Inflamation of gastic mucos leading to atrophy.
Fundic (type A): Autoantibodies to parietal cells/intrinsic factor. Involves: body and fundus. Loss of parietal cells, decreased acid secretion, increased gastrin, perncious anemia. Pathologically- loss of rugal folds. Mucosal atrophy with loss of glans and parietal cells, chronic inflamation, intestinal metaplasia, and increased risk of gastric carcinoma
Antral (type B): MOST COMMON form. Cause: H. pylori (curved, gram-negative rods that produce urease). Risk of infection increases with age. asst with-chronic gastritis, duodenal and gastric peptic ulcers, gastric carcinoma. Micro- foci of acute inflammation, chronic inflammation with lymphoid follicles, and intestinal metaplasia.
Epidemiology: Chrohns disease- bimodal distribution with peaks at ages 10-30 and 50-70. Ulcerative Colitis: Peaks at ages 20-30
Most common site: Terminal ileium vs Rectum
Distribution: Mouth to anus vs rectum to colon
Spread: Skip vs Continuous
Gross features; Focal ulcers with intervening normal mucosa, linear fissure, cobblestone appearnce, thickened bowel wall, creeping fat. VS extensive ulceration and pseudopolys
Micro: Noncaseating granulomas vs crpy abscesses
Inflamattion: Transmural vs limited to mucosa and submucosa
Comolications: Strictus, string sign, obstruction, abscsses, fistuals, sinus tracts vs toxic megacolon
Genetic asst: none vs HLA B27
Extraintestingal manifestations: More common is UC: arthritis, sponylitis, primary schlerosing cholangitis, erythema nodosum pyoderma gangrenosum, uveitis
Cancer risk: 1-3% vs 5-25%
Preseht with: vloody diarrhea or stools with mucus, crampy lower abd pain, or fever
-Inflammation arrising from injury to the exocrine pancrease
Etiology gallstones, alcohol, hypercalcemia, drugs, shock, infections, trauma, and scorpion stings
Clinical features: Acute pancreatitis typically presents with stabbing epigastric abdominal pain radiating to back. Lab: increase amylase and ilpase. Complications: ARDS, DIC, hypcalcemia
Patho: focall hemorrage and liquefication necrosis accompanied by chalky, white-yellow fat necrosis of adjacent adipose tisue.
Chronic: Repeated bouts of pancratitis. Patho-grossly frim, white birotic. Extensive fibrosis and chronic inflamation.
Viral: MCC enterovirus. 100-1000 lymphocytes. NORMAL glucose, increased protiens, and slighlty elevated pressure.
Bacterial: Cause- Neonates: group B strep and E. xoli, Infants and children: H. influenze, Adolescents and young adults: N. meningitides, Elderl: S. pneumonia a L. monocytogenes
Patho: Opaq leptomeninges, neutrophilic infiltration
Clinical features: Headache, fever, nuchal rigidity,
Labs; Up to 90,000 neutrophils, DECREASED glucose, increased prtoetins, markedly elevatd pressure
Intracerebral. Most frequently due to HTN. Most frequntly invovle: basal gangia, cereblleum, pons, and centru semiovale. Present with severe ha, frequent naue/vomiting, and steady progression of symptoms
Epidural hemmorage: Virtually always traumatic, skull fracture. Tearing of MIDDLE MENINGEAL artery. Cerebral herniation. "talk and die syndrome"
Subdural hemorrage: Usually traumatic in older invididuals and caused by ruptur of BRIDGING VENS (cerebral convexitiestosagital sinus). Presents with headach, drowsiness, focal neurolgic defects, and sometimes dementia. Recurrent
Subarachnoid hemorrage: Most frequentsly caused by rupture of berry aneurysm. Sudden thunderclap HA, nuchal rigidity neurologic deficits on onse side, and stupor.
AR disorder with early onset in childhood leadng to degneration of nerve tissue in spinal cord. Espcially sensory neurons connected to cerebellum affecting muscle movement of arms and legs
Genetics: GAA repet in FRATAXIN gene on chromosome 9. Mitochonrial iron builds up leadint to free radical damage and mito dyfunction
Patho: Degeneration of doral root ganglia, clarke column, posterior column of spinal cord, CN VII, X, XII , Dentate nucleus and pukinje cells of cerebellum, Betz neurons of PMC.
Clinical; gait ataxia, dyarthria, hand clumsiness, loss of sense of position, impaired vibraotry sensation , and loss of tendon refelex.
Type: Most commonly squamous.
RF: Early age of first intercourse, multiple sex partners, multiple pregnancies, OC use, smoking, HPV (16, 18, 31,33) , andvhave viral oncogenes E6 binds p53. E7 binds Rb. Imunnosupressoin.
Precuror lesion: Commonly occurs in squamous to columnar transformation zone.
Clinically: asymptomatic, postcoital vaginal bleeding, malodoours dishcharge.
DX: Pap test to detect, colposcopy and biopsy to confirm
- Increases with age, androgens play impt role, NOT premalignant
Clinically: decrased caliber and force of stream, troulbe stoping and starting stream, postvoid dribbling, urinary retention, and incontinece, frequency, nocturia, and dysuria. PSA may be elevate but usually less than ten
Location: transitional zone
RX TURP, 5-alphareductase inhibit (finasteride) and selective alpha-1-blockers: terazoxin and prazosin
Patho: Enlarged prostatic hypertrophy causes an enlarged prostate in transition zones.
