Patho Flashcards
Hormones travel In the BLOODSTREAM throughout the body.
Endocrine cells secrete hormone into the blood stream
Know
____ ___ associated disorders
Decrease in NUMBER of receptors
Impaired receptor functions
Presence of ANTIBODIES
Surface receptor
___ disorders
Acquired disorders in the post receptor signaling cascades.
Inadequate synthesis of a second messenger
Target cell response problem
Intracellular disorders
Diseases of the ANTERIOR PITUITARY
HYPOPITUITARISM- absence of SOME pituitary hormones or the complete failure of ALL pituitary hormone functions
Causes:
Pituitary INFARCTION Sheehan's syndrome is a condition that affects women who lose a life-threatening amount of blood in childbirth or who have severe low blood pressure during or after childbirth, which can deprive the body of oxygen. Hemorrhage Shock Head trauma (TBI) Infections and tumors
Know
Diseases of the anterior pituitary
PAN HYPOPITUITARISM
ALL pituitary hormones are low, and the individual suffers from multiple complications ACTH deficiency TSH deficiency FSH & LH deficiency GH deficiency ADH deficiency
Know
___ is commonly caused by A slow growing pituitary adenoma. has symptoms of headache and fatigue, visual changes, weakness, weight loss, muscle and soft tissue wasting, personality changes
HYPOPITUITARISM
Diseases of ANTERIOR PITUITARY ____ is a hyper secretion of growth hormone during adulthood*
Manifestations:
Enlargement of bones and face, hands and feet, protruding forehead and jaw.
Acromegaly
Diseases of the ANTERIOR PITUITARY
____ of ____
Caused by PROLACTINOMAS
Manifestations:
In Females: amenorrhea (no ovulations or periods) galactorrhea (milk secretion) hirsutism (hair growth) and osteopenia (bone loss)
In males: hypogonadism (small testes) and erectile dysfunction
Hypersecretion if PROLACTIN
DISEASES OF POSTERIOR PITUITARY
____ is hypersecretion of ADH
Causes: head trauma, circulatory damage
Manifestations: enhanced renal water retention, serum hyponatremia, serum hypo osmality, decreased urinary output, concentrated urine.
SIADH syndrome of inappropriate anti diuretic hormone secretion
___ is a hormone that increases collecting duct In the kidney nephron permeability to water, which increases absorption of water in the kidney which leads to dilutional hypoatremia
ADH
Diseases of the POSTERIOR PITUITARY
___ ___ is insufficiency of ADH- causing loss of too much water in urine.
Manifestation:
Polyuria, nocturia, continuous thirst
Diabetes insipidus
Diseases of POSTERIOR PITUITARY
TYPE OF DIABETES INSIPIDUS
__ insufficient secretion of ADH
Neurogenic (central)
Diseases of POSTERIOR PITUITARY
TYPE OF DIABETES INSIPIDUS
____ Is inadequate response of kidney tubules to ADH
Nephrogenic
Alterations of thyroid function
___ has a high T3 and T4, a low TSH and TRH.
Manifestations: like sympathetic NS stimulation, exothalamos-Bulging of the eyes, which causes the eyes to move out of the sockets in one or both eyes.
Hyperthyroidism
Alterations of thyroid function
has a high T3 and T4, a low TSH and TRH.
___ ___ is hyperthyroidism from TSH receptor antibodies, leads to nodular thyroid disease, eventually hypothyroidism
Treatment is thyroid destroying meds, surgery, iodine isotopes
Graves’ disease
Alterations of thyroid function
has a high T3 and T4, a low TSH and TRH.
__ ___ can lead to death within 48 hours without treatment.
Manifestations:
Fever, tachycardia, sweating, psychosis
Thyrotoxic crisis (thyroid storm)
Alterations of thyroid function
Deficient production of thyroid hormones T3, T4 by the thyroid.
___ ___ is a decreased T3 and T4, high TSH & TRH
Primary hypothyroidism
Alterations of thyroid function
___ ___ is the most common cause of primary hypothyroidism
Autoimmune disease causing gradual destruction of thyroid tissue.
Treatment: hormone replacement
Hashimoto disease
Hypothyroidism Low T3,T4 Low metabolic rate Present with endemic goiter Pale, cool, with edema. Cold intolerance No change with eyes Bradycardia, enlarged heart Lethargic, slow intellectual functions Some weight increase with decreased appetite
Hyperthyroidism High T3,T4 High metabolic rate Present goiter with Graves’ disease Flushed and warm Heat intolerance Exophthalmos with graves Tachycardia increased BP Restlessness, nervous, tremors Thin but increased appetite
Alterations of thyroid function
__ ___
Most common endocrine malignancy. Ionizing radiation most common cause.
Treatment with thyroidectomy, suppression therapy, radiation, and chemotherapy, hormone replacement
Thyroid carcinoma
Alterations of the parathyroid function
___ is increased secretion of parathyroid hormone.
Manifestations: hypercalcemia and hyperphosphatemia.
Hyperparathyroidism.
Alterations of the parathyroid function
Hyperparathyroidism is increased secretion of parathyroid hormone.
Manifestations: hypercalcemia and hyperphosphatemia.
___ is excess secretion of PTH from one or more parathyroid glands
Primary
Alterations of the parathyroid function
Hyperparathyroidism is increased secretion of parathyroid hormone.
Manifestations: hypercalcemia and hyperphosphatemia.
__ is increase in PTH secondary to chronic hypocalcemia
Secondary
Type ___ diabetes Mellitus has loss of beta cells, hyperglycemia when 80-90% of cells lost. Macrophages, T and B Lymphocytes and t natural killer cells are stimulated and result in beta cell destruction and apoptosis. Lack of insulin, amylin, excess glucagon lead to hyperglycemia.
