Patho Exam 4
primary adrenal insufficiency caused by destruction of adrenal gland
Addison's disease
glucose transporter present in all tissues and does not require insulin action to transport glucose into cells of the nervous system
GLUT-1
major transporter of glucose into beta cells and liver cells only when plasma glucose levels are high (e.g., after a meal)
GLUT-2
insulin-dependent glucose transporter that is sequestered inside the membrane of skeletal muscle and adipose tissue cells
GLUT-4
The most common cause of hyperthyroidism is _____, which is accompanied by ophthalmopathy and diffuse goiter. Many of the manifestations of hyperthyroidism are related to the increase in ____ consumption and use of ____ fuels associated with the hypermetabolic state, as well as to the increase in sympathetic nervous system activity.
Graves disease; oxygen; metabolic
autoimmune disorder in which the thyroid gland may be totally destroyed; presents with hypothyroid
Hashimoto thyroiditis
occurs primarily by the fecal-oral route with fecal shedding about 2-3 weeks before symptoms occur
Hepatitis A
inoculation with infected blood and/or spread by oral or sexual contact
Hepatitis B
most common cause of chronic hepatitis, cirrhosis, and hepatocellular cancer in the world
Hepatitis C
coinfection or superinfection linked to HBV
Hepatitis D
high mortality rate in pregnant women; does not cause chronic hepatitis or the carrier state
Hepatitis E
functional GI disorder characterized by variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities; characterized by abdominal pain relieved by defecation and associated with change in consistency or frequency of stools
IBS
Adenomatous polyps are benign neoplasms that arise from the mucosal epithelium of the intestine. ____ are found mostly in the sigmoid colon and are broad-based, elevated lesions with a shaggy cauliflower-like surface; while ____ are smooth-surfaced spheres less than 2 cm that attach to the mucosal surface by a stalk. The _____ form appears as both tubular and villous.
Villous adenomas; tubular adenomas; tubulovillous
polypeptide co-secreted by beta cell and acts as a hormone producing inhibition of gastric emptying and glucagon secretion
amylin
manifestations of untreated congenital hypothyroidism
cretinism
secrete somatostatin
delta cells
Difficulty in swallowing is termed dysphagia, which may be caused by _____ . Check all that apply.
disruption of neural networks coordinating the swallowing mechanism weakness of the oropharyngeal or esophageal muscular structures narrowing of the esophagus lack of salivary secretion
eyelid retraction, bulging eyes, light sensitivity, discomfort, double vision, and vision loss
ophthalmopathy
conversion of amino acids to ketoacids and ammonia
oxidative deamina
The pancreas is made up of 2 major tissue types. The ____ secrete digestive juices into the duodenum and the ___ secrete hormones into the blood.
pancreatic acini; islets of Langerhans
deficiency of all pituitary-derived hormones
panhypopituitarism
inflammatory condition of the lining of the abdominal cavity with translocation of extracellular fluid into the cavity
peritonitis
______ results from absent mesenteric ganglia that carry vagal fibers to the lower esophageal sphincter resulting in incomplete relaxation of the lower esophageal sphincter and stasis of food.
primary achalasia
large molecule in the beta cells composed of A and B chains connected by a connecting peptide chain
proinsulin
infectious enterocolitis most severe in children 3-24 months presenting with fever, vomiting, frequent watery stools
rotavirus
diarrhea occurring with fecal impaction, fat malabsorption, chronic laxative abuse, etc. when secretory processes of the bowel increased
secretory diarrhea
polypetide hormone with 14 amino acids and short half-life secreted by delta cells; inhibits release of insulin and glucagon and extends the time during which food is absorbed into the blood
somatostatin
growth hormone-secreting cells
somatotropes
fatty infiltration of the liver
steatosis
Curling ulcer that may develop when person has large-surface-area burns, trauma, sepsis, ARDS, severe liver failure or major surgical procedures
stress ulcer
Thyroid hormones are bound to ____ and other plasma proteins for transport in the blood. Measures of these thyroid hormones, T3, T4, and TSH, are obtained through _____ methods.
thyroxine-binding globulin; immunoassay
diarrhea and rectal bleeding common
ulcerative colitis
intestinal mucosa primary level of involvement with continuous lesions
ulcerative colitis
primarily occurs in rectum and left colon
ulcerative colitis
ulcerative and exudative inflammatory process
ulcerative colitis
Hyperthyroidism that is inadequately treated can cause a life-threatening condition known as thyroid storm. What are the manifestations of a thyroid storm? Mark all that apply.
very high fever tachycardia delirium
infectious enterocolitis that produces Shigella-like toxins that attach to and damage the mucosal lining of the intestine, causing bloody diarrhea
E. coli
Colorectal cancer arises from preexisting adenomatous polyps and has had a reduced incidence in recent years due to routine screening with CT scans and/or pelvic MRI.
