unit 3 exam Flashcards
Name all hormones secreted by the anterior lobe of the pituitary gland
Growth hormone, thyroid stimulating hormone, follicle stimulating hormone, luteinizing hormone, prolactin, ACTH, lipotropin, melanocyte stimulating hormone
Name all hormones secreted by the posterior lobe of pituitary gland
ADH and oxytocin
What are causes of hypofunction or hyperfunction
inflammation (usually chronic but can be acute) or tumor originating in endocrine glands
Name the hormones the thyroid gland produces
Thyroxine (T4) and triiodothryonine (T3) and calcitonin
What do the thyroid hormones do
they are necessary for normal growth and development, regulate basal metabolism, increase metabolic activity and protein synthesis, influence renal decelopment
what is the function of parathyroid hormone
regulate calcium and phosphate metabolism
how is calcium and phosphate regulated
stimulating resorption of calcium and phosphate from bone, reabsorption of calcium and excretion of phosphate by the kidneys, combined action with vitamin D, and absorption from GI tract
What is the function of mineralocorticoid
regulate reabsorption of sodium and excretion of potassium by kidneys, regulate blood pressure
Why is there changes in the endocrine system from age
Concentration of hormones needed dont change, but the way we achieve the equilibrium hormone levels do
Where are changes in the system seen from aging
pituitary, adrenal, and thyroid function. ———glucose homeostasis, reproductive function, and calcium metabolism——–
If a patient has a lack of progress in PT, what should the therapist note
it should signal the possibility of a systemic origin of musculoskeletal symptoms
If a patient has muscle weakness, atrophy, myalgia, and fatigue that persists despite rest, what diseases could be manifested?
thyroid or parathyroid disease, acromegaly, diabetes, cushing syndrome, or osteomalacia
What are the functions of cortisol
regulates metabolism of proteins, carbs, and lipids to elevate blood glucose levels. essential to norepinephrine-induced vasoconstriction. dampening body’s inflammatory response to foreign agents.
What is acromegaly
Excessive secretion of growth hormone after normal completion of body growth
Graves disease is..
most common type of hyperthyroidism, increase in T4 production
Pathogenesis of hyperthyroidism
people with graves have circulating autoantibodies called TSIs that react against thyroglobulin
What do TSIs do
Stimulate enlargement of thyroid gland and secretion of excess thyroid hormone
Symptoms of hyperthyroidism
Larger thyroid, nervousness, heat intolerance, weight loss, increased appetite, sweating, diarrhea, tremor, palpitations, afib, increase risk of myocardial infarction, and congestive heart failure
What role does the Mu receptor take part of
respiratory depression
Management of hyperthyroidism
antithyroid medication, radioactive iodine, and surgery
Type 1 hypothyroidism is..
reduced thyroid mass, impaired hormonal synthesis or release of hormones, or elevated TSH hormone
symptoms of type 1 hypothyroidism
slowing of body processes, bradycardia, decreased GI tract motility, slowed neuro, decrease in body heat, absence of hydrochloric acid, development of anemia, lipid metabolism is altered
Type 2 hypothyroidism
result of failure of pituitary gland to synthesize and release adequate amounts of TSH
What are mixed agonist-antagonists
they exhibit some agonist and antagonist-like activity, there’s less risk of the side effects associated with Mu receptors
What kind of opiate classification would you use if you need to treat severe pain
strong agonists
Where does metabolic inactivation of opioids take place
liver
What are the three mechanisms of action for opioids
spinal, supraspinal, and peripheral effects
Explain the spinal effects of opioids
the inhibitory effect (decreased transmitter release from presynaptic and decreased excitability of post synaptic neuron) mediated by opioid receptors
explain supraspinal effects of opioids
bind to receptors in midbrain and remove inhibition of pathways that decrease pain. Release setatonin and norepinephrine and inhibit ability of synapses to transmit painful impulses to the brain
Adverse effects of opioids
drowsiness, respiratory depression, orthostatic hypotension, GI distress
When do withdrawal symptoms show
6-10 hours after last dose
What is opioid induced hyperalgesia
may fail to respond to opioids or report increased pain sensitivity.
What are corticosteroids
naturally occurring hormones made by adrenal cortex
what are glucocorticoids
effect carb and protein metabolism, —-increase blood glucose and liver glycogen
what are mineralocorticoids (aldosterone)
regulate electrolyte and water metabolism
What are the anti-inflammatory effects of glucocorticoids
act on macrophages, lymphocytes, and endothelial cells to inhibit expression of cytokines, inhibit production of adhesion molecules diminish ability of leukocytes to enter inflamed tissues
What are adverse effects of glucocorticoids
Changes in mood, effects on skin and connective tissue, cardiovascular effects, steroid-induced myopathy, effect of growth and bone.
What are the applications of glucocorticoids
decrease inflammation, for immunosuppression, replacement steroid for adrenal insufficiency
Adverse effects of prolonged systemic corticosteroids
hyperglycemia, fluid retention, increase risk of infection, osteoporosis, bone fractures, peptic ulcer disease, gastritis, nausea, change in mood
pharmacological properties of NSAIDs
decreases inflammation, relieve mild to moderate pain, decrease fever, decrease blood clotting
what is the role of eicosanoids in health
have effects on every major system
What does aspirin inhibit
COX-1 and COX-2
What are the clinical applications of aspirin
pain and inflammation, fever, vascular disorders, and prevention of cancer
How does aspirin help pain and inflammation
provide analgesic effects similar to opioid drugs without harmful side effects
should children use aspirin for a fever
NO, can cause Reye syndrome
how does aspirin help vascular disorders
help prevent onset or recurrence of heart attacks by inhibiting thrombus formation in coronary arteries—- using daily can prevent stroke
What is the mechanism of aspirin
inhibit platelet induced thrombus formation through its ability to inhibit thromboxane biosynthesis
How does aspirin prevent cancer (mechanism)
inhibit COX-2 enzyme which inhibits the synthesis of prostaglandins that cause abnormal cell division
inhibits platelet activation
What kind of CV problems can be caused by aspirin
increase BP and chance of thrombotic events, can lead to stroke, heart attack in susceptible individuals
Why would a patient prefer COX-2 selective drugs
Useful to patients who can’t tolerate traditional NSAIDS or aspirin
or
preferred for patients who are at risk for prolonged bleeding and bruising that can happen with aspirin and NSAIDs
COX-2 inhibitors spare the production of _________
thromboxane
How do COX-2 drugs increase the risk of CV events
COX-2 inhibition can cause loss of prostaglandins that cause vasodilation and prevent thrombosis which allow PROthrombotic prostaglandins to dominate
What is thromboxane
a prostaglandin that facilitates platelet aggregation and clot formation
What is the major advantage of acetaminophen
les supper GI tract irritation
is acetaminophen considered an NSAID
NO, lacks anti-inflammatory and anti-coagulant properties
Name the body parts involved in the upper GI tract
mouth, esophagus, stomach, and duodenum
Name the parts involved in the lower GI tract
small intestine and large intestine
What are the most common GI problems in older adults
constipation, incontinence, and diverticular disease
What is a hiatal hernia
esophageal hiatus of diagram gets enlarged and causes the stomach to go through the hole
what are symptoms of a hiatal hernia
Heartburn or reflux
Contraindications for hiatal hernia
avoid flat supine position or valsalva manuever
What is GERD
reflux of gastric contents into esophagus accompanied by a failure of anatomic and physiologic mechanisms to protect the esophagus
clinical manifestations of GERD
heartburn, asthma, cough, laryngitis
older that 70 years old can have dysphagia, vomiting, respiratory issues, weight loss, anemia, or anorexia.
What are the general functions of the liver
digestive, endocrine, excretory, hematologic, and immune
-Conversion and excretion of bilirubin,
-produce clotting factors and storage of vitamins,
- metabolize drugs, chemicals, and toxins,
filters all of blood from GI system
examples of liver function
How much bile does the liver produce per day
600 ml
Functions of pancreas as an exocrine gland
secretion of digestive enzymes and pancreatic juices and neutralize
functions of pancreas as endocrine gland
secretion of glucagon ad insulin by islet of langerhans cells
bile helps in….
alkalinizing intestinal contents and plays role in emulsification, absorption, and digestion of fat
How does hepatic failure occur
mass of liver cells diminished or cirrhosis, liver cancer, infection, or inflammation
What is palmar erythema
warm redness of skin over palms
what hormone is associated with spider angiomas
increase estrogen
When liver dysfunction causes increased serum ammonia and urea levels, it will IMPAIR THE CNS OR PNS
PNS
What is acute cholangitis
obstruction and stasis of bile from choledocholithiasis, biliary strictures, or malignancy can lead to a suppurative infection of the biliary tree
what is acute cholecystitis
inflammation of gallbladder, causes prolonged abdominal pain lasting more than 6 hours
asterixis
can’t maintain wrist extension with forward flexion of upper extremities
symptoms of hepatic failure in MSK
thoracic pain, hepatic osteodystrophy
what is osteodystrophy
abnormal development of bone, osteomalacia and porosis, pain in wrist and ankles, and referred pain
Neuro symptoms of hepatic failure
confusion, sleep disturbances, muscle tremors, hyperreactive reflexes, and asterixis, hepatic encephalopathy or portosystemic encephalopathy
medications that are lipophilic have an increased area of distribution in older people secondary to an increase in the proportion of….
