Exam 2 Pathophysiology

☆What are the functions of the lungs/Respiratory system?

1. Gas exchange -> Alveoli 

   1. Oxygen moves from alveolar air into blood

   2. Carbon dioxide moves from blood into alveolar

☆Define ventilation, perfusion, and respiration.

1. Ventilation

   1. Movement of air into and out of the lungs

2. Perfusion

   1. movement of blood through the lungs

3. Respiration

   1. Gas exchange 

What is the difference between Alveolar 1 and 2?

1. Type I Alveolar Cells

   1. Cell surface

2. Type II Alveolar Cells

   1. Produce surfactant

What are the types of ventilation-perfusion mismatching?

1. Dead-air space

   1. Lungs are ventilated but are not perfused  (No gas exchange)

2. Shunting (Shunt)

   1. Lungs are perfused but are not ventilated (No gas exchange)

      1. Leads to Hypoxia (Decrease in O2)

☆What are the Cough reflexes and Cheyne-stoke?

1. Cough reflexes 

   1. Protection 

2. Cheyne-stoke

   1. Abnormal pattern of breathing

☆What are the different types of respiration failure?

1. Hypoxemia 

   1. Decrease in O2 supply in the blood -> Hypoventilation 

2. Hypercapnia (COPD patients)

   1. Increase in CO2 ( caused by: decreased ventilation)

   2. Compensate 

      1. Increase RR

      2. Disorientation -> Coma

         1. Warm, flushed, headache

What are the symptoms of Chronic and Acute Respiratory Failure?

1. Acute

   1. Increase in HR

      1. Peripheral vasoconstriction 

   2. Increase BP

      1. Mental state confusion 

2. Chronic 

   1. Worse

   2. Increase in RR

   3. Pulmonary vasoconstriction (Pulm. HTN)

   4. Increase RBC

   5. Cyanosis (Late stage)

   6. Clubbing of nails 

☆What are the types of pleural disorders?

1. Pleuritis- Inflammation of the pleura (pain) 

2. Pleural Effusion- Fluid

   1. Chyle- Lymph Fluid 

3. Hemothorax- Blood

4. Pneumothorax- Air

☆What are Spontaneous and Traumatic Pneumothorax?

1. Spontaneous: an air-filled blister on the lung ruptures

2. Traumatic: air enters through chest injuries

   1. Tension: cannot leave on exhalation

   2. Open:  leaves on exhalation

What is one of the main causes of COPD? <3

Most common cause: Smoking

☆What are the 2 Chronic Obstructive Pulmonary Disorders?

1. Emphysema (Alveolar walls are damaged, reducing surface area)

   1. Neutrophils -> secrete trypsin

      1. Enlargement of air space

      2. Destruction of lung tissue

      3. Loss of lung elasticity

   2. Symptoms

      1. Decreased breath sounds

      2. Barrel chest

      3. COR pulmonale (Right-sided heart failure)

      4. Dead Air space

      5. Cough

2. Chronic Bronchitis (Small airways/Bronchioles) 

   1. Most common cause: Smoking

   2. Symptoms 

      1. Dyspnea 

      2. Cough

      3. Narrow airway 

      4. Rhonchi 

      5. Increase Mucous

What are the Characteristics and Symptoms of Pleural Pain? <3

1. Abrupt in onset

2. Unilateral; localized to lower and lateral part of the chest

3. Pain in shoulder

4. Worse by chest movements

5. Tidal volumes are kept small

6. Breathing more rapid

7. Reflex splinting

☆What is Acute Respiratory distress syndrome (ARDS)?

1. Lack of ability to gas exchange because of too much fluid

   1. Epithelial cell injury 

   2.  Increased permeability

☆What are the ways to prevent and recognize a Pulmonary Embolism?

1. Prevent

   1. Ambulate 

   2. Anticoagulante 

   3. Prevent DVT (Most common reason) 

   4. Compression 

2. Recognize 

   1. Sudden shortness of breath

   2. Chest pain

   3. Increase RR

   4. Increased heart rate 

☆What is Atelectasis? (Name the 5 symptoms)

1. Incomplete expansion

   1. Atelectasis leads to Obstruction Compression 

2. Symptoms

   1. Tachypnea

   2. Tachycardia

   3. Dyspnea

   4. Cyanosis (Late sign)

   5. Absence of breath sounds

☆What are the 4 types of treatment for Atelectasis?

