Pathology Block 2 Flashcards
What are the known teratogenic causes of congenital heart diseases?
Chemical- ETOH= Septal
TORCH- Rubella= PDA
Genetic- Tri21= Both
What is the most common congenital heart disease?
Septal defects (Ventrical Septal defect most common) L to R shunt
Atrial Septal Defects are caused by what two things?
Patent Foramen Ovale
Incomplete septal formation
What are the four parts of Eisenmengers Syndrome in VSD
Inc blood volume and pressure cause: RVH Pulmonary HTN Inc pulmonary resistance Blood pushed back R/L ventricle
What are the two characteristics of shunts during Eisenmengers Syndrome
L to R- reverses
R to L- cyanosis
Septal defects causes what type of auditory identifiable noise?
Systolic murmur
Best heard at L sternal border- tricuspid or pulmonic
What type of murmur is heard w/ Patent Ductus Arteriosus
Machinery-like- continuous/inc with diastolic phase
Best heard at L sternal border
Patent Ductus Arteriosus is often associated with a _____
Thrill
What parts of Esenmengers Sydrome are evident with Patent Ductus Arteriosus
Aortic back flow
Pulmonary HTN
Pulmonary HTN causes back flow to aorta
Cyanotic L to R shunt
How are newborns treated for Patent Ductus Arteriosus
NSAIDs- prostaglandin inhibitor
What is the most common cause of cyanosis in neonates?
Tetralogy of Fallot
Tetralogy of Fallot is AKA ? with ? spell
Blue Babies
Tet Spells
Tetralogy of Fallot is a complex malformation with what four typical lesions and which ones lead to cyanosis
Pulmonary valve stenosis
R ventricle Hypertrophy (c)
Ventricular Septal Defect (c)
Overriding aorta (c)
How is Tetralogy of Fallot fixed?
Surgery or death occurs prior to puberty
Where do coarctations of the aorta typically occur?
Distal to origin of L subclavian artery
Approximate site of ligamentum arteriosum
What are the clinical findings of a coarctation of the aorta?
BP differences upper/lower extremeties
Systolic ejection murmur at apex
Rib notching
Define Transposition of the Great Arteries and what is the risk of this
Great vessels are reversed at their origins
Incompatible w/ postnatal life
What causes more morbidity and mortality in Western society than any other disease?
Vascular/Ischemia related diseases
What are the two principle mechanisms of vascular diseases?
Narrowing- atherosclerosis, emboli
Weakening- aneurysm, fistula, varicosity
Define Bruit
Swishing sound with auscultation from atherosclerosis
What are the two parts of atherosclerosis manifestations?
Chronic narrowing- bruit, ischemia, angina, claudication
Acute- infarction
What are the 3 red flags of claudication?
Pain at rest
Skin ulcers
Dependent rubor
What are the two types of angina?
Stable/Predicatble- pain stops with rest or after Nitro
Unstable- pain at rest, not stopped with Nitro
Define Prinzmetal Angina
Angina variant, coronary artery spasm causing transient ischemia, not from obstruction
Chest pain @ rest/sleep w/ smoking as factor
What are the four classic symptoms of MI
Chest pain
Radiation to L jaw/arm
Dyspnea
Syncope
How does a MI show on an EKG?
ST elevation
What are the four cardiac markers?
Troponin 1- most sensitive/specific, 2-6hrs
CK-MB- k- brain, m- muscle, 3-12hrs
Myoglobin A- 1-2hrs
Alaninaminotransferase/LDH- day 2 to wks later
What are the 3 common sites for aneurysm development?
What size is at risk for rupture?
Abdominal aorta
Iliac artery
cerebral artery
Greater than 1.5 normal size
Define True Aneurysm
Define Pseudo Aneurysm
True- all 3 layers of artery involved
Pseudo- not all layers are involved
Aortic dissections create a second lumen between what layers?
Intima and Media
Aortic dissections start in ____ and can be seen on ____
Aortic arch
Widened mediastinum x-ray
Define Saccular aneurysm and what is it associated with
Cerebral aneurysm- Berry aneurysm in Circle of Willis
HTN
What are the classic S/Sx of a Cerebral Aneurysm
Tunderclap headache
Worst ever
AAA are more likely to rupture if its greater than what size?
5cm
High mortality with rupture, 50% still die in OR
Define Arterio-Venous Fistula
Channel connecting hollow organs/cavity
What will be found on examination for Arterio-Venous Fistulas?
Palpation will feel thrill
Auscultation will hear bruit
What are the 4 causes of fistulas?
Congenital- brain, lung, skin
Inflammation- Chrons Dz
Trauma
Surgical- hemodialysis
How are varicose veins saved from direct damage?
Atherosclerosis
HTN
What are 3 complications of varicose veins?
Thrombophlebitis
Stasis dermatitis
Stasis ulcer
What are the S/Sx of Giant Cell Arteritis
Unilateral temporal headache
Unilateral blurry vision
Unilateral jaw claudication
How is Giant Cell Arteritis diagnosed?
