Pathophysiology II

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created 9 years ago by sammiellama
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Review of reproductive, renal, neurological, musculoskeletal, endocrine, and digestive alterations in function.
updated 9 years ago by sammiellama
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1

Primary dysmenorrhea

painful menstruation associated with prostaglandin release in ovulatory cycles

2

Secondary dysmenorrhea

painful menstruation related to pelvic pathology, can occur at any time during the menstrual cycle

3

Primary amenorrhea

definition: the absence of menstruation by age 14.

causes: congenital defects of gonadotrophin production, genetic disorders (Turner's syndrome), CNS nervous system defects (hydrocephalus), anatomic malformation (w/o vagina or uterus), acquired CNA lesions (brain tumor)

4

Secondary amenorrhea

definition: absence of menstruation for a time equivalent to three or more cycles or 6 months in women who have previously menstruated

causes: pregnancy, dramatic weight loss

5

Dysfunctional Uterine Bleeding (DUB)

definition: heavy bleeding in the ABSENCE of disease, progesterone is absent

6

Polycystic Ovarian Syndrome (PCOS)
**describe the process

high levels of insulin cause excess production of androgens, which then causes immature ovarian follicles, leading to the inability to ovulate. The multiple immature follicles look like cysts.

7

Premenstrual Syndrome (PMS)

definition: Cyclic physical, psychological, or behavioral changes that impair interpersonal relationships or interfere with usual activities

common symptoms: depression, fatigue, anger, irritability

8

Pelvic Inflammatory Disease (PID)

inflammatory infection that starts at the cervix, caused by STI or polymicrobial infections

9

Pelvic Relaxation Disorders/ Pelvic Organ Prolapse

The muscles and fascia lose tone and strength with aging, fails to maintain organs in proper position

caused by: trauma, surgery, childbirth, nerve damage

10

Ovarian cysts (ovarian torsion)

Biggest concern is the development of an ovarian torsion... the ovaries rotate and twist, strangulating the surrounding vasculature (medical emergency!!)

11

Endometriosis

Presence of functioning endometrial tissue or implants outside the uterus

common symptoms: infertility, pelvic pain, dyzchezia

12

Leiomyomas

**causes/risk factors, clinical manifestations

1. heredity, never being pregnant, obesity, PCOS

2. mostly asymptomatic; but can cause pain, bleeding, or a feeling of pressure

13

Cervical cancer
*cause, symptoms

1. HPV, almost always

2. slowly growing and asymptomatic

14

Endometrial cancer

**who has highest occurrence, most common manifestation

1. highest occurrence of cancer in post-menopausal women

2. abnormal vaginal bleeding most common CM

15

Ovarian cancer

**causes, risk factors, manifestation

1. genetics and environment... causes more deaths than any other cancer

2. risk factors include family history, increased age, infertility

3. generally asymptomatic

16

Urethritis
**definition, cause

1. inflammation of the urethra

2. STI is most common, urologic procedures, insertion of foreign objects, anatomic abnormalities, or trauma

17

Urethral strictures
**definition, cause

definition: fibrotic narrowing of the urethra caused by scarring

commonly a result of trauma or untreated/severe urethral infections

18

Phimosis

inability to retract foreskin from glans of penis

19

Paraphimosis

Inability to replace foreskin or cover the glans

20

Peyronie disease

Slow development of fibrous plaques (thickening) in the erectile tissue of the corpus cavernosa, causing a lateral curvature of the penis during erection

21

Priapism

Condition of prolonged penile erection
,emergency

22

Crytorchidism

Failure of one of the testes to descend from the abdominal cavity into the scrotum, individuals are susceptible to testicular cancer

23

Orchitis

Acute inflammation of the testis, most commonly caused by mumps

24

Testicular torsion

rotations of testes, cutting off blood supply, medical emergency

25

Benign Prostatic Hyperplasia (BPH)

enlargement of the prostate gland, symptoms are similar to urethral compression, r/t age and hormone levels... Urge to urinate, Delay in urination, Decrease force of stream

26

Prostatitis

Inflammation of the prostate

interruption with: Normal protective barriers:
Urethral length, urination, and ejaculation

27

Testicular cancer

painless testicular enlargement, most curable, ages 15-35

28

Prostate cancer

Prostatic cancer is asymptomatic until its advanced stages

Symptoms are similar to BPH

29

Galactorrhea

Persistent and sometimes excessive secretion of milky fluid from the breasts of a woman who is not pregnant or nursing
overstimulation of pituitary from tumor = too much prolactin

