Patho Exam 3 Flashcards
1
Q
cardiac specific protein not normally found in serum, released only when myocardial cell death has occurred
A
troponin
2
Q
reflects ventricular contraction, the cardiac work phase
A
systolic
3
Q
infection of the cardiac endothelium that most commonly affects the heart valves
A
endocarditis
4
Q
non-st segment elevation myocardial infarction; occurs when damage is not completely through the heart well, heart attack does not go through the myocardium
A
NSTEMI
5
Q
classification of MI based on ECG; ST segment elevation myocardial infarction; occurs because oxygen needs of the myocardium are not met
A
STEMI
6
Q
also known as electrical cardioversion, electrical shock that can restore a normal heat rhythm in cardiac arrest or ventricular arrhythmia
A
defibrillation
7
Q
durable blood clot
A
thrombus
8
Q
enzyme whose function is to regulate BP and filtration rate of the glomerulus
A
renin
9
Q
to choke: chronic chest pain that the pt has experienced in the past & feels similar to past episodes
A
stable angina
10
Q
a cardiac isoenzyme released & increased from dead myocardial cells
A
CPK-MB (creatine phosphokinase muscle/brain
11
Q
death of tissue as a consequence of prolonged ischemia
A
infarction
12
Q
chronic inflammatory disease affecting the arterial wall that’s caused by agents that damage the endothelial cells
Plaque build up on arterial wall
this is a common type of arteriosclerosis that develops from plaque buildup
A
atherosclerosis
13
Q
inadequate blood flow
A
ischemia
14
Q
the heart’s pumping action is restricted because of an accumulation of fluid surrounding it
A
tamponade
15
Q
pacemaker other than SA or AV node is initiating a contraction: ventricles are beating independently
A
premature ventricular contractions (PVCs)
16
Q
smooth, contagious surface of cells that blanket all the inner linings of the arteries
A
endothelium
17
Q
absence of coordinated, rhythmic atrial contractions: rate & rhythm are irregular… this is the most common arrhythmia and can cause thrombus formation so increased risk of stroke
A
AFIB (atrial fibrillation)
18
Q
immediate treatment needed for MI: morphine (pain), oxygen (O2), nitrates (vasodilation to increase blood flow to the myocardium, aspirin aka anti-platelet)
A
MONA
19
Q
reflects ventricular relaxation, cardiac rest phase
A
diastolic
20
Q
chest pain occurring for the first time or is unlike prior episodes; not relieved by rest
A
unstable angina
21
Q
decrease in BP that occurs when changing position from lying to standing, this causes a decrease in cerebral perfusion that leads to dizziness
*often experienced by elderly and ppl on antihypertensive meds
A
orthostatic HTN
22
Q
what does orthostatic HTN cause? what are the s/s?
A
causes a temporary internal of inadequate cerebral perfusion
s/s: fainting (syncope), dizzy, weak, tachycardia, diaphoresis
23
Q
Type of MI when the artery is completely occluded, completely through the heart wall.
*There are also calls ECG changes during this such as T-wave inversion, ST-segment elevation, Q wave development
A
STEMI (ST Elevation Myocardial Infarction)
24
Q
Type of MI where the artery is partially occluded causing a milder infarction, subendocardial and not completely thought the heart wall
A
NSTEMI (Non-ST Elevation Myocardial Infarction)
25
What causes an acute MI occur?
a coronary artery is completely obstructed by atherosclerotic plaque or clot, & blood flow carrying oxygen to the myocardium is blocked
26
this is a dead area of the cardiac muscle that is not perfused with coronary artery blood flow
MI
27
s/s of acute MI aka acute coronary syndrome (ACS)
-diaphoresis
-dyspnea
-extreme anxiety
-Levine's sign (fist to chest)
-pallor
-crushing chest pain that radiates to shoulder, left arm, jaw or back
-weak pulses
28
diagnostic tests for an MI
-ECG
-Serum cholesterol, LDL, HDL
-serum electrolytes
-serum glucose
-hs-CRP
-serum homocysteine
-cardiac enzymes: CPK-MB
-cardiac troponin (cTn)
-CT scan
-cardiac Cath
29
this is when chest pain occurs for the first time
unstable angina
30
this is chronic chest pain, the pt has experienced in the past and feels similar to past episodes, triggered by physical activity and caused by transient myocardial ischemia
also called chronic coronary artery disease
stable angina
31
this is a squeezing pain in the chest that occurs when there is a lack of blood flow to the myocardium
angina
32
what is the treatment for chronic stable angina?
-nitroglycerin preparations
-sublingual glyceryl trinitrate tablets
-NTG spray (glyceryl trinitrate spray)
-nicorandil (K+ channel activator)
-ranolazine (inhibits the late Na+ current, improves myocardial relaxation)
-ivabradine (reduces firing rate of SA node)
-long acting nitrates such as oral isosorbide mononitrate (this can cause headaches, hypotension, lightheadedness)
-transdermal patches
33
what is an acute MI aka acute coronary syndrome (ACS)
occurs when the heart tissue endures prolonged ischemia without recovery
34
a less-than-normal amount of blood flow to part of your body which means your tissues aren't getting the oxygen they need
ischemia
35
the gradual process by which plaque builds up on the body's arterial walls.
