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Internal Medicine Final > unit 3 stuff > Flashcards

unit 3 stuff Flashcards

1
Q

5 functions of the endocrine system

A
  1. splits reproductive and CNS of the fetus
  2. Stimulates sequential growth/development during puberty
  3. Coordination of reproductive systems
  4. Maintenance internal environment
  5. activated in emergencies
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2
Q

what is the main center in the brain for endocrine + autonomic nervous systems

A

hypothalamus

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3
Q

how does the hypothalamus control endocrine

A

by neural and hormonal pathways

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4
Q

what type of feedback system is the endocrine system controlled by

A

negative feedback systems

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5
Q

what is somatotropin’s target

A

bones, muscles, organs

aka growth hormone

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6
Q

follicle-stimulating hormone (FSH) target

A

ovaries, seminiferous tubules

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7
Q

luteinizing hormone target

A

follicle
intestinal cells

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8
Q

prolactin (PRL; luteotropic hormone) target

A

corpus luteum
breast

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9
Q

adrenocorticotropic hormone (ACTH) target

A

adrenal cortex

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10
Q

lipotropin (LPH) target

A

corticotropes (cells in anterior pituitary)

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11
Q

Melanocyte-stimulating hormone (MSH) target

A

melanotrope
(cells in anterior pituitary)

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12
Q

antidiuretic hormone (ADH) target

A

distal tubules of kidney

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13
Q

oxytocin (OXT) target

A

uterus

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14
Q

what 2 hormones are produced by the posterior pituitary gland

A

antidiuretic hormone
oxytocin

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15
Q

basic action of growth hormone (somatotropin)

A

Stimulates growth and cell reproduction, releases insulin-like growth factor 1 from liver, retention of nitrogen to promote protein anabolism

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16
Q

basic action of thyroid-stimulating hormone

A

Promotes secretory activity (T3 and T4)

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17
Q

basic action of follicle-stimulating hormone (FSH)

A

Promotes development of ovarian follicle, secretion of estrogen (females)
and
maturation of sperm (males)

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18
Q

basic action of luteinizing hormone

A

Promotes ovulation
formation of corpus luteum
secretion of progesterone
secretion of testosterone

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19
Q

basic action of prolactin

A

Maintains corpus luteum progesterone secretion
stimulates milk production
sexual gratification after sexual activity

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20
Q

basic action of adrenocorticotropic hormone (ACTH)

A

Stimulates secretory activity synthesis of corticosteroids

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21
Q

basic action of Lipotropin (LPH)

A

Breaks down fat (lipolysis)
stimulates melanin production

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22
Q

basic action melanocyte-stimulating hormone (MSH)

A

Produces melanin in skin and hair

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23
Q

basic action of antidiuretic hormone (ADH)

A

Reabsorption of water retention in kidneys
vasoconstriction
release ACTH in anterior pituitary

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24
Q

basic action of oxytocin (OXT)

A

Stimulates contraction (cervix, vagina, orgasm)
releases breast milk
regulates circadian rhythm (body temperature, sleep–wake cycle, activity level)

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25
Q

what type of tissue is classified as an endocrine gland

A

adipose tissue

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26
Q

how is adipose tissue an endocrine gland

A

secretes hormones

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27
Q

what are 2 main causes of endocrine system dysfunctions

A

inflammation
tumor growth (hypothalamus, pituitary gland, etc)

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28
Q

ectopic hormone production

A

hormone production of cancer cells that causes paraneoplastic syndrome

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29
Q

neuroendocrine theory of aging

A

cells are programmed to function for a given amount of time

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30
Q

clinical symptoms of endocrine/metabolic diseases

A

fatigue
muscle weakness
muscle/bone pain

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31
Q

what autoimmune disorder can be an underlying sign of endocrine disease

A

rheumatoid arthritis

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32
Q

what is a symptom of carpal tunnel syndrome that indicates an endocrine disorder rather than an overuse issue

A

CTS presents BILATERALLY

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33
Q

what hormone and gland causes acromegaly

A

growth hormone
anterior pituitary gland

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34
Q

what are the 3 hormones produced by the thyroid

A

thyroxine (t4)
triiodothyronine (t3)
calcitonin

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35
Q

what thyroid hormone(s) regulate the metabolic rate of the body and increase protein synthesis

