Pathophysiology Test 3 Flashcards
Hormone
chemical messenger
Circadian Rhythm
24hr cycle of the bodies normal rise and fall or hormones
TSH Levels
peak between 8pm-12am
Hypothalmus Hormones
CRH, TRH, GNRH, GnRH, Somatastatin `
CRH
corticotropin-releasing hormone
thyrotropin-releasing hormone
TRH
GNRH
growth hormone releasing hormone
GnRH
gonadatropin-releasing hormone
Somatastatin
inhibits GH and TSH
Steroid
anti-iflammatory
Hypothalmus
- located in the brain
- Senses increase/decrease levels in hormones in the blood
- secretes releasing or inhibiting hormones
- releasing hormones signal release of pituitary hormones.
Pituitary gland
- below the hypothalmus
- 3 lobes (anterior, posterior, intermediate)
- release is stimulated by the hormones sent by the hypothalmus.
Anterior pituitary hormones
ACTH, TSH, GH, LH, FSH, Prolactin
Posterior pituitary hormones
ADH and oxytocin
TSH
- anterior pituitary
- target organ= thyroid
- activates t3 and t4
- affects almost every organ in the body
Goiter
enlargement of the thyroid
Hyperthyroidism
toxic, the extra tissue produces thyroid hormones
Hypothyroidism
non-toxic, the extra tissue does not produce thyroid hormones.
Euthyroidism
normal amount of thyroid hormones produced
Grave’s Disease
- autoimmune disorder
- seen in patients 20-40 Y/O
- 5x more likely in women
- S/Sx: all associated with hyperfunction plus dysphagia and choking
- exophthalmus(fluid behind the eyes)
- goiter
Treatment: radioactive iodine, surgical removal (thyroidectomy)
Hashimoto’s Disease
- autoimmune disorder: destroys the thyroid
- gender female to male (5:1)
- radiation exposure
- S/Sx: all associated with hypofunction
- fatigue, weakness
- weight gain, despite loss of appetite
- constipation, flatulence
- brittle hair, dry skin
- cold intolerances
- mental dullness, lethargy
treatment: hormone replacement
myexedema/ myxedematous coma
- life threatening complication of hypothyroidism
- S/Sx: same as hypothyroidism
- low body temperature (low 80’s)
- edemas/ pretibial edema w/ rash
- coma (collapse of arteries)
- pleural effusion and pericardial effusion (fluid shifting)
Treatment: replacement of thyroid hormones
Adrenocorticotropin hormone (ACTH)
- anterior pituitary
- target organ: adrenal glands
- activates release of hormones from the adrenal cortex
- adrenal gland sits atop each kidney
- cortex is the outer layer
- medulla is the inner space
Kidney’s
- normally 2 kidneys
- size of the fist
- no blood=no urine
- urinary tract = kidneys, ureters, bladder, and urethra.
Functions of the Kidney
- filtration of blood
- isolate essential substances, such as water, potassium, and sodium
- selectively reabsorbs blood or urine as needed
- passes unwanted substances into the urine
- secretes renin from juxtaglomerular apparatus
- secretes erythropoietin
- helps maintain carbonic buffering system (H+ and bicarb)
Hypervolemic
too much water for urine
Nephron
- each kidney has about a million
- blood through nephron= urine
- jobs of nephron
- filter waste form blood
- help control F&E of the body
- parts of the nephron
- glomerulus
- proximal convoluted tubule
- loop of henle
- distal convoluted tubule
- collecting duct
Glomerulus (Bowman’s Capsule)
filtration of toxins and waste from incoming blood
Tubes
re-absorption or release of water and electrolytes as needed.
Blood supply to/from kidneys
- a single renal artery to each kidney from the aorta
- segmental and interlobular arteries within the kidney
- smaller and smaller arterial vessels end at the afferent arterioles
- renal vein returns blood to venous circulation
Healthy urine
- yellow, clear/transparent, no bacteria, no RBC or WBC
- occasional casts(bacterial WBC)
- pH: 4.6-8.0
Creatinine
a byproduct of muscle metabolism. Each day 1-2% of muscle creatine is converted to creatinine
BUN (blood urea nitrogen)
urea nitrogen is a byproduct of protein metabolism in the liver.
Glomerular filtration
occurs in the Bowman’s capsule, incoming blood is filtered, waste products removed, added to urine.
