test #39 4.29 Flashcards
what does “end-organ” blood supply mean?
interruptions in blood flow lead to formation of infarct
renal: small number of collaterals between segmental renal arteries
brain too?
recall nephrotic syndrome presents w/ 5 things
- edema (loss of albumin / oncotic pressure
- proteinuria
- hyperlipidema
- hypercoagulation (loss of antithrombin III & increased coag factors
- infection (loss of immunoglobulins)
histology of crohn’s vs. ulcerative colitis
crohns: noncaseating granulomas & lymphoid aggregates (Th1 mediated)
ulcerative colitis: crypt abscesses (Th2 mediated)
blood in crohn’s vs. ulcerative colitis
crohn’s: + occult blood
ulcerative colitis: gross bleeding
string sign on barium swallow
crohn’s disease: narrowing of the intestinal segment due to inflammation of intestinal wall
ulcers in crohn’s? gross morphology?
- linear or serpiginous ulcerations
- cobblestone mucosa
- transmural inflammatory infiltrate.
“string sign”
gross morphology of ulcerative colitis
- mucosal & submucosal inflammation
- friable mucosal pseudopolyps w/ freely hanging mesentary
loss of haustra = lead pipe
cells in moles vs. choriocarcinoma
mole: only trophoblasts; swelling villi
choriocarcinoma: trophoblasts & syncitiotrophoblasts; NO VILLI
clinical presentation of:
complete vs. partial hydatidiform mole
both: vaginal bleeding & cramps/pressure
complete:
- SIZE greater than dates &
- extremely HIGH b-hCG
partial:
- normal size
- b-hCG high/normal
[hCG can lead to:
- hyperemesis gravidarum
- pre-eclampsia
- hyperthyroidism
- theca-lutein cysts
macroscopic: complete vs. partial hydatidiform mole?
complete: friable mass of cystic, thin-walled, grapelike structures. exclusively TROPHOBLASTIC TISSUE. “bunch of grapes”
partial: mix of normal & gross enlarged chorionic villi; FETAL PARTS (fetus, cord, amniotic membrane)
micropscopic appearance: complete vs. partial hydatidiform mole?
complete: enlarged, EDEMATOUS villi w/ extensive & diffuse trophoblastic HYPERPLASIA
(no fetal tissue)
partial: some enlarged vili w/ more moderate & FOCAL trophoblastic hyperplasia.
- normal villi & fetal tissue also present
karyotype of complete & partial hydatidiform mole?
complete: completely PAPA 46 XX or 46 XY (sperm fertilizes empty egg; sperm chromosomes duplicate usu: 46 XX more common)
partial: 69 XXX or XXY
(TRIPLOID)
usu 1 egg w/ 2 sperms
risk of malignancy in complete & partial hydatidiform mole?
complete: 15-20% risk of malignant trophoblastic disease
partial: low risk of malignancy <5%
where is TRH made?
paraventricular nucleus of hypothalamus
main regulator of TSH section?
T3
- T3 acts on paraventricular nucleus to decrease synthesis/release of TRH.
- down regulate TSH gene transcription & TRH receptor expression
T4 in peripheral tissues
converted to T3 or rT3 by specific deiodinases
t3 cannot become T4 or rT3
potency, half-life, metabolism of T4, T3, rT3
half-life
T4: 7 days
T3: 1 day
rT3: <1 day
cleared via glucuronidation in liver
[t3 not prescribed bc short half-life & rapid GI absorption = wide fluctuations]
acute acalculous cholecystitis
acute inflammation of gallbladder in absence of stones.
stasis & ischemia
PE: jaundice & palpable right upper quadrant mass = NOT SEEN IN calculous cholecystitis
complications: gangrene, perforation, emphysematous cholecystitis – infxn w/ gas-producing agent: clostridium, e. coli
usu in hospitalized patients & severely ill
porcelain gallbladder
diagnosed on abdominal radiograph: rim of calcium deposits outline gallbladder
associated w/ gallbladder carcinoma
cholechondral cysts
congenital dilations of common bile duct
chronic cholecystitis results in..
thickening of gallbladder wall.
US: shruken, fibrosed gallbladder
clornarchis infxn of gallbladder is associated w..
brown pigment stones
black vs. brown gallstones
pigment stones
black: intravascular hemolysis
brown: biliary infxn
how does valsalva affect heart?
decrease preload.
exhale against closed glottis