How is it treated?
Elevated erythrocyte sedimentation rate for elevated CRPs
Corticosteroids
What type of issue is Raynauds Disease?
Functional disturbance causing vasospasms
What is the sequence of colors that skin turn during Raynaud’s Phenomenon
White
Blue
Red
Raynaud’s Disease is associated with what predisposing factors?
Smoking Autoimmune (lupus) Atherosclerosis Occupation Drugs
What are the 3 determinant of BP?
Volume
CO
Vascular resistance
What are the contributing factors of HTN?
Genetics
Age
Lifestyle
Diet
What are the contributing factors of Secondary HTN?
Disease- apnea
Medication-
Physiologic events- pregnancy
What are the 3 types of cardiomyopathy?
Dilated- ETOH
Hypertrophic- chronic HTN
Restrictive- scar tissue
How is cardiomyopathy treated?
Hear transplant
What are 3 causes of cardiomegaly?
Conditioning
MI injury
Chronic HTN
Why does the left ventricle become non-compliant with cardiomegaly?
Ischemia
Fibrous changes
What is the sequence of events leading to right sided heart failure from cardiomegaly?
Ischemia/fibrous leads to LV non-compliance, back pressure in pulmonary vein causes RV to dilate and fail due to pulmonary HTN
Define Cor Pulmonale
R sided heart failure due to pulmonary HTN
What are the common causes of CHF?
HTN
Valve Dz
Ischemia
Cardiomyopathy
Rheumatic Heart Dz arises from what?
Immune response to Streptococcal infection
Abs react with PTs cells damaging CT in heart/joints/brain
Rheumatic Heart Disease can have an onset as quick as ?
Two weeks after Strep Throat
Where does endocarditis effect and what issue does it cause?
Left valves
Vegetations and fibrous scars on valves causing stenosis or regurgitation
When are Aschoff Bodies found?
Myocarditis from Rheumatic Heart Disease
Lymphocytes and macrophages destroying myocardium
Severe cases of Rheumatic Heart Disease tends to effect what layer of the heart?
Pericardium, causes pericardial effusion and fluid build up
What are the Major Criterias for Jones’ RF criteria?
Polyarthritis Carditis Chorea Subcutaneous nodules Erythema Marginatum
Bacterial Endocarditis is AKA?
Infective endocarditis
What is the difference in appearance between RHD and Bacterial Endocarditis?
Bacterial causes larger vegetations than RHD, vegetation forms pocket for bacteria and thromboemboli
What are the 3 risk groups for bacterial endocarditis?
IV drug users
Prosthetic/Heart valves
RHD
What are the clinical characteristics of bacterial endocarditis?
Rapid onset febrile illness
Cardiac murmur
Arterial emboli- splinter hemorrhage, Janeway Lesion
Myocarditis is usually caused by ?
Viral- coxsackie or enterovirus
Occasional parasite- Chagas
Rare- RF, SLE
How does the heart get damaged during myocarditis?
T lymphocytes are attracted to infected cells that secrete cytokines to kill invaders but damages heart in process
What are the clinical features of myocarditis?
Vague, non-specific Sx
Delayed Diagnosis
Pericarditis is often associated with what other conditions?
Myocarditis
Autoimmune- RHD, SLE
Trauma
What are the clinical features of pericarditis?
Acute-> tamponade, prevent proper filling during diastole
Chronic- water bottle silhouette sign on x-ray, friction rubbing
URIs are AKA and are usually caused by ?
Common Cold
Rhino Virus
What are the clinical features of URIs?
Acute inflammation of nose, throat, sinus w/ rhinorrhea
Non-productive cough
Low fever
Sx for 2-3 days, 7-10 day resolution
Middle Respiratory Syndromes are diseases of what structures?
What PT population is it most common in?
Larynx, Trachea, Major bronchi
Children
What are the three main types of middle respiratory syndromes?
Croup
Epiglottitis
Bronchiolitis
What is the medical term for the Croup
Laryngotracheobronchitis
The Croup usually affects what PTs and is caused by ? microbe?
Children under 3 y/o
Parainfluenza or Adeno
When are the S/Sx of the Cropu the worst?
Last day of infection
What are the clinical features of the Croup?
Barking cough, worse at night
Steeple sign on C-spine x-ray
What is the treatment for the Croup?
Supportive
Oral steroids
Nebulized epi (racemic)
What PTs are susceptible for eipglottitis and by what microbe?
School age/Early teens
HIB w/out vaccine
Strep/Staph w/ vaccine
What are the clinical presentations of epiglottitis?
Rapid onset fever
Painful swallowing/drooling
Sniffing position
Thumbprint sign on C-spine
What is the treatment for Epiglottitis?
Admission, abx, steroids
Intubation possible
HIB vaccine
What PTs are susceptible to bronchiolitis and by what microbe?