- if kidneys are healthy then the concentration of creatinine and urea nitrogen decrease and urine concentration increases.
Normal blood test for urine
BUN: 5-25mg
Creatinine: 0.6- 1.5mg
potassium: 3.5-5.5
Diagnostic studies for kidney function
- KUB: x-ray of the kidney, ureters, and bladder
- IVP(intravenous pyelogram): injection of dye; x-rays as the dye moves through the KUB
- renal arteriogram: assesment of blood flow through the kidneys.
- endoscopy: camera in the urethra to assess structures
- renal biopsy: dx of kidney cancer; needle enters the back and a sample is aspirated.
UTI
- ascending bacterial infection
- usually e.coli or pseudomonas
- usually in females
- catheterization: nonscomial or infection from the hospital.
- obstruction: from renal caliculi (stones)
- urine retention: incomplete bladder emptying, reflux, hurried voiding, enlarged prostate in males.
Types of UTI’s
- Cystitis: bladder infection
- typical cause is ascending bacteria
- less serious than pyelonephritis
- S/Sx: frequency, urgency, malodorous, cloudy urine, hematuria(blood in urine).
- Dx: urinalysis with C&S
- Tx: antibiotics 7-10 days, fluids
- Pyelonephritis: kidney infection
- typical cause: complication from untreated cystitis
- serious complication: scarring of kidney
- S/Sx: same as cystitis plus fever, chills, nausea, and flank pain, malaise.
- Dx: urinalysis and blood work (elevated WBC in blood urine, bactremia)
- antibiotics 10-14 days, fluids
Oliguria
24hr UOP of 100-400ml
Anuria
24hr UOP of less than 100ml
Renal Caliculi or Kidney stones
- aka nephrolithiasis
- more common in men 20-55
- most kidney stones are made of calcium or oxalate (dairy, tofu, soy, spinach)
- risk factors: decreased fluid intake, elevated Ca, vegetarianism, family hx, sedentary lifestyle.
- S/Sx: Colicky pain, N/V, fever, chills, UTI
- Dx: KUB and IVP
- 90% pass spontaneously
- Tx: pain meds, fluid intake of 3000ml per day, lithotripsy, lthotomy.
Lithotripsy (electacorporeal shock wave therapy)
- ESWT
- non-invasive removal of stones; for stones less than 2cm
- uses shock to break stone and pass through urine
- sometimes done under water.
Bladder cancer
- most common in males, Caucasians, who smoke
- other risk factors: smoking, exposure to certain chemicals, chronic UTI’s and stones
- Most common sign: painless hematuria **
- Dx: ultrasound, CT, biopsy
- Tx: endoscopic resection of tumor, cystectomy(removal of bladder), bladder made form ileum, intravesical chemotherapy.
BPH (benign prostatic hyperplasia)
- very common in men
- age/bph correlation
- as prostate grows, it obstructs urine flow through the urethra
- S/Sx: decreased force, small stream, nocturia, urinary retention, dribbling, impotence
Dx: digital rectal exam, biopsy.
BPH surgical options
- transurethral resection of the prostate (TURP): cystoscope enters the penis and trims prostatic tissue
- 3 way foley catheter is inserted
- frist port inflates the balloon
- second port irrigates fluid to bladder
- third port urine/fluid/blood to collection bag
- external incision resection
Prostate cancer
- 2nd most common cancer in men
- slow growing cancer
- highest incidence in Af. Am men
- Sx: similar to BPH
- Dx: digital rectal exam, prostatic specific antigen(blood test marker PSA), ultrasound, biopsy
Treatment for Prostate cancer
- watchful waiting
- radical prostatectomy
- TURP
- external and internal radiation
- cyberknife
Glomerulonephritis
- inflammation of the glomerulus
- acute: caused by viral or bacterial infection of the blood that travels to the kidneys
- Chronic: result of lupus, hypertension, diabetes.
- S/Sx: hematuria (pink urine), proteinuria, edema
- Dx: blood, urine, KUB, and CT
- Tx: based on cause
Dialysis
cleaning blood outside the body
Alpha cells
glucagon
Beta cells
insulin
Islets of Langerhans
cells in the pancreas that makes alpha and beta cells
Insulin
- hormone released by the pancreas in response to increases serum glucose levels.