1. Deep breathing

2. Coughing

3. IS

4. Ambulate 

What are the effects of the Bronchial Parasympathetic and Sympathetic? (Opposite) <3

1. Parasympathetic: vagal control

   1. Lungs- Bronchoconstrictor

   2. Periphery- Dilate 

2. Sympathetic: β2-adrenergic receptors

   1. Lungs- Bronchodilator

   2. Periphery- Constrict

☆What is Asthma?

1. Chronic disorder of the airways

   1. Inflammation 

#1 cause; Allergens

☆What are the two types of Asthma?

1. Type 1- Extrinsic (Outside body) 

   1. Reaction to:

      1.  Allergen

      2. Antigen 

2. Type 2- Intrinsic (Inside body) 

   1. Reaction to:

      1. Infection

      2. Exercise

      3. Cold air

☆What is the function of the kidney?

1. Urine formation

2. Excreting waste 

3. Production in red blood cell (erythropoiesis)

4. Synthesis of Vitamin D

☆Why is Renin produced?

1. Renin is produced because of hypotension (can be caused by dehydration) 

Renin holds onto Sodium

☆What is the functional unit of the kidneys?

Nephron (High pressure)

What are the 3 components of Urine Formation? **

1. Filtration (Begins the formation of urine)

2. Tubular Reabsorption

3. Tubular Secretion

☆What is the Vascular and Tubular component?

1. Vascular component

   1. Circulatory system (Glomerular = Filtration -> Bowman’s capsule) 

   2. Bowman’s capsule -> Protein and RBC free 

2. Tubular component

   1. Circulatory system and the Elimination functions

      1. Absorption and Elimination (Removal of Potassium)

What are the 4 Tubular components consist of? **

1. Proximal

   1. Reabsorbs 

2. Loop of Henle

   1. Reabsorption based on concentration 

      1. Normal range -> 1.010% to 1.025%

         1. Lower = Dilute (Hydrated)

         2. Higher = Concentrated (Dehydration)

3. Distal

   1. Renin** (Released 

4. Collection

   1. Releases the urine

What is Afferent and Efferent? **

1. Afferent

   1. blood flows in

2. Efferent

   1.  blood flows out

What is secreted in our urine? **

Potassium (K+)

☆Which diagnostic tests are used to assess kidney function (list and describe)

1. Blood Urea Nitrogen (BUN)

   1. End product of protein metabolism (Related to the GFR)

      1. High BUN is bad

2. Urine Test (Specific gravity)

   1. Measures concentration of urine

      1. Increased SG = Concentrated 

      2. Decreased SG = Dilute 

      3. Normal lab numbers: 1.005 - 1.025

3. Serum Creatine 

   1. Estimating the functional capacity of the kidneys

4. Glomerular filtration rate (GFR)

   1. How much urine each make (125 ml/min)

      1. 1.5L = 1500 mL/daily

What is Antidiuretic Hormone (ADH)? **

1. Hormone secreted in response to changes in osmolality of the blood

   1. Decreased water intake = blood osmolality increase = ADH release = ADH acts on the kidney to increase reabsorption of water 

   2.  Increased water intake = ADH is suppressed = less water is reabsorbed = diuresis (increased urine volume) 

What actions by the juxtaglomerular apparatus would occur to restore GFR?**

Juxaglomerular -> Renin -> Angiotensin -> Lungs ->  Angiotensin II -> Adrenal cortex -> Aldosterone

What is Cystic disease?

1. A fluid-filled sacs of a nephron

   1. Lead to an obstruction 

Pain in abdomen back (Stasis obstruction)

☆What are some of the types of obstructions of the urinary tract?

1. Calculi (stones)

2. Pregnancy

3. Scar tissue

4. Tumors

5. Benign prostatic hyperplasia (BPH)

6. Neurologic disorders

What are the effects of urinary obstructions? **

1. Stasis (Back flow)

   1. Increased pressure (Affect renal blood flow)

   2. Infection

   3. Stone formation

2. Development of backpressure

   1. Damage to kidney tissue

What are the manifestations of a urinary obstruction? **

1. Pain

2. Signs and symptoms of UTI (Burning)

3. Renal dysfunction (Increased BUN, Increase Creatine, Decrease GFR)

   1. Causes = Hypertension and infection

☆What is Hydronephrosis and the symptoms?