A

T3 and T4

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36
Q

what regulates the thyroid

A

hypothalamus
pituitary

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37
Q

hyperthyroidism symptoms

A

heat intolerance
weight loss
sweating
tremors
palpitations

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38
Q

graves disease is caused by

A

hyperthyroidism

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39
Q

autoimmune condition that increases T4 production

A

graves disease

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40
Q

thyroid storm

A

acute episode of thyroid over-activity

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41
Q

what autoantibody circulates in people with graves disease

A

TSI
(they react against thyroglobulin)

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42
Q

hypothyroidism symptoms

A

slowing of metabolism, heart, GI tract, and neurological functioning
cold intolerance
anemia

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43
Q

what is type II hypothyroidism

A

the failure of the pituitary gland to synthesize and release adequate amounts of TSH
(the hormone that stimulates the thyroid)

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44
Q

what is myxedema and what is it a symptom of

A

nonpitting, boggy edema around the eyes, hands, and feet
it is a symptom of hypothyroidism

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45
Q

TSH levels are always ____ in primary hypothyroidism

A

Elevated

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46
Q

T4 levels are always ___ in primary hypothyroidism

A

decreased

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47
Q

what are the main goals of hypothyroid treatment

A

correct thyroid hormone deficiency
reverse symptoms
prevent further cardiac/arterial damage

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48
Q

what does PTH regulate

A

calcium and phosphorus metabolism

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49
Q

where are the parathyroid glands located

A

posterior surface of each thyroid gland lobe

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50
Q

basic action of parathyroid hormone

A

calcium and phosphorus metabolism
calcification of bone

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51
Q

what does the parathyroid hormone target

A

bone
kidney
intestinal tract

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52
Q

hypoparathyroidism symptoms

A

decreased bone resorption
depressed serum calcium levels
elevated serum phosphate levels

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53
Q

t/f: PTH is regulated by the pituitary and the hypothalamus

A

FALSE: PTH maintains normal blood calcium levels by increasing bone resorption and GI absorption, NOT BY PITUITARY OR HYPOTHALAMUS

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54
Q

what disease could cause calcifications in the eyes and basal ganglia

A

hypoparathyroidism

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55
Q

tetany

A

neuromuscular irritability that causes involuntary muscle contractions

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56
Q

what are the 2 parts to the adrenal gland

A

outer cortex
inner medulla

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57
Q

the outer cortex secretes what 3 hormones

A

mineralocorticoids
glucocorticoids
androgens

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58
Q

what are mineralocorticoids what do they do

A

steroid hormones that regulate fluid and mineral balance

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59
Q

what are glucocorticoids and what do they do

A

steroid hormones responsible for controlling the glucose metabolism

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60
Q

what hormones does the medulla produce

A

epinephrine and norepinephrine

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61
Q

epinephrine + norepinephine’s basic action

A

fight or flight
increased HR
vasoconstriction
increased BP
increased blood glucose
ACTH production

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62
Q

addison disease can be caused by (2)

A
  1. decreased production of cortisol
  2. aldosterone deficiency
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63
Q

what are some clinical symptoms of addison disease (cortisol deficiency)

A

weak/fatigued
hypotensive
anorexic/weight loss
nausea
less resistance to stress
hypoglycemia

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64
Q

in addisons disease, the drop in cortisol results in a failure to inhibit….

A

anterior pituitary secretion of ACTH

(results in a bronze/tan appearance)

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65
Q

what are some clinical symptoms of addison disease (aldosterone deficiency)

A

fluid/electrolyte imbalances
sodium excretion
dehydration
hypotension
decreased heart size

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66
Q

what is the hallmark of Addison disease

A

decreased serum cortisol levels

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67
Q

what do PTs need to watch out for in patients with addison disease

A

not to overstress the body
dizziness, nausea, tremors

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68
Q

is primary or secondary adrenal insufficiency more common

A

secondary is more common

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69
Q

how can secondary adrenal insufficiency develop (3)

A
  1. steroid therapy
  2. opportunistic infections due to HIV
  3. removal of the pituitary or hypopituitarism
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70
Q

what hormone is responsible for the symptoms of secondary adrenal disease

A

cortisol ONLY

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71
Q

cushing syndrome cause

A

excess of cortisol in the body from either
1. hyperfunction
2. corticosteroid medication

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72
Q

what hormone responds to stress and is anti-inflammatory

A

cortisol

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73
Q

cortisol has a key role in ____ metabolism

A

glucose

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74
Q

cushing disease cause

A

hypercortisolism due to oversecretion of ACTH from the pituitary (usually tumor on anterior pituitary gland)

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75
Q

pseudo-cushing syndrome cause

A

depression, alcoholism, estrogen therapy, or eating disorders cause cushing syndrome-like symptoms