Under 2y/o w/ winter outbreaks
Respiratory Syncytial Virus- kills cells and narrows lumen
What are the clinical features of bronchiolitis?
Wheezing
Forceful cough
Low grade fever
Define Stridor
Define Wheeze
S- high pitched inspriation
W- course expiration
What are the two types of pneumonia
Alveolar- broncho/lobar pneumonia (bacterial)
Interstitial- Bilateral, diffuse, reticular (viral/atypical)
What is the difference between Primary/Community Acquired and Secondary Pneumonia
Community- healthy get it from the community
Secondary- nosocomial
What are the pathogens for bacterial pneumonia?
Strep Pneumo- +50% of cases
HIB
Staph- rare, lung abscesses
Klebsiella- currant jelly, aspiration/alcoholics
Pseudo Aeruginosa- most common nosocomial/intubated
What are the pathogens of walking pneumonia?
Mycoplasma
Barracks, dorms, work crews and remains for weeks/months
What are the clinical features of common pneumonias?
Fever/chills- high w/ bacteria, low with viral/atypical
Dyspnea/Tachypnea- dec O2
Chest pain with cough/deep breath
Rales/rhonchi
Localized infiltrates on x-ray
High CBC w/ bacteria, normal/mild WBC elevation with viral
Pulmonary exposures to fungal pnemonias rarely causes S/Sx in what type of PT?
Immuno-competent
Where are fungi endemic?
Soil
Construction
Landscape
Farming
How do fungal pneumonias present clinically?
Fatigue
HAs
Muscle/joint pain
Solitary nodule -> calcified granuloma
What are the pathogenesis of fungal pneumonias and which ones are the most common?
Histoplasmosis- bird shit
Coccidiomycosis- valley fever
Pneumocyctits jiroveci- AIDS
HIV PTs may get secondary fungal pneumonia from ? microbes?
Candida
Aspergillus
How do fungal pneumonias appear on chest x-rays?
Coin lesion
Multiple nodules
What did the Greeks call TB?
Consumption
What type of microbe is TB?
Acid-fast bacillus
What is Primary TB?
PTs first encounter
Ghon complex
Granuloma calcifies and TB is dormant
What is Secondary TB?
Reactivation/reinfection
TB is uncontained
Causes apical penumonias
When is a TB PT highly contagious?
PT coughing up TB
Bilateral dissemination
How can TB Pts die?
Pulmonary vessel rupture
How is Pulmonary TB diagnosed?
Clinical S/Sx
+PPD
How does Pulmonary TB present in Primary and Secondary TB
1*- mild, low fever, 95% not diagnosed
2*- non productive dry cough, low fever, hemoptysis and dyspnea late signs
How long does a Pulmonary TB sputum test take to culture?
4 wks
Positive PPD is what type of response?
T-cell mediated
Pulmonary TB can have what 3 x-ray signs?
Hilar lymphadenopathy
Ghon complex
Apical Pneumonia
How are lung abscesses identified?
Localized destructive suppurative lesion
How do lung infections present clinically?
Suppurative lesion
Malodorous productive cough
Fever
What are the main causes of lung abscesses?
Staph Aureus
Klebsiella
Aspiration
How do lung abscesses appear on x-rays?
Air-fluid level
What is the Pack year Hx equation
of packs per day X # yrs smoked
COPD PTs have a decreased expiratory volume called?
Dec FEV1
COPD volume is ___ and but take longer to ___
Less than normal
Exhale
What are the 3 entities of COPD
Chronic bronchitis
Bronchiectasis
Emphysema
What two processes of chronic bronchitis decreases airway diamete?
Metaplasia
Hyperplasia
What is a common complication of chronic bronchitis?
Bronchiectasis- permanent dilation of bronchioles from repeated inflammation and fibrous scarring
When is emphysema seen in non-smoking PTs?
Genetic deficiency of A1-antitrypsin
Define an Asthma Attack
Bronchospasm w/ dyspnea
Wheezing
Cough
Bronchi have chronic inflammation and inc mucus
What is the treatment goal for asthma?
Reducing bronchospasms and inflammation
How is mast cell degranulation reduced in asthmatics?
Antihistamines
Leukotrienes inhibitors
How are bronchospasms reduced in asthmatics?
How is bronchial inflammation reduced?
Bronchodilators
Inhaled steroids
Intrinsic asthma is AKA?
Adult onset since there no immune mechanism/non-atopic
Define Extrinsic Asthma
Type 1 Hypersensitivity, atopic response to allergen exposure
Childhood onset
Extrinsic asthma involves immune responses with what cells?
IgE
Mast
Both intrinsic and extrinsic asthma share what similar issue?
Airway constriction
What type of disease is Sarcoidosis
Granulomatous dz
T-lymphocytes infiltrate lungs forming granulomas w/o necrosis
What is the incidence rate of Sarcoidosis?
10x more in blacks
2x more often in women
What are the clinical features of Sarcoidosis?
