Patho Exam 3 Objectives

this is the most prevalent type of esophageal cancer that forms "glands"/clusters and tends to occur at the distal end of the esophagus (towards the GE junction) - increasing in the US - Risk factor: Barrett esophagus - HER2 receptor amplification responds to trastuzumab (antibody)

(esophageal) adenocarcinoma

this type of esophageal cancer is decreasing in the US, tends to be in the mid-esophagus, and morphologically has squamous differentiation - Risk factors: alcohol and tobacco use - Sx: initially asymptomatic, increasing obstruction can cause progressive dysphagia, wt loss, and malnutrition - poor prognosis

(esophageal) squamous cell carcinoma

this tumor arises from the epithelium of pancreatic ducts, and commonly metastasizes with a poor prognosis - Sx: if in the body or tail generally asymptomatic until significant growth has occurred, wt loss, if in the head may present earlier as painless jaundice

(primary) pancreatic adenocarcinoma

What are the risk factors for developing an ovarian tumor

BRCA1 or BRCA2 mutation, estrogen replacement therapy, nulliparity (never given birth), age

this is a chronic inflammatory bowel disease that affects the lining of the digestive tract; can sometimes cause life-threatening complications; form of inflammatory bowel disease (IBD) - Sx: may be asymptomatic throughout life or cause chronic bouts of fever, abdominal pain, diarrhea, weight loss, anemia, and fatigue - cannot be cured - Tx: steroids and immunosuppressants are used to slow the progression of disease. If these aren't effective, a patient may require surgery. - patients with this may need to receive regular screening for colorectal cancer due to increased risk

Crohn's disease (regional enteritis) (Location: mouth to anus Extent: skip lesions/segmental involvement Other: fistula & stricture formation, severe fibrosis, granulomas Cancer risk: yes)

this is an inherited, progressive form of muscular dystrophy that occurs primarily in *males*, though in rare cases may affect females. It causes progressive weakness and atrophy of skeletal and heart muscles - Caused by a *rare genetic mutation* that causes muscles' cell membranes to allow more Ca2+ influx --> H2O follows Ca2+ and causes membranes (and muscles) to rupture - muscle destruction is replaced by fat and fibrosis, usually in the thighs and upper arms - X-linked recessive mutation - Positive Gower's sign (use this manuever to transition from sitting to standing since they often have weak thighs and upper arms) - Prognosis: progressive disease with no known cure leading to death in the 20s due to cardiac and respiratory failure :(

Duchenne muscular dystrophy (DMD)

Initial acute cystitis is almost always caused by what bacteria

E coli

this is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. It most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis - Possible causes: retrograde menstruation, transformation of peritoneal or embryonic cells, autoimmune disorder - Sx: painful periods, pain with intercourse, urination, and defecation, excessive bleeding, infertility

Endometriosis

this is an inherited disorder characterized by cancer of the large intestine (colon) and rectum - May be due to loss of APC (tumor supressor gene) = autosomal dominant disease - Causes colon to be carpeted with polyps (growths) - Colorectal cancer risk = 100% by age 50 - Can treat with proactive colectomy - Sx: cancer sx, osteomas (non-cancerous bony growths, usually found on the jaw), benign skin changes, adrenal masses

FAP (familial adenomatous polyposis)

this is a long-term condition where acid from the stomach comes up into the esophagus (this occasionally happens to everyone, but a person is classified to having this condition if they experience acid reflux more than twice a week) - Pathogenesis/development: acid reflux --> inflammation of esophageal mucosa, erosion/ulceration --> pyrosis (heartburn), dysphagia - As an adaptive protective measure, the mucosa of the distal esophagus may undergo metaplastic change to mucin secreting epithelium (Barret esophagus). This will benefit because the new cells are more acid-resistant. However, it increases risk for cancer

GERD (gastroesophageal reflux disease)

Cervical squamous metaplasia and dysplasia is generally caused by _______ which targets immature squamous cells of the transformation zone - low grade changes may regress, persist, or progress to high-grade "squamous intraepithelial lesions" (SIL) - high-grade SIL may regress, persist, or progress to invasive carcinoma - Screen with pap smear

HPV

this viral STD is the most common STD with many subtypes that causes genital warts, as well as *precancerous and cancerous lesions* - Many people with are asymptomatic but can still infect others through sexual contact. - Sx: warts on the genitals or surrounding skin. - There's no cure for the virus and warts may go away on their own. Treatment focuses on removing the warts.

HPV (human papilloma virus)

this type of hepatitis is self-limited and acute - primarily affects children and young adults - Does *NOT* progress to chronic hepatitis - Transmission: Fecal-oral via contaminated (sea)food/water - 15-45 day incubation period prior to Sx onset - Sx: malaise, fatigue, anorexia, nausea, vomiting, potential abrupt fever, TTP liver, +/- jaundice - presence of IgM during acute illness and IgG after recovery - *Lifetime immunity acquired after person recovers*

Hep A (HAV - Hep A virus)

this type of hepatitis is a *more serious viral infection* acquired by *contact with blood or other bodily fluids* - 1-6 mo. incubation period (avg 2 mo.) with gradual onset of Sx (prominently jaundice due to hepatic damage) - Outcomes: most recover (fatal in less than 20% of cases) - Presence of viral antigens or antibodies to those antigens help establish the presence and severity of disease when assessing patient - there is a vaccine for this now

Hep B

this type of hepatitis was formerly known as non-A/non-B Hep; Most cases arise as a result of *exposure to contaminated blood or bodily secretions* - multiple sex partners & IV drug users = most common infected - easy blood-to-blood route transmission - *Most are asymptomatic* (goes unnoticed) - persistent infection and chronic hepatitis in the majority of infected patients (majority will develop chronic hepatitis)

Hep C

____________ is a common and highly contagious skin infection that mainly affects infants and children. It usually appears as red sores on the face, especially around a child's nose and mouth, and on hands and feet. The sores burst and develop honey-colored crusts - inflammatory disease caused by Group A Beta-hemolytic streptococcus in adults - in neonates and infants, caused by coagulase-positive staphylococci

Impetigo

this condition is characterized by damage of the glomerular capillaries by *immune-mediated* inflammation - S&S: *Hematuria*, *RBC casts in urine*, proteinuria, hypertension (HTN), azotemia (abnormally high nitrogen in blood), oliguria - Diseases associated with this condition: Acute proliferative (post-infection) glomerulonephritis, rapidly progressive glomerulonephritis

Nephritic syndrome

this is the most common joint disease of the body, affecting 80-90% of patients > 65 y/o - Pathogenesis: results from over-loading of normal joints or normal loading of an abnormal joint; chronic degenerative breakdown of cartilage in joints causing loss of joint space - Risk factors: obesity, trauma, diabetes, age - Clinical presentation: pain in WB joints (knees, hips, spine; + hands), morning stiffness (< 1 hr), pain that worsens with activity and improves with rest, no erythema or warmth, reduced joint ROM with crepitus (creaking)

OA (osteoarthritis) (aka DJD - degenerative joint disease)

___________ ___________ is a rare genetic disorder in which bones fracture easily. Sometimes the fractures happen for no known reason. This condition can also cause weak muscles, brittle teeth, a curved spine, and hearing loss. - Caused by gene mutation leading to abnormalities in collagen production, a protein that helps make bones strong. - Clinical Features: several types (depends on form of gene defect), Sx range from mild increase in Fx risk to lethal form in utero that causes multiple Fx's - can have thick skin, thin dermal enamel, blue sclera, hearing problems, hypermobile joints, and/or defective heart valves - Complications: brittle bones Fx easily - Clinical management: orthotics, Fx recognition, redding, exercise to improve bone and muscle stregth, avoid steroids