Type 1
Type __ diabetes rages from INSULIN RESISTANCE with RELATIVE INSULIN DEFICIENCY to insulin secretory defect with insulin resistance and is caused by GENETIC ENVIORNMENTAL INTERACTION
Risk factors are ** age, obesity, hypertension, physical activity, and family history.
Metabolic syndrome
Type 2
Type ___ diabetes is the destruction of Beta cells related to genetic susceptibility and environmental factors.
Immunologically mediated destruction of beta cells
Manifestations
Hyperglycemia Polydipsia Polyuria Polyphagia Weight loss Fatigue
Type 1
Type __ diabetes manifestations:
Fatigue, recurrent infections, visual changes, neuropathy, weight loss, hyperinsulinemia
Type 2
Acute complications of diabetes mellitus
Hypoglycemia
Diabetic ketoacidosis
Hyperosmolar hyperglycemic non ketotic syndrome dangerous condition resulting from very high blood glucose levels. HHNS can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes.
Know
____ _____ is onset over 4-10 hours. Lack of insulin, GI upset, Febrile illness. Breath has a fruity smell, kussmaul respiration’s, hypotension, thirsty, dehydration, high blood sugar, hyperkalemia,
Need to hydrate, insulin, electrolyte replacement
Diabetic ketoacidosis
Types of diabetes
___ __ ___ ___ beta cell function or insulin action affected by autosomal dominant mutations
Maturity onset diabetes of youth (MODY)
Type of diabetes
__ ___ ___ is any degree of glucose intolerance with onset or first recognition during pregnancy
Gestational diabetes mellitus (GDM)
Chronic complications of diabetes mellitus
TOXIC EFFECTS OF GLUCOSE
MACROVASCULAR DISEASE
INFECTIONS
HYPERGLYCEMIA
MICROVASCULAR DISEASE
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Disorder of adrenal cortex
___ disease is autoimmune of ADRENAL CORTEX
** not enough corticosteroid and mineral corticosteroid; need to ADD some more
Manifestations:
Bronze pigmentation of skin, changes in distribution of body hair, GI disturbances, weakness, weight loss, postural hypotension, hypoglycemia
Addison’s disease
Disorders of adrenal cortex
__ is high estrogens, development of female secondary sex characteristics
Feminization
___ is high androgens, development of male secondary sex characteristics
Virilization
Disorders or the adrenal medulla:
HYPER
adrenal medulla hyperfunction
Caused by tumors
Secrete CATECHOLAMINES on a continuous or episodic basis.
Pheochromocytoma (tumor)
Know
Lower bladder urinary tract obstruction types
Anatomical obstructions:
Enlarged prostate, prolapsed uterus, stricture or the urethra, low bladder wall compliance (stretch) blockage of urethra or lower bladder.
Symptoms: frequent voiding, nocturia, urgency, unable to empty, intermittent stream, poor force.
Overactive bladder syndrome
Contractions of bladder wall.
Symptoms: urgency, leaking, frequency crampy pain with no urinary tract infection.
Know
Normal bladder has a detrusor muscle contracting when bladder is full.
Overactive bladder is detrusor muscle contracting before bladder is full.
Know
Stages of urinary tract infection
- ___ is where pathogens colonizes the urethra and ascends towards the bladder
Colonization
Stages of UTI
- ___ is where pathogen penetrates bladder and bacteria replicates, potentially forming biofilms.
Uroepithelium penetrati
M
Stages of a UTI
- ___ is where bacteria ascends towards the kidneys via the ureters.
Ascension
Stages of UTI
- __ is where infection of the renal parenchyma causes an inflammatory response called pyelonephritis
Pyelonephritis
Stages of UTI
- __ ___ ___ is where bacteria continues to cascade up to the kidneys, leading to acute kidney injury
Acute kidney injury
___ __
Risk factors: urinary stasis due to (?)
Most common pathogens: e coli (bowel) and staphylococcus saprophyticus
Manifestations: frequency, urgency, dysuria, suprapubic and low back pain. RBC & WBC In urine.
Treatment is antibiotics hydration and avoid stasis.
Acute cystitis
__ __ is unpleasant sensation with lower urinary tract symptoms for more than 6 weeks with no infection or other causes.
Treatment; avoid triggers (foods), anti inflammatory meds, anti histamine, steroids.
Interstitial cystitis
__ ___ is infection of upper urinary tract (ureter, renal pelvis, and interstitium
Pathogens: E. coli, proteus, pseudomonas
Risk: cystitis, stasis/obstructions, general risk for infections (diabetes)
Manifestations: cystitis symptoms, plus fever, back pain, especially “CVAT”
Treatment: relieve stasis, antibiotics, hydration, pain meds, and fever reducers as needed.
Acute pyelonephritis. Oh
__ ___ persistent or recurring episodes of acute pyelonephritis that lead to scarring in one or both kidneys.
Chronic pyelonephritis
__ is a inflammation of the glomerulus, can be primary or secondary. Immune mechanisms are main component of primary and secondary injury.
Glomerulonephritis
Two major symptoms of glomerulonephritis if severe,
Hematuria with red blood cell casts.
Proteinuria exceeding 3-5 g/day with albumin (macroalbuminuria) as the major protein.
Know
__ ___ obstructs renal blood flow: decreased GFR, obstructs glomerular capillary blood flow and decreases GFR.
Loss of filtration barrier and escape of albumin.
Obstruction and loss of tubular reabsorption functions
Diabetic glomerulopathy
__ ___ is a characteristic of glomerulonephritis. Excretion if 3.5G or more of protein in urine per day. The protein excretion is caused by glomerular injury.