50% w/out Sx
Low fever, anorexia, fatigue
How does Sarcoidosis appear on chest x-rays?
How is diagnosis confirmed?
Pulmonary nodules and hilar lymph nodes resembling pulmonary edema
Biopsy of granulomas
Define ARDS
Collection of lung changes after acute lung injury (capillary or aveolar endothelium)
Alveoli fill with fluids or collapse preventing gas exchange
How do ARDS present in clinical features?
Severe respiratory distress and hypoxia
Define Neonatal Respiratory Distress Syndrome
Micro-atelectasis due to surfactant production not startin until 24-28wks of pregnancy
Define Pneumoconiosis
Disease caused by inhaling mineral dusts/fumes
Coal Worker’s Disease is AKA?
What happens in this disease?
Anthracosis
Black Lung Disease
C particles build and cause lung destruction/fibrosis
Define Silicosis and its cause
Silica crystals from mining/stone work lodging in lungs and killing macrophages leading to fibro-nodular lesions in lung tissue
What is the only form of Pneumoconiosis that is a predisposing factor to lung cancer?
Asbestosis -> Mesothelioma
What type of laryngeal carcinomas occur most?
Glottic tumors
Laryngeal carcinomas are linked to what 3 things?
Smoking
Chronic alcohol
Rare- radiation treatment for neck cancer
What is the leading cause of cancer deaths in males and females across the US?
Lung carcinomas
90% of smokers under 40, 70% will have metastesized at time of diagnosis
What are the 4 types of primary lung cancers?
Adenocarcinoma
Small cell
Squamous
Large cell
Characteristics of Small Cell tumors
Aggressive
Treat w/ chemo only
Characteristics of Non-Small cell tumors
Treated with surgery and chemo/radiation
How doe lung carcinomas present clinically?
Coughing from irritation
Extensions into mediastinum/pleural cavity cause dyspnea
Lung ____ are more common than primary lung tumors
Metastases due to capillary network making lungs more prone to hematogenous spread
Lung metastases have what distinct x-ray image?
Cannonball lesions
Upper GI tract = ?
Lower GI tract =?
Upper- Mouth to duodenum
Lower= Treitz to anus
What is the difference between Visceral and Parietal pain?
Visceral: Vague, cramp, Colicky spasm preventing PT from sitting still
Parietal: Pin point, PT guards and remains still
What causes the different pain in visceral and parietal pain?
Visceral- stretching of unmyelinated fibers
Parietal- irritation of fibers innervating lining above pain source
When do cleft lip/palate form in pregnancy?
1st trimester
Cleft lip or palate are genetic issues with what three predisposing risk factors?
Smoking
DM
Seizure meds
Cleft lip generally occurs where on the mouth?
Left of the philtrum, from nasal base to upper gum line
What are the characteristics of Aphthous Ulcers?
Immune link seen in PTs under 20y/o
Ulcerations on inner mucosal surfaces w/ gray/white center
What are the characteristics of Cold Sores?
HSV Type 1, vesicles on oral exterior surfaces
How are the chances of developing dental caries reduced?
Dental care
Flouridation
Define Periodontal Disease
Inflammation of gingiva and lining extending into root resulting in MORE tooth loss than all other dental Dzs combined
How does preiodontal disease progression present?
Gums red and tender
Tooth becomes looser and dies
Define Sialadentis
Inflammation of major salivary gland (Mumps, Staph/Strep, Sjogrens Synd)
Define Sialothiasis
Stone formation in salivary duct
What form of Sialadentis presents with foul tasting discharges?
Bacterial
What two conditions can present with painful swollen salivary glands?
Sialorrhea
Xerostomia
What is the treatment for salivary gland diseases?
Acute cases with sour products to stimulate salivation
Define Esophageal Atresia
Congenitally incomplete lumen, esophagus doesn’t communicate with stomach
Usually fistula present
How does a Tracheo-Esophageal fistula present in babies?
Frothy/white bubbles
Coughing/choking while feedings
Vomiting
Aspiration
What is the most common variation of esophageal atresia and tracheo-esophageal fistula?
Atresia with distal fistula
Define Achalasia
Failure to relax
Disordered peristalsis, incomplete relaxation, high sphincter pressure
Achalasia has an unknown etiology except for?
Chagas (Trypanosoma)
What are the clinical features of Achalasia?
Dysphagia for fluids and liquids
Regurgitating undigested food
Bird Beak appearance on x-ray
What are the three types of esophageal diverticulum?
Zenker- upper esophagus, most common
Midthoracic- traction on esophagus
Epiphrenic- directly above diaphragm
How do esophageal diverticulum present clinically?
Difficult/painful swallowing
Regurgitating food when bending/lying/standing
Chronic bad breath and cough
What causes hiatal hernias?
High intrabdominal pressures
What are the two types of hiatal hernias?
Sliding- stomach slides through hiatus forcing gastroesophageal junction into the chest
Rolling- para-esophageal, fundus rolls up next to esophagus leaving gastroesophageal junction in abdomen but stomach can become strangulated
GERD is AKA?
