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Pathophysiology > Unit 11 > Flashcards

Unit 11 Flashcards

1
Q

two distinct medullary centers for vomiting

A

vomiting and chemoreceptor trigger zone

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2
Q

emesis

A

vomiting

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3
Q

hypoxia exerts direct effect on

A

vomiting center

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4
Q

what are some neurotransmitters that work on chemoreceptors for the vomiting

A

dopamine, serotonin, opioid

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5
Q

do we want excess or little of dopamine, serotonin, opioids

A

we want little

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6
Q

why do we want to attack dopamine, serotonin, opioid

A

to prevent nausea

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7
Q

where is the chemoreceptor trigger zone located

A

small area on the floor of the fourth ventricle

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8
Q

the chemoreceptor trigger zone is exposed to

A

blood and cerebrospinal fluid

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9
Q

the chemoreceptor trigger zone is thought to mediate the emetic effects of

A

blood borne drugs and toxins

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10
Q

swallowing depends on the coordinated action of the

A

tongue and pharynx

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11
Q

swallowing structures are innervated by cranial nerves

A

V (5), IX (9), X (10), XII, (12)

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12
Q

dysphagia

A

difficulty in swallowing

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13
Q

Odynophagia

A

painful swallowing

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14
Q

achalasia

A

failure of the esophageal sphincter to relax

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15
Q

Mallory-Weiss Syndrome

A

non penetrating mucosal tears at gastroesophageal junction

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16
Q

Gastroesophageal Reflux Disease (AKA Gerd)

A

heart burn

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17
Q

GERD can lead to cancer how?

A

constant inflammation and then healing cycle

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18
Q

GERD pain is easily confused with

A

angina

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19
Q

Barret esophagus squamous replaced by

A

columnar

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20
Q

Barret esophagus can lead to

A

cancer

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21
Q

GERD in children commonly will present with

A

evidence of pain when swallowing, irritability, inconsolable crying

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22
Q

GERD in children may cause

A

respiratory problems, dental carries or ear pain

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23
Q

how do you get dental carries with GERD in children

A

because acid errodes the enamle

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24
Q

GERD children are very

A

colicly

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25
Q

two types of gastric mucosa

A

water insoluble and water soluble

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26
Q

water insoluble mucus forms

A

thin, stable gel that adheres to the gastric mucosal surface

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27
Q

water soluble mucus is ______ and it is a lubricant that prevents mechanical damage to the mucosal surface

A

viscid

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28
Q

Gastric Mucosal barrier is

A

impermeable epithelial cell surface

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29
Q

Gastric Mucosal Barrier mechanism for selective transport of ________ and ____ ions and characteristics of gastric mucosa

A

hydrogen, bicarb

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30
Q

ASA is non ionized and lipid soluble rapidly diffuses increases

A

mucosal permeability and damages epithelial cells

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31
Q

prostaglandin role

A

secrete bicarb

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32
Q

shock affects the

A

protaglandin

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33
Q

if you are in shock you will have more acid why?

A

prostaglandins are not working

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34
Q

Acute gastritis can or cannot heal its self

A

can heal itself

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35
Q

transient

A

short term

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36
Q

Acute Gastritis is transient inflammation of

A

gastric mucosa

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37
Q

acute gastritis inflammation is caused by

A

bacterial endotoxins, alcohol or asprin

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38
Q

acute gastritis severity ranges from

A

edema to hemorrhagic erosin

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39
Q

acute gastritis is self limiting with complete regeneration and healing within

A

days

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40
Q

Chronic Gastritis is transient or not transient

A

not transient

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41
Q

what is the most common cause of chronic gastritis is

A

H. Pylori

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42
Q

what else could cause chronic gastritis

A

autoimmune

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43
Q

how to get rid of H. Pylori

A

antibiotics

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44
Q

H. Pylori colonizes the

A

mucus secreting epithelial cells of the stomach

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45
Q

H. Pylori bacteria have what that allow them to move through the mucous layer of the stomach

A

multiple flagella

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46
Q

H. Pylori secretes _______ which enables them to produce sufficient ammonia to buffer acidity of their environment

A

urease

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47
Q

H. Pylori produce _______ and ______ that interfere with mucosal protection against injury from gastric acid

A

enzymes, toxins

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48
Q

second most common cause of Chronic Gastritis

A

NSAIDs

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49
Q

H. Pylori causes damages to the stomach lining which could lead to what 2 issues

A

ulcers or increased risk of gastric cancer

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50
Q

When you take Aspirin/NSAIDs those drugs inhibit the synthesis of prostaglandins leading to

A

increased acid production because acid production is regulated by prostaglandins so when you inhibit them you have unregulated acid production

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51
Q

NSAIDs and aspirin contribute to the formation of gastritis by inhibiting the

A

synthesis of prostaglandins

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52
Q

when you take NSAIDs/asprin the synthesis of prostaglandins is decreased due to the __________ action of the drug; there for ____ _________ is unregulated

