Pathophysiology Final Study

Asthma Case Study

13-year-old boy was taken to the ED after gym class. He has shortness of breath and tightness in his chest. The boy is sweating profusely to the point of drenching his gym clothes. The father explains that his son was just running the mile in class when suddenly, he couldn't breathe well, and an ambulance was called. The father explains this isn't the fist time the boy has had trouble breathing, but the intensity this time is much worse and in the past the symptoms cleared up. The ED puts the boy on oxygen and gives him some inhaled corticosteroids.

AIDS (acquired immune deficiency syndrome) (case study)

40 year old Thomas has retinitis, esophagitis, chronic diarrhea, and tuberculosis. He had tested positive for HIV 1, 3 years ago, but didn't take any treatments because he could not afford them.

pelvic inflammatory disease (PID) (case study)

A 20 - year old women presents to the ER with pelvic pain, fever, and abnormal vaginal discharge, of 5 days. She admits to having several different sexual partners over the last 6 months.

prostatitis (case study)

A 25-year-old white male presented with suprapubic pain, difficulty urinating, hematuria, and fever. The patient developed fever and nausea with vomiting. He also described genitourinary symptoms of dysuria and difficulty voiding with blood in his urine. He admitted to several sexual partners over the past month.

human immunodeficiency virus (HIV) (case study)

A 35 year old South Indian female, presented with weight loss, pancytopaenia (low RBCs, WBCs, and platelets) and generalized lymphadenopathy (swollen large lymph nodes). Multiple investigations were performed to elucidate the cause of her presentation, with the eventual unexpected diagnosis of human immunodeficiency virus 2.

Nephrolithiasis (Kidney Stones) : Case Study

A 36-year-old woman with a 2-week history of left flank pain presented to the ED via emergency medical services. She also has been noticing blood in her urine. She admits to nausea and vomiting.

Kidney Failure (Acute) Case Study

A 43-year-old woman is involved in an automobile accident. When paramedics arrive at the scene she is found to be with a blood pressure of 60/40, a pulse of 120; her extremities are cold and clammy, and her abdomen is hard and tender. She is taken to the hospital receiving intravenous fluids during transport with her blood pressure increasing to 80/50 upon arrival to the ER. A Foley catheter is placed in the patient's bladder to monitor the urine output, which is scant. A point- of-care hemoglobin is 6.3 (normal 12-15). Upon arrival at the hospital she is given several blood transfusions and she stabilizes. She undergoes a CT scan of her abdomen with intravenous contrast, which demonstrates a splenic rupture. She is taken to the operating room where she undergoes splenectomy. Concerned about the possibility of infection the surgeon orders gentamicin antibiotic, which she receives before leaving the operating room. The patient is admitted to the surgical intensive care unit for her post-operative care. She is alert and oriented, and her vital signs are now stable with a BP of 120/80, pulse of 80, and a respiratory rate of 18. Her cardiovascular exam is normal, and she has no edema. Her urine output, however, has not improved (12 ml/hour). Urinalysis shows a specific gravity of 1.010, there is no blood or protein on dipstick, and microscopic examination shows many muddy brown casts but is otherwise normal without RBC or WBC Explanation: Acute tubular necrosis (ATN) presents with acute kidney injury (AKI) and is one of the most common causes of AKI. Common causes of ATN include low blood pressure and use of nephrotoxic drugs. The presence of "muddy brown casts" of epithelial cells found in the urine during urinalysis is pathognomonic for ATN

Pneumonia (community-acquired) (case study)

A 66-year-old male presented to an urgent care clinic with a 4-day history of dry cough, progressing to rusty colored sputum, sudden onset of chills the previous evening, subjective fever, and malaise. Originally, the man thought he had a cold, but the symptoms had worsened and he "barely slept last night with all this coughing."He denied experiencing shortness of breath but suggested he may be breathing "a little faster than normal."

Lung Cancer Case Study

A 69-year-old female chef worked in downtown Chicago at the Marriot Hotel. She was presented with sign and symptoms of dyspnea, cough , hemoptysis and fatigue and has never smoked in her life. She alerted her doctor of how she noticed that she was steadily losing weight over the past few months. Her primary care doctor decided to run labs and have a chest x-ray done.

Asthma

A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing. (considered an obstructive disease) Chronic inflammatory disorder of the bronchial mucosa -Caused by bronchial hyper-responsiveness! Leads to: - Constriction of the smooth muscles of the airways - Excess mucous secretion - Obstruction of the airways - Asthma can be triggered by allergens, exercise, smoke, and toxic fumes. - Asthma is either inherited or acquired (or a combination of the two). - If Inherited, Asthma is associated with a condition called, "atopy." -Genetic tendency to develop allergic diseases - allergic rhinitis, asthma and atopic dermatitis (eczema) -Heightened immune responses to common allergens - inhaled allergens and food allergens Patho: - Airway inflammation - Reversible airflow obstruction - Bronchial hyper-responsiveness - Exaggerated response to exogenous and endogenous stimuli - Ventilation/perfusion imbalance - Leads to hypoxemia - Expiratory obstruction = air trapping Diagnosis: - Nitric oxide — inflammation of the airways leads to increased levels of exhaled nitric oxide - Serum eosinophils: can be helpful in diagnosing allergic Asthma (High levels of exhaled nitric oxide means airways are inflamed and Predicts whether or not steroid medications will work) - Inhaled histamines or methacholine promote bronchoconstriction. - Histamines cause nasal and bronchial mucus secretion and bronchoconstriction through the H1 receptors. -Methacholine causes bronchial constrictions. - Pulmonary function tests show obstructive disease. Treatment - No cure - Must focus on symptom control managing exposure to triggers - Inhaled corticosteroids are the preferred treatment for long term management - Short-acting beta agonists are the most effective for acute symptoms

cystic fibrosis (CF)

A genetic disorder that is present at birth and affects both the respiratory and digestive systems. In people with CF, mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause the CFTR protein to become dysfunctional. When the protein is not working correctly, it's unable to help move chloride -- a component of salt -- to the cell surface. Without the chloride to attract water to the cell surface, the mucus in various organs becomes thick and sticky. In the lungs, the mucus clogs the airways and traps germs, like bacteria, leading to infections, inflammation, respiratory failure, and other complications. For this reason, minimizing contact with germs is a top concern for people with CF. Symptoms: - Very salty-tasting skin - Persistent coughing, at times with phlegm - Frequent lung infections including pneumonia or bronchitis - Wheezing or shortness of breath - Poor growth or weight gain in spite of a good appetite - Frequent greasy, bulky stools or difficulty with bowel movements People with CF have inherited two copies of the defective CF gene -- one copy from each parent. Both parents must have at least one copy of the defective gene. People with only one copy of the defective CF gene are called carriers, but they do not have the disease. Each time two CF carriers have a child, the chances are: 25 percent (1 in 4) the child will have CF 50 percent (1 in 2) the child will be a carrier but will not have CF 25 percent (1 in 4) the child will not be a carrier and will not have CF

Brain Cancer

A malignant tumor of the brain or one located centrally within the spinal cord. Distinct types of brain tumors exist. Some brain tumors are noncancerous (benign), and some brain tumors are cancerous (malignant). Signs and Symptoms: Signs and Symptoms of a brain tumor vary greatly and depend on the brain tumor's size, location and rate of growth. New onset or change in pattern of headaches Headaches that gradually become more frequent and more severe Unexplained nausea or vomiting Vision problems, such as blurred vision, double vision or loss of peripheral vision Gradual loss of sensation or movement in an arm or a leg Difficulty with balance Speech difficulties Confusion in everyday matters Seizures, especially in someone who doesn't have a history of seizures Hearing problems Primary brain tumors: Primary brain tumors originate in the brain itself or in tissues close to it, such as in the brain-covering membranes (meninges), cranial nerves, pituitary gland or pineal gland. Primary brain tumors are much less common than are secondary brain tumors, in which cancer begins elsewhere and spreads to the brain. Metastases to the brain: Secondary (metastatic) brain tumors are tumors that result from cancer that starts elsewhere in the body and then spreads (metastasizes) to the brain. Secondary brain tumors most often occur in people who have a history of cancer. But in rare cases, a metastatic brain tumor may be the first sign of cancer that began elsewhere in the body. Secondary brain tumors are far more common than are primary brain tumors! Any cancer can spread to the brain, but the most common types include: Breast cancer, Colon cancer, Kidney cancer, Lung cancer, Melanoma Look For: Progressive, unremitting headache and Metastases to this organ are more common than primary cancers: Brain Cancer

Giardiasis (Beaver Fever) (case study)

A patient of 9.5 year old, with chronic abdominal pain and history of diarrhea and pasty stools, neither fever nor vomiting. The feces from patient were processed seeking for pathogenic bacteria and the results were negatives. The microscopic examination looking for cysts was positive. The lactose hydrogen breath test was positive: (used to determine abnormal bacterial growth in the intestines).

Clostridium difficile Case Study

A typical case for a scenario of recurrence would be a 72-year-old woman with a prior history of CDAD who is admitted to the hospital from a nursing home after 3 days of watery diarrhea. At the time of admission, she is receiving antibiotics for an acute exacerbation of chronic bronchitis and she is taking a proton pump inhibitor for gastroesophageal reflux disease symptoms.

Abnormal Uterine Bleeding (AUB)

Abnormal uterine bleeding (AUB) is a broad term that describes irregularities in the menstrual cycle involving frequency, regularity, duration, and volume of flow outside of pregnancy. Up to one-third of women will experience abnormal uterine bleeding in their life, with irregularities most commonly occurring at menarche and perimenopause. · Heavy or irregular bleeding in the absence of organic disease · Associated with lack of ovulation · Usually peri-menopausal · Can lead to iron deficiency anemia and associated symptoms · Treated with NSAIDs, oral hormonal contraceptives, levonorgestrel intrauterine device, ablation, or hysterectomy Main Symptom: - irregular excessive menses -As spotting or bleeding between your periods - After sex - For longer days than normal - Heavier than normal - After menopause

Mononucleosis (kissing disease/mono)

Acute, self-limiting infection of lymphocytes transmitted by saliva through personal contact condition caused by the Epstein-Barr virus and characterized by an increase in mono-nuclear cells (monocytes and lymphocytes) in the blood along with enlarged lymph nodes (lymphadenopathy), fatigue, and sore throat (pharyngitis). Main Symptoms: fever and sore throat Serious complications are rare: Splenic rupture Infectious Mononucleosis Diagnosis (Mono Spot Test) = looks for atypical lymphocytes mainly: (irregular borders and irregular nucleus)

A 14 year old goes to her health care provider complaining of fever, sore throat, and swollen lymph nodes. He diagnoses her with mononucleosis. Which of the following lab results would you expect to see?

Atypical lymphocytes = (MONO kissing disease)

A 20-year-old woman presents to clinic with a 3-week history of bloody diarrhea and abdominal pain. She states that she has not traveled recently or changed her eating habits. A stool culture is negative for infectious disease. Flexible sigmoidoscopy shows numerous lesions in the descending colon interrupted by normal appearing mucosa. Which of the following features would most likely be present on a tissue biopsy? A.Cells with loss of mucin and hyperchromatic nuclei - more associated with ulcerative colitis B.Crypt abscesses - more associated with ulcerative colitis C.Noncaseating granulomas D.Ulcerated mucosa only - Ulceration limited to the mucosa is a feature of ulcerative colitis. This patient has Crohn's which is transmural.

C) Noncaseating granulomas Crohn's disease. IBD typically presents during late adolescence to early adulthood with symptoms of abdominal pain and frequent bouts of diarrhea. Crohn disease has transmural inflammation interspersed with normal mucosa (skip lesions) as seen in this patient and can affect any part of the GI tract but usually spares the rectum. Noncaseating granulomas may be found in Crohn's disease but are not found in ulcerative colitis

Cancer Lymphoma (cancer of actual lymph nodes and tissue)

Cancers which develop in lymphatic system and occupy lymph tissues Painless lump is usually the 1st sign · Inflamed nodes, enlarged nodes = lymphadenopathy​ Non-hodgekins = Solid tumors. Classified according to size, B-Cell and T-Cell markers and pattern of growth. Hodgekins = Presence of Reed-Sternberg cells which are part of the tissue macrophage system. Can metastasize to extralymphatic sites including liver, marrow, spleen and lungs. One of the most curable cancers. Main Symptom: enlarged nodes· In lymphoma, you have enlarged lymph nodes (more than one place)

Case Study: Gallstone pancreatitis (Clarify that the patient has acute pancreatitis. The two most common etiologies of acute pancreatitis are alchohol and choledocholithiasis- gallstones.)

Chief Complaint: Abdominal pain, nausea, vomiting. HPI: Lisa Rodriguez is a 46-year-old woman presenting to ED (early in the morning) with acute onset of nausea/vomiting and abdominal pain x 8 hours. Her abdominal pain was sudden in onset which is intermittent and sharp, located in the right upper quadrant and is 8-9 out of 10 at its worst. Her pain and nausea seem to be worsening since onset 8 hours ago and she notes her epigastric pain has started to radiate to her back. Her nausea remains constant and she has had non-bloody emesis 1-2 times per hour for the past 3 hours. Nothing specific seems to improve or worsen her symptoms. Lisa lives with her wife, Sarah, and their 2 children. They all ate leftover Chinese food last night but none of the other family members have any similar symptoms as Lisa. Lisa denies any change in her bowel habits - no worsening constipation or diarrhea. She denies any prior episodes particularly similar to this presentation but does admit to intermittent right upper quadrant pain with mild nausea after eating large, fatty meals over the past few months. Those prior episodes were self-limited, so she did not seek medical attention

14.A 46 year old man says he's been starting to experience right upper quadrant pain, particularly after he eats a high-fat meal. What is likely his condition? a.UTI b.Ischemic colitis c.Cholelithiasis d.Irritable bowel syndrome

Cholelithiasis (gallstones) A hardened deposit within the fluid in the gallbladder, a small organ under the liver. Gallstones are hardened deposits of digestive fluid. The gallbladder stores bile, a combination of fluids, fat, and cholesterol. Bile helps break down fat from food in your intestine. The gallbladder delivers bile into the small intestine. **The gallbladder stores bile. Bile is needed to digest fats. After eating a high fat meal, the body "senses" it, and the gallbladder contracts in response to that. This causes biliary colic because the gallstone is lodged in the duct and bile can't get out. NOTE:**Cholelithiasis is a risk factor for pancreatitis!!! ●By getting a gallstone lodged in the common bile duct near Sphincter of Oddi, this can cause a backup of pancreatic enzymes (enzymes are stuck in pancreas -- autodigestion--- inflammation of pancreas)

Kidney failure (chronic)

Chronic Kidney Disease is when the kidney loses permanent loss of function. It is a longstanding disease of the kidneys leading to renal failure. The kidneys filter waste and excess fluid from the blood. As kidneys fail, waste builds up. Causes: - the progession of acute kidney injury - cardiovasular disease -diabetes mellitus - hypertension Diagnosis: - elevated creatinine, BUN, GFR, and urinary abnormalities; for at least 3 months. Main Symptoms: Diabetes and hypertension Patho: Hypertension in CKD is marked by extracellular fluid volume expansion, sympathetic nervous system activation, and vasoconstrictor accumulations of endothelin and asymmetric dimethylarginine, an endogenous nitric oxide inhibitor. Diabetes is also associated with increased arterial stiffness from accelerated atherosclerosis There are multiple mechanisms in the development of hypertension in patients with DKD, including inappropriate activation of the renin angiotensin aldosterone system (RAAS) and the sympathetic nervous system, volume expansion due to increased sodium reabsorption, peripheral vasoconstriction, upregulation of endothelin 1, inflammation and generation of reactive oxygen species, and downregulation of nitric oxide.

Deep vein thrombosis (DVT) / Pulmonary embolus

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but also can occur with no symptoms. DVT: Deep venous thrombosis Obstruction of venous flow, usually due to a pulmonary embolus that travels down, usually to the foot. Deep vein thrombosis can develop if you have certain medical conditions that affect how your blood clots. It can also happen if you don't move for a long time, such as after surgery or an accident, or when you're confined to bed. Deep vein thrombosis can be very serious because blood clots in your veins can break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism). Pulmonary embolism occurs when a blood clot gets lodged in an artery in the lung, blocking blood flow to part of the lung. Blood clots most often originate in the legs and travel up through the right side of the heart and into the lungs. A serious complication associated with deep vein thrombosis is pulmonary embolism. - A pulmonary embolism usually happens when a blood clot called a DVT, often in your leg, travels to your lungs and blocks a blood vessel. ​ - Leads to low oxygen saturation​ - May damage the lung and other organs, may progress to heart failure Blood stasis= coagulation, this causes blood clot to go to the lungs and cause more problems

type 2 diabetes

Diabetes of a form that develops especially in adults and most often obese individuals and that is characterized by high blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production. Etiology: Insulin Resistance High levels of Insulin at the time of diagnosis The progression of type 2 diabetes is gradual. There is high likelihood of family history, as well. Treatments: Weigh loss, excercise, hypoglycemic agents, and insulin as last resort! Hyperosmolar hyperglycemic state (HHS) can occur from Type 2 diabetes in old patients. Later Stages of Type 2 Diabetes: Both beta cell dysfunction and insulin resistance lead to persistent hyperglycemia which characterizes type 2 diabetes With beta cell dysfunction, insulin secretion is impaired whereas with insulin resistance, insulin may still be secreted but insulin insensitivity manifests in target tissues. As beta cell dysfunction and insulin resistance exacerbate, hyperglycemia amplifies leading to the progression to type 2 diabetes.

Diabetes mellitus type 1

Diabetes of a form that usually develops during childhood or adolescence and is characterized by a severe deficiency of insulin, leading to high blood glucose levels. Type 1 diabetes: - Genetic susceptibility - Environmental factors - Immunologically mediated destruction of beta cells Manifestations: - Hyperglycemia - Polydipsia - Polyuria - Polyphagia - Weight loss - Fatigue ● Polyuria—excessive urination ○ **Glucose in urine (glucosuria) because of high blood glucose (hyperglycemia) = glucose acts as a solute that "pulls" water into the urine ● Polydipsia - excessive thirst ○ Loss of water in urine = dehydration ● Polyphagia - excessive hunger ○ Eating a lot but cells aren't able to utilize the glucose because of lack of insulin (insulin is what lets glucose into cells) = cells are starving = hunger Prone to DKA (diabetic ketoacidosis, because they don't have insulin production, so certain acids (ketones) accumulate to use fats for energy. Ketones cause Metabolic Acidosis= Low bicarb levels and low pH= acidic Also, pancreas is damaged due to an autoimmune attack. Zero Insulin levels, when diagnosed and the treatment is injecting insulin in them. Low likelihood of family history. The progression of this disease is very abrupt and may present to weigh loss or "starvation" and dehydration.

Mesenteric Artery Insufficiency

Disruption of the blood supply to the intestine Celiac artery Superior and inferior mesenteric arteries Types of problems: - Mesenteric venous thrombosis- especially with A. fibrillation, then moves South and can enter Mesenteric Circulation and can cause a clog in the vessel - Acute mesenteric artery insufficiency- Abdominal Angina= blocked blood supply causing Ischemia - Chronic mesenteric ischemia= from Vascular Disease, usually as patients age, can get plaques in vessels, patients usually don't have an appetite, and when they eat, they get abdominal pain Example: Clot in Superior Mesenteric Arteries Causes of Acute Mesenteric Insufficiency: · Venous Thrombosis = from a Hyper coagulate state · Arterial Embolus = from A fib · Arterial Thrombosis = Atherosclerosis Disease · Non-occlusive Shock = Volume Depletion Main Symptom: Abdominal Pain

Sickle cell disease

Genetic disorder in which red blood cells have abnormal hemoglobin molecules and take on an abnormal shape. So, decreased O2 + dehydration = increased sickling usually in African American population Autosomal recessive disorder Main Symptoms: Swollen hands/feet Priapism​m (prolonged erection) Splenomegaly​ (hyper hemolytic= excessive destruction on RBCs so they continuously need to be recycled) Bone Marrow= may not work effectively, prone to more infections Prone to get gallstones = bilirubin causes gallstones (due to super saturation) May have vision problems (sickle cell shape are sticky: stroke can happen due to maybe a blood clot) All these people will be in a lot of pain, may need opioids to treat that Hemolytic anemia—Sickled RBCs die earlier than normal ones (lots of RBCs die quickly)

Giardiasis (Beaver Fever)

Giardiasis is a diarrheal disease caused by the microscopic parasite Giardia. Cysts ingested with contaminated water or food. Beavers are often implicated as potential reservoirs: cysts are passed through their feces. Giardiasis spreads through contaminated food or water or by person-to-person contact. It's most common in areas with poor sanitation and unsafe water. Symptoms might include watery diarrhea alternating with greasy stools. Fatigue, cramps, and belching gas also may occur. Main Symptom: Abdominal Pain

Constipation

Hard, slow stools that are difficult to eliminate; Defined as infrequent or difficult defecation Primary condition Causes: - Normal transit (functional) - Slow transit - Pelvic floor or outlet dysfunction Secondary Constipation: Caused by many different factors such as diet, medications, various disorders, aging (IBS and Diverticular Disease for example) Manifestations: - Straining with defecation; hard stools - Sensation of incomplete emptying Need to Manage underlying disease! Common Triggers of Constipation= Low fiber diet, low fluid intake, sedentary lifestyle, ignoring the urge to defecate, travel, laxative overuse Foods that Cause Constipation: Low fiber food= dairy, meat, pasta, white bread Main Symptom: abdominal pain

A man is in the ICU following a traumatic car accident that resulted in sepsis. His nurse notices bleeding at the IV sites and bruising in multiple areas around his body. What is the pathophysiology of his condition?

His coagulation and fibrinolytic systems are out of control: Disseminated Intravascular Coagulation (DIC)

How do you distinguish hematuria of renal origin from that arising lower in the urinary tract?

If the blood is coming from the kidney you will see RBC cases in the urine. If the blood is coming from the ureter, bladder, or urethra there will be intact RBCs in the urine.

A 6 year old boy is recovering from the flu when his parents notice that he has a lot of purpura and petechiae on his chest. What is his condition?

Immune-mediated thrombocytopenia purpura (ITP) (case study)

INFERTILITY (FEMALE)

Inability to conceive due to blocked fallopian tubes or severe scarring (STD's) or problems with the ovaries releasing eggs. Check the Thyroid! Thyroid hormone problems can cause menstrual irregularities = fertility issues DDX of female Infertility: Anatomical problem(s) · Uterine fibroids · Endometriosis · Adhesions / Scarring · Others Ovarian failure · Primary ovarian failure · Polycystic ovaries Infection · PID · Chlamydia · Other STIs Endocrinologic Problems · Diabetes · Hypothalamic amenorrhea · Hypothyroidism · Pituitary microadenoma · Thyroid dysfunction Evaluate the female factors: Assess ovulatory function: mid-luteal phase (1 week before menses, day 21) serum progesterone level · OTC prediction kits detect LH surge in urine · Serial ultrasound (development of follicle) · Assess tubal function (with a test such as a hysterosalpingogram)

Pancreatitis

Inflammation of the pancreas. Causes: Alcohol abuse Any obstruction to the outflow of pancreatic enzymes Inflammation Medications (steroids) Main symptom: Upper left quadrant pain (abdominal pain) Causes of Acute Pancreatitis: · Alcohol · Gallstones · Meds (steroids) · Cystic Fibrosis cystic fibrosis is a cause of pancreatitis! causes AUTODIGESTION = when enzymes digest their own pancreatic cells = Causes Inflammation, vascular damage and tissue necrosis. Gallstones, produced in the gallbladder, can block the bile duct, stopping pancreatic enzymes from traveling to the small intestine and forcing them back into the pancreas. The enzymes then begin to irritate the cells of the pancreas, causing the inflammation associated with pancreatitis

appendicitis: Case Study

Jamie is a 24-year-old female who presented to the accident & emergency department (A&E) with a four-hour history of right lower quadrant (RLQ) abdominal pain. The pain originated in the umbilical region, radiating diffusely across the lower abdomen and subsequently localized to the RLQ. The pain was of sudden onset, sharp and colicky with progressing intensity. The pain was exacerbated by lifting the right leg and relieved by leaning forwards. Severity was rated eight on a scale of one to 10. There was no relevant family history. The patient did not smoke, reported alcohol consumption occasionally, and denied recreational drug use.

Anemia -Macrocytic Anemia

LARGE RBCs= Vitamin B12 or folate deficiency These are coenzymes for nuclear maturation (DNA synthesis) Symptoms: Fatigue, · Weight loss​ · Paresthesia of feet and fingers (pins and needles sensations)​ · Neurologic--- loss of balance, decreased vibration sense, decreased sense of touch​ Patho= Cause = Autoimmune condition​ specific to stomach Destruction of Parietal Cells: secretes intrinsic factor (binds to B12)​ Antibodies bind to intrinsic factor​ Blocking B12 from binding

Diverticulitis (Diverticular Disease)

Lower GI bleed: ○Hematochezia ( bright red blood in stool)-- fresh blood (indicates it's from lower GI bleed) Diverticula: multiple out-pouching's = usually with aging! the loosening of the colon muscles over time Herniation of mucosa through the muscle layers of the colon wall, especially the sigmoid colon considered to be the inflammatory stage of diverticulosis. Inflammation or infection one or more the small pouches in the digestive tract​. Complications= Bleeding, Infections, Small tears/ perforations, Blockages, Abscess. Main Symptom: Abdominal Pain Nausea and vomiting Fever. Abdominal tenderness Constipation less commonly diarrhea. Most common after age 40​ Treatment: rest, liquids​ Most common cause? Low fiber diet

Leukemia Cancer (cancer of the bone marrow)

Malignant disorder of white blood cells. Cancer of the Bone Marrow!!! Pancytopenia if cells crowd bone marrow= leukemias form in the bone marrow, blast forms of early stages and multiply without regard for other cells and crowd out other cells, such as RBCs and platelets Pancytopenia= LOW white count, red count, and platelet count! Acute leukemia: Undifferentiated or immature cells, usually blast cells / Aggressive, fast-growing Chronic leukemia = more normal looking cell, but don't function properly Predominant cell is mature but does not function normally / Slower growing typical in children Main Symptoms:· Bleeding (petechiae, ecchymosis- bruising), bone pain - from dysfunctional bone marrow​· Liver, spleen, lymph node enlargement (from infiltration by WBCs) ​· Fatigue, fever, weight loss​· Infections! (because of so many non-functional WBCs) ​· Increased uric acid (due to WBCs dying at fast rate, they release uric acid when they die)

Cellulitis (case study)

Mila is a 21 year old female. She recently went on vacation with friends that involved camping and the opportunity to interact with people from all over the world. During the trip she received several bug bites on her legs, causing her to scratch profusely over the course of a week. Upon returning from the trip,she noticed the scratching had led to small cuts in the area of the bites. A week after returning home she noticed the skin around the bite had increasingly become red and swollen. After a day or so, the areas began to feel warm and she was in moderate discomfort. The blood test can confirm a high white blood cell count that would indicate a possible bacterial infection. Mila had recently been diagnosed with a kidney infection (within the last month) that put her on antibiotics for around 5 days.

Infertility: Males

Multiple factors (e.g. advanced age, fever, radiation, prescription drugs, stress, environmental toxins, drug abuse, alcoholism, cigarette smoking) can reduce sperm number, shape, and motility. Evaluate the male factor: Semen analysis

Lactose Intolerance

Need Lactase to digest Lactose Lactase deficiency Patho: Deficiency of lactase (enzyme) Leads to inability to digest lactose (break into monosaccharides) Lactose if fermented by bacteria gas (cramping pain, flatulence) osmotic diarrhea= where substance is in lumen of GI tract and can't be absorbed. Puts osmotic pressure on lumen, water tends to move from surface of GI tract into the lumen, due to indigestible lactose. causes Osmotic diarrhea= nonabsorbable substance is digested (laxatives) Types of lactose intolerance: Primary lactose intolerance - Most common type - Lactase production decreases in adulthood - Genetically determined = Appears later in in life usually Secondary lactose intolerance: - After an illness, injury or surgery - Secondary to celiac disease, bacterial overgrowth or Crohn's disease Congenital lactose intolerance: Genetic - Born with lactose intolerance Symptoms of Lactose Intolerance= Abdominal Bloating and cramping, Diarrhea, Nausea, Vomiting, Dyspepsia also known as indigestion, is a term that describes discomfort or pain in the upper abdomen!

irritable bowel syndrome (IBS)

No test to prove this, only signs + symptoms reported. periodic disturbances of bowel function, such as diarrhea and/or constipation, usually associated with abdominal pain Manifestations of Irritable Bowel Syndrome: - Lower abdominal pain! - Bloating - Symptoms are usually relieved with defecation - No interference with sleep - No cure, but many treatments available - Associated with anxiety, depression - Significantly reduced quality of life Proposed Theory: - Visceral hypersensitivity - Abnormal intestinal permeability, motility, and secretion - Inflammation - Alteration in gut microbes - Food allergy/intolerance - Psycho-social factors (such as stress) Pathophysiology: The "Brain-Gut Axis" = Brain + Gut Connection

Community Acquired Pneumonia (CAP)

Occurs in community setting or within the first 48 hours after hospitalization Pneumonia is a type of lung infection. It can cause breathing problems and other symptoms. In CAP, infection occurs outside of a healthcare setting. Most cases of CAP are caused by viruses and don't require treatment with antibiotics. Antibiotics are the key treatment for most types of CAP caused by bacteria. -Major cause of death from infectious disease in US -Often follow influenza Worldwide, Streptococcus pneumoniae is a bacteria that is most often responsible for CAP in adults. Main Symptoms: Cough and fever Symptoms of CAP often develop quickly: Shortness of breath Coughing Heavy sputum Fever and chills Chest pain that is worse when you breathe or cough Nausea and vomiting (less common) What are the complications of community-acquired pneumonia? Lung abscess and, rarely, empyema are possible complications of CAP. In empyema, a collection of pus builds in the space between the lung and the chest wall. You usually need antibiotics and drainage to treat it. A CT scan can often help diagnose these problems. Respiratory failure and death are other possible complications. These are more likely to happen in older people or people with other health problems.

Abdominal Pain

Parietal pain: irritation of the peritoneal lining Visceral pain: activation of nociceptors of the thoracic, pelvic, or abdominal viscera Referred pain: pain felt in a part of the body other than its actual source

What is the pathophysiology of each of the 3 manifestations of Type 1 Diabetes?

