Patho Exam 4

primary adrenal insufficiency caused by destruction of adrenal gland

Addison's disease

glucose transporter present in all tissues and does not require insulin action to transport glucose into cells of the nervous system

GLUT-1

major transporter of glucose into beta cells and liver cells only when plasma glucose levels are high (e.g., after a meal)

GLUT-2

insulin-dependent glucose transporter that is sequestered inside the membrane of skeletal muscle and adipose tissue cells

GLUT-4

The most common cause of hyperthyroidism is _____, which is accompanied by ophthalmopathy and diffuse goiter. Many of the manifestations of hyperthyroidism are related to the increase in ____ consumption and use of ____ fuels associated with the hypermetabolic state, as well as to the increase in sympathetic nervous system activity.

Graves disease; oxygen; metabolic

autoimmune disorder in which the thyroid gland may be totally destroyed; presents with hypothyroid

Hashimoto thyroiditis

occurs primarily by the fecal-oral route with fecal shedding about 2-3 weeks before symptoms occur

Hepatitis A

inoculation with infected blood and/or spread by oral or sexual contact

Hepatitis B

most common cause of chronic hepatitis, cirrhosis, and hepatocellular cancer in the world

Hepatitis C

coinfection or superinfection linked to HBV

Hepatitis D

high mortality rate in pregnant women; does not cause chronic hepatitis or the carrier state

Hepatitis E

functional GI disorder characterized by variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities; characterized by abdominal pain relieved by defecation and associated with change in consistency or frequency of stools

IBS

Adenomatous polyps are benign neoplasms that arise from the mucosal epithelium of the intestine. ____ are found mostly in the sigmoid colon and are broad-based, elevated lesions with a shaggy cauliflower-like surface; while ____ are smooth-surfaced spheres less than 2 cm that attach to the mucosal surface by a stalk. The _____ form appears as both tubular and villous.

Villous adenomas; tubular adenomas; tubulovillous

polypeptide co-secreted by beta cell and acts as a hormone producing inhibition of gastric emptying and glucagon secretion

amylin

manifestations of untreated congenital hypothyroidism

cretinism

secrete somatostatin

delta cells

Difficulty in swallowing is termed dysphagia, which may be caused by _____ . Check all that apply.

disruption of neural networks coordinating the swallowing mechanism weakness of the oropharyngeal or esophageal muscular structures narrowing of the esophagus lack of salivary secretion

eyelid retraction, bulging eyes, light sensitivity, discomfort, double vision, and vision loss

ophthalmopathy

conversion of amino acids to ketoacids and ammonia

oxidative deamina

The pancreas is made up of 2 major tissue types. The ____ secrete digestive juices into the duodenum and the ___ secrete hormones into the blood.

pancreatic acini; islets of Langerhans

deficiency of all pituitary-derived hormones

panhypopituitarism

inflammatory condition of the lining of the abdominal cavity with translocation of extracellular fluid into the cavity

peritonitis

______ results from absent mesenteric ganglia that carry vagal fibers to the lower esophageal sphincter resulting in incomplete relaxation of the lower esophageal sphincter and stasis of food.

primary achalasia

large molecule in the beta cells composed of A and B chains connected by a connecting peptide chain

proinsulin

infectious enterocolitis most severe in children 3-24 months presenting with fever, vomiting, frequent watery stools

rotavirus

diarrhea occurring with fecal impaction, fat malabsorption, chronic laxative abuse, etc. when secretory processes of the bowel increased

secretory diarrhea

polypetide hormone with 14 amino acids and short half-life secreted by delta cells; inhibits release of insulin and glucagon and extends the time during which food is absorbed into the blood

somatostatin

growth hormone-secreting cells

somatotropes

fatty infiltration of the liver

steatosis

Curling ulcer that may develop when person has large-surface-area burns, trauma, sepsis, ARDS, severe liver failure or major surgical procedures

stress ulcer

Thyroid hormones are bound to ____ and other plasma proteins for transport in the blood. Measures of these thyroid hormones, T3, T4, and TSH, are obtained through _____ methods.

thyroxine-binding globulin; immunoassay

diarrhea and rectal bleeding common

ulcerative colitis

intestinal mucosa primary level of involvement with continuous lesions

ulcerative colitis

primarily occurs in rectum and left colon

ulcerative colitis

ulcerative and exudative inflammatory process

ulcerative colitis

Hyperthyroidism that is inadequately treated can cause a life-threatening condition known as thyroid storm. What are the manifestations of a thyroid storm? Mark all that apply.

very high fever tachycardia delirium

infectious enterocolitis that produces Shigella-like toxins that attach to and damage the mucosal lining of the intestine, causing bloody diarrhea

E. coli

Colorectal cancer arises from preexisting adenomatous polyps and has had a reduced incidence in recent years due to routine screening with CT scans and/or pelvic MRI.

