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Anatomy and Physiology 1 > Pathophysiology Test 3 > Flashcards

Pathophysiology Test 3 Flashcards

1
Q

Hormone

A

chemical messenger

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2
Q

Circadian Rhythm

A

24hr cycle of the bodies normal rise and fall or hormones

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3
Q

TSH Levels

A

peak between 8pm-12am

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4
Q

Hypothalmus Hormones

A

CRH, TRH, GNRH, GnRH, Somatastatin `

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5
Q

CRH

A

corticotropin-releasing hormone

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6
Q

thyrotropin-releasing hormone

A

TRH

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7
Q

GNRH

A

growth hormone releasing hormone

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8
Q

GnRH

A

gonadatropin-releasing hormone

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9
Q

Somatastatin

A

inhibits GH and TSH

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10
Q

Steroid

A

anti-iflammatory

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11
Q

Hypothalmus

A
  • 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.
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12
Q

Pituitary gland

A
  • below the hypothalmus
  • 3 lobes (anterior, posterior, intermediate)
  • release is stimulated by the hormones sent by the hypothalmus.
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13
Q

Anterior pituitary hormones

A

ACTH, TSH, GH, LH, FSH, Prolactin

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14
Q

Posterior pituitary hormones

A

ADH and oxytocin

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15
Q

TSH

A
  • anterior pituitary
  • target organ= thyroid
  • activates t3 and t4
  • affects almost every organ in the body
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16
Q

Goiter

A

enlargement of the thyroid

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17
Q

Hyperthyroidism

A

toxic, the extra tissue produces thyroid hormones

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18
Q

Hypothyroidism

A

non-toxic, the extra tissue does not produce thyroid hormones.

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19
Q

Euthyroidism

A

normal amount of thyroid hormones produced

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20
Q

Grave’s Disease

A
  • 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)
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21
Q

Hashimoto’s Disease

A
  • 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
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22
Q

myexedema/ myxedematous coma

A
  • 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
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23
Q

Adrenocorticotropin hormone (ACTH)

A
  • 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
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24
Q

Kidney’s

A
  • normally 2 kidneys
  • size of the fist
  • no blood=no urine
  • urinary tract = kidneys, ureters, bladder, and urethra.
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25
Q

Functions of the Kidney

A
  • 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)
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26
Q

Hypervolemic

A

too much water for urine

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27
Q

Nephron

A
  • each kidney has about a million
  • blood through nephron= urine
  • jobs of nephron
    1. filter waste form blood
    2. help control F&E of the body
  • parts of the nephron
    1. glomerulus
    2. proximal convoluted tubule
    3. loop of henle
    4. distal convoluted tubule
    5. collecting duct
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28
Q

Glomerulus (Bowman’s Capsule)

A

filtration of toxins and waste from incoming blood

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29
Q

Tubes

A

re-absorption or release of water and electrolytes as needed.

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30
Q

Blood supply to/from kidneys

A
  • 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
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31
Q

Healthy urine

A
  • yellow, clear/transparent, no bacteria, no RBC or WBC
  • occasional casts(bacterial WBC)
  • pH: 4.6-8.0
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32
Q

Creatinine

A

a byproduct of muscle metabolism. Each day 1-2% of muscle creatine is converted to creatinine

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33
Q

BUN (blood urea nitrogen)

A

urea nitrogen is a byproduct of protein metabolism in the liver.

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34
Q

Glomerular filtration

A

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.

