Patho final Flashcards
define fibrosis
thickening and scarring of CT
define cirrhosis
degeneration of cells
typically result of alcoholism or hepatitis
describe the liver
reddish brown organ
4 lobes
at T9-L1
where does the hepatic artery carry blood to?
liver
where does the portal vein carry blood from?
GI
spleen
associated organs
to the liver
what are the functions of the liver?
metabolsim - carbos, fat, protein
secretory - bile acids, bile salts, pigments
excretory - bilirubin, drugs, toxins
synthesis - albumin, coagulation factors
storage - vitamins, carbos
detoxification - toxins, ammoina
how much bile does liver produce in a day?
500-600 ml
what is bile required for?
digestion of dietary fats and absorption of fats and fat soluble vitamins from intestine
what does bile contain?
bile salts
water
bilirubin
where is bilirubin produced?
in bone marrow and also liver as end product of hemoglobin breakdown
what are the normal levels of bilirubin?
less than 1.5 mg/dl
what is jaundice?
abnormal high amounts of bilirubin in blood
sclera changes - 2-3 mg/dl
changes in skin color - 5-6 mg/dl
what causes jaundice?
imbalance between synthesis and clearance of bilirubin
- excessive destruction of RBCs
- excessive production of bilirubin
- obstruction of bile flow
what are spider angiomas
dilations of superficial capillaries
increased estrogen levels
palmar erythema
warm redness of skin over palms
increased estrogen levels
associated with throbbing and tingling
primary pain for liver and gallbladder
right upper quadrant abdominal pain
what is hepatic osteodystrophy
alterations in bone mineral metabolism
what are the neuro involvements of the liver
CNS altered function and metabolism
confusion
tremors
asterixis - flapping tremor/liver flap
other signs and symptoms of liver problems
GI
edema due to decreased serum albumin levels
bile converted from bilirubin causes coloration of stool
what is cirrhosis
progressive inflam
reduced blood flow to liver
12th leading cause of death
what is the most common causes of cirrhosis
alcohol abuse
hep C
toxic reactions to drugs
clinical manifestations of cirrhosis
hepatomegaly
weight loss, weakness, anorexia, jaundice
pain in right quad
fatigue with mild exertion
impaired coag
portal hypertension
hepatic encephalopathy
what is ascites
distended abdomen
accumulation of fluid
what are causes of ascites
malnutrition
heart failure
infection
malignancy
how does ascites present
distended abdomen
protruding, displaced umbilicus
bilateral edema of feet and ankle
pain in groin and low back
what tests of liver function will be high with cirrhosis?
alanine aminotransferase (ALT)
aspartate aminotransferase (AST)
serum bilirubin
alkaline phosphatase (ALP)
gamma-glutamyltransferase (GGT)
what tests of liver function will be low with cirrhosis?
serum albumin
what is hepatitis?
acute/chronic inflam of liver caused by virus, chemical, drug reaction, or alcohol abuse
risk factors of hepatitis
injection drug users
acupuncture
tattoo inscription/removal
ear and body piercing
recent operative procedure
hemodialysis
health care worker exposed to blood products/body fluids
exposure to certain chemicals/bisexual activity
travel to high risk areas
consumption of raw shellfish
which types of hepatitis have a vaccine?
A and B
which types of hep are transmitted by fecal-oral?
A and E
which types of hep are transmitted by contact with infected blood?
B, C, D
which types of hep are chronic?
B, C, D
what does the incubation/preclinical period of hep look like?
lasts 10-50 days
asymptomatic
what does the prodromal/preicteric period of hep look llike?
1-3 weeks
dark urine
light colored stools
vague GI symp
fatigue, malaise, weight loss, nausea, vomiting, diarrhea
aversion to food
alcohol
cigarette smoking
enlarged tender liver
itching
arthralgias
what does the icteric period of hep look like?
2-4 weeks
jaundice
GI sym subside
liver tenderness
enlarged spleen
enlarged cervical lymph nodes
what does the recover/convalescence period of hep look like?
3-4 months
easily fatigued
liver enlarged and tender
implications to PT with hep
wear PPE
need a balance of activity and rest
look for side effects of medications: muscle pain, headache, skin irri, depression, hair loss, cough, anything intolerable - report to physician
what is alcohol related liver disease?
a spectrum that includes fatty liver disease, alcoholic hep, cirrhosis
men > women
women develop after shorter exposure and lower quantity of alcohol than men
what % of heavy drinkers develop alcohol related liver disease?