Cushing syndrome; increased levels of glucocorticoids (cortisol)
Conn syndrome: primary hyperaldosteronism. Adenom producin aldosterone. Increased soium, decreased potasium, decreased renin
Waterhouse-Friderichsen sydrome: Potentially fatal bilateral hemorrhagic infarction of adrenal glands asst with N. meningitids in children. DIC, acute respiratory distress syndrome, hypotension, shock, adrenal insufficiency. RX with ab and steroids.
Addisons disease: Destruction of adrenal cortex leads to deficiency of glucocorticoid, mineralcoricoids and androgens. MCC autoimmune adrenalitis. Gradual onset of weakness, skin hyperpigmentation, hypotension, hypoglycemia, porr response to sress, loss of libido RX: steroids
I: AD: fractrues, blue sclera, hearing loss, little progression after puberty
II: AR: Stilbown infant or death after birth. Crumpled bones
III: AD or AR. Progressive, multiple fracures, sever skeletal deformity. Dentnogenesis imperfecta, hearing loss. Blue to white sclera
IV: AD, variable severity, fractures, skeletal deformity, NORMAL sclera. Sometimes dentinogenesis imperfeca
Systemic, chronic, inflammatory disease characterized by progressive arthris, production of RF, and exta-articular manifestions.
Genetics predisposition: HLA-DR4 and DR1. Autoimmune reaction triggered by infection is susceptiple ind
Clinicl: hand, wrist, knee, and ankle most commony involved. Symetric. Morning stiffnes that IMPROVES WITH ACTIVITY
Pathoogy: Diffuse proliferative synovittis, pannus formation. Radial deviation of wrist and ulnar divation. Swan neck deformities: Hyperextinsin of IP flexion of DIP. Baker systs may be present
Lab: Increaed ESR, hypergmmaglobulinemea, RF (IgM autoantibody againd Fc IgG) positive 80%
Extra-articular manifestation fever, malaise, fatigue, nectoizing vascuitis.
- Rheumatoid nodules- subcutaneous skin noduls on extensor surfaces composed of centra fibrinoid necrosis.
Sydromes: Sjogren, Felty: RA plus splenomegally and neutropenia. Caplan: RA plus pneumonoconiosis
Gs protins- B1,B2, D1, glucagon, H2, prostacyclin, serotonin
Gi: M2,, a2, d2, opiod
Gq: Ach (M1 and M3), Ne (a1), angiotensin II, vasopressin
NO: drugs: niroglycerin, bethaechol. Endogenous compounds- bradykinin and histamine.
MOA: Interact with cytoplasmic membrane-binding prtoeins (PBPs) to inhibit traspeptidation involved in cross-linking , the final steps in cell wall synthesis
Mechanisms of resistance: Pencicillinases (beta-lactamases): reak lactam ring structure. Structural changes in PBP (MRSA)m Change in porin structure (psedomonas)
Narrow spectum, beta-lactamase sensitive: penicillin G and V- strep, pneumocccci, meningococci, Trep pallidum
Merry narrow specturm, beta-lactamse resistint: nafcillin methicillin, oxacillin- staphlycoccie (Not MRSA)
Anti pseudomonal, betal lactamase sensitive: Ticarcillin, piperacillin, azlocilin
Use with: Clavulanic acid, sulbactam (beta lactamase inhibitors) to incrae activity. Synergy with aminogolycosies
Pharmokinetics: Tubular secretion blocked by probenecid
SE: Hypersensitivty, Methicillin (interstitial nephrites), GI distress (ampicillin), Jarish-Herxhemier reaction in treatment of syphilis
MOA: Acts on 30S unti to block the attatment of aminoacty tRNA to acceptor site (-static) Activity and clinical use:
-"Broa-spectrum: Good activity in chlamydia and mycoplasma, H. pylori (GI ulcers), Ricettsia, Borreia burgdorferi, Brucella, Vibrio
Drugs: Doxycycline- Prostatitis
Minocycline: In saliva and tears at high concenration and used in the meningococca carier states
Demeclocycline: USED in SIADH. Blocks ADH receptor function in collecting ducts
Pharmokinetics: Chelators: tetracyclines bind divalent cations (Ca, Mg, FE) which decreased their absorption
Side effects: Tooth enamel dysplasia and possible decrease bone growth in children, phototoxicity, GI disrtess, vestibular dysfunction (minocycline), have caused liver dyfunction during pregnancy at very high doses (contraindicated
Quinolones: Drugs- ciprofloxacin, levoflaxacin, other "floxacins"
MOA: Bactericidal and interfere with DNA synthesis. Inhgibe topoisomerase II (DNA gyrase), and topoisomerase IV (responsible for separation of replicated DNA during cell divisions
Uses: UTI, PID, skin, soft tissue, and bone infections by gram negative organms. Diahrea to Shigell, Salmonella, E.coli, Camplybacter. Crg-resistant pneumococci (levofloxacin)
Pharm: Iron, calcium limit their absorption.
Side effects: TENDONITES, TENDON rupture, phototixity, rashes, CNS affect,
Contraindicated in preganancy and in children (INHIBITION OF CHONDROGENESIS)