exams 2 study guide Flashcards
1
Q
wha is pernicious anemia
A
- Caused by a LACK of INTRINSIC FACTOR made by the gastric parietal cells which is required for vitamin B12 absorption
so basically the body cannot absorb vitamin b12 leading to =
- vitamin B12 deficiency
2
Q
when can pernicious anemia also occur
A
- after GI surgery (i.e., gastrectomy, gastric bypass, small bowel resection involving the ileum)
- In strict vegetarians since most of vitamin B12 come from meat
- Excessive alcohol or smoking
- More common in elderly than in younger patients*
3
Q
what are some typical anemia symptoms
A
- Neurologic manifestations due to nerve demyelination
- Loss of appetite, abdominal pain, beefy red tongue (atrophic glossitis), icterus, splenic enlargement
- Treatment
Parenteral or high oral doses of vitamin B12
Often unrecognized in older adults due to subtle, slow onset and presentation
4
Q
what is the Neurologic manifestations due to nerve demyelination of pernicious anemia
A
Weakness, paresthesias of feet and hands, ↓ vibratory and position senses, ataxia, muscle weakness, and impaired thought processes
5
Q
what are some treatment for pernicious anemia
A
- Parenteral or intranasal administration of Vit B12 is the treatment of choice
- Patients will die in 1-3 years without treatment
- Long-standing neuromuscular complications may not be reversible
- Increasing dietary cobalamin does not correct this anemia if intrinsic factor is lacking or if there is impaired absorption in the ileum
Dose: 1000 mg of cobalamin IM daily for 2 weeks and then weekly until the Hgb is normal, then monthly for life
6
Q
Common causes of Folic Acid Deficiency Anemia (absence of neurological problems)
A
- dietary deficiency (leafy greens, citrus fruits)
- Malabsorption syndromes ( celiac disease, chron’s disease, small bower resection)
- Increased requirement (i.e., pregnancy
- drugs
- alcohol abuse and anorexia
- loss during hemodialysis
7
Q
what is celiac disease
A
- genetic autoimmune disease
- people can’t eat gluten because it will damage their small intestine
- Gluten is a protein found in wheat, rye bread, and barley. It may also be in other products like vitamins and supplements, hair and skin products, toothpastes, and lip balm
- affects each person differently and can occur in digestive system or other parts of the body
8
Q
treatment of celiac disease
A
glutten free diet
9
Q
other characteristics of celiac disease
A
- One person might have diarrhea and abdominal pain, while another person may be irritable or depressed.
- Irritability is one of the most common symptoms in children.
- Some people have no symptoms.
10
Q
what is Folic Acid Deficiency
A
- Serum folate level is low but vit b12 is normal
11
Q
treatment of folic acid deficiency
A
We can treat them by replacement therapy or eat the food with larger amount of folic acid
- In malabsorption states or with chronic alcoholism, up to 5 mg per day may be required.
- During diagnostic studies, the gastric analysis is positive for hydrochloric acid.
11
Q
treatment of folic acid deficiency
A
We can treat them by replacement therapy or eat the food with larger amount of folic acid
- In malabsorption states or with chronic alcoholism, up to 5 mg per day may be required.
- During diagnostic studies, the gastric analysis is positive for hydrochloric acid.
12
Q
what are Iron Deficiency Anemia
A
- Most common type of anemia worldwide
- Nutritional iron deficiency
- Metabolic or functional deficiency
13
Q
Symptomatic hemoglobin level for iron deficiency anemia
A
Symptomatic @ Hgb 7-8 g/dl
14
Q
Progression of iron deficiency causes:
A
- Brittle, thin, coarsely ridged, spoon-shaped nails
- A red, sore, painful tongue
15
Q
treatment goal of iron deficiency anemia
A
Treat underlying disease that is causing reduced intake or absorption of iron
16
Q
how to replace iron in iron deficiency anemia
A
- Nutritional therapy
- Oral iron supplements if adequate nutrition
- Transfusion of packed RBCs
17
Q
what is normocytic anemia
A
Anemia resulting from blood loss may be caused by either acute or chronic problems
- It means you have normal-sized red blood cells, but you have a low number of them
18
Q
Acute blood loss occurs as a result of
A
Acute blood loss occurs as a result of sudden hemorrhage
19
Q
Sources of chronic blood loss are similar to?
A
those of iron-deficiency anemia
20
Q
how does the body respond when acute blood loss is gradual
A
- the body maintains its blood volume by slowly increasing the plasma volume, but then the number of RBCs is significantly DIMINISHED
21
Q
Causes of sudden hemorrhage/ acute blood loss
A
- Trauma
- Complications of surgery
- Conditions or diseases that disrupt vascular integrity
22
Q
conditions that disrupt vascular intergrity
A
- Hypovolemic shock
- Compensatory increased plasma volume with diminished O2 -carrying RBCs
- Hypovolemic shock is an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body
23
Q
Some causes of chronic blood loss:
A
Bleeding ulcer
Hemorrhoids
Menstrual and postmenopausal blood loss
24
Management of chronic blood loss involves
Identifying the source
Stopping the bleeding
Providing supplemental iron as needed
25
complications of blood transfusions
- Fluid overload
- Blood-borne infection
- Exposure to donor leukocytes
26
what is blood transfusion
Not linked into one baseline hemoglobin level but recommended for people with hematocrit level of < 30
- Benefits/risks weighed
27
blood transfusion reactions
- Incompatibility, Major - - Acute hemolytic transfusion reaction
- Febrile reaction
- Allergic reaction
- Hypocalcemia
- Bleeding
- Hypothermia – ventricular dysrhythmias
28
Laboratory Tests for Red Blood Cells
- Red blood cell count (RBC)
- Percentage of reticulocytes (normally approximately 1%)
- Hemoglobin (grams per 100 mL of blood)
- Hematocrit
29
what is Red blood cell count (RBC)
measures the total number of red blood cells in 1 mm3 of blood
30
what is Percentage of reticulocytes (normally approximately 1%)
Provides an index of the rate of red cell production
31
what is Hemoglobin (grams per 100 mL of blood) test
Measures the hemoglobin content of the blood
32
what is Hematocrit test
Measures the volume of red cell mass in 100 mL of plasma volume
33
what is Sickle Cell Disease
Inherited structural abnormality in the hemoglobin
- Crystal-like, elongated, rigid cell causes occlusion in the microcirculation
- Sickling in response to cold, dehydration, hypoxia, infection, and acidosis
34
Clinical presentation
| of sickle cell disease
- Severe bone pain
- Microinfarcts in many organs, leading to cardiomegaly, renal failure, and chronic leg ulcers
- Pulmonary infarction leading to HTN and possible ARDS
35
Treatment of Sickle Cell Crisis
- Oxygen administration
- Aggressive intravenous fluid hydration
- Prompt treatment of infection with broad-spectrum antibiotics
- RBC transfusions are not usually required
- Pain control with around-the-clock narcotics
- Folic acid supplementation
- Hydroxyurea
- Hematopoietic stem cell transplantation (HSCT) is promising towards finding a cure for Sickle Cell Disease
36
Aging and Red Blood Cells
Reduction in hematopoietic progenitors
- Reduced production of hematopoietic growth factors
- Inhibition of erythropoietin
- Inflammatory cytokines interfere with erythropoietin interaction with its receptors.