30

Gynecomastia

Growth of breast tissue in a man, Due to hormone alterations

31

Breast cancer in males

crusting and nipple discharge

32

Breast cancer in females

painless lump

33

Bacterial vaginosis

Characterized by a thin, grey-white vaginal discharge with a strong “fishy” odor

34

Chlamydia

most common bacterial STI in US, asymptomatic 50% of the time, vaginal discharge

35

Syphilis

Fever, rashes, headache, joint pain
Local symptoms: Development of chancres or sores on the genitalia

36

Gonorrhea

adolescents at higher risk. Urethral, vaginal, renal, or oral infections, painful urination, menstrual irregularity

37

HPV

most common viral STI in the US, frequently asymptomatic, Formation of genital warts that are soft, skin colored, whitish pink to reddish brown and occur singly or in clusters

38

Herpes

herpes simplex 1 and 2, Transmitted through mucus membrane contact or infectious saliva
Small, painful scattered vesicles in the genital area

39

Hydronephrosis

dilation of renal pelvis b/c of obstruction... gets bigger for urine to fit through

40

Ureterohydronephrosis

ureter dilation b/c of obstruction

41

Urinary Tract Obstruction
anatomic & functional

1. intereference with flow of urine at any site along the urinary tract

anatomic: genetic/change in structure
functional: tumors/kidney stones/enlarged prostate

42

Upper Urinary Tract Obstruction

Masses of crystals, protein, or other substances that form within & may obstruct the urinary tract

risk factors: male gender, Caucasian, fluid intake, dehydration, urinary retention, diet, changes in urine pH...

KIDNEY STONES

43

Neurogenic bladder

dysfunction r/t neurological disease (stokr,e spinal cord injury, MS)...

dyssynergia: loss of coordination in the contraction of the bladder

44

Renal cancer

Renal adenomas (benign) --> noncancerous
Renal cell carcinoma (rare) ... carcinomas originate from epithelial cells

45

Bladder cancer

Transitional cell carcinoma (most common): gross, painless, hematuria ... most common in males 60+ & smokers

TOP 5 of all malignancies: pt may have flank pain, weight loss, and may feel mass upon palpation

46

Acute cystitis

Dysuria, urgency, frequency, sub-pubic pain.. can happen anywhere in urinary system... most common, women at higher risk b/c short urethra & urethra closer to anus. Pathogen that causes it = E. coli.... catheters are most common cause

47

Interstitial cystitis

Nonbacterial... manifestations: most common in women 20-30, bladder fullness, frequency, small urine volume, chronic pelvic pain, cloudy urine, flank pain, fever, hematuria (causes are only known to be genetics, environment, and/or autoimmune)

48

Pyelonephritis

Infection of renal pelvis, caused by urine reflux, E. coli, Proteus, Pseudomonas

Chronic pyelonephritis: persistent/recurrent acute pyelonephritis, risk of chronic increases w/ individuals with renal infections and some type of obstructive pathologic condition.... tissue gets thick & fibrous can cause obstruction

49

Glomerulonephritis

inflammation of the glomerulus...
most commonly caused by immunologic abnormalities, drugs/toxins, vascular disorders, systematic disease (Secondary), viral causes......... remember antigens & antibody response

manifestations: hematuria, proteinuria

50

Nephrotic Syndrome

excretion of 3.5g or more of protein in the urine per day

**protein excretion is caused by glomerular injury... membranes highly permeable for protein to escape

Findings: hypoalbuminemia, edema, hyperlipidemia, lipiduria, vitamin D deficiency

51

Acute kidney injury
Prerenal, intrarenal, postrenal...

decrease in glomerular filtration rate = renal failure

1. prerenal: most common cause of ARF, impaired renal blood flow, GFR declines b/c of decreased in filtration pressure... blood isn't getting to kidney -> nephron -> glomerulus

2. intrarenal: acute tubular necrosis (death of tubular cells in kidney) is most common cause, postischemic (decrease in blood flow) or nephrotoxic (increase in toxins)... oliguria

3. postrenal: UTO that affect kidneys bilaterally, i.e. enlarged prostate

52

Chronic kidney disease
define, how it affects every system...