fat mass and decrease of lean mass
At >2.0 mg/dL, how does jaundice look like
Yellow discoloration of skin, sclerae, and mucous membrane
At 3.0 mg/dL, how does jaundice look like
Skin becomes yellow, urine gets dark, stool is light
When does cirrhosis occur
when inflammation causes liver tissue damage and/or necrosis
How is cirrhosis characterized
Progressive loss of normal tissue that’s replaced with fibrosis and nodular regeneration
Is cirrhosis reversible
no
Elevated portal pressure gradient occurs when pressure of blood entering the liver is higher than pressure of blood in inf vena cava
portal hypertension
_________, __________, and __________ combine to form mechanical barriers to blood flow and increase resistance
Fibrosis, nodularity, and abnormal liver architecture
What syndrome is a complex neuropsychiatric syndrome and motor disturbances to coma and death?
Hepatic encephalopathy
what are the grades of hepatic encephalopathy
minimal, grade 1-4
Ascites
abnormal accumulation of fluid within the peritoneal cavity
What is hepatitis
acute or chronic inflammation of the liver caused by a virus, chemical, drug reaction, or alcohol abuse
How many different viruses does hepatitis have
six, A-G
What kind of hepatitis comprises several diseases with common clinical manifestations, usually asymptomatic, an ongoing injury for over 6 months
chronic hepatitis
What kind of liver failure is rare but fatal, rapidly progressing, cause is acetaminophen hepatotoxicity/?
Acute liver failure
what kind of hepatitis can be easily spread before symptoms appear, symptoms include malaise, fatigue, fever, nausea, and so on.
Viral hepatitis
Which hepatitis is transmitted via fecal-oral route, due to poor hygiene, highly contagious, greatest danger of transmission during incubation
Hepatitis A
Which hepatitis is highly infections, trasmitted via percutaneously or mucosal contact, and a sexually transmitted disease
Hepatitis B
Which hepatitis is commonly associated with injection use, period of infectivity before onset of symptoms, lifetime carrier, often symptomatic
hepatitis C
Which hepatitis is uncommon in the US, a coinfection of HBV, requires hepatitis B for its replication
Hepatitis D
Which hepatitis is transmitted by contaminated water via the fecal-oral route and clinically resembles HAV
Hepatitis E
What’s the pathogenesis of alcoholic liver disease
fatty liver disease occurs with the accumulation of fat in hepatocytes
Chronic alcohol use results in bacterial overgrowth and disturbance of junctions between intestinal cells stimulates…
Immune system and inflammation
How does the liver respond to inflammation and injury
a fibrogenic scar
Alcoholic fatty liver disease is associated with
elevated AST and ALT enzymes, bilirubin less than 3 mg/dL, ultrasound may show steatosis
What is alcoholic steatohepatitis
inflammation on liver biopsy
What is associated with alcoholic hepatitis
elevated AST and ALT, increased bilirubin greater than 3 mg/dL, 50% have advanced fibrosis or cirrhosis on liver biopsy
What is nonalcoholic fatty liver disease
its without significant inflammation, related to diabetes and insulin resistance
What is the definition of pancreatitis
serious inflammation of pancreas and surrounding organs that can result in auto digestion of pancreas by its own enzymes
What pancreatitis is 80% of cases and mild course and few complications
interstitial pancreatitis
what pancreatitis is 20% of cases and has significant complications and higher mortality
necrotizing pancreatitis
what type of acute pancreatitis is characterized by absence of organ failure or local or systemic complications
Mild acute
what type of acute pancreatitis is characterized by transient organ failure with local or systemic complications and severe right upper quadrate pain
Moderately severe
What type of acute pancreatitis has severe cytokines and free radicals mediate a systemic response, leading to persistent multi-organ failure or death
severe
What pancreatitis has the development of irreversible changes in the pancreas secondary to chronic inflammation
chronic pancreatitis
Which cancer has the lowest 5 year survival rate after diagnosis
pancreatic cancer
