patho exam 4

Question 1

what is polycystic kidney disease and what is the etiology and RF

Answer 1

Genetic; Growth of multiple bilateral grapelike clusters of fluid-filled cysts in kidneys. cells within the tubule epithelium undergo repeated cell division, creating a cyst– enlarges the kidney and thickens basement membrane of tubule–compression and replacement of functioning renal tissue–deterioration–fatality
RF: family history, sickle cell disease, aortic/brain aneurysm, pancreatic/liver cysts, diverticula

Question 2

polycystic kidney disease CM& complications

Answer 2

neuro/ MS: headache
Cardio: HTN
GI/GU: abdominal pain, flank pain, polyuria, UTI, gross hematuria, increased abdominal girth
Skin: pallor, dry skin, edema

complications: cyst rupture, liver failure, kidney cancer & failure, respiratory and heart failure

Question 3

Urinary Tract Infection UTI? etiology and RF

Answer 3

bacterial infection of upper and lower urinary tract system: cystitis (bladder/lower), urethritis (urethra/lower), pyelonephritis (upper, renal parenchyma); caused by ascending infection by gram- bacterium like E. Coli, local defense mechanisms in bladder break down–bacteria invade mucosa & multiply
RF: more common in women bc anatomy, inadequate fluid consumption, catheter use, urinary stasis, benign hyperstatic hyperplasia, sexual activity, poor hygiene

Question 4

UTI manifestations, complications, Dx

Answer 4

Neuro: malaise, fatigue, OLDER ADULTS: altered mental status and confusion
GI/GU: urgency, frequency, burning urination, bladder cramps or spasm, pain, nocturia, dysuria, discharge, flank pain, nausea, vomiting, foul smelling urine, hematuria

Compliations: dmg to uterine lining, pyelonephritis, sepsis, kidney abscess, acute urinary outlet obstruction, acute bacterial prostatitis (men)

Use clean catch urinalysis to show bacterial count

Question 5

Pyelonephritis? etio & RF

Answer 5

bacterial infection of renal parenchyma affecting one or both kidneys w sudden onset, E.Coli most common, infection spreads from bladder to ureters then to kidney
etio: more common in ppl 50+ and women; occurs in approx 20-30% pregnancies
RF: female, lower UTI, nephrolithiasis, pregnancy, catheter, cystoscopy, sex, DM

Question 6

pyelonephritis CM

Answer 6

Neuro/MS: fatigue, malaise, weakness, change in
mental status
GI/GU: CVA pain, nausea, vomiting, urgency, frequency,
burning urination, dysuria, nocturia, hematuria, anorexia,
cloudy urine, oliguria, foul smelling urine
Skin: chills, moist skin
Other: fever

complications: renal calculi, acuye kidney injury, renal abscess, multisystem infection, sepsis, HTN, kidney scarring

Dx: urinalysis and CT

Question 7

glomerulonephritis? etio and RF

Answer 7

kidney disease of inflamed glomeruli–affect kidney function, associated with a postinfectious state,
commonly a streptococcal infection of the respiratory
tract, antigen-antobody complexes trapped in glomerular capillary membrane–inflammation–thickened glomerular membrane and dec. function
etio: Untreated group A beta-hemolytic streptococcus
infection, such as of the respiratory tract (strep
throat) or the skin (impetigo)
RF: strep throat, depressed immune state (AIDS, cancer), alocohol and IV drugs, children and elderly, males

Question 8

glomerularnephritis CM, complications, Dx

Answer 8

Neuro/MS: back pain or joint stiffness, fatigue, malaise, headache,
confusion,
Respiratory: dyspnea, orthopnea, cough, crackles,
Cardio: hypertension, brady or tachycardia
GI/GU: hematuria, rust-color urine, abdominal pain, anorexia, anuria,
oliguria, CVA tenderness
Skin: pallor
Other: edema, weight gain, fever
complications: hypertensive retinopathy or encephalopathy, azotemia, anemia, HTN, heart failure, pulmonary edema, nephrotic syndrome, hyperkalemia, hypocalcemia, microhematuria
Dx: high serum potassium, low serum Ca, matabolic acidosis w/kidney impairment, BUN and creatinine elevated, GFR dec