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76
Q

clinical symptoms of cushing syndrome

A

hyperglycemia
hypertension
proximal muscle wasting
osteoporosis

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77
Q

conn syndrome cause

A

adrenal lesion results in hypersecretion of aldosterone

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78
Q

what does an excess of aldosterone do in the kidneys

A

enhances sodium reabsorption

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79
Q

adipokines

A

proteins released by adipocytes after being induced by neurotransmitters and glucose

(basically the protein hormone fat produces in the body)

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80
Q

adipokines act as ____ hormones locally but as ____ hormones in the bloodstream

A

autocrine
endocrine

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81
Q

what is the function of adipokines

A

regulating appetite
energy expenditure
insulin sensitivity
lipid uptake

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82
Q

brown fat is important for

A

thermoregulation

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83
Q

white fat is responsible for

A

storage of triglycerols to provide long-term energy storage

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84
Q

fat accumulation in the lower body is called _____ and results in what kind of body shape

A

subcutaneous fat
pear-shaped

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85
Q

fat accumulation in the abdominal region is called _____ and results in what kind of body shape

A

visceral fat
apple shape

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86
Q

what 2 anthropometric measures are more predictive of visceral fat than BMI

A

waist circumference and waist-to-height ratios

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87
Q

bariatrics

A

branch of medicine concerned with the management of obesity

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88
Q

normal range BMI

A

18.5-24.9

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89
Q

obese BMI

A

> or = to 30

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90
Q

overweight BMI for kids is in what percentile

A

85-94th percentile

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91
Q

islets constitute for __% to __% of the pancreas

A

1% to 2%

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92
Q

what cells produce and secrete insulin

A

beta cells

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93
Q

type 1 diabetes mellitus

A

insulin-dependent

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94
Q

type 2 diabetes mellitus

A

insulin resistant

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95
Q

is type I or type II diabetes more common

A

type II

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96
Q

is type I or type II diabetes autoimmune

A

type I

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97
Q

diabesity

A

obesity-dependent diabetes in childhood

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98
Q

when does gestational diabetes occur

A

24-28 weeks of gestation

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99
Q

what % of pregnancies are accompanies with gestational diabetes

A

0.08

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100
Q

A1C % in prediabetes

A

5.7-6.4%

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101
Q

fasting blood sugar test levels in prediabetes

A

100-125 mg/dL

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102
Q

glucose tolerance test levels in prediabetes

A

140-199 mg/dL

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103
Q

what does A1C measure

A

the percent of blood sugar attached to hemoglobin

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104
Q

__% of the adult population in Texas have diabetes and __% have prediabetes

A

12.4%
34%

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105
Q

what causes type I diabetes

A

autoimmune destruction of beta cells in the pancreas, which results in a lack of insulin

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106
Q

3 steps to diabetes

A
  1. insulin resistance
  2. hyperglycemia
  3. beta cell dysfunction
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107
Q

polyuria

A

excessive urination

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108
Q

polydipsia

A

excessive thirst

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109
Q

polyphagia

A

excessive hunger

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110
Q

5 main complications with type 2 diabetes

A

blindness
kidney failure
heart disease
stroke
loss of toes, feet, or legs

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111
Q

macrovascular complications in type 2 diabetes

A

affecting arteries that supply heart, brain, and lower extremities

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112
Q

microvascular complications in type 2 diabetes

A

retina
renal glomerulus
peripheral nerve

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113
Q

hypoglycemia symptoms

A

shallow breathing
tachycardia
shaky/hungry/dizzy

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114
Q

hyperglycemia symptoms

A

dry
weak
fruity breath
thirst

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115
Q

which type of diabetes is diabetic ketoacidosis (DKA) mostly found in

A

type I

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116
Q

the triad of diabetic ketoacidosis (DKA)

A
  1. hyperglycemia
  2. acidosis
  3. ketosis
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117
Q

what are the ABC levels to be controlled when treating type II diabetes (and the values)

A

A1C = less than 7%
BP = less than 130/80
cholesterol = less than 100 LDL, more than 50 HDL, less than 150 triglycerides

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118
Q

what type of insulin does not have a peak response

A

long-acting insulin

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119
Q

type II diabetes raises a person’s risk of dying from heart disease by ___ to ____x

A

2-3x

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120
Q

__% of myocardial infarctions and ___% of strokes are attributable to diabetes

A

50%
75%

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121
Q

what are the 3 distinct families of endogenous opioid peptides

A

endorphins
enkephalins
dynorphins

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122
Q

what are common side effects of Mu receptor activation

A

sedation and respiratory depression

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123
Q

antagonists don’t produce ____

A

analgesia

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124
Q

antagonists are primarily used to treat….