A

anti inflammatory, acid production

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53
Q

why would the c urea breath test with when testing for H. Pylori

A

because they released urease

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54
Q

ways to test for H. Pylori

A

C urea breath test, stool antigen test

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55
Q

C urea breath test using

A

radioactive carbon isotope

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56
Q

Peptic ulcer disease can be caused by

A

H. Pylori, use of ASA and NSAIDs

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57
Q

peptic ulcer you get discomfort and pain when the stomach is empty or full

A

empty

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58
Q

melena

A

black tarry stool

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59
Q

stress curling happens when you have

A

massive burns

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60
Q

cushings is increased

A

cranial pressire

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61
Q

you get cushings after

A

injury, operation, tumors

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62
Q

complications of peptic ulcers

A

hemorrhage, obstruction, perforation

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63
Q

hemorrhage does or does not go through the wall

A

can happen when the ulcer doesn’t go through the wall

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64
Q

hemorrhage

A

caused by bleeding from granulation tissue or from erosion of an ulcer into an artery or vein

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65
Q

obstruction caused by

A

edema, spasm, or contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or adjacent areas

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66
Q

perforation occurs when an ulcer erodes

A

through all the layers

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67
Q

perforation looks like a

A

flower

68
Q

hematemesis and Selena occurs with

A

hemorrhage

69
Q

hematemsis

A

blood in vomitus

70
Q

melena

A

blood in stool

71
Q

occult

A

hidden

72
Q

cancer of the stomach is often

A

asymptomatic

73
Q

autoimmune gastritis is chronic

A

inflammation

74
Q

chrons is

A

skip lesions of mucosa

75
Q

ulcerative colitis is located just in

A

colon

76
Q

ulcerative colitis is ___________ of mucosa

A

continuous

77
Q

Crohn type of inflammation

A

granulomatous

78
Q

ulcerative colitis type of inflammation

A

ulcerative/exudative

79
Q

crohns area of involvement

A

primary ileum, secondary colon

80
Q

ulcerative colitis area of involvement

A

primarily rectum and left colon

81
Q

Crohn and ulcerative colitis diarrhea

A

common with both

82
Q

crohn rectal bleeding

A

rare

83
Q

ulcerative colitis rectal bleeding

A

common

84
Q

crohns fistulas

A

common

85
Q

ulcerative colitis fistulas

A

rare

86
Q

crohns strictures/perianal abcess

A

common

87
Q

ulcerative colitis strictures/perianal abcess

A

rare

88
Q

crohns development of cancer

A

may occur

89
Q

ulcerative colitis development of cancer

A

high risk

90
Q

clostridium difficile colitis is caused by

A

a lot of antibiotics

91
Q

clostridium difficile colitis you get _______ with lower abdominal cramping

A

diarrhea

92
Q

clostridium difficile is caused by disruption to the normal flora which leads to

A

colonization and release of toxins which cause mucosal damage and inflammation

93
Q

E coli is a ____ borne transmission, person to person

A

food

94
Q

E. coli may occur in

A

nursing homes, day care and hospitals

95
Q

e coli may lead to watery

A

diarrhea

96
Q

e coli may lead to

A

hemorrhagic colitis, hemolytic uremic syndrome and TTP

97
Q

Appendicitis is

A

swollen, gangrenous

98
Q

in appendicitis it wil eventually

A

perforates

99
Q

cause of appendicitis is unknown but may be due to

A

intraliminal obstruction with fecalith or twisting

100
Q

appendicitis has abrupt or longer onset

A

abdrupt

101
Q

appendicitis pain is

A

referred

102
Q

with appendicitis the pain will localize to the ____ in 2-12 hours

A

RLQ

103
Q

the key factor with appendicitis is

A

rebound tenderness

104
Q

rebound tenderness

A

does not hurt when you press down but when you removed pressure

105
Q

peritinoitus has rebound tenderness in

A

all quadrants

106
Q

2 types of intestinal obstruction

A

mechanical or paralytic

107
Q

mechanical obstruction can lead to

A

vomitting

108
Q

why would mechanical obstruction lead to vomiting

A

because the bolus cannot go thorough the obstruction so it must come up rather than down

109
Q

mechanical obstruction can be caused by

A

hernia, adhesions, intussusception and volvulus

110
Q

paralytic obstruction is caused by

A

neurogenic or muscular impairment of peristalsis most commonly after abdominal surgery

111
Q

4 types of mechanical obstructions

A

adhesions, volvulus, incarcerated inguinal hernia, intuddusception

112
Q

voluvus

A

twisting

113
Q

adhesions

A

two portions of the intestine are connected by a scar

114
Q

intussusception

A

the intention folds in

115
Q

in mechanical you have what type of pain

A

severe, colicky pain

116
Q

in mechanical you will hear borborygmus which is

A

rumbling thundery noise of air rushing

117
Q

paralytic will have what type of pain

A

continous

118
Q

will paralytic have noise or be silent

A

silent

119
Q

paralytic there is not true blockage but the bowels are

A

paralyzed

120
Q

results of obstruction

A

vomiting which leads to fluid and electrolyte loss, distension of bowel, and anaerobic bacteria will produce endotoxin which lead to toxemia

121
Q

with peritonitis where will you get rebound tenderness

A

all over abdominal

122
Q

peritonitis is well adapted for inflammatory response how?