Question 9

acute kidney injury? etiology, classifications & phases

Answer 9

interruption of kidney function resulting in acute decline in GFR, retention of urea, interrupted regulation of ECF volume and electrolytes
1. prerenal failure: crush injury, hemorrhagic blood loss, hypotension/ hypoperfusion, hypovolemia, loss of plasam vol, water and electrolyte loss, dec CO, ACE inhibitors
2. intrarenal dailure: acute tubular necrosis, coagulation defect, HTN, infection, cancer, artery or vein obstruction
3. postrenal failure: mechanical obstruction, siaruption of urinary flow: bladder neck obstruction, renal calculi, fibrosis, renal vein thrombosis or hematoma
*
1. onset phase: cause: burn/ blood or fluid loss–kidney perfusion decreases& urine output <0.5 mL/kg/hr
2. oliguric-anuric phase: 1-2 weeks, urine output <400 mL/day, fluid volume excess, azotemia,hypoperfusion, necrosis
3. diuretic phase: 1-2 weeks, kidney function recoverd, cause is corrected, urine output graduallt increases & electrolyted return to normal range, GFR imporves
4. recovery phase: 3-12 months, gradual return of near normal kidney function, edema decreases, fluid and electrolyed return to normal balance

Question 10

acute kidney injury patho, RF

Answer 10

RF: advanced age, ACE inhibitors, autoimmune disease, blood loss, exposure to toxic metal solvents, severe dehydration, heart failure, liver disease, HTN, DM,

Prerenal: caused by volume loss or impaired flow, decrease in GFR occurs due to decreased filtration pressure, failure to restore blood volume may result in tubular necrosis/ acute cortical necrosis
Intrarenal: structural injury, leads to intrarenal vasoconstriction, severe episode of hypotension, hypovolemnia; can also be caused by cytotoxic, ischemic, or inflammatory injury to kidney; reperfursion may lead to cell swelling and necrosis
Postrenal: mechanical urinary tract obstruction affecting kdineys unilaterally (obstruction of renal pelvis, ureter, bladder, urethra) or bilaterally (prostatic hyperplasia); tublar pressure increases, leading to a decrease in forces of filtration

Question 10

acute kidney injury CM, complications, Dx

Answer 10

Neuro/MS: fatigue, weakness, back pain, confusion, muscle cramps,
irritable, drowsy, confusion, altered LOC, seizures, retinopathy,
Respiratory: dyspnea, shortness of breath, crackles,
Cardio: tachycardia, hypo or hypertension, atrial fibrillation, peaked T wave, edema
GI/GU: anorexia, nausea, vomiting, diarrhea, oliguria, anuria,
Skin: ecchymosis, purpura, pruritus, dry mucous membrane,
Other: fever, chills, thirst

complications: Electrolyte imbalance, Metabolic acidosis, Acute pulmonary edema, Heart failure, pericarditis, Arrhythmias, Fluid overload, Hypertensive crisis, infection, sepsis, Gastrointestinal bleeding, Cognitive or memory deficits, Uremia, Death

Dx: BUN and creatinine increased, BUN to creatinine ratio is greater than 20:1, crystals in urine as well as protien and blood, decreased hematocrit

Question 11

R.I.F.L.E Acute Kidney Injury

Answer 11

Risk: GFR is greater than 25% or serum creatinine (SCr) is increased 1.5 to 2 times
baseline; UO is less than 0.5 mL/kg/hour for less than 6 hours
Injury: GFR is decreased by more than 50% or SCr is increased two to three times the
baseline; UO is less than 0.5 mL/kg/hour for more than 12 hours
Failure: GFR is decreased by 75% or SCr is increased by three times the baseline, is
greater than or equal to 4 mg/dL, or is increased acutely 0.5 mg/dL or more; UO is less
than 0.3 mL/kg/hour for 24 hours (oliguria) or is absent (anuria)
Loss of function: complete loss of kidney function for more than 4 weeks
End-stage renal disease: complete loss of kidney function for more than 3 months

Question 12

Chronic Kidney Disease? etio and RF

Answer 12

progressive loss of kidney function, resulting in decline in GFR, retention of urea, interrupted ECF vol and electrolytes, signs minimal until 75% GFR lost, fatal if nor treated w/ dialysis or transplant. Nephron destruction eventually causes
irreversible kidney damage; Stage 1 GFR is greater than 90 mL/minute/1.73m2; stage 5, less than 15 mL/minute/1.73m2.

Etio: HTN, DM, glomerular disease, congenital abnormality (polycystic kidney disease), kidney dmg, vascular disease, cystic kidney disease
RF: >65, genetics, chronic infection, collagen diseases, nephrotoxic agents, calculi, vascular disease, high cholesterol

Question 13

CKD stages

Answer 13

⦿ Stage 1: GFR normal or increased (greater than 90 mL/minute/1.73 m2) but at
an increased risk of kidney disease
⦿ Stage 2: GFR mildly reduced (60 to 89 mL/minute/1.73 m2) and signs of mild
kidney disease
⦿ Stage 3a: GFR moderately reduced (45 to 59 mL/minute/1.73 m2) and signs of
moderate chronic renal insufficiency
⦿ Stage 3b: GFR moderately reduced (30 to 44 mL/minute/1.73 m2) and signs of
moderate chronic renal insufficiency
⦿ Stage 4: GFR severely reduced (15 to 29 mL/minute/1.73 m2) and signs of
severe chronic renal insufficiency
⦿ Stage 5: GFR indicates kidney failure (less than 15 mL/minute/1.73 m2) and
signs of end-stage kidney disease

CKD is defined as either the presence of kidney damage or a sustained glomerular filtration rate (GFR) of lower than 60 mL/minute/1.73m2 for 3 months.

Question 14

CKD CM, complications, Dx

Answer 14

Neuro/MS:fatigue, muscle cramps, weakness, twitching, altered LOC,
Respiratory: shortness of breath, chest pain, crackles, pleural rub,
Cardio: peripheral edema, hypo or hypertension, arrhythmias,
GI/GU: nausea, vomiting, anorexia, infertility, decreased libido, amenorrhea,
erectile dysfunction, change in urine output, malnutrition, abdominal pain on
palpation,
Skin: ecchymosis, poor skin turgor, pale or bronze skin, thin brittle nails and
hair
Other:dry mouth, hiccups, sleep problems, gum ulceration and bleeding

complications: anemia, HTN, CV disease, hyperparathyroidism, lipid disorder, malnutrition, decreased immune response, death
Dx: BUN, creatinine, Na, K, PO4, ammonia elevated; hematocrit low

Question 15

GERD? etio and RF

Answer 15

gastroesophageal reflux disease; backflow of gastric or duodenal contents (acid) into esophagus past the lower esophageal sphincter w/o vomiting, usually is after a meal; AKA heartburn; esophageal motility is slowed leading to decerased clearance of acidic material, lower esophageal sphincter is dysfunctional, casued decreased gastric emptying and consequent increase in volume and pressure of stomach

Etio: condition/ position increasing intra-abdominal pressure, hiatal hernia w/in ompetent sphincter, pyloric surgey, >40 y/o; asthma can cause lower esophageal sphincter to relax allowing stomach contents to flow back

RF: any agent that lowers lower esophageal sphincter pressure (acidic/fatty food, cigarettes, anticholinergenics), NG Tube for more than 4 days, obesity, smoking

Question 16

GERD CM, Complications, Dx

Answer 16

Respiratory: chronic cough, morning hoarseness,
wheezing, laryngitis
GI/GU: pyrosis (heartburn), retrosternal burning, pain
(relieved with antacids), sour or bitter taste in mouth,
radiating pain to neck/arm/jaw that may imitate angina
pectoris,

CM:peptic stricture, reflux esopagitis, esophageal stricture, esophageal ulcer, barreyy esophagus, reflux aspiration leads to COPD, GERD-induced asthma

Dx: Barium swallow showing evidence of recurrent reflux; pH monitoring

Question 17

peptic ulcer disease? etio and RF

Answer 17

development of circumscribed lesion (ulder) in mucosal membrame of lower esophagus, stomach, duodenum, jejeunum; 2 forms: duodenal(80%) or gastric; h. pylori releases toxin promoting mucosal inflammation and ulceration,
etio: H. pylori infection, NSAIDS use
RF: Type A in gastric Type O in duodenal, mucosal defects, exposure to irritants, tobacco use, stress, genetics

Question 18

Peptic ulcer CM, complications, Dx

Answer 18

GI/GU: left epigastric pain described as heartburn and feeling of
fullness shortly after meals, weight and appetite loss, nausea, vomiting, pain thats worse at night and morning, relieved by antaids or vomitng (gastric) or between meals
(duodenal); epigastric pain that awakens patient at night;
heartburn, pain relieved by antacids, pain after 1.5-3 hours after eating; belching; bloating; dark stools; hematemesis;
difficulty swallowing; vomiting; early satiety, epigastric
tenderness; anorexia; hyperactive bowel sounds
Skin: pallor
Other: weight loss
70% asymptomatic!