Peptic Esophagitis
Esophageal sphincter tone can be compromised by what two things or decreased by ?
Compromised by pregnancy or hiatal hernia
Reduced by smoking, caffeine, acidic/citrus
What are the clinical features of GERD?
Water brash
Recurrent heart burn
Chronic cough
Sx worse at night and after meals
Barretts Esophagitis is predisposed by what two risk factors?
Smoking
Alcohol
What is the sequence of cell changes in Barrett’s Esophagitis
Metaplasia
Dysplasia
Neoplasia
Cancer
Define Mallory-Weiss Syndrome
What can cause this?
Esophageal tear near gastroesophageal junction from alcohol abuse or forced retching
How does pyloric stenosis present
Projectile vomiting immediately after feeding
What are the characteristics of Acute Gastritis
Can the stomach recover from this?
Decreased gastric blood flow
Increased acid production
Exogenous irritants
Stomach can recover if blood flow returns or acidity neutralizes
What are the characteristics of Chronic Gastritis?
Autoimmune from pernicious anemia
Infection- H. pylori
How do NSAIDs cause Gastritis
Inhibit prostaglandin synthesis reducing mucous blood blow and BiCarb production
What are the clinical features of NSAID Gastritis?
Vague epigastric pain
Dyspepsia (indigestion)
Vomiting
How is NSAID Gastritis treated?
H2 blockers
PPI
What happens in the stomach if a PT has Auto-Immune Gastritis?
Decreased IF which inhibits absorption of B12
A PT with autoimmune gastritis will present with what underlying issue?
Pernicious anemia w/ megaloblastic RBCs
How will autoimmune gastritis present clinically?
Nonspecific neurologic Sx: numbness, tingling, weakness, clumsiness
PTs wil autoimmune gastritis will have what type of CBC report?
Macrocytic RBCs
Hypersegmented WBCs
What is the most common cause of non-erosive gastritis and peptic ulcer disease?
H. Pylori
What are the 4 predisoposing factors of Infectious Gastritis (H pylori)?
Smoking
Emotional stress
Alcohol
Steroid
PT that is unresponsive to standard GERD or ulcer treatments need to be evaluated for ? issue
Infectious gastritis
How is Infectious Gastritis diagnosed?
What is a residual issue with it’s confirmation?
Biopsy or Urea Breath test
Once pos, always pos
Duodenal ulcers are __ times more common than gastric ulcers?
4x
More likely in +50y/o
Peptic Ulcer disease is often associated with ? infection
H pylori
How do peptic ulcers present clinically?
Shallow= vague pain and dyspepsia Deep= melena or hematemesis Perforation= peritonitis, pnemoperitoeum, pancreatitis
What are the differences between PUD presentations?
Inner wall of duodenum/stomach= pain w/out bleeding/perf
Bleeding when ulcer erodes into vessel, occult stool blood(slight) or melena/hematochezia (heavy)
Perforation= no blood vessel involved so no bleeding is evident
Define Hirschsprungs Disease
Similar to Achalasia Process
Congenital lack of innervation at sigmoid/rectum
No innervation=permanent spasm=mechanical obstruction=megacolon
How is Hirschsprungs Disease presented clinically?
Stool/fecal liquid expelled forcefully
Overflow diarrhea
Failure to thrive
Abdominal swelling
Define Meckel’s Diverticulum
Outpouching of small bowel from remnant of intestine/umbilical connection
What is the Rule of 2s for Meckel’s Diverticulum
2% of population
Withing 2 feet of ileocecal valve
2 mucosa- gastric and pancreatic
Meckel’s Diverticulum is a failed form of what cell process?
Apoptosis
Meckel’s Diverticulum S/Sx can resemble what other issue?
Appendicitis
What is the difference between Diverticulosis and Diverticulitis?
osis- condition/presence of diverticula
itis- inflammed/infected diverticula
How do Colonic Diverticulosis pathogenesis form?
Low fiber and sedentary
High intra-colon pressure causing fecal matter to get trapped
What is the incidence of Colonic Diverticulosis?
Common in industrial nations where diets are high in fiber; tend to be asymptomatic
How does Colonic Diverticulitis present clinically?
LLQ pain- most common Sx
Fever
Leukocytosis
Tenesmus
How is un/complicated colonic diverticulosis
Uncomp- Bowel rest, ABX
Comp- Surgery after one complicated or multiple uncomplicated
Hemorrhoids are AKA
Piles
Acute Ischemic Bowel Disease is aka?
Mesenteric Ischemia
How does Ischemic Bowel Disease present?
Sudden GI bleeding/Sepsis
Postprandial pain
Pain out of proportion to exam
How does Chronic Ischemic Bowel disease presnt?
Atherosclerosis w/out occlusion
Food Fear
Postprandial pain w/ 10-30m onset and peaking at 1-3hrs
IBS includes what two diseases?
