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Patho: Assigment 9 &10

Terms in this set (62)

GERD (gastroesophageal reflux disease)
+ Cause- Hiatal hernia,
+ S/s:
-Pyrosis (heartburn), chronic cough (acid in trachea), acid taste in the mouth (acid regurgitation)

+ Complication= Barrett's metaplasia (chronic reflux)

+ TX= decrease acid, stop smoking, avoid tight clothing-
Peptic Ulcer Disease (PUD)
- Cause= NSAIDs, H. pylori, alcohol, tabaco
S/S:
-gastric pain right pc eating
-duodenal pain 2-3 hrs pc eating, nocturnal pain

- TX= decrease acid, H. pylori
Liver cirrhosis
- Causes= Hepatitis B &C, alcohol, biliary disease
- S= Asterixis (flapping/tremor)

Complications=
-Hepatic encephalopathy [amino from protein breakdown pile in the blood]
-Portal HTN: causes backup of fluid to esophagus [esophageal varices and ascites, and splenomegaly]

- Labs=
[increase AST/ALT, bilirubin, prothrombin time] and decrease albumin
Pancreatitis
-Acute Cause: obstruction of bile ducts/ pan ducts, EOH binge cause inflammation
++S= Chronic: Wt. loss oily stool, hyperglycemia, pain
-Labs= increase AST + ALT
-TX:
-acute: "rest the gland", NPO and NG suctioning
- chronic: Insulin, enzyme replacement, stop EOH
Stage 1 of Acute Hepatitis
++ Prodromal when the pt has:
-flu-like, headache, malaise, low temp, and N/v

Labs= increase AST + ALT and increases bilirubin
Stage 2 of Acute Hepatitis
++ Icteric when pt turns:
-Jaundice, urine is dark and stools are light (bilirubin in urine not in the stool)

Labs: bilirubin and liver enzyme are higher than in the prodromal stage.
Stage 3 of Acute Hepatitis
++ Recovery shows:
-normal skin color, brown stools and light amber urine

Labs: decrease liver enzymes & bilirubin
Hepatitis types A and E
Transmitted by Fecal and oral route
. Virus from feces in ingested thru contaminated h2o/ poor hygiene
-Cause only Acute hepatitis
+++ All types of hepatitis can cause prodromal, icteric, and recovery stages
Hepatitis types B, C, D
Transmitted by blood [IV drugs, childbirth] and sex
---cause acute and chronic hepatitis.
-Enzyme is decreasing in Recovery stage of Acute Hepa but it remains elevated can lead to: Live cirrhosis and liver failure
Upper GI Bleeding
Bleeding in the esophagus, stomach, and duodenum
SS= vomiting coffee-ground/ bright red blod/hematemesis

-Causes:
* Ruptured esophageal varices from portal HTN,
* Peptic ulcer [erosion]
*Mallory-Weiss tear
Lower GI bleeding
Bleeding in the jejunum, ileum, or large intestine
SS:
-Hematochezia: bright red blood in stools
-Melena: Blk tarry stools from blood that contacts with enzyme
-Occult blood: hidden causes colon polyps, diverticulitis, Crohn's disease and ulcerative colitis.
Paralytic ileus assessment finding
is no bowel sound bc no peristalsis in the colon
IBS assessment
Abdominal pain :[3 days of the month for at least 3 of the last 6 months]
-Pain can occur with change in frequency of stool [constipation or diarrhea]
-Pain can improve with bowel movement
-Pain can occur with change of stool
IBS: DX and TX
Dx: The frequency and duration of abd pain

TX: Anti-anxiety drugs
IBD - Dx & Tx
DX: based on intestinal damage from inflammation

TX: Anti-inflammatory drug and immunomodulators [change immune response]
Crohn's disease
the inflammation extends thru all 3 layers of GI wall: Transmural inflammation.
Crohn's disease symptoms
-low RBC count, hgb, hct cause anemia
-occasional bloody diarrhea
-Elevated: sedimentation rate, C-reactive protein, WBC count, liver enzymes.
-Wt. loss and fatigue
-Fistula, decrease albumin, fever, lesions in esophagus [terminal ileum+ transverse colon], "cobblestone" appearance +lesion from mouth and anus,
Transmural inflammation, migrating joint pain, Redness in eyes, Red nodules of skin

Complications: Crypt abscess which rupture cause Peritonitis- Fistulas form creating tunnel b/w colon
Ulcer colitis
the inflammation extends thru all 2 layers of GI wall called mucosal and submucosal inflammation.
Ulcerative colitis symptoms
-low RBC, hgb, hct
-Elevated: sedimentation rate, C-reactive protein, WBC, and liver enzymes
-"friable/brittle" appearance and lesion in colon only. -Lesions: rectum, sigmoid, and descending colon
-Redness in eyes, -Normal albumin, -Frequent bloody diarrhea, -Migrating joint pain, Mucosal and Submucosal inflammation
-Fever, Psuedopolyp