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35
Q

Normal blood test for urine

A

BUN: 5-25mg
Creatinine: 0.6- 1.5mg
potassium: 3.5-5.5

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36
Q

Diagnostic studies for kidney function

A
  • 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.
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37
Q

UTI

A
  • 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.
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38
Q

Types of UTI’s

A
  1. 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
  2. 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
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39
Q

Oliguria

A

24hr UOP of 100-400ml

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40
Q

Anuria

A

24hr UOP of less than 100ml

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41
Q

Renal Caliculi or Kidney stones

A
  • 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.
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42
Q

Lithotripsy (electacorporeal shock wave therapy)

A
  • ESWT
  • non-invasive removal of stones; for stones less than 2cm
  • uses shock to break stone and pass through urine
  • sometimes done under water.
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43
Q

Bladder cancer

A
  • 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.
44
Q

BPH (benign prostatic hyperplasia)

A
  • 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.
45
Q

BPH surgical options

A
  • transurethral resection of the prostate (TURP): cystoscope enters the penis and trims prostatic tissue
  • 3 way foley catheter is inserted
    1. frist port inflates the balloon
    2. second port irrigates fluid to bladder
    3. third port urine/fluid/blood to collection bag
  • external incision resection
46
Q

Prostate cancer

A
  • 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
47
Q

Treatment for Prostate cancer

A
  • watchful waiting
  • radical prostatectomy
  • TURP
  • external and internal radiation
  • cyberknife
48
Q

Glomerulonephritis

A
  • 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
49
Q

Dialysis

A

cleaning blood outside the body

50
Q

Alpha cells

A

glucagon

51
Q

Beta cells

A

insulin

52
Q

Islets of Langerhans

A

cells in the pancreas that makes alpha and beta cells

53
Q

Insulin

A
  • hormone released by the pancreas in response to increases serum glucose levels.
  • decreases serum glucose by moving glucose out of blood and into cells
54
Q

Normal fasting glucose

A

80- 110 mg/dl

55
Q

blood glucose after eating

A

generally 140

56
Q

hyperglycemia

A

fasting blood glucose greater than 110

57
Q

hypoglycemia

A

fasting blood glucose lower than 80

58
Q

Glucosuria

A

sugar in urine

59
Q

Glucagon

A
  • a glucocorticoid made in the alpha cells
  • secreted in response to decreased glucose levels
  • stimulates carbohydrate metabolism in the liver
60
Q

Glycogenesis

A

glucose converts to glycogen and stored (break down glycogen)

61
Q

Glycogenolysis

A

glucose converted back to glucose (Break down glcogen to glucose)

62
Q

Gluconeogenesis

A

synthesis of glucose form amino acids and fats (when no carbs are available) make new glucose

63
Q

Fasting blood glucose

A

no food or drink for 12 hours prior to blood draw

64
Q

post-prandial blood draw

A

blood drawn 2 hours after ingesting 75g oral glucose

65
Q

Oral glucose tolerance test

A

blood drawn every 30 minutes for 2 hours after ingesting 75g oral glucose

66
Q

HgA-1C

A

3 month reflection of blood glucose levels

67
Q

Diabetes Mellitus

A
  • 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)
68
Q

Diabetes Type 1

A
  • 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
69
Q

3 P’s of DM

A

Polyuria (frequent urination)
Polydipsia (excessive thirst)
polyphagia (hunger/increased appetite)
involuntary weight loss

70
Q

Polyuria cause

A

excess glucose in the blood comes to kidneys and acts as an osmotic diuretic

71
Q

Polydipsia cause

A

the hypothalamus detects loss of fluid from the kidneys; interprets this as thirst

72
Q

Polyphagia

A

cells cannot receive glucose without the help of insulin; cells interpret this as starving

73
Q

DM type 1 treatment

A
  • insulin injection
  • diet:control carb intake
  • exercise
74
Q

The Somogyi effect

A
  • 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
    1. bedtime snack
    2. 0200-0300 BG checks
75
Q

Diabetic ketoacidosis (DM1 complication)

A
  • 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.
76
Q

Hypoglycemia (DM1 complication)

A
  • 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
77
Q

Microvascular changes: microangiopathy

A
  • damage to small arteries
78
Q

retinopathy

A

aneurysms in the tiny retinal arteries= blindness

79
Q

nephropathy

A

damage to the glomerular capillaries= kidney disease q

- look for increased BUN, creatinine, albumin in urine.