Complications: Bleeding (hemorrhage)from granulation tissue from erosion of an ulcer into a blood vessel, perforation of ulcer eroding through layers of stomach, bowel, or duodenum wall (peritonitis), outlet obstruction: edema, spasm, or contraction of
inflammation or scar tissue and interference with the free passage of gastric contents through the pylorus or
adjacent areas.

Dx: CBC showing anemia, fecal occult blood test positive, H.pylori antibody test positive, barium swallow, x ray showing mucosal abnormalities in upper GI

Question 19

Inflammatory bowel disease

chrons and ulcerative colitis

Answer 19

produce inflammation of bowel, pattern of familial occurence.

Question 20

Crohn’s? etio and RF

Answer 20

chronic inflammatory bowel disease affecting GI tract from mouth to anus, extends through all layers of intestinal wall, may involve regional lymph nodes and mesentery, slow preogressive inflammation of bowel or GI tract, granulomas through all layers of intestinal wall

etio: idiopathic, altered immune response to intestinal bacteria, lymph obstruction and infection, genetics
RF: history of allergies, immune disorders, high protien lvls of tumor necrosis factor, smoking, NSAIDs

Question 21

Crohns CM complications and Dx

Answer 21

Neuro/MS: fatigue, weakness, arthritis
GI/GU: flatulence, nausea, cramping pain in right lower
quadrant, diarrhea (especially after emotional upset or ingestion
of poorly tolerated foods), abdominal mass, anorexia,
hyperactive bowel sounds, bloody diarrhea, perianal abscess
Other: intermittent fever, weight loss, uveitis, iritis, episcleritis

complications: fistulae, colon perforation, toxic megacolon, gallstones, osteoporosis, malabsorption, abscess, colon cancer, hemorrhage

Dx: fecal occult blood test positive, hemoglobin and hemotocrit decreased or reflect anemia

Question 22

ulcerative colitis? etio and RF

Answer 22

Episodic chronic inflammatory bowel disease that
causes ulcerations of the mucosa in the colon, Initially affects the lower colon (rectum and sigmoid
colon) and may extend upward into the entire colon

etio: idopathic, immune disorder in GI tract

RF: stress, genetics, jewish ancestry, NSAIDs, dairy consumption

Question 23

ulcerative colitis, CM, Dx

Answer 23

Neuro/MS: fatigue, weakness, arthralgia, joint pain
Cardio: tachycardia
GI/GU: cramping and lower abdominal pain, mucosal discharge,
bloody diarrhea, tenesmus, anorexia, nausea, vomiting,
urgency, incontinence, distended abdomen, hemorrhoids
Skin: jaundice
Other: weight loss, fever

complications: nutritional deficiency, sepsis, anal fissure/ fistula, abscess, hemorrhage, anemia

Dx: stool specimen analysis revealing blood, pus, mucus, no pathogenic organisms

Question 24

hepatitis? etio and RF

Answer 24

Infection and inflammation of the liver caused by Direct cellular injury or induction of immune responses against the viral antigens; Marked by hepatic cell destruction, necrosis, and autolysis, leading to
anorexia, jaundice, and hepatomegaly; hyertrophy and hyperlasia of kupffer cells and sinusoidal lining cells occur

etio: A: fecal-oral route, poor hygeine and sanitation; B&C: exposure to bodily fluids of those infected

RF: A: internatinoal travel, homeless, in jail, drug use

Question 25

hepatitis incubation

Answer 25

A: 14-28 days
B: 75 days
C:2-26 weeks

Question 26

hepatitis CM and DX

Answer 26

Fever, Malaise, Nausea, Anorexia, Abdominal discomfort, Dark urine, Jaundice

A& have a vaccine, C does not

Dx: bilirubin elevated, jaundice (icteric phase), liver biopsy

Question 27

cirrhosis? etio and RF

Answer 27

represents the end-stage chronic liver disease, in which much of the functional liver tissue has been replaced by fibrous tissue, Cirrhosis also accompanies metabolic disorders that cause the deposition of
minerals in the liver. Two of these disorders are
○ 1-hemochromatosis (i.e., iron deposition)
○ 2-Wilson disease (i.e., copper deposition).
Diffuse destruction and fibrotic regeneration of hepatic cells occurs, Necrotic tissue yields fibrosis, Liver structure and normal vasculature are altered

etio: nonalcoholic fatty liver disease, alcoholism, hep B and C, autoimmune hepatitis, exposure to liver toxins, acetominophen
RF: Alcoholism, Toxins, Biliary obstruction, Hepatitis, Metabolic disorders, Heart failure