90%
which stages of liver disease are reversible?
steatosis
hepatitis
what is pancreatitis?
serious inflam of pancreas
build up of pancreatic enzymes - autodigestion
acute - mild, reversible
chronic - recurrent or persisting
what are the different pancreatic enzymes?
trypsin - digest protein
amylase - digest carbos
lipase - digest fast
what are the most common causes of pacreatitis?
gall stones
alcohol
toxins: acetaminophen
what happens with pancreatitis
severe ischemia, inflam
disrupts ducts - leakage of fluid and formation of pesudocysts that contain necrotic tissue
can get infected with bacteria
clinical manifestations with acute pancreatitis
mild nonspecific pain to profound shock
abdo pain abruptly in mid epigastrium
pain radiates to back and worse by lying or supine
clinical manifestations with chronic pancreatitis
persistent or recurrent episodes of epigastric and left upper quadrant pain, mid thoracic pain and to left shoulder
what are the triggers of pancreatitis?
eating meals
drinking alcohol
other symptoms of pancreatitis
nausea
vomiting
anorexia
fever
tachycardia
jaundice
management of pancreatitis
low fat diet
alcohol is forbidden
referral for pancreatitis
new onset of myopathy
obvious signs of hepatic disease with hx of cancer
arthralgias of unknown cause
presence of bilateral carpal tunnel syndrome
presence of sensory neuropathy of unknown cause
cues for screening in pancreatitis
liver involvement: right shoulder pain
shoulder motion not limited by pain
unable to localize pain/tenderness
GI symp
B/L CTS
hx of cancer/liver/gallbladder disease
hx of statin or hepatotoxic frugs
recent injection drugs use/piercing/tattoo
changes in skin
alcohol consumption
normal range of pH
7.35-7.45
single value: 7.4
what is blood gas analysis?
tests on blood from anywhere in circulatory system
what is arterial blood gas?
tests on blood from an artery
what does an ABG report consist of?
pH
PaCO2
PaO2
SaO2
HCO3
what is the normal range for PaO2?
> 80 mmHg
single value: 97
hypoxemic ranges for PaO2
mildly - 60-80
moderately - 40-60
severely - 40 or below
what is the normal range for PaCO2?
35-45 mmHg
single value: 40
abnormal ranges for PaCO2
hyperventilation: < 40
hypovent: > 40
ventilatory failure: > 50
what is acid-base balance?
balance between acids and bases in blood
hydrogen ion concentration is inverse of pH
what is the normal range for HCO3
22-26
single value: 24
what do buffer systems do?
resist pH change
regulate acid base balance
plasma buffer system
reacts within seconds in response to hydrogen ion concentration
respiratory buffer system
reacts within minutes to excrete CO2 through change in respiratory rate
renal buffer system
reacts within hours/days through the production, absorption, excretion of acids, bases, ions
pH < 7.4
acidic - acidemia - acidosis
low HCO3 - meta acidosis
high PaCO2 - res acidosis
pH > 7.4
alkaline - alkalemia - alkalosis
high HCO3 - metabolic alkalosis
low PaCO2 - respiratory alkalosis
respiratory compensations for primary metabolic disorders
if decres HCO3, decres PaCO2 and hyperventilation
uncompensated
pH outside of range and compensator WNL
partially compensated
pH and compensator outside of range
compensated
pH WNL and compensator outside range
steps for acid base disorder interpretation
look at pH value - determine acidic or basic
look at CO2 and HCO2 - acid or base
match CO2 and HCO3 with pH - same acid or base
what is cancer?
disease in which abnormal cells divide w/o control and can invade nearby tissues and to the other parts of the tissues through blood and lymphatic system
what is neoplasm?
new growth
what is a tumor?
abnormal growth
swelling
what is malignancy?
presence of cancer cells that have the ability to spread to other areas
what is carcinoma?
cancer of epithelial cells
define neoplasia
disorganized growth
net increase in number of dividing cells
6 hallmarks of cancer
self sufficient in growth signals
insensitivity to anti-growth signals
tissue invasion and metastasis
limitless replicative potential
sustained angiogenesis
evading apoptosis
where does a benign tumor spread?
it is confined to its original location
where does a malignant tumor spread?
capable of invading surrounding tissue or even the entire body
define metastasis
spread of cancer cells away from origin point
where does bladder cancer metastasize to?