-erythropoitin is a hormone. hematopoeiten is the process
37
what is Polycythemia Vera
A condition in which the red blood cell mass is increased.
38
what is Relative polycythemia:
results from a loss of vascular fluid and is corrected by replacing the fluid
39
what is Primary polycythemia:
a proliferative disease of the bone marrow with an absolute increase in total red blood cell mass accompanied by elevated white cell and platelet counts
40
what is Secondary polycythemia
is caused by other disease processes that induce hypoxia. For these, the underlying cause is treated. These include: chronic heart and lung disease, living at high altitude, sleep apnea.
41
examples of conditions that leads secondary polycepthemia
- chronic heart
- lung disease
- living at high altitude
- sleep apnea
42
Polycythemia Manifestations
Variable and related to an increase in RBCs, hemoglobin level, and hematocrit with increased blood volume and viscosity
- Splenomegaly
- Depletion of iron
- Disrupted cardiac output
- Hypertension
- Decreased cerebral blood flow
- Venous stasis
- Thromboembolism and hemorrhage
43
Treatment of Polycythemia
- Prevention of thrombosis
- Therapeutic serial phlebotomy
- Treatment with hydroxyurea
- Watch for progression to acute leukemia
44
what are Leukemias
Malignant neoplasms arising from the transformation of a single blood cell line derived from hematopoietic stem cells
45
Classifications of leukemia according to cell lineage
- Lymphocytic (lymphocytes)
| - Myelocytic (granulocytes, monocytes)
46
what are Chronic Leukemias
Malignancies involving the proliferation of well-differentiated myeloid and lymphoid cells
47
Types of chronic leukemia
- Chronic lymphocytic leukemia (CLL)
| - Chronic myelogenous leukemia (CML)
48
what leukemias involve the pluripotent myeloid stem cells in bone marrow and interfere with the maturation of all blood cells.
- Acute myelogenous (myeloblastic) leukemia (AML)
| - Chronic myelogenous leukemia (CML)
49
what leukemias involve immature lymphocytes and their progenitors in the bone marrow, the spleen, lymph nodes, CNS, and other tissue.
- Acute lymphocytic (lymphoblastic) leukemia (ALL)
| - Chronic lymphocytic leukemia (CLL)
50
what is Thrombocytopenia
Results from a decrease in platelet production, increased sequestration of platelets in the spleen, or decreased platelet survival
51
types of thrombocytopenia
- Drug-induced thrombocytopenia
- Idiopathic thrombocytopenic purpura
- Thrombotic thrombocytopenic purpura
52
in vitamin K deficiency,
the liver produces inactive clotting factor resulting in abnormal bleeding.
53
Manifestations of Thrombocytopenia
Mucous membranes
Nose, mouth, gastrointestinal tract, and uterine cavity
Commonly occurs in small vessels
Petechiae—pinpoint purplish-red spots
Seen almost exclusively in conditions of platelet deficiency
Purpura—purple areas of bruising
54
Hemorrhagic telangiectasia
An uncommon autosomal dominant disorder characterized by thin-walled, dilated capillaries and arterioles
55
Vitamin C deficiency (scurvy) bleeding
Results in poor collagen synthesis and failure of the endothelial cells to be cemented together properly, causing a fragile wall
56
what is Cushing disease
Causes protein wasting and loss of vessel tissue support because of excess cortisol
57
what is Senile purpura
(bruising in elderly persons)
| - Caused by the aging process
58
Five Stages of Hemostasis
- Vessel spasm
- Formation of the platelet plug
- Blood coagulation or development of an insoluble fibrin clot
- Clot retraction
- Clot dissolution
59
what is Thrombosis
the inappropriate formation of clots within the vascular system
60
what is Bleeding
Failure of blood to clot in response to appropriate stimulus
61
Vascular Constriction
- Vessel spasm constricts the vessel and reduces blood flow. It is a transient event that usually lasts minutes or hours.
- Vessel spasm is initiated by endothelial injury and caused by local and humoral mechanisms.
62
Clot Retraction and Dissolution
The process involves the interaction of substrates, enzymes, protein cofactors, and calcium ions that circulate in the blood or are released from platelets and cells in the vessel wall.