This is a chronic, progressive disease w/ a long asymptomatic phases.
atherosclerosis
36
what are risk factors for atherosclerosis (modifiable vs non modifiable)
non-modifiable:
-gender: males
-age: over 45 for males, over 55 for females
-race: AA
-family hx: hypercholesterolemia, DM, MI, HTN, stroke
modifiable: high fat & high sodium diet, physical inactivity aka sedentary lifestyle, obesity, high triglycerides over 150 mg/dl, high stress, diabetes, hypertension, alcohol & tobacco use
37
this is when a pt has chest pain at rest, caused by coronary artery vasospasm, can be associated w/ MI, life threatening ventricular arrhythmias, sudden death
prinzmetal's angina aka vasospastic angina
38
risk factors for prinzmetal's angina (vasospastic angina)
risk factors have no directly been associated w/ this except:
-cigarette smoking
-inflammatory states, as evidenced by high levels of hs-CRP
-drugs
-cold water can cause spasms in the coronaries as well as valsalva maneuver, hyperventilation, & coronary manipulation
39
how to treat prinzmetal's angina (vasospastic angina)
-IV or sublingual NTG and calcium blocker antagonist (first line treatment)
-long acting nitrates
39
how to diagnose prinzmetal's angina (vasospastic angina)
-cardiac monitoring for 24-48 hrs
-coronary angiography
-serial cardiac enzyme assays
-ECG may show ST-segment elevation or depression
40
risk factors for stable angina aka chronic coronary artery disease
same as Atherosclerosis risk factors:
-high cholesterol / triglyceride levels
-high blood pressure
-smoking
-diabetes
-obesity
-physical activity
-eating saturated fats.
41
this is the hardening & narrowing of the arteries, plaque builds on the arterial walls & restricts blood flow
arteriosclerosis
42
what should not be administered with sildenafil (viagra)? & why?
NTG (nitroglycerin) and other nitrate preparations bc it can cause severe hypotension
43
if a pt takes 3 NTG tablets within 15 mins and no relief of chest pain, what do we assume?
the pt is having an MI
44
what is treatment for unstable angina?
we want to prevent MI, so educate!
-antihypertensive, antilipidemic, or anti diabetic meds
-morphine, oxygen if under 95%, nitrates (vasodilators), aspirin
45
risk factors for unstable angina
same as those w/ arteriosclerosis:
-cigarette smoking
-DM
-hypercholesterolemia
-systemic hypertension
-LV hypertrophy
-obesity
-elevated serum levels of homocysteine, triglycerides, LDLs
-low levels of HDLs
46
how to diagnose unstable angina?
very similar to arteriosclerosis diagnose
-bp measurement
-total blood cholesterol
-LDL, HDL, triglycerides measurements
-ECGs
-high sensitivity C-reactive protein (CRP)
-high sensitivity cardiac troponin (hs-cTn)
-chest x ray or CT scan
47
what is RAAS? & how does it work
-Renin-angiotensin-aldosterone system (RAAS) is a key part of BP regulation
-RAAS is a multistep reaction that raises bp in response to diminished circulation in the body.
It works by:
-when bp is diminished, the kidney is sensitive to the drop in bp so renin (enzyme released by juxtaglomerular apparatus of nephrons in response to decreased perfusion) is released into blood stream stimulating the liver to release large protein aka angiotensinogen.
-In the lungs, angiotensinogen is transformed into angiotensin I then angiotensin converting enzyme (ACE) changes angiotensin I into angiotensin II which is an arterial vasoconstrictor which stimulates the adrenal gland (and raises bp) to release the hormone aldosterone.
-aldosterone works at the nephron to increase Na & H2O reabsorption into bloodstream & secrete potassium into nephron tubules. Retention of Na & H2O increases volume of bloodstream and bp!
48
how does atherosclerosis work? (Patho)
-begins after endothelial injury
-WBCs & platelets are drawn to injury
-WBCs engulf & digest LDL
-forms the foundation for arteriosclerotic plaque (makes narrowed artery)
49
low density lipoprotein, deposited on artery walls
what level should it be?
LDL (lousy!!!!!)
less than 130
50
high density lipoprotein, type of cholesterol that is excreted
**cardioprotective because it carries cholesterol away from the artery walls to be excreted
What level should it be?
greater than 60
51
what are the 2 types of hypertensions?
primary- aka essential hypertension, has no known cause
secondary- occurs due to a disease or condition that is known (ex: kidney disease, hormone disorders, oral contraceptives, some drugs
52
risk factors for hypertension
-age
-gender (males)
-AA
-family hx
-obesity
-insulin resistance
-increased salt intake
-alcohol
-diabetes
-tobacco
-sedentary behavior
insufficient vit D & potassium
53
what are the stages of high blood pressure?