Polyuria : excessive urination due to glucosuria (glucose in urine) = glucose has an osmotic effect and "pulls" water into the urine, increasing urine Polydipsia : excessive thirst; loss of water in the urine makes a person more thirsty Polyphagia : excessive hunger. Cells are "starving" and sending out signals to increase appetite because all the glucose is in the blood and is not being taken into the cells. Cells need glucose to function

Diarrhea

Presence of loose, watery stools; can be acute or persistent. Large-volume diarrhea= Caused by excessive amounts of water or secretions or both in the intestines Small-volume diarrhea= Volume of feces is not increased, usually results from excessive intestinal motility Diarrhea: Acute vs Chronic: Acute - Less than 2 weeks can be caused by: Stress, food intolerance, drugs, infectious agents, poison mushrooms Chronic types of diarrhea= A.) Osmotic diarrhea= nonabsorbable substance is digested (laxatives) for example- lactose intolerance B.) Secretory diarrhea= electrolyte absorption is impaired (viral gastroenteritis) C.) Motility diarrhea= hypermotility, diagnosis of exclusion Inflammatory diarrhea= D.) Bacterial dysentery (EHEC, shigella) chemotherapy, radiation, inflammatory bowel disease Diarrhea can Cause: Dehydration Electrolyte imbalance Weight loss

Intestinal obstruction (ileus)

Prevents the flow of chyme through the intestinal lumen= 1.)Simple obstruction Mechanical blockage of the lumen 2.)Functional obstruction (paralytic ileus) = not contracting normally - Failure of intestinal motility - Often occurs after intestinal or abdominal surgery or as medication side effect Signs of intestinal obstruction: Colicky pains Nausea and vomiting Hypogastric pain Abdominal distention Small Bowel Obstruction: are most often due to adhesions and hernias Large Bowel Obstruction: most often due to tumors and volvulus. Main Symptom: Abdominal Pain ileus: Inability of the intestine (bowel) to contract normally and move waste out of the body

Normal Values to Remeber:

Respiratory Rate: 16 Heart Rate: 80 Blood Pressure: 120/80 Serum pH: 7.4 Hemoglobin: 15 Hematocrit (3x the hemoglobin) : 45

Kidney Failure (acute)

Sudden loss of Kidney function (acute kidney injury or illness) Diagnosis: · Kidney Failure= low specific gravity · Dehydration is close to 1.00 (clear fluid)= high urine output - Hight blood urea nitrogen aka BUN -Associated with the development of chronic kidney disease Prerenal: · Most common cause of ARF · Caused by impaired renal blood flow · GFR declines because of the decrease in filtration pressure · Example: dehydration - Blood loss - Hemmorrhage - hypertension - heart failure ( Kidneys don't get as much blood) Intrarenal aka intrinsic: · Direct damage to the renal tissue · Acute tubular necrosis= tissue death (ATN) is the most common cause · Causes of ATN: Ischemia, Toxin, Sepsis - Severe glomerulonephritis Post-renal(after the kidney= ureters or bladder issue): · Blockage distal to the kidney causes kidney damage · Like the plumbing has backed up -kidney stones in ureter - Benign Prostatic Hyperplasia (causes problems with bladder emptying) - Obstruction to urine outflow Symptoms: Multiple - low Erythropoietin (due to kidney's job of producing this!) - Patient would display anemia

Ovarian Torsion Case Study

The classic presentation of adnexal torsion is sudden onset of unilateral lower abdominal pain which is initially visceral in character (ie, vague and poorly localized) and may be accompanied by nausea and vomiting. It may radiate to the groin or flank. Sometimes the patient will describe several episodes of pain over the course of hours, days, or even weeks, if the ovary has been torsing intermittently. A history of prior ovarian cyst or mass, prior ovarian torsion, or current pregnancy (ie, corpus luteum cyst) should increase your suspicion for torsion. Physical examination may reveal lower abdominal tenderness. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. Fever is uncommon, and usually low-grade if present.

Liver Cancer

The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Cancer that spreads to the liver is more common than cancer that begins in the liver cells. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer. - metastasizes most commonly from lung. (when Cirrhosis occurs- scar tissue forms on liver, may put patient at a high risk for Liver Cancer) Main Symptom: Liver Mass Abdominal Pain Weight loss White, chalky stools - Obstructive jaundice in end stage High Risk: Hep. B or C infection - Cirrhosis - Diabetes Metastases to this organ are more common than primary cancers in Liver Cancer!

What does the finding of red cell casts tell you about the renal injury?

There is severe cellular injury or cell destruction in the glomeruli with defects that allow intact red cells to enter the urinary space.

Why is cystic fibrosis a cause of pancreatitis?

Thick mucus secretions block the pancreatic ducts, which blocks the outflow of pancreatic enzymes (pancreatic enzymes are STUCK in the pancreas and can't leave to the small intestine to do digestion). Because of this backup of pancreatic secretions and enzymes, the activation of enzymes happens INSIDE the pancreas, which causes AUTODIGESTION (enzymes digest their own pancreas cells) → resulting in inflammation, vascular damage and tissue necrosis. Also know: patient presentation on exam: ●child, young ●Doesn't gain weight despite normal eating habits ●Isn't absorbing nutrients properly Pancreatic insufficiency is characterized by pancreatic exocrine dysfunction and lack of pancreatic proteases, lipase and amylase that assist in digestion of proteins, fats and carbohydrates. diagnosing exocrine pancreatic insufficiency= Generally, stool studies include fecal fat collection or fecal elastase testing.

Immune-mediated thrombocytopenia (ITP)

Thrombocytopenia = low platelet count​ IgG autoantibody that targets platelets Antibody-coated platelets are sequestered and removed from the circulation Acute ITP often develops after a viral infection (especially in kids); usually have purpura and petechiae One of the most common childhood bleeding disorders!

Ovarian torsion

Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in infarct of the ovary. Etiology (cause): Sometimes a mass or cyst in the ovary can cause twisting. If the stalk of the ovary is long, it may also lead to torsion Main Symptom: Abdominal Pain Early symptoms: Pain in the lower belly, usually sharp and sudden when it starts. Later symptoms: Worse pain that is constant, vomiting, nausea Surgery is the only treatment for ovarian torsion.

Peptic Ulcer Disease (PUD)

Ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum May be Superficial or deep Types by location: Gastric and duodenal Developmental factors: - Helicobacter pylori infection (almost all peptic ulcers are caused by H. pylori) - Hypersecretion of stomach acid - Use of NSAIDs Patho: H. Pylori bacteria attracts Protease's to the site = Epithelial Damage + Inflammation = Gastric Ulcer Infection is common Must treat with antibiotics or the ulcer will not heal Main Symptom: Epigastric Pain ( a name for pain or discomfort right below your ribs in the area of your upper abdomen)

Crohn's disease "skip lesions"

a chronic autoimmune disorder that can affect any part of the digestive tract from mouth to anus - Causes Inflammation, which makes sores to form along GI tract! - More susceptible to malabsorption and skipped lesions in the tract. - Anemia may result from malabsorption of vitamin B12 and folic acid. Main Symptom: Weight loss Diarrhea Fever Fatigue Abdominal pain and cramping Blood in your stool Mouth sores Reduced appetite Melena (dried blood) Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula) Extra-intestinal manifestations of IBD= can affect eyes, mouth, kidney (stones), skin, blood circulation, joints, and liver Patho: Transmural inflammation with mononuclear cell infiltrate, scarring, Non-caseating granulomas! Exact Cause: unknown may be: Env't triggers, Genetics, Luminal Antigens "cobblestoning" - affects all the layers of the alimentary canal, higher risk for colonrectal cancer

Ulcerative Colitis (UC) : mostly affects distal colon

a chronic inflammatory bowel disease (IBD) primarily located in the sigmoid colon and rectum (distal colon) Begins in the rectum and may extend proximally to the entire colon Intermittent periods of remission and exacerbation Colon is more responsible for water reabsorption: Causing the bright red stool: Hematochezia! Symptoms: Severe diarrhea Urgency = Need to find bathroom ASAP Bloody stools(hematochezia)! Cramping Patho: Inflammation above the muscularis propria; ulcers with pseudo polyps, crypt abscesses - Ulceration limited to the mucosa is a feature of ulcerative colitis. "Psedopolyps" UC over 10 years: Extremely high risk of colon cancer

