diseases exam 3

Urolithiasis-patho

• development of renal calculi

  • C+ most common component

urolithiasis-etiology

• urinary stasis

• elevated urinary levels of salt, organic/inorganic acids

urolithiasis-risk factors

• genetics

• UTI

• cystic kidney disease

• diabetes

• obesity

• gout, hyperparathyroidism

• gastric bypass

urolithiasis-clinical manifestations

• pain

  • colic

    • distention of collecting systems or ureter

    • acute, intermittent, radiating, excruciating

  • noncolic

    • distention of renal calices or pelvis

    • dull, deep with varying intensity

urolithiasis-diagnosis

subjective findings

• history of pain

imaging

• CT

• renal ultrasound

Lab analysis

• urinalysis

• analysis of calculi composition

urolithiasis-treatment

supportive treatment

• pharm

  • analgesics

  • antispasmodic agents

  • calcium channel blockers, alpha blockers

• fluids

• calculi removal

  • inc. fluid intake

  • reduction in calculi size

  • surgical

• prevention

  • diet low in calcium oxolate

  • adequate fluid intake

  • alkalinization of urine

urolithiasis-food to avoid

• beets

• chocolate

• coffee

• coke

• nuts

• wheat

urinary incontinence-patho

inability to voluntary prevent the discharge of urine

urinary incontinence-etiology

• impaired muscle contraction

• altered neural transmission

• hormonal stimulation

• mechanical factors

• female: relax of pelvic structure

• male: mechanical obstruction by prostate

urinary incontinence-clinical manifestation

determined by classification

• stress incontinence

  • external stimulus

• urge incontinence

  • overactivity of detrusor muscle; have to go

• overflow incontinence

  • exceeding bladder capacity

• functional incontinence

  • inability to independently toilet

urinary incontinence-diagnosis

• H&P of patterns and triggers

• specialized test

  • bladder tress test

  • post residual bladder volume

  • urodynamic testing(gold standard)

    • cytometry, cystometrogram, voiding cystometrogram

• endoscopic testing

  • cystoscopy

urinary incontinence-treatment

behavioral strategies

• bladder training

• pelvic floor strenghthening (kegel exercise)

pharm

• anticholinergic meds

• alpha adrenergic meds

surgical

• support urethra

• relief of mechanical obstruction from an enlarged prostate

polycystic kidney disease(PKD)-patho

growth of fluid filled cyst bilaterally in kidneys

• functional tissue replaced

• reduced perfusion

• tubule obstruction

categories:

• genetic, autosomal dominant or recessive

• acquired

PKD-clinical manifestations

• enlarged kidneys

• flank pain

• nausea, anorexia

• hypertension

• liver and pancreatic cyst

• renal calculi

  • diverticular disease

PKD-diagnosis

• family hystory

• genetic testing

• Physical→ hypertention

• imaging

  • presence of >3 or more kidney cyst on ultrasound

  • estrarenal cyst

• lab confirmation of renal failure

  • GFR, BUN, Cr

PKD-treatment

symptomatic care

• pain control

• treatment of infection

• BP control

• Lifestyle modifications

promotion of renal function

• dialysis

  • special filters, heparin, wastes and excess water removed by peritoneal membrane, exchange of solution and wastes

• renal transplant → severe cases

diverticular-patho

• prolong pressure on large intestine walls alters structure and function

• weakness leads to outpouching

• GI consequences

  • decreased motility

  • obstruction

  • impaired perfusion

• diverticulum along the wall of colon

  • small sac; outpouching

• diverticula

  • more than one diverticulum

• diverticulosis

  • prescense of diverticula

• diverticulosis

  • diverticula infected due to fecal matter

diverticular- clinical manifestations

• abdominal pain

• fever

• N&V

diverticular-diagnosis

• H&P

  • abdominal tenderness

  • distention

• lab analysis

  • bloody stools

  • low hemoglobin and hematocrit → anemia

  • CBS → infection

• imaging studies

  • inflamed and/or ruptured diverticuli

diverticular-treatment

• management of symptoms

• control of infection

• bowel rest

• prevention of complications

• surgical correction of perforated diverticula

  • bowel resection

  • colostomy

diverticular-prevention

• dietary alterations

• lifestyle alterations

• meds

  • bulk-forming laxatives

  • antispasmodics

Lung cancer-patho

• leading cause of cancer deaths

• smoking and industrial exposures often implicated

• tumors most frequently originate in epithelial lining of the bronchi, bronchioles, and alveoli

• 4 subtypes

  • adenocarcinoma(most common), squamous cells, large cell, and small cell carcinoma

lung cancer-clinical manifestations

• persistent cough

• hemoptysis(bloody sputum)

• chest pain

• shortness of breath

lung cancer-diagnosis

• H&P exam

• Bronchoscopy

• chest x-ray

• CBC(high early on and low later on)

• tissue biopsy/cytology

Lung cancer-treatment

• based on tumor type

• small cell carcinoma

  • chemo

• non-small cell carcinoma

  • surgery

  • chemo

  • radiation, when surgery not feasible

colon cancer-patho

proliferation abnormality in colon

common tumors

• nonneoplastic polyp

• neoplastic polyps

• adenocarcinomas

mutation pathways

• chromosomal instability

• replication errors

affinity to go to liver

colon cancer-risk factors

• age

• family history

• smoking

• alcohol

• bowel disease

• obesity

• high-fat diet

colon cancer-clinical manifestations

• change in bowel habits

• occult/frank blood in stool

• abdominal pain

• bowel obstruction

• anemia

colon cancer-diagnosis

• CBC→ anemia

• liver function test (affinity to liver)

• CEA high

• colonoscopy

• sigmoidoscopy

• biopsy of suspicious lesions

colon cancer-treatment

• surgery

• chemo

• biology agents

• radiation

brain cancer-patho

metastasis much more common to brain than primary tumor

• primary tumors:

  • gliomas

  • meningiomas

  • pituitary adenomas

  • acoustic neuromas

brain cancer-clinical manifestations

• loss of motor or sensory function

• cognitive or behavioral changes

• headache

• vomiting

• seizures

brain cancer-diagnosis

neurological exam

• CN

• reflexes

• sensory function

• motor function

direct visualization

• brain scan

• x-ray

• CT/MRI

• cerebral angiography

• PET scan

brain cancer-treatment

• surgery(common)

• radiation(common)

• chemo

• palliative care(when nothing can be done)

Leukemia-patho

• Malignant neoplasms of blood and blood-forming organs

• overproliferation of WBC

  • immature WBC

• acute

  • lymphocytic(ALL); most common in children

  • myeloid(AML); most common in adults

  • rapid, onset, more life threatning

• chronic

  • lymphocytic(CLL)

  • myelogenous(CML)

  • can be asymptomatic

leukemia-clinical manifestation

• anemia

• bruising

• fatigue

• headache

• visual disturbances

• N&V

• weight loss

• fever

• lymph node and organ enlargement

leukemia-diagnosis

• H&P exam

• CBC

• bone marrow biopsy

• cytologic exam of blood cells

leukemia-treatment

• chemo

• radiation

• bone marrow or stem cell transplant

lymphoma-patho

• derived from WBCs and lymph tissues that form solid organ tumors in the lymph tissue and later in bone marrow

• classified:

  • Hodgkin lymphoma

  • Non-Hodgkin lymphoma

lymphoma-clinical manifestations

hodgkin

• painless, progressive enlargement of cervical lymph nodes

• low-grade fever, night sweats, weight loss, fatigue

non-hodgkin

• painless enlargement of lymph nodes

• