetes made on the basis of?
□ fasting blood sugar: ≥7.0 mmol/L
□ oral glucose tolerance test: ≥ 11.1 mmol/L
□ A1C: ≥ 6.5% (in adults)
What is a complication of diabetes associated with it?
long-term exposure to hyperglycemia (high levels of glucose in the blood)
What is Type 1 diabetes?
the pancreas produces too little or no insulin
cause unknown
What are the probable causes of Type 1 diabetes
probably autoimmune
body’s immune system attacks the beta cells of the pancreas
Is Type 1 diabetes preventable?
No
What was Type 1 diabetes previously known as?
insulin-dependent or juvenile diabetes (old term)
How many cases does diabetes account for?
accounts for 10% of cases
onset in childhood to young adulthood
What is Type 2 diabetes?
the pancreas produces too little insulin or the body is no longer sensitive to the presence of insulin
insulin resistance
What are the risk factors of Type 2 diabetes
obesity, age, (>40 y), ethnicity, genetics
When is Type 2 diabetes traditionally present?
adult-onset disease (old term)
□ now diagnosed in children & adolescents
How many cases does Type 2 diabetes account for?
90% of diabetic cases
What is Gestational Diabetes (GDM)?
temporary condition in pregnancy (5.4%, PHAC, 2016)
What causes GDM?
pancreas produces insufficient insulin to deal with excess needs in pregnancy & change in hormones
What are the risk factors of GDM?
age (≥35y), obesity, previous baby > 9lbs (macrocosmic)
Pre-diabetes, GDM in a previous pregnancy
What does GDM increase the future risk of?
increases future risk of diabetes – mom & baby
What are prevention strategies for Type 2 Diabetes?
- lifestyle factors:
- healthy eating
- limit intake of refined sugars
- increase soluble fibre intake
· regular PA (physical activity)
weight management
*all of these aid in blood glucose control
(primary risk)
What are the Signs and Symptoms of diabetes?
· excessive thirst, frequent urination
· excessive hunger
· extreme fatigue
· weight loss (type 1)
· headache, blurred vision
· elevated blood sugar - hyperglycemia
glucose in the urine - glucosuria
What are some Health complications associated with diabetes?
· associated with chronic exposure to increase blood sugar
· damage to vessels & nerves
· retinopathy - eye disease and blindness
· nephropathy - kidney disease
· peripheral vascular disease, neuropathy
· tingling or numbness in extremities
· poor circulation – infection & amputation
· erectile dysfunction
Diabetes is a key risk factor for?
a key risk factor for CVD
What are the annual statistics for people living with diabetes
Annually, people living with diabetes account for:
* 30% of strokes, 40% of heart attacks,
* 50% of kidney failure requires dialysis
70% of non-traumatic amputations
What are some management/ treatments for diabetes?
- diet planning
· regular balanced meals + snacks
□ 50-60% energy from CHO spread over the day
· limit intake of refined/added sugars (<10%)
· ↑ fibre intake - including soluble fibre sources
· small amount of protein at each meal
stabilizes blood sugar - regular exercise, weight management
- blood glucose control
▪ oral medications, insulin
* monitoring of blood sugar
▪ traditional = glucometer
· skin check - footcare
· regular medical assessment
· lower/regulate blood sugar levels: 4-7 mmol/L - Anti-diabetic medications
▪ several types
▪ multiple mechanisms of action - Insulin
▪ rapid, short, intermediate, and long-acting
▪ different strengths: e.g. U-100
▪ by injection: 1-4 /day
syringes, pens, pumps
What is the cause of hypoglycemia?
too much insulin or not enough food
too much PA - no adjustment of food or insulin
What are the early signs of hypoglycemia?
shaky, lightheaded, sweaty, weak, tachycardia, headache
How can we find out if we have hypoglycemia?
check blood sugar
- eat or drink a form of simple sugar
wait 10-15 minutes → test → treat again?
Why is severe hypoglycemia is extremely dangerous?
disorientation, seizure, loss of consciousness
What is it like living with diabetes?
· 1st goal – primary prevention
· after diagnosis:
- Blood sugar control
- minimize long-term complications
· resources:
- family physician, certified diabetes educator
- Diabetes Canada, Health Canada
- Regional public health Department
What is Cardiovascular disease (CVD)?
Collection of diseases of health and blood vessels
- Heart disease and stroke
· 2nd leading cause of death in Canada
· 23.3% of all deaths in Canada (>66,000/year, Stats Can, 2020)
Why are the incidence and mortality rates declining?