- decreases serum glucose by moving glucose out of blood and into cells
Normal fasting glucose
80- 110 mg/dl
blood glucose after eating
generally 140
hyperglycemia
fasting blood glucose greater than 110
hypoglycemia
fasting blood glucose lower than 80
Glucosuria
sugar in urine
Glucagon
- a glucocorticoid made in the alpha cells
- secreted in response to decreased glucose levels
- stimulates carbohydrate metabolism in the liver
Glycogenesis
glucose converts to glycogen and stored (break down glycogen)
Glycogenolysis
glucose converted back to glucose (Break down glcogen to glucose)
Gluconeogenesis
synthesis of glucose form amino acids and fats (when no carbs are available) make new glucose
Fasting blood glucose
no food or drink for 12 hours prior to blood draw
post-prandial blood draw
blood drawn 2 hours after ingesting 75g oral glucose
Oral glucose tolerance test
blood drawn every 30 minutes for 2 hours after ingesting 75g oral glucose
HgA-1C
3 month reflection of blood glucose levels
Diabetes Mellitus
- decreased production of insulin
- insulin resistance by the cells
- sometimes both
25. 8 million have DM (1M have type 1 and 24M have type 2)
Diabetes Type 1
- no insulin production
cause: usually an autoimmune response following an acute illness. - pancreas stops producing insulin
- sudden onset of symptoms
- often young (before age 20)
- insulin dependent for life
- prone to ketosis
3 P’s of DM
Polyuria (frequent urination)
Polydipsia (excessive thirst)
polyphagia (hunger/increased appetite)
involuntary weight loss
Polyuria cause
excess glucose in the blood comes to kidneys and acts as an osmotic diuretic
Polydipsia cause
the hypothalamus detects loss of fluid from the kidneys; interprets this as thirst
Polyphagia
cells cannot receive glucose without the help of insulin; cells interpret this as starving
DM type 1 treatment
- insulin injection
- diet:control carb intake
- exercise
The Somogyi effect
- during early morning hours BG drops
- causes the release of hormones like GH and cortisol
- cortisol makes the liver release stored glucose to treat the hypoglycemia
- the DM pt has no insulin to carry the BG from the blood to cells, resulting in hyperglycemia
- rebound hyperglycemia occurs
Treatment- bedtime snack
- 0200-0300 BG checks
Diabetic ketoacidosis (DM1 complication)
- without insulin, too much glucose
- compensated by by body using protein and fat
- end product= ketones
- ketones are acidic which causes the acidosis
causes: missed injections, illness, too many carbs
untreated?: dehydration, hypotension, coma, death.
Hypoglycemia (DM1 complication)
- too much insulin, too few carbs
- excessive exercise
S/Sx: caused by release of epinephrine, lack of glucose to the brain
Tx: fast acting carbs, glucagon IM injection
Microvascular changes: microangiopathy
- damage to small arteries
retinopathy
aneurysms in the tiny retinal arteries= blindness
nephropathy
damage to the glomerular capillaries= kidney disease q
- look for increased BUN, creatinine, albumin in urine.
Neuropathy
changes in myelin sheath= sensory and memory loss
Macroangiopathy
damage to the large arteries
- accelerated athersclerosis: accumulation of plaque in important arteries
- coronary arteries= MI
- cerebral arteries= CVA
- peripheral arteries=PVD
Diabetes Mellitus Type 2
- decreased insulin production
- insulin resistance at target cells
- insidious onset
- often older and obese people (80% obese)
- family hx
- not always insulin dependent
- not prone to DKA
Hyperglycemic hyperosmolar non-ketotic coma (HHNKC)
- w/o insulin in the blood, excess glucose in the blood creates increased osmolarity in the blood
- osmolarity pulls fluid from the interstitium into vascular spaces
- kidneys excrete more urine to prevent fluid overload
- dehydration, shock, and coma
- no ketosis; thereis just enough insulin to prevent
- HHNKC can be triggered by illness, surgery, infection
S/SX: 3P’s , glycosuria, dehydration, elevated blood glucose (up to 800)
Tx: rehydration and insulin
Cushing’s Syndrome
Too much adrenal cortex activity
- casues:
1. cortisol secreting tumor in adrenal glands
2. ACTH secreting tumor in pituitary gland
3. latrogenic Cushing’s: caused by long term use of steroid medication
Tx: identify and remove cause
Cushing’s Signs and Symptoms
- moon face
- muscle wasting
- decreased immune resistance
- thin skin, poor healing
- bone thinning and weight gain
- truncal obesity, buffalo hump
- purple striae
- excess androgens; hair growth, acne, menstrual cycle changes
Hypofunction of the Adrenal Cortex
- Addison’s disease: too little adrenal cortex activity
causes- destruction of adrenal glands by autoimmune process
- complication tb
- lack of ACTH from pituitary
- long-term steroid use followed by abrupt withdrawal
Addison’s Disease
- S/Sx related to lack of cortisol, aldosterone, androgens,
- adrenal crisis: undiagnosed Addisons disease, or abrupt withdrawal of steroid use.
