Exam 3 Pathophys - Resp, GI, Liver, Renal

Is the apex of the lungs the top or bottom?

Top (superior most)

How many lobes do the right and left lungs have?

Right - 3

Left - 2

Family of viruses that contribute to colds?

Rhinovirus, parainfluenza viruses, syncytial viruses

Signs and symptoms of colds?

- Clear, watery secretions

- Red, swollen mucous membranes, sore throat, hoarseness w pharynx/larynx involved

- Headache, malaise, fever and chills

Definition of Rhinosinitis?

- Obstruction of ostia draining sinuses

- Infections (Viral or bacterial), allergies, nasal polyps, decongestant abuse

Acute, subacute, and chronic time frame for rhinosinitis?

Acute - Viral (5-7 days), Bacterial (Up to 4 weeks)

Subacute - 4-12 weeks

Chronic - >12 weeks

Signs and symptoms of Rhinosinitis?

- Purulent discharge

- Facial pain

- Headache

- Fever

Viral influenza characteristics?

- Upper respiratory track infections, loss of mucus secreting and ciliated cells, watery discharge

- Lower tract: Shedding bronchial + alveolar cells

Signs/Symps for Viral influenza?

- Abrupt fever/chills, headache, muscle ache, profuse + watery nasal discharge, dry cough, sore throat

- Symps peak day 3-5 then gone day 7-10

Goals for influenza with rest, warmth, and fluids?

Rest - Lower resp. rate/depth for less spreading to lower resp tract

Warmth - Slows viral replication

Fluids - Hydration of epithelial cells

Hemagglutinin and Neuraminidase receptor functions?

Hemagglutinin - Entry into cell

Neuraminidase - Release out of cell

What distinguishes Influenza from Rhinosinitis?

The rapid onset of malaise = Influenza

Purulent nasal discharge = Rhinosinitis

COVID characteristics?

- Community spread droplet respirations

- Uses ACE2 for entry (also expressed in heart, intestines, kidneys, gall bladder for bp)

Signs/Symps of COVID?

- Fever, fatigue, chills, dry cough, myalgias, diarrhea

Lung dysfunction of COVID?

- Covid specifically attacks AT2 cells in lungs

- Leads to lack of secretion of surfactant, trans-epithelial water movement, and regeneration of epithelial cells

Pneumonias characteristics?

- Inflammation of parenchyma (Alveoli and bronchioles)

- Common etiology: Pseudomonas, S. aureus

Signs/Symps of Pneumonias?

- Cough (Thick and colored), fever, chills, pleuritic chest pain (pain with breathing), tiredness, weakness, muscle aches, noisy breathing, SOB

Pneumonia classification?

Type of agent

- Atypical = viral/fungal

- Typical = Bacterial

Distribution of infection

- Lobar pneumonia = A part of of or all of a single lobe

- Bronchopneumonia = More than one lobe

Setting where acquired

- Community = outside of hospital/long term care facility

- Nosocomial = In hospital/long term care facility

Consolidation term definition?

- Alveoli filled w/ bacteria, pus, and exudate

Anaplasia definition?

Loss of specialization of cell = promotes cancer cell growth

Carcinoma vs sarcoma?

Carcinoma - Started in epithelial tissue

Sarcoma - Started in Mesenchymal tissue (Anything besides epithelial)

Bronchogenic carcinomas characteristics?

- Aggressive, invasive, metastatic tumors

2 Types of bronchogenic carcinomas?

- Small Cell Lung carcinoma (SCLC)

- Non-Small cell lung carcinoma (NSCLC)

Small Cell Lung Carcinoma characteristics?

- Strongly associated w smoking

- Small, round, oval cells that grow in clusters

- Highly malignant (infectious)

Treatment = Radiation + chemo

Non-Small Cell Lung Carcinoma characteristics?

- Squamous starts in central bronchi

- Adenocarcinoma starts in alveoli

(Associated w non-smoking common type)

Treatment = Surgery, radiation, and chemo

Signs/Symps of Bronchogenic carcinomas?

- Chronic cough, SOB, wheezing, blood in sputum (Hemoptysis), Insidious onset (smoking + bronchitis), anorexia, occasional endocrine effects

Tidal volume definition?

- Normal, passive inhale + exhale volume

Residual volume definition?

- Air left in lungs after forceful exhale

Vital capacity definition?

- Total volume inhaled and exhaled forcefully

Total inspiratory Capacity definition?

- Tidal and inspiratory capacity

Functional residual capacity volume?

- Expiratory reserve + forceful exhale volume

Pleural effusion characteristics?

- Abnormal fluid in pleural cavity

Hydrothorax - Watery serous exudates

Chylothorax - Lymph fluid

Hemothorax - Blood

Pneumothorax characteristics?

- Air trapped in pleural cavity

Spontaneous - Without cause/injury

Traumatic - Injury caused to chest walls/airways (lungs pull away)

Atelectasis definition?

- Incomplete expansion of lung due to obstruction, compression, or increased recoil

Signs/symps of Atelectasis?

- Tachypnea, Hypoxia, Shallow breath sounds

Difference between extrinsic (Atopic) and intrinsic asthma? What causes each?

Extrinsic (Atopic)

- Hypersensitivity to antigen (type 1)

Cause: Dust, Animals = any allergen

Intrinsic

- Initiated by non-immune mechanisms

Cause: Respiratory Tract Infections, Exercise

Pathway of Bronchial Asthma Pathogenesis?

Treatment for early and late phases of asthma pathogenesis?

Early phase

- Beta-2 Agonists, anticholinergics

Late phase

- Anti-inflammatories

Changes in bronchial walls of chronic asthmatics?

- Increased goblet cells = More mucus makers

- More mucus overall

- Thickened basement membrane and thickened smooth muscle

- Thickened lamina propria

- Increased cellular infiltrates

- Increased glands and secretions from the glands

Change in %FEV due to changes in bronchial walls of chronic asthmatics?

Lowered %FEV due to many obstructions

Emphysema characteristics?

- Obstructive lung disease

- Caused from chronic exposure to harmful substances or genetic alpha-anti-trypsin deficiency

- Causes tissue damage leading to inflammation and neutrophil recruitment

Protease and Anti-protease balance about emphysema walkthrough?

- Neutrophils release elastase to break down elastin in alveoli

- Normally, alpha-anti-trypsin inhibits elastase, but free radicals like tobacco smoke inactivate alpha-anti-trypsin

- This leads to the continued destruction of alveolar walls = loss of elastic recoil and more lung compliance

Signs/Symps of Emphysema?

- Loss of elastic recoil, increased lung compliance = Lungs not returning to og state and being very moveable for air trapping = barrel chest

- Reduced gas exchange from less alveolar SA from elastin

- Dyspnea from reduced lung function

- More RTIs = impaired clearance of mucus and debris

Affect of emphysema on tidal volume and residual volumes?

- Decreased tidal volume, increased residual volume

Chronic Bronchitis characteristics?

- Obstructive lung disease

- Comes from chronic irritation from smoking or pollutants and excess mucus plugging of airway lumens

- Less %FEV from less space due to inflammation and mucus

Signs/Symps of Chronic Bronchitis?

- Productive cough for 3 consecutive months in at least 2 consecutive years

- Progressive SOB

- Lower respiratory rate and greater tidal volume = Easier for more air in than out

Characteristics of Cystic fibrosis?

- Obstructive lung diease

- Recessive gene mutation for chloride channels in epithelial cells = abnormal Na+ and water absorption for thick and viscous mucus

- Less %FEV from obstructive mucus plugging alveoli

Signs/Symps for Cystic Fibrosis?

- Viscous mucus in bronchi

- Impaired lung clearance

- Chronic infections like bronchitis

- Atelectasis present from collapse of alveoli due to fluid, compression, and a mucus plug

Characteristics of Chronic Interstitial Diseases (AKA Restrictive lung diseases)

- Often end in osis = ex: asbestosis

- Idiopathic progressive fibrosis of lung

- Injury to alveolar epithelium, chronic inflammation and fibrosis of inter-alveolar spaces

- Stiff, noncompliant lungs with high elastic recoil but normal airway function

- Less Tidal volumes and more Respirations per min = More resps to make up for inability to fill lungs fully

- Greater %FEV

Pneumoconiosis = Diseases caused by inhalation of inorganic dusts

Examples of Pulmonary Vascular Disorders with definitions?

Pulmonary Embolism

- Thrombus, air, fat, or amniotic fluid in lungs resulting in dyspnea w/ pleuritic pain, rapid and shallow breathing, cough w blood

- Large emboli can result in obstructive shock

Pulmonary Hypertension

- Primary pulmonary HTN due to thickened blood vessel walls = fibrosis potential

- Cor pulmonale = abnormal enlargement of right ventricle due to pulmonary HTN

Acute Respiratory Distress Syndromes (ARDS) characteristics?

- Acute lung injury resulting in more permeability of alveolar capillary membranes

- Permeability = fluid entering alveoli causing no gas exchange, difficulty breathing

- Neutrophils enter lungs resulting in inflammation, proteolytic enzyme distribution for less surfactant, fibrosis, hypoxia, and potentially multiple organ failure

- Decreased Tidal volume and residual volume

Causes of ARDS?

Aspiration

- Near drowning = aspiration of gastric contents

Drugs, Toxins, Therapeutic agents

- Heroin, gases, radiation

Infections

- Bacteria or viral

Trauma

- Burns, lung bruising

Gastro-esophageal Reflux Disease (GERD) characteristics?

- Comes from reflux of gastric contents from an incompetent lower esophageal sphincter that causes metaplasia of the lower esophagus

- Barett Esophagus = Persistent reflux leading to mucosal damage, erosion, scarring that leads to strictures, dysphagia, and metaplasia that causes risk of esophageal cancer

Signs/Symps of GERD?

- Local irritation, inflammation, heartburn, epigastric pain, belching 30-60 mins after meal, worse when laying

Acute gastritis characteristics?

- Self limiting inflammation

- Associated w/ irritants

- Mild heartburn, gastric distress, vomiting, bleeding

Chronic gastritis characteristics?

H. Pylori gastritis

- Enzymatic toxins from bacterial infection

Autoimmune gastritis

- Antibodies against parietal cells (risk of gastric carcinoma)

Chemical gastritis

- Chronic alkaline reflux from duodenum via an incompetent pyloric sphincter following GI surgery

Peptic Ulcer characteristics?

- In duodenum or gastric areas

- Cyclical exacerbations and remissions

- Caused by H. Pylori infections or NSAID overuse

- Can cause burning, recurring midline pain between meals

- Complications include perforations (peritonitis), bleeding

Stress Ulcer characteristics?

- Ulcerations following severe psychological stress

- Come from stomach ischemia, tissue breakdown resulting in acidosis, and increased intracranial pressure

- Cushing Ulcer = Hypersecretion of HCl due to increased intracranial pressure

Irritable bowel syndrome characteristics?

- Intestinal disorder

- RELIEVED BY DEFECATION

- Comes from dysregulation of intestinal motility by CNS, exacerbated by stress or menstruation

- Results in bloating, flatulence, nausea, anorexia, alternating diarrhea and constipation for at least 12 consecutive weeks (3 months) in a year

Inflammatory Bowel Disease characteristics?

- Symps include marked diarrhea, lower abdomen pain w/ exacerbations and remissions, weight loss

Crohn's disease and Ulcerative colitis similarities?

- General inflammation

- Overactive immune system cause

- Genetic component

- Marked diarrhea

- Abdomen pain

- Malabsorption and nutrition deficiencies

Crohn's disease inflammation, tissue level, rectal bleeding, and areas affected?

- Cobblestone

- Submucosal

- Rare

- Ileum and colon

Ulcerative colitis inflammation, tissue level, rectal bleeding, and areas affected?

- Continuous

- Mucosal

- Common

- Rectum and colon

Viral enterocolitis characteristics?

- Caused from rotavirus and adenovirus

- Infection causes death of epithelia mucosal cells

- Less water secretion and absorption = diarrhea with a concern of dehydration

- Spread fecal-oral

- Immune contamenent = repopulation of cells produces relief

Bacterial enterocolitis characterics?

- More severe from endo/exotoxins from the bacteria that cause inflammation, peristalsis, hemorrhage, and cell necrosis

- Causes cramping, watery bloody diarrhea, toxemia, renal failure, anemia, and potentially neurological problems

C. Diff - Antibiotic associated colitis, hospital setting (fecal oral)

E. coli - Food borne by unpasteurized milk, fecal contaminated, undercooked food

Celiac disease characteristics?

- Immune-mediated disorder to gluten-containing complexes

- IgA antibodies against variety of antigens (transglutiminase, endomysium, gliadin)

- Genetic component

- Causes malabsorption of nutrients if severe due to loss of absorptive villi in small intestine

- Symps: diarrhea and abdominal comfort, failure to thrive in infants, iron deficiency

- Must remove gluten from diet

Diverticulosis characteristics?