Lung Cancer

a condition in which cancer cells form in the tissues of the lung Cause: The primary risk factor for developing Lung Cancer is cigarette smoking, which is to account for 90 percent of all Lung Cancers. •Secondhand Smoke Exposure •Radon •Environmental and Occupational Exposure - Asbestos Exposure(That Asbestosis exposure can lead to Mesothelioma) - Air Pollution - Ionizing Radiation Patho: Non-Small Cell Lung Cancer Adenocarcinoma (AC) •Adenocarcinoma starts in cells in your air sacs that make mucus and other substances, often in the outer parts of your lungs. It's the most common kind of lung cancer among both smokers and nonsmokers and people under 45. It often grows more slowly than other lung cancers. •Adenocarcinoma makes up about 40% of lung cancers. •It is usually on the Lung's Periphery•Alveolar Type II Cells •Adenocarcinoma can happen in many places, like your colon, breasts, esophagus ,pancreas, or prostate Squamous Cell Lung Cancer: •Starts in cells that line the inner airways of the lungs. •Is located in the central lung area. •Mucociliary Epithelial Cells •About 20-25% of lung cancers Main Symptoms: •Persistent cough •Chest pain that gets worse with deep breathing, laughing or coughing •Hoarseness •Unexplained loss of appetite and weight •Coughing up blood or rust-colored phlegm •Shortness of breath•Feeling weak and/or tired •Bronchitis, pneumonia or other infections that keep recurring •Wheezing •Pleural Effusion (Fluid between the Lung and the Chest). •Airway Obstruction •Dyspnea (Shortness of Breath) •COPD (may coexist The leading cause of cancer deaths in the United States: Lung Cancer Sputum cytology is used for in diagnosis: Lung Exposure to asbestos: Lung (mesothelioma)

Gastroparesis

a condition in which the muscles in the stomach slow down and work poorly or not at all, preventing the stomach from emptying normally. - Delayed gastric emptying in the absence of mechanical gastric outlet obstruction - Associated with diabetes mellitus, surgical vagotomy, or fundoplication Etiology of Gastroparesis: Most cases are Idiopathic (36%) Diabetic (29%) Surgery (13%) Other (22%) The pathogenesis of gastroparesis is poorly understood. - Condition that affects the stomach muscles and prevents proper stomach emptying​ Symptoms include: nausea, vomiting, abdominal pain, and postprandial fullness or bloating (early satiety) - Affects digestion​ - Cause Damage to the nerve that controls stomach muscles​ Diet changes/medication may offer relief

sickle cell anemia

a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape Body tries to get rid of these sickle cell RBC's and therefore causes anemia in the body.

Colon Cancer

a malignant tumor of the colon, Cancer of the large intestine Can cause lower GI bleeding, appearing as Hematochezia (bright red blood in stool)-- fresh blood. Patho: Colon cancer typically affects older adults, though it can happen at any age. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time some of these polyps can become colon cancers. Doctors aren't certain what causes most colon cancers Main Symptoms: - Melena (dark sticky feces containing partly digested blood) - Weakness or fatigue - Persistent abdominal discomfort, such as cramps, gas or pain - A feeling that your bowel doesn't empty completely - Unexplained weight loss Risks: 10 years or more of Ulcerative Colitis is large chance for Colon Cancer

Anaphylaxis (Anaphylactic Shock)

a severe response to an allergen in which the symptoms develop quickly, and without help, the patient can die within a few minutes. Rapid, severe hypersensitivity reaction Occurs within minutes of re-exposure to antigen. Can lead to: shock, Body leases mass amounts of Histamine Symptoms: (Rapid Onset) - Itching - Low BP - Tachycardia - Dyspnea = Tight throat, bronchospasm - Loss of Consciousness Common: Bee-stings, peanuts, shellfish, or eggs (some pay have allergies from substances like iodine or penicillin)

human immunodeficiency virus (HIV)

a virus that attacks the immune system and causes a deficiency in T-cells. HIV is a retrovirus that occurs as two types: HIV-1 and HIV-2. Both types are transmitted through direct contact with HIV-infected body fluids, such as blood, semen, and vaginal fluids, or from a mother who has HIV to her child during pregnancy, labor and delivery, or breastfeeding.

A 28 year old woman goes to her doctor saying she's been having abdominal discomfort and cramping as well as the urge to defecate for the past month. She says she noticed her stools have been bright red. She hasn't been taking any medication. What is the likely diagnosis? a.Ulcerative Colitis b.Crohn's Disease c.IBD d.Diarrhea due to gastroenteritis e.IBS

a.Ulcerative Colitis

Disseminated Intravascular Coagulation (DIC)

abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues. Main Symptoms: Bleeding/ Clotting Clotting + hemorrhage occurring at the same time! Always secondary to another condition! Underlying causes: inflammation, infection, cancer Especially gram-negative SEPSIS = can lead to DIC Patho of DIC: -Primary disease causes unregulated thrombin, means excessive blood clots -Excessive amount of thrombin being made, overwhelms antithrombin -Get multiple amounts of blood clots everywhere, excessive use of platelets and clotting factors -Then, fibrinolytic system is stimulated very rapidly, leading to hemorrhage. -Blood flow isn't going to organs= decreased perfusion can cause infarction- death of tissues. -MODS= Multiple organ disfunction

Varicose veins

abnormally swollen, twisted veins with defective valves; most often seen in the legs. Patho: They happen when faulty valves in the veins allow blood to flow in the wrong direction or to pool. Varicose veins and spider veins are normal veins that have dilated under the influence of increased venous pressure. In healthy veins, one-way valves direct the flow of venous blood upward and inward. Blood is collected in superficial venous capillaries, flows into larger superficial veins, and eventually passes through valves into the deep veins and then centrally to the heart and lungs - Pregnant women are more susceptible to varicose veins. - People who are overweight have an increased risk of varicose veins. Main Symptoms can include aching legs, swollen ankles, and spider/ enlarged veins. Varicose veins are generally benign. The cause of this condition is not known. For many people, there are no symptoms and varicose veins are simply a cosmetic concern. In some cases, they cause aching pain and discomfort or signal an underlying circulatory problem. Treatment involves compression stockings, exercise, or procedures to close or remove the veins. Causes: genetics, age, pressure, decreased Vitamin C (collagen) with protein

prostatisis

acute or chronic inflammation of the prostate gland Main Symptoms: Dysuria and hematuria The prostate's main job is to help make fluid for semen. Prostatitis can be caused by bacteria that leak into the prostate gland from the urinary tract and from direct extension or lymphatic spread from the rectum. It can also result from various sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, or HIV

10. A man experiencing weight loss and abdominal cramping undergoes diagnostic testing through which they discover lesions in his mouth and small intestine. Based on these findings, what condition does he likely have? a.Gastrointestinal infection from traveling b.Crohn's Disease c.Ulcerative Colitis d.Celiac disease

b. Crohn's Disease

A 39 year old woman presents to the ED with sharp pain in her sides that radiates. The pain comes and goes. She complains of nausea and has vomited once and feels urgency to urinate. Which of the following conditions does she most likely have? a.Cholelithiasis b.Nephrolithiasis c.Splenomegaly d.UTI

b.Nephrolithiasis

All of these are factors related to the release of prostaglandins, which causes dysmenorrhea, EXCEPT FOR what? a.Increased myometrial contractions b.Vasodilation of endometrial blood vessels c.Increased nerve hypersensitivity d.Ischemia of endometrium

b.Vasodilation of endometrial blood vessels

Gastro-Esophageal Reflux Disease (GERD)

backflow of contents of the stomach into the esophagus, often resulting from abnormal function of the lower esophageal sphincter, causing burning pain in the esophagus. Reflux of acid from the stomach= Can cause esophagitis Conditions that increase abdominal pressure or delay gastric emptying can contribute to the development of reflux esophagitis Main Symptom: Heartburn Acid regurgitation Dysphagia Chronic cough Asthma attacks Laryngitis Abdominal pain Sources of GERD: impaired digestion, hiatus hernia, bacterial or fungus imbalance, Lifestyle Stress, Poor Diet, Poor Posture, Bad Sleep Habits

Clostridium difficile colitis (C. diff)

bacteria which causes severe watery diarrhea and other intestinal disease when competing bacteria have been wiped out by antibiotics; It is spread by spores that are difficult to kill and can be carried on the hands of caregivers who have direct contact with residents or an environmental surface (i.e., floors, toilets, bedpans). Some people carry the bacterium C. difficile in their intestines but never become sick, though rarely may still spread the infection. Signs and symptoms usually develop within five to 10 days after starting a course of antibiotics, but may occur as soon as the first day or up to two months later. Main Symptoms: Watery diarrhea three or more times a day for two or more days. Mild abdominal cramping and tenderness, belly pain, and fever. Patho: The first phase involves suppression of the normal protective intestinal microbiota. This can occur as a result of antibiotics. Subsequent ingestion of C difficile, which is ubiquitous, leads to germination of C difficile spores and growth of toxin-producing cells that change the gastrointestinal epithelium and invoke an immune response, leading to CDAD symptoms.

