N 312 pathophysiology exam 2

what is the function of the digestive system?

digestion, mechanical/chemical breakdown of food, provides water, eliminates waste

*controlled by hormones and ANS

what are some digestion considerations for infants and children?

birth weight triples, different needs, lack teeth, depends on suck/swallow reflex, choking risk, by 2 digestive processes complete

what are some digestion considerations for elderly?

tooth enamel and dentin wear down (dentures needed), taste buds decline, smell diminishes, saliva decreases, changes in microflora, reduces absorption, decrease in metabolic efficiency

what are some common manifestations of GI disorders

anorexia, nausea, retching, vomiting, GI bleeding

*these are protective processes, signals presence of disease

what is GERD?

when stomach acid or gastric contents flows back into the esophagus or oral cavity due to a weak esophageal sphincter

what is the patho of GERD

relaxation of the esophagus, delayed gastric emptying causes increased pressure

what are some clinical manifestations of GERD?

heartburn, regurgitation, burping, painful swallowing, vomiting, belching, chest pain, tooth enamel erosion, respiratory symptoms if aspiration happens

*symptoms worse after eating, bending at waist, mainly at night

what are some diagnostics for GERD?

acid suppression trials (proton pump inhibitor medication trial), esophagoscopy (visualize esophagus), ambulatory esophageal pH monitoring (use electrode device placed into esophagus to analyze data)

how do you treat GERD?

medications, avoid triggering foods, surgery as last resort

what is the patho of diarrhea?

frequent passage of loose or unformed stools

caused by infections organisms, food poisoning, intolerance, drugs, intestinal disease

- excessive amounts of water or secretions in the intestines

what is acute diarrhea

less than 14 days, commonly caused by infectious agent

- noninflammatory: large volume, watery, nonbloody stools, caused by toxin producing bacteria/viruses, disrupts normal absorption

- inflammatory: fever and bloody stools, invasion of intestinal cells, prominently effects the colon

what is chronic diarrhea?

associated with chronic conditions like IBD, IBS, malabsorption syndrome, metabolic disorders

hyperosmotic, secretory, inflammatory, infectious

what is chronic secretory diarrhea

secretory processes in the bowels are increased

excess bile acids remain in the intestines as they enter the colon

what is chronic inflammatory dirrhea?

associated with acute or chronic inflammation or disease of the colon

evidences by frequency and urgency and colicky abdominal pain

what are some clinical manifestations of diarrhea?

depends on cause

systemic effects (dehydration electrolyte imbalance, metabolic acidosis, weight loss) bacterial infection (fever, vomiting cramping), malabsorption (bloating), anal and perineal skin irritation

what are some diagnostic tools for diarrhea?

history and physical exam (onset, frequency, volume, travel history), stool culture, examination of stool, endoscopy or intestinal biopsy

what are some treatment options for diarrhea?

replenish lost fluid and electrolytes, antimotility drugs, treat underlying cause, correct nutritional deficiencies, probiotics, fecal transplant

what is the patho of constipation?

difficult/infrequent defecation caused by

primary: sedentary lifestyle, low fiber/high processed diet, low fluid intake, slow transit in colonic motor activity, pelvic floor dysfunction

secondary: caused by diet, medications, or neurogenic disorders (spinal cord injury, PD, stroke, MS), abdominal pain

what are some clinical manifestations of constipation?

2 of the following for at least 3 months: straining with defecation, lumpy or hard stools, sensation of incomplete emptying, manual removal, fewer than 3 BMs per week

fecal impaction, intestinal obstruction

what are some diagnostics of constipation

health and physical history (meds, onset) digital exam (fingers), colonoscopy

what are treatments for constipation?

treat underlying cause, bulking agents, stool softeners, biofeedback training for pelvic floor dysfunction, med change

what can cause insufficient nutrition?

inadequate intake, impaired absorption, ineffective nutrient utilization, insufficient caloric intake, starvation, BMI below 18.5

what can cause excess nutrition?

excessive nutritional intake, BMI above 25, high fat diet, obesity

what are some consequences of excess nutrition?

micronutrient insufficiency, DM II, heart disease, hypertension, stroke, respiratory problems, MSK disorders

how can malnutrition impact nutrition?

