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Patho 2- final exam study guide
Terms in this set (84)
Natriuresis & what do the heart and brain release & why?
Natural diuresis by the heart and the brain.
Heart releases ANP (atrial natriuretic peptide) and brain releases BNP.
Response to excess water in blood stream. Helps to regulate BP.
Organs damaged by HTN
5. peripheral arteries
Hypertensive heart disease is a compensatory response to:
A compensatory response to increased afterload (the force the heart muscle must pump against in order to eject blood).
Left ventricle hypertrophies.
What does long-term HTN lead to:
What causes atherosclerosis (plaque buildup in arterial walls)?
1- oxidizing free radicals
2- shearing force of high BP
3- high circulating glucose levels
4- elevated levels of LDL
Main purpose of foam cells (which start out as macrophages)
* Engulf & digest LDL which accumulate & create plaque
Also, can transmit cholesterol back to blood stream.
What causes an increased risk for stroke?
- Plaque that calcifies over time, fissures easily, and a piece breaks off.
- It travels to an arterial site where it can obstruct blood flow.
- This is an embolism that then can cause a stroke.
How long can ischemia last before it causes irreversible damage to the heart?
Left sided heart failure causes what?
Diminished perfusion of the kidneys which stimulates the secretion of renin from the nephron which initiates the cycling of RAAS.
What causes peripheral edema, where does it accumulate, and what are some complications ?
- Cause by a build-up of hydrostatic pressure within the capillary beds.
- Accumulates in the sacral region (if supine) and in lower legs (when in depended position).
- can lead to ulcers in sacral area
Edema in feet and lower legs also happens in RVF.
What is the serious side effect of a DVT?
Pulmonary embolism- clot can travel within the venous system and enter lungs where it becomes a PE
What is ventilation-perfusion mismatching and what is the most common cause?
Occurs when air cannot flow into an alveolus or blood flow around an alveolus is altered. Most common cause is a PE. The clot prevents blood flow to the alveolus and gas exchange can't take place.
What is TB?
An infection cause by bacteria- Mycobacterium tuberculosis. Usually found in lungs (also adrenal gland, vertebrae, lymph nodes) and can spread with thin the bloodstream & cause multi-system disease.
How is TB spread?
Spread when the bacterial is inhaled from another person's cough or sneeze and droplets pass down the airway, eventually settling in the bronchial tree. TB organism is aerobic & prefers area of the lung with high O2 levels (apex).
Lesion (called a tubercle which is a granulomatous accumulation of WBCs, bacilli, and fibrotic tissue) in TB. When calcified, called a Renke complex.
What precautions are necessary in TB?
Which cells are involved in the patho of asthma?
T helper lymphocytes.
- Th1 cells- stimulated by microbes and allergen and assist B cells transform into plasma cells that produce IgE.
- Th2 cells- attract mast cells, eosinophils, & basophils which promote inflammation.
IgE binds to mast cells & provokes their degranulation, which releases histamine
** The degranulation of mast cells releases histamine. Histamine contributes to bronchospasm & inflammation.
What is the primary cause of pulmonary edema?
An increase of hydrostatic pressure in the capillary bed of the lungs usually caused by
left ventricular heart failure
Weakened left ventricle can't eject all of blood within the chamber causing blood to accumulate in the left ventricle. As a result, hydrostatic pressure builds backwards into left atrium, pulmonary veins, and eventually pulmonary capillaries. High hydrostatic pressure within capillaries causes fluid form blood to diffuse into interstitial tissue.
What is the most common cause of acute kidney injury (AKI)?
Acute tubular necrosis (when ischemia & hypoxia damage renal tubules)
Risk factors of altered renal function (including acute tubular necrosis)
1. Long-term DM & HTN
2. Exposure to nephrotoxic agents (meds)
3. Strep infection
4. Major surgeries (which can reduce renal blood flow & lead to injury)
5. Acute MI or heart failure
What is acute glomerulonephritis & cause
A renal disorder in which an immunological mechanism triggers inflammation that damages the membranes god the glomerulus.