cardiovascular: increased workload on heart

pulmonary: fluid overload, edema, Kussmaul respirations (deep & labored)

hematologic: hypercoagulation

neurologic: headaches, sleep disorders, memory loss

GI: increased risk of bleeding ulcers

Endocrine & reproductive: lower circulating estrogen & testosterone

Integument: higher risk of hematoma

Immune: suppressed

53

Clinical manifestations of alterations in arousal

level of consciousness change (most critical), pattern of breathing, pupillary changes indicate brain stem dysfunction, oculomotor response is resting/spontaneous eye movements -- look for changes, motor responses evaluate for damaged side (purposeful, inappropriate, not present)

54

Brain death

body can no longer maintain homeostasis... unresponsive coma, no spontaneous respirations, no brain stem function, flat EEG... brain is damaged so severely it is irreversible -- damage to BRAIN STEM

55

Cerebral death
definition, four types...

irreversible coma, death of CEREBRAL hemispheres -- exclusive of brain stem and cerebellum... no behavioral or environmental responses, brain maintains homeostasis

1. remain in coma, nursing home
2. persistent vegetative state -- opens eyes, normal sleep pattern
3. minimal conscious state (MCS) -- follows simple commands, yes/no questions
4. locked-in syndrome, awake but paralyzed (can only move their eyes)

56

Seizures

sudden, temporary, transient alteration of brain function caused by abrupt explosive discharge of cerebral neurons

tonic phase: continued muscle contraction

clonic phase: alternation contraction/relaxation
postictal: immediately following end of seizure,
pt will be disoriented

aura: partial seizure people experience right before they seize

prodromal: sign that someone has hours/days before the seizure.. i.e. headache

57

Agnosia

cow, pen.... tactile/visual/auditory impairment

58

Dysphasia (3 types)

aphasia: most severe
expressive: Broca's area, can't express
Receptive: Wernicke's area, cannot comprehend

59

Acute confusion state

transient disorder of awareness that results from cerebal dysfunction -- secondary to intoxication, metabolic disorder, or nervous system disease

impaired or lost detection, inability to concentrate, restless/irritable, compulsive behavior

60

Delirium

worse than acute confusion, progresses to worsening symptoms like violence/aggression

61

Alzheimer's disease

forgetfulness, emotional upset, disorientation, confusion, lack of concentration, decline in judgment/abstract thinking

neurofibrillary tangles, neuritic plaques, neural degeneration (neuron death, loss of transmitters, brain atrophy)

62

Increased Intracranial Pressure (IICP)
4 stages

caused by increased intracranial content, requires reduction in other volumes

1. no change in ICP due to compensation

2. expansion of intracranial content, slight ICP rise, subtle CM

3. hypoxic tissue, patient deteriorates

4. herniation of brain tissue

63

Cerebral edema

increase in fluid within the brain, occurs after injury, distorts brain tissue = harmful effects

64

Hydrocephalus
define, triad of symptoms

excess fluid in cranial vault and/or subarachnoid space... interference in CSF flow
1. unsteady gait
2. incontinence
3. signs that mimic dementia

65

Huntington disease

Autosomal dominant hereditary degenerative disorder -> severe degeneration of basal ganglia

chorea: involuntary movement of facial and arms
athetosis: writhing movements
ballism: flinging movements

66

Parkinson disease

unknown cause, severe degeneration of basal ganglia -- loss of dopamine and excess neural cell activity

parkinsonian tremors, rigidity, bradykinesia

67

Focal brain injuries

damage to one specific area of the brain

68

Contusions

bruising of the brain resulting from injured vessels -- causes immediate loss of consciousness & reflexes, changes in memory, behavior, and attention

69

Epidural hemorrhages

results from ARTERIAL bleed, loss of consciousness, the more bleeding = the worse it gets (medical emergency!)

70

Subdural hemorrhages

associated with torn VEINS, common in elderly (headaches, mimics dementia)

71

Spinal cord injury

occurs b/c of vertebral injuries from whiplash, deformation forces, happens usually in most flexible areas of the spine

72

Spinal shock

loss of movements and all reflexes below the level of injury

73

Autonomic dysreflexia

rise in blood pressure responding to pain stimulus below the level of injury

74

Cerebrovascular accidents (CVA)

stroke, leading cause of disability... risk factors: HTN, DM, smoking

75

Hemorrhage

blood leaking in the brain

76

Ischemia with and without infarction (3 types)

loss of blood and oxygen to the brain

thrombotic: atherosclerosis
embolic: clot that traveled, DVT
transient ischemic attack: temporary loss of blood and oxygen caused by vessel blockage

