Pathophysiology Exam 3 Part 2 #2
Diabetes
- Disease in which the body's ability to produce or respond to insulin is impaired - Results in abnormal metabolism of carbohydrates - Elevated levels of glucose in the blood and urine
Stress
- Disruption of Homeostasis - "Fight or flight"
Grains
- Fiber - Vitamin B - Minerals (Iron, Magnesium, Selenium)
Hematoma Formation
- Fibrin meshwork forms and seals fracture site - Keeps bacteria out and prevents blood loss
What is HbA1c?
- Glycated hemoglobin - Identifies the average plasma glucose concentration over prolonged periods - 6.5% or higher is diabetic
Hyperglycemia
- High blood sugar - 3 Ps - Polyphagia - Polyuria - Polydipsia
What are the five signs of Metabolic Syndrome?
- Hyperglycemia - Hyperinsulinemia - High triglycerides - Low HDL - HTN
Hyperosmolar Hyperglycemic State
- Hyperglycemia - Hyperosmolarity - Dehydration - WITHOUT significant ketoacidosis - More common in Type 2 Diabetes with an underlying infection
Protein pump inhibitors
- Hypocalcemia - Hypomagnesemia - Look for those with GERD
What is the role of cortisol in stress?
- Impair T-cell proliferation - DELAYED WOUND HEALING - DECREASED RESPONSES TO VACCINES - INHIBIT immune system function
Tendonitis
- Inflammation of a tendon - Overuse - REST, NSAIDS, surgery
Spongy bone
- Inner shell - Lattice pattern (force absorption) - Unit: Trabeculae
Dairy
- K+ - Ca+ - Vitamin B12 - Vitamin D - Protein
Antihypertensives
- K+ - Ca+ - Zinc
Vegetables
- K+ - Fiber - Vitamin A - Vitamin C - Folic Acid
Fruits
- K+ - Fiber - Vitamin C - Folic Acid
Osteoarthritis
- Loss of cartilage in synovial joints - Joint pain, stiffness
Hypoglycemia
- Low blood sugar - Inc HR - Sweating - Nervousness - Trembling
Paget's Disease
- Make new bones wherever they feel like it - BONE PAIN (Due to sharp edges of new formations) - Brain compression, deafness, atrophy of the optic nerve
Major Influences on Bone Homeostasis
- Mechanical stress: Exercise - Calcium and phosphate levels: Diet - Cytokines - Hormones: Hormone replacement
How does chronic stress affect the vasculature?
- NE increases vasoconstriction - Increases BP
Neuropathic pain
- Nerve damage - NO response to NSAIDS - Respond to SSRIs or Anti-epileptics
What nutrients are deficient in patients with Pellagra?
- Niacin/Vitamin B3 - 4 Ds (Dementia, Diarrhea, Dermatitis, and Death)
Diabetic Ketoacidosis
- Occurs when the body cannot use glucose as fuel and uses fat instead - Causes of DKA: Infection, injury, a serious illness, surgery, or non-compliance to insulin therapy - More common in Type 1 Diabetes - More common in younger females
Congenital Clubfoot
- One of the most common pediatric orthopedic conditions - Treated by manipulation, casting, surgery
Compact bone
- Outer shell - Compact/dense - Unit: Osteon
A-delta
- Pain (Mechanical and thermal) - Small sheath - Modest
C
- Pain (Mechanical, thermal, and chemical) - No sheath - Slow
How do you make someone more insulin sensitive?
- Physical activity - Weight loss - Avoiding high blood sugar - Reduce stress - Getting enough sleep
Insulin
- Primary stimulus of glucose - Allows body to use glucose - Inhibits lipolysis (breakdown of fat) - Allows uptake of glucose, fatty acids, and amino acids
Fibrocartilaginous Callus Formation
- Procallus (granulation tissue) - Fibroblasts invade procallus and form soft callus - Callus forms in 2nd-3rd week
How does chronic stress affect metabolism?
- Produces insulin and leptin - Insulin -> Turns food to energy; control blood sugar - Leptin -> Inhibits hunger; maintain normal weight
Gluconeogenesis
- Production of glucose - Liver can do this in times of need
A-alpha
- Proprioception - Very large sheath - Wicked fast
What nutrients are deficient in patients with Kwashiorkor?
- Protein - Associated with alcoholics - Extended abdomen
Osteopenia
- Reduction in bone mass - Term used to describe lack of bone mass on x-ray (not a diagnosis) - Between 1-2.5 Bone Density
RANKL
- Released by osteoblasts - Activates osteoclasts
OPG
- Released during resorption - Recruits osteoblasts
Developmental Hip Dysplasia
- Screening: Ortolani test - Flex/abduct hips
Senses to brain
- Senses to spinal cord via first order neuron - Spinal cord dorsal root to thalamus via second order neuron - Thalamus to somatosensory cortex via third order neuron
Osteoporosis
- Severely decreased bone mass - Sudden fractures - Above 2.5 bone density - Kyphosis Hump - Diagnosis: DXA (Lumbar, Femur, Wrist) - Tx: Exercise/Weight-bearing
Postural scoliosis
- Small curve that corrects with bending - Corrected with passive and active exercises
Osteomalacia
- Softening of bone in adults due to inadequate mineralization - Most common as VITAMIN D DEFICIENCY - DEFORMATIES
What does chronic stress do to reproduction?