Complication: Crypt abscess which cause Pseudopolyp may form
Goal of tx for IBD: Induce remission
- Anti-inflammatory drugs: aminosalicylates and corticosteroids.
-Immunomodulator drugs at higher doses: tumor necrosis factor inhibitors (TNF inhibitor)
IBD: Maintain Remission
- Immunomodulator drugs at lower doses
- Lifestyle changes: Stop smoking, diet [avoid dairy, fats, and fibers]
- Stress reduction
IBD prevention complications
-Antibiotic for infection and surgery necessary to lose the fistula or repair perforation
-Screening should begin 8yrs later pc dx or at age 40
Symptoms of benign prostatic hyperplasia
Enlarged prostate causes:
-Having to go to the bathroom often/frequency
-Having to go the bathroom right now /urgency
-hesitancy, post void dribbling/dribbling pc voiding
-Not being able to complete empty the bladder
-Not being able to start the steam of urine
-Small urine stream
-Cramping abd pain and bloody diarrhea.
-Low abd pain assoc. with bladder infection
Tertiary syphilis
Causing damage to blood vessels thru the body. Large bumps called gummas - soft gummy lesion that leads to degeneration of blood vessels in brain, liver, bones, and skin
- Loss of sensation and weakness in legs
- Argyll Robertson pupil [pupils constrict to focus on close object but not constrict with light]
-Aortic aneurysm
Early latent syphilis
-No symptom
-Occurs within 2 yrs of initial exposure
Late latent syphilis
- No symptom
- Occurs more than 2 yrs after initial exposure
Primary syphilis
Occur about 3 weeks pc initial exposure
-Painless sore/ Chancre appears on the penis/ cervix
-Lymph nodes in the inguinal area enlarge [inguinal lymphadenopathy]

Tx: Chancre heals w/wo tx in about 3-6 weeks
Secondary syphilis
Occurs about 9 weeks after the initial exposure
- Fever
- Generalized lymphadenpathy
- Skin rash appears all over the body (palms + soles)
- Large warts = condylomata appear on the penis or the vaginal wall
Congenital syphilis in early signs
Occurs when they baby contacts syphilis from the mother in utero
- Most babies have no signs early
-If have, Hepatosplenomegaly
- Pneumonia (syphilis in lungs)
- Rash all over the body (palms + soles)
Congenital syphilis in late signs
Occurs after the 1st yr of life
- Notched central incisors, deafness, and blindness
- Saddle nose deformity (depress nasal cartilage)
- Saber shin deformity (sharp edges of tibia)
Chlamydia
Can cause reactive arthritis & redness/conjunctivitis
leading to clouding of the eye called Trachoma
- Reiter's syndrome: "can't see, can't pee, can't climb a tree." this causes trachoma, urethritis, reactive arthritis
- Most common sexual transmitted disease
Gonorrhea and Chlamydia
Transmitted by sex (oral, anal, vaginal) and birth
- Infective arthritis
- Crushing of eye in newborn
- Creamy purulent drainage (pus) from penis or cervix
- Can get repeated infections- no immunologic memory
-Pelvic inflammatory disease (PID)
- Pneumonia in newborn
- Prostatitis
- Treated with antibiotics
-Trachoma
- Urethritis causing painful urination
Human papilloma virus (HPV)
Sexually transmitted and can cause : genital warts, cervical cancer, and head and neck cancers.
- HPV vaccines are only given to girls, boys and 11-18 yrs old
-Pap smear can detect irregular cells in the cervix
- Males can develop genital warts and head neck cancer
Rheumatoid arthritis
Autoimmune disease that causes systemic inflammation
- joints are affected due to synovitis and pannus formation (granulation tissue)
- In the fingers: proximal interphalangeal joint (PIP) affected, distal interphalangeal joint (DIP) spared
-
DX test: RF positive
increased neutrophils in synovial fluid
OA
Occurs due to overuse
- Cartilage destruction causes crepitus (grinding) in the joint.
- Osteophytes (bone enlargement) or bone spurs cause enlargement of the fingers joints.
- Bouchard nodes are enlargement of the proximal interphalangeal (PIP) joints
- Heberden nodes are enlargement of the distal interphalangeal (DIP) joints.
OA symptoms
-Pain in joints asymmetrically or in different joints on each side.
- The pain is worse at night after using the joint during the day.
- Joint cool to touch and crepitus/griding, enlarged DIP and PIP joint.
OA treatment
Weight loss
NSAIDs, acetaminophen, and steroid injection
RA symptoms
Symmetrical joints pain and swelling; early morning stiffness; malaise; and fatigue.
- Affected joints warm to touch and reddened, enlarged PIP joint
RA treatment
- DMARDs (disease modifying anti-rheumatic drugs)
- NSAIDS and oral steroids
Osteoporosis
-Bone mass by age 30: Diet, exercise, and Vitamin D
-Bone loss after 30 yr: Diet exercise and estrogen
++ Complications: Bone fractures, Bone pain, and Kyphosis/ hunchback
+++ Tx:
-Avoid corticosteroids
-Diet with Vit D & Ca supplement
-Drugs that decrease osteoclast activity
Acute HIV syndrome: Phase 1
SS:
"the worst flu ever" with symptoms such as headache, fever, sore throat, muscle pain, joint pain, rash, enlarged lymph nodes, and mouth sores.