□ Understanding, and management of risk factors
□ Advances in diagnostic procedures, treatments
□ Better emergency medical assistance programs
What is the cardiovascular system?
Heart and blood vessels
- Transports, O2, nutrients, hormones, and enzymes to tissues, removal of waste products
- Role in regulation of body temp, fluid balance, pH
- Protects the body from infection, blood loss
What is the cardiorespiratory system?
Heart, lungs, blood vessels
Gas exchange - O2 and CO2
What is the anatomy of the heart?
· Weights 200-425g (7-15 oz)
· During an average lifetime
- 2.5 billion beats
· 100,000/day (7,200 litres)
Pericardium: (double-layered sac surrounding heart)
· 4 chambers
· Separated by valves - regulate the flow of blood
· Sinoatrial (SA) node - pacemaker
Electrical signal for contraction of the right atrium
The flow of blood through the heart?
What are the blood vessels?
Arteries carry blood away from the heart
□ Branch into smaller blood vessels -arterioles
Veins carry blood back to the heart
□ Branch into smaller blood vessels - venules
Capillaries: very small blood vessels
□ Connect the arterial and venous sub-circulation
□ Passage of oxygen, nutrients, and waste between blood and part of your body.
What is the coronary blood supply part of the blood vessels
□ Right and left coronary arteries
- Supply blood to the heavy muscle - myocardium
□ Cardiac veins
▪ Removal of de-oxygenated blood
- My/-(muscle), cardi/o-(heart), -um(a structure)
Cardiovascular Diseases- what is atherosclerosis?
- General term - narrowing and hardening of the arteries
· Fatty substances (plaque) in lining of artery
□ Arteries lose elasticity and narrow- Impeded blow flow - partial or full blockage
- Sten/o-(narrowness), -osis (condition)
· Atherosclerosis develops over time
· Likely begins with damage to the lining of blood vessels
□ Elevated blood pressure
□ Elevated blood cholesterol, triglycerides, and blood sugar
□ Smoking
□ … fatty deposits accumulate - Blockage, bleeding blood clots
· Atherosclerosis: minor blockage?
□ Blood may reroute through small unused blood vessels - collateral circulation - Damages tissue (heart muscle) may heal itself
Cardiovascular Diseases- what can atherosclerosis lead to?
□ Coronary heart disease
□ Carotid artery disease
- Reduced flow to the brain
□ Peripheral artery disease
- Pelvis, legs, arms
Cardiovascular Diseases- What is coronary heart disease (CHD)
MOST COMMON
AKA - coronary artery disease (CAD)
· Caused by: atherosclerosis
□ Plaque build-up in one or more coronary arteries
· Restricted blood flow (75%)
□ Ischemia - insufficient blow flow relative to demands of tissue
▪ Decreases in oxygen supply
- Chest pain (angina)
· Severe restriction or complete blockage
□ Myocardial infarction (MI), AKA “heart attack”
· Often caused by thrombosis:
□ Blood cloy in coronary artery
▪ Blockage of normal blood supply to an area of heart
Cardiovascular Diseases- Heart Attack- warning signs?
□ Chest discomfort - pain/pressure
□ Radiating pain - neck, shoulders arm, chin
□ Shortness of breath
□ Sweating, nausea
□ Light headedness
· Men vs women?
· Potential consequences
Heart damage, cardiac arrest, death
Cardiovascular Diseases- What is a stroke?
· AKA “cerebrovascular accident”
□ Sudden loss of brain function
· Caused by:
□ Thrombus (blood clot) or embolus
□ Disruption of blood flow to the brain
□ “ischemic stroke”
· Aneurysm: weakened blood vessel
□ Rupture of blood vessels in the brain
□ “hemorrhagic stroke”
· Transient ischemic attack (TIA)
▪ “mini-stroke”
A temporary decrease in blood flow to the brain
Cardiovascular Diseases- warning signs of stroke?
What does F.A.S.T mean?
What are the potential consequences of stroke?
Based on where the brain was injured? Degree of damage?
Impairments in movement, speech vision cognition
death
What are other diseases of the heart?
Atrial fibrillation
□ Condition involving irregular heart rhythm (arrhythmia)
□ Tachycardia vs bradycardia
Cardiomyopathy
□ disease of the heart muscle - decreased ability to pump blood
Congenital heart disease
□ defect in heart or blood vessels near the heart at birth
Congestive heart failure
□ heart disease means the heart is damaged or weakened
Decreased pumping action – back up of fluid in lungs, extremities
What are some modifiable and non-modifiable risk factors of CVD?
MODIFIABLE:
· High blood pressure (plaque build up in arterial walls
· High blood cholesterol
· Smoking
· Physical inactivity
(decrease in our blood pressure modify blood cholesterol)
· Overweight, obesity
· Stress
· Diabetes (metabolic)
· Excessive alcohol intake
NON-MODIFIABLE:
· Age, gender, family history (genetic predisposition),
ethnicity, previous CVD event (angina, heart attack)
Risk factors of CVD?
· hypertension: chronic elevated BP
□ > 140/90 mmHg
▪ > 130-139/85-89 = high normal
· systolic BP (upper value)
▪ pressure exerted against walls of arteries – the heart is contracting
· diastolic BP (lower value)
▪ pressure exerted against walls of arteries – the heart is relaxed
· primary (essential) vs. secondary
“silent killer”
Other risk factors of CVD?
- Hypertension à not white coat syndrome,
- High normal 140/90 upper number higher than 130, lower number higher than 85 means you are at risk and intervention must occur
- Secondary hypertension – is caused by some other underlying condition, i.e. could be related to kidney function etc.
- Primary – chronically develops over time from one of the factors
- elevation in blood pressure is known as silent killer – because people with this are typically asymptomatic
Blood pressure is one of the most important risk factors for stroke
What are CVD prevention strategies?
lifestyle behaviours:
· healthy eating
- Increased fibre (beans, okra, strawberries)
- less saturated & trans fats
- More unsaturated fats
- Less added sugars
- less sodium (hyper-responders to sodium intake)
· regular exercise
· no smoking
limit alcohol consumption stress management
manage:
* blood pressure
* blood cholesterol
* body weight
Diabetes risk
Diagnostic procedures for CVD - electrocardiogram (ECG)
- records electrical activity of heart
Holter Monitor: 24 hour heart rate, rhythm
Diagnostic procedures for CVD - ultrasound - echocardiogram?
□ high-frequency sound waves
▪ creates image of heart and blood vessels
▪ Non invasive test
First line of diagnostic
Diagnostic procedures for CVD - other diagnostic imaging?
□ positron emission tomography (PET)
□ computed tomography (CT)
magnetic resonance imaging (MRI)
Diagnostic procedures for CVD - serum analysis?
□ Lipid profile, C-reactive protein
□ Homocysteine
Cardiac enzymes
- Lipid profile – a combination of lipid measures
- C-reactive protein (CRP) – a measure of inflammation, inflammation is rising to the top of the list of risk factors. This test does not tell you where the inflammation is.
- Homocysteine (is an amino acid): elevation in this associates with significant risk
Cardiac enzymes – provide info after a cardiac event (like angina, heart attack) à tells you how much heart damage was sustained after this event
Diagnostic procedures for CVD - Angiogram
cardiac catheterization
□ catheter threaded from groin or wrist into heart
□ contrast dye injected ® x-ray outlines structure, flow
▪ detect blockages, stenosis (narrowing of arteries), weakened valves
What are some CVD treatement options?
· low to intermediate risk: the first line of defence
□ lifestyle changes
drug therapy:
□ reduce BP/blood lipids (i.e. beta blockers/statins)
□ decrease & regulate heartbeat (digoxin)
□ relieve angina (nitrates class of drugs) - used sublingual - placed under the tongues, dissolve rapidly
prevent or dissolve blood clots (anticoagulants)
CVD treatment options - angioplasty?
balloon on tip of the cardiac catheter
□ inflated to compress fatty deposits
opens artery – increases blood flow
CVD treatment options - percutaneous coronary intervention (PCI)?
□ angioplasty with stent
- “through the skin” coronary intervention
Angioplasty with stent – stent remains and functions like a balloon for a longer period of time
CVD treatment options - pacemaker?
□ surgical implantation of the device
▪ regulates heart rate and rhythm
CVD treatment options - thrombolysis?
reperfusion therapy
□ immediate treatment for blocked artery
□ injection of medication (tPA) to dissolve blood clot
▪ restore blood flow® and prevent or reduce tissue damage
· ideally administered within 1-3 hours of event (<12 hours)
· Is an anti coagulant
· Can inject medicine using catheter right at the blood clot site
CVD treatment options - major heart surgeries?
coronary bypass
□ section of blocked artery replaced with healthy blood vessel from patient’s leg, arm or chest - increased blood flow to heart muscle
valve replacement (open heart surgery)
□ damaged or poorly functioning valves replaced
▪ repair or minimally invasive procedures
heart transplant
□ heart replaced with a donor heart
▪ extended recovery, immunosuppressive therapy
- Taking own tissue does not require rejection medicine
Immunosuppressive therapy decreases chances of rejecting the new heart
What are some final thoughts on CVD?
· treatment trade-offs: surgery vs. other treatments
· prevention, detection and early intervention are key
□ reducing morbidity and mortality
· cardiac rehabilitation
heart-healthy lifestyle changes address risk factors
What is the survival measurement rate of cancer in Canada?
5 years
Canadian Cancer Statistic, 2021?
· prostate, breast, lung, colorectal
□ 46% of new cases
· 1 in 9 males will develop prostate CA
· 1 in 8 females will develop breast CA
· overall 5-year relative survival: 64%
· significant improvements: 1992-2021
· Some variability in this statistics
Male and Female cancer rates?
What is cancer?
- uncontrolled growth & spread of abnormal cells
- caused by: mutations in genes that regulate cell division
- mutations may be acquired (spontaneous errors, environmental exposures) or inherited
- dysregulation of cell cycle
· unchecked cell proliferation - malignant growths - tumour invades healthy tissue
□ disrupts the function of vital organs
· if cells break away from the primary site they can metastasize (travel to other parts of the body)
□ form secondary tumours
· carcinogenesis: the process of cancer development
· angiogenesis: formation of new blood vessels
What is the difference between Malignant and benign?
- tumor: abnormal mass of poorly differentiated cells:
- abnormal cells may be pre-cancerous
· benign: (not cancer) - local growth
· malignant: (cancer) - can metastasize
Different kinds of cancer?
Kinds of cancer- Carcinomas?
- metastatic disease, form solid tumours
- arise from cells that cover external, and internal body surfaces
- lung, breast, colon, bladder, prostate
Kinds of cancer- Sarcomas?
- metastatic bloodstream, solid tumour
- arise from cells found in supporting tissues of the body
bone, cartilage, fat, connective tissue, muscle
- arise from cells found in supporting tissues of the body
Kinds of cancer- Lymphomas?
- solid tumour, palpate
- arise in the lymph nodes and tissues of the immune system
Kinds of cancer- Leukemias?
- abnormal white blood cells, non solid tumors
cancers of the immature blood cells that grow in - the bone marrow - tend to accumulate in large #’s in bloodstream
What are cancer risk factors?
· most cancers result from a complex mix of multiple risk factors:
· Genetic predisposition is not considered a key factor for triggering factors – present itself, but only 5% overall
· Aspartame – artificial sweetener
False – cell phone use, hair dyes, and aspartame intake are known to cause cancer Iatrogenic infection
What is the most important risk factor according to Canadian cancer statistics, 2021?
Age
teady increase in incidence throughout adulthood
* > 50 y: 90% of new cases, 96% of cancer deaths
* Why is age a risk factor?
* Exposure to cancer-causing substances (carcinogens)
* Immune system becomes weaker with age
What are lifestyle factors associated with cancer?
· Healthy lifestyle is associates with significant risk reduction
· Body weight control – 33% preventable
weight, diet, physical activity, smoking and alcohol
Lifestyle factors associated with cancer - Diet?
· Red/processed meat, salt, and alcohol increased risk
□ e.g. sodium nitrates → nitrosamines
* added sugars/dietary fat → weight gain
veggies/fruits, fibre = protective effect
Lifestyle factors associated with cancer - Physical activity?
- regular PA risk increased
□ promotes GI, increased immune function,
healthy bodyweight
Lifestyle factors associated with cancer - weight?
overweight/obesity increased risk
□ effect on hormones, inflammation
increased risk of mortality
Lifestyle factors associated with cancer - smoking?
· associates with many forms of CA
□ leading cause of lung CA(80-90%)(NCI, 2019)
□ most common form of CA in Canada AND leading cause of cancer deaths (26%) (CCS, 2019)
· contain ~70 carcinogenic chemicals
increased risk (20-30%) associated with second-hand smoke
Lifestyle factors associated with cancer - alochol?
- alcohol is a known carcinogen
□ associates with many forms of CA
Multiple mechanisms
How are genetics associated with cancer?
- genetic inheritance
□ accounts for ~ 5-10% of cancers - inheritance of gene mutation
□ increases susceptibility
□ e.g. breast cancer, colorectal cancer
those who develop cancer based on genetic predisposition tend to develop it at an earlier age
Environmental exposures associated with cancer?
- Environmental contaminants:
□ toxic substances in air, water, soil
□ natural or manufactured
□ examples: asbestos, arsenic, formaldehyde
□ risk associates with level of exposure & duration - Ionizing radiation
□ e.g. x-rays, ultraviolet rays
□ associates with DNA damage
e.g. UV-B and skin cancer
Infectious agents associated with cancer?