-Elevated: 120-129 / less than 80
-Stage 1: 130 - 139 / 80 - 89
-Stage 2: 140 - 179 / 90 - 119
-Hypertensive crisis: 180+ / 120+
54
treatment of hypertension
major lifestyle changes:
-decreasing salt/sugar intake
-stop smoking and drinking alcohol
-lose weight
or medication therapy
55
complications of hypertension
-heart failure (initially form increased after load from increased peripheral vascular resistance in arterioles)
-atherosclerosis (from damage to blood vessels)
-MI or stroke
-damage to blood vessels which can affect eyes, kidneys, & increase risk for aneurysms
56
this lab is elevated during acute heart failure
BNP (B-type natriuretic peptide)
57
unilateral leg pain, edema, erythema, warmth
DVT
58
heart attack from a partially occluded artery
NSTEMI
59
SBP between 120 - 129mmHg and DBP < 80 mmHg
elevated blood pressure
60
risk factors for varicose veins
-sedentary lifestyle
-pregnancy
-increased age
-female
-leg crossing
-obesity
-prolonged sitting or standing
61
this causes back flow from one chamber to another
regurgitation
62
pts w/ hepatic encephalopathy (change in mental status/confusion) will exhibit elevated levels for this lab
ammonia
63
this is the pacemaker of the heart
SA node
64
this lab indicates death to myocardial muscle cells
troponin level
65
most common risk factor for diverticulosis
low fiber diet
66
one cause of HF due to uncontrolled hypertension causing an enlarged and weakened heart
LVH (left ventricular hypertrophy)
**systolic = life sided HF
67
reduction in blood flow to tissue
ischemia
68
this causes RUQ pain after eating fatty meal, stone in common bile duct, four Fs
cholecystitis
69
this causes narrowing of a heart valve, obstructing forward blood flow
stenosis
70
death of tissue d/t obstructed blood supply
infarction
71
heart attack from a totally occluded artery
STEMI
72
these labs will be elevated in pts w/ acute pancreatitis
amylase & lipase
***Increased serum lactic dehydrogenase & C-reactive protein are indicative of severe panc
73
pericardial sac fills w/ fluid and compresses the heart
tamponade which causes reduction in SV & CO which will drop bp.. this causes HR to increase in order to overcome the low bp
74
common sign of diverticulitis
LLQ pain
75
risk factor for esophageal cancer
GERD
76
what is portal HTN and who does it occur in
increased pressure within the portal venous system
occurs in alcoholics, pt w/ cirrhosis & ascites
77
SBP greater or equal to 140
DBP greater or equal to 90
stage 2 HTN
78
dyspnea and cough is a s/s of what type of heart failure
LV failure
79
rhythm disorder in which ventricles beating independently without signal from SA or AV node
aka extra heartbeats
PVCs (Premature ventricular contractions)
80
pain in BLE w/ activity that improves with rest
intermittent claudication
81
what is volvulus
twisting of the intestine
82
this conduction disorder shows irregular rhythm w/ loss of atrial kick
Afib (atrial fibrillation)
83
common s/s of celiac disease
diarrhea, abdominal pain, weight loss
84
an ejection fraction of what % is indicative of HF?
less than 40%
85
what are the 3 layers of an arterial wall
1. tunica adventitia (connective tissue, outer layer)
2. tunica media (smooth muscle, middle layer, expands to accommodate pressure)
3. tunica intima (interior lining of artery made of basement membrane & endothelial cells)
86
this is responsible for growth of new blood vessels (angiogenesis),
collateral branches of arterioles form in response to this
VEGF (vascular endothelial growth factor)
87
when blood is excessive, this types of cells produce C-natriuretic peptide to promote diuresis (reduces bp)
endothelial cells
88
this causes vessel constriction which raises bp
endothelin
89
what is prostacyclin vs thromboxane A2
prostacyclin = clot formation
thromboxane A2 = clot prevention
90
this causes vessel dilation (opens vessels, improves blood flow, lowers bp)
nitric oxide
91
this activates clotting
von Willebrand factor
92
laminar vs turbulent blood flow
laminar = smooth flow parallel to vessel
turbulent = rough flow perpendicular to vessel
93
cardiac contraction (s or d)
systole
94
cardiac relaxation (s or d)
diastole
95
amt of blood ejected per beat
stroke volume
96
this is the amt of blood pumped by LV per minute
HR x SV
cardiac output
97
what is FH? & what are risk factors
familial hypercholesterolemia which is a specific type of hyperlipidemia
risk factors - FH, DM, obesity, hypothyroidism, lack of physical activity, some meds
98
s/s of hypertension
-often no signs
-organ sign damage: headaches, chest pain, vision disturbances, dizziness
-protein in urine, LVH on ECG, bruits bc turbulent flow, alteration in PMI, retinal vessels
99
s/s of atherosclerosis
only symptom is weak pulse and bruits
100
how to diagnose PAD (Peripheral Arterial Disease)
-ankle-brachial index (Ratio of the BP in lower legs to arms)
-CBC
-lipid profile
-inflammatory markers
-impedance arterial
-CT
-coventional angiography
-MAR (magnetic resonance angiogram)
-duplex & plethysmography ultrasonography
101
treatment of PAD (peripheral arterial disease)
-lifestyle modification (exercise)
-meds (cholesterol lowering, anti hypertensive, platelet inhibitors, vasodilators, thrombolytic agents (prevents DVT or PE bc high risk of blood clot)
102
arterial dysfunction & reduced blood flow within the lower extremities, most common site is femoral artery above knee... gradual onset
-pulse is not palpable in this lower extremity
peripheral arterial disease (PAD)
103
Weakened segment of the artery that creates an outpouching that is susceptible to rupture & can cause turbulent blood flow within the artery which causes bulging of walls or dilation (enlarging of the walls)
aneurysm
104
largest blood vessel in body
aorta
105
who is at risk for aneurysm