- Mucosal layer of intestinal walls herniates through muscularis layer due to functional (chronic) constipation or anatomical abnormalities

- Causes a change in bowel habits, bloating or flatulence, bleeding in small amount, relatively asymptomatic

Diverticulitis characteristics?

- Inflammation of the pockets made from diverticulosis

- Intense lower left abdominal pain, tenderness, fever

- Perforation of diverticula can cause peritonitis, bleeding, or bowel obstruction

Appendicitis characteristics?

- Obstruction or twisting of appendix

- Causes abrupt epigastric/periumbilical pain and nausea, pain localizes to lower right quadrant, tenderness, fever, raised WBCs

- Potential complications include rupture, peritonitis, abscess, or septicemia

Small volume diarrhea characteristics?

- More motility of intestines due to inflammation or disease

- Colicky pain or cramping associated

Large volume diarrhea characteristics?

- Lactose intolerance = Osmotic LV diarrhea

- Painless, watery stool w/out blood = Secretory LV diarrhea

Intestinal obstructions characteristics?

- Impairment of movement of contents that causes abdomen distension, pain, absolute constipation, and vomiting

Mechanical

- External hernia, tumors, strictures, Intestinal folding or twisting

- Complication = Tissue strangulation, necrosis

Paralytic

- Neurogenic or muscular impairment of peristalsis from surgery, inflammation, or toxins

Neoplasms characteristics?

- Most common is adenomatous polyps

- Proliferation of epithelium

- Increased risk of colorectal cancer

- Asymp. or slight bleeding

Colorectal cancer = Adenocarcinoma characteristics?

- Increased risk due to family history, ulcerative colitis, adenomatous polyps, a diet high in fat and sugar, low in fiber

- Rectal bleeding, change in bowel habits, increased urgency, feeling of incomlete bowel emptying

Jaundice (Icterus) characteristics?

- Yellowish skin = high bilirubin in blood

- Dark urine, light colored stool

- High ALT , AST, GGT = Damage in liver results in release of enzymes

- Lower plasma albumin

- High prothrombin time

- High alkaline phosphatase

3 Jaundice (Icterus) types and definitions?

Extrahepatic

- High breakdown of RBCs

Hepatocellular

- Dysfunction of hepatocytes resulting in decreased liver uptake or conjugation of bilirubin

Cholestatic

- Increased bile duct obstruction

Acute Hepatitis characteristics?

- Autoimmune disease related

- Viral infection related

- Reactions to drugs, toxins, or chemicals

Chronic Hepatitis characterisics?

- Chronic alcoholism

- Autoimmune disease related

- Viral infection related

- Reactions to drugs, toxins, or chemicals

- Associated w type B and C

- Symps include malaise, anorexia, bouts of jaundice for years

Fulminant hepatitis characteristics?

- Rapid onset of encephalopathy in 2-3 weeks

- Causes include HAV and HBV related, drug toxins, or chemical

- Can lead to liver failure

Hepatitis A characteristics?

- ssRNA virus

- 15-35 day incubation

- Usually benign and self-limiting

- Abrupt onset with mild symps of fever, malaise, nausea, anorexia, and jaundice

- Fecal oral transmission

- Vaccine available

- Common in areas w/ poor sanitation and contaminated food/water

Hepatitis B characteristics?

- dsDNA virus

- Can cause chronic hepatitis, cirrhosis, or tissue necrosis

- Insidious onset with fever, chills, weakness, and hepatocellular jaundice

- Infected blood, saliva, STD transmission

- Vaccine available

Hepatitis C characteristics?

- ssRNA virus

- Can cause chronic hepatitis, cirrhosis, carcinoma

- Insidious onset with asymptomatic or mild symptoms

- Persistent and chronic

- 6-26 week incubation

- Blood borne (needle sticks) transmission

- No vaccine

Clinical course of hepatitis?

Acute asymptomatic

- Incidentally detected by elevated LFTs, common with HCV

Acute symptomatic (Pre-Icteric phase)

- Progressive symptoms of malaise, fatigue, anorexia, nausea, vomiting, diarrhea, mild right abdomen pain

Icterus phase

- Chills, fever, high AST and ALTs, jaundice, tenderness, pruritus = itchy skin

Alcoholic liver disease stages?