bone
liver
lung
where does breast cancer metastasize to?
bone
brain
liver
lung
where does colon cancer metastasize to?
liver
lung
peritoneum
where does kidney cancer metastasize to?
adrenal gland
bone
brain
liver
lung
where does lung cancer metastasize to?
adrenal gland
bone
brain
liver
other lung
where does melanoma metastasize to?
bone
brain
liver
lung
skin
muscle
where does ovarian cancer metastasize to?
liver
lung
peritoneum
where does pancreatic cancer metastasize to?
liver
lung
peritoneum
where does prostate cancer metastasize to?
adrenal gland
bone
liver
lung
where does rectal cancer metastasize to?
liver
lung
peritoneum
where does stomach cancer metastasize to?
liver
lung
peritoneum
where does thyroid cancer metastasize to?
bone
liver
lung
where does uterine cancer metastasize to?
bone
liver
lung
peritoneum
vagina
what is an “-oma”
benign, nonmalignant tumor
what does “adeno-“ mean
gland like
what does “lipo-“ mean
fat
what is a sarcoma
cancer of CT
leukemia
cancer originating in bone marrow
lymphoma
originating from immune tissue - lymph or spleen
what is cell proliferation?
increase in cell number by mitotic cell division
what is cell differentiation?
giving them a job
cell characteristics of benign vs malignant tumors?
B: well differentiated and resemble tissue of origin
M: undifferentiated and little resemblance of origin tissue
rate of growth of benign vs malignant tumors?
B: progressive and slow
M: variable, the more undiff more rapid growth
mode of growth of benign vs malignant tumors?
B: w/o invasion
M: grows by invasion
metastasis of benign vs malignant tumors?
B: none
M: access to blood, and lymph
anaplasia
loss of differentiation
diagnostic methods of cancer
blood tests for tumor markers
cytological studies and tissue biopsy
endoscopic exam
US
x ray
MRI
CT
PET (positron emission tomography)
grade 1 cancer
differ slightly from normal
well differentiated
grade 2 cancer
more abnormal
mod differentiated
grade 3 cancer
poorly diff
grade 4 cancer
immature, primitive, undiff cells
difficult to determine cell of origin
anaplastic
clinical stages of cancer (0-4)
0: cancer small and in situ (still in origin)
1: tumor limited to tissue of origin
2: limited local spread
3: extensive local and regional spread
4: metastasis
staging of primary tumor (T)
Tx - primary tumor cannot be assessed
T0 - no evidence of primary tumor
T1,T2,T3,T4 - increasing in size +/or local extent of T
staging of regional lymph nodes (N)
Nx - regional lymph nodes cannot be assessed
N0 - no regional lymph node metastasis
N1,N2,N3 - increasing involvement of N
staging of distant metastasis (M)
Mx - distant metastasis cannot be assessed
M0 - no distant metastasis
M1 - distant metastasis
what are tumor cell markers?
antigens expressed on the surface of tumor cells
substances produced by cancer cells or in response to presence of cancer cells
how are tumor markers monitored?
hormones
enzymes
genes (B-Rraf, K-Ras, ect)
antigens (PSA - in blood or prostate cancer)
antibodies
what is the process of cancer development?
exposure of cells to carcinogenic agents
growth of cells
tumor cells acquire malignant phenotypic changes
what the modifiable risk factors in cancer?
smoking, tobacco use
chemical exposure
alcohol consumption
sedentary lifestyle
obesity
diet
radiations
STDs/viruses
vitamin B12 deficiency
lack of access to use of health care and screening tests
what are the non-modifiable risk factors in cancer?
age
previous cancer
ethnicity
gender
heredity/genetics
congenital diseases/immunodeficiency
what are the 7 warning signs of cancer?
change in bowel or bladder habits
a sore throat that does not heal
unusual bleeding or discharge from body orifice
thickening or lump in breast or elsewhere
indigestion or difficulty swallowing
obvious change in wart or mole
nagging cough or hoarseness
what is the PT most likely to see in regards to cancer?
S&S of reoccurrence or metastasis
clinical manifestations of cancer
earliest stages are asymptomatic
as cancer progresses, symptoms start to develop
rapid growth encroaches healthy tissue
continued spread
cancer pain
cancer related fatigue
paraneoplastic syndromes
cancer related anorexia/cachexia
risk factor assessment for skin lesions
how long have you had it?
has is changed in past 6 weeks to 6 months?
has you physician examined this area?