smokers
106
a true one of these involves all three layers of vessel wall
true aneurysm
107
these are classified by size, shape, location
aneurysm
108
what is a false aneurysm
hematoma where the clot is outside arterial wall
109
weakness on one side of vessel (aneurysm)
saccular shape
110
all layers of vessel wall dilate equally (aneurysm)
fusiform shape
111
s/s of aneurysm
n/v in AAA
no signs if cerebral aneurysm
112
treatment of aneurysm
-stop smoking
-regulate BP
-surgical treatment
-FU yearly or every 6 months
113
sudden severe headache then mental status change
subarachnoid hemorrhage (aneurysm)
114
acute coronary syndrome (ACS) vs. myocardial infarction (MI)
ACS- due to ischemia
MI- due to prolonged ischemia leading to cell death
115
3 layers of heart wall
-epicardium (outer)
-myocardium (muscle, middle)
-endocardium (interior)
116
classic ECG changes with MI
-T wave inversion
-ST Segment elevation
-Q wave development
117
biochemical markers w/ MI
-elevation of Troponin & T
-increase in CPK-MB (creatinine phosphokinase)
118
this is a surgical option for angina, this creates new routes around occlusions (makes new vessels to bypass the ones that are no longer functioning)
CABG (coronary artery bypass graft)
119
what does a ST-segment elevation on a EKG show?
MI
120
myalgia vs arthralgia
myalgia = muscles aches/pain
arthralgia = joint pain
121
s/s of Vfib (ventricular fibrillation)
loss of consciousness , death may occur because this is life threatening!
122
contraction is uncoordinated with no effective pumping during this. you have to shock pt to reset the heart if this occurs
Vfib (ventricular fibrillation)
123
in HF, this is decreased d/t weak LV that cannot adequately pump blood out of chamber
CO (cardiac output)
124
amt of blood in heart at end of diastole, causes stretch & increased pressure in ventricular chamber increasing SV
preload
125
amt of resistance the ventricle overcomes to pump blood out of heart
increased this reduces cardiac output
afterload
126
this is the volume of blood pumped w/ each ventricular contraction
this should be 60-70% in healthy ppl, if under 40% then HF!
LVEF (left ventricular ejection fraction)
127
4 changes that contribute to development of heart failure
1. increased fluid volume
2. impaired ventricular filling
3. degeneration of ventricular muscle
4. decreased ventricular contractile function
128
cor pulmonale (an enlarged right ventricle in your heart that happens because of a lung condition
right sided heart failure
129
risk factors for HF
age
AA
DM
lifestyle- obesity, tobacco, alcohol, sedentary lifestyle
family hx
breathing issues
heart disorders
kidney conditions
meds: antifungals, anabolic steroids, chemotherapeutic angets
130
types of HF
1. left ventricular HF:
-systolic, decreased contractility so weak floppy heart
-diastolic HF so decreased relaxation due to thick ventricles
-PND (paroxysmal nocturnal dyspnea) aka fluid accumulates in lungs while supine
2. right ventricular HF:
-weak RV, causes backup of blood into right heart chambers
-causes organomegaly, ascites, hypoxia
3. high output HF:
-uncommon cause, severe anemia
131
LVF vs RVF (right ventricular failure)
LVF: affects breathing (dyspnea, cough, orthopnea, PND, weak pulse, decreased cerebral perfusion)
RVF: affects gut (JVD, ascites, GI disturbances, hepatomegaly, splenomegaly, peripheral edema, hepatojugular reflex)
132
how to diagnose HF
-elevated BNP (greater than 100pg/ml)
-diluted electrolytes due to fluid retention
-chest x ray (cardiomegaly, vascular congestion in pulmonary fields)
-ECG (no specific sign, but may see elevation of ST segment)
-Echo (estimates LVEF)
-MGAS (multiple gate acquisition scan)
-cardiac Cath
-angiography (use of dye to view vessels)
133
how to treat HF
-diuretics (to reduce fluid vol)
-aldosterone antagonist (reduce fluid vol)
-ACE inhibitors (blocks angiotensin converting enzyme)
-angiotensin II receptor blockers (ARBs for those who can't tolerate ACE inhibitors and good for diabetics bc protects renal)
-Beta 1 adrenergic blockers (slows HR, lessen vasoconstriction)
-positive inotropic & negative chronotropic agents (increases force & HR)
-synthetic natriuretic
-nitrates
-arterial vasodilators
-neprilysin inhibitors (breakdowns BNP and ANP)
134
this might develop in HF due to constant aldosterone
hypokalemia (low K)
135
this is severe RVF which leads to massive peripheral edema, affects most of tissues of body
anasarca
136
if this is elevated, then indicative of HF
BNP
137
adverse effects of this is hyperkalemia, angioedema, cough ... this treats HF
ACE inhibitors
138
this has negative side effects that require careful monitoring, med for HF
inotropic drugs
139
these have a hypotensive effect if combined w/ sildenafil meds
nitrates
140
must take apical pulse for 1 full minute w this medication that helps HF, it can slow the HR excessively
digitalis
141
this is the mitral and tricuspid valve closure (atrioventricular valves), known as S1 aka the lub
Systole
142
this is the aortic & pulmonic valve closure (closing of semilunar valves), known as S2 aka the dub
diastole
143
S3 vs S4
S3 = kentucky
S4 = Tennessee
144
when you have this, you are at risk for LVH
stenosis
145
narrow opening which is high resistance to flow, excess blood is left behind, can increase workload on heart
stenosis
146
when you'll hear murmurs
MSARD (mitral, stenosis, aortic, regurgitation, diastole)
MRPASS (mitral, regurgitation, pulmonary, artery, stenosis, systole)
MVP (mitral valve prolapse)
147
this is when narrow mitral valve hinders blood flow into the left ventricle, so blood flow backs up in the left atrium causing enlargement, pressure builds backward into pulm veins which causes pulmonary edema
one of the most common heart valve disorder!
