Unit 1 Flashcards
Outcomes of acute inflammation x4
Resolution
Abscess formation
Fibrosis/ healing scar formation
Chronic inflammation
Adenosine
Lowers GFR by constricting afferent arterioles in superficial nephrons + mediator of the tubuloglomerular feedback. leads to vasodilation in deep cortex and medulla.
Role of Adenosine
1) Increased GFR * increases fluid flow to DCT.
2) Increased Na+ uptake into mac densa cells stim adenosine release from macula densa cells
3) Adenosine triggers VASOCONTRICTION of afferent arteriole * reducing GFR
4) Adenosine inhibits renin secretion from granular cells (JG cells).
Vit D synthesis
7 dehydrocholesterol
Cholecalciferol
Calcidiol
Calcitriol
Urate crystals synthesis
Purines
Hypoxanthine
Xanthine
Iris acid
WHO definition trad med
Traditional medicine is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness
CAM
is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well being. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed.
patient centered care
Five dimensions:
Biopsychosocial perspective
‘Patient-as-person’: understanding the personal meaning of the illness for each patient
‘Doctor-as-person’: awareness of the influence of the personal qualities and subjectivity of the doctor
Sharing power and responsibility
The therapeutic alliance
identity
Identity: ‘The distinctive characteristics of a person’s character or the character of a group, which relate to who they are and what is meaningful to them
3 types jandice
Pre-Hepatic
In pre-hepatic jaundice, there is excessive red cell breakdown which overwhelms the liver’s ability to conjugate bilirubin. This causes an unconjugated hyperbilirubinaemia.
Any bilirubin that manages to become conjugated will be excreted normally, yet it is the unconjugated bilirubin that remains in the blood stream to cause the jaundice.
Hepatocellular
In hepatocellular (or intrahepatic) jaundice, there is dysfunction of the liver itself. The liver loses the ability to conjugate bilirubin, but in cases where it also may become cirrhotic, it compresses the intra-hepatic portions of the biliary tree to cause a degree of obstruction.
This leads to both unconjugated and conjugated bilirubin in the blood, termed a ‘mixed’ picture.
Post-Hepatic
Post-hepatic jaundice refers to obstruction of biliary drainage. The bilirubin that is not excreted will have been conjugated by the liver, hence the result is a conjugated hyperbilirubinaemia.
Blood breakdown
heme heme oxygenase biliverdin bilverdin reductase bilirubin urobilinogen Stercobillin
Who definition impariment
Impairment refers to ‘any loss or abnormality of psychological, physiological or anatomical structure or function’.
Who definition disability
‘Disability’ denotes ‘any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being’.
Who definition handicap
‘Handicap’’, is the ‘disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfilment of a role that is normal (depending on age, sex and social and cultural factors) for that individual’
chronic illness biographical disruption
This concept refers to the disruption and destabilising, questioning and reorganisation of identity after the onset of a chronic illness
Need to renegotiate the present while past might seem like a strange place and the future doubtful
what is stigma + four examples
Goffman (1968): “an attribute that is deeply discrediting”. Discrediting stigma (visible or known stigma) Discreditable stigma (differentness not immediately apparent, can be managed/hidden, can become discrediting if people find out) Felt stigma (internal or self-stigmatization) Enacted stigma (experience of unfair treatment by others)
bone mineralization
Bone mineralisation - Phase I
osteoblasts release matrix vesicles
Ca2+and Piare internalised
forming non-crystalline amorphous CaP
converted to insoluble hydroxyapatite crystals
Bone mineralisation – Phase II
phospholipases mediate penetration of the hydroxyapatite through the vesicle membrane
Levels of extra-vesicular Ca2+, Pi, and H+, as well as Ca2+-binding proteins regulate the continued nucleation of hydroxyapatite crystals
4 phases of fracture + wound healing
Haemostasis
Inflammation
Proliferation
Maturation
Somatostatin
inhibits release insulin + glucagon released by delta cells
Released fed state + inhibits GI secretion + contraction gall bladder
Diagnosing RA standards
- Inflammatory arthritis involving three or more joints. Heat swelling tenderness – MCP and PIP hands then leads into larger joints wrist.