A

opioid overdoses
addiction

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125
Q

what is the primary agent used to treat opioid overdose

A

naloxone

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126
Q

strong agonists are used to treat…

A

severe pain

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127
Q

morphine is an example of

A

strong agonist

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128
Q

mild-to-moderate agonists are used to treat….

A

moderate pain

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129
Q

codeine, hydrocodone and oxycodone are what type of agonsit

A

mild-to-moderate

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130
Q

mixed agonist-antagonists strength

A

less risk of side effects with Mu receptors

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131
Q

mixed agonist-antagonist weaknesses

A

may produce psychotropic effects
maximal analgesic effect may not be as strong

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132
Q

spinal effects/mechanism of opioids

A

inhibits both presynaptic and postsynaptic membranes of pain-mediating synapses by “trapping” neurotransmitters

(basically is able to stop neurons from communicating to each other that there is pain)

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133
Q

opioid receptors are linked via _________ to signaling pathways

A

G proteins

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134
Q

supraspinal effects/mechanism of opioids

A

opioids bind to the midbrain’s gray matter (PAG) and sends signals down a pathway to the pain sight to slow the pain signals

(basically decreases pain by stopping the pain signals to the brain)

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135
Q

increased activity of descending pathways travel through the ventromedial medulla (VMM) to reach the ______

A

dorsal horn of the spinal cord

136
Q

neurons in descending pathways release _____ and _____ onto _______ to inhibit pain impulses to the brain

A

serotonin
norepinephrine
dorsal horn synapses

137
Q

orthostatic hypotension

A

when you get up too fast and get dizzy

138
Q

2 mechanisms of opioid tolerance

A
  1. receptor down-regulation
  2. loss of communication between opioid receptors and G proteins
139
Q

when do withdrawal symptoms become evident, when is the peak, and how long do they last for?

A

evident: 6-10 hours
peak: day 2-3
last for: 5 days

140
Q

some symptoms of physical dependence to pain medicine include

A

body aches
diarrhea
fever
insomnia
irritability
stomach cramps
vomiting/nausea

141
Q

opioid-induced hyperalgesia

A

failure to respond to opioids
could increase pain sensitivity

142
Q

methadone function

A

offers milder withdrawal symptoms

143
Q

peripheral effects/mechanism of opioids

A

the exogenous opioids assist the endogenous peptides in stopping the transmission of pain

144
Q

2 types of corticosteroids

A
  1. glucocorticoids (cortisol)
  2. mineralocorticoids (aldosterone)
145
Q

what corticosteroid affects carbohydrate and protein metabolism

A

glucocorticoids (cortisol)

146
Q

what corticosteroid regulates electrolyte and water metabolism

A

mineralocorticoids (aldosterone)

147
Q

glucocorticoids __(increase/decrease)___ blood glucose and liver glycogen

A

increase

148
Q

glucocorticoids act on macrophages, lymphocytes, and endothelial cells to inhibit the expression of __________

A

inflammatory proteins (cytokines)

149
Q

how do glucocorticoids reduce inflammation

A
  1. inhibits inflammatory proteins (cytokines)
  2. reduces lymphocytes and eosinophils
  3. inhibits adhesion molecules so leukocytes can’t promote inflammation
  4. reduces vascular permeability by suppressing histamine and kinins
150
Q

in order to reduce vascular permeability, ____ and ___ must be produced (think endogenous)

A

histamine and kinins

151
Q

what are the main functions of glucocorticoid medications

A

decrease inflammation
immunosuppression
replacement for adrenal insufficiency

152
Q

the main adverse symptom of prolonged corticosteroids in the ENDOCRINE system

A

hyperglycemia

153
Q

the main adverse symptom of prolonged corticosteroids in the CARDIOVASCULAR system

A

fluid retention/edema

154
Q

the main adverse symptoms of prolonged corticosteroids in the IMMUNE system

A

increase risk of infections
activates latent viruses
masks infection

155
Q

the main adverse symptoms of prolonged corticosteroids in the MUSCULOSKELETAL system

A

osteoporosis
bone fractures

156
Q

the main adverse symptoms of prolonged corticosteroids in the GASTROINTESTINAL system

