Week 7 Flashcards
CM of Ulcerative Colitis
Bleeding Diarrhea Loss of fluid and electrolytes Abdominal pain Fever Weight loss Anemia Tachycardia Dehydration Protein loss Malnutrition.
Diagnostic Tests for Ulcerative Colitis
CBC, serum electrolytes, serum protein, double-contrast barium enema, small bowel series, transabdominal ultrasound, CT, MRI, colonoscopy, sigmoidoscopy, patient history.
Interintestinal Complications of Ulcerative Colitis
Hemorrhage (result of inflammation) Perforation Toxic Megacolon Colonic Dilation Increased risk for GI cancers
Extraintestinal complications of Ulcerative colitis
Joint, skin, mouth, eye disturbances, anemia, leukocytosis, thrombocytosis, skin lesions, uveitis.
What is ulcerative colitis?
Inflammatory condition of the bowel. Begins at the rectum and works its way up GI system.
What layers of the intestine does ulcerative colitis involve?
Mucosa and submucosa.
Where do abscesses develop in ulcerative colitis?
Can develop in the intestinal glands. Abscesses can break and leave ulcerations.
What can inflamed mucosa form as a result of ulcerative colitis?
Psuedopolyps in bowel hymen.
What are treatment options for Ulcerative colitis?
Nutritional support Antimicrobial therapy Corticosteroids Antidiarrheal agents Sulphasazaline Total proctocolectomy with a permanent ileostomy. Total proctocolectomy with ileoanal reservoir. Low residue diet
What ages are people most at risk for ulcerative colitis?
15-25 yrs and then again from 50-70 years.
What is Crohn’s disease?
Caused by inflammation in GI system. Happens all over. Systematic autoimmune disorder.
What parts of the GI system are most affected by Crohn’s disease?
Terminal ileum and colon.
What organs are uncommon to be affected by Crohn’s disease?
Esophagus, stomach, and duodenum.
What are skip lesions in Crohn’s disease?
Parts of the bowel are infected, with healthy parts in between.
What layers of the bowel does Crohn’s disease affect?
All layers.
What percent of patients are granulonmas present in patients with Crohn’s disease?
50%
What are the clinical manifestations of Crohn’s disease?
Diarrhea Fatigue Weight loss Abdominal Pain Abdominal Distention Finger clubbing and arthritis.
What are some diagnostic tests for Crohn’s disease?
History, CBC, ESR, serum chemistries, stool occult, radiological studies, sigmoidoscopy, colonoscopy.
What are some treatments for Crohn’s disease?
High calorie, high vitamin, high protein, low residue, dairy-free diet.
Antimicrobial agents, corticosteroid drugs, Immuno-suppressants, element diet, rest, surgery.
What are some risk factors of Celiac disease?
Genetic predisposition, gluten ingestion, immune-mediated response.
What is Celiac disease?
An autoimmune disease characterized by damage to the small intestinal mucosa. Tissue damage is a result of chronic inflammation.
What is the gene associated with Crohn’s disease?
NOD2.
What are some complications of Crohn’s disease?
Narrowing of lumen may cause strictures and obstruction. Fistulas Perforation Arthritis Liver disease Ankylosing spondylitis Pyoderma gangrenosum Erythema Nodosum Uveitis Renal disorders Nutritional abnormalities Deficiency in fat-soluble vitamins.
What peptide is found in gluten that causes problems in celiac patients?
Prolamins. They bind to human leukocyte antigens and activate an inflammatory response.
Where is the damage most severe in celiac patients?
Duodenum decreases distally.
What are the clinical manifestations of celiac disease?
Smelly diarrhea Flatulence Abdo distention Malnutrition Rash may be present. Anemia Calcium and Vit D deficiencies may cause osteoporosis and weak bones.
What are some atypical symptoms of Celiac disease?
Decreased bone density, osteoporosis, dental enamel hypoplasia, iron and folate deficiencies, peripheral neuropathy, reproductive problems.
How is Celiac diagnosed?
Biopsy of small intestine, patient history and symptoms. Histological evidence disappears when gluten-free diet is followed. IGA and tTG lab testing also used.
Which diseases are associated with Celiac?
Other autoimmune diseases: thyroid disease, T1D, RA.
What are potential complications of Celiac?