Osteogenesis imperfecta (OI)

____________ is a type of cancer that produces immature bone. It is the most common type of cancer that arises in bones, and it is usually found at the end of long bones, often around the knee - malignancy of osteoblasts - more common in younger patients (10-25 y/o), and more common in males - Clinical presentation: gradually worsening bone pain, often at night (wakes patient up), swelling, possible acute pain if bone Fx - Tx: based on surgical resection/amputation combined with chemo

Osteosarcoma

this renal condition is an inherited disorder in which *clusters of cysts* develop in the kidney over time and *interfere with filtration*; additional abnormalities are also present elsewhere in the body - Two forms: autosomal recessive (childhood) or autosomal dominant (adult)

PKD (polycystic kidney disease)

___________ is a skin disease that causes red, itchy scaly patches, most commonly on the knees, elbows, trunk and scalp; common, chronic disease with no cure. It tends to go through cycles, flaring for a few weeks or months, then subsiding for a while or going into remission. - non-infectious disorder that produces well circumscribed scaly lesions

Psoriasis

this common disease is a systemic autoimmune reaction causing chronic inflammation/destruction of the joints - most common in adults b/w 40-70, women affected more than men - affects small joints with symmetric distribution - unpredictable clinical course - Clinical Presentation: joints are warm, painful with swelling and stiffness that lasts > 1 hr, pain worse in the AM and with rest, improves with gentle movement, may result in joint deformities and contractures - can cause systemic disease due to wide spread inflammation

RA (rheumatoid arthritis)

(OA/RA) is an *autoimmune* disease that affects *middle aged* to older adults whereas (OA/RA) is common in almost all *older* adults with a more general disease progression. (OA/RA): affects larger WB joints, has no warmth/swelling, short lasting stiffness, Sx worsen with movement and improve with rest (OA/RA): affects smaller joints, has warmth/swelling, long lasting stiffness, Sx improve with gentle movement and worsen with rest - both are worse in the AM, affect joint spaces, and decrease ROM

RA, OA, OA, RA

Normal pathway of bilirubin metabolism - - Starts with ___________ being broken down and eaten by macrophages --> then is isolated in the spleen where _______ gets kicked out --> this heme is then turned into (unconjugated/conjugated) bilirubin --> once in the liver it gets (unconjugated/conjugated) and made ready for excretion --> stored in the bile duct and gallbladder --> excreted into the _____________

RBCs (erythrocytes), heme, unconjugated, conjugated, intestines (unconjugated biliruben can also be excreted into the kidneys directly)

_____________ ___________ is a painful infection in a joint. The infection can come from germs that travel through your bloodstream from another part of your body. Can also occur when a penetrating injury delivers germs directly into the joint. - Infants and older adults are most commonly affected. - Knees are most commonly affected, but can also affect hips, shoulders and other joints. - Bacterial infection with Staphylococcus aureus (staph) is the most common cause. - This condition can quickly and severely damage the cartilage and bone within the joint, so prompt treatment is crucial - Clinical presentation: acute onset of red, warm, painful joint with decreased ROM, may be accompanied by systemic symptoms

Septic arthritis

______________ is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on your genitals, rectum or mouth. It spreads from person to person via skin or mucous membrane contact with these sores - Primary form: develops 21 days post-infection with cancer at site of infection; resolves in several weeks - Secondary form: develops without treatment of primary form; lymphadenopathy, rash - Tertiary form: last phase, occurs w/o treatment; CV damage, neurologic damage - Congenital form: fetal malformations/abortions

Syphilis

this is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers in your digestive tract. It affects the innermost lining of your large intestine (colon) and rectum - having this puts a patient at *higher risk* for developing colon cancer - Recurrent acute & chronic inflammatory disease-causing extensive ulceration of the mucosal surfaces of the colon - Sx: abdominal pain, cramps, bloody diarrhea often followed by periods of emotional stress, wt loss, fever, electrolyte disturbances

Ulcerative colitis (Location: rectum, colon, terminal ileum Extent: continuous Other: mucosal, fistuala formation less frequent Cancer risk: yes/high)

this is viral infection that causes a painful rash. Can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso; Caused by the varicella-zoster virus - occurs in *partially immune* patients that have previously been exposed to the virus - caused by *reactivation* of latent virus harbored in cranial and/or spinal sensory ganglia - most cases occur in adults and are self-limiting - Cutaneous eruption follows the development of neuritic pain and typically consists of exquisitely painful, grouped papules on an erythematous based which rapidly becomes vesicular

Zoster (shingles)

what three conditions may predispose to the formation of gallstones (cholelithiasis): - gallstones are less common than renal stones and more frequently occur in obese women b/w 40-60 y/o - *cholesterol* is a main component of gallstones - Most are *asymptomatic* unless obstructing the cystic or common bile ducts (leading to cholecystitis)

abnormal bile composition, bile stasis (cholestasis = decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts), infection (of the gallbladder)

An ________ _________ is a rough, red-brown scaly patch on your skin that develops from years of *exposure to the sun*. It's most commonly found on your face, lips, ears, back of your hands, forearms, scalp or neck. - enlarges slowly and usually causes no signs or symptoms other than a patch or small spot on your skin. - These patches take years to develop, usually first appearing in people over 40. - small percentage can eventually become skin cancer (squamous cell carcinoma), particularly when they involve the ear, lip, or dorsum of hand

actinic keratosis (aka solar keratosis)

this visceral condition is commonly due to a gallstone being lodged within the gallbladder neck or cystic duct, but can also be due to bacterial infection - Sx: nausea, vomiting, severe right upper quadrant (RUQ) abdominal pain, fever, and elevated WBC counts (leukocytes) - Complications: perforation of gallbladder with subsequent peritonitis, pancreatitis, septicemia

acute cholecystitis

this condition is the sudden inflammation of the bladder - Causes: usually an *ascending infection* from the urethra, descending infection from the kidney, residual urine after micturation (incomplete emptying), external objects introducing infection - *Sx*: frequent need to urinate, sudden urgent need to urinate, lower abdominal pain (localized around bladder), dysuria, dyspareunia (painful intercourse) - *Lab Dx*: urinalysis (positive leukocyte esterase, increased WBCs, increased nitrite, increased bacteria), urine culture and sensitivity - *Tx*: antibiotics - If left untreated, can progress to pyelonephritis (kidney infection) which is potentially life threatening (can become septic or cause irreversible damage to kidney)

acute cystitis

this condition is characterized by the temporary inflammation of the lining of the stomach caused by injury, bacteria, viruses, stress, or ingesting irritants (e.g. alcohol, NSAIDs, steroids, spicy food) - Pathogenesis/development: injury/irritation/stress --> alterations in mucosal barrier and acid production --> mucosal damage (inflammation, hemorrhage, erosion) - Sx: gnawing/burning ache or pain (indigestion) in upper abdomen that may become either better or worse with eating.; nausea, vomiting, feeling of fullness, or asymptomatic - *Risk factors*: bacterial infection (H. pylori), regular use of pain relievers (aspirin, ibuprofen), older age (stomach lining tends to thin with age), excessive alcohol use, stress - Complications if left untreated: peptic ulcers, stomach bleeding