A 24 year old woman is diagnosed with PCOS after running tests to check for possible causes of her infertility. Which of the following is the pathophysiology of her condition? a.Growths of endometrial tissue outside her uterus that respond to the hormonal changes of the menstrual cycle b.Benign cyst on her left ovary that is secreting excess androgens c.Insulin resistance and hyperinsulinemia causing excess androgen production d.Increased insulin responsiveness and glucose uptake by cells, which promotes estrogen synthesis

c. Insulin resistance and hyperinsulinemia causing excess androgen production

Cholelithiasis / Cholecystitis

cholelithiasis- gallstones Gallstones are hardened deposits of bile that can form in your gallbladder. Patho:- Impaired metabolism of cholesterol, bilirubin, and bile acids = stone formation Often asymptomatic or vague symptoms - Epigastric and right hypochondrium pain - Intolerance to fatty foods= presence of fat in the intestines, triggers the gallbladder to secrete bile for digestion of fat. How Gallstones Cause Symptoms: usually after eating a fatty meal. Cholecystitis - obstruction of the bile duct-colicky epigastric RUQ pain, right shoulder; after fat meal - Most often caused by stones Patho: If your gallbladder doesn't empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones! Gallbladder= breaks down fats Main Symptom: abdominal pain - Right Quadrant Pain

polycystic ovary syndrome (PCOS)= high androgen level + insulin resistance

condition where both ovaries have many cysts due to a hormone imbalance. Diagnostic criteria: Two of the following= · Few or anovulatory menstrual cycles · Elevated levels of androgens · Polycystic ovaries Associated with genetic predisposition and obesity: · Insulin resistance · Excessive insulin and androgens Symptoms: related to anovulation and hyperandrogenism. Treated with oral contraceptives PCOS signs and symptoms: High insulin: weight gain skin changes high estrogen (fat) triggers testosterone causing: Acne Facial hair male pattern baldness masculine features

13.A 19 year old presents to the ED complaining of severe right lower quadrant pain. She has a low-grade fever and complains of nausea. What is the likely cause of her condition? a.Nephrolithiasis b.Cholelithiasis c.Cholecystitis d.Appendicitis

d.Appendicitis

4.Which of the following ISN'T a risk factor for the development of GERD? a.Hiatal hernia b.Obesity c.Gastroparesis d.High sphincter resting tone e.Increased gastric acid

d.High sphincter resting tone

A 78 year old woman with a history of atherosclerosis and hypertension presents to the doctor with significant rapid weight loss. When asked about her nutrition, she says she's had to eat less often because after she does, her abdomen hurts really bad. What is the pathophysiology of her condition? a.Intolerance to fatty substances resulting in poor digestion b.Malabsorption syndrome finding that is common in old age c.Erosion of the stomach lining from stomach acid d.Inadequate blood flow to the intestines due to narrowed vessels

d.Inadequate blood flow to the intestines due to narrowed vessels Mesenteric Vascular Insufficiency= - Chronic mesenteric ischemia= from Vascular Disease, usually as patients age, can get plaques in vessels, patients usually don't have an appetite, and when they eat, they get abdominal pain Causes of Acute Mesenteric Insufficiency and "equivalents" + Same process elsewhere in the body · Venous Thrombosis = from a Hyper coagulate state · Arterial Embolus = from A fib · Arterial Thrombosis = Atherosclerosis Disease · Non-occlusive Shock = Volume Depletion

Anemia, Iron deficiency

deficiency in hemoglobin level due to a lack of iron in the body Microcytic with high RDW! Most common type of anemia: Low RBCs = increase workload of the heart Nutritional iron deficiency or blood loss E.g., women's menses Signs and symptoms: FATIGUE, Pale skin, Dyspnea, Tachycardia, Dizziness, even fainting, Inflammation or soreness of tongue, Brittle nails, Unusual cravings for non-nutritive substances (Pica)

Cellulitis

diffuse, acute infection of the skin marked by local heat, redness, pain, and swelling. A common and potentially serious bacterial skin infection. With cellulitis, the bacteria enters the skin. Cellulitis may spread rapidly. Affected skin appears swollen and red and may be hot and tender. Without treatment with an antibiotic, cellulitis can be life-threatening. Cellulitis usually affects the skin on the lower legs, but it can occur in the face, arms and other areas. It occurs when a crack or break in your skin allows bacteria to enter. Left untreated, the infection can spread to your lymph nodes and bloodstream and rapidly become life-threatening. It isn't usually spread from person to person. Cellulitis occurs when bacteria, most commonly streptococcus and staphylococcus, enter through a crack or break in your skin. The incidence of a more serious staphylococcus infection called methicillin-resistant Staphylococcus aureus (MRSA) is increasing. Cellulitis symptoms include: - pain and tenderness in the affected area - redness or inflammation of your skin - a skin sore or rash that grows quickly - tight, glossy, swollen skin - a feeling of warmth in the affected area - an abscess with pus - fever

Esophageal varices

enlarged and swollen veins at the lower end of the esophagus considered an upper GI bleed. Main symptom: hematemesis= vomiting of blood, occurs when varices rupture Very commonly seen in portal hypertension! very dangerous, if that ruptures = diffuse bleeding and vomiting of blood Blood is under high pressure, so a lot of blood comes out! Patho: Esophageal varices sometimes form when blood flow to your liver is blocked, most often by scar tissue in the liver caused by liver disease. The blood flow begins to back up, increasing pressure within the large vein (portal vein) that carries blood to your liver. Blood finding alternate routes = Varices Upper GI bleed ○Hematemesis (vomiting blood)-- could be from gastric ulcer ○Melena ( black "tarry" stool) ■It's dark because the blood is partially digested by the time the person expels it (from the upper GI tract is has time to get partially digested)

Ectopic Pregnancy

implantation of the fertilized egg in any site other than the normal uterine location Most often occurs in a fallopian tube, which carries eggs from the ovaries to the uterus. This type of ectopic pregnancy is called a tubal pregnancy. Sometimes it occurs in other areas of the body, such as the ovary, abdominal cavity or the lower part of the uterus (cervix), which connects to the vagina. An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue may cause life-threatening bleeding, if left untreated. Main Symptom: Abdominal Pain light vaginal bleeding and pelvic pain. If blood leaks from the fallopian tube, you may feel shoulder pain or an urge to have a bowel movement. Emergency symptoms= If the fertilized egg continues to grow in the fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is likely. Symptoms of this life-threatening event include extreme lightheadedness, fainting and shock.