Findings: hypoalbuminemia, edema, hyperlipidemia, lipiduria, vitamin d deficiency, hypothyroidism
Nephrotic syndrome
Classification of kidney dysfunction
Renal insufficiency
Acute kidney injury
Kidney failure
End stage kidney disease
Know
___ ___ ___ is from renal insufficiency, kidney failure, and end stage kidney failure
Acute kidney injury
___ ___ __ is a sudden decline in kidney function with a decrease in glomerular filtration and accumulation of nitrogenous waste products in the blood as demonstrated by an elevation in plasma creatinine and blood urea nitrogen BUN levels
Acute kidney injury
AKI-Pre renal.
Most common cause of AKI
Caused by impaired renal blood flow
Glomerular filtration rate (GFR) declines because of decrease in filtration pressure
Know how’s
____ is most commonly caused by acute tubular necrosis.
Intrarenal (intrinsic)
___ occurs with urinary tract obstructions that affect the kidneys BILATERALLY
Postrenal
AKI OLIGURIA
mechanisms: decrease in renal blood flow. Tubular obstruction, tubular backleak.
Duration depends on duration of ischemia and severity of injury.
Know
AKI PHASES AND RECOVERY
Initiation: kidney injury is evolving. Prevention of injury is possible.
Maintain oliguric: Established kidney injury: urine output is lowest
Serum creatinine and blood urea nitrogen both high
Recovery (polyuric) injury repaired and normal renal function reestablished. Diuresis is common. Decline in serum creatinine and urea. Increase in creatinine clearance.
Know
Chronic kidney disease
5 stages
Normal: (GFR>90 ml/min)
Mild (GFR 60-89 ml/min)
Moderate: (GFR 30-59 ml/min)
Severe: (GFR: 15-29 ml/min)
End stage: (GFR less than 15)
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CKD progression.
Factors in advanced renal disease:
Proteinuria & angiotensin II activity.
Poor creatinine and urea clearance from blood.
As GFR falls plasma creatinine increases.
Know
CKD effects on fluids and electrolyte balance.
Sodium and water balance: sodium excretion increases with obligatory water secretion leading to sodium deficit and volume loss. Kidneys ability to concentrate or dilute urine decreases.
Potassium: tubular secretion of K increases early lowering serum K. Once oliguria sets in, potassium retained; serum potassium goes UP.
Acid base balance: metabolic acidosis when GFR 20%-25% and can not secrete H+ of reabsorb bicarb
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3 affects of CKD
Calcium, phosphate, and bone Vitamin D.
Protein, CHO, fat metabolism change
Anemia (low hematopoietin)
Know
CKD MANIFESTATIONS
alterations seen in all systems
Cardiovascular Pulmonary Hematologic Immune Neurologic Gastrointestinal Endocrine and reproduction Integumentary
Know
__ ___ called nephrolithiasis, calculi, or urinary stones.
Risk factors: gender, age, race, geographic location, seasonal factors, fluid intake and diet: occupation. Genetic predisposition.
Classified by the minerals that make up the stone.
Kidney stones
Why do kidney stones form:
Supersaturation of one or more salts: presence of salt in a higher concentration with a fluid (urine) than the volume is able to dissolve to maintain equilibrium.
Precipitation of a salt from liquid to solid state:
Temperature and pH of urine. An alkaline urinary pH increases risk of stone formation.
Growth into a stone via crystallization or aggregation: crystals grow from a small nidus (nucleus) to larger stones in the presence of a super saturated urine
Know
Types of stones:
Calcium oxalate or calcium phosphate 70-80%- calcium oxalate
Struvite stones- 15% infection
Uric acid stones 7%
Know
Kidney stones:
Manifestations: renal colic; pain related to dilation and spasms
Evaluation: history, stone and urine analysis 24-hour urine, strain all urine. Imaging.
Treatment: high fluid intake. Decrease dietary intake of stone forming substances. Stone removal.
Know
Neuro anatomy of pain:
Nociception: activation of pain perception.
Nociceptors: free nerve endings in skin, muscles, joints, arteries, and viscera. Detect wide range of stimuli: chemical, mechanical, thermal. Two types of nerve fibers to spinal cord: a delta myelinated fibers (new, localized, and fast.)
Unmyelinated C polymodal fibers (old, diffuse, and slow)
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Sequence of pain perfection
Transduction: activation of nociceptors.
Transmission: nerve fiber conduction to dorsal horn and up spinal cord.
Perception: interpretation in the brain
Modulation: facilitation or inhibition of transmission before, during, or after perception
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Mechanisms of pain:
___ properly functioning nervous system sends signals that tissues are damaged requiring attention and care.
Nociceptive
Mechanisms of pain
___ damaged or malfunctioning nerves, also called pathological pain.
Neuropathic
Mechanisms of pain
Nociceptive: somatic (body pain) and visceral (gut) pain.
Neuropathic: peripheral neuropathies and central neuropathic pain.
Know
How to describe pain:
Pain threshold: point at which stimulus is perceived as pain.
Perceptual dominance: pain at one location may cause an increase in pain threshold in another location.
Pain tolerance: duration of time or the intensity of pain that a person will endure before initiation of pain responses
Know
__ __
Protective mechanism- alerts to a condition or experience that is immediately harmful.
Transient
Begins suddenly
Relieved after pain stimulus removed.