acute gastritis

this visceral condition results from sudden enzymatic necrosis of the pancreas and para-pancreatic fat - Cause: unknown, but associated with alcohol and gallstones - Pathogenesis: proteolytic destruction of pancreatic parenchyma & vasculature - Sx: sudden onset of abdominal pain (may radiate sharply into back) followed by rapid vascular collapse and shock - Mortality of first episode is 25%

acute pancreatitis

this stomach condition is an exaggeration of acute erosive gastritis, resulting in mucosal erosion into the submucosa - aka "stress ulcers" - Predisposing factors: steroid therapy, aspirin abuse, smoking - Pathogenesis: uncertain; may involve disturbances in vascular perfusion of mucosa, damage to mucosal barrier, and/or back diffusion of gastric acid - S&S: often asymptomatic, may cause mild-mod bleeding - Usually heal without sequelae once stressor has been removed

acute peptic ulcer

this disease is associated with nephritic syndrome and results from immune complexes formed after *streptococcal skin or pharynx infection* deposited in the kidneys and causes damage (~3 weeks post-infection) - usually happens in kids - typically an *acute, transient* process (common "renal" or "intrinsic" cause of AKI) - Process: deposition of *immune complexes* attracts WBCs which release catalytic enzymes --> damages cells leading to *RBC leakage* into urine --> cells proliferate as they recover leading to compression and decreasing blood flow --> less blood, less filtration --> *oliguria* (low/decreased urine output) - Prognosis: almost all children fully recover (95%), prognosis in adults is slightly poorer (~60% fully recover)

acute proliferative glomerulonephritis (post-streptococcal glomerulonephritis)

this condition is the acute inflammation of the parenchyma, calices, and pelvis of the kidney - usually results from an *ascending bladder infection* with *E.coli* being the most common agent - can also result from *hematogenous spread* (usually patient is septic and very sick) - Predisposing conditions: urinary tract obstruction, surgery/instrumentation, vesicourecteral reflux (urine backflow when bladder contracts due to dysfunction of the valve b/w ureter and bladder), pregnancy, pre-existing renal disease, or diabetes - Gross/macro view: patchy, pus, necrosis - *Sx*: abrupt onset of *fever and chills*, *CVA pain* (positive Murphy's percussion test), dysuria, urinary urgency and frequency - *Complications*: necrotizing papillitis (necrosis of medullary pyramids), pyonephrosis (pus fills renal pelvis), perinephric abscess - *Lab findings*: elevated WBCs, pyuria (WBCs in urine) with *WBC casts*, positive urine bacterial cultures

acute pyelonephritis ("pyelo" = pelvis, "nephro" = kidney, "itis" = inflammation) (Hematogenous spread - infection outside urinary tract with septicemia and bacterial embolization to the kidney; infection is in the blood and gets into the kidneys via arteries)

this condition is characterized by the rapid, frequently irreversible, loss of kidney function most often due to ischemic or toxic damage to the renal tubules - clinical onset begins gradually ~24-36 hours after initial insult - Decreased urine output and blood filtration lead to fluid overlaod, uremia (urine in the blood), and electrolyte retention - recovery of kidney function is heralded by diuresis which may cause electrolyte loss; may need dialysis support - as tubular damage is repaired, the diuresis abates and renal function returns to normal

acute renal failure (ARF)

this type of hepatic cirrhosis is the *most common* type of cirrhosis in the US and is a result of the *hepatotoxic effect of alcohol* - alcohol causes fatty changes in liver cells resulting in a large, yellow, greasy, smooth, soft liver - Over time fibrosis occurs; initially liver may be normal size with yellow-brown color with fine and uniform scars, later the liver becomes small and atrophic with a brown-green color - Sx: jaundice, portal HTN, endocrine disturbances, inability to metabolize endogenous estrogen, & hepatic failure with ensuing coma & death

alcoholic (cirrhosis)

what are the three main types of hepatic cirrhosis - Complications for all 3: portal HTN, increased risk for hepatocellular carcinoma, liver failure

alcoholic, post-necrotic, primary biliary

ABCDs of melanoma - prognosis for all melanomas is based on the depth of invasion (deeper the invasion = poorer the prognosis)

asymmetry, border, color, diameter

an absence or abnormal narrowing of an opening/passage in the body

atresia

this type of chronic gastritis is characterized by the body attacking the cells that make up your stomach lining; this reaction can wear away at your stomach's protective barrier Pathogenesis/development: parietal cells attacked by CD4+ T cells --> parietal cell destruction --> decreased HCl --> hypergastrinemia --> decreased intrinsic factor --> decreased B12 absorption --> pernicious anemia --> intestinal metaplasia --> dysplasia --> adenocarcinoma

autoimmune (chronic gastritis) (more common in people with autoimmune disorders like Type I diabetes or Hashimoto's)

this type of polycystic kidney disease (PKD) involves an inherited mutation in the PKD1 or PKD2 gene from one parent; incidence is slightly more common (~1:400-1:1,000) - Sx usually present between *ages 30-40* - Findings: variable, progressive kidney cyst formation and chronic kidney disease (pain in back and sides, high BP/HTN, UTIs, hematuria), intracranial aneurysms, can also affect liver, pancreas, spleen, seminal vesicle, and lungs

autosomal dominant PKD (adult PKD) (If you have a patient with this type of PKD and they have a sudden severe headache you need to suspect an aneurysm has burst)

this type of polycystic kidney disease (PKD) involves an inherited mutation in the PKHD1 gene from each parent; very rare incidence (~1:20,000 individuals) - Sx *present before birth or during early childhood* - Findings: multiple renal cysts and renal failure, congenital hepatic fibrosis (+/- hepatic and pancreatic cysts), *Potter syndrome*

autosomal recessive PKD (childhood PKD)

abnormally high nitrogen compounds *measurable* in the blood - measured via Blood urea nitrogen = BUN or creatine levels - when severe with clinical manifestations = uremia

azotemia

this term refers to inflammation of the glans of the penis from infection

balanitis

________ _______: characterized by intestinal metaplasia (cells change), normal tissue lining of the esophagus changes to tissue that resembles the lining of the intestines - adaptive protective mechanism where the distal esophagus may undergo metaplastic change to mucin secreting epithelium

barrett esophagus

(Squamous/Basal) cell carcinoma is the *most common malignant tumor of the skin* - related to *chronic sun radiation damage* and occurs on sun-exposed areas of skin; may also be a genetic component to it - most commonly occurs on *root of nose and scalp line* in a solitary translucent or "pearly" nodule with a depressed center and superficial veins - *rarely metastasizes*, but local infiltrative nature makes definition of the surgical boundaries difficult and recurrence is common

basal (BCC)

congenital narrowing or severe stenosis of all or a portion of the intrahepatic or extrahepatic biliary tree - results in jaundice, hepatic cirrhosis, and death within the first year of life - Tx: surgery or transplant

biliary atresia

this type of calculi develops when flow of urine becomes stagnant, urine becomes concentrated causing *minerals to crystalize* - Underlying Causes: bladder outflow obstruction due to urethral stricture or *enlarged prostate*, nerve damage, recurring UTIs, bladder diverticulum or cystocele (outpouching of the bladder where urine can get stuck and form a stone - Majority of these stones *occur in older male patients* - *Sx*: abdominal pain, hematuria (blood in urine), difficulty urinating, recurrent UTIs - Prevention/Tx: drinking adequate amounts of water, small stones often pass w/o intervention, larger ones may require surgical removal