Fatty liver

- Steatosis = accumulation of fat in hepatocytes

- Asymptomatic or slightly enlarged liver

Alcoholic hepatitis

- Inflammation and death of hepatocytes

- Binge drinking association

Alcoholic cirrhosis (Irreversible step)

- Fibrosis from repeated alcohol related hepatotoxicity

- Bad tissue remodeling from compression, cholestasis, and portal HTN

- Progresses to liver failure and death

Cirrhosis characteristics?

- Represents end stage chronic liver disease

- Damaged hepatocytes replaced with fibrosis

- Common in chronic viral hepatitis, chronic drug toxicity, biliary obstruction, or heart failure

- Jaundice, weakness, ascites (fluid in peritoneal cavity), bleeding, hepatomegaly, abdomen pain, portal HTN

- Results in lack of urea/uric acid from ammonia

Liver cancers characteristics?

Hepatocellular carcinoma

- Most common

- Hepatocyte involved

- Risk factors: HBV, HCV, Cirrhosis

Cholanglocarcinoma

- Involves bile duct cells

- Risk factors: Chronic inflammation of bile duct cells

Cholelithiasis characteristics?

- Gall stones

- No obstruction is asymptomatic

- Present obstruction: abrupt pain, upper right epigastric pain, cholestatic jaundice

- Potential causes:

Abnormal compilation of bile (Drug induced, obesity)

Stasis of bile (ductal stenosis/scarring)

Inflammation of gall bladder (Excessive absorption of water and bile salts)

Cholecystitis characteristcs?

- Gall bladder attacks

Acute

- Complete/partial block of bile duct that leads to local irritation, bacterial infections, ischemia, mucosal necrosis, and perforation with unrelenting pain, fever, elevated WBCs and LFTs

Chronic

- Related episodes of acute and chronic irritation with vague intolerance to fatty meals, belching, indigestion, and colicky pain

Nephritic syndromes? (2)

- Acute post infectious glomerulonephritis

- Rapid progressive glomerulonephritis

Acute Post Infectious Glomerulonephritis characteristics?

- Post step infection, Hep B, or malaria infection

- Immune complexes stuck in glomerulus

- Abrupt onset of hematuria, proteinuria, water retention, and oliguria (low urine output) with reduced GFR and renal salts

Rapid Progressive Glomerulonephritis characteristics?

- Autoantibodies against glomerulus

- Continued poor function leads to irreverisble damage

- Inflammation in capillary walls

- Decreased GFR

- RBCs in urine = Hematuria

Nephrotic syndromes characteristics?

- Non-inflammatory damage to glomerular filtration barrier that increases glomerular permeability

- Heavy proteinuria, albuminuria

- Edema from reduced GFR = Potential for pulmonary edema --> dyspnea, pleural effusions

Heavy proteinuria causes?

- Immunoglobulins and complement -->immunodepression

- Clotting and anti-clotting proteins --> thrombosis or bleeding

- Albumin --> altered drug distribution and kinetics with edema

Secondary glomerular disorders characteristics?

Diabetic Glomerulosclerosis (Neuropathy)

- Sclerosis, glomerular basement membrane thickening

Hypertensive Glomerular Disease

- Sclerosis, decreased perfusion from untreated/poorly controlled HTN

Systemic Lupus Erythematosus Nephritis

- Autoimmune disease where immune cells deposit into glomerulus

What needs to happen to the detrusor muscle and sphincter for urine to flow?

- Detrusor contracts and sphincter releases

Obstructive Uropathy?

- Acute or chronic, bilateral or unilateral obstruction to urine flow

Ex: Calculi, pregnancy, benign prostatic hyperplasia, tumors, scarring, chronic inflammation

Renal Calculi (Nephrolithiasis) characteristics?

- Kidney stones

- Renal pain, stretching of ureter, excruciation pain on affected sides, hematuria, nausea, vomiting

Prerenal acute kidney injury description and causes?

- Reduced blood flow to kidneys

- Embolisms, hemorrhage, dehydration, heart failure, any reduced cardiac output

Intrinsic acute kidney injury description and causes?

- Damage to tubules, glomerulus, or blood vessels of kidneys

- Acute tubular necrosis, glomerulonephritis, SLE = Lupus, Vasculitis

Postrenal acute kidney injury description and causes?

- Obstruction of urine outflow

- Calculi, BPH = pelvic tumor