Acute pain
___ pain is from skin, joints, muscles. A-delta fibers: sharp and well localized. C-fibers: dull, aching,. Poorly localized
Somatic pain
__ pain is internal organs and lining of body cavities.
C fibers: poorly localized, aching, gnawing, throbbing, or intermittent cramping quality:
Often radiates or is referred
Visceral pain
Acute pain- REFFERRED
pain felt distant from its point of origin
Area of referred pain is supplied by the same spinal segment as site or origin
Know
___ pain is constant or intermittent. Sudden onset, or develops insidiously. Lasts at least 3-6 months. Response patterns very. Significant behavior and psychologic changes. Do NOT see psychologic signs like acute pain.
Chronic painless
Temp varies in response to
Location Activity Environment Circadian rhythm Gender Age
Know
Temperature regulation
Peripheral and central thermoreceptors, hypothalamic control, heat protection and conservation.
Chemical reactions of metabolism, skeletal muscle contractions, chemical thermogenesis, vasoconstriction, shivering, voluntary mechanisms
Knowi
Heat loss
Radiation Conduction Convection Evaporation Vasodilation Decreased muscle tone Increased respiration’s Voluntary measures Adaptation to warmer climates
Know
Age and temperature
Infants: produce sufficient body heat but are unable to conserve heat produced.
Small body size and high body surface to weight ratio. Thin subcutaneous layer.
Elderly: slow blood circulation, vasoconstrictive response, and decreased metabolic rate. Decreased sweating, shivering, and perception of heat and cold
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Fever:
Temporary resetting of the hypothalamic thermostat.
Active heat production and conservation measures to a new sent point
Exogenous pyrogens
Endogenous pyrogens
Fever of unknown origin
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Benefit of fever
Kills many micro organisms. Decrease serum levels of iron, zinc, and copper needed by germs.
Promotes lysosomal breakdown and auto destruction of cells
Increases lymphocytic transformation and phagocyte motility
Increases antiviral interferon production and phagocytosis
Know
__. Is elevation of the body temperature without an increase in the hypothalamic set point. Can produce nerve endings, coagulation or cell proteins, and death.
Many be therapeutic, accidental, or associated with stroke or heat trauma.
Hyperthermia
___ __ is inherited muscular disorder.
Precipitated by inhaled anesthetics and neuromuscular blocking agents.
Causes uncoordinated muscle contractions
Increased oxygen consumption and lactic acid production
Symptoms include absent reflexes, fixed pupils, apnea and flat ECG
Malignant hyperthermia
Other reactions to hyperthermia
Heat cramps
Heat exhaustion
Heat stroke
Know
Heat cramps
Severe spasmodic cramps in the abdomen and extremities
Following prolonged sweating and associated sodium loss
Common in individuals not accustomed to heat or those performing strenuous work in warm climates
Hyperthermia, rapid pulse, and increased blood pressure often accompany the cramps
Know
Heat exhaustion
Cause: prolonged high core or environmental temps
Profound vasodilation and profuse sweating causes;
Dehydration and low plasma volumes
Low bp, rapid pulse
Headache, fatigue, weakness, moist skin, anxiety, confusion, low fluid intake, high heat exposure, increased activity, low body temp.
Know
Heat stroke
Potentially lethal
Caused by overstressed thermoregulatory center
Brain cannot tolerate temperature greater than 104 F
Cardiovascular and thermoregulatory centers stop working
Temperature lowering mechanisms fall- no sweat
Anxiety-confusion. Skin hot and dry sodium and potassium depletion. Impaired sweating. Listlessness. High body temp, cerebral edema, seizures, delirium, coma, high pulse an RR rate
Management cooling, rest, electrolyte support, fluid
Heatstroke complications
Cerebral (brain) Edema Degeneration of the central nervous system Swollen dendrites Renal tubular necrosis Death
Know
__ is a body temp less than 35 C
Produced ice crystals, which form inside the cells, causing them to rupture and die.
Tissue hypothermia effects
Slows cellular metabolism
Increases blood supply viscosity, slows capillary flow
Facilitates blood coagulation, stimulates vasoconstriction
Hypothermia
___ hypothermia is used to slow metabolism and preserve ischemic tissue during surgery or limb reimplantation
May lead to ventricular fibrillation and cardiac arrest
Therapeutic Hypothermia
__ hypothermia is commonly the result of sudden immersion in cold water or prolonged exposure to cold
Accidental Hypothermia
Trauma and central fever
CNS trauma leads to central fever
Inflammation, increased intracranial pressure, intracranial bleeding. Does not induce bleeding, resistant to antipyretic therapy.
Accidental injuries
Hemorrhagic shock
Major surgery
Thermal burns
Know
Sleep:
Active, multiphase process
Hypothalamus is the major sleep center
Hypocretins promote wakefulness and REM sleep
Know
Sleep phases
— sleep
75-80% of sleep time.
Sympathetic tone decreased
Parasympathetic activity increased
Cerebral blood flow to brain decreases
NREM sleep
Sleep phases
__ sleep is 20-25% of sleep time
Also known as paradoxical sleep
Occurs every 90 mins beginning after 1-2 hours of sleep
REM no
Sleep disorders
___ is insomnia, obstructive sleep apnea syndrome, narcolepsy, circadian rhythm sleep disorder.
Dyssomnias
Sleep disorders
__ is somnambulism, night terror, restless leg syndrome, eating, violent behaviors
Parasomnias
___ is inability to fall or stay asleep:
Mild moderate or severe
Transient or chronic
Insomnia
Obstructive sleep apnea syndrome.
Most commonly diagnosed disorder
Risk factors: obesity, male, older
Total or partial upper airway collapse
Leads to chronic diseases like hypertension, diabetes, dysrhythmias
Hypersomnia, daytime sleepiness, accident risk.