63
another name for Disseminated intravascular coagulopathy (DIC)
Known as the “clotting-bleeding syndrome”
64
facts about Disseminated intravascular coagulopathy (DIC)
Clotting cascade is triggered, causing widespread systemic intravascular clotting
- ITS LIMITED, WHEN USED UP CAUSES MICROCLOTS
65
release of kinins
increases vascular permeability and causes hypotension and shock
66
Fibrin and fibrinogen breakdown causes
increase in fibrin degradation products and D-dimers
67
what activates Disseminated intravascular coagulopathy (DIC)
- Burns
- Bacterial endotoxins (especially gram-negative)
- Heat stroke
68
conditions associated with Disseminated intravascular coagulopathy (DIC)
- Obstetric conditions
- Cancers
- Infections
- Shock
- Trauma or surgery
- Low-flow states
69
treatment of Disseminated Intravascular Coagulation DIC
- Treat the causative factor
- Correct hypotension, hypoxemia, and acidosis
```
- Medications
Heparin
FFP
Platelets
Cryoprecipitate
```
70
what are Infectious Mononucleosis
Self-limited lymphoproliferative disorder
71
Causes and Characteristics
| of mononucleosis
- Caused by the B-lymphocytotropic EBV, a member of the herpes virus family; transmitted in saliva
- Characterized by fever, generalized lymphadenopathy, sore throat, and the appearance in the blood of atypical lymphocytes and several antibodies
- Highest incidence in adolescents and young adults
- Treatment is symptomatic and supportive.
72
what is Hodgkin disease
Lymphoma arises in a single node or chain of nodes.
73
what is Non-Hodgkin disease
Lymphoma originates at extranodal sites and spreads to anatomically contiguous nodes.
74
Reed-Sternberg cells are derived from?
B lymphocytes
75
Reed-Sternberg cells are present in what disease
Hodgkin disease
76
Stage A of Hodgkin Disease
Lack constitutional symptoms
77
Stage B of Hodgkin Disease
- (40% of persons with Hodgkin disease)
| - Significant weight loss, fevers, pruritus, or night sweats
78
Advanced Stages of hodgkin disease
- Fatigue and anemia
| - Liver, lungs, digestive tract, and CNS may be involved.
79
Low-grade lymphomas of Non-Hodgkin Lymphomas
Predominantly B-cell tumors
80
Intermediate-grade lymphomas of Non-Hodgkin Lymphomas
Include B-cell and some T-cell lymphomas
81
High-grade lymphomas Non-Hodgkin Lymphomas
Largely immunoblastic (B cell), lymphoblastic (T cell), Burkitt, and non-Burkitt lymphomas
82
Staging of Non-Hodgkin Lymphomas Disease
- Bone marrow biopsy
- Blood studies
- Chest and abdominal CT scans
- Nuclear medicine studies
- Cytologic examination of the cerebrospinal fluid
83
Treatment for Hodgkin and NHL
- Radiation
| - Combination chemotherapy
84
Non-Hodgkin Lymphomas Disease treatment ONLY
- Adjuvant radiation therapy
| - Monoclonal antibodies
85
what is Multiple Myeloma
A plasma cell dyscrasia characterized by expansion of a single clone of immunoglobulin-producing plasma cells and a resultant increase in serum levels of a single monoclonal immunoglobulin or its fragments
86
main site involved in Multiple Myeloma
- The bones and bone marrow
- Proliferation and activation of osteoclasts that lead to bone resorption and destruction
- Pathologic fractures
- Hypercalcemia
87
what is Pleural effusion:
abnormal collection of fluid in the pleural cavity
- Transudate or exudate, purulent (containing pus), chyle, or sanguineous (bloody)
88
Spontaneous Pneumothorax
Occurs when an air-filled blister on the lung surface ruptures
89
what is Traumatic Pneumothorax
Caused by penetrating or nonpenetrating injuries
- accidents airbag hitting chest, hard hit on chest, blow, stabbing, gunshot
90
what is Tension Pneumothorax
occurs when the intrapleural pressure exceeds atmospheric pressure
91
types of fluid in pleural effusion
- Transudate
- Exudate
- Purulent drainage (empyema)
- Chyle
- Blood
92
what is Atelectasis
The incomplete expansion of a lung or portion of a lung
93
causes of atelectasis
- Airway obstruction
- Lung compression such as that occurs in pneumothorax or pleural effusion
- Increased recoil of the lung due to loss of pulmonary surfactant
94
types of atelectasis
- Primary = present birth
| - Secondary = Develops in the neonatal period or later in life
95
what is transudative pleural effusion
- occurs due to increased hydrostatic pressure or low plasma oncotic pressure
LOW IN PROTEIN AND LDH
96
examples of transudative pleura effusion
- CHF
- cirrhosis
- nephrotic sundrome
- pulmonary edema
- Hypoalbuminemia
97
what is exudative pleural effusion
occurs due to inflammation and increased capillary permeability
HIGH IN PROTEIN AND LDH
98
examples of exudative pleural effusion
- pneumonia
- viral infection
- pe
- autoimmune
99
what is Asthma
A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production
AFFECTS THE AIRWAYS
100
Genetic Factors Involved in the Pathophysiology of Asthma
- Atopy
- Early versus late phase
Atopy refers to the genetic tendency to develop allergic diseases
101
Factors Involved in the Pathophysiology of Asthma
| Environmental
Viruses
Allergens
Occupational exposure
102
Contributing Factors to an Asthmatic Attack
-Allergens
-Respiratory tract infections
Exercise
Drugs and chemicals
Hormonal changes and emotional upsets
Airborne pollutants
Gastroesophageal reflux
103
Classifications of Asthma Severity
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
104
Status asthmaticus
- Bronchospasm not reversed by usual measures
- Life-threatening
does not respond to regular treatment
105
Clinical manifestations of asthma
- Asymptomatic between attacks
| - Chest constriction, expiratory wheezing, dyspnea, nonproductive coughing, prolonged expiration, tachycardia, tachypnea
106
what is tuberculosis
World’s foremost cause of death from a single infectious agent
- Tuberculosis (TB) usually involves the lungs, but any organ can be infected including brain, kidneys, and bones
DRUG-RESISTANT FORMS
107
M. tuberculosis hominis (human tuberculosis)
- Airborne infection spread by minute droplet nuclei harbored in the respiratory secretions of persons with active tuberculosis
- Living under crowded and confined conditions increases the risk for spread of the disease
108
Bovine tuberculosis
- Acquired by drinking milk from infected cows; initially affects the gastrointestinal tract
- Has been virtually eradicated in North America and other developed countries
109
The major factors that contributed to the resurgence of TB were
- high rates of TB among patients with HIV infection
| - the emergence of multidrug-resistant (MDR) strains of M. tuberculosis
110
Positive Tuberculin Skin Test
Results from a cell-mediated immune response
- Implies that a person has been infected with M. tuberculosis and has mounted a cell-mediated immune response
- Does not mean the person has active tuberculosis
111
what is emphysema
- Enlargement of air spaces and destruction of lung tissue
Types: centriacinar and panacinar
112
what is Chronic Obstructive Bronchitis
Obstruction of small airways
113
Characteristics of Pulmonary Emphysema
```
Smoking history
Age of onset: 40 to 50 years
- Often dramatic barrel chest
- Weight loss
Decreased breath sounds
Normal blood gases until late in disease process
Cor pulmonale only in advanced cases
Slowly debilitating disease
```
114
characteristics of pathophysiology of chronic bronchitis
- enlarged submucosal gland
- inflammation of epithelium
- mucous plug
- mucus accumaltion
hyperinflation of alveoli
115
what is Bronchiectasis
Permanent dilation of the BRONCHI and BRONCHIOLES
| - Weight loss and anemia are common
116
manifestations of Bronchiectasis
```
Atelectasis
Obstruction of the smaller airways
Diffuse bronchitis
Recurrent bronchopulmonary infection
Coughing; production of copious amounts of foul-smelling, purulent sputum; and hemoptysis
Weight loss and anemia are common.
```
117
what is Cystic Fibrosis
An autosomal recessive disorder involving fluid secretion in the exocrine glands and the epithelial lining of the respiratory, gastrointestinal, and reproductive tracts
118
Manifestations of Cystic Fibrosis
```
Pancreatic exocrine deficiency
Pancreatitis
Elevation of sodium chloride in the sweat
Excessive loss of sodium in the sweat
Nasal polyps
Sinus infections
Cholelithiasis
```
119
Acute Respiratory Distress Syndrome
A number of conditions that produces pathologic lung changes that include diffuse epithelial cell injury with increased permeability of the alveolar–capillary membrane
120
Occupational Lung Diseases
- Pneumoconioses
The inhalation of inorganic dusts and particulate matter
Hypersensitivity diseases
- The inhalation of organic dusts and related occupational antigens
- Byssinosis: cotton workers; has characteristics of the pneumoconioses and hypersensitivity lung disease
121
Causes of Acute Respiratory Distress Syndrome
- Aspiration of gastric contents
- Major trauma (with or without fat emboli)
- Sepsis secondary to pulmonary or nonpulmonary infections
- Acute pancreatitis
- Hematologic disorders
- Metabolic events
- Reactions to drugs and toxins
122
what is pneumonia
Respiratory disorders involving inflammation of the lung structures (alveoli and bronchioles)
123
infectious agents of pneumonia
such as bacteria and viruses
124
Noninfectious agents of pneumonia
gastric secretions aspirated into the lungs
125
Factors Facilitating Development of Pneumonia
An exceedingly virulent organism
A large inoculum = culture
Impaired host defenses
126
Classifications of Pneumonias
- According to the source of infection = community or hospital acquired
- According to the immune status of the host = whether they are immunocompentent or immunocompromise
127
Cor Pulmonale
- Right heart failure resulting from primary lung disease and long-standing primary or secondary pulmonary hypertension
- Involves hypertrophy and the eventual failure of the right ventricle
- Manifestations include the signs and symptoms of the primary lung disease and the signs of right-sided heart failure.
128
normal pH range
7.35 - 7.45 is NORMAL
- pH less than 7.35 = acidic
- pH greater than 7.45 = alkalotic
129
example of Respiratory acidosis
hypoventilation = pH is low
130
Respiratory alkalosis example
hyperventilation = pH is high
person breathing too fast
131
PCO2 range
35 – 45
below 35 = respiratory akalosis
above 45 = repiratory acidic
132
HCO3 (metabolic) ranges
22-26
below 22 = metabolic acidic
above 26 = metabolic akalosis
133
Functions of the Digestive System
- Production of enzymes and hormones
- Storage and synthesis of vitamins
- Dismantling and reassembling of food
- Entrance of nutrients, vitamins, minerals, electrolytes, and water through the gastrointestinal tract
- Collection and elimination of wastes
134
what is digestion
Digestion is the process of dismantling foods into their constituent parts. Digestion requires hydrolysis, enzyme cleavage, and fat emulsification.
135
what is absorption
Absorption is the process of moving nutrients and other materials from the external environment of the GI tract into the internal environment.
136
Signs and Symptoms Common to Gastrointestinal Disorders
- Anorexia = LOSS OF APETITE
- Nausea = feeling like throwing up
- Vomiting
- Gastrointestinal bleeding
137
what is retching
- feeling like throwing up but nothing coming. Just brushing your teeth and bruch goes towards throat
- Retching consists of the rhythmic spasmodic movements of the diaphragm, chest wall, and abdominal muscles.
138
Anorexia, Nausea, Retching, and Vomiting responses to GI disorders
These responses are protective to the extent that they signal the presence of disease and, in the case of vomiting, remove noxious agents from the GI tract.
- They can also contribute to impaired intake or loss of fluids and nutrients.
139
Swallowing
- Depends on the coordinated action of the tongue and pharynx
These structures are innervated by cranial nerves V, IX, X, and XII.
140
Dysphagia
Difficulty in swallowing = narrowing of the esophagus
141
Odynophagia:
Painful swallowing
142
Achalasia
Failure of the esophageal sphincter to relax. The place btween the end of the esophagus and the opening of the stomach
143
Infection with H. pylori
- Thrives in an acid environment of the stomach
- Disrupts the mucosal barrier that protects the stomach from harmful effects of its digestive enzymes
- Colonize the mucus-secreting epithelial cells of the stomach.
- Produce enzymes and toxins that have the capacity to interfere with the local protection of the gastric mucosa against acid.
- Produce intense inflammation.
- Elicit an immune response.
144
Major Causes of Gastric Irritation and Ulcer Formation
Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
- on’t take NSAIDs on empty stomach cus it can cause gastric inflammation
NSAIDS Irritate the gastric mucosa and inhibit prostaglandin synthesis
145
Acute Gastritis
- A transient inflammation of the gastric mucosa
| - Most commonly associated with local irritants such as bacterial endotoxins, alcohol, and aspirin
146
Chronic Gastritis
- Characterized by the absence of grossly visible erosions and the presence of chronic inflammatory changes
- Leads eventually to atrophy of the glandular epithelium of the stomach
147
Autoimmune gastritis
body recognize itself as foreigh and start producing against in or attacking it
148
what is Peptic Ulcer
Ulcerative disorders that occur in areas of the UPPER gastrointestinal tract that are exposed to acid–pepsin secretions
149
what are common in peptic ulcers
Spontaneous remissions and exacerbations
150
what are common in peptic ulcers
Spontaneous remissions and exacerbations
151
causes of peptic ulcer
- H. pylori
- Aspirin = if you take them on an empty stomach
- Age
- Warfarin
- Smoking
152
Complications of Peptic Ulcer
Hemorrhage
Obstruction
Perforation
153
what is Hemorrhage from peptic ulcer
Caused by bleeding from granulation tissue or from erosion of an ulcer into an artery or vein
154
Obstruction peptic ulcers
Caused by edema, spasm, or contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or adjacent areas
155
Perforation peptic ulcer
Occurs when an ulcer erodes through all the layers of the stomach or duodenum wall
156
Hematemesis
- Blood in the vomitus
| - May be bright red or have coffee ground appearance
157
Melena & Hematochezia
| from GI bleeding
blood in stool
```
melena = tarry black stool
hematochezia = bright red stool
```
MAY BE OCCULT(HIDDEN) = CAN APPEAR NORMAL
158
Zollinger-Ellison syndrome
rare digestive disorder that results in too much gastric acid
159
Symptoms of Diverticulitis
TREATMENT=EAT MORE FIBER
pouches in the large intestine
- Pain in the lower left quadrant
- Nausea and vomiting
- Tenderness in the lower left quadrant
- A slight fever
- An elevated white blood cell count
160
Viral Infection
| of the intetstine
Rotavirus
161
Bacterial Infection
| of small intestine
Clostridium difficile colitis
| Escherichia coli O157:H7 Infection
162
Protozoal Infection
| intestine
E. histolytica
163
Ulcerative Colitis
ONLY THE COLON - nonspecific inflammatory condition of the colon
CONTINOUS INFLAMMATION
164
Crohn Disease
A recurrent, granulomatous type of inflammatory response that can affect any area of the gastrointestinal tract from the mouth to the anus
SKIP LESSIONS
CAN AFFECT ANYWHERE IN THE GI TRACT
165
Peritonitis
```
- Perforated peptic ulcer
RUPTURED APPENDIX
- Perforated diverticulum
- Gangrenous bowel
- Pelvic inflammatory disease
- Gangrenous gallbladder
- Abdominal trauma and wounds
```
166
Intestinal Malabsorption
Failure to transport dietary constituents from the lumen of the intestine to the extracellular fluid
167
Types of Diarrhea
Large Volume
- osmotic = when you eat something your stomach cant absorb
- secretory = when your body secretes electrolytes into your intestine
168
Small Volume
| diarrhea
Inflammatory bowel disease
Infectious disease
Irritable colon
169
Common Causes of Constipation
- Failure to respond to the urge to defecate
- Inadequate fiber in the diet
- Inadequate fluid intake
- Weakness of the abdominal muscles
- Inactivity and bed rest
- Pregnancy
- Hemorrhoids
170
Fecal Impaction
large, hard mass of stool that gets stuck so badly in your colon or rectum
171
characteristics of fecal impaction
- Painful anorectal disease
- Tumors
- Neurogenic disease
- Use of constipating antacids or bulk laxatives
- A low-residue diet
- Drug-induced colonic stasis
- Prolonged bed rest and debility
172
Intestinal Obstruction
Mechanical obstruction can result from post operative causes such as external hernia and postoperative adhesions.
- IMPAIRMENT OF PERISTALSIS
173
Functions of the Liver
- Production of bile salts
- Elimination of bilirubin
- Metabolism of steroid hormones
- Metabolism of drugs
174
Cause of Jaundice
- Excessive destruction of red blood cells
- Impaired uptake of bilirubin by the liver cells
- Decreased conjugation of bilirubin
- Obstruction of bile flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts
175
Prehepatic jaundice ( Unconjugated bilirubin )
Major cause is excessive hemolysis of red blood cells.
- the unconjugated bilirubin that remains in the blood stream to cause the jaundice.
176
Intrahepatic jaundice ( Conjugated bilirubin )
Caused by disorders that directly affect the ability of the liver to remove bilirubin from the blood or conjugate it so it can be eliminated in the bile
- The liver loses the ability to conjugate bilirubin for it to be eliminated in the bile
177
Posthepatic (Conjugated bilirubin)
Occurs when bile flow is obstructed between the liver and the intestine
178
which categories of jaundice are conjugated
intrahepatic and post hepatic
179
conditions that affect liver
- injury from drugs and toxins
- Infection, inflammation, and immune responses
- Metabolic disorders
- Neoplasms
180
Phase 1 reaction Hepatic Detoxification and Metabolism
involve chemical modification or inactivation of a substance
181
Phase 2 reactions Hepatic Detoxification and Metabolism
Involve conversion of lipid-soluble substances to water-soluble derivatives
182
Causes of Hepatitis
- Autoimmune disorders
- Reactions to drugs and toxins
- Infectious disorders
- Hepatotropic viruses that primarily affect liver cells or hepatocytes
183
Infectious disorders hepatitis
Malaria, infectious mononucleosis, salmonellosis, and amebiasis
184
Hepatotropic viruses that primarily affect liver cells or hepatocytes
Direct cellular injury and induction of immune responses against the viral antigens
185
Early symptoms Intrahepatic Biliary Disease
- Unexplained pruritus or itching
- Weight loss
- Fatigue
186
Later symptoms Intrahepatic Biliary Disease
- Dark urine and pale stools
| - Jaundice
187
examples of Portal Hypertension
- Ascites
- Esophageal varices
- Splenomegaly
188
Manifestations of Liver Failure
- Hematologic disorders
- Endocrine disorders
- Skin disorders
- Hepatorenal syndrome
- Hepatic encephalopathy
189
Hepatic Encephalopathy
Complex neurological syndrome characterized by impaired behavioral, cognitive, and motor function
190
Clinical manifestations of Hepatic Encephalopathy
```
Personality changes
Confusion
Irritability
Lethargy
Sleep disturbances
Flapping tremor (asterixis)
Stupor, coma, death
```
191
treatment of Hepatic Encephalopathy
- Correct fluid and electrolyte imbalances.
- Withdraw depressant drugs metabolized by the liver.
- Restrict dietary protein intake.
- Hypertonic saline, mannitol, hypothermia
Eliminate intestinal bacteria.
192
Hepatocellular carcinoma
Arises from the liver cells
193
Cholangiocarcinoma
A primary cancer of bile duct cells
194
Effects of Malnutrition and Starvation
- Loss of muscle mass
- Impaired wound healing
- Impaired immunologic function
- Decreased appetite
- Loss of calcium and phosphate from bone
- Anovulation and amenorrhea
Decreased testicular function
195
Kwashiorkor-like secondary protein–energy malnutrition
Hypermetabolic acute illnesses
| - Trauma, burns, and sepsis
196
Marasmus-like secondary protein–energy malnutrition
Chronic illnesses
- Chronic obstructive pulmonary disease (COPD)
- Congestive heart failure
- Cancer and human immunodeficiency virus (HIV) infection
197
Anorexia nervosa
- Refusal to maintain normal body weight
- Intense fear of gaining weight or becoming fat
- Disturbance in the way body is perceived
- Causes amenorrhea (ABSENCE OF MENSTRUATION) in girls
198
Bulimia nervosa
- Recurrent binge eating
- Inappropriate compensatory behaviors (purging)
- Self-evaluation unduly influenced by body shape and weight
- Determination that eating disorder does not occur exclusively during episodes of anorexia nervosa
199
Action of Vitamin D
- Increases intestinal absorption of CALCIUM
- Increases intestinal absorption of PHOSPHATE
Increases renal excretion of phosphate
Can increase bone resorption
Can increase bone formation
200
Causes of Musculoskeletal Injuries
- Blunt tissue trauma
- Disruption of tendons and ligaments
- Fractures of bony structures
201
Acute Athletic injuries
- Caused by sudden trauma
- Include injuries to soft tissues (contusion, strains, and sprains) and to bone (fractures)
FRACTURES=bones
202
what are Overuse injuries
- Chronic injuries
- Include stress fractures that result from constant high levels of physiological stress without sufficient recovery time
203
Contusion injury
- An injury to soft tissue that results from direct trauma and is usually caused by striking a body part against a hard object
EXAMPLE = BRUISE
204
Hematoma
| injury
A large area of local hemorrhage
205
Laceration injury
an injury in which the skin is torn or its continuity is disrupted
206
strain joint injuries
A stretching injury to a muscle or a musculotendinous unit caused by mechanical overloading.
207
Sprain joint injuries
Involves the ligamentous structures surrounding the joint, pain and swelling subside more slowly than in a strain
- Caused by abnormal or excessive movement of the joint
208
Dislocation joint injuries
Displacement or separation of the bone ends of a joint with loss of articulation
209
Loose bodies joint injuries
Small pieces of bone or cartilage within a joint space
210
Hematogenous Osteomyelitis
Originates with infectious organisms that reach the bone through the blood stream
211
Contiguous Spread Osteomyelitis
- Secondary to a contiguous focus of infection
| - Direct inoculation from an exogenous source or from an adjacent extraskeletal site
212
chronic Osteomyelitis
Occur secondary to an open wound
213
Chronic Osteomyelitis
- Chronic osteomyelitis usually occurs in adults
- It generally occur secondary to an open wound, most often to the bone or surrounding tissue
- It includes all inflammatory processes of bone, excluding those in rheumatic diseases that are caused by microorganisms.
- The hallmark feature of chronic osteomyelitis is the presence of infected dead bone, a sequestrum, that has separated from the living bone.
214
what is Osteonecrosis
Osteonecrosis, or death of a segment of bone, is a condition caused by the interruption of blood supply to the marrow, medullary bone, or cortex in the absence of infection.
215
Causes of osteonecrosis
- Mechanical disruption of blood vessels
- Thrombosis and embolism
- Vessel injury
- Increased intraosseous pressure
216
functions of Gamma globulins
antibodies of the body, protects the body from infectious diseases
217
function of alpha globulin
transport bilirubin and steroids
218
functions of beta globulin
transport iron and copper
219
components of plasma
albumin
globulins
fibrinogen
220
fuction of albumin
maintanence of osmotic pressure and FLUID/BLOOD IMBALANCE
221
The heme molecule is converted to
bilirubin and transported to the liver
222
The red blood cell has a life span
approximately 120 days
It is broken down in the spleen.
The degradation products (iron and amino acids) are recycled.
223
Eosinophils
increase in number during allergic reactions and parasitic infections
The agents associated with allergic reactions
In parasitic infections, the eosinophils use surface markers to attach themselves to the parasite and then release hydrolytic enzymes.
224
Because DNA synthesis requires
vitamin b12
225
Internal hemorrhage may cause pain that is localized or referred.
YES
226
clinical manifestations of acute blood loss
The patient may have pain at the same time due to
Internal hemorrhage
Tissue distention, organ displacement, nerve compression
Retroperitoneal bleeding
Numbness
Pain in lower extremities
Shock is major complication
227
major complication of acute blood loss
shock!
228
When anemia exists after acute blood loss,......
dietary sources of iron will probably not be adequate to maintain iron stores
229
Goals of Treatment for CML
A hematological response characterized by normalized blood counts
A cytogenetic response demonstrated by the reduction or elimination of the Ph chromosome from the bone marrow
A molecular response confirmed by the elimination of the BCR-ABL fusion protein
230
Criteria for Remission of ALL and AML
Less than 5% blasts in the bone marrow
Normal peripheral blood counts
Absence of cytogenetic abnormalities
Return to preillness performance status
231
Factors Affecting the Likelihood of Achieving Remission
Age (most significant prognostic variable)
Type of leukemia
Stage of the disease at time of presentation
232
Leukemic Cells
Are immature and poorly differentiated
Proliferate rapidly and have a long life span
Do not function normally
Interfere with the maturation of normal blood cells
Circulate in the blood stem
Cross the blood–brain barrier
Infiltrate many body organs
233
Requirements for Blood Clotting Process
Presence of platelets produced in the bone marrow
Von Willebrand factor generated by the vessel endothelium
Clotting factors synthesized in the liver using vitamin K
234
Why Should Blood Clot?
```
Hemostasis is designed to maintain the integrity of the vascular compartment.
Infection
Volume
Oxygen production
Tissue damage
Healing
```
235
Characteristics of Malignant Bone Tumors
Tend to be ill defined
Lack sharp borders
Extend beyond the confines of the bone
236
Types of Malignant Bone Tumors
- Osteosarcoma = Aggressive and highly malignant
- Ewing sarcoma = Peripheral primitive neuroectodermal tumor
- Chondrosarcoma = Malignant tumor of cartilage
237
tumors that frequently spread to skeletal system
breast, lung, prostate, kidney, and thyroid,
238
Treatment Goals for Metastatic Bone Disease
Preventing pathologic fractures
Promoting survival with maximum functioning
Allowing the person to maintain as much mobility and pain control as possible
239
treatment Methods for Metastatic Bone Disease
Chemotherapy
Irradiation
Surgical stabilization
240
Mild limb deformities (relatively common)
- Syndactyly = simple webbing of the fingers or toes
- Polydactyly = the presence of an extra digit
- Absence of a bone such as the phalanx, rib, or clavicle
241
Congenital Deformities
- Mild limb deformities
| - Major limb malformations
242
Major limb malformations (relatively rare)
- Joint contractures and dislocations
| - Absence of entire bones, joints, or limbs
243
Osteogenesis imperfecta
Hereditary disease characterized by defective synthesis of type I collagen
244
Developmental dysplasia of the hip (DDH)
Abnormality in hip development that leads to a wide spectrum of hip problems in infants and children
245
Clubfoot or talipes
Congenital deformity of the foot that can affect one or both feet
246
Juvenile Osteochondrosis
A group of children’s diseases in which one or more growth ossification centers undergoes a period of degeneration, necrosis, or inactivity that is followed by regeneration and usually deformity
247
Scoliosis
Lateral deviation of the spinal column that may or may not include rotation or deformity of the vertebrae
248
Postural scoliosis:
a small curve that corrects with bending
249
Structural scoliosis:
fixed deformity that does not correct with bending.
250
Idiopathic scoliosis
Structural spinal curvature for which no cause has been established
251
Neuromuscular scoliosis
Develops from neuropathic or myopathic diseases
252
Congenital scoliosis
Caused by disturbances in vertebral development during the 6th to 8th week of embryologic development
253
Major Influences on Equilibrium of Bone Tissue
Mechanical stress
Calcium and phosphate levels in the extracellular fluid
Hormones and local growth factors
Cytokines
254
Types of Bone Remodeling
- Osteoblasts and osteoclasts in homeostatic balance in normal tissue
- Structural remodeling
- Internal remodeling
255
what is Internal remodeling
Largely involves the replacement of trabecular bone
| Continuous during adulthood
256
what is structural remodelling
Involves deposition of new bone on the outer aspect of the shaft at the same time that bone is resorbed from the inner aspect of the shaft
257
Osteopenia
Reduction in bone mass greater than expected for age, race, or sex
258
causes of osteopenia
- Decrease in bone formation
- Inadequate bone mineralization
- Excessive bone deossification
259
Osteoporosis
- Skeletal disorder characterized by the loss of bone mass and deterioration of the architecture of cancellous bone with a subsequent increase in bone fragility and susceptibility to fractures
- Loss of mineralized bone mass causes increased porosity of the skeleton. = more holes in the bones. Most likely due to aging
260
Causes of osteoporosis
- Can occur as the result of an endocrine disorder or malignancy
- Most often associated with the aging process
261
treatment of osteoporosis
- Regular exercise and adequate calcium intake are important factors in preventing osteoporosis
- Weight-bearing exercises such as walking, jogging, rowing, and weight lifting are important in the maintenance of bone mass
262
Osteomalacia softening of bone
A generalized bone condition in which inadequate mineralization of bone results from a calcium or phosphate deficiency, or both
263
Rickets
A disorder of vitamin D deficiency, inadequate calcium absorption, and impaired mineralization of bone in children
264
Primary arthritis
- Those affecting body systems in addition to the musculoskeletal system
- Resulting from an immune response
265
Secondary arthritis
- Rheumatoid conditions limited to a single or few diarthrodial joints
- Resulting from a degenerative process and the resulting joint irregularities that occur as the bone attempts to remodel itself
266
Systemic Autoimmune Rheumatic Diseases =
A group of chronic disorders characterized by diffuse inflammatory lesions and degenerative changes in connective tissue
These disorders share similar clinical features and may affect many of the same organs
Rheumatoid arthritis
Systemic lupus erythematosus
Systemic sclerosis/scleroderma
Polymyositis
Dermatomyositis
267
Characteristics of Rheumatoid Arthritis
Associated with extra-articular as well as articular manifestations
Usually has an insidious onset marked by systemic manifestations such as fatigue, anorexia, weight loss, and generalized aching and stiffness.
Characterized by exacerbations and remissions
May involve only a few joints for brief durations, or it may become relentlessly progressive and debilitating
268
Criteria for Rheumatoid Arthritis
Morning stiffness at least 1 hour for at least 6 weeks
Swelling of three or more joints for at least 6 weeks
Swelling of wrist, metacarpophalangeal or proximal interphalangeal joints for 6 or more weeks
Systemic joint swelling
Hand roentgenogram changes typical of RA
Rheumatoid nodules
Serum rheumatoid factor
269
Rheumatoid Arthritis symptoms
```
Fatigue
Weakness
Anorexia
Weight loss
Low-grade fever
Anemia
```
270
Treatment Goals for a Person with RA
Reduce pain
Minimize stiffness and swelling
Maintain mobility
Become an informed health care consumer
271
Systemic Sclerosis
Systemic sclerosis, sometimes called scleroderma, is an autoimmune disease of connective tissue characterized by excessive collagen deposition in the skin and internal organs
Diffuse or generalized form
Skin changes involve the trunk and proximal extremities.
Limited or CREST variant
Hardening of the skin (scleroderma) is limited to the hands and face.
272
Osteoarthritis
Osteoarthritis, formerly called degenerative joint disease, is the most prevalent form of arthritis
It is a leading cause of disability and pain in older adults
Primary variants of OA occur as localized or generalized syndromes
Secondary OA has a known underlying cause such as
congenital or acquired defects of joint structures, trauma, metabolic disorders, or inflammatory diseases.
273
Causes of Osteoarthritis- induced joint chnages
```
Postinflammatory diseases
Posttraumatic disorders
Anatomic or bony disorders
Metabolic disorders
Neuropathic arthritis
Hereditary disorders of collagen
Idiopathic or primary variants
```
274
Osteoarthritis-Induced Joint Changes PROGRESSIONS
A progressive loss of articular cartilage
Synovitis
Osteophytes=Bone spurs
275
MANIFESTATIONS of Osteoarthritis-Induced Joint Changes
```
Joint pain
Stiffness
Limitation of motion
Joint instability
Deformity
```
276
Metabolic and Endocrine Diseases Associated with Joint Symptoms
```
Amyloidosis
Gout syndrome
Osteogenesis imperfecta
Diabetes mellitus
Hyperparathyroidism
Thyroid disease
AIDS
Hypermobility syndromes
```
277
Gout Syndrome
Acute gouty arthritis with recurrent attacks of severe articular and periarticular inflammation
Tophi or the accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage
Gouty nephropathy or renal impairment
Uric acid kidney stones
278
Primary gout
- Designate cases in which the cause of the disorder is unknown or an inborn error in metabolism
- Characterized primarily by hyperuricemia and gout
279
Secondary gout
The cause of the hyperuricemia is known but the gout is not the main disorder
280
Objectives for Treatment of Gout
Termination and prevention of the acute attacks of gouty arthritis
Correction of hyperuricemia
Inhibition of further precipitation of sodium urate
Absorption of urate crystal deposits already in the tissues
281
Juvenile Idiopathic Arthritis categories of diseases with three principle types of onset:
(1) Systemic onset disease
(2) Pauciarticular arthritis
(3) Polyarticular disease
282
Symptoms of Juvenile Idiopathic Arthritis
Synovitis
Stunted growth also may occur
Influence epiphyseal growth by stimulating growth of
283
Juvenile Rheumatoid Arthritis (JRA)
A chronic disease characterized by synovitis
284
Manifestations
| of juvinile rheumatoid arthritis
Can influence epiphyseal growth by stimulating growth of the affected side
Generalized stunted growth also may occur.
285
paget disease
abnormal bone resorption. leading to osteoporosis
Definition
A progressive skeletal disorder that involves excessive bone destruction and repair
Etiology
Genetic and environmental influences.
People with Paget disease have been found to have a mutation of the SQSM1/p62 gene in their diseased bone and tumor samples.
Clinical Manifestations
Characterized by increasing structural changes of the long bones, spine, pelvis, and cranium
Diagnosis
Treatment
286
pathophysiology of rheumatoid arthritis
aberrant immune response that leads to synovial inflammation and destruction of the joint architecture.
287
medication does the nurse recognize is useful in treating inflammation, arthritis, and pleuritis?
NSAIDS
288
Characteristics of Systemic Lupus Erythematosus (SLE) (AUTOANTIBODIES)
Systemic Lupus Erythematosus is a chronic inflammatory disease that can affect virtually any organ system, including the musculoskeletal system.
It is a major rheumatic disease, with approximately 1.5 million Americans and over 5 million people worldwide diagnosed with lupus.
Etiology
Formation of autoantibodies and immune complexes
B-cell hyperreactivity
Increased production of antibodies against self- (autoantibodies) and nonself antigens
289
Auto-antibodies SLE
```
The autoantibodies can directly damage tissues or combine with corresponding antigens to form tissue-damaging immune complexes.
Autoantibodies
Antinuclear antibodies
Other antibodies
Platelets
Coagulation factors
Red blood cell surface antigens
```
290
dermatomyositis
long-term muscle, joint, and organ damage. Corticosteroids are the mainstay of treatment for this condition.
291
Risk Factors for Development of Stress Ulcers
```
Large surface area burns
Trauma
Sepsis
Acute respiratory distress syndrome
Severe liver failure
Major surgical procedures
Zollinger-Ellison syndrome
```
292
prevention and treatment of diverticular disease
EATING MORE FIBER
293
irritable bowel disease
Persistent or recurrent symptoms of abdominal pain
Altered bowel function
Varying complaints of flatulence, bloatedness
Nausea and anorexia
Constipation or diarrhea
Anxiety or depression