1. Urine filled dilation of the renal pelvis

   1. ☆**Symptoms:

      1. Anuria = no urination

      2. Oliguria= Decrease in urination (<50 mL/day)

      3. Polyuria = excess urination

      4. Nocturia = waking at night to urinate 

      5. Diuresis = excessive production of urine

☆What are the clinical manifestations of Renal Calculi (Kidney Stones)?

1. Pain (Renal colic)

   1. Skin cool and clammy

   2. Nausea and vomiting (GI distress)

      1. Stones 1-5mm

2. Noncolicky renal pain

   1. dull, deep ache in the flank or back

   2. Pain exaggerated by drinking large amounts of fluid

☆What are the treatments for kidney stones?

1. Hydration 

2. Diet change

☆What is Cystitis and Pyelonephritis?

1. Cystitis=Lower UTIs

2. Pyelonephritis=Upper UTIs

☆Define dysuria, pyuria, hematuria, Proteinuria, Anuric, Uremia.

1. Dysuria: Burning and pain on urination

2. Pyuria: Pus in urine

3. Hematuria: Blood in urine 

4. Proteinuria: Protein in urine

5. Anuric: making no urine

6. Uremia: Urea in urine

What is the cause of Nephrotic Syndrome? What’s the result? **

1. Damage to the glomeruli

   1. Result: High Protein 

☆What is the difference between Acute pyelonephritis and Chronic pyelonephritis?

1. Acute pyelonephritis

   1. Acute infection of the kidneys

      1. Casts (Dead epithelial tissue)  

2. Chronic pyelonephritis

   1. Persistent or recurring infection of the kidneys

What is Nephrotoxic medication? Who is at risk? **

1. Most at risk are older adults

2. Medication that causes damage to the kidneys exposure to a drug

What is Hyperkalemia? **

1. Increase in potassium  (Caused by decreased function of kidney) 

Cause; Arrhythmias

What happens when the kidneys fail? **

1. Less waste is removed

2. Unable to regulate fluid, electrolyte, and pH balance

3. Nitrogenous compounds build up in the blood

4. Test would show an increase in BUN + Creatinine due to kidney’s not being able to filter waste 

☆Define prerenal, intrinsic, and postrenal. (Acute)

1. Prerenal

   1. Issue blood going into kidneys

   2. Example

      1. Dehydration, blood loss, low perfusion

      2. Cause (Anything that’ll cause a decrease in blood flow = Hypovolemia, Heart failure)

2. Intrinsic 

   1. Any damage inside of the kidney (damage to the kidney itself)

   2. Example

      1. Glomerulonephritis or Acute tubular necrosis (Infection)

         1. Exposure to nephrotoxic drugs

3. Postrenal 

   1. Issues with urine leaving the kidney 

   2. Obstruction examples:

      1. Stones

      2. BPH

      3. Pregnancy 

☆What are the 4 phases of the AKI? (Acute)

1. Onset: precipitating

2. Oliguric: decreased urine output 

3. Diuretic: kidneys try to heal and urine output increases

4. Recovery:  tubular edema resolves

What are the causes of Chronic kidney Disease? Treatment? **

1. Hypertension

2. Diabetes mellitus

3. Polycystic kidney disease

4. Obstructions of the urinary tract

5. Glomerulonephritis

6. Chronic use of pain medication

   1. Dialysis

      1. Hemodialysis

      2. Peritoneal dialysis

☆What is the function of the parasympathetic and sympathetic?

1. Parasympathetic 

   1. promotes bladder emptying

2. Sympathetic 

   1. promotes bladder filling

☆What are the involuntary and voluntary controls?

1. Involuntary 

   1. autonomic nervous system

2. Voluntary

   1. somatic nervous system

☆What are Neurogenic Bladder Disorders?

1. Spastic Bladder Dysfunction

   1. Unable to Store urine in the bladder

      1. Neurologic lesions above level of the sacral cord 

2. Flaccid Bladder Dysfunction

   1. Unable to empty the bladder

      1. affect motor neurons in the sacral cord

What is Chronic kidney Disease?

1. Causes a permanent loss of nephrons

   1. Causes: decrease in erythropoietin = fatigue, pallor, low hemoglobin.