Diagnosed with polysomnography
Treatment is CPAP, BIPAP, mouth appliance or surgery
Know
__ is a primary hypersomnia. Hallucinations, sleep paralysis, and rarely, cataplexy. Associated w immune mediated destruction of hypocretin secreting (orexin secreting) cells in the hypothalamus
Narcolepsy
Circadian rhythm sleep disorder
Causes:
Rapid time zone change. Alternating sleep schedule, advanced sleep phase disorder. Delayed sleep phase disorder.
Circadian rhythm desyncronized
Long term health consequences
Know
Common parasomnias:
Unusual behaviors occurring during NREM stage 3 sleep
Sleep walking Night terrors Rearranging furniture Eating food Sleep sex Violent behavior Restless leg syndrome
Manifested by loss of REM paralysis
Know
___ return blood to the heart, via vena cava, or pulmonary vein
They are Wide, thinner, and LESS MUSCULAR, have valves, and hold a lot of the circulating blood
Veins
___ veins are distended, tortuous, and palpable veins. Caused by trauma or gradual venous distention.
Varicose veins
Chronic venous insufficiency
Inadequate venous returned over a long period.
Due to varicose veins or valvular incompetence.
Venus stasis ulcers
Know
__ is attached to a vessel wall.
Thrombus
___ is a clot that is detached and floating
Thromboembolus
Three main factors promoting thrombosis (triad of virchow)
- Venous stasis.
- Venous endothelial damage
- Hyper coagulable states
Other: cancer, orthopedic surgery, heart failure
Know
Artery problems:
Hypertension and hypotension
Aneurysm
Thrombus and embolism
Peripheral vascular disease
Peripheral artery disease
Atherosclerosis
Coronary artery disease
Myocardial ischemia
Know
Blood pressure= hydrostatic pressure in arteries.
BP is determined by: how much fluid (blood), how wide or narrow hose, force of the pump (heart)
BP controls: arterial size (ANS), kidneys (RAAS), pituitary (ADH)
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Sympathetic:
Faster heart, narrow arteries.
Parasympathetic: slower heart, vasodilation.
Know
Kidney BP controls: renin angiotensin- aldosterone system
Know
___ hypertension is Essential or idiopathic hypertension. Genetic and environmental factors. Affects 92% to 95% of individuals with hypertension.
Silent but deadly
Primary
__ hypertension is caused by a systemic disease process that raises a peripheral vascular resistance or cardiac output
Kidney diseases
Adrenal tumors (sympathetic)
Drugs
Secondary
___ hypertension is damage to blood vessels and tissues leading to target organ damage.
Myocardial hypertrophy (enlarged heart, heart failure)
Complicated hypertension
Complicated hypertension
Heart (enlarged, failure)
Kidney (chronic failure)
Brain (hemorrhagic, stroke)
Eyes (retinal damage, blindness.)
Knowi
___ ___ rapidly progressive hypertension, systolic pressure >180 mm Hg and/or diastolic pressure >120 mmHg and is life threatening
Hypertensive crisis
___ ___ is a decrease in both systolic and diastolic blood pressure upon standing
Lack of normal blood pressure compensation in response to gravitational changes on the circulation (ANS, or low blood volume)
Acute or chronic
Orthostatic hypotension
__ is a blood clot that remains attached to the vessel wall
Thrombus
___ is a clot that breaks off, travels in the blood steam.
- Stasis (pooling of blood)
- Intimal (internal) vessel injury, inflammation
- Obstruction of flow
Embolus
Embolus types- not only blood clots
Dislodged thrombus Air bubble Amniotic fluid Aggregate of fat Bacteria Cancer cells Foreign substance
Know
Peripheral vascular disease
___ ___ is an auto immune disease of the peripheral arteries. Strongly associated with smoking: characterized by the formation of thrombi filled with inflammatory and immune cells. Causes pain, tenderness in the affected area: can often lead to gangrenous lesions and amputations.
Buerger disease or thromboangitis obliterans
___ __ is episodic VASOSPASM in arteries and arterioles of the fingers, less commonly of toes.
Raynaud phenomenon
Raynaud phenomenon
__ is vasospastic disorder of unknown origin.
Primary
Raynaud phenomenon
___ is secondary to other systemic diseases or conditions
Secondary
___ is thickening and hardening caused by accumulation of lipid laden macrophages In the arterial wall.
Plaque development from fatty streaks, takes decades.
Risk factors: diabetes, smoking, hyperlipidemia, dyslipidemia; hypertension and auto immunity
Atherosclerosis
Atherosclerosis progression
Inflammation of endothelium
Cellular proliferation.
Macrophage migration and adherence
LDL oxidation (foam cell formation)
Fatty streak
Fibrous plaque
Complicated plaque
Results with inadequate perfusion, ischemia, necrosis
Know
___ __ disease is atherosclerosis disease of arteries that perfuse limbs.
ESP lower limbs.
Same manifestations as atherosclerosis
Intermittent claudication
Pain with walking and gradual occlusion
Peripheral arterial disease
Peripheral arterial disease in lower extremities is also linked to coronary artery disease
___ __ disease is any vascular disorder that narrows or occludes the coronary arteries leading to myocardial ischemia
Atherosclerosis is most common cause
Primary cause of heart disease in the US
Coronary artery disease
Coventional risk factors for CAD
Non modifiable
Increased age, family history, male gender or post menopause.