A

peptic ulcers
GI bleeding
gastritis
nausea

157
Q

the main adverse symptoms of prolonged corticosteroids in the NERVOUS system

A

insomnia
mood changes

158
Q

prazole

A

proton pump inhibitor

helps with gastric ulcers

159
Q

idine

A

histamine H2-receptor blockers

helps with gastric ulcers

160
Q

amide

A

oral antidiabetics (sulfonylurea group)

helps with type 2 diabetes (antidiabetics)

161
Q

dronate

A

bisphosphonates

helps with osteoporosis

162
Q

what is the first step of the eicosanoid biosynthesis and then what are the 2 pathway options

A

arachidonic acid is released then either goes the LOX or COX pathway

163
Q

prostaglandin

A

a group of lipid-like compounds that are produced by all living cells (except RBCs)

164
Q

leukotriene

A

pro-inflammatory and mediates airway inflammation

165
Q

increased PGE2 causes

A

inflammation

166
Q

how do eicosanoids promote fever

A

altering thermo-regulatory set-point

167
Q

dysmenorrhea

A

painful cramps that accompany menstruation

168
Q

eicosanoids cause

A

pain
fever
dysmenorrhea
thrombus formation
inflammation

169
Q

how do eicosanoids cause thrombus formation

A

TXA2 causes platelet aggregations that result in the blood clot formations

170
Q

what do aspirin and other NSAIDs inhibit

A

Cyclooxygenase (COX)

171
Q

what does it mean to say that aspirin is a nonselective inhibitor? Why is this a bad thing?

A

it means that aspirin inhibits COX1 and COX2

This is bad because COX1 helps platelet function and gastric protection

172
Q

COX1 function

A

gastric protection
platelet function

173
Q

COX2 function

A

pain
fever
bone formation

174
Q

what is aspirin good at preventing

A

pain/inflammation
fever
vascular disorders
cancer prevention

175
Q

what is the primary NSAID used in treating fever in adults

A

aspirin

176
Q

2 main adverse effects of aspirin-like drugs

A
  1. gastrointestinal problems
  2. cardiovascular problems
177
Q

aspirin is linked to causing _______ in children

A

reye syndrome

178
Q

benefit of COX-2 selective drugs

A

because COX1 is untouched, the chance of gastric irritation is much lower

179
Q

what does NSAID stand for

A

Nonsteroidal anti-inflammatory drugs

180
Q

which COX drug (1 or 2) may increase the risk of serious cardiovascular events like heart attack/stroke

A

COX-2

181
Q

is acetaminophen an NSAID drug? why or why not?

A

no because it lacks anti-inflammatory and anti-coagulant properties

182
Q

what is the main contraindication to taking acetaminophen

A

people who have pre-existing liver disease (or are alcohol abusers)

acetaminophen is filtered through the liver and can be especially toxic in these individuals

183
Q

contents of the upper GI tract

A

mouth
esophagus
stomach
duodenum

184
Q

contents of lower GI tract

A

small intestine
large intestine

185
Q

what is the small intestine’s job

A

digestion and absorption of nutrients

186
Q

what is the large intestine’s job

A

absorbs water and electrolytes
stores waste products of digestion until elimination

187
Q

enteric nervous system

A

the “second brain” in the gut

188
Q

the gut immune system has ____% to ___% of the body’s immune cells

A

70% to 80%

189
Q

what are the 3 most common GI problems in older adults

A

constipation
incontinence
diverticular disease

190
Q

hiatal hernia

A

esophageal hiatus of the diaphragm becomes enlarged which causes the stomach to poke through into the thoracic cavity

(basically stomach squeezes into thoracic cavity)

191
Q

are sliding hernias or rolling hernias more common

A

sliding hernias

192
Q

____% of people over 60 have hiatal hernias

A

0.6

193
Q

what is the main symptom of having a hiatal hernia

A

Reflux –> causes heart burn

194
Q

what structure is most involved in heart burn

A

incompetence of the lower esophageal sphincter (LES)

195
Q

valsalva maneuver

A

breath technique that increases intraabdominal pressure

(think about bracing abs when lifting)

196
Q

post-prandial heartburn

A

heart burn shortly after eating (typically 30-60 mins)

197
Q

what is GERD

A

backflow of gastric contents into the esophagus (reflux) typically due to the esophageal sphincter being open

198
Q

foods that increase GERD incidence

A
199
Q

____% to ___% of adults have GERD

A

10% to 20%

200
Q

what are the 2 main causes of GERD

A
  1. decreased pressure of the lower esophageal sphincter
  2. gastric contents near junction (typically from increased intraabdominal pressure)
201
Q

3 barriers in healthy people that prevent GERD

A
  1. anatomic barriers in tact
  2. mechanisms that clear stomach acid from esophagus
  3. maintaining stomach acidity & volume
202
Q