bladder (calculi)

this condition is another name for squamous cell carcinoma of the vulva

bowen disease

what are the most common cancers/tumors that *metastasize to bones* - metastatic tumors are the most common bone tumors and clinically present as a gradual worsening of bone pain (often at night that wakes the pt up), swelling, and possible acute pain if bone Fx

breast, lung, thyroid, prostate, renal (BLT w/ Pickle and Relish)

a ________ is a fluid-filled sac or lesion that appears when fluid is trapped under a thin layer of your skin. It's a type of blister

bulla

Almost all cases of bladder cancer are: a. Ureter sarcoma b. Urethral lipoma c. Urothelial carcinoma d. Cystic carcinoma

c (urothelial carcinoma)

this is the *most common benign hepatic tumor*, found just below the liver capsule - usually asymptomatic and don't require treatment - rarely cause complications - may bleed and cause abdominal pain - can cause hemorrhage when biopsied

cavernous hemangiomas (Hepatic hemangiomas)

this reproductive cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. Most cervical cancers are this type - Risk factors: early onset of sexual activity & # of sexual partners, almost all are *associated with HPV infection* - Pathogenesis: *HPV infection* leads to dysplasia of cervical cells, eventually spreads to local surrounding viscera and then metastasizes via lymph nodes - Sx: Vaginal bleeding after intercourse, between periods or after menopause. Watery, bloody vaginal discharge that may be heavy and have a foul odor. Pelvic pain or pain during intercourse.

cervical squamous cell carcinoma

small lesions that occur when a non-immune person is exposed to the varicela-zoster virus

chicken pox

this bacterial STI is the most common STI in the US and often co-infects with gonorrhea - may cause reactive arthritis in patients with HLA-B27 gene

chlamydia

this is a less common type of malignant hepatic tumor that arises from the bile duct epithelium - Risk factor: chronic biliary tract disease - Sx: abdominal pain, jaundice, weight loss, generalized itching, and fever

cholangiocarcinoma

this condition is the inflammation of the bladder persisting over months or years; aka "painful bladder syndrome" - Cause: unknown - Occurs *most frequently in middle-aged women* - debilitating impact on quality of life; eval and Dx is controversial; bladder biopsy often done to rule out cancer - S&S: blood in urine - Tx: mostly symptomatic with PT and relaxation therapy

chronic (interstitial) cystitis

this visceral condition generally develops without a previous history of acute inflammation and is associated with pre-existing cholethithiasis (gallstones) - most frequently seen in obese, middle-aged females - Sx: recurrent attacks of epigastric pain w/ heartburn, excessive bowel gas, pain may radiate to R shoulder, pain after a fatty meal - Complications: sepsis, gallbladder perforation, fistula formation, increased risk for infection and cancer

chronic cholecystitis

a patient is said to have this diagnosis if they've had this condition for more than 6 months - often due to chronic alcoholism, Hep B, or Hep C - Many cases are asymptomatic, but milder cases have vague recurrent symptoms of malaise, weakness, loss of appetite, and occasionally mild jaundice - aggressive cases are characterized by progressive liver destruction - Complications: fatal (40% of cases), cirrhosis (40% of cases), increased hepatocellular carcinoma risk, ~20% spontaneously improve

chronic hepatitis

this visceral condition is characterized by repeated episodes of mild inflammation of the pancreas over the course of months-years - results in fibrosis of the pancreatic parenchyma - Cause: *alcohol abuse* (most common), duct obstruction, autoimmune disease, rare genetic abnormalities - Sx: repeated attacks of abdominal pain, may be totally asymptomatic until sufficient damage is done to produce symptoms

chronic pancreatitis

this condition results from acid-pepsin digestion of non-acid secreting mucosa; usually due to solitary lesions occuring in the duodenum or stomach - onset generally happens in mid-adult life - both duodenal and gastric types are associated with *H. pylori* bacterial infection - Clinical presentation: often asymptomatic, duodenal type may present with intermittent burning epigastric or substernal pain that begins a few hours after eating, gastric type may be irritated by food and induce vomiting leading to anorexia and wt loss

chronic peptic ulcers

this condition is characterized by recurrent infections of the kidney leading to scarring and renal failure - Usually caused by chronic *vesicoureteral reflux* (urine backflow when bladder contracts due to dysfunction of the valve b/w ureter and bladder) (years of reflux in same areas leads to blunted calices with overlying fibrosis) - Findings: may present with Sx associated with repeated bouts of acute pyelonephritis (back pain, fever, pyuria, bacteriuria), insidious onset presenting as renal insufficiency and HTN, progressive tubular damage leading (loss of ability to concentrate urine) to polyuria (urinating often) and nocturia (peeing at night)

chronic pyelonephritis

this condition is the result of gradual loss of kidney function reaching an advanced state and can no longer work to meet the body's needs - when blood filtration is 20-30% of normal, leading to azotemia (increased blood urea, nitrogen, and creatinine); frequently associated with HTN; patients cannot regulate H2O and electrolyte balance leading to *edema*, metabolic acidosis, and hyperkalemia (increased K+) - When filtration is 15-20% of normal, azotemia is complicated by Sx of uremic syndrome (dysfunction of multiple organ systems in combo w/ fluid, electrolyte, and acid/base disturbances) - When filtration is < 15% of normal these patients are classified as having end-stage renal disease (ESRD) and require long-term dialysis or kidney transplantation

chronic renal failure (CRF)

name one disease that can lead to an increase of *conjugated* bilirubin

cirrhosis of the liver (blocks extrahepatic ducts)

what are the 3 most common cancers that metastasize to the liver - with these, the liver is typically enlarged and contains multiple nodular tumor implants

colon (all of GI tract blood supply have venous drainage strait to liver, easy to metastasize here), lung, breast

this is the most common type of colon cancer; arises in a stepwise fasion of cell conversion: normal epithelium --> adenomatous polyps (growths) --> carcinoma - screening via colonoscopy looks for polyp adenomas --> remove them since they have high malignancy risk - typically affects older adults, though it can happen at any age. Usually begins as small, benign polyps that form on the inside of the colon. - polyps = generally asymptomatic - Sx: diarrhea or constipation, Rectal bleeding or blood in your stool, Persistent abdominal discomfort, feeling that your bowel doesn't empty completely, Weakness or fatigue, Unexplained weight loss - KRAS mutations can accelerate this process

colorectal carcinoma (colorectal adenocarcinoma)

this term refers to the condition where one or both of the testes fail to descend from the abdomen into the scrotum

cryptorchidism

what are the risk factors for developing a testicular tumor

cryptorchidism (testes don't descend into scrotum from embyologic position), genetics, testicular dysgenesis

Both cystic duct obstruction and common bile duct obstruction will produce symptoms of abdominal pain, nausea, and vomiting (Cystic duct/Common bile duct) obstruction may lead to *acute cholecystitis* (Cystic duct/Common bile duct) obstruction will lead to obstructive *jaundice* and possible *biliary cirrhosis*

cystic duct, common bile duct

group of superficial fungal infections that grow in keratinized tissues (hair, nails), producing irregular annular lesions with irregular interior clearing and peripheral scale

dermatophytosis

What are the two possible mechanisms through which drugs or toxins may cause liver injury

direct toxicity (degree of hepatic damage is directly proportional to amount of toxin; occurs w/ chloroform, mushroom poisoning, & carbon tetrachloride exposure), hypersensitivity reaction (degree of hepatic damage & necrosis is unpredictable; occurs w/ halothane anesthesia exposure if person is allergic)