False

_____ commonly presents in infancy as failure to thrive resulting from a T-cell-mediated immune response due to dietary intake of gluten.

celiac disease

occurs when bile flow is obstructed between the liver and the intestine

cholestatic jaundice

Gallstones are caused by precipitation of substances contained in bile, including ______. Select all that apply.

cholesterol bilirubin

absence of grossly visible erosions with presence of inflammatory changes leading to atrophy of glandular epithelium of stomach

chronic gastritis

autoimmune gastritis affects the body and fundus of stomach with hypergastrinemia and hyperplasia of antral gastrin-producing cells

chronic gastritis

chemical gastropathy with gastric injury resulting from reflux of alkaline duodenal contents, pancreatic secretions and bile into the stomach

chronic gastritis

often caused by H. pylori gastritis of the antrum and body of stomach

chronic gastritis

Peptic ulcer disease describes a group of ulcerative disorders that occur in areas of the upper gastrointestinal tract that are exposed to acid-pepsin secretions. Select all true responses about this condition from the list below.

clinical manifestations include burning, gnawing, cramp-like pain occurring when stomach empty and relieved with food intake risk factors include H. pylori infection, NSAID or aspirin use most common forms are duodenal and gastric ulcers complications include hemorrhage, perforation, penetration and gastric outlet obstruction exacerbations of this condition may last for weeks followed by periods of remission

increases protein synthesis in all body cells, mobilizes fatty acids from adipose tissue and antagonizes effects of insulin

growth hormone

glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide that stimulate insulin secretion after heavy carbohydrate meal

gut-derived hormone

Growth hormone cannot directly produce bone growth; instead, it acts indirectly by causing the liver to produce insulin-like growth factor. The secretion is stimulated by ____ . Select all that apply.

heavy exercise hypoglycemia increased blood levels of amino acids fasting and starvation emotional stress

Approximately 300 mL of blood per minute enters the liver through the __________ ; another 1050 mL per minute enters by way of the ____________ .

hepatic artery; portal vein

diarrhea occurring when water is pulled into the bowel by the hyperosmotic nature of its luminal contents when saline cathartics used or in instances of lactase deficiency

hyperosmotic diarrhea

decreased secretion of pituitary hormones

hypopituitarism

In an acute adrenal crisis, the onset of symptoms is sudden, and in the case of Addison disease, can be precipitated by exposure to a minor illness or stress. Mark all of those manifestions of an acute adrenal crisis.

hypotension muscle weakness vascular collapse dehydration

Select the major functions of the thyroid hormone that make it necessary for growth and development in children.

increase protein synthesis increase metabolism

Portal hypertension is characterized by _______ Select all that apply.

increased resistance to flow in the portal venous system sustained increase in portal venous pressure

manifestations that result from activation of inflammatory cells in the bowel with elaboration of inflammatory mediators causing nonspecific tissue damage; characterized by remissions and exacerbations of diarrhea, fecal urgency and weight loss

inflammatory bowel disease

Malabsorption syndrome is the failure to transport dietary constituents, such as fats, carbohydrates, proteins, vitamins, and minerals, from the lumen of the intestine into the extracellular fluid compartment for transport to various parts of the body. What are the major clinical manifestations of this condition? Select all that apply.

macrocytic anemia, glossitis, peripheral neuropathy bruising, bleeding, bone pain, predisposition to fractures, tetany weakness, muscle wasting, weight loss and abdominal distention failure to absorb fat-soluble vitamins diarrhea, steatorrhea, flatulence, bloating, abdominal pain and cramps

What are the clinical manifestations and causes of Mallory-Weiss syndrome? Select all that apply.

may occur during acute illness with severe vomiting hematemesis chronic alcoholism causing severe retching and/or vomiting nonpenetrating, longitudinal mucosal tears in esophagus at gastroesophageal junction

The term Cushing syndrome refers to the manifestations of hypercortisolism from any cause. From the list below, mark the typical manifestations of this condition.

moon face protruding abdomen thin extremities and muscle weakness buffalo hump

The term ______ implies the presence of a nonpitting mucus-type edema caused by the accumulation of hydrophobic extracellular matrix substances in the connective tissues of a number of body tissues.

myxedema

One of the jobs the liver performs is to export triglyceride. When the liver's capacity to export triglyceride is maximized, excess fatty acids accumulate in the liver. What is the disease these excess fatty acids contribute to?

nonalcoholic fatty liver disease

____ provides a strong stimulus for ______ contraction and is released when food enters the intestines.

Cholecystokinin; gallbladder

granulomatous inflammation

Crohn disease

primarily involved in ileum, secondarily in colon

Crohn disease

strictures, fistulas, perianal abscesses common complications

Crohn disease

submucosal level of involvement with skip lesions

Crohn disease

____ occurs when the amount of fluid in the peritoneal cavity is increased. When an individual has this condition along with cirrhosis, ______ is a complication.