negatively impact growth and development, impaired absorption, altered nutrient utilization

- kwashiorkor

- marasmus

what is obesity?

excess body fat accumulation with multiple organ-specific pathologic consequences

- 65% of US adults defines as overweight or obese

- based on BMI

what can cause obesity?

imbalance between calories in and out, lack of physical activity, genetics, metabolism, behavior, environment, culture, socioeconomic status

what is the patho of obesity

adipocytes are the cellular basis of obesity

- increase in size and numbers, store triglyderides, and secrete adipokines (adipokines participate in regulation of food intake and energy metabolism)

what are some diagnostics of obesity

BMI, DEXA scans, skinfold calipers, waist-hip ratio, waist circumference

what are the structures of the pulmonary system?

trachea, bronchi, bronchioles

- conducting airways: warm, filter, and moisten air

- gas exchange airways: functional structure is alveoli, inactivate vasoactive substances (surfactant), reservoir for blood storage

what is the respiratory center and what is it made up of

located in the medulla

pneumotaxic center: switches inspiration off

apneustic center: excitatory effect on inspiration

what are central chemo receptors?

extremely sensitive to short term changes in PaCO2 (which when increased can increase ventilation), increased respiratory rate and depth

What are peripheral chemoreceptors?

located in aorta and carotid bodies

stimulated by hypoxemia (PaO2)

little control over ventilation until less than 60 mmHg

responsible for the increase in ventilation that occurs in response to arterial hypoxemia

what should be noted for babies/children regarding gas exchange?

smaller airways, infants are nose breathers since they breastfeed, suffer more obstruction relative to mucosa

surfactant is produced by 20-24 weeks gestation

chest wall is easily collapsible

neural control is immature, may not respond to hypoxia and hypercapnia as quickly

what should be noted for pregnant women regarding gas exchange?

pregnancy raises diaphragm and decreases ability to expand lungs, respiratory rate is increased to keep up with increased O2 needs, chest circumference increases, changes to upper respiratory mucosa can increase risk for nasal stuffiness/nosebleed, blood pH may be more alkaline (blowing off more CO2)

*monitor O2 during labor to prevent adverse effects on a baby's O2 status

how does aging effect gas exchange?

loss of elastic recoil, stiff chest wall, flow resistance, alveoli lose wall tissue and capillaries, decrease in PaO2 and ventilatory reserve, decrease in respiratory muscle strength and exercise

what are the classifications of pulmonary disease

acute or chronic

obstructive or restrictive

infectious or noninfectious

what are some clinical manifestations of pulmonary disease?

dyspnea, cough, abnormal sputum, hemoptysis, altered breathing patterns, hypoventilation/hyperventilation, cyanosis, clubbing, chest pain

what are some conditions that are caused by pulmonary disease?

hypercapnia (increased O2 concentration)

- hypoventilation, respiratory acidosis, limits amount of CO2 available

hypoxemia (reduced O2 concentration)

- decreased inspired oxygen, hypoventilation, decreased pulmonary capillary perfusion

what is respiratory failure defined as?

hypoxemia: PaO2 < 50 mmHg

hypercapnia: PaCO2 > 50 mmHg

occurs from direct or indirect injury, potential complication of any major surgery

What is atelectasis?

collapse of lung tissue:

compression, absorption, surfactant impairment

tends to occur after surgery

what is aspiration?

Passage of fluid and solid particles into the lungs

what are some clinical manifestations and treatments for aspiration?

choking, intractable cough, dyspnea, wheezing

supplemental oxygen, mechanical ventilation, antibiotics if bacterial

what is obstructive pulmonary disease?

airway obstruction that is worse with expiration

more force required to expel air, emptying of lungs is slowed

what is croup?

infection of the upper airway that effects the full layngotracheal tree, can be viral or bacterial, mostly in children bc of their underdeveloped airway

what are some clinical manifestations of croup?

cold symptoms, stridor, wet, barking cough

fever=viral

acute/urgent=bacterial

what are some diagnostic tools for croup?

symptoms: barking cough, stridor, redness in upper airway

sometimes Xray or labs but rare

what are some treatments for croup?

comfort measures: rest/fluids/humidifier

meds: acetaminophen, corticosteroids, epi

antibiotics for bacterial

what is asthma? whats the patho?

chronic inflammatory disorder of the bronchial mucosa

caused by exaggerated hyperresponsiveness to a variety of stimuli, airway epithelial cells become exposed to antigen and immune response is initiated

- vasodilation, increased mucous, mucosal edema, bronchospasms, narrowing of airways

what are some clinical manifestations of asthma?