- Damage is caused by antibodies that are commonly activated by strep bacteria.
- Antibodies combine with antigen & deposit as immune complexes within the kidney that are normally eliminated in the circulation. In glomerulonephritis, the immune complexes accumulate & cause inflammation and membrane damage.
Primary cause of chronic renal failure (which usually progresses to ESRD)?
**DM & HTN.
Also, related to polycystic kidney disease & glomerulonephritis
Hernia of the urinary bladder into the vaginal canal.
polycystic ovary syndrome- cause & risk factors
- Leading cause of infertility.
- Autosomal dominant genetic disorder
- Involves a dysfunctional hypothalamic-pituitary-overy axis.
- Can be part of metabolic syndrome
- Obesity (38%)
- endometrial carcinoma (can result in a cancer)
S/S of ectopic pregnancy
3. Vaginal bleeding
1. Lower abdominal pain
2. Bleeding into abdomen
3. Referred shoulder pain from bleeding in abdomen
Treatment for ectopic pregnancy
Laparoscopic surgery followed by methotrexate to eliminate residual pregnancy tissue.
Causes & risk factors of ectopic pregnancy
- Slow oven transport (from decreased Fallopian tube mobility or distorted structure)
- Past infection & scaring in fallopian tube
- Pelvic inflammatory disease
- Tubal ligation
- Previous ectopic pregnancy
- infertility (& use of fertility drugs)
- Progestin-only oral contraceptive)
- Morning after pill
Undescended testicles, testicles remain within abdomen
- affects 2-9% of all newborns
- 1-3% of boys at 3 months
She said seen in infants and young adults
More common in premature boys
s/s of benign prostatic hyperplasia
1. frequent urination
4. straining to urinate
5. weak stream
6. retention of urine in bladder
Chlamydia is caused by which bacteria (which means can be treated & cured with meds)?
Gonorrhea is caused by which bacteria
Syphilis is caused by which bacteria
Which STD is the silent STD?
Also most common
Clinical presentation of syphilis
Primary stage *highly infectious
- skin lesions called chancre (2-10 weeks after sexual contact, often unnoticed b/c painless)
- As heals, enters T. palladium bacteria enters blood stream enlarged inguinal lymph nodes
Secondary stage *highly infectious
- rash in body, palms, soles of feet
- 1/3 heal spontaneously, 1/3 remain asymptomatic, 1/3 progress
- granulomas (called gummas that consist of macrophages, plasma cells, & T-cells) form in organs
- neurological & cardiovascular complications
Granulomas made of macrophages, plasma cells, & T-cells during latent stage of syphilis
Causes of dysphasia & major risk
1. Structural abnormalities such as diverticula, stricture, webs, & rings cause mechanical problems of swallowing. Food becomes obstructed.
2. Damage to cranial nerves IX, X, or XII that become dysfunctional b/c of stroke, degenerative neurological diseases, and trauma
Aspiration and aspiration pneumonia- esophagus lies posterior to trachea, creating this risk. Food or fluid enters trachea instead and lodge in sterile environment of resp system leading to aspiration pneumonia.
Greatest risk for aspiration pneumonia:
- hx of stroke
- trauma to upper spinal cord
- brain injury
- someone who receives internal feedings
Symptoms: drooling, frequent coughing while eating, pain when eating
Clinical presentation of upper GI bleed
1. hematemesis (bloody vomit, bright red streaks or coffee grinds) Bright red is current
2. melena (bloody stool that looks black)
3. occult blood (blood not visible in feces)
If slow GI bleed:
-Fatigue & lethargy. May or may not have pain.