77

Meningitis

inflammation of meninges, can be bacterial, aspetic, or fungal

bacterial: infection from meningococcus or pneumococcus

aseptic: caused by virus

fungal: chronic, less common, progresses slowly, mimics other neurological syndromes

78

Encephalitis

acute inflammation and infection of the brain, west nile virus/herpes simplex

can cause: edema, IICP, hemorrhage, necrosis

79

Multiple sclerosis

Common acquired autoimmune inflammatory disorder of the CNS, after virual infection, inflammation/demyelination of the axon, nerve conduction disrupted, neuron death

2 initial symptoms: vision and sensory impairment

80

Amyotrophic Lateral Sclerosis (ALS)

AKA Lou Gehrig, cause unknown, degeneration and destruction of motor neurons, leads to progressive weakness -- respiratory failure & death

81

Myasthenia gravis

acquired chronic autoimmune disease, antibody is produced against acetylcholine receptors on muscle fibers... muscular depolarization, myasthenia crisis :respiratory distress, weak diaphragm

82

Transverse fracture

perpendicular to long axis, complete

83

Greenstick fracture

breaks and splinters, incomplete

84

Torus fracture

buckling, incomplete

85

Bowing fracture

bending, incomplete

86

Stress fracture

microfracture r/t fatigue or abnormal stress, incomplete

87

Open versus closed fractures

open: bone has broken through skin
closed: bone does not come through skin

88

Comminuted fracture

bone has broken into multiple fragments, complete

89

Linear fracture

parallel to long axis, complete

90

Oblique fracture

angular compared to long axis, complete

91

Spiral fracture

encircles the bone, complete

92

Impacted fracture

fragments are pushed together, complete

93

Pathologic fracture

at point of weakness (like osteoporosis), complete

94

Osteoporosis
definition, 5 types...

old bone is being reabsorbed faster than it can be made, not normal with aging, bone becomes porous

1.regional osteoporosis: immobility, prolonged bedrest (i.e. leg cast)

2. secondary osteoporosis: caused by PTH, hormone imbalance, some cancers

3. postmenopausal: most common, female, decreased estrogen levels = imbalance of osteoblasts and osteoclasts

4. glucocorticoid-induced: steroids interfere with osteoblast function

5. age-related osteoporosis: function of osteoclasts and osteoblasts decreases, risk factors affect this

95

Osteomalacia

soft bones b/c calcification cannot occur, malabsorption of vitamin D, dietary deficiency of vitamin D, decreased sun exposure

96

Paget disease

excessive reabsorption and formation of bone.. bone is replaced with abnormal, fibrous bone, we are most concerned with pressure on the brain from an abnormal skull

97

Osteomyelitis

bone infection caused by Staph aureus

98

Osteoarthritis

degeneration and loss of articular cartilage, sclerosis of bone underneath cartilage, and formation of bone spurs... pain increases with movement

99

Rheumatoid arthritis

chronic, inflammatory autoimmune joint disease, related to HLA (human leukocyte antigen), joint swelling/tenderness/joint destruction, pannus growth destroys cartilage ... constantly reoccurring -- pain improves with movement

100

Ankylosing Spondylitis

systemic, autoimmune inflammatory disease seen in spine/sacroiliac joints -- stiffening and fusion of joints, related to HLA

101

Gout

syndrome caused by incomplete purine metabolism resulting in excess uric acid levels, you'll eventually get:

urate crystal deposit in the tissue causing tophi formation and painful manifestations

102

SIADH

too much ADH, commonly caused by tumor in stomach or duodenum (tumor causes ectopic hormone production), pt will NOT have edema

103

DI

too little ADH
neurogenic: pituitary not secreting ADH, tumor
nephrogenic: produces hormone, but kidneys fail to respond

104

Acromegaly

hypersecretion of GH during adulthood... enlarged hands, protruding jaw, thick/oily skin, excessive sweating

105

Gigantism

hypersecretion of GH in children and adolescents... 8-9ft tall, proportionately big

106

Dwarfism

hyposecretion of GH in a child, proportionately small

107

Graves Disease

increase in thyroid hormone, autoimmune, TSI's attach and overstimulate thyroid... intolerant to heat, weight loss, increased metabolism

special manifestations: pretibial myxedema, opthalmopathy (4 things)

108

Thyrotoxic Crisis

AKA thyroid storm, pt's excessive stress causes overproduction of TH and more importantly: epinephrine