Lack of Cortisol (Addison’s)
- hypoglycemia due to decreased gluconeogenesis (pts with AD cant tolerate food deprivation
- Hyperpigmentation due to increase of compensatory ACTH also stimulates melanocyte stimulating hormone
- inability to handle stress of any kind (emotional, surgery, illness, trauma)leads to vascular collapse
Tx: replace hormone
Lack of aldosterone (Addison’s)
- dehydration due to excessive loss of water and Na+
- potassium excess
Tx: replace hormone
Lack of Androgens (Addison’s)
- loss of axillary and pubic hair
Tx: replace hormone
Osteoarthritis (Degenerative joint disease)
- local thinning of articular cartilage
- bone surfaces roughen
- insidious onset; morning inflammation weight bearing pain.
- joints most often affected
- knees
- fingers
- hips
- vertebral joints
- any previously traumatized joint
Osteoarthritis S/Sx
- stiffness in the joint
- decreased ROM
- morning pain
- swelling
- Heberden’s Nodes: distal finger joints
- Bouchard’s nodes: proximal finger joint
Osteoarthritis Tx
- ice/heat
- NSAIDS
- assistive devices
- joint replacement
- *most older pts have some degree of DJD
Rheumatoid Arthritis
-systemic disease process
- chronic and progressive
- affects synovial membrane
- bilateral joint movement
- more common in women 30-50 y/o
cause: autoimmune, inflammatory response
-development of pannus (painful stuff that floats in the joint)
Rheumatoid factor: antibody produced as a result of inflammation.
RA symptoms
- pain,swelling, warmth, erythema, decreased use of the joint.
- fever, fatigue, weightloss
- elevated RF and ESR in the blood
onset can be acute or insidious
RA joints most affected
- small joints in the hands and feet
- progresses to knees, hips, shoulders, and spine
- ulnar drift
- swan neck deformities (fingers)
- exacerbation/ remissions of symptoms
RA Dx
- history, physical exam of joints, blood draw presence of RF and elevated ESR (sed rate)
RA Tx
- NSAIDS and mobic: consistent and high doses
- steroids: prednisone
- DMARDs: disease-modifying snti-rheumatic drugs (bad side effects)
- methotrexate (stomach upset, rash)
- plaquenil (eyes)
- embrel, humira, remicide(inject)
Systemic Lupus erythematosus
- a chronic, autoimmune, inflammatory disease
- more common in women
- avg. age onset is 30
- multi-system
Causes: exaggerated production of autoantibodies, inflammation.
Lupus S/Sx
- M/S: arthralgias, pain, swelling
- butterfly rash, sun sensitivity
- pericarditis
- pleuritis/ effusion
- gomerular damage
- arteritis
Raynaud’s Phenomenom
- vasospasm of arteries
- usually in hands/feet
- during attack: skin turns white/blue, numbness
- after attack: skin is red and painful
causes: lupus, cold, stress (norepi secretion), poor blood circulation.
Lupus Dx and Tx
- difficult to diagnose. No blood test; only made by S/Sx
Tx: NSAIDS, steroids, heat/ice, assistive joint devices physical therapy, avoid sun and stress.
Sjogren’s Disease
- similar to lupus with dry mouth and eyes. Tear ducts and saliva ducts are attacked by antibodies.
Osteoporosis/osteopenia
porosis is the imbalance in between bone production and bone re-absorption (loss)
- loss of bone density
- penia is early loss
- women after menopause
cause: decreased levels of estrogen and androgens that maintain bone gain/loss balance
Osteoporosis
S/Sx: loss of height, kyphosis, pathologic fractures
- most common fx spots are hip, vertebrae, wrist
Prevention: weight-bearing exercise, Ca+plus it D, estrogen replacement
Dx: bone density test
Tx: medications- fosamax, forteo, boniva