Modifiable: Dyslipidemia Hypertension Cigarette smoking Diabetes and insulin resistance Obesity and sedentary lifestyle Atherogenic diet
Know
Non traditional factors for Coronary artery disease
Markers of inflammation and thrombosis Adipokines Chronic kidney disease Air pollution and ionizing radiation Certain medications Micro biome
CAD leads to myocardial ischemia
Know
___ ___ is local, temporary deprivation of the coronary blood supply. Myocardial cells become ischemic within 10 seconds. Cardiac cells remain viable for 20 mins under ischemic conditions. Most common cause- atherosclerotic plaques. Some plaques are unstable and may ulcerate or ruptur
Myocardial ischemia
Myocardial infarction
Sudden and extender obstruction of the myocardial blood supply
After 8-10 seconds of low blood flow the myocardium becomes cyanotic, 02 reserves are depleted, glycogen stores decrease and anaerobic metabolism begins, and lactic acid begins to accumulate
K, Ca, and Mg are lost from the cells.
The deprivation of 02 and nutrients leads to decreased pumping ability
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Myocardial infarction
Ischemia causes myocardial cells to release toxic catecholamines.
Norepinephrine elevates glucose levels
Angiotensin II is released causing peripheral vasoconstriction and fluid retention, increasing cardiac workload
Know
Myocardial infarction ending
Cellular death of heart muscle
Structural and functional changes
Myocardial stunning
Hibernating myocardium
Myocardial remodeling
Repair, scarring.
Know
Myocardial infarction
Manifestations:
Sudden, severe, chest pain; may radiate.
Nausea, vomiting, diaphoresis, dyspnea
Complications:
Sudden cardiac arrest due to ischemia, left ventricular dysfunction, electrical instability
Know
Conduction system of the heart
Pacemakers: cells that initiate signals
Sinoatrial node
Atrioventricular node
Bundle of his AV bundle
Right and left bundle branches
Purkinje fibers
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Cardiac action potentials
Resting membrane potential Depolarization Repolarization Hyperpolarization Refractory period
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Dysrhythmias
Disturbance or heart rhythm
Range of occasional missed or rapid beats to severe disturbances that reduce pump effectiveness
Causes: abnormal rate of impulse generation or abnormal impulse conduction
Know
Infective endocarditis
Inflammation of the endocardium
Agents: Bacteria Viruses Fungi Rickettsiae Parasites
Patho genesis:
Damaged endocardium
Blood borne micro organisms adherence
Proliferation of the micro organisms
Know
Infective endocarditis
Classic findings
Fever
New or changed cardiac murmur
Petechial lesions of the skin, conjunctiva and oral mucosa
Characteristic physical findings
Osler nodes
Jane way lesions
Other: weight loss, back pain, night sweats, and heart failure
Know I
___ ___ is a systemic inflammatory disease caused by a delayed immune response to pharyngeal infection by the group A B-hemolytic streptococci.
Febrile illness
Inflammation of the joints, skin, nervous system, and heart
If left untreated, may cause rheumatic heart disease
Can be prevented with antibiotic treatment for strep within first 9 days of infection
Rheumatic fever
Rheumatic fever common manifestations Fever Lymphadenopathy Arthralgia Nausea and vomiting and abdominal pain Tachycardia Epistaxis
Major manifestations Carditis Poly arthritis Chorea Erythema marginatum Subcutaneous nodules
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Mitral valve prolapse syndrome
One or both cusps of mitral valve billow upward into the left atrium during systole
Mitral regurgitation if blood leaks into atrium
Patients can be asymptomatic or have vague symptoms
Know
Heart failure
Heart is unable to generate adequate cardiac output
Inadequate perfusion of tissues
Increased diastolic filling pressure of left ventricle
Pulmonary capillary pressures increase
Know
___ __ is the amount of blood pumped by each ventricle in 1 min
Cardiac output
__ __ is the number of contractions of the ventricles each minute
Heart rate
___ __ is the amount of blood ejected from each ventricle with each contraction.
Stroke volume
HR times stroke volume equals Cardiac output
Know
Left heart failure
Systolic heart failure
Ejection fraction less than 40%
Inability of the heart to generate adequate cardiac output to perfuse tissues
Contractility is reduced
Falling cardiac output progressively worsens heart failure
Causes include MI, myocarditis, and cardiomyopathy
Know
Left heart failure
Diastolic heart failure
Pulmonary congestion despite normal stroke volume and cardiac output
Decreased compliance (filling) of the left ventricle and abnormal diastolic relaxation leading to increase left ventricle end diastolic pressure
Major causes include: hypertension induced myocardial hypertrophy and myocardial ischemia- induced ventricular remodeling, diabetes, valvular, and pericardial disease
Know
Right heart failure
Inability of right ventricle to provide adequate blood flow at a normal venous pressure.
Can result from an increase in left ventricular filling pressure that is reflected back into the pulmonary circulation (left heart failure)
Most commonly caused by a diffuse hypoxic artery pulmonary disease
Results in
- Peripheral edema
- Hepatomegaly, hepatosplenomegaly, distended jugular veinsl
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High output failure
Inability of the heart to supply the body with blood borne oxygen and nutrients despite adequate blood volume and normal or elevated myocardial contractility
Causes:
Anemia; hyperthyroidism, septicemia, and beriberi
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Shock
Cardiovascular system fails to perfuse body tissues adequately
Leads to impaired cellular metabolism
Impaired oxygen use and impaired glucose use
Manifestations:
Feeling weak, cold, hot, confused, afraid, thirsty; short of breath. Hypertension, tachycardia, increased RR
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Types of shock:
Cardiogenic: heart failure
Hypovolemic: insufficient intravascular fluid volume
Neurogenic: neural alterations of vascular smooth muscle tone
Anaphylactic: immunologic processes
Septic: infection.