Crohns and Ulcerative Colitis
What are the similarities of IBS?
More common in Caucasian Peak onset 20-30y/o Familial Inflammatory mediators Altered microbiomes
Crohn’s Disease is a ___ Dz
Right sided, mostly in terminal ileum and proximal colon involving all 3 layers of intestine
How does Crohn’s disease present on x-ray?
Skip lesions
Cobble Stone
Ulcerative Colitis is a __ Dz
Left sided in colonic mucosa
How does ulcerative colitis present on imaging?
Sandpaper- friable
Pseudopolyps
Toxic megacolon
How does Ulcerative Colitis present in clinic?
Cycle of Sx to no Sx
Diarrhea, rectal bleeding, abd pain
Rotavirus affects ___y/o
Norwalk affects ___ populations
6mon-2yrs
Ships, nursing homes, delpoyed
S/Sx of rotavirus
S/sx of norwalk
Watery diarrhea
N/V, diarrhea, abd pain
VGE includes what two microbes?
Rotavirus
Norwalk virus
Bacterial Diarrhea is AKA and includes what two microbes?
Enteritis
Bacteria toxins/lytic action
Difference between toxic and lytic enteritis?
Toxic- food poisoning by Staph A, E Coli, Vibrio from seafood
Lytic- invades mucosa, yersinia, Campylobacter or Salmonella/Shigella
What are the clinical features of appendicitis?
Vague peri-umbillical pain to RLQ @ What iMcBurney’s Pt
What are the two classifications of peritonitis?
Infectious- rupture
Sterile/chemical- pancreatic enzyme, bile, post surgical
Sterile Peritonitis healing often occurs with what side effect?
Fibrous Adhesions
What is the key Sx of peritonitis?
Rebound tenderness
Ileus is associated with what two diseases?
Peritonitis
Spinal cord injury
Ileus is often seen after ___
Surgery
Causes lack of emulsion and seen by air-fluid level on x-ray
What is the most common form of bowel obstruction?
Inguinal hernia
Define Intussusception
One segment of bowel telescopes into adjacent segment
How does Intussusception present?
Intermittent/colicky ab pain
Define Volvulus
Bowel twists itself in middle aged/elderly PTs
Define Celiac Sprue
Gluten sensitive intropathy
Define Tropical Sprue
Bacterial pathogen in tropical travelers
Define Whipple Disease
Rare overgrowth of Tropheryma Whipple in small bowel causing malabsorption
Most cancers of the oral cavity/tongue are what type of cell?
Squamous
What type of cells are seen in upper/middle carcinoma and lower esophagus?
Upper/middle- squamous
Lower- adenocarcinoma (Barretts precursor)
Gastric Neoplasm is usually from ? and is featured by ? sensation
H Pylori
Early satiety
Intestinal neoplasms start as ? and 95% are ?
Polyps
Adenocarcinomas
How do intestinal neoplasms present in clinic?
Occult bleeding
Weight loss
Constipation
What gives feces the brown color?
Bilirubin processed into stercobilinogen
Jaundice is a ______ not a ____
Manifestation of hyperbilirubinemia
Not a disease
When do jaunidce symptoms become evident?
> 3mg
What are 3 causes of jaundice?
Pre-hepatic- elevated indirect/unconjugated bilirubin
Heptaic- elevated indirect/unconjugated bilirubin
Post-Hepatic- direct conjugated bilirubin
Define Pre-Hepatic Jaundice
Inc bilirubin production
Malaria, sickle, anemia
Define Hepatic Jaundice
Impaire uptake/conjugation in liver
Hepatocellular
Hepatocyte injury or Gilberts Dz/Tylenol OD
Define Post-hepatic Jaundice
Decreased excretion of conjugated bilirubin
Cholestatis
Gallstone obstruction
How does cholestatis appear clinically?
Alcoholic feces- pale/cream colored feces
Brown foamy urine
What viruses can cause hepatitis?
A B C D E
Epstein Barr, Herpes, Cytomegalo
What are the 3 phases of hepatitis?
Acute- w/ or w/out jaundice
Chronic- may transmit, possible cirrhosis
Fulminant- necrosis, fatal
What are the 3 phases of Hep B
Preicteric- weak, jaundice
Icteric- jaundice w/ elevated liver enzyme
Convalescent- most recover
What form of hepatitis has “blood and body fluid” transmission?
Hep B
What is the hallmark of Hep C?
Persistant/chronic infection
Hep A transmission route Hep B route Hep C route Hep D route Hep E route
Fecal-oral Blood and body fluid Blood transmission Blood and body fluid Fecal-oral
Hep D is dependent on ?
Hep B co-infection
Higher progression to fulminant
Where is Hep E found in the world?
Asia
Africa
S. America
What are the ABCs of Cirrhosis?
Alcohol with Hep B and Hep C a close Second
Cirrhosis is synonymous for?
End stage liver Dz
What is the progression of portal cirrhosis?