This common colon disease develops when small pouches form in the colon wall and become infected, causing pain, fever and other constitutional symptoms - Pathogenesis: inherent weakness in bowel wall + elevated intraluminal pressure --> herniation of mucosa and submucosa through muscularis propria --> diverticulosis --> diverticulitis & perforation - common in people over age 40. Usually, no symptoms occur, unless the diverticula become inflamed or infected (diverticulitis) which can result in fever and abdominal pain.

diverticular disease of the colon

this condition may be caused by drugs or toxins and is characterized by inflammation of the spaces between the tubules of the kidney, impairing filtration - Drugs lead to this condition via *immunologic hypersensitivity* - Toxins lead to this condition via *direct damage* of renal tubular cells - *Sx*: fever, eosinophilia, +/- rash, abnormally high nitrogen compounds in the blood (azotemia), edema/inflammation - this condition begins ~15 days post-exposure to the drug/toxin - Tx: discontinue use of the drug/exposure to the toxin

drug induced tubulointerstitial nephritis

difficulty swallowing

dysphagia

Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches to the lining of the uterus. An _______________ pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus (usually in the fallopian tube) - Risk factors: fallopian tube damage (endometriosis, STI, prior surgery), IUD - If not Dx and treated quickly there is a risk of massive hemorrhage and fallopian tube damage/loss

ectopic

this condition is characterized by an inflammatory reaction of skin patches due to a wide variety of inciting agents - includes internal and external allergens (contact dermatitis), irritants, trauma, and certain microorganisms - Clinically presents as an initial lesion with erythema and edema with possible epidermal blistering - most cases = primary irritant contact dermatitis

eczema

what are potential causes of dysfunctional uterine bleeding (4)

endocrine disorders, adolescence (anovulatory cycles), endometrial hyperplasia, endometrial carcinoma

this type of cancer that begins in the uterus and is often detected at an early stage because it frequently produces abnormal vaginal bleeding - Presents as postmenopausal uterine bleeding - Risk factors: obesity, diabetes, HTN, infertility, also linked to prolonged or excessive estrogen stimulation - Prognosis based on depth and grade of tumor

endometrial adenocarcinoma

this term refers to the presence of endometrial glands outside of the uterus

endometriosis

this condition is the most common developmental abnormality of the esophagus, occurring near the tracheal bifurcation - results in a blind upper pouch that leads to excessive salivation and regurgitation of food

esophageal atresia

this condition happens when there is an increase in pressure in the portal venous system (enlarged veins in the esophagus often due to obstructed blood flow through the portal vein) - Pathogenesis/development: portal HTN --> increased flow to esophagus --> distension/enlargement of submucosal esophageal veins --> severe bleeding --> vomiting blood - tend to be superficial (towards the epithelium and lumen); if ruptured this can lead to significant bleeding since, unlike a cut on our skin, we cannot just apply direct pressure on the area and stop the bleeding

esophageal varices

Fill in the following structures based off their listed physiologic function - - ______________: moves food from mouth to stomach - ______________: digests food through acid; mixes & churns contents; temporary storage for food - ____________: enzymatic breakdown of food, nutrient absorption, vitamin B12 absorption -_____________: water and electrolyte absorption, produce and absorb vitamins, prep and move contents toward rectum for elimination

esophagus, stomach, small intestine (small bowel), large intestine (colon)

endometrial polyps (growths), hyperplasia, and adenocarcinoma are the result of *chronic excessive ___________ secretion* - polyps and adenocarcinoma occur post-menopausal - endometrial adenocarcinoma occurs if endometrial hyperplasia isn't treated

estrogen

what two conditions have potential to cause secondary biliary cirrhosis

extrahepatic biliary obstruction (the blockage of the normal flow of bile from the liver to the intestinal tract; most commonly caused by pancreatic disease or gallstones), biliary tract infection

this structure functions to transport the egg from the ovary to the uterus and carry sperm to eggs where fertilization might take place

fallopian (uterine) tubes

T/F: Primary liver tumors are more common in the liver than tumors that have metastasized from other areas in the body

false (cancers that metastasize to the liver are much more common causes of hepatic tumors compared to true primary liver tumors)

T/F: tumors (benign and/or malignant) of the gallbladder and extrahepatic ducts are quite common and occur most frequently in men

false (tumors of the gallbladder and extrahepatic ducts are RARE and are more common in WOMEN)

Acute cystitis is more common in (females/males), why?

females, length of urethra is shorter (compared to males)

an abnormal connection/passageway between two structures usually caused by an injury or surgery but can also result from an infection or inflammation

fistula

this is the most common cause of *nephrotic* syndrome in *adults* and is due to injury of podocytes and leakage of proteins leading to *progressive fibrosis* of the glomeruli; 3 types... - Primary: idiopathic/unknown cause - Secondary: due to drugs, HIV, diabetes, sickle cell disease - Genetic/Familial (rare) - Prognosis: ~50% of patients progress to end-stage renal disease (ESRD) within 10 years, variable responses to corticosteroid therapy

focal segmental glomerulosclerosis (focal = less than 50% of all glomeruli affected) (segmental = less than 50% of individual glomerulus affected)

this condition is the inflammation of hair follicles - Superficial: presents as pinhead-size pustules on an erythematous background, centered around hair follicles - Deep: presents as palpable dermal nodule

folliculitis

this organ *stores* bile, drains waste products from the liver into the duodenum, and controls the release of bile to help with digestion - 3 parts = fundus, body, neck

gallbladder

Pathogenesis of _______ ________ : H. pylori infection --> chronic inflammation --> metaplasia (goblet cells) --> dysplasia --> adenocarcinoma - adenocarcinomas in this area of the body typically present *late stage* due to non-specific symptoms such as anemia, wt loss, or anorexia; - these tumors don't tend to obstruct anything, cause bleeding, or cause very much pain - Risk factors: H. pylori infection, nitrosamines (dietary)

gastric malignancies

Name the condition based off the following information - - Potential causes: developmental or acquired pyloric stenosis, cancer - S&S: dysphagia, starvation (obstruction of lumen), erosion into trachea (fistula formation) can lead to aspiration (of GI contents into lungs) --> pneumonia, erosion into the aorta can lead to hematemesis and exsanguination (bleeding to death)

gastric obstruction

this is a viral STD caused by two types of viruses. The viruses are called herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) - can cause life-threatening infection in newborns or immunocompromised patients - Sx: Pain, itching, and small sores appear first

genital herpes

acute inflammation of the kidney, typically caused by an immune response

glomerulonephritis

this bacterial STD is quite common and causes an inflammatory reaction that most often affects the urethra, rectum or throat - males may have purulent urethral discharge and can cause prostatitis, epididymitis, and orchitits - females may get an infection in their fallopian tubes, a tubo-ovarian abscess, and pelvic inflammatory disease - scarring of fallopian tubes can predispose to ectoptic pregnancy --> infertility - disseminated infection can occur, including septic arthritis - can damage eyes of infants born to infected mothers --> blindness