False
_____ commonly presents in infancy as failure to thrive resulting from a T-cell-mediated immune response due to dietary intake of gluten.
celiac disease
occurs when bile flow is obstructed between the liver and the intestine
cholestatic jaundice
Gallstones are caused by precipitation of substances contained in bile, including ______. Select all that apply.
cholesterol bilirubin
absence of grossly visible erosions with presence of inflammatory changes leading to atrophy of glandular epithelium of stomach
chronic gastritis
autoimmune gastritis affects the body and fundus of stomach with hypergastrinemia and hyperplasia of antral gastrin-producing cells
chronic gastritis
chemical gastropathy with gastric injury resulting from reflux of alkaline duodenal contents, pancreatic secretions and bile into the stomach
chronic gastritis
often caused by H. pylori gastritis of the antrum and body of stomach
chronic gastritis
Peptic ulcer disease describes a group of ulcerative disorders that occur in areas of the upper gastrointestinal tract that are exposed to acid-pepsin secretions. Select all true responses about this condition from the list below.
clinical manifestations include burning, gnawing, cramp-like pain occurring when stomach empty and relieved with food intake risk factors include H. pylori infection, NSAID or aspirin use most common forms are duodenal and gastric ulcers complications include hemorrhage, perforation, penetration and gastric outlet obstruction exacerbations of this condition may last for weeks followed by periods of remission
increases protein synthesis in all body cells, mobilizes fatty acids from adipose tissue and antagonizes effects of insulin
growth hormone
glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide that stimulate insulin secretion after heavy carbohydrate meal
gut-derived hormone
Growth hormone cannot directly produce bone growth; instead, it acts indirectly by causing the liver to produce insulin-like growth factor. The secretion is stimulated by ____ . Select all that apply.
heavy exercise hypoglycemia increased blood levels of amino acids fasting and starvation emotional stress
Approximately 300 mL of blood per minute enters the liver through the __________ ; another 1050 mL per minute enters by way of the ____________ .
hepatic artery; portal vein
diarrhea occurring when water is pulled into the bowel by the hyperosmotic nature of its luminal contents when saline cathartics used or in instances of lactase deficiency
hyperosmotic diarrhea
decreased secretion of pituitary hormones
hypopituitarism
In an acute adrenal crisis, the onset of symptoms is sudden, and in the case of Addison disease, can be precipitated by exposure to a minor illness or stress. Mark all of those manifestions of an acute adrenal crisis.
hypotension muscle weakness vascular collapse dehydration
Select the major functions of the thyroid hormone that make it necessary for growth and development in children.
increase protein synthesis increase metabolism
Portal hypertension is characterized by _______ Select all that apply.
increased resistance to flow in the portal venous system sustained increase in portal venous pressure
manifestations that result from activation of inflammatory cells in the bowel with elaboration of inflammatory mediators causing nonspecific tissue damage; characterized by remissions and exacerbations of diarrhea, fecal urgency and weight loss
inflammatory bowel disease
Malabsorption syndrome is the failure to transport dietary constituents, such as fats, carbohydrates, proteins, vitamins, and minerals, from the lumen of the intestine into the extracellular fluid compartment for transport to various parts of the body. What are the major clinical manifestations of this condition? Select all that apply.
macrocytic anemia, glossitis, peripheral neuropathy bruising, bleeding, bone pain, predisposition to fractures, tetany weakness, muscle wasting, weight loss and abdominal distention failure to absorb fat-soluble vitamins diarrhea, steatorrhea, flatulence, bloating, abdominal pain and cramps
What are the clinical manifestations and causes of Mallory-Weiss syndrome? Select all that apply.
may occur during acute illness with severe vomiting hematemesis chronic alcoholism causing severe retching and/or vomiting nonpenetrating, longitudinal mucosal tears in esophagus at gastroesophageal junction
The term Cushing syndrome refers to the manifestations of hypercortisolism from any cause. From the list below, mark the typical manifestations of this condition.
moon face protruding abdomen thin extremities and muscle weakness buffalo hump
The term ______ implies the presence of a nonpitting mucus-type edema caused by the accumulation of hydrophobic extracellular matrix substances in the connective tissues of a number of body tissues.
myxedema
One of the jobs the liver performs is to export triglyceride. When the liver's capacity to export triglyceride is maximized, excess fatty acids accumulate in the liver. What is the disease these excess fatty acids contribute to?
nonalcoholic fatty liver disease
____ provides a strong stimulus for ______ contraction and is released when food enters the intestines.
Cholecystokinin; gallbladder
granulomatous inflammation
Crohn disease
primarily involved in ileum, secondarily in colon
Crohn disease
strictures, fistulas, perianal abscesses common complications
Crohn disease
submucosal level of involvement with skip lesions
Crohn disease
____ occurs when the amount of fluid in the peritoneal cavity is increased. When an individual has this condition along with cirrhosis, ______ is a complication.
Ascites; spontaneous bacterial peritonitis
biologically inactive peptide chain connecting A and B chains and released simultaneously with active insulin from the beta cells; can be used to measure beta cell function
C-peptide chain
infectious enterocolitis caused by gram-positive, spore-forming bacillus characterized by diarrhea and lower abdominal cramping and beginning within 1-2 weeks after antibioitic treatment initiated
C. difficile
capable of removing and phagocytosing old and defective blood cells
Kupffer cells
growth hormone levels normal or elevated, but person has a hereditary defect in insulin-like growth factor production
Laron-type dwarfism
____ is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormone; and ____ is manifested by a very high fever, extreme cardiovascular effects, and severe CNS effects.