3 extra-esophageal manifestations of GERD

A

asthma
cough
laryngitis

203
Q

what are the 2 recommended sleeping positions for patients with GERD

A

supine
left side-lying

204
Q

what is peptic ulcer disease

A

a break in the lining of the stomach or duodenum of 5mm or more

205
Q

what are the 2 most common ways of developing peptic ulcer disease

A
  1. NSAID medications
  2. H. pylori bacterial infection
206
Q

what are the main symptoms of a peptic ulcer

A

epigastric pain
burning, gnawing, cramping near xiphoid or radiating to the back

207
Q

4 main complications of peptic ulcers

A
  1. bleeding
  2. perforation
  3. penetration
  4. gastric outlet obstruction
208
Q

Crohn disease

A

chronic inflammatory disorder that can affect any segment of the intestinal tract (most commonly ileum and/or colon)

209
Q

ulcerative colitis

A

chronic inflammatory disorder of the mucosa of the colon and rectum

210
Q

age at onset of crohn disease vs ulcerative colitis

A

crohn:10-30 years
ulc: 10-40 years

211
Q

family history of crohn disease vs ulcerative colitis

A

20-25% (c)
20% (u)

212
Q

granulomas, thickened bowel wall, fissures, and narrowed lumen are common in _______ (crohn or ulcerative)

A

crohn disease

213
Q

inflammation of just the mucosal layer is involved is most common in _______ (crohn or ulcerative)

A

ulcerative

214
Q

location of lesions mostly on rectum and left colon are common in _______ (crohn or ulcerative)

A

ulcerative

215
Q

where does an abdominal mass form in crohn disease

A

right lower quadrant

216
Q

does growth retartation occur in crohn disease or ulcerative colitis

A

crohn disease

217
Q

does crohn disease or ulcerative colitis typically have bloody stools

A

ulcerative colitis

218
Q

does crohn disease or ulcerative colitis commonly have a cancer association

A

ulcerative colitis

219
Q

diverticulosis

A

the presence of out pouching in the wall of the colon or small intestine

220
Q

diverticulitis

A

inflammation/infection of the diverticula

221
Q

diverticular disease is asymptomatic in ___% of affected people

A

0.8

222
Q

in complicated diverticular disease, what develops with the bladder

A

fistula

223
Q

what exercises should be avoided in patients with diverticular disease

A

increased intraabdominal pressure

224
Q

risk factors of diverticular disease

A

constipation
physical inactivity
eating red meat
obesity
smoking

225
Q

pneumaturia

A

air in the urine

226
Q

fecaluria

A

urine in the stool

227
Q

what referred pain can be present in diverticular disease

A

back pain
referred hip/thigh pain

228
Q

what age and what gender is most susceptible to appendicitis

A

15-19
males

229
Q

1/3 appendicitis cases are caused by

A

an obstruction that prevents normal drainage

230
Q

what structure of the appendix is primarily obstructed

A

lumen

231
Q

where will the pain be for appendicitis

A

lower right quadrant with tenderness

232
Q

40-50% of appendicitis cases are atypical because

A

the position of the tip of the appendix

233
Q

symptoms of appendicitis

A

abdominal pain
nausea/vomiting
low-grade fever

Referred pain:
thigh
groin
pelvic
hip

234
Q

rectal fissure

A

ulceration/tear of the lining in the anal canal

235
Q

what part of the anal canal is typically torn in a rectal fissure

A

posterior wall

236
Q

how do hemorrhoids typically develop

A

through anything that increases intraabdominal pressure

237
Q

5 system functions of the liver

A

digestive
endocrine
excretory
hematologic
immune

238
Q

where is albumin produced

A

Liver

239
Q

the liver converts and excretes…

A

bilirubin

240
Q

what makes the pancreas an exocrine gland?

A

digestion!
it releases digestive enzymes and pancreatic juices to help the GI system

241
Q

what makes the pancreas an endocrine gland?

A

glucagon and insulin secretion for metabolism

242
Q

what is the function of the gallbladder

A

reservoir for bile
releases bile in duodenum in response to food

243
Q

what does bile do

A

alkalinizes the intestinal contents and plays arole in emulsification, absorption, and digestion of fat

244
Q

dark urine and light stools occur in association with…

A

jaundice

245
Q

3 indications of hepatic issues

A

skin changes
spider angiomas
palmar erythema (warm palms)

246
Q

jaundice can be diagnosed when _________ levels increase

A

serum bilirubin

247
Q

why is stool normally brown?