- rapid onset of anxiety, dizziness, weakness, SOB, change in mental status, tachycardia, skin pale and clammy
Clinical presentation of PUD
- duodenal ulcers in epigastric
- abdominal pain (intense, burning, gnawing slightly relieved by food & strong enough to wake person up)
- episodes occur 2-3 hours after eating
S/S of peritonitis (3 of 4)
1. Abdominal pain (with movement so patient wants to be still)
2. Abdominal rigidity (like board) aka involuntary guarding
3. Rebound tenderness
4. electrolyte imbalances due to fluid shift (preset with severe hypotension or shock)- tachycardia, clammy skin, decreased or absent bowel sounds, oliguria
5. fever if infection
1- only affects large intestine (rectum continually upward into colon)
2- only affects upper layers of intestinal wall (mucosa & submucosa)
3- pseudopolyps seen on exam
4- no fistula/anal fissure
5- predisposes to colon cancer
How is hep A transmitted
Contaminated food or water or contracted from person to person by unsanitary conditions
Etiology of NAFLD
Metabolic syndrome related to:
- insulin resistance
- Other: DM, protein malnutrition, HTN, sleep apnea, various drugs
______________________ builds within the vascular beds of the GI system producing ____________, ______________, ______________ and eventually _______________.
Increased venous pressure builds within the vascular beds of the GI system producing:
and eventually ascites.
cerebral arteriosclerosis related to ischemic stroke
Plaque in the cerebral artery can cause:
1- the blood vessel diameter to decrease (lessens blood flow to tissue)
2- thrombi when plaque breaks off and lodges in an arteriole and obstructs blood flow.
Causes ischemia & infarction of brain tissue
Predisposing factors of ischemic stroke (obstruction blocks blood flow to brain)
- Arterial fibrillation
- Carotid stenosis
- Cerebral arteriosclerosis
The perimeter around the core ischemic area. Rapid repercussion of this area is critical b/c, if left untreated, the penumbra will succumb to ischemia and infarction.
Transient Ischemic Attack (TIA) & causes
Minor stroke; where neurological function is regained quickly (several minutes to hours)
- most commonly resolve within an hour
- embolus. In TIAs, the body's fibrinolytic system dissolves the occlusion and the focal deficits disappear in fewer than 24 hours
Risk factors for stroke
Think ABC's! Look at risk fact, can address HTN which is directly related to circulatory system. Tie pieces together
- high BP
- high cholesterol
- heart disease
- previous strike or transient ischemic attack (TIA)
- sickle cell
- physical inactivity
- oral contraceptives- estrogen increases susceptibility to clotting
- age and gender- increases with age. Men more than women & men 65 & older
- race & ethnicity- AA, hispanics, native Americans
Absence seizures (petit mal)
- brief sudden laps of consciousness for 5-30 sec
> looks like staring into space
- more common in kids than adults
- Typical (briefly loses awareness of surroundings) & atypical (has muscle spasms with loss of awareness)
Tonic-clinic seizures (grand mal)
- commonly vocalizes loudly b/f the seizure and loses consciousness
- rhythmic jerking movements & stiffening of muscles that can last up to 5 min.
- One that lasts up to 30 min or a series of 3 is a medical emergency and called status epilepticus
What can patients experience before a seizure? How does it manifest?
1. perception of strange light
2. unpleasant smell
3. confusing thoughts or experiences
Parkinson's Disease is associated with....
Associated with progressive loss of dopamine-producing cells in the substantial migration within the basal ganglia of the midbrain.
What is ALS and what does it lead to
A progressive neurodegenerative disorder characterized by a loss of upper and lower motor neurons.
Eventually results in respiratory failure (or a pneumonia that can set in)
Symptoms: painless muscle weakness & atrophy
What is MS?
- chronic neurological disorder that affects the brain & spinal cord
- A demyelinating disorder that results in inflammation & damage to the myelin and other cells within the CNS.
- characterized by remissions and exacerbations
Guillain-Barre syndrome & clinical symptoms
- An acute peripheral neuropathy that leads to progressive limb weakness over the course of several days up to 4 weeks.
- post infectious disease
1. progressive, usually symmetric muscle weakness accompanied by absent or depresses deep tendon reflexes.