- Positive RF/ ACCP
- Elevated levels of CRP/ESR
- Exclude diseases with similar features – psoriatic arthritis, acute viral polyarthritis, polyarticular gout (urate cyrstals), systemic lupus erythematous
- Duration symptoms more than 6 weeks
RACE
Race” as biologically determined difference in physical characteristics
Skin colour, facial characteristics
Physical characteristics which also reflect cultural differences
Racism
Racism, in general terms, consists of conduct or words or practices which disadvantage or advantage people because of their colour, culture or ethnic origin. In its more subtle form it is as damaging as in its overt form’
Ethnicity
Cultural values and norms which distinguish the members of a given group from others’
Creatine clearance
Ccr=(Ucr×V )/(Scr×24×60)
estimated creatine clearance
eCcr =((140-age(yrs))× mass (kg)× K)/(Scr (UM))
Ethnic group
‘A group that regards itself, or is regarded by others, as a distinct community by virtue of certain characteristics that will help to distinguish the group from the surrounding community’
Ethnic minority
Definition: ‘a category of people distinguished by physical or cultural traits, who are socially disadvantaged’ (Macionis and Plummer, 2008: 276)
Who definition QOL
“An individual’s perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, standards and concerns” (WHO, 1993)
6 domains:
physical health, psychological state, levels of independence, social relationships, environmental features, spiritual concerns
How alcohol affects pancreas
Stim release cytokines - IR -> neutrophils release super oxide + proteases.
Increase zymogen secretion from acinar cells + decreases fluid + bircarbonate in ducts * pancreatic juices become thick + viscous forming plug - block duct - pancreatic juices back up. Increase pressure - distends ducts. Membrane trafficking becomes chaotic + zymogen granules fuse lysosomes * trypsinoggen in contact lysosomal digestive enzymes. breaks down trypsin - activate other pro enzymes - auto digestion
liqufactive heamorrhagic necrosis
Pancreatic tissue destruction from proteases + inflam responce -> blood vessels leak + rupture - causes capsule pancreas to swell + activation of lipases -> destroy PERIPANCREATIC FAT. leads to digestion + bleeding
-> liquefy pancreatic tissue.
What is more specific more pancreatitis amylase or amylase
Elevated lipase levels are more specific to the pancreas than elevated amylase levels
Variable penetrance vs variable expresivity DMD
Veriable penetrance depending number mutant choromosmes either have a phenotype or no phenotype
Variable expresivity - more cells wild type inactivated more severs phenotype will be
Exons DMD
49-50
Exons BMD
48
myogenesis
DETERMINATION Pre cursor mesoderm progenitors stimulated via MYO D to proliferate into myoblasts Myocytes - withdraw cell cycle Myocytes fuse to form myotubules maturation myofibre
What cell responsible building muscle
embryo - mesoderm progenitors
Post natal = exercise - satellite cells
TRH
THYROTROPIN-RELEASING HORMONE (TRH)Released from nerve endings of the hypothalamus↓Binds to TRH receptors on the anterior pituitarycell membranes↓Activates Gq protein PLC cleaves PIP2 IP3+ DAG+ PKC IP3& PKC increaseintracellular Ca2+which causes the release of TRH
TSH
Released by the anterior pituitary gland in response to increased stimulation by TRH↓Binds to TSH receptors on thyroid follicular cells↓Activates Gs protein activates adenylyl cyclase increased cAMP production activates PKA phosphorylates target proteins to cause increased thyroglobulin production and cleavage of thyroid hormone residues, increased iodination of thyroid hormones and increased activity of iodide pumps to increasethe synthesis of thyroid hormones
