Test 4 cases Flashcards
etiology/patho of peptic ulcer disease
etiology: H. pylori infection
Patho: activation of immune cells including mast cells which release histamine and stimulates acid secretion contributing to the erosion/ulceration in the GI tract
How does the infectious agent in peptic ulcer disease trigger ulcer formations
Corkscrew shape which allows them to penetrate the stomach or duodenum and attach to lining
Produces urease in highly acidic environment - stimulates an increased release of gastrin
Dx of peptic ulcer disease
guaiac test, urea breath test
Tx peptic ulcer disease
antibiotics, PPIs (omeprazole)
what is the greatest predictor of crohn’s disease?
family hx
What population has an increased risk for developing crohn’s disease?
smokers - two-fold risk
Patho of crohns
chronic inflammatory disease of the GI tract that extends through the intestinal wall form mucosa to serosa.
Any part of the GI tract can be afcected
What are two unique features that are present in crohn’s but not ulcerative colitis?
skip lesions and cobblestone appearance
What genes are affected in celiac disease?
HLA class 2 genes DQ2 and DQ8
Patho of celiac disease
inappropriate t-cell mediated response against alpha-gliadin (a component in gluten)
Dx and tx of celiac
dx: serology for antibodies, genetic testing
tx: gluten free diet
How long can it take for a celiac patient to see effects of a gluten-free diet?
2-18 months
Patho of liver cirrhosis
Liver tissue replaced by fibrosis, scar tissue and regenerative nodules - loss of liver function
How does liver cirrhosis lead to issues with clotting factors?
Decreased production of bile which leads to decreased fat and Vit K absorption; decreased production of prothrombin
Patho behind major complications of cirrhosis: portal hypertension, steatorrhea, hepatic encephalopathy, jaundice, ascites, edema
Portal hypertension occurs when blood flow through liver is impaired due to cirrhosis
Steatorrhea: Impaired synthesis and secretion of bile - impaired fat absorption
Hepatic encephalopathy: Impaired amino acid interconversion - increased levels of ammonia, fibrosis, blood diversion from hepatic circulation
Jaundice: buildup of bilirubin in the blood stream
Ascites: increased hydrostatic pressure due to portal hypertension
Edema: decreased capillary colloidal osmotic pressure due to decreased albumin production
What are the major causes of acute pancreatitis?
Short term alcohol overuse, gallstones, pancreatic cancer
Patho behind acute pancreatitis
Reversible inflammatory process of pancreatic acini, premature activation of pancreatic enzymes due to blockage of bile duct or alcohol
Complications of acute pancreatitis
necrosis leading to organ failure, high mortality rate 20-30%
What is the main diagnostic test for acute pancreatitis?
Serum amylase or lipase
Patho of myasthenia gravis
antibodies reduce or block excitation-contraction coupling at the NMJ, compromises ability of skeletal muscle to contract and maintain contraction
What phenomena does not occur in myasthenia gravis
summation - occurrence of additional twitch contractions before the previous twitch has completely relaxed
Dx of myasthenia gravis
repetitive electromyography - with more stimulation, will have weaker contractions
Tx of myasthenia gravis
anticholinesterase inhibitor, immunosuppressants
Define open vs. closed fracture
• Open fracture: bone protruding through skin
Closed fracture: no skin
What is a complication of fracture, and what is the infectious agent?
osteomyelitis
staph aureus
How do fat emboli occur with fracture?
fat globules released and attract platelets which create microemboli and occlude small blood vessels
Risk factors for osteoporosis
advanced age
women
smoking
patho of osteoporosis
bone loss exceeds bone growth
how is osteoporosis linked to decreasing estrogen values?
decreasing estrogen = increased osteoclasts
How does osteoporosis usually present?
multiple fractures
Tx osteoporosis
estrogen replacement, biphosphonates
Risk factors for paget’s
family history
occurs mostly in north america, australia, NZ
Patho of paget’s
accelerated pattern of bone remodeling - rapid bone breakdown followed by short periods of bone formation
Sx of pagets
bone pain, fractures
What is the main diagnostic for paget’s and what diseases does it rule out?
elevated serum alkaline phosphatase
not seen in osteoporosis or osteoarthritis
What are the normal functions of skin that are affected by burns?
infection prevention
temp regulation
fluid retention
sensory
What layers are affected in first-degree/superficial burns?
outer layers of the epidermis only
What layers are affected in second-degree partial thickness vs. deep dermal partial thickness burns?
partial: epidermis and part of the dermis
deep dermal: epidermis and entire or most of dermis
Deep dermal partial thickness - what function is lost and how long does it take to recover?
Sensory
weeks
What layers are affected in third-degree/full thickness burns? What is most affected, how long does it take to heal and what does the skin look like?
epidermis, dermis, subcutaneous tissue, may involve muscle and bone
capillaries, veins and nerves destroyed
months to heal
red, white, black or leathery skin
What is used to determine the extent of injury in skin burns
Rule of nines
Complications of skin burns (9)
- Renal failure
- myoglobinuria, 3. hemoglobinuria
- multi-organ failure
- Hypovolemic shock
- infections
- Edema
- Desiccation = removal of water from blood vessels
- Electrolyte imbalances
Tx of burns
fluid replacement
ventilation support
ALL: risk factors, genetic changes
Prevalence of cases with genetic changes
Risk factors genetics
Changes: numeric and structural changes in chromosomes of leukemic cells
90% of cases
Dx of ALL
cytogenic studies to determine chromosomal abnormalities
Patho of ALL
Lymphoid precursors proliferate and replace normal hematopoietic cells of the marrow – typically affects B cells rather than T
What are the two main causes of DIC?
OB disorders: tissue factors released from necrotic placental or fetal tissue
infection/trauma: endothelial cell injury through intrinsic or extrinsic pathway
Patho of DIC
Consumptive disorder that initiates overwhelming clotting in response to an event where clotting factors and platelets are consumed
Define thrombocytopenia
thrombin induced platelet aggregation reduces circulating platelets
What does PT measure
evaluates how long it takes for a clot to form in a blood sample
What does aPTT measure
evaluates coagulation factors prekallikrein and kininogen
RA: what is a pannus?
synovial sac becomes thick and covered in granular tissue, can spread through tissue and cause scarring
Tx of RA
NSAIDs, corticosteroids
What do 85% of cases of atopic dermatitis have in common
personal or family history of allergic rhinitis or asthma
Patho of atopic dermatitis
Relapsing inflammatory skin condition, associated with asthma or hay fever to be defined as atopic dermatitis
Phases of wound healing (3)
Inflammatory phase: hemostasis and phagocytes clean site
Proliferative phase: collagen helps build new tissue, formation of granulation tissue occurs during this phase – highly vascular CT that forms
Remodeling phase: fibrous scar becomes smaller and stronger
Define resolution, regeneration, replacement
resolution: minimal tissue damage that is fully restored
regeneration: cells are replaced by proliferation of similar nearby cells, normal structure and function at the area of injury
replacement: extensive damage, cells cannot complete mitosis, fibrous tissue and scar formation
Define first intention vs. second intention healing
First: scar tissue laid across a clean wound with edges in close approximation
Second: occurs in wounds in which large sections of tissue have been lost or in wounds complicated by infection
Factors of compromised wound healing (4)
- impaired blood flow and O2 delivery
- impaired inflammatory and immune response
- malnutrition
- medications
