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