gonorrhea

_________ is a common and complex form of arthritis that can affect anyone. It's characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the *big toe*. - Pathogenesis: joint damage due to deposition of monosodium urate crystals - Clinical presentation: acute attacks with red, warm joint, throbbing pain with gradual resolution; can produce granulomatous formations and bone deformity

gout

vomiting blood

hematemesis

The passage of fresh blood through the anus, usually in or with stools

hematochezia

name one disease that can lead to an increase of *unconjugated* bilirubin in the serum

hemolytic anemia (increased destruction of RBCs)

this condition is extremely common in the general population, but unusual before the age of 30 - Pathogenesis: portal HTN/pregnancy/straining (constipation) --> increased venous pressure --> submucosal dilated veins --> bleeding thrombosis - *most common cause of rectal bleeding* - Can be internal (dilated veins beneath rectal mucosa) or external (dilated veins beneath anal mucosa)

hemorrhoids (anal varices)

this type of hepatic tumor is *benign*, quite rare, and most common in young women who take oral contraceptives - risk of rupture, but not common

hepatic adenoma (hepatocellular adenoma)

this condition is can be caused by many things including a single episode of massive destruction to the liver, chronic liver problems with minimal marginal reserve function, viral hepatitis, cirrhosis, or as a result of complications from many diseases - Clinical features: *jaundice*, hepatic encephalopathy, increased # of astrocytes, asterixis ("*flapping*" tremor of the hands), failure to metabolize estrogens (leading to accumulation), Fetor hepaticas ("breath of the dead"), hepatorenal syndrome, loss of protein synthesis, inability to story glycogen (hypoglycemia) - can be *reversible* due to regenerative capacity of liver

hepatic failure (hepatic encephalopathy = decline in brain function that occurs as a result of severe liver disease; can result in personality alterations, confusion, decreased alertness, mild lethargy, or coma) (Fetor hepaticus = pungent sweet-sour odor generally present, especially in urine)

__________ = inflammatory disease of the liver, often caused by viral infections in the US - 3 main subtypes: A, B, & C

hepatitis

this is the *most common primary malignant hepatic tumor* that arises from hepatocytes - Predisposing factors: chronic hepatitis, cirrhosis, chronic alcoholism - Can appear multifocal with invasion into hepatic veins - Sx: hepatomegaly with abdominal pain, fatigue, wt loss, liver dysfunction, jaundice - Poor prognosis, these tumors tend to recur (18% 5 yr survival rate)

hepatocellular carcinoma

_____________ is caused by ureteral obstruction due to a stone or other causes - condition that typically occurs when a kidney swells due to urine failing to properly drain from the kidney to the bladder - can lead to acute kidney injury or kidney failure

hydronephrosis

this condition is the dilation of the renal pelvis and calices due to *ureteral obstruction* (caused by a stone or other object) - "post-renal" form of acute kidney injury (AKI) - can be unilateral or bilateral - acute obstruction is usually painful (back pain); gradual obstruction can be painless - Can lead to the *progressive atrophy of the kidney* leading to *kidney failure* (irreversible after ~3 wks of complete obstruction or several months or partial obstruction) - Tx of renal stones: medication (pain relief, breakdown of certain types of stones), lithotripsy, ureteroscopy

hydronephrosis

this term refers to the condition where the fallopian tube is blocked with water

hydrosalpinx

There are a wide variety of *drugs* that may produce renal injury, specifically, *interstitial nephritis* through ___________ ____________ - Common drugs that may cause this: NSAIDs, diuretics, synthetic penicillin, misc. drugs

immunologic hypersensitivity

Stages of fracture healing

impact (immediate), induction (min/hr following), inflammation (1/2 wks), soft callus (2/3 wks), hard callus (3/5 wks), remodeling (6/8 wks-few yrs)

what three conditions can lead to hyperbilirubinemia: - cause can usually be determined by measuring levels of unconjugated and conjugated bilirubin in the blood and the amount of liver enzymes in serum

increased destruction of RBCs (e.g. hemolytic anemia), failure of hepatocytes to take up/convert unconjugated bilirubin to conjugated bilirubin (may be congenital or acquired), blockage of extrahepatic ducts (due to tumors, scarring, etc)

what are the two types/causes of chronic gastritis

infection, autoimmune

this type of chronic gastritis is typically caused by the bacteria *H. pylori* - chronic inflammation from this bacteria leads to ulcer formation --> intestinal metaplasia (cells change) to create a more basic pH (H. pylori likes to live in v acidic conditions) --> pH change leads to dysplasia --> adenocarcinoma

infectious (chronic gastritis)

inflammation of the spaces between the tubules of the kidney, impairing filtration

interstitial nephritis

________ is the result of increased levels of unconjugated or conjugated bilirubin in the blood producing a yellow-green coloration of the tissues - caused by *hyperbilirubinemia*

jaundice (fancy term for jaundice = icterus)

this is a condition in which brain damage occurs when there is a large level of unconjugated bilirubin in the blood (> 20 mg/dL), this exceeds the ability of albumin to bind it and allows it to cross the BBB - condition in newborns with jaundice

kernicterus

this term refers to a specific epithelial cell type that develops after HPV infection

koilocytosis

this term refers to the use of *sound waves* to break up a calculi/stone

lithotripsy

this condition refers to a *tear* or laceration of the mucous membrane, most commonly at the point where the esophagus and stomach meet, that may result in severe bleeding from the GI tract - Pathogenesis/development: forceful vomiting (from bulimia, alcohol abuse, etc) --> mucosal tearing at the gastroesophageal (GE) junction --> hemorrhage --> hematemesis (vomit blood)

mallory-weiss syndrome

_______ _______ _______ are the most common type of ovarian germ cell tumour. - They are benign. - often called a dermoid cyst. - They are most common in women during their reproductive years (from teens to 40s) - comprised of all 3 germ layers (endoderm, mesoderm, ectoderm)

mature cystic teratomas

this condition is an outpouching or bulge in the lower part of the small intestine. The bulge is congenital (present at birth) and is a leftover of the umbilical cord. - this is the most common congenital defect of the gastrointestinal tract - Caused by incomplete obliteration of the vitelline duct - Pathogenesis: persitence of proximal vitelline duct --> formation of true diverticulum of wall --> heterotrophic gastric mucosa --> peptic ulcer - Sx: generally asymptomatic, may have GI bleeding, abdominal pain/cramping, tenderness near navel, bloating, diarrhea, constipation, or vomiting

meckel diverticulum

dark sticky feces containing partly digested blood

melena

this is the 2nd most common cause of *nephrotic* syndrome in *adults* and is characterized by immune complexes being deposited in the basement membrane (BM) causing damaging and thickening, giving it a "*spike & dome*" appearance and makes the BM permeable to large proteins - Primary cause: idiopathic/unknown (more common) - usually an insidious onset that is slowly progressive - Secondary cause: drugs, infections, tumors, lupus - approx. 40% of patients with this condition with develop renal failure

membranous nephropathy

this term refers to profuse or prolonged bleeding during a woman's period

menorrhagia

this term refers to irregular bleeding between periods

metrorrhagia

this condition is the most common cause of *nephrotic* syndrome in *children* (can also occur in adults) - Unknown cause; minimal or no change in glomeruli except for podocyte abnormalities - Podocytes assist with selective filtration, but abnormal changes cause dysfunction leading to *leaky filtration* (allowing proteins like albumin to pass through into the urine) - Sx: massive loss of protein in the urine leading to low protein levels in the blood, and development of edema - Prognosis: most children respond to *corticosteroid* therapy, adults respond more slowly; overall *excellent prognosis* in children and adults