Question 28

hepatitis CM, complications, Dx

Answer 28

Neuro/MS: asterixis, slurred speech, paranoia, hallucinations, confusion,
Respiratory: dyspnea,
Cardio: edema, anemia
GI/GU: umbilical hernia, distended abdominal blood vessels, ascites, testicular atrophy, menstrual irregularities, hematemesis, melana, splenomegaly, abdominal pain, nausea, vomiting, clay-colored stool,
Skin: Telangiectasis on the cheeks, palmar erythema, clubbed fingers, ecchymosis, jaundice, pruritis

complications: ascites, muscle wasting, coagulopathy, malnutrition, portal HTN, bleeding esophageal varicies, hepatic encephalopathy

Dx:elevated lvls of liver enzymes, decreased total serum albumin, cholesterol, and protien lvls, liver biposy

Question 29

Portal Hypertension? etio and RF

Answer 29

inc resistance to blood flow in portal vein

prehepatic obstruction: spenic or portal vein thrombosis; increased portal flow: arteriovenous fistula, massive splenomegaly

Intrahepatic presinusoidal: idiopathic; sinusoidal: cirrhosis (major cause of protal HTN, bands of fibrous tissue distort architecture of liver and oncrease resistance to portal blood flow, leads to hypertension); postsinusoidal: hepatic sinusodial obstruction

posthepatic obstruction: hepqtic vein thrombosis, obstruction of inferior vena cava; resistance to right heart filling: constrictive pericarditis

Question 30

Portal hypertension CM, complications, Dx

Answer 30

asymptomacic, manifestations from complications of disorder, most dangerous is acute variceal bleeding

complications: ascites, splenomegaly, hepatic encephalopathy, formstion of portosystemic shunts

Dx: doppler ultrasound

Question 31

cholelithiasis? etio and RF

Answer 31

biliary disorder affecting gallbladder, leading to biliary tract disease, formation of calculi (gallstones) in bladder, sustances such as cholesterol and calcium bicarbonate accumulate and form microscopic crystals

etio: acute: result of condition affecting gallbladders ability to fill or empty; stone formation: depends on where gallbladder/ biliary tract calculi collect

RF: high calorie high cholesterol diet, obestiry, genetics,
DM

Question 32

cholelithiasis CM, complications, Dx

Answer 32

Cardio: tachycardia
GI/GU: severe pain in right upper quadrant or mid-epigastric area, dark urine, clay-colored stool, palpable mass, hypoactive bowel sounds
Skin: pallor, diaphoresis, jaundice
Other: fever

complications: cholangitis, cholecystitis, gallstone ileus, biliary-enteric fistula

Dx: ultrasound of gallbladder

Question 33

pancreatitis? etio and RF

Answer 33

Inflammation of the pancreas that ranges from mild to
life-threatening; idopathic; Common bile duct blockage from gallstones leads to reflux of juices
back into the pancreas after initial release.

etio: idopathic, genetic mutation
RF acute: alcohol abuse, smoking, obesity, hypertriglyceridemia
RF chronic: alcohol abuse, genetic mutation, ductal obstruction, systemic disease

Question 34

pancreatitis CM, complications, Dx

Answer 34

Neuro/MS: myalgia, arthralgia, confusion,
Respiratory: dyspnea, orthopnea, crackles, pleural effusion,
Cardio: hypotension, tachycardia
GI/GU: nausea, vomiting, hypoactive bowel sounds, cullen sign, turner sign, abdominal tenderness/distention/rigidity/guarding
Skin: pale complexion, diaphoresis, jaundice,

complications: DM, hemorrhage, ARDS

Dx: amylase and lipase elevated, WBC count and hemoatocrit elevated; Chronic: alkaline and bilirubin elevated, amylase and lipase normal or decreased