mitral stenosis
148
how to grade murmurs? when is it dangerous?
grade 0-6
0 = no murmur, 6 = so loud
3-6 is dangerous
149
s/s of mitral stenosis
dyspnea w/ exertion, PND (paroxysmal nocturnal dyspnea), orthopnea
150
this is also known as regurgitation
mitral valve insufficiency which increases risk of HF & death ... MV fails to close, allowing back flow of blood into LA as LV contracts
151
s/s of mitral insufficiency aka regurgitation
-chest pain (decreased coronary flow)
-pulmonary symptoms due to fluid backup in lungs
-Afib
-diminished S1 sound bc leaflets don't close
152
this is intermittent episodes of mild mitral insufficiency, often asymptomatic, can be part of Barlow's disease aka floppy heart valve syndrome
MVP (mitral valve prolapse)
153
this is a common cause of mitral insufficiency, affects females 14-30, common in ppl w/ genetic connective tissues disorders such as Marfan's, osteogenesis imperfect, ehlers-danlos syndrome but in most cases is unknown
; commonly asymptomatic , SYSTOLIC heart murmur
MVP (mitral valve prolapse)
154
this is the calcification of the aortic valve, it's difficult for LV to pump blow which increases resistance, LVH
aortic stenosis (AS)
155
s/s of aortic stenosis (AS)
-exertion dyspnea
-pulmonary edema
-angina pectoris
-carotid arterial pulse rises slowly w/ a delayed peak
-lateral displacement LV impulse
-murmur is systolic, crescendo & low pitched
156
this is a genetic disorder that inhibits ejection of blood from LV, diamond shaped systolic murmur, leading cause of sudden death in young
(HCM) hypertrophic cardiomyopathy
157
this is due to incomplete closure of AV, allows. backward leakage of blood into LV during diastole
-Austin flint murmur
aortic insufficiency
-can be acute or chronic, more common in men / peaks at 40-60 of age
158
3 different types of venous disorders
1. DVT
2. PE
3. VTE
159
these return deoxygenated blood to heart and have a low type of pressure
veins
160
this occurs b/c of poor venous return, associated with immobility, sedentary behavior or valve dysfunction within the leg veins.
venous stasis
161
D-dimer test is used to diagnose this, if positive (over 500)
DVT
162
why is pancreatitis dangerous?
because chronic inflammation can lead to fibrosis, strictures, and cyst formation
163
s/s of pancreatitis
-Pain, sometimes very severe (main manifestation)
-Fever
-Nausea
-Vomiting
-Leukocytosis
164
what it the most common cause of chronic pancreatitis
chronic alcohol abuse.
165
____________ is a stable virus spread by blood products, bodily fluids, or sexual contact
what are s/s
Hep B
▪ Fatigue
▪ Vomiting
▪ Anorexia
▪ Malaise
▪ Abdominal pain ▪ Fever
▪ Myalgias ▪ Headache
▪ Jaundice
▪ Dark urine
▪ Light-colored stools o Risk Factors
▪ Non-Hispanic black ethnicity
▪ Cocaine use
▪ High number of sexual partners
▪ Unprotected sex
▪ Sexually transmitted
infection
▪ Human
immunodeficiency virus
▪ Handling blood products
▪ Intravenous drug use
Male homosexuality
▪ Hemodialysis
▪ Living with someone with HBV
166
______ is transmitted via blood as in intravenous drug use, sexual transmission is not as likely
what are the s/s
Hep C
▪ Fever
▪ Vomiting
▪ Anorexia
▪ Malaise
▪ Abdominal pain
▪ Myalgias
▪ Headache
▪ Jaundice
▪ Dark urine
▪ Light colored stools
Risk Factors- High IV drug use, Cocaine with shared straws
167
____ is transmitted via ingestion of contaminated food/water or contracted by unsanitary conditions from person-to-person
what are the S&S
Hep A
▪ Flu-like symptoms
▪ Hepatomegaly
▪ Jaundi
Pale stools
▪ Dark urine
▪ Pruritus
Risk factors:
▪ Weak immune system, Living in unsanitary conditions, Institutionalization, Foreign travel to a country where HAC is endemic, Male homosexuality, Illicit parenteral drug use
168
This is aged RBC or Hgb. Conjugated in liver and put in bile. Starts unconjugated (increases with dysfunction) and becomes conjugated- stored in bile (water soluble- excreted).