A

bile and bilirubin

248
Q

what does light-colored stool and tea/cola colored urine indicate

A

bilirubin goes to urinary system rather than digestive system

249
Q

hepatic encephalopathy (or portosystemic encephalopathy)

A

reversible neuro-psychological symptoms caused by liver failure and metabolic buildup of toxins

250
Q

asterixis

A

inability to maintain wrist extension with forward flexion of the upper extremity

251
Q

musculoskeletal symptoms with liver disease

A

thoracic pain between scaps, right shoulder, right upper traps, right interscap, right subscap

252
Q

hepatic osteodystrophy

A

abnormal development of bone associated with liver malfunction

253
Q

due to skin changes in liver disease, individuals are more susceptible to ________

A

pressure ulcers

254
Q

coagulopathy

A

easy bruising and bleeding under the skin or into joints in response to the slightest taumas

255
Q

liver __(increases/decreases)__ size, weight, and blood flow with age

A

decreases

256
Q

lipophilic

A

strong affinity for lipids

257
Q

why does the decrease of albumin production impact how drug dosages are given

A

drugs typically bind to albumin

258
Q

what is the livers role in the immune system response

A

it produces proteins associated with acute inflammatory reactions

259
Q

5 severe complications that result from liver damage/nonfunctioning

A
  1. jaundice
  2. cirrhosis
  3. portal hypertension
  4. hepatic encephalopathy
  5. ascites
260
Q

characteristics of jaundice (icterus)

A

yellow discoloration of the skin/eyes
urine turns dark
stool turns light

261
Q

4 common causes of jaundice

A
  1. increase bilirubin production
  2. decreased uptake in bilirubin metabolism
  3. hepatocyte dysfunction
  4. impaired bile flow
262
Q

cirrhosis

A

fibrosis and nodular regeneration of the liver from chronic inflammation

263
Q

jaundice of newborns is caused by

A

a decreased uptake in bilirubin metabolism

264
Q

portal hypertension

A

higher portal vein pressure (entry) than inferior vena cava pressure (exit)

265
Q

what usually causes portal hypertension

A

cirrhosis

266
Q

Lab findings in cirrhosis

A

decreased albumin
- increased prothrombin time (longer to form blood clots)
- anemia
- increased alanine aminotransferase, lactate dehydrogenase

267
Q

clinical presentations of cirrhosis

A

Hepatomegaly
Spider angiomata
Splenomegaly
GI bleeding
Edema
Jaundice
Portal hypertension
Ascites

268
Q

decreased plasma proteins results in what 2 symptoms

A

ascites and edema

269
Q

what happens to the body when metabolism of proteins, carbs, and fats occurs

A

the body becomes hypoglycemic

270
Q

3 direct symptoms of liver inflammation

A

pain, fever, GI symptoms

271
Q

Ascites

A

abnormal accumulation of fluid within the peritoneal cavity

272
Q

what is the most common cause of ascites

A

liver cirrhosis (85%)

273
Q

spontaneous bacterial peritonitis

A

infection of ascitic fluid in the setting of portal hypertension

274
Q

an increase of urobilinogen is an indication of

A

liver necrosis

275
Q

a DECREASE in bilirubin metabolism, bile in GI tract, vitamin K absorption is an indication of

A

liver necrosis

276
Q

what does a decreased hormone metabolism result in and what are the symptoms

A

increased androgens and estrogens in the body

spider angiomas
palmar erythema
loss of body hair

277
Q

what is hepatitis

A

acute or chronic inflammation of the liver

278
Q

what can cause hepatitis

A

virus (main)
chemical/drug/alcohol abuse

279
Q

how long must a person have hepatitis for it to be considered CHRONIC

A

6 months

280
Q

what liver disease can chronic hepatitis lead to

A

cirrhosis

281
Q

what is the most common cause of acute liver failure

A

acetaminophen hepatotoxicity (50% of cases)

282
Q

fulminant hepatic failure

A

acute liver failure that is rare but can be fatal

283
Q

t/f: viral hepatitis can be easily spread even if symptoms are not present

A

t

284
Q

how is hepatitis A transmitted

A

fecal-oral route
(consuming contaminated water/food)

285
Q

what two types of viral hepatitis are transmitted through the fecal-oral route

A

Hepatitis A and E

286
Q

hepatitis A results ONLY this type of infection

A

acute infection

287
Q

____ occurs in 90% of heavy drinkers

A

alcoholic steatosis (fatty liver)