++ Test:
-exposed to the virus less than 4 weeks ac, the HIV test- Negative
-the CD4 T cell count is low
-HIV viral load is high indicating an HIV infection.
Chronic HIV infection (phase 2)
-Low CD4 T
-Viral load (measure amt of HIV present in the blood)
-No physical symptoms
AIDS (phase 3)
Occurs when the body no longer has a functioning immune system
- CD4 T cell count less than 200 and/or an AIDS
- high viral load
-Positive HIV test
-Marked weight loss
HIV transmission routes
1. Blood in contact with mucous membranes (mouth, vagina, or rectum)
2. Breastfeeding an infant
3. Childbirth
4. IV drug use with needle sharing
5. needle stick injury exposures
6. Skin breaks due to chlamydia, syphilis, or herpes
7. Semen, vaginal fluid, or rectal fluid in contact with broken skin
HIV is not transmitted by
1. Hugging or shaking hand
2. Touching a toilet seat
3. Tears, saliva, or sweat in contact with broken skin
4. Sharing plates or utensils
5. Urine or feces in contact with mucous membranes (mouth, vagina, rectum)
HIV diagnosis
Dx is based on the blood test.
- A Positive HIV test means antibodies against HIV or HIV protein is in the blood
- The "window period" is when the HIV test is negative and the patient has HIV.
- A positive ELISA test and a negative Western Blot test means the patient Doesn't have HIV.
- A Positive ELISA test and Positive Western Blot test confirm the DX of HIV.
Anti-retroviral drugs for HIV treatment.
1. CCR5 antagonists: Prevent entry of HIV into CD4 T cells
2. Fusion inhibitors: Prevent entry of HIV into CD4 T cells
3. Use 2-3 drugs at a time: To avoid resistance to any one of them
4. Non-nucleoside reverse transcriptase inhibitors (NNRTI), Integrase inhibitors, Nucleoside reverse transcriptase inhibitors (NRTI), and Protease inhibitors are: Inhibit enzymes necessary for HIV replication
Properties of Cancer cells
1. Does not self destruct when mutations occur
2. Metastasizes to distant sites in the body
3. Invasive and grows very rapidly
4.No contact inhibition
Properties of Normal cells
1.Self destructs through apoptosis when mutations occur
2. Does not metastasize
3. Non-invasive
4. Stops growth through contact inhibition
Breast cancer risk factors
- early menarche- less than 12 yrs old
- birth control pills with estrogen
-having first child after 30 years old
-hormone replacement therapy after menopause
- late menopause- greater than 55 years old
- nulliparity
- not breastfeeding
Breast cancer symptoms
- dimpling of skin
-hard painless lump
- nipple retraction
-nipple discharge other than breast dry flaky skin
-red dry flaky skin
Breast screening guidelines
- annual mammograms ages 45-54 years
-option for annual mammograms ages 40-44 years
-option for every other year mammograms ages 55 years and older
Colon cancer risk factors
-age, polyps, inflammatory bowel disease (IBD: Crohn's disease or ulcerative colitis) for over 10 years, family hx, race, and MD2.
- Diet high in red meat or processed meat
-EOH and Diet low in Vit D
Colon cancer symptoms
- diarrhea, constipation, or thin stool for over one week
- bloody stool (black tarry or bright red)
- weakness and fatigue
Colon cancer screening
- fecal occult blood test (FOBT) annually over 45 years for average risk
-colonoscopy every 10 years
-sigmoidoscopy every 5 years
- virtual colonoscopy every 5 years
prostate cancer risk factors
age, race, family history, geography, and gene mutations (BRCA 1 and 2 and Lynch Syndrome).
Prostate cancer symptoms
-enlarged prostate and liver
-elevated PSA levels
- signs of urethral obstruction (frequency, urgency, and hesitancy)
- Bone pain
-Lower extremity edema
-Lung tumor
Prostate cancer screening
-prostate specific antigen (PSA) levels annually
-Digital rectal exam annual start at age 50 and annually starting at 45 years for high risk (blacks, family history)
-needle biopsy to confirm
Lung cancer risk factors
- smoking
-radon (radioactive gas that can be trapped in houses, especially basements)
- medical imaging (radiation from X-rays and CT scans)
Lung cancer ss
Fever,. weight loss, SOB
Type of lung cancer
1. Small cell carcinoma: -smoking causes cancer
2. Non-small cell carcinoma: -Adenocarcinoma Secretes mucin (lubricant the lung) and is not associated with smoking.
- Carcinoid tumors Releases hormones
-Squamous cell carcinoid has great link to smoking.
-Large cell carcinomas associated w/ smoking.
Cancer staging (TNM)
1. T1 N0 M0 means the tumor is less than the size of a quarter.
2. the lymph nodes have no cancer cells & no metastasis
3. T4 N3 M1 means the tumor is in multiple locations in the lungs
4. the lymph nodes have cancer cells in them on both sides of the chest and metastasis to one or many locations outside the chest
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