minimal change disease

this condition of the kidney is a result of damage due to *hypertension* (HTN) - chronic HTN leads to sclerosis and stiffening of the renal arterioles - the renal arterioles and smaller arteries becomes *thickened* and vascular lumens become *narrowed* leading to microscopic *ischemic changes* including glomerular damage, tubular atrophy, and interstitial fibrosis - "Benign" = occurs slowly with age (severity correlates with BP) - "Malignant" = occurs with malignant HTN (diastolic BP > 130 mmHg), vessels feature intimal thickening, fibrinoid necrosis, RBC fragmentation, and thrombosis. Leads to other issues in other organs, and likely death

nephrosclerosis

this condition is characterized by dysfunction/damage of the glomerulus that allows *large* amounts of *proteins* to pass in the urine - S&S: *Proteinuria* (> 3.5 g/day), hypoalbuminemia, edema (begins in the face), hyperlipidemia, lipiduria - Process: Loss of albumin (most common protein in the blood) --> *hypoalbuminemia* --> reduced oncotic pressure w/in blood vessels ---> fluid moves into tissues --> edema --> liver increases synthesis of lipoproteins --> *hyperlipidemia* --> increased lipids go through damaged glomerulus without proper filtration --> *lipiduria* - Primary causes: minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy - Secondary causes: diabetic nephropathy, lupus nephritis, Hep B, Hep C, HIV, amyloidosis

nephrotic syndrome

this term is another name for mole or birthmark

nevus

low or decreased urine output

oliguria

a small elevated bump on the skin that forms in response to various diseases, infections, or simple things like razor burn or goosebumps

papule

this is a rare reproductive cancer that occurs in males, generally 40-70 years of age; begins in flat cells in the top layer of the skin - associated with HPV infection - smoking increases risk - Lesions appear as white, plaque-like lesion which eventually ulcerates; preceded by a painless red or white thickening of the skin - S&S: sores or other skin changes, discharge, and bleeding

penile invasive cell carcinoma

elevated superficial lesion that may be scaly or pruritic depending on its cause

plaque

The following signs and symptoms are associated with what hepatic condition - - congestive splenomegaly (abnormally enlarged spleen) - esophageal varices - abdominal vein distension/swelling - hemorrhoids - ascites (abnormal buildup of fluid in the abdomen)

portal HTN (hypertension)

this type of hepatic cirrhosis can follow any cause of extensive liver damage/necrosis (viral/toxic/immune) - the live may appear normal or shrunken with irregular, thick bands of scar tissue - Complications: portal HTN, increased risk for hepatocellular carcinoma, liver failure

post-necrotic (cirrhosis)

this condition is characterized by the following process - - Bilateral renal agenesis (lack of formation) leads to lack of urine --> deficient amniotic fluid (oligohydramnios) --> prevents lungs from developing --> stillbirth or death soon after birth due to pulmonary hypoplasia

potter syndrome

this type of hepatic cirrhosis is caused by autoimmune disease in which the intrahepatic bile ducts are destroyed gradually - causes green liver - obstruction of bile flow results in jaundice - Usually seen in middle-aged females with a Hx of pruiritis (buildup of bile acids in serum) prior to jaundice development - Sx: chronic itching, mild scleral icterus, raised plaques around eyelids - MOI: prolonged cholestasis --> inflammation --> periportal fibrosis --> cirrhosis - Complications: portal HTN, increased risk for hepatocellular carcinoma, liver failure

primary biliary (cirrhosis) (cholestasis = decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts)

this is the most common form of cancer in men with a relatively low mortality rate - Risk factors: age, genes, environment, hormones - generally asymptomatic - Dx with PSA test, palpable with rectal exam, or needle biopsy - can metastasize (often to bone)

prostatic adenocarcinoma

what are the 4 main functions of the liver

protein synthesis (albumin, coagulation factors), waste removal (nitrogen, ammonia - toxic if not broken down), detoxification (drugs, chemicals, etc. broken down so they can be excreted into bile or eliminated by kidneys), bilirubin metabolism and excretion

a small blister or pimple on the skin containing pus.

pustule

a type of urinary tract infection (UTI) that generally begins in the urethra or bladder and travels to one or both of the kidneys

pyelonephritis

this term refers to the condition where the fallopian tube fills up and swells with pus

pyosalpinx

this disease is associated with nephritic syndrome and results from something strongly activating neutrophils to release lots of lytic enzymes leading to *severe and rapid* glomerular injury and loss of kidney function - usually happens in adults - about half are idiopathic (don't know the cause) and about half are associated with an underlying disease - Characteristic finding = glomerular crescent formation - renal failure occurs within weeks/months of onset of symptoms (Sx: hematuria, oliguria, RBC casts in urine, proteinuria)

rapidly progressive glomerulonephritis

the backward reflux of urine from the bladder into the kidney due to obstruction

reflux nephropathy

this type of calculi is more common in patients - Risk factors: *dehydration*, *low urine volume*, hypercalciuria - Large stones may remain in the renal pelvis (some asymptomatic, others may cause hematuria or predispose to infection) - small stones may pass into ureters and produce colic and ureteral obstruction (ureter obstruction pain often described as *radiating from flank to groin*) - Prevention/Tx: drinking adequate amounts of water, small stones often pass w/o intervention, larger ones may require surgical removal

renal (calculi; Nephrolithiasis)

this congenital/developmental disorder of the kidney can be unilateral or bilateral - Unilateral = missing one kidney; affects 1 in ~2,000; usually asymptomatic; generally incidental finding via imaging for other reasons - Bilateral = missing both kidneys; fatal disorder; associated with *Potter syndrome*

renal agenesis

this is the most common *malignant renal tumor in adults* that is characterized by cancer of the renal tubular cells and tends to occur in mid-late adult life (60s-70s) - Greatest risk factors are *lifestyle related*: smoking, obesity, HTN - Sometimes produce abnormal hormones leading to systemic symptoms (*paraneoplastic effects* - polycythemia/increased RBC production, HTN, hypercalcemia) - Generally asymptomatic and discovered incidentally; initially present with hematuria; may develop flank pain & abdominal mass - Prognosis: need to know whether or not the tumor has *invaded the renal vein* (if yes, tumor will easily metastasize via bloodstream) - Highly unpredictable clinical course because it can metastasize widely (especially to lung and bone) - Tx: nephrectomy, chemo and radiation (if metastasized)

renal cell carcinoma (RCC)

when blood flow to the kidneys is decreased, what system is activated

renin-angiotensin system (activation of this system causes Renal Arterial Stenosis which may cause HTN, so the kidney wouldn't be increasing BP because there's true hypovolemia but instead it's a result of the stenosis of the vessel providing it blood)