288
Q

how is hepatitis B transmitted

A

sexually transmitted disease

(percutaneous or mucosal contact)

289
Q

how long can HBV survive on environmental surfaces

A

1 week

290
Q

how is hepatitis C developed

A

injection drug use

291
Q

what form of hepatitis is uncommon in the US

A

hepatitis D

292
Q

how is hepatitis D transmitted

A

it is a coinfection or superinfection of hepatitis B

(it needs hep b to replicate)

293
Q

what causes oxidative stress to the hepatocytes in the liver

A

metabolizing alcohol

294
Q

how does the liver respond to inflammation and injury

A

by forming scars (fibroids)

295
Q

nonalcoholic fatty liver disease (NAFLD) causes

A

related to diabetes and insulin resistance

genetic, environmental, and inflammatory factors

296
Q

what quadrant is the pancreas located

A

left upper quadrant (near stomach)

297
Q

what is the pancreas’s dual function

A

secrete insulin/glucagon
acts as endocrine gland

298
Q

2/3rds of acute pancreatitis involve what

A

gallstones and chronic alcohol consumption

299
Q

what type of pancreatitis makes up 80% of cases

A

interstitial pancreatitis

300
Q

what type of pancreatitis makes up 20% of cases

A

necrotizing pancreatitis

301
Q

is necrotizing pancreatitis or interstitial pancreatitis more severe

A

necrotizing pancreatitis

302
Q

moderately severe acute pancreatitis is related to

A

the gallbladder

303
Q

chronic pancreatitis

A

the development of irreversible changes in the pancreas secondary to chronic inflammation

304
Q

what are the 3 risk factors of chronic pancreatitis

A

chronic alcohol consumption
smoking
genetic predisposition

305
Q

the pancreas is able to work until more than __% of pancreatic function is lost

A

0.9

306
Q

what is the 3rd leading cause of cancer mortality in the US

A

pancreatic cancer

307
Q

what cancer has the lowest 5-year survival rate after diagnosis

A

pancreatic cancer

308
Q

95% of pancreatic cancers are _____.
Where is it located in the pancreas?

A

adenocarcinomas
head of pancreas

309
Q

what disease can increase the risk of developing pancreatic cancer

A

type II diabetes

(glucose tolerance)

310
Q

what are the 3 main clinical manifestations of pancreatic cancer

A

abdominal pain
weight loss
jaundice

311
Q

t/f: tumors in the head of the pancreas are 2x as likely to metastasize to peritoneum than in the body or tail

A

false

the body/tail tumors are 2x more likely to metastasize

312
Q

chole-

A

pertaining to bile

313
Q

cholang-

A

pertaining to bile ducts

314
Q

cholangiography

A

radiographic study of bile ducts

315
Q

cholangitis

A

inflammation of bile duct

316
Q

cholecyst-

A

pertaining to gallbladder

317
Q

cholecystectomy

A

removal of gallbladder

318
Q

cholecystitis

A

inflammation of gallbladder

319
Q

cholecystostomy

A

incision and drainage of gallbladder

320
Q

choledocho-

A

pertaining to common bile duct

321
Q

choledocholithiasis

A

stones in common bile duct

322
Q

choledochostomy

A

exploration of common bile duct

323
Q

cholelith-

A

gallstones

324
Q

cholelithiasis

A

presence of gallstones

325
Q

cholescintigraphy

A

radionuclide imaging of biliary system

326
Q

cholestasis

A

stoppage or suppression of bile flow

327
Q

lith-

A

stone

328
Q

what are gallstones made of

A

75% cholesterol
25% bilirubin salts (pigment stones)

329
Q

cholelithiasis happens more in men or women

A

women

330
Q

what does it mean to be litho-genic

A

to be more prone to stone formation

331
Q

what causes cholelithiasis

A

changes in composition of bile salts, bilirubin, and cholesterol due to supersaturation

332
Q

2 main complications of cholelithiasis

A
  1. cholecystitis (inflammation of gallbladder)
  2. cholangitis (inflammation of bile duct)
333
Q

charcot triad

A

pain
fever
jaundice

334
Q

peynolds pentad

A

pain
fever
jaundice
hypotension
mental confusion

335
Q

___ may be the only presenting sign of acute cholangitis in the elderly

A

hypotension

336
Q

acute cholangitis

A

obstruction and stasis of bile from choledocholithiasis (stones in common bile duct), biliary strictures, or malignancies

337
Q

how long does acute cholecystitis abdominal pain last for

A

greater than 6 hours

Internal Medicine Final (5 decks)

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