bilirubin
169
what causes endocarditis?
mainly bacteria, but fungal can too
170
how to diagnose endocarditis
based on a set of specific clinical signs as well as labs and echocardiographic findings called DUKE criteria (1 major findings 3 minor findings OR 5 minor findings)
171
treatment of endocarditis
mainly IV antibiotics for 6 weeks or longer or high dose oral antibiotics
172
who is at risk for endocarditis
pts w/ underlying valvular heart dz & those who illicit IV drugs
can also be over 50 or hospital acquired infection
173
this is caused by fluid accumulation in the lungs
PND (paroxysmal nocturnal dyspnea)
this is sudden SOB that occurs in middle of night
174
this is caused by fluid accumulating in the pulmonary interstitial spaces
orthopnea
175
how to treat inflammation of the esophagus
-Proton pump inhibitor (PPI)
-Histamine-2 blocker (H2 blocker)
176
most common cause of GERD (Gastroesophageal Reflux Disease)
functional or mechanical problem that decreases muscles tone of the LES (lower esophageal sphincter), which allows for regurgitation of stomach contents into the esophagus
177
s/s of GERD (Gastroesophageal Reflux Disease)
Dysphagia
Heartburn
Epigastric pain
Regurgitation
Dyspepsia (indigestion)
Acid indigestion
178
treatment for GERD (Gastroesophageal Reflux Disease)
-PPIs (proton pump inhibitors) Most effective! OTC or Rx
-H2RAs (histamine-2 receptor antagonist)
-lifestyle changes
-transoral inåisionless fundoplication (TIF)
-laparoscopic antireflux (fundoplication)
179
What condition is considered to be pre-cancerous and requires frequent evaluation?
Barrett's Esophagus which results from GERD
180
what does stool w/ melena look like? (s/s of chronic upper gastrointestinal bleed)
black & tarry
181
what is hematemesis, common in upper GI bleeds
vomit w/ bright red blood & "coffee grounds" which indicates the blood has mixed with the acid of the stomach
182
This is engorged esophageal veins,
Often due to portal vein hypertension or Liver issue (Jaundice may be present)
***Veins may rupture
Esophageal Varices
183
risk factors for GERD (Gastroesophageal Reflux Disease)
obesity
smoking
age
sedimentary lifestyle
anxiety/depression
184
Stomach pushes up through opening in diaphragm
hiatal hernia (upper stomach)
185
how to diagnose hiatal hernia (upper stomach)
endoscopy
186
s/s of hiatal hernia (upper stomach)
dysphagia
epigastric discomfort
OR may be asymptomatic
187
treatment of hiatal hernia (upper stomach)
-surgical repair aka laparoscopic fundoplication
-PPIs (proton pump inhibitors) OTC or Rx
-histamine-2 blockers
188
intestinal protrusion through abdominal wall, more common in males
hernia
189
s/s of hernia
depends on location/ degree of protrusion
can be asymptomatic or pain near site
*coughing & straining can make it worse
190
most common type of hernia
inguinal hernia (inner groin)
191
difference between reducible, incarceration, and strangulation hernia
-reducible: returned to normal position with manual pressure
-incarceration: loop of intestine trapped between muscle fibers
-strangulation: blood supply to hernia compromised by pressure
192
diagnose and treatment of hernia
diagnose- pt hx & physical exam
treatment- herniorraphy
193
this is known as "sprue" and "gluten-sensitive enteropathy"
condition that occurs form a hypersensitivity reaction to gluten, a by product of wheat, barley, rye
celiac disease - autoimmune dz
194
s/s of celiac dz
-bloating & diarrhea bc can't digest carbs
-gas
-steatorrhea (loss of fat in stools)
-malnutrition .. can't absorb protein or fats so decrease in A (visual disturbances), D, E (RBC damage), K (iron deficiency)
195
how to diagnose celiac disease
-serology: celiac panel
-positive antibody titer of IgA anti tissue transglutaminase (IgA TTG)
-intestinal biopsy
196
how to treat celiac disease
dietary modificatioon (elimate gluten products)
pt needs vitamin replacement
if extreme, corticosteroids ay be prescribed
197
risk factors for celiac dz
-family hx
-DM1
-obesity
-caucasian w/ European ancestors
198
night blindness is associated with what disease
celiac dz due to lack of vitamin A
199
what causes SBO?