A

exudes thick, sticky, fibrinous substance that adheres and walls off perforated viscus and aids in localizing process

123
Q

peritonitis uses sympathetic stimulation that limits intestinal activity why?

A

inhibits movement of contaminants

124
Q

peritonitis translocation of ECF to peritoneal cavity and bowl can cause

A

nausea, vomiting, hypovolemia and shock

125
Q

what are some things that could lead to peritonitis

A

perforated peptic ulcer, ruptured appendix, perforated divertivulum, gangrenous bowl, gangrenous gallbladder

126
Q

with colorectal cancers pain is a early or late symptom

A

late

127
Q

with colorectal cancer _____ side colon could lead to no symptoms until it develops to a mass

A

right

128
Q

colorectal cancer could be caused by

A

crohn disease, ulcerative colitis

129
Q

liver function tests

A

liver enzymes, protein levels, prothrombin time, bilirubin, ultrasound, CT, MRI, angio

130
Q

jaundice in the eye is also called

A

sclera icterus

131
Q

cause of jaundice

A

excessive destruction of red blood cells, impaired uptake of bilirubin by the liver cells, decreased conjucation of bilirubin, obstruction of bile flow

132
Q

prehepatic

A

before liver

133
Q

intrahepatic

A

in liver

134
Q

posthepatic

A

after liver

135
Q

prehepatic major cause is

A

excessive hemolysis of red blood cells

136
Q

intrahepatic causes by disorders that directly affect the ability of the liver to removed

A

bilirubin

137
Q

posthepatic occurs when bile flow is obstructive between the liver and the

A

intestine

138
Q

which of the following is not a cause of jaundice?
- excessive destruction of red blood cells
- impaired uptake of bilirubin by the liver cells
- ingestion of iron supplements
- obstruction of bile flow in the canaliculi of the hepatic lobules or in the tntrahepatic or extra hepatic bile ducts

A

ingestion of iron supplements

139
Q

Tylenol affects the ______

A

liver

140
Q

cause of hepatitis

A

autoimmune disorders, reactions to drugs and toxins, infectious disorders, hepatotoxic viruses that primarily affect liver cells or hepatocytes

141
Q

spectrum of alcoholic liver disease includes

A

fatty liver disease
alcoholic hepatitis
cirrhosis

142
Q

in cirrhosis the ___________ is disrupted

A

cytoskeleton

143
Q

cirrhosis end state chronic liver disease in which normal architecture of liver is replaced by

A

fibrous septa

144
Q

portal hypertension ___________ resistance to flow in portal venous system and sustained pressures

A

resistance

145
Q

portal hypertension causes increased pressure in ___________ capillaries

A

peritoneal

146
Q

portal hypertension cause portosystemic _________ of blood

A

shunting

147
Q

portal hypertension

A

splenomegaly

148
Q

increased pressure in peritoneal capillaries causes

A

ascites

149
Q

splenomegaly causes

A

anemia, leukopenia, thromboytopenia, bleeding

150
Q

decreased albumin causes decrease colloidal osmotic pressure which causes

A

ascites

151
Q

increase bilirubin causes

A

decrease clotting factors

152
Q

manifestations of cirrhosis

A

weight loss, portal hypertension, ascites, esophageal varies, splenomegaly

153
Q

cholelithiasis

A

gallstones

154
Q

cholecystitis

A

inflammation of gallbladder

155
Q

acute pancreatitis

A

serve life treating disorder associated with escape of activated pancreatic enzymes into pancreas and surrounding tissue

156
Q

acute pancreatitis: enzymes induce fat necrosis or

A

autodigestion of pancreas

157
Q

acute pancreatitis: onset of

A

severe pain abrupt

158
Q

acute pancreatitis: loss of _________ into retroperitoneal and peripancreatic spaces

A

volume

159
Q

acute pancreatitis: hypocalcemia due to ___________ of calcium in fat necrosis

A

precipitation

160
Q

acute pancreatitis what is used for diagnosis

A

serum amylase and lipase

161
Q

acute pancreatitis causes ____ and ____ may result in death

A

ARDS, ATN

162
Q

common causes acute pancreatitis:

A

gallstones

163
Q

Cullens sign

A

test for pancreatitis blood behind belly button

164
Q

chronic pancreatitis

A

calcifying or obstructive

165
Q

cancer of pancreas: cause

A

unknown

166
Q

are they pain endings in pancreas

A

no

Pathophysiology (44 decks)

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