- Stress can inhibit reproductive function - DOES NOT cause infertility
Rheumatoid arthritis
- Systemic Autoimmune disorder where lining of joints are attacked - Usually symmetrical and polyarticular - Anti-CPP
Pain assessment
- Take comprehensive history - Use VAS (Visual Analog Scale)
What nutrients are deficient in patients with Beri Beri?
- Thiamin - Wet and dry form which affects nerves leading to Wernicke encephalopathy and Korsakoff syndrome
Gout
- Tophi - Accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage - Uric acid kidney stones - Elevated serum uric acid - Uric acid management: Low-purine diet
A-beta
- Touch - Large sheath - Fast
Diabetic CVD
- Twice as likely to develop CV issues - May accelerate the rate of atherosclerosis formation and cause plaques to be unstable. - Associated with low HDL and high triglycerides
Marasmus
- Undernourishment characterized as energy deficit and reduction in all nutrients - Loss of muscle and fat stores - Symptom: Diarrhea
Neuralgia
- Very severe, brief attacks of pain
Protein
- Vitamin B - Vitamin E - Minerals (Iron, Magnesium, Zinc) - Protein
What nutrients are deficient in patients with megaloblastic anemia?
- Vitamin B12 - Large RBCs
Antacids (Long term usage)
- Vitamin B12 deficiency
What nutrients are deficient in patients with Scurvy?
- Vitamin C - Bruising, SWOLLEN/BLEEDING GUMS, weakness, fatigue, RASH, coiled hair, failure to thrive, irritability, muscle weakness, or weight loss
What nutrients are deficient in people with obesity?
- Vitamin D - Ascorbic Acid - Thiamin - Zinc
What are the fat soluble vitamins?
- Vitamins A, D, E, K - Retinol - (DAKE)
What are the water soluble vitamins?
- Vitamins B and C - Folic Acid - Choline - Pantothenic Acid - Biotin
Retinopathy
- Weakening of the blood vessels in the retina and the obstruction in the capillaries from very tiny blood clots - Leading cause of new cases of blindness in adults - Tx: Photocoagulation and Virectomy
Visceral adipose tissue
- White adipose tissue surrounding organs in the peritoneal cavity - Adipose tissue becomes insulin-resistant by inhibiting insulin signal transduction - Closely associated with Type 2 Diabetes (Apple-shaped)
PTSD Diagnosis Requirements
1.Intrusive thoughts/memories 2.Avoidance of trauma related contexts 3.Alterations in cognition and mood 4.Alterations in arousal and reactivity
Fasting Diabetic
126 mg/dl
How many cups of vegetables daily?
2 1/2 cups
How many cups of fruits daily?
2 cups
Oral Glucose Diabetic
200 mg/dl
How many cups of dairy daily?
3 cups
How many ounces of protein daily?
5 1/2 ounces
How many ounces of grains daily?
6 ounces
What is the average age of healthspan?
60-65
What is the average age of lifespan?
78
Ligament
Bone to bone
Osteoblasts
Bone-building cells
Osteoclasts
Bone-chewing cells; responsible for resorption
Genu Varum
Bow legged
Bariatric Surgery
Bypass reduces the size of the stomach so fewer calories are consumed
What nutrients are deficient in patients with osteoporosis, osteomalacia, and rickets?
Calcium
What nutrients are deficient in patients with osteoporosis?
Calcium, Vitamin D
Insulin sensitive
Cells are more effective at absorbing blood glucose, so less insulin is needed
Insulin Resistance
Cells in your body do not respond well to insulin
Photocoagulation
Intense beam of laser light to seal leaking or bleeding blood vessels
What nutrients are deficient in patients with Goiter?
Iodine
What nutrients are deficient in patients with anemia?
Iron, Vitamin B12, Folate
Genu Valgum
Knock knees
What nutrients are deficient in patients with type 2 diabetes, metabolic syndrome, heart disease, and osteoporosis?
Magnesium
Osteocytes
Mature bone cells
Compartment Syndrome
- Compromises circulation and function - Nerve and muscle death in 8 hrs - Tx: Relieve pressure (fasciotomy)
Anterolateral Pathway
- "Just need the info" - Slower transmission - PAIN
Discriminative Pathway
- "Need precision" - Rapid transmission - Actions such as hand holding
Migraine
- 3x more likely in women - Hormonal, dietary, neurogenic - Tx: Avoid stress, Sumatriptan
Osteomyelitis
- Acute or chronic infection of the bone and marrow - Pyogenic - Staphylococcus aureus is most common cause
Diabetic peripheral neuropathy
- Affects nerves in the toes, feet, legs, hand, and arms - Tingling, burning, deep pain, weakness, light-headed, fast heart rate
Diabetic autonomic neuropathy
- Affects nerves that help regulate digestive, bowel, bladder, heart, and sexual function - Digestive problems, bladder infections and incontinence, sexual problems
Osteonecrosis
- Aseptic destruction of a segment of bone due to an interruption in blood flow - Femoral head is a common site for this
What are the concerns with an open fracture?