-post op adhesions
-malignancy
-chron's
-hernia
200
s/s of SBO
-varies w/ obstruction severity
-pain
-n/v
-hyperactive bowel sounds
-diarrhea if partial obstruction
201
how to diagnose SBO
abdominal X ray
202
how to treat SBO
-NG tube (decompress bowel & removes accumulation of fluid)
-meds
-surgery if complete obstruction
203
classic triad for peritonitis (inflammation of peritoneum due to bacterial infection or leakage of intestinal content into peritoneal cavity)
abd pain, abd rigidity, rebound tenderness
204
s/s of PE resulting from DVT
acute dyspnea (SOB), chest pain, tachycardia (high HR), diaphoresis (sweating), anxiety
205
risk factors for DVT
-age
-pregnancy
-birth control
-obesity
-sedentary lifestyle
-smoking
-cancer
-family hx
206
treatment for DVT
anticoagulants
207
s/s of IBS (irritable bowel syndrome)
-abd pain
-bloating
-distention
-constipation
-diarrhea
208
IBS (irritable bowel syndrome) vs IBD (inflammatory bowel disease)
IBS- no pathological changes within interior of bowel
IBD- pathological changes in colon (crohn's dz, ulcerative colitis)
209
how to diagnose LBO
abdominal x-ray
210
how to treat LBO
-depends on the cause
-fluid replacement
-intestinal decompression
211
s/s of LBO
-abd pain
-abd rigidity
-abd distention
-abd tenderness
-high pitched bowel sounds partial obstruction vs no sounds or feces in complete obstruction
212
SBO vs LBO
SBO- n/v
LBO- constipation, abd distention
213
what causes LBO
50-60% is caused by cancer of colon or rectum
20% is caused by diverticular disease
5% is caused by volvulus
age, post op, hernia
214
-this is RLQ pain (Mc Burney's point)
-diagnose this by Psoas sign, Obturator sign
-CT scan is most accurate for diagnosis
appendicitis
215
Disorder characterized by abd pain, altered bowel activity in absence of pathology. Also called colitis, irritable colon, spastic colon
IBS (irritable bowel syndrome)
216
risk factors for IBS
-acute bacterial gastroenteritis
-sedentary work
-lack of exercise
-processed food
-females are 2x more likely
-age
-fam hx
-stress
-possibly hormonal
217
weight loss an iron deficiency anemia are alarming symptoms of this
IBS
218
how to treat IBS
regulate bowel movements, bulk forming laxatives, antidiarrheals
219
diverticulosis vs diverticulitis
diverticulosis: weakened area bowel wall, small outpouchings that collect intestinal contents & form obstruction
diverticulitis: diverticula inflammation
220
risk factor for diverticular disease
low fiber diet
age
western culture
genetics
221
s/s of diverticular disease
-bowel habits may be altered
-LLQ or RLQ depending on area affected
-depends on severity of inflammation
-fever, tachy, anorexia
222
treatment for diverticular disease
diet modification
adequate fluid & fiber intake
or NPO if severe
pain meds
223
what causes volvulus
-constipation and high fiber diet
-obstruction & ischemia
224
s/s of volvulus
-bilious vomiting
-colicky (aka in waves) & then steady abd pain
-blood, mucus in stool
225
how to diagnose and treat volvulus
diagnose w/ upper & lower barium GI series
treatment is surgery
226
high pitched bowel sounds indicate what
partial obstruction
227
bowel sounds are absent indicates what
complete obstruction
228
what lab shows perforation of the bowel or organ
elevated serum amylase
229
what should you do first for acute abdomen pain in females
pregnancy test to rule out ectopic pregnancy
230
this can happen in ulcerative colitis or Crohn's disease, it is a medical emergency
toxic megacolon
231
Crohn's disease vs ulcerative colitis
Crohn's disease: entire GI wall aka transmural (any part of GI), cobblestones, malabsorption
ulcerative colitis: not transmural (only mucosal layer of large intestine), more common, pseudopolyps, precancerous
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murmur associated with mitral stenosis
diastolic, low pitched
233
murmur associated with aortic stenosis
systolic, low pitched, crescendo
234
mitral vs aortic stenosis murmur
both low pitched, mitral is diastolic whereas aortic is systolic
235
unconjugated vs conjugated bilirubin
unconjugated: indirect bilirubin
conjugated bilirubin: direct bilirubin (this is where bilirubin becomes water soluble)
236
bilirubin is derived from what?
the breakdown of aged RBCs
237
pts w/ liver dysfunction are at increased risk for what?
blood clots!
238
what causes jaundice
excessive RBC hemolysis (too much breakdown/destruction), hepatocellular injury, bile duct obstruction
239
this occurs when the liver may not be secreting bile for fat digestion
steatorrhea
240
which hepatitis is contaminated food/water and fecal oral
Hep A (HAV)
bc A for agriculture aka food
and bc A & E come from the sea aka water
if it ends w/ a vowel then it comes from the bowel!
241
which hepatitis(s) is blood/body fluids
Hep B (HBV)
Hep C (HCV)
Hep D (HDV)
242
which hepatitis is contaminated water and fecal/oral route
Hep E (HEV)
bc A & E come from the sea aka water.. if it ends w/ a vowel then it comes from the bowel!