ABCDE of skin lesions
asymmetrical
border
color
diameter
evolving
what are the causes of cancer pain?
pressure on nerves
visceral obstruction
throbbing pain from interference with blood supply
bone metastasis
inflammation, infection, necrosis
immobility
anxiety/depression increases perception of pain
how can cancer pain be managed?
opioids
non-opioids
acupunture
cryotherapy
biofeedback
relaxation techniques
duration of systemic/MSK pain
S: constant, progressive, awakens at night
M: intermittent
aggravating factors of systemic/MSK pain
S: mvmt doesn’t help it
M: altered by mvmt
relieving factors of systemic/MSK pain
M: usually none
S: rest, change in support, heat/cold, stretching
quality of systemic/MSK pain
M: uni/bilateral, deep aching, diffuse
S: unilateral, sharp, local
what is cancer related fatigue (CRF)?
sense if tiredness or exhaustion related to cancer or cancer treatment
what can be done to combat CRF?
activity pacing
aerobic exercise
diet
exercise at lower intensity
progress at slower pace
what are paraneoplastic syndromes?
not the direct effects of either tumor or metastasis
symptoms at distant sites
ex: small cell carcinoma of lung produces ACTH and causes cushings
what is cancer related cachexia?
most severe form of malnutrition
hypermetabolic state and altered nutrient metabolism
loss of both muscular and skeletal compartment
mechanisms of cancer related cachexia
tumor uses large amounts of glucose
use of fats and proteins
suppresses satiety center in hypothalamus
when should a physician referral for cancer happen?
changes in DTRs
myotomal weakness pattern
changes in bladder/bowel function
pain the is unrelieved by rest or change in position
recently discovered lumps/nodules
hard, immovable lymph nodes
idiopathic proximal muscle weakness
treatment of cancer
surgery
radiotherapy
chemotherapy
immunotherapy
hormones
biologic therapy
what is chemotherapy?
interrupt tumor growth or kill tumor cells
cytotoxic to dividing cells
rapidly dividing cells are most sensitive
taxol/taxotere + cytoxan
side effects of chemo
peripheral neuropathy
fatigue
GI effects
anxiety/depression
fluid electrolyte imbalance
hepatotoxicity
bone marrow suppression- anemia, leucopenia
hair loss
poor wound healing
ACSM considerations for cancer pts
slower progression
if tolerable same exercise prescription as healthy
bone is a common metastasis site
contact physician is these happen during exercise training
fever
extreme unusual fatigue
unusual muscular weakness
irregular HB, chest palpitations
sudden onset of dyspnea
leg pain/cramps
unusual joint pain
recent or new onset of back, neck or bone pain
unusual bruising or bleeding
sudden nausea
rapid weight change
severe diarrhea/vomiting
dizziness, lightheadedness
blurred vision or other visual disturbances
unusual skin rash
night pain
describe radiation therapy
damage cell DNA and prevent further replication
can also affect normal tissue
radiation side effects
fatigue
immunosuppression
decreased platelets, bleeding, anemia
decreased WBCs
infections
diarrhea
skin redness, dryness, irritation, itching, burns
edema
hair loss
ulceration
delayed wound healing
destruction of lymph tissue
bone necrosis and demineralization
exercise and radiation therapy
mod intensity 3-5x/week
reduce anxiety
improve mood
reduce stress
improve QOL
cancer surgery side effects
fatigue
loss of function
disfigurement
infection
increased pain
deformity
bleeding
scar tissue
fibrosis
oncology rehabilitation
cancer-related fatigue
poor endurance
postural changes
gait abnormality
balance/coordination deficits
joint stiffness
muscle weakness
pain
pelvic floor dysfunction
pre and post op teaching
scar tissue restriction
radiation fibrosis
chemo induced peripheral neuropathy (CIPN)
cognitive changes
lymphedema/edema
sleep disturbances
body image changes
symptoms of chemo induced peripheral neuropathy (CIPN)
glove and stocking
symmetric
tingling
numbness
burning
impaired sensation to touch and vibration
sensitivity to heat and cold
drugs that cause CIPN
platinum based agents
taxanes
vinca alkaloids
- thalidomide
- lenolidamide
- methotrexate
rehabilitation
- balance
- mobility
- QOL
- strength
what are treatments for lymphedema?
complete decongestive therapy
- manual lymphatic drainage
- compression - bandages
- exercises