Wheezing, cough, dyspnea, and chest tightness after exposure to trigger

what are some diagnostics for asthma

history of allergies, spirometry, peak flow meter, arterial blood gas, hypoxemia and alkalosis (early), hypercapnia and acidosis (resp failure, need intubation)

symptoms: wheezing, cough, exercise intolerance,

how do you treat asthma

classify between intermittent, mild, moderate, and severe to direct treatment and identify high risk groups

prevent, desensitization, pharm (inhaled corticosteroids, mast cell stabilizers, leukotriene modifiers) or quick relief with beta agonists

what is pneumonia? whats the patho

infection of the lower respiratory tract, infectious stuff in alveolar sacs

*can be community or hospital acquired

what are some clinical manifestations of pneumonia?

sudden onset, malaise, chills, fever, diminished breath sounds with crackles, productive cough, chest pain, shortness of breath or hypoxia

what are some diagnostics for pneumonia?

WBC count, procalcitonin or CRP levels, CXR, H&P, sputum culture

what are some treatments for pneumonia

antibiotics for bacterial infection, prevent, adequate ventilation and O2, adequate hydration, pulmonary hygiene, rest

what is cystic fibrosis? whats the patho

genetic disease that causes obstruction from excessive and thick mucous

mutation in CFTR gene that impairs reabsorption of NaCl and increases absorption of water and Na into the blood and out of the mucous making it sticky

what are some clinical manifestations of CF

wheezing cough, bronchiolitis, bronchitis, bronchiectasis, chronic pulmonary bacterial infections

malabsorption in GI and malnutrition, abdominal pain

infertility in males

what are some diagnostics for CF

newborn screening, sweat chloride tests, CFTR gene analysis

what are some treatments for CF

no cure

air clearance with vibrating vest

meds: bronchodilators, antibiotics, inhaled mannitol, mucolytics, nebulizers, anti-inflammatory meds

surgery/lung transplant

can lead to chronic lung infections and pancreatic insufficiency

what is one cardiac cycle?

each ventricular contraction and relaxation

what is systole?

ventricular contraction, blood ejected

what is diastole

ventricular relaxation, blood fills ventricles

what are the coronary arteries

Arteries that branch off the aorta & surround the heart, ensuring that it gets all the oxygenated blood it needs

gets perfused during diastole

what is the order of signals that contracts the heart?

sinoatrial node (SA), atrioventricular node (AV) (bundle of His), right and left bundle branches, purkinje fibers

how does the parasympathetic nervous system work in cardiac innervation?

releases acetylcholine

decreases electrical conductivity

decrease heart right

slows conduction through AV node

decrease contractility

calms

how does the sympathetic nervous system work in cardiac innervation

releases norepinephrine

fight or flight

increases electrical conductivity

increase contractility

increase HR

dilates coronary arteries

what is stroke volume?

amount of blood ejected from each ventricle per heartbeat

what is cardiac output

amount of blood ejected from the heard per minute

what is the preload

amount of blood returning to the heart per beat

what is the afterload

amount of force the heart must pump against to eject blood

what is contractility

ability of the heart to contract

what are the layers of the blood vessels?

tunica intima, tunica media, tunica externa

layered walls give vessels strength, elasticity allows changes in vessel diameter

are arteries low pressure or high?

high pressure: delivers blood to tissues

are veins low pressure or high>

low pressure: collects blood from capillaries

what are arteries composed of?

elastic and fibrous, connective tissue, and smooth muscle

stretch during systole, recoil during diastole

what are veins comprised of

thinned walls and fibrous, valves for one way flow, muscle pumps

*more veins than arteries, are larger

what are arterioles

resistance vessels

what is endothelium

one cell thick layer that lines all blood vessels, comprised solely of an endothelial layer surrounded by basement membrane

what is the endothelium for?