Necrosis, fibrosis, nests of regenerating liver cells
Define Primary Biliary Cirrhosis
Autoimmune middle age women 30-65
Scarring of bile ducts cause cirrhosis
Define Secondary Biliary Cirrhosis
Stone in bile duct
Define Sclerosing Cholangitis
Men under 40
Ulcerative colitis
What is the term for Fattly Liver Diz
Steatohepatitis
Chronic alcohol causes increased FA production and altered cell membrane decreases lipid exportation
Non-ETOH Fatty Liver Dz is caused by ? 3 things?
Obesity
DM
HTN
Dilation of portal veins cause what 3 things?
Ascites- hypoalbuminemia
Splenomegaly
Venous congestion- esophageal varices, Caput Medusa
Portal vein is a confluence of what two structures?
Splenic vein
Superior mesenteric vein
How is Gilbert Syndrome identified?
Intermitent Jaundice
How is an Alpha1-Antitrypsin deficiency identifed?
Non-smoking emphysema
What are the characteristic findings of Hemochromatosis?
How is it treated?
Pigmentary cirrhosis
Bronze diabetes
CHF
Blood letting/Frequent phlebotomy
Copper eye ring of Wilson’s Disease is AKA?
How is this treated?
Kayser-Fleischer ring
Chelating agents
Difference between Cholelithiasis and Choledocholithiasis
thiasis- stones in gallbladder/biliary ducts
docho- stones in common bile ducts
What are gallstones that are yellow, black, or brown?
Yellow- cholesterol
Black- bilirubin
Brown- cholesterol and calcium
What are the 4 F’s of cholesterol stones?
Forty
Fat
Fertile
Female
What causes black bilirubin stones?
hemolytic Dz
What causes brown cholesterol and calcium stones?
Biliary parasites
Define Biliary Colic
Chronic cholecystitis
No fever or leukocytosis
How does acute cholecystitis present?
RUQ pain after fatty meal
Fever and leukocytosis
Murphys sign- exhale, press, inhale= pain
Hepatocellular carcinomas has what pathogenic origins?
Hep B and C
Chronic liver diseases
50% of all liver cancers produce ____ which is usefule for early diagnosis
Alpha-Fetoprotein
How does the pancreas excrete the exocrine juices?
Ampulla of Vatar
Amylase- for starch and lipase
Protease- protein
What are the exocrine cells of the pancreas?
What are the endocrine cells?
Acinar cells
Islets of Langerhans
What do A B and D cells of the pancreas produce?
A- glucagon
B- insulin
D- somatostatin and pancreatic peptide
How do gallstones cause acute pancreatitis?
How does alcohol cause it?
Obstruction near Ampulla of Vater force bile into pancreas
Damages acinar cells causing unregulated enzyme release
What are the 3 rare causes of pancreatitis?
Trauma
Meds
Hyperlipidemia
What kind of pain does pancreatitis present with?
Epigastric
Boring through them
Worse when supine, better sitting up
Define Cullens Sign
Define Grey/Turners Sign
Cullen- echymosis in periumbilical region
Grey- ecchymosis in posterior flanks
What lab result will be altered in pancreatitis?
Serum lipase 3x normal
What are some compliations of Pancreatitis?
Peritonitis
Pseudocyst
Abscess
Transient DM
Chronic pancreatitis is usually seen in what PT population?
Middle age men w/ alcohol abuse
What is the treatment for mild pancreatitis?
Pancreatic rest, no ETOH
NPO or clear liquids only for 48hrs
What are the requirements to discharge a PT home who has mild pancreatitis?
PO tolerant
Pain controlled
How does pancreatic adenocarcinoma present?
Smokers
Older males w/ jaundice
Weight loss
New onset DM
What are the two types of Islet Cell tumors?
Insulinoma- B cell tumor causing hypoglycemia
Gastroinoma- reverts cells to revert back to fetal function
Define Zollinger Ellison syndrome
Excess gastric acid and intractable peptic ulcers (refractory to standard ulcer meds)
What are the meanings of the roots of diabetes mellitus?
Diabetes- to pass through
mellitus- sweet
DM is a disturbance in what two things
Insulin deficiency
Insulin resistance
What are the two classifications of DM?
Type 1- insulin dependent/juvenile-onset
Type 2- non-insulin dependent/adult onset
What are the two subgroups of Type 1 DM?
1A- autoimmune destruction
1B- virus damage
What are the two primary defects of Type 2 DM?
Peripheral tissue resistance to insulin
Declining B cell secretion
Serum insulin levels in Type 2 DMs will be ?
Normal
What are the Polys of DM?
Plyuria
Polydipsia
Plyphagia
Fasting glucose should be above ?
126mg
Pre-Diabetic= 110-125
What are the long term risks of DM?
Atherosclerosis
Renal ischemia
Retinopathy
Peripheral neuropathy
What is normal urine production amount?
What is normal GFR?