2. Paresthresias and numbness usually first symptoms
3. Motor and sensory, distal to proximal, starting in limbs and moving upwards
There are 4 mechanisms for TBI. One is...
- When skull stops abruptly (as in car accident). Brain continues to move forward, rotating within the skull and causes shearing of brain tissue against the skull's rough interior edges.
- Bounces of skull and moves in opposite direction of first impact and strikes skull on opposite side- referred to as COUP-CONTRECOUP injury. Whiplash.
- Stretching and shearing of neural axons, resulting in diffuse axonal injuries.
Brain death (may want to read p. 799)
Brain death is the reversible end of all brain activity.
Occurs: when ICP is not lowered and the brain tissue is compresses & forced downward in the skull. Brain tissue becomes herniated or displaced to another region of the brain.
Most common type: transtenrotial herniation (aka uncal herniation)- part of the temporal lobe (uncus) is forced through the tectorial notch (opening in the sheet of tissue b/t temporal lobe & cerebellum).
Brain tissue compression results in death to tissue. If herniation compresses vital centers of brainstem, death happens. Vital centers control: HR, RR, BP, and LOC
Cushing's triad and clinical manifestations
2. HTN (with wide pulse pressure)
3. erratic respiratory rate
....caused by rising intracranial pressure that affects the brain stem
Clinical manifestations of ICP (intracranial pressure)
Early signs: heading (caused by direct compression of brain tissue), vomiting (caused by compression of vomiting center in medulla), decreasing LOC (level of consciousness caused by compression of reticular activating system)
- altered response of pupil to light & altered size- caused by pressure on 3rd cranial nerve (oculomotor) causes by an uncal herniation
- If ICP continues to rise and there is significant pressure on brainstem, Cushing's Triad occurs
Occurs when SCI (spinal cord injury) is above T6 b/c sympathetic nerves are affected. SNS dysfunction prevents the tachycardia & peripheral vasoconstriction that should normally counteract hemorrhagic shock.
Therefore, imp to suspect hemorrhagic shock even when tachycardia is absent.
T6 or above causes: hypotension & bradycardia
C4 and above: respiration ability
PTDS can cause...
suicidal or homicidal actions
Clinical presentatomi of PTSD
3. hyperarousal & hyper vigilance
Can lead to socially inappropriate behavior and legal problems
Can be chronic and be associated with dysfunctions of :
- nervous system
- hypothalamus-pituitary-adrinal axis
- cardiovascular, metabolic, and immune systems
Facts about Major Depressive Disorder
- highest life-time prevalence of any psychiatric disorder 17%
- women twice as more than men b/c of hormones, childbirth, & psychosocial reasons
- mean onset 40 although found throughout lifespan (half dx b/t 20-50)
** suicide major complication
Diagnosis of Major Depressive Disorder
At least 5 of the following for min of 2 weeks:
1. sad mood most of day, nearly every day
2. decreased interest n pleasurable activities (anhedonia)
3. weight loss to gain
4. daily insomnia or hypersomnia
5. psychomotor retardation or agitation
6. fatigue/loss of energy
7. feelings of worthlessness
8. inappropriate guilt
9. diminished levels of concentration and decisiveness
10. recurrent suicidal thoughts & plan
Alzheimer's disease and changes
progressive, neurological degenerative disease of the brain characterized by significant changes to brain tissue.
- accumulation of neurofibrillary tangles
- senile plaques (aka beta-amyloid plaque)
- cerebrocortical atrophy
Dementia vs Delirium
Dementia- decline of reasoning, memory, judgment, and other cognitive functions
Delirium- transient, usually reversible, cause of cerebral dysfunction
dementia- gradual onset
delirium- sudden onset
delirium- fluctuating course
dementia- months to years in duration
delirium- days in duration
dementia- consciousness: alert
delirium- consciousness: altered level, impaired attention
dementia- not reversible
delirium- fully reversible with treatment
Alcohol withdrawal symptoms
- Shakes approximately 12-24 hours after last drink
- tremors cause by over excitation of CNS
After 24-72 hours, may have seizure
After 3-5 days may have delirium tremens (disorientation, fever, visual hallunacions)
medical emergency & must be hospitalized
Compartment syndrome occurs when ________________ pressure exceeds _________________ pressure in a _________________ anatomical space.