filtration and permeability, vasomotion, hemostatic balance, inflammation/immunity, angiogenesis/vessel growth

what is autoregulation?

ability of organs to regulate blood flow by altering the resistance in their arterioles

for flow to stay constant: as pressure decreases, resistance must also decrease

what are the vasoconstrictor hormones

epinephrine, norepinephrine, angiotensin II (RAAS system), serotonin

what are the vasodilator mediators

nitric oxide

stimulated by endothelial agonists like acetylcholine, bradykinin, and histimine

or increased blood flow/pressure

what is the lymphatic system for

one way network of vessels and nodes for fluid balance, immune function, transport of lipids, hormones, and cytokines

what are the types of lymph cells?

lymphocytes (B and T cells)

antigen presenting cells-mediate cellular immune response

how does the lymph system work?

as lymph travels toward the heart, it is filtered through thousands of lymph nodes

facilitates phagocytosis of forgein substances

large role in immune function

what are the important parts of the lymphatic system?

bone marrow, thymus, lymph nodes, spleen, tonsils, mucous membranes, peyer's patches, liver

what are some considerations for perfusion in infants and children?

greater risk for heart failure since more sensitive to volume and pressure overload, affected by stress, exercise, fever, respiratory distress

causes problems with oxygenation, children overcompensate with RBCs and bradycardia

what are some considerations for perfusion in pregnant women?

CO increases early in preg, more SOB

blood volume increases until 30-34 weeks

BP falls during second trimester, increase at term

bigger uterus interferes with return of blood flow (can cause stasis or postural hypotension)

fibrin, plasma, fibrinogen levels, clotting factors increase (can cause venous thrombosis)

HTN is not normal

what are some considerations for the aging cardiovascular system

most common cause of morbidity and mortality

myocardial and blood vessel stiffening

changes in neurogenic control

loss of exercise capacity

left ventricular hypertrophy, LV works harder in response to stiff arteries

fibrosis of AV node

calcification of vessels

what is kawasaki disease?

acute febrile disease of young children (fever)

affects skin, brain, eyes, joints, liver, lymph nodes, and heart

leads to coronary artery aneurysms, myocardial infarctions, sudden death, cardiac arrest

what is the patho of kawasaki disease?

follows an infection due to an altered immune system

vasculitis begins in small vessels and progresses to larger arteries

wide spread inflammation, narrows walls

intima proliferates and thickens, contributes to stenosis or a thrombus

what is the acute phase of kawasaki disease?

abrupt onset of fever, conjunctivitis, rash - generalized oral mucosa involvement, redness redness and swelling of hands, feet, and enlarged cervical lymph nodes

unresponsive to antibiotics

strawberry tongue, unrelenting fever, generalized rash, red eyes

what is the subacute phase of kawasaki disease?

begins when fevers have stopped, lasts until all signs of the disease have disappeared

desquamation of digits, thrombocytosis, development of coronary aneurysms

risk for sudden death is highest in this phase

what is the convalescent phase of kawasaki disease?

complete resolution of clinical signs of disease

return to baseline labs

inflammatory changes to heart may persist for up to 4 years

what is the cardiac involvement in kawasaki disease?

cardiac abnormalities develop in 1/4 cases

coronary artery dilation and aneurysm formation

manifestations of myocardial ischemia, mitral or aortic regurgitation, heart failure, arrhythmias

what are some diagnostics for kawasaki disease

no specific test, fever for more than five days, four of the principle features

chest xray (enlarged heart)

ECG and echo (ultrasound)

what are some treatments for kawasaki disease?

IV immunoglobulin - relieve acute inflammation to reduce risk of coronary aneurysms

aspirin - synergistic effect with IV Ig

corticosteroids - stop inflammation

cardiac screening/testing

anticoagulation therapy

what is atherosclerosis?

hardening of the arteries from the formation of the fibrofatty lesions in the intimal lining of large and medium sized arteries

what is the patho of atherosclerosis?

slow accumulation of plaque in the artery walls from LDL elevated

narrows arteries