Thyrotoxicosis; thyroid storm
diagnosis based on elevated gastrin and basal gastric acid levels
Zollinger-Ellison Syndrome
Cholestasis is a condition in which there is a decrease in bile flow through the intrahepatic canaliculi and a reduction in secretion of water, bilirubin, and bile acids by the hepatocytes. Cholestasis can have more than one cause, but, in all cases, there is what?
accumulation of bile pigment in the liver
associated with NSAID/aspirin use, chronic alcoholism, or bacterial endotoxin
acute gastritis
self-limiting with complete regeneration and healing within several days of removal of inciting agent
acute gastritis
transient in nature and may be accompanied by hemorrhage into mucosa and sloughing of superficial mucosa
acute gastritis
transport protein/plasma colloidal osmotic pressure
albumin
secrete glucagon
alpha cells
secrete insulin and amylin
beta cells
splitting of fatty acids into two-carbon acetyl-coenzyme A
beta oxidation
A major exocrine function of the liver is _____ secretion; and the most important of the secretory proteins of the liver is ____.
bile; albumin
formed from senescent red blood cells
bilirubin
Acromegaly is a disorder that is caused by production of excessive GH in the adult. Because the person cannot grow taller, the soft tissues continue to grow, presenting a very distinctive appearance. Select the distinctive characteristic(s) of acromegaly.
broad, bulbous nose and a protruding lower jaw
catecholamine that maintains blood glucose levels during periods of stress
epinephrin
inhibits insulin release from beta cells and decreases movement of glucose into muscle cells
epinephrin
obstruction of large bile ducts reducing bile secretion
extra hepatic cholestasis
Conjugation of bilirubin is impaired when _______ Select all that apply.
free bilirubin is unable to combine with glucuronic acid transport of bilirubin into liver cells is impaired liver cells are damaged
polypeptide molecule secreted by the alpha cells that maintains blood glucose between meals and during fasting by initiating glycogenolysis in the liver
glucagon
steroid hormones synthesized in adrenal cortex that promote survival during periods of fasting and starvation
glucocorticoid hormone
Body tissues obtain glucose from the blood. After meals, blood glucose levels rise and insulin is secreted to regulate blood serum levels by moving glucose into body tissues or into the liver for storage. Between meals glucose levels fall below normal causing the liver to synthesize glucose from amino acids, glycerol, and lactic acid in a process called ___ for either release into the circulation or storage as glycogen. ____ occurs when the glycogen in the liver is broken down and glucose is released into the bloodstream.
gluconeogenesis; Glycogenolysis
When produced as part of the stress response, ___ hormones aid in regulating the metabolic functions of the body and in controlling the inflammatory response. ____ stimulates glucose production by the liver, promotes protein breakdown, and causes mobilization of fatty acids.
glucosteroid; Cortisol
increase in the size of the thyroid gland
goiter
Release of insulin from the pancreatic beta cells is regulated by blood glucose levels, increasing as blood glucose levels rise and decreasing when blood glucose levels decline. What are the actions of insulin in lowering blood glucose levels? Select all that apply.
inhibits protein breakdown and increases protein synthesis by active transport of amino acids into body cells and prevents use of amino acids for gluconeogenesis promotes fat storage by increasing transport of glucose into fat cells, facilitating triglyceride synthesis from fat cells and inhibiting intracellular breakdown of stored triglycerides provides for glucose storage in liver by entering portal circulation and traveling directly to the liver when secreted by beta cells and promotes glucose uptake by target cells by binding to membrane receptor
only hormone that directly lowers blood glucose levels by glucose uptake in cells and tissues and glucose storage in liver as glycogen
insulin
Several hormones are essential for normal body growth and maturation, including _____ . Select all that apply.
insulin androgens growth hormone thyroid hormone
abnormally high accumulation of bilirubin in the blood
jaundice
Chronic pancreatitis is characterized by _____ Select all that apply.
late stage destruction of endocrine pancreas progressive destruction of the exocrine pancreas fibrosis
What laboratory markers are most commonly used to diagnose acute pancreatitis?
lipase and amylase
Gastroesophageal reflux disease (GERD) is the persistent reflux of gastric contents into the esophagus. What are the a) major clinical features, b) diagnosis, and c) treatment measures? Select all that apply.
wheezing, chronic cough and hoarseness are respiratory symptoms produced by reflux of gastric contents pharmacologic treatment may include antacids and/or H2-receptor antagonists or proton pump inhibitors frequently linked with asthma most frequent symptom is pyrosis occurring 30-60 minutes after eating and increasing with bending at the waist or recumbent position diagnosis based on history of symptoms, barium radiographic studies of upper GI tract, esophagoscopy, and esophageal pH monitoring