Ascites; spontaneous bacterial peritonitis

biologically inactive peptide chain connecting A and B chains and released simultaneously with active insulin from the beta cells; can be used to measure beta cell function

C-peptide chain

infectious enterocolitis caused by gram-positive, spore-forming bacillus characterized by diarrhea and lower abdominal cramping and beginning within 1-2 weeks after antibioitic treatment initiated

C. difficile

capable of removing and phagocytosing old and defective blood cells

Kupffer cells

growth hormone levels normal or elevated, but person has a hereditary defect in insulin-like growth factor production

Laron-type dwarfism

____ is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormone; and ____ is manifested by a very high fever, extreme cardiovascular effects, and severe CNS effects.

Thyrotoxicosis; thyroid storm

diagnosis based on elevated gastrin and basal gastric acid levels

Zollinger-Ellison Syndrome

Cholestasis is a condition in which there is a decrease in bile flow through the intrahepatic canaliculi and a reduction in secretion of water, bilirubin, and bile acids by the hepatocytes. Cholestasis can have more than one cause, but, in all cases, there is what?

accumulation of bile pigment in the liver

associated with NSAID/aspirin use, chronic alcoholism, or bacterial endotoxin

acute gastritis

self-limiting with complete regeneration and healing within several days of removal of inciting agent

acute gastritis

transient in nature and may be accompanied by hemorrhage into mucosa and sloughing of superficial mucosa

acute gastritis

transport protein/plasma colloidal osmotic pressure

albumin

secrete glucagon

alpha cells

secrete insulin and amylin

beta cells

splitting of fatty acids into two-carbon acetyl-coenzyme A

beta oxidation

A major exocrine function of the liver is _____ secretion; and the most important of the secretory proteins of the liver is ____.

bile; albumin

formed from senescent red blood cells

bilirubin

Acromegaly is a disorder that is caused by production of excessive GH in the adult. Because the person cannot grow taller, the soft tissues continue to grow, presenting a very distinctive appearance. Select the distinctive characteristic(s) of acromegaly.

broad, bulbous nose and a protruding lower jaw

catecholamine that maintains blood glucose levels during periods of stress

epinephrin

inhibits insulin release from beta cells and decreases movement of glucose into muscle cells

epinephrin

obstruction of large bile ducts reducing bile secretion

extra hepatic cholestasis

Conjugation of bilirubin is impaired when _______ Select all that apply.

free bilirubin is unable to combine with glucuronic acid transport of bilirubin into liver cells is impaired liver cells are damaged

polypeptide molecule secreted by the alpha cells that maintains blood glucose between meals and during fasting by initiating glycogenolysis in the liver

glucagon

steroid hormones synthesized in adrenal cortex that promote survival during periods of fasting and starvation

glucocorticoid hormone

Body tissues obtain glucose from the blood. After meals, blood glucose levels rise and insulin is secreted to regulate blood serum levels by moving glucose into body tissues or into the liver for storage. Between meals glucose levels fall below normal causing the liver to synthesize glucose from amino acids, glycerol, and lactic acid in a process called ___ for either release into the circulation or storage as glycogen. ____ occurs when the glycogen in the liver is broken down and glucose is released into the bloodstream.

gluconeogenesis; Glycogenolysis

When produced as part of the stress response, ___ hormones aid in regulating the metabolic functions of the body and in controlling the inflammatory response. ____ stimulates glucose production by the liver, promotes protein breakdown, and causes mobilization of fatty acids.

glucosteroid; Cortisol

increase in the size of the thyroid gland

goiter

Release of insulin from the pancreatic beta cells is regulated by blood glucose levels, increasing as blood glucose levels rise and decreasing when blood glucose levels decline. What are the actions of insulin in lowering blood glucose levels? Select all that apply.

inhibits protein breakdown and increases protein synthesis by active transport of amino acids into body cells and prevents use of amino acids for gluconeogenesis promotes fat storage by increasing transport of glucose into fat cells, facilitating triglyceride synthesis from fat cells and inhibiting intracellular breakdown of stored triglycerides provides for glucose storage in liver by entering portal circulation and traveling directly to the liver when secreted by beta cells and promotes glucose uptake by target cells by binding to membrane receptor

only hormone that directly lowers blood glucose levels by glucose uptake in cells and tissues and glucose storage in liver as glycogen

insulin

Several hormones are essential for normal body growth and maturation, including _____ . Select all that apply.

insulin androgens growth hormone thyroid hormone

abnormally high accumulation of bilirubin in the blood

jaundice

Chronic pancreatitis is characterized by _____ Select all that apply.

late stage destruction of endocrine pancreas progressive destruction of the exocrine pancreas fibrosis

What laboratory markers are most commonly used to diagnose acute pancreatitis?

lipase and amylase

Gastroesophageal reflux disease (GERD) is the persistent reflux of gastric contents into the esophagus. What are the a) major clinical features, b) diagnosis, and c) treatment measures? Select all that apply.

wheezing, chronic cough and hoarseness are respiratory symptoms produced by reflux of gastric contents pharmacologic treatment may include antacids and/or H2-receptor antagonists or proton pump inhibitors frequently linked with asthma most frequent symptom is pyrosis occurring 30-60 minutes after eating and increasing with bending at the waist or recumbent position diagnosis based on history of symptoms, barium radiographic studies of upper GI tract, esophagoscopy, and esophageal pH monitoring