243
hepatitis that is blood/body fluids, vertical... rare
Hep G (HGV)
244
treatment for varicose veins
elevated legs, compression stockings
245
s/s of Hep A
fever, abd pain, flu like symptoms
246
s/s of Hep B
anorexia
n/v
jaundice
hepatomegaly
fatigue
splenomegaly
flu like symptoms
lymphadenopathy
247
s/s of hep C
low grade fever, malaise, n/v, fatigue, jaundice, anorexia, weight loss
248
this disease is silent & gradual, irreversible damage due to collagen & connective tissue infiltration ... #1 caused by HCV then alcoholic liver disease, NAFLD
**9th leading cause of death in US
cirrhosis
249
s/s of cirrhosis
most ppl remain asymptomatic until late stage
-ascites
-hepatic encephalopathy
-variceal bleeding from portal HTN
-peritonitis (inflammation of the peritoneal caused by bacterial infection or leakage of intestinal contents into peritoneal cavity)
250
ppl with this hepatitis can still be carriers of this inactive hepatitis
Hep B (HBV)
251
this hepatitis is the #1 cause of cirrhosis
Hep C (HCV)
252
risk factors for cirrhosis
wide range of diseases and conditions such as:
-chronic alcohol use
-chronic viral hepatitis (B,C,D)
-NAFLD (non alc fatty liver dz)
-CF
-infection such as syphilis
-meds like acetaminophen
253
treatment for cirrhosis
nothing except liver transplant if severe
254
this is a serious disorder, potentially lethal but is reversible.
the organ involved gets inflamed and injured due to the leakage of an activated digestive enzyme
acute pancreatitis
255
risk factors of acute pancreatitis
-biliary dz (cholelithiasis)
-abd trauma
-mumps, varicella, measles, rubella
-hypercalcemia
-hepatits
-excessive alcohol ingestion
-hypertriglyceridemia
-infections
-periampullary tumors
-certain meds
256
s/s of acute pancreatitis
-severe abd pain in epigastric region, can radiate to back
-fever
-tachy
-hypotension
-n/v
-diarrhea
-decreased bowel sounds
-jaundice
-abd tenderness, guarding, distention
-cullen sign aka discoloration around umbilicus due to hemorrhage
-grey turner sign aka discoloration around flanks, retroperitoneal bleeding
257
treatment of acute pancreatitis
NPO until resolution of pain
fluids for hydration, electrolyte support/balance
low fat diet
pain control
258
s/s of chronic pancreatitis
-upper abd pain that radiates to back, worsens w/ eating/drinking and becomes constant, n/v, diarrhea, weight loss, steatorrhea
259
risk factors for chronic pancreatitis
-30 to 40y/o
-AA
-alcohol induced in men, lipid induced in women
-genetics if under 30
260
chronic vs acute pancreatitis
-chronic does not heal & causes permanent damage .. can happen due to acute pancreatitis
-acute heals and is reversible
261
what labs will be elevated for pancreatitis
amylase & lipase !!!
CBC, glucose, CRP as well
262
jaundice may be the first sign of this cancer due to tumor compromising bile duct
pancreatic cancer
263
this is the muscle pain that happens when you're active and stops when you rest.
intermittant claudication
264
the resistance in the circulatory system that is used to create blood pressure, the flow of blood and is also a component of cardiac function
SVR (systemic vascular resistance) aka Peripheral vascular resistance
265
s/s of PAD (peripheral arterial disease)
pulseless
pallor
cold
hairloss
smooth, shiny skin
ulcers
266
2nd leading cause of death resulting from cancer, preventable disease
colorectal cancer
267
risk factors for colorectal cancer
-males
-age, over 50
-AA
-inflammatory bowel disease (Crohn's, ulcerative colitis)
-DM
-long term immunosuppression
-high consumption of red meats
-obesity
-tobacco/alc
-low fiber diet, high fat
-sedentary lifestyle
268
s/s of colorectal CA
fatigue, weakness, abd cramping, weight loss, iron deficiency anemia, blood in stool, diarrhea, constipation, melena aka dark tarry stools
269
diagnose and treatment for colorectal CA
diagnose: colonoscopy, DRE, FOBT, barium enema, abd & pelvic US, CT, MRI, PET scan
treatment: surgical resection of tumor , radiation, chemo, cryotherapy
270
systemic disorder that involves the narrowing of peripheral blood vessels as a result of arteriosclerosis (buildup of plaque), can happen with veins or arteries.
Peripheral vascular disease (PVD)
271
narrowing or blockage of your coronary arteries, which supply oxygen-rich blood to your heart. as a result of plaque buildup in these arteries limits how much blood can reach your heart muscle
CAD (coronary artery disease)
272
the alternate or “backup” blood vessels in your body that can take over when another artery or vein becomes blocked or damaged.
collateral circulation
273
the measurement of the percentage of blood leaving the heart each time it squeezes
ejection fraction
normal is 60-70%, if it is 40% or below then HEART FAILURE
274
these divide into right and left bundles that fire rapidly to allow for simultaneous excitation of the right and left ventricles
purkinje fibers (aka subendocardial branches)
275
this travels down the septum between the ventricles and purkinje fibers in the walls of both ventricles
also called atrioventricular bundle
bundle of HIS
276
impulse begins here within the right atrium, it is the pacemaker of the heart
SA node
277
conduction of heart
impulses begin in SA of the right atrium, dottiness down into AV node then down the right and left bundle of HIS to the Purkinje fibers