80
Q

Neuropathy

A

changes in myelin sheath= sensory and memory loss

81
Q

Macroangiopathy

A

damage to the large arteries

  • accelerated athersclerosis: accumulation of plaque in important arteries
    1. coronary arteries= MI
    2. cerebral arteries= CVA
    3. peripheral arteries=PVD
82
Q

Diabetes Mellitus Type 2

A
  • 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
83
Q

Hyperglycemic hyperosmolar non-ketotic coma (HHNKC)

A
  • 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
84
Q

Cushing’s Syndrome

A

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

85
Q

Cushing’s Signs and Symptoms

A
  • 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
86
Q

Hypofunction of the Adrenal Cortex

A
  • Addison’s disease: too little adrenal cortex activity
    causes
    1. destruction of adrenal glands by autoimmune process
    2. complication tb
    3. lack of ACTH from pituitary
    4. long-term steroid use followed by abrupt withdrawal
87
Q

Addison’s Disease

A
  • S/Sx related to lack of cortisol, aldosterone, androgens,

- adrenal crisis: undiagnosed Addisons disease, or abrupt withdrawal of steroid use.

88
Q

Lack of Cortisol (Addison’s)

A
  • 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
89
Q

Lack of aldosterone (Addison’s)

A
  • dehydration due to excessive loss of water and Na+
  • potassium excess
    Tx: replace hormone
90
Q

Lack of Androgens (Addison’s)

A
  • loss of axillary and pubic hair

Tx: replace hormone

91
Q

Osteoarthritis (Degenerative joint disease)

A
  • local thinning of articular cartilage
  • bone surfaces roughen
  • insidious onset; morning inflammation weight bearing pain.
  • joints most often affected
    1. knees
    2. fingers
    3. hips
    4. vertebral joints
    5. any previously traumatized joint
92
Q

Osteoarthritis S/Sx

A
  • stiffness in the joint
  • decreased ROM
  • morning pain
  • swelling
  • Heberden’s Nodes: distal finger joints
  • Bouchard’s nodes: proximal finger joint
93
Q

Osteoarthritis Tx

A
  • ice/heat
  • NSAIDS
  • assistive devices
  • joint replacement
  • *most older pts have some degree of DJD
94
Q

Rheumatoid Arthritis

A

-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.

95
Q

RA symptoms

A
  • 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
96
Q

RA joints most affected

A
  • small joints in the hands and feet
  • progresses to knees, hips, shoulders, and spine
  • ulnar drift
  • swan neck deformities (fingers)
  • exacerbation/ remissions of symptoms
97
Q

RA Dx

A
  • history, physical exam of joints, blood draw presence of RF and elevated ESR (sed rate)
98
Q

RA Tx

A
  • NSAIDS and mobic: consistent and high doses
  • steroids: prednisone
  • DMARDs: disease-modifying snti-rheumatic drugs (bad side effects)
    1. methotrexate (stomach upset, rash)
    2. plaquenil (eyes)
    3. embrel, humira, remicide(inject)
99
Q

Systemic Lupus erythematosus

A
  • a chronic, autoimmune, inflammatory disease
  • more common in women
  • avg. age onset is 30
  • multi-system
    Causes: exaggerated production of autoantibodies, inflammation.
100
Q

Lupus S/Sx

A
  • M/S: arthralgias, pain, swelling
  • butterfly rash, sun sensitivity
  • pericarditis
  • pleuritis/ effusion
  • gomerular damage
  • arteritis
101
Q

Raynaud’s Phenomenom

A
  • 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.
102
Q

Lupus Dx and Tx

A
  • 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.

103
Q

Sjogren’s Disease

A
  • similar to lupus with dry mouth and eyes. Tear ducts and saliva ducts are attacked by antibodies.
104
Q

Osteoporosis/osteopenia

A

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
105
Q

Osteoporosis

A

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

Anatomy and Physiology 1 (16 decks)

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