urinary tract infection (UTI)

infection of one or more organs of the urinary tract. Types of Urinary Tract Infections: Acute cystitis (bladder) Pyelonephritis (kidney) Acute cystitis: Inflammation of the bladder (most common type of UTI) Clinical Presentation: · Frequency, Dysuria, Urgency · Lower abdominal and/or suprapubic pain Treatment: · Antibiotics · Urinary analgesics Acute Pyelonephritis: affects the kidneys · Bacteria ascend from the lower urinary tract; rarely, reach kidney via bloodstream · Bacteria invade the renal parenchyma · May lead to renal scarring Common bacteria is E. Coli.

pelvic inflammatory disease (PID)

inflammation of organs in the pelvic cavity; usually includes the fallopian tubes, ovaries, and endometrium; most often caused by bacteria. Sexually transmitted diseases migrate from the vagina to the upper genital tract Associated with multiple sexual partners. Most common cause: chlamydia and gonorrhea! ​ Main Symptom: Pelvic Pain Need rapid empiric treatment to prevent complications, such as infertility

appendicitis

inflammation of the appendix, which is usually acute and caused by blockage of the appendix followed by infection. inflammation of the appendix, usually due to obstruction or infection. Possible causes: Obstruction of appendix, foreign bodies, infection. RLQ pain: Right Lower Quadrant Abdominal Pain. In the appendix, these are good bacteria, and their purpose is to help break down the foods you eat and stave off the growth of bad bacteria -- the kinds that make you sick. These good bacteria also play a critical role in producing vitamins and hormones needed by your body.

Dsyfunctional Uterine Bleeding (DUB)

is irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy. It reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining. - usually due to hormone imbalance When hormones are the problem, doctors call the problem dysfunctional uterine bleeding, or DUB. Abnormal bleeding caused by hormone imbalance is more common in teenagers or in women who are approaching menopause.

Celiac disease

malabsorption syndrome caused by an immune reaction to gluten, damages the villi in the small intestines; Creates inflammatory response which damages the intestinal lining​ Autoimmune disease = Celiac disease is genetic. Patho:When you eat gluten = it will go into the small intestines and will damage the villi, can't take in the nutrients and absorb them properly. Micro Villi in small intestine = surface area for increased nutrient absorption Celiac Disease = decreases surface area of the small intestine. Main Symptoms: Dyspepsia= indigestion and losing weight Prevents absorption of some nutrients (malabsorption)​ S/S --> Diarrhea​, Bloating, gas, fatigue, osteoporosis, anemia (or no symptoms)​ Treated by:a gluten free diet: If you have celiac disease and eat foods with gluten, your immune system responds by damaging the small intestine. Gluten is a protein found in wheat, rye, and barley. Can cause secondary lactose intolerance, due to damaged villi.

Infertility definition

o "Frequent" intercourse (most consider that approximately semiweekly or more) o Unprotected (no use of birth control) o Attempts to become pregnant for - at least a year if under 35 - at least six months if 35 or older. Systems that might be involved in infertility o Endo o GU / Renal o Immune § Autoimmune disease § Anti-sperm antibodies Risk factors for Infertility: · Age · Smoking · Alcohol use · Being overweight or underweight · Excessive exercise / Extremely low body fat

Atrial Fibrillation (A-Fib)

occurs when the normal rhythmic contractions of the atria are replaced by rapid irregular twitching of the muscular heart wall chaotic flow in atrium, can cause Embolic Stroke! A-fib is a type of Cardiac Arrhythmia (very common) Irregular, often rapid heart rate that commonly causes poor blood flow​. Atria beat out of coordination with the ventricles​ May appear with no symptoms​: S/S Palpitations, SOB, fatigue​ Treatment​ Medication​ Cardioversion​ Ablation V-fib causes death usually in a person!

Hyperthyroidism: Grave's Disease

overactivity of the thyroid gland Excess thyroid hormone= (low TSH) (high TH) Patho: Antibody mimics TSH= autoantibodies act like TSH and stimulate the TSH receptor = stimulate the thyroid - Thyrotoxicosis: a toxic level of thyroid hormone. - Abnormal feedback mechanism - Inflammatory attack on the thyroid gland Main Symptoms: Anxiety and exopthalmos(bulging eyes) - Young women most affected ​ - Turn up the "thermostat"

Dysmenorrhea (painful cramps)

painful cramps due to mentrual cycle, can occur before or during menses. Results from increased prostaglandin production during the luteal phase of the menstrual cycle. · Increased myometrial contractions= o Constricted endometrial blood vessels o Increased nerve hypersensitivity Treatment of Dysmenorrhea= · Non-steroidal anti-inflammatory drugs (NSAIDs) for pain (prostaglandin inhibitors) · Hormonal contraceptives "Pill": (reduces spikes in hormones and lining build up in uterus)

Nephrolithiasis / Urolithiasis

presence of stones in the kidney (genetic predisposition) Urolithiasis refers to stones originating anywhere in the urinary system, including the kidneys and bladder. Nephrolithiasis refers to the presence of such stones in the kidneys Patho: dietary and lifestyle factors along with acquired (genetic) metabolic factors o Supersaturation of one or more salts - Presence of a salt in a higher concentration than the volume able to dissolve the salt o Precipitation of a salt from liquid to solid state - due to Temperature and pH o Growth into a stone via crystallization or aggregation Main Symptom: Colic = Waves of sharp, intense pain caused by kidney dysfunction. Hematuria= blood in the urine Evaluation: Imaging studies 24-hour urinalysis Risk: not drinking enough water

AIDS (acquired immune deficiency syndrome)

sexually transmitted infection caused by HIV, resulting in damage to the immune system. Acquired immunodeficiency syndrome (AIDS) is caused by HIV, which damages the cells in the body's immune system so that the body is unable to fight infection or certain cancers.

Benign Prostatic Hypertrophy (BPH)

swelling of the prostate gland which surrounds the base of the male bladder and urethra causing difficulty urinating, dribbling, and nocturia (wake up at night to pee) · Prostate gland is enlarged · Not cancer! · Enlarged prostate pinches the urethra · Bladder wall becomes thicker · Bladder may weaken - less able to empty · Leaves some urine in the bladder, causing post-void residual! Main Symptom: Urinary Hesitancy May cause acute kidney failure

Menopause

the time of natural cessation of menstruation; also refers to the biological changes a woman experiences as her ability to reproduce declines Menopause is the permanent cessation of menses for 12 months resulting from estrogen deficiency and is not associated with a pathology. The median age of menopause is 51. Patho: Menopause is a normal physiologic process in aging women, in which the number of ovarian, primary follicles quickly diminish, such that there are inadequate amounts to respond to the effects of FSH. In turn, there is no LH surge, and ovulation does not take place, resulting in the decline of estrogen production and the cessation of menstruation. Moreover, LH and FSH go uninhibited and remain at high levels years after the onset of menopause. Main Symptom: Heat Flashes

Hematomas

usually caused by a trauma (like car accident or blunt force trauma)

Endometriosis

· Presence of functioning endometrial tissue or implants outside the uterus · Responds to hormone fluctuations of the menstrual cycle Associated with: o Dysmenorrhea o infertility o pelvic pain o painful menses Patho: With endometriosis, the endometrial-like tissue acts as endometrial tissue would — it thickens, breaks down and bleeds with each menstrual cycle. But because this tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other. Endometriosis can cause pain — sometimes severe — especially during menstrual periods.

Hormones produced by the kidney:

· Vitamin D o Necessary for the absorption of calcium and phosphate and critical for bone formation · Erythropoietin (synthetic version exists as well) o Released when decreased oxygen to the kidney o Stimulates RBC production o So, in kidney failure, Patient would show anemia!!!

Complications of Diabetes Mellitus

○ Microvascular disease= disease of the very Small vessels of the body (more with Type 1 diabetes: eye disease, kidney disease) Diabetic retinopathy (eyes), nephropathy (kidney), neuropathy (nerves)= may not feel injury, may need to get toes cut off, for example ○ Macrovascular disease= disease of the BIG vessels of the body (both Type 1 and 2) EX: Cardiovascular disease, stroke, peripheral vascular disease ○ Infection= occur often due to hyperglycemia and the disruption of the normal biome