Risk for non-hodgkins lymphoma, chronic inflammation, hyperplasia, GI cancers.
What is the treatment for Celiac Disease?
Gluten free diet, corticosteroids.
What is asthma?
Chronic inflammatory disorder of airways.
What does asthma cause?
Causes airway hyper-responsiveness, leading to wheezing, breathlessness, cough and chest tightness.
What are environmental triggers of asthma?
Cold air, exercise, air pollutants, emotional stress.
What are some allergy triggers of asthma?
Dust mites, cockroaches, animals, mold, pollen.
What are some respiratory triggers of asthma?
Increased inflammation due to hyperresponsiveness of tracheobronchial system.
What are some drug/food additives that trigger asthma?
Beta-adrenergic blockers, NSAIDS, ASA, sensitivity to salicylates.
What is the patho for the early phase of asthma?
Characterized by bronchospasm. Peaks 30-60 min after trigger exposure, subsides between 30-90 min after exposure.
What are the CM in the early phase of asthma?
Increased mucous secretions, edema, increased amount of tenacious sputum.
What is the patho for the late phase of asthma?
Primarily inflammation, can be more severe. Peaks 5-12 hrs after trigger. May last several hours to days. Can lead to irreversible lung damage if not treated.
What is an effective treatment of late-stage asthma?
Corticosteroids.
What are the clinical manifestations of asthma?
Recurrent episodes of wheezing, breathlessness, cough and tight chest.
What time is the most common time for an asthma attack to occur?
0200 to 0500 hrs in the morning.
What are the inspiration to expiration ratios?
1:2, 1:3, 1:4.
What are some signs that the client is having difficulty with air movement during an asthma attack?
Client may be anxious, restless, sitting upright and slightlightly forward.
What are the symptoms of cough variant asthma?
cought is the only symptom, bronchospams not severe enough to cause obstruction.
What hormones are the mast cells releasing when aggravated by allergins?
Bradykinin, prostaglandins, luekotrinins,
What do goblet cells do?
Responsible for mucus production.
What are the signs of hypoxemia?
Increased anxiety and restlessness, increased pulse and BP, pulsus paradoxus, increased respiratory rate, use of accessory muscles, O2 stat less than 95%, cyanosis, poor tissue perfusion, difficulty speaking.
What are the diagnostic tests for Asthma?
Detailed history and physical exam, pulmonary function test, peak flow monitoring, chest x-ray (not diagnostic), ABGs, oximetry, allergy testing, blood levels of eosinophils, sputum culture and sensitivity.
What is the overall goal of asthma care?
Achieve asthma control with minimal pharmocotherapy.
What is the green zone?
Peak flow results, 80%-100%. Medications continued.
What is the yellow zone?
50%-79%. Indicates caution, something is triggering asthma.
What is the red zone?
Less than 60% of personal best. Indicates a serious problem. Action needed.
What is COPD?
Chronic Obstructive Pulmonary Disorder, a progressive respiratory disorder characterized by airflow obstruction, systematic manifestations, exacerbations of increasing frequency.
What is emphysema?
enlargement of the airspaces distal to terminal bronchioles. Radiologically defined.
What is chronic bronchitis?
Mucus gland hyperplasia and airway structure design, clinically defined.
What are the major symptoms of COPD?
Dyspnea with activity limitation. Mucus production and cough.
What are the risk factors for COPD?
Smoking, Pollution, Asbestos, alpha-1-antitrypsin deficiency (AAT) (autosomal recessive disorder causing destruction of lung tissue), aging.
What is the defining characteristic of COPD?
Chronic inflammation.
What happens to the body as a result of chronic inflammation in COPD?
Inflammation of the brionchioles and alveoli and pulmonary blood vessels cause a) airflow obstruction due to mucus, edema and bronchospasm.
b) airflow limitation due to loss of elastic recoil.
What does oxidative stress inactivate and stimulate?
Inactivates anti-proteases
Stimulates mucus secretion
What type of tissue does protease break down?
Connective tissue.
Where is protease found?
Neutrophils and macrophages.
What inhibits proteases?
Anti-proteases like AAT.
What factor increases proteases and decreases anti-proteases?
Smoking.
What happens when their is an imbalance of proteases and anti-proteases?
Alveolar walls are destroyed.