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Neurogenic shock
Imbalance between sympathetic and parasympathetic stimulation
Massive vasodilation Low vascular tone Low SVR Inadequate cardiac output Low tissue perfusion Impaired cellular metabolism
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Liver
Insulin- like growth factor somatomedin angiotensinogen, angiotensin, thrombopoietin
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Duodenum
Secretin
Cholecystokinin
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Kidney
Renin
Erythropoietin
Calcitriol
Thrombopoietin
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Stomach: Gastrin Ghrelin Neuropeptide Y Somatostatin Histamine Endothelin
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Pancreas
Insulin
Glucagon
Somatostatin
Pancreatic polypeptide
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Adrenal glands
Glucocorticoids
Mineralocorticoids
Androgens
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Adrenal medulla
Adrenaline
Noradrenaline
Dopamine
Erikephalin
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Mechanisms for high hormone levels
Failure of feedback systems
Dysfunction of an endocrine gland
Hormone secreting cells can not produce
Endocrine gland makes or releases too much hormone
Increased hormone degrading or inactivation
Ectopic hormone release (cancer cells)
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Surface receptor associated disorders
Decrease in number of receptors
Impaired receptor function
Presence of antibodies
Intracellular disorders:
Acquired disorders in post receptor signaling cascades, inadequate synthesis of a second messenger. Target cells response problem
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Diseases of the anterior pituitary
Hypo pituitarism
Absence of some pituitary hormones or the complete failure of all pituitary hormone functions
Causes: Pituitary infarction Sheehan syndrome Shock Head trauma infections Tumors
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___ puberty is onset of clinical signs of puberty before age 8.
Delayed or absent puberty is no menses by 16.
Delayed puberty is normal in most causes
Abnormal cases caused by disruption of hypothalamic pituitary gonadal axis (hormone release) or systemic disease
Precocious we
Hormonal and menstrual alterations: dysmenorrhea
Cheri symptoms is pelvic pain associated with onset of menses
NSAIDS for pain, anti prostaglandin
May be relieved with hormone contraceptives
Primary dysmenorrhea is painful mensuration associated with ovulatory cycles
Secondary dysmenorrhea is related to pelvic pathology (other reasons) may occur any time in the menstrual cycle
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___ ___ is painful menstration associated w ovulatory cycles
Primary dysmenorrhea
__ ___ is related to pelvic pathology (other reasons) and may occur any time in the menstrual cycle
Secondary dysmenorrhea
__ ___ is failure or menarche and absence of menstration
Primary amenorrhea
___ ____ is absence or menses after previous menstrual period
Common In early adolescence, pregnancy, lactation, and during peri menopause
Associated with thyroid disorders; hyperprolactinemia, excessive stress or weight loss, and poly cystic ovary syndrome
Pregnancy must be ruled out before any further eval
Secondary amenorrhea
Hormonal and menstrual alterations: abnormal uterine bleeding:
Bleeding that is abnormal in duration, volume, frequency, or regulatory and present for 6 months
Excessive bleeding can lead to iron deficiency anemia and associated symptoms
Treated with NSAIDs, oral hormonal contraceptives, levonorgestrel intrauterine device, ablation, hysterectomy
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poly cystic ovarian syndrome:
Two of the following
Irregular ovulation/menses
Elevated levels of androgens
Multiple cysts identified within the ovaries on ultrasound
Associated with genetic predisposition and obesity
Insulin resistance
Excessive insulin and androgens
Treated with oral contraceptives, metformin
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Premenstrual syndrome and premenstrual dysphoric disorder
Cyclic physical, psychologic, or behavioral changes that impair interpersonal relationships or interfere with usual activities.
PMDD considered a severe sometimes disability extension of PMS
multiple therapies to explain causes/symptoms
Hormones
Genetics
Symptomatic treatment
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Pelvic inflammatory disease
Acute inflammatory process caused by infection
May involve any organ of the upper general tract
Salpingitis
Oophoritis
STD migrate from vagina to upper genital tract
Associated with multiple sexual partners, previous PID, douches, IUD for birth control
Symptoms often vague
Rapid empiric treatment to prevent complications
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___ inflammation of Fallopian tubes
Salpingitis
___ inflammation of ovaries
Oophoritis
___ is irritation/inflammation infection of the vagina.
STD overgrowth of normal flora; and irritation, caused by low estrogen levels
Acidic nature of the vagina provides some protection
Maintained by cervical secretions and normal flora
Altered by douching, soaps, spermicides, hygiene sprays, deodorized pads/tampons, pregnancy, diabetes:
Treatments to develop and maintain acidic environment, administration of anti microbials or anti fungals; symptom relief
Vaginitis
___ ___ is where the bladder, urethra, and rectum are supported by the endopelvic fascia and perineal muscles
The muscular and fascial tissue loses tone and strength with aging
Falls to maintain organs in proper position
Associated with aging, childbirth, obesity, and hysterectomy
Organ prolapse
___ is benign tumors of smooth muscle cells in the myometrium.
Cause abnormal uterine bleeding, pain, and symptoms related to pressure on nearby structures
Benign growths
___ is a benign growth, presence of functioning endometrial tissue or implants outside the uterus:
Responds to hormone fluctuations of the menstrual cycle.