- Blood Loss - Infection
Type 1 Diabetes
- Body DOESNT produce insulin - Diagnosed in childhood - Failure to take up absorbed nutrients and have an increase in circulating glucose
Type 2 Diabetes
- Body is insulin-resistant - Most common (90-95%) - Older adults (40+) - Increase in circulating glucose
Bony Callus Formation
- Bony Callus (Callus ossified) - Fibrocartilage -> Woven bone
Fracture
- Broken bone - X-ray to confirm; directs treatment - Tx: Reduction/Reset, Immobilization, Restore Function
How does chronic stress affect the heart?
- Catecholamines increase HR and CO
How does chronic stress affect the kidneys?
- Catecholamines increase vasoconstriction - Increases BP
Obesity
- Cause: Unknown - Eating too many calories from energy dense, nutrient poor foods - Tx: Diet and surgery (Focus on adipose tissue)
Post-herpetic Neuralgia
- Caused by chicken pox or shingles - Single dermatome - Tx: Antivirals and lidocaine
Neurontransmitter
- Cell body - Down axon - Released in synapse
Systemic Lupus Erythematosus
- Chronic autoimmune inflammatory disease - Affects ANY organ - "The great imitator" - Blood test: Anti-nuclear Ab - Seen in young females - Elimination of self-reactive B cells
Adipose tissue
- Contains adipocytes and immune cells
Sprain
- Damage to a ligament or joint capsule - Tx: RICE
Strain
- Damage to a muscle or tendon - Tx: RICE
Diabetic Nephropathy
- Damage to kidney - Protein in urine - Leading cause of end-stage renal disease (ESRD) - Dialysis is required to remove metabolic waste from blood
Remodeling
- Dead bone removed by osteoclast - Compact bone replaces spongy bone
Diuretics
- Decrease K+ - Decrease Mg+ - Decrease Ca+
Cholestyramine
- Decrease absorption of fat soluble vitamins - Also, Vitamin B12, Folic acid and Ca+
Hydralazine
- Depletes Vitamin B6
Rhabdomyolysis
- Direct or indirect severe muscle injury; release myoglobin into blood - Dark red or brown urine - Tx: IV fluids
Metabolic Syndrome
- Cluster of metabolic abnormalities related to insulin resistance - Apple-shaped individuals
Fracture Healing
1. Hematoma formation 2. Fibrocartilaginous callus formation 3. Bony callus formation 4. Bone remodeling
What are the 9 essential amino acids?
1. Histidine 2. Isoleucine 3. Leucine 4. Lysine 5. Methionine 6. Phenylalanine 7. Threonine 8. Tryptophan 9. Valine MV PIT HALL (Argenine for kids)
What are the essential fatty acids?
1. Linoleic 2. Alpha-linolenic
PTSD
A mental health condition triggered by experiencing or witnessing a terrifying event OR experiencing multiple repeated traumas
Allodynia
A painful response to normally non-painful stimuli
Wolff's Law
A tissue adapts to the level of stress imposed upon it
Hyperalgesia
An increased responsiveness to normally painful stimuli
Pyroxidine
Another name for Vitamin B6
What are bones best at resisting?
Compression and tension
What causes impaired working memory in chronic stress?
Decreased hippocampal activity
What causes cognitive and executive dysfunction in chronic stress?
Decreased prefrontal activity
Sequestra
Devascularized fragments
What causes anxiety in chronic stress?
Increased amygdala activity
HOMA-IR
Fasting glucose and fasting insulin
Structural scoliosis
Fixed deformity
What nutrients are deficient in patients with neural tube defects?
Folic acid
What is at equilibrium in the bone remodeling cycle?
Formation and resorption
Who formed the GAS?
Hans Selye
Tendon
Muscle to bone
Does being obese mean you're getting all the necessary nutrients?
No - "Too many calories does not mean you are getting all the nutrients you need every day"
Where is insulin produces?
Pancreas
Greenstick
Partial break; often seen in children
Allostasis
Process that produces a new, alternative homeostasis or set point
Vitrectomy
Removal of the blood deposits and scar tissue strands within the vitreous fluid by suction
Nociceptive and Inflammatory pain
Respond to NSAIDS
RICE
Rest, Ice, Compression, Elevation
Mechanism of acute pain
Same process as senses to the brain
Stress & SNS
Stress -> Hypothalamus -> Spinal cord -> Catecholamine Receptors (Epi and NE) -> Fight or Flight
What hormone does stress inhibit?
Thyroid hormone - Conserves energy - Dec immune, reproductive, and metabolic function
Osteoprogenitor
Undifferentiated cells but becomes osteoblasts
What nutrients are deficient in patients with night blindness?
Vitamin A
What nutrients are deficient in patients increased fractures, muscle weakness, bone loss?
Vitamin D
Who formed the concept of stress?
Walter Cannon
When does a person experience stress?
When a demand exceeds a person's coping abilities