· accounts for 17% of cancers worldwide
□ 7% in developed countries
· mechanisms:
□ Chronic inflammation, immune suppression, DNA damage
· examples:
□ human papilloma virus (HPV) ® cervical cancer
□ Hepatitis B, C ® liver cancer
Helicobacter pylori ® stomach cancer
Medical Cancer treatments?
· Diethylstilbesterol (DES) - ~1940-1971
□ used to control bleeding during pregnancy and reduce risk of miscarriage, premature labor
□ Increased risk of reproductive cancers, problems with fertility and pregnancy in daughters (NCI, 2011)
* Hormone replacement therapy
□ estrogen & progesterone
□ Increased risk of breast, ovarian, endometrial cancer
* Some chemotherapy treatments
Increased risk for other cancers e.g. leukemia, lipomas
What are some cancer prevention behaviours?
lifestyle behaviours:
· healthy eating
□ limit red meat, sodium
□ avoid processed meat
□ plant-based diet
□ limit alcohol intake
· regular PA
· healthy body weight
· no smoking
· sun protection
· ↓ infectious disease risk
immunization, safe sex
significant risk reduction (primary risk)
What is cancer prevention strategies?
- Self-exams and cancer screening
- early detection → early intervention
□ Secondary/tertiary prevention
· significant impact on disease progression
· ↓ morbidity and mortality
□ e.g. skin, colon, prostate, testicular, cervical and breast
Caught cancer and early treatment
Self-exams?
skin check
- A - asymmetry
- B – border irregularity
- C – color is not uniform
- D – diameter > 6mm
- E – evolving, is it changing over time?
breast self exam
· become familiar with look and feel - monthly
□ lumps, dimpling, swelling, redness, changes in nipple
testicular self exam - monthly unusual lumps, markings
· Recommends done in a lay down position
· Hot shower before testicular self exam, common age 17-34. See if something unusual happening. Painless, enlargement, thickening of the tissue.
Multiple section just like slices of oranges
When to seek medical attention?
What are the different types of cancer screening?
- breast:
- Mammography, genetic testing
- colorectal:
- NEW: fecal immunochemical test (FIT)
- colonoscopy
- prostate:
- Rectal exam
- Prostate-specific antigen (PSA)
- cervical:
· Pap test - Genetic CA 1 or CA 2- common test for young women or women who do have a breast cancer family history
- FIT – looking for blood cells in the stool that should not be there
- Prostate (only for men)
Cervical – delayed until women patient is sexually active
What are cancer diagnostic procedures?
- screening tools also used for diagnostics
- in addition:
- biopsy
○ Removal of tissue - examined by pathology - Diagnostic imaging
○ MRI, CT scans
□ tumor location, size, shape
□ Metastases
Biopsy, needle (take out a small sample of lipid, if able good sign, if not, bad sign)
- biopsy
What is cancer staging/grading?
- staging: extent of disease at diagnosis
- T: how large is the tumor?
- N: have cancer cells spread to regional lymph nodes?
- M: has cancer spread to other parts of body? (metastasis)
- grading: other important tumor characteristics
Stage 0 (in-situ): non-invasive
Stages 1-4: invasive
Cancer treatments - surgery?
- removal of the tumour
- Surrounding tissue
goal: - Clear margins
- Leave no irregular cells behind
- Surrounding tissue
Cancer treatments - chemotherapy?
- destroy cancer cells, prevent growth,
- prevent angiogenesis
- target cells dividing rapidly
- collateral damage → side-effects
- usually 4-8 treatments over 3-6 months
- adjuvant vs. neoadjuvant
what’s ahead? - Targeted therapies
○ less toxic to healthy cells
○ fewer side effects
Shrink cancer cells
- adjuvant vs. neoadjuvant
Cancer treatments - radiation?
- Radiation
- Most effective in treating localized tumours
- Destroys malignant cells
- Local damage of healthy cells (side effect)
· Often requires daily treatments over 4-6 weeks
· May radiate larger areas - E.g. whole brain radiation
· New “surgical” techniques
Stereotactic radiosurgery increase precision - new surgical technique (not actually surgery, very targeted and emerging)
What is life after cancer?
· Cancer diagnosis less threatening/isolating today
- Increased public awareness and improved prognosis
· During active treatment
- Improved medical car, education, support groups
· Growing population of cancer survivors
· Need for ongoing rehabilitative and support services
- Effects of treatment- increased morbidity
- Managing risks for recurrence of disease
Emotional support -outside “circle of care”