109

Hashimoto Disease

decrease in thyroid hormone, autoimmune, thyroid gland destroyed... weight gain, intolerant to cold, decreased metabolism, lethargy

110

Hypoparathyroidism

damage to parathyroid during surgery, hypocalcemia *muscle spasms*

111

Hyperparathyroidism

tumor, increase in calcium, kidney stones, bone fractures

112

Diabetes type 1

autoantigens, beta cells, autoantibodies, destroys beta cells

113

Diabetes type 2

no destruction, insulin resistance, decreased insulin secretion leading to compensatory hyperinsulinemia

114

HHNKS

seen in type 2 diabetics, no breakdown of fat, no ketones in urine, still have some insulin

115

DKA

in type 1 diabetics, insulin loss causes breakdown of fat for energy, makes ketones (acid), fruity breath, Kussmaul respirations

116

Cushing disease

excess secretion of cortisol.... moon face, trunkal obesity, buffalo hump

117

Addison disease

too little cortisol, autoimmune destroys adrenal cortex. increased amount of ACTH because adrenal gland is not producing cortisol

118

Conn disease

too much aldosterone b/c of adrenal tumor... leads to fluid & electrolyte imbalances

119

Manifestations of GI dysfunction

anorexia, vomiting, nausea, retching, constipation, diarrhea

120

Dysphagia

difficulty swallowing

mechanical: tumor

functional: neurological, stroke, MS

121

GERD

reflux of stomach chime, usually after eating

1. delay in gastric emptying
2. lower sphincter has lost its muscle tone

122

Hiatal hernia (2 types)

sliding hiatal hernia: part of stomach goes up into diaphragm

paraesophageal hernia: greater curvature of the stomach goes through diaphragm and esophagus... risk for STRANGULATION

123

Gastritis

inflammatory disorder of the gastric mucosa... acute = too much NSAIDS, chronic = degeneratory or H. pylori ----------------- gastritis leads to peptic ulcer disease

124

Peptic ulcer disease

a break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum

caused by H. Pylori (most of the time), NSAIDS, or Zollinger-Ellison syndrome

125

Ulcerative colitis

chronic, relapsing inflammatory bowel disorder of SIGMOID COLON AND RECTUM with unknown origin, pt has diarrhea

126

Crohn disease

inflammatory disorder that affects both SMALL AND LARGE INTESTINE (w/o colon).. pt has malabsorption

127

Appendicitis

inflammation of the appendix, pt has epigastric pain, RLQ pain, rebound tenderness...

possible causes: obstruction, ischemia, infection, ulceration, etc.

128

Diverticula

herniations of mucosa through the muscle layers of the colon wall, SIGMOID COLON...... herniations can rupture, causing high fever, increased WBC count

129

Diverticulosis

asymptomatic diverticular disease

130

Diverticulitis

inflammatory stage of diverticulosis, mostly likely start to see symptoms like cramping, diarrhea, constipation, distention

131

Anorexia nervosa

pt has poor body image disorder and refuses to eat, loses 25-30% of total body weight

132

Bulimia nervosa

cycles of binge & purge, body weight remains normal but pt has aspirations for weight loss

133

Starvation

decreased caloric intake leading to weight loss, cachexia (seen in cancer pts, emaciation -- wasting away)

134

Portal hypertension

abnormally high blood pressure in the portal venous system caused by resistance to portal blood flow

135

Jaundice

yellow or greenish pigmentation of the skin caused by hyperbillirubinemia

136

Ascites

fluid in the peritoneum related to liver cirrhosis, heart failure, any kind of tumor/abdominal malignancy, malnutrition

137

Varices

dilated veins in the lower esophagus, stomach -- they can either bleed or rupture.. consequence of portal HTN

138

Splenomegaly

enlargement of the spleen

139

Encephalopathy

confusion, change in level of consciousness, coma(hepatic encephalopathy --> not getting rid of toxins like AMMONIA)

140

Hepatitis

system viral disease that primarily affects the liver

A: feces and bile
B: infected blood, blood fluids
C: post-transfusion, IV drug use

prodromal: highly transmittable
clinical: 1-2 weeks later, jaundice, ABD pain/tenderness, itching, anorexia
recovery: jaundice resolves itself

141

Cirrhosis

irreversible, chronic liver disease. liver is replaced by fibrous cells

142

Pancreatitis

inflammation of the pancreas
most commonly caused by alcoholism or biliary tract disease

chronic pancreatitis: irreversible change in structure and function