1.5L/day
90-120ml/min
Define Azotemia
Uremia
BUN elevation from decreased excretion into urine caused by decreased GFR
Define Acute Renal Failure
Oliguria or Anuria often with azotemia
What can cause renal failure?
Glomerular or intestinal injury (acute tubular necrosis)
Trauma directly doesn’t cause it, resulting shock does
What are the characteristics of a Solitary Kidney?
1 : 800 mostly males, usually L is missing or Horseshoe Kidney
What are three causes of Glomerular Diseases?
Immunologic Dz
Metabolic Disorder
Circulatory disturbances
What are the characteristics of Nephritic Syndrome?
Ritic- HTN, Hematuria
Edema, proteinuria, hypoalbuminemia
Acutely caused post glomerulonephritis/lupus
What are the characteristics of Nephrotic Syndrome?
No HNT or Hematuria
Membranous nephropathy
Focal glomerulosclerosis
Lipoid nephrosis
What causes Acute Glomerulonephritis?
Post Strep Glomerulonephritis after GBAHS
Ag-Ab trapped in basement membrane
Acute Glomerulonephritis is what type of glomerular disease?
Nephritic
HTN and Hematuria
Facial edma and Oliguria
What is the most common examples of crescentic glomerulonephritis
Goodpasture Syndrome
Crescentic glomerulonephritis is what type of glomerular disease?
Nephritic
Membranous nephropathy is what type of glomerular disease?
Nephrotic
Most common nephrotic syndrome in kids
Hyperlipidemia
Lipiduria
What is the most common nephrotic syndrome in adults?
Focal Segment Glomerulosclerosis
What is the most important metabolic disease that affects the kidneys?
DM
Thickening of glomerular membranes from DM causes what 3 changes?
Increased permeability- proteins leak out
Renal ischemia/papillary necrosis
Polynephritis
What are the 4 main types of stones?
Ca- 75%
Struviate- Staghorn calculi (chronic UTIs and prone to urosepsis)
Uric acid- gout
Cystine- metabolic error
Symptoms of renal stones are dictated by what two things?
Size
Location in tract
Migrating kidney stones trigger what events?
Renal colic- wrap around pain
Flank pain
hematuria
Stone size less than __ mm have a __ pass rate
5
98%
What is the most common site of obstruction by kidney stones?
Ureterovesical junction
Blockage causes secondary UTIs and pyelonephritis
Define hydronephrosis
Renal pelvis and calyces dilate due to increased urine pressure due to outflow obstruction
Hydronephrosis is a common sequel to _____ thus making it not a true ______
Stone obstruction
True metabolic renal disorder
What causes nephroangiosclerosis
Chronic hypoperfusion
Atherosclerosis
heavy scarring leads to renal insufficiency
1/3 of all end stage renal diseases are caused by ?
HTN resulting in chronic renal ischemia
What is the most common form of UTI?
Ascending
Descending UTIs are caused by what process?
Hemtagogenous spreading
What are the two common forms of UTIs
Cystitis
Pyelonephritis
What are the clinical features of Cystitis?
What must always be ordred with these Sx?
Frequency
urgency
Dysuria
Urine culture
What is the treatment for UTIs?
Phenazopyridine
Pyridium or OTC Azo
What is the most common etiology of Polynephritis?
Ascending infections
Pyelonephritis w/ urethral obstruction is triaged as ?
Urological emergency
What are the S/Sx of pyelonephritis
CVA tenderness
Fever/Chill
N/V
What PT population has the highest risk for renal and bladder carcinoma?
Smokers
What is the most common type of renal cell carcinoma?
Clear cell
What is the red flag of renal cell and bladder carcinoma?
Painless hematuria
What are the clinical features of Acute Glomerulonephritis?
HTN
Hematuria
Edema on face
Oliguria
What glomerular disease is Rapidly Progressive Glomerulonephritis?
Crescentic Glomerulonephritis
How is Crescentic Nephritis marked?
What is the resulting end point?
Severe damage with WBC exudate in urinary space
Acute renal failure
What Immunologice Glomerular disease is in adults and kids?
Membranous- adults
Focal- most common nephrotic syndrome in adults
Lipoid- kids
How do Membranous and Focal Segmental appear in adults?
Membranous- Generalized edema and proteinuria
Focal- Proteinuria and unresponsive to steroids
UTIs are usually caused by what type of microbes?
Gram Neg enteric bacteria
Pyelonephritis is inflammation of the entire kidney which includes what three parts?
Parenchyma
Calyces
Renal pelvis
Difference in PT populations for Renal Cell Carcinoma and Urinary Bladder Carcinoma?
Majority, middle aged men, clear cell most common
UBC- Older, males more likely
Earlier Sx onset, higher recurrence
How are RCCs diagnosed?
How are UBCs diagnosed?
US and CT
Cytoscopy and biopsy
Pancreatic Adenocarcinoma are ranked as # ?? for cancer related deaths in US
4 - 5
What type of pancreatic tumor is the majority of tumors?
Pancreatic head