(Left/Right)-sided colon cancer presents as chronic bleeding, causing blood in stool and weakness realted to iron-deficient anemia and weight loss (Left/Right)-sided colon cancer presents as rectal bleeding and obstructive symptoms (constipations, decreased caliber of stools) - colon cancer metastasizes most frequently to the *liver*

right, left

__________ ________ is a common *benign* skin growth. People tend to get more of them as they get *older* and are associated with *sun exposure* - usually brown, black or light tan. The growths look waxy, scaly and slightly raised. They usually appear on the head, neck, chest or back. - harmless and not contagious. They don't need treatment, but you may decide to have them removed if they become irritated by clothing or you don't like how they look. - *most frequent "tumor" of the skin*

seborrheic keratosis

this condition of the kidney may be congenital or acquired and is the *most common* type of cystic renal lesion - single or multiple - vary in size - rare before age of 40, but increases in frequency as one ages - usually asymptomatic - Gross/Macroscropic view: translucent, smooth lining, filled with clear fluid - Needs to be differentiated from renal malignancies

simple cortical cysts

Fill in the term that goes with the following Fx descriptions - - _________ Fx: simple Fx line - _________ Fx: multiple Fx lines & fragments - _________ Fx: Fx extending from one side of the bone to the other - _________ Fx: Fx that does not extend the full thickness of the bone - _________ Fx: Fx in which the overlying skin is intact - _________ Fx: Fx in which the overlying skin is disrupted - _________ Fx: Fx occurring without evidence of trauma - _________ Fx: Fx occurring in a structurally abnormal bone that cannot withstand normal outside pressure and tension (e.g. osteoporosis) or in bone that has been destroyed by a pathologic process (e.g. tumor) - _________ Fx: occur when the bony block or vertebral body in the spine collapses, which can lead to severe pain, deformity and loss of height. These fractures more commonly occur in the thoracic spine - _________ Fx: Fx occuring in the vertebral bones secondary to osteoporosis - __________ Fx: Fx causing bending of the bone rather than a break

simple, comminuted, complete, incomplete, closed, open (compound), spontaneous, pathologic, compression, linear stress, greenstick

(Squamous/Basal) cell carcinoma *usually arises from areas of actinic (solar) keratosis*, especially on the lip and ear - related primarily to sun exposure - begin as indurated keratoses that eventually become nodular and tend to ulcerate - cutaneous tumors of this type have a *much lower metastatic potential* than those arising from mucous membranes

squamous (SCC)

condition in which widened venules (tiny blood vessels) cause threadlike red lines or patterns on the skin; associated with basal cell carcinoma

telangiectasia

the esophagus runs next to two other passageways of great clinical importance: the ______ and the _________ - the esophagus also marks the transition from a neutral environment to an acidic one as it joins the stomach

trachea (air), aorta (blood)

this condition is a byproduct of esophageal atresia and is characterized by the lower segment of the esophagus being connected to the trachea or bronchus - can result in a distended stomach and can produce coughing spasms related to reflux of gastric secretions

tracheoesophageal fistula

T/F: the kidneys can be damaged by high BP and also *cause* high BP

true (when blood flow to kidneys is decreased the renin-angiotensin sys is activated causing Renal Arterial Stenosis which may cause HTN, so the kidney wouldn't be increasing BP because there's true hypovolemia but instead it's a result of the stenosis of the vessel providing it blood) (restoration of blood flow by expanding the lumen can completely reverse HTN caused by the kidneys)

this is a group of renal diseases involving inflammatory injuries of the tubules and interstitium - diverse causes and different mechanisms (infections, toxins, contrast agents, metabolic disease, neoplasms, immunologic reactions, vascular disorders)

tubulointerstitial nephritis

this term literally means urine in the blood and is due to high levels or urea and other waste products building up in the body - this is a complication of both chronic kidney disease (CKD) and acute kidney injury (AKI) - Sx: nausea/vomiting, fatigue, wt loss, muscle cramps, mental status change (confusion, agitation, seizure, coma), easy/spontaneous bleeding (platelet dysfunction), SOB, arrhythmia - Tx: generally dialysis

uremia

these are tiny, tube-shaped particles that can be found when urine is examined under a microscope. - may be made up of WBCs, RBCs, kidney cells, proteins, or fats - form in the tubules of the kidneys - if these particles are made up of RBCs and present in the urine indicates that the source of hematuria is within the kidney (not from renal pelvis, ureter, or bladder) - if these particles are made up of fats/lipids are present this is usually a result of nephrotic syndrome

urinary casts

this condition is cancer of the epithelial cells of the renal pelvis (can also happen in the bladder) - comprises 5-10% of malignant renal tumors in adults - 50% of patients have a coexisting or previous cancer of the bladder - Due to its location, this tumor tends to fragment and produce *painless hematuria* fairly early (therefore, usually discovered when small) - If not caught early, these tumors infiltrate the wall of the pelvis frequently and have a poor prognosis - Tx: nephrectomy +/- chemo and immunotherapy depending on spread

urothelial carcinoma

this condition of the bladder is most commonly seen in *males* in their *50s-60s* - Causes: *smoking* (tobacco), occupational hazards (industrial aromatic amines - used in textile dye and rubber industry) - Initially asymptomatic; usually the *earliest Sx is painless hematuria*, may progress to patient having frequent, urgent, painful urination - Majority are *superficial*, non-invasive, low-risk of recurrence or progression to invasive - Often *multifocal* (geographically and chronologically) in that patient's with this condition tend to have *multiple tumors* synchronously or metachronously (over different periods of time) - tumors can be anywhere there is urothelium (bladder, ureter, pelvis of kidney)

urothelial carcinoma (minority of these tumors are invasive/malignant - invasive tumors of this type are associated with high morbidity/mortality since they present so subtly and Sx don't appear until significant damage has been done)

neoplasms in this reproductive area are the most common tumor in females during reproductive life - usually asymptomatic, but may have abnormal menstrual bleeding and pain - multiple generally present in varied size, these tumors will decrease in size after menopause due to decreased estrogen

uterine myometrium

this reproductive cancer may arise as primary tumors in the upper portion of the vaginal canal in older women - usually brought to clinical attention due to bleeding or abnormal vaginal discharge - Cancer that forms in the thin, flat cells lining the inside of the vagina - spreads slowly and usually stays near the vagina, but may spread to the lungs, liver, or bone. - This is the most common type of vaginal cancer

vaginal squamous cell carcinoma

this is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab over. It usually starts on the chest, back, and face. - results from exposure of a *non-immune* person to the virus, *usually occurs in children* - followed by a general cutaneous eruption within 2 weeks - lesions begin as small papules that develop into umbilicated vesicles and then crust - vaccine is available

varicella (chickenpox)

what are 3 mechanisms through which *chronic hepatitis* may develop

viral induced (90%/majority of cases), drug induced, autoimmune

This cancer begins in the thin, flat cells that line the surface of the vulva - Two distinct forms: high-risk HPV-associated and HPV-negative - Gross/macro view: multicentric (geographically and temporally), firm, possible ulceration - S&S: itching and local discomfort

vulvar squamous cell carcinoma (HPV associated form - cig smoking and immunosupression lead to increased risk) (HPV negative - older, post-menopausal women)

this is the most common *pediatric renal malignancy*, being the 4th most common of all childhood tumors with a peak incidence between 2-5 y/o - Sx: palpable *abdominal mass or swelling* = most common initial Sx, abdominal pain, hematuria - *Lung metastasis* is common - Prognosis: used to be v deadly but now has ~90% 5-yr survival rate - Tx: nephrectomy +/- chemotherapy and radiation

wilms tumor

what are the 3 major forms of renal malignancies/tumors

wilms tumor, renal cell carcinoma, urothelial carcinoma