Tissue, perfusion, closed
Pressure greater than 30
What can occur in compartment syndrome?
paresthesias (pins & needles)
weak distal pulses/ or pulselessness
rhabdomyolysis (breakdown of skeletal muscle tissue)
nephron tubule dysfunction due to breakdown of products- renal failure & death
Patho of osteoarthritis. What causes inflammation?
Inflammation occurs as:
various inflammatory mediators
are released into joint and degrade cartilage.
Criteria Systemic inflammatory responce syndrome (SIRS) criteria
Must have 2 of any 4 signs:
- Tachycardia (HR greater than 90/min)
- Tachypnea (resp rate greater than 20/min)
- hyper or hypothermia (temp greater than 100.4 or lower than 96.8)
- leukocytosis (greater than 12,000) or leukopenia (less than 4,000) or greater than 10% immature forms
state of severe sepsis with persistent life-threatening hypotension that is refractory (unmanageable) to fluid replacement and vasopressors.
What causes septic shock?
1. Toxins and inflammatory mediators cause widespread arterial vasodilation
2. Capillary permeability is increased (makes sense since they are dilated) with plasma entering tissues.
3. Inflammatory mediators also activate coagulation pathway, which leads to micro thrombi. Initiation of coagulation cascade. And inhibits activation of protein C, naturally occurring anticoagulant. Can also leas to coagulopathy, inability to clot.
Initial stage of shock
Sudden drop in tissue perfusion.
- SNS (triggers tachycardia as compensatory measure) and RAAS system (increased blood volume & stimulates vasoconstriction) are triggered.
But these don't work and BP isn't normalized. Patient anxious, pale, extremities cold and clammy
Progressive stage of shock
All available blood is conserved for heart and brain.
Begins to show signs of MODS
Organs begin to fail
Lactic acid shock is a result of:
Anaeorobic metabolism b/c liver is unable to convert lactic acid back to sugar compounds.
shock resulting from blood or fluid loss
Example: hexmoorrhage, diarrhea (in kids), vomiting, ascites, burns
type of shock where SNS is disrupted by spinal cord injury
Tachycardia is expected compensatory response in shock. However bradycardia occurs in this shock b/c shut-in if SNS and unopposed influence of PSNS.
S/S of ARDS (acute respiratory distress syndrome)
SOB at rest, breathing fast (tachypnia), anxious. Despite how much oxygen given, still low saturation. May have fever or hypothermia.
Reasons for AKI (acute kidney injury)
In sepsis, shock, and MODS caused by hypotension, the kidney has to conserve water and maximally concentrate urine.
Consequences of increased intra-abdominal pressure:
1. compression fo inferior vena cava reduces cardiac output
2. Renal perfusion is reduced increasing likelihood of acute tubular necrosis
3. Barrier b/t bowel wall & bowel content breaks down. Diffusion of microbes and toxins into blood stream
leading to sepsis, shock, MODS
4. Decreased ventilation as increased pressure pushes up the diaphragm and compresses base of lungs.
5. Increased intrathoracic pressure is transmitted upward towards jugular veins. Increased intracranial pressure causing decreases LOC
Blood transfusions contain __________________ which binds with _________________.
Therefore, treatment with multiple blood transfusions requires calcium supplementation.
Citrate is used in transfusion as anticoagulant b/c binds with calcium which is necessary for clotting.
Transfusions of RBCs and crystalloids don't contain what?
Clotting factors. Therefore, coagulation factors must be administered.
Fresh, frozen plasma contains....
coagulation factors and should be part of DIC plan.
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