Highly associated with infertility
Dyschezia (pain in defecation) hallmark symptom
Treatment to prevent progression, alleviate pain, and restore fertility
Endometriosis
___ ___ is almost always caused by HPV infection.
Causes high grade dysplasia and cancer
Risk factors: include multiple sex partners, young age at first sexual intercourse, high parity, immunosuppression, oral contraceptives, use of nicotine
Progresses slowly; normal cervical epithelial cells to dysplasia to carcinoma in situ and eventually invasive cancer
Cervical cancer
Ovarian cancer
Risk reduced by factors that suppress ovulation
Benign and malignant tumors come from each of three ovarian cell types
Usually no early symptoms
Advanced cancer when caught
Surgery to remove tumor
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Sexual dysfunction
Lack of satisfaction with sexual dysfunction from pain or a deficiency in sexual desire, arousal, or orgasm/climax
Organic and or psychosocial
Dyspareunia- pain at any time from the beginning of arousal to after intercourse
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Infertility
Inability to conceive after 1 year of unprotected intercourse
Ovulatory disorders account for about 40% if female infertility
Initial work up include semen analysis, determination of ovulation, and hysterosalpingography of the Fallopian tubes
Tx: aimed toward correction of problems identified
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Benign breast disease
Spectrum of non cancerous changes in breast
Most common symptoms are pain, palpable mass, or nipple discharge
Broadly classified as breast lesions or lumps
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Risk factor for breast cancer
Menopausal hormone replacement therapy and breast cancer
Insulin and insulin like growth factors
Oral contraceptives combined with estrogen progesterone oral contraceptives
Radiation
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Risk factors for breast cancer
Physical activity:
Associated with reduced risk of breast cancer and improved cancer outcomes
May reduce invasive ness of breast cancer
Sedentary lifestyle may Increase risk
Increased insulin resistance
Inflammation
Decreased immune function
Risk increases with number or first degree realitives affected
Tumors stay small but metastasize early
70% of breast cancers
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Manifestations of breast cancer
Majority of carcinomas found in upper outer quadrant
First sign is painless lump Palpable nodes in axilia Dimpling or skin Orange peel appearance to skin Nipple inversion
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Urethritis
Inflammation of the urethra. Can be caused by a sexually transmitted disease
Nonsexual origins can be caused by urologic procedures, insertion of foreign objects, anatomic abnormalities or trauma:
Symptoms:
Urethral tingling, itching, or burning
Frequency and urgency with urination
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Urethral strictures
Narrowing of the urethra causing scarring
Commonly a result of trauma or untreated or severe urethral infection
Primary symptom is diminished force of urine upstream
Can result in hydronephrosis and renal failure if severe and prolonged
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___ is the inability to retract the foreskin from the glans of the penis (distal to proximal)
Frequently caused by poor hygiene or chronic infections
May require circumcision
Phimosis
__ is the inability to replace or cover the glans with the foreskin (proximal to distal)
Surgical emergency to prevent necrosis if severe
Paraphimosis
Disorders of the penis
Peyronie disease
“Bent nail syndrom”
Slow development of Fibrous plaques (thickening) in the erectile tissue. Causing a lateral curvature of penis during erection.
Occurs in Middle Aged men and causes painful erections and intercourse
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__ condition of prolonged penile erection
Urologic emergency
Priapism
___ __ is a benign tumor caused by HPV
Condyloma acuminatum
___ is abnormal dilation of the testicular vein and the pampinform plexus within the scrotum
Appearance is a bag of worms.
Commonly identified in infertile men. Usually found on left side and most develop in adolescence. Scrotal support if mild, surgery if severe
Varicocele
___ is scrotal swelling caused by collection of fluid
May be congenital or caused by infection, trauma, or torsion.
Diagnosed with transilumination
Hydrocele
___ is a benign cystic collections of fluid of the epididymis
Discrete form and freely mobile masses distinct from the testis
Usually painless
Spermatocele
___ failure of one or more of the testes to descend completely
Common congenital anomaly identified at birth or shortly after
Treated with hormonal therapy or surgery
Cryptorchidism
____ __ __ ___ the testis rotates or twists; restricting blood supply.
Painful swollen testes, condition may be spontaneous or follow physical exertion or trauma
Surgical emergency
Torsion of the testes
__ acute inflammation of the testes
Most are actually cases of inflammation of both the epididymis and testes
Sudden onset
High fever, erythema, edema, scrotal tenderness, and leukocytosis
Cause sterility if bilateral
Supportive treatment
Orchitis
Testicular cancer
Highly treatable usually curable
Prevalent among young and middle aged men.
Common first sign: painless testicular enlargement
Commonly misdiagnosed
Tx with surgery chemo and radiation
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Disorders of epididymis
Inflammation of epididymis
Usual cause is a sexually transmitted micro organism like gonorrhea or c trachomatis
Reaches the epididymis by ascending the vasa deferentia from an already infected urethra or bladder
Main symptom is scrotal or inguinal pain
Chemical epididymis is reflux of sterile trine into ejaculatory ducts
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Benign prostatic hyperplasia
Enlargement of prostate gland
Symptoms are associated with urethral compression
Relationship to aging
Evaluation is digital rectal exams
PSA
Treat with meds to shrink prostate
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Prostate cancer
Usually good prognosis even without treatment
Often dysmptomatic until advanced
Evaluation and treatment
Screening includes digital rental exam, PSA
Treatment depends on age and health of individual stage of neoplasm, and anticipated effects, no treatment, surgical treatment, radiation, hormone, or chemotherapy, immunotherapy
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Normal sexual response:
Sexual dysfunction is impairment of any or all of these
Factors: Vascular Endocrine/ hormonal Neurologic or psychologic disorder Chronic diseases Penile disease or trauma
Treatment both med and surgical
Correction of underlying disorders
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Infertility
Altered spermatogenesis, sperm abnormal or are produced in insufficient quantities
Can be affected by inadequate sperm motility
Variety of causes, many can be corrected hormonal disorders and temperature elevations
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___ is over development of breasts in males. Result from hormone alterations: idiotropic and systemic disorders, drugs or neoplasms.
Gynecomastia
Carcinoma is most common seen in after age 60. Tumors resemble carcinomas of the breast in women
Crusting and nipple discharge are common
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STI
Gonoccoccal infections
Bacterial vaginosis
Syphilis
Chlamydial infections
Viral source
Genitalia herpes
Scabies
Pediculosis pubis
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