test #39 4.29 Flashcards Preview

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Flashcards in test #39 4.29 Deck (159)
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1

what does "end-organ" blood supply mean?

interruptions in blood flow lead to formation of infarct

renal: small number of collaterals between segmental renal arteries

brain too?

2

recall nephrotic syndrome presents w/ 5 things

1. edema (loss of albumin / oncotic pressure
2. proteinuria
3. hyperlipidema
4. hypercoagulation (loss of antithrombin III & increased coag factors
5. infection (loss of immunoglobulins)

3

histology of crohn's vs. ulcerative colitis

crohns: noncaseating granulomas & lymphoid aggregates (Th1 mediated)

ulcerative colitis: crypt abscesses (Th2 mediated)

4

blood in crohn's vs. ulcerative colitis

crohn's: + occult blood

ulcerative colitis: gross bleeding

5

string sign on barium swallow

crohn's disease: narrowing of the intestinal segment due to inflammation of intestinal wall

6

ulcers in crohn's? gross morphology?

1. linear or serpiginous ulcerations
2. cobblestone mucosa
3. transmural inflammatory infiltrate.

"string sign"

7

gross morphology of ulcerative colitis

1. mucosal & submucosal inflammation
2. friable mucosal pseudopolyps w/ freely hanging mesentary

loss of haustra = lead pipe

8

cells in moles vs. choriocarcinoma

mole: only trophoblasts; swelling villi

choriocarcinoma: trophoblasts & syncitiotrophoblasts; NO VILLI

9

clinical presentation of:
complete vs. partial hydatidiform mole

both: vaginal bleeding & cramps/pressure

complete:
-SIZE greater than dates &
-extremely HIGH b-hCG

partial:
-normal size
-b-hCG high/normal

[hCG can lead to:
- hyperemesis gravidarum
- pre-eclampsia
- hyperthyroidism
- theca-lutein cysts

10

macroscopic: complete vs. partial hydatidiform mole?

complete: friable mass of cystic, thin-walled, grapelike structures. exclusively TROPHOBLASTIC TISSUE. "bunch of grapes"

partial: mix of normal & gross enlarged chorionic villi; FETAL PARTS (fetus, cord, amniotic membrane)

11

micropscopic appearance: complete vs. partial hydatidiform mole?

complete: enlarged, EDEMATOUS villi w/ extensive & diffuse trophoblastic HYPERPLASIA
(no fetal tissue)

partial: some enlarged vili w/ more moderate & FOCAL trophoblastic hyperplasia.
- normal villi & fetal tissue also present

12

karyotype of complete & partial hydatidiform mole?

complete: completely PAPA 46 XX or 46 XY (sperm fertilizes empty egg; sperm chromosomes duplicate usu: 46 XX more common)

partial: 69 XXX or XXY
(TRIPLOID)
usu 1 egg w/ 2 sperms

13

risk of malignancy in complete & partial hydatidiform mole?

complete: 15-20% risk of malignant trophoblastic disease

partial: low risk of malignancy <5%

14

where is TRH made?

paraventricular nucleus of hypothalamus

15

main regulator of TSH section?

T3

- T3 acts on paraventricular nucleus to decrease synthesis/release of TRH.
- down regulate TSH gene transcription & TRH receptor expression

16

T4 in peripheral tissues

converted to T3 or rT3 by specific deiodinases

(t3 cannot become T4 or rT3)

17

potency, half-life, metabolism of T4, T3, rT3

half-life
T4: 7 days
T3: 1 day
rT3: <1 day

cleared via glucuronidation in liver

[t3 not prescribed bc short half-life & rapid GI absorption = wide fluctuations]

18

acute acalculous cholecystitis

acute inflammation of gallbladder in absence of stones.

stasis & ischemia

PE: jaundice & palpable right upper quadrant mass = NOT SEEN IN calculous cholecystitis

complications: gangrene, perforation, emphysematous cholecystitis -- infxn w/ gas-producing agent: clostridium, e. coli

usu in hospitalized patients & severely ill

19

porcelain gallbladder

diagnosed on abdominal radiograph: rim of calcium deposits outline gallbladder

associated w/ gallbladder carcinoma

20

cholechondral cysts

congenital dilations of common bile duct

21

chronic cholecystitis results in..

thickening of gallbladder wall.
US: shruken, fibrosed gallbladder

22

clornarchis infxn of gallbladder is associated w..

brown pigment stones

23

black vs. brown gallstones

pigment stones

black: intravascular hemolysis
brown: biliary infxn

24

how does valsalva affect heart?

decrease preload.

exhale against closed glottis

25

systemic mastocytosis

abnormal proliferation of mast cells & increased histamine secretion

--> increase histamine --> gastric hypersecretion

can see nests of mast cells in bowel mucosa

26

Rokitansky-Aschoff sinus

chronic cholecystitis:

chemical irritation from long-standing cholethiasis

herniation of gallbladder mucosa into muscular wall --> Rokitansky-Aschoff sinus: ducts in muscle

late complication: porcelain gallbladder

27

mast cells in GI tract?

systemic mastocytosis!

28

systemic mastocytosis

mast cell proliferation in bone marrow & other organs

increase histamine

1. GI: increased gastric acid
- inactivation of pancreatic & intestinal enzymes --> diarrhea
- also N/V, cramps, ulcer

2. syncope, flushing, hypotension, tachycardia, bronchospasm

3. pruitus, uticaria, dermatographism

29

H2 receptors increase intracellular

cAMP

(gastrin/Ach = Ca2+)

30

gastrin & Ach increase intracellular..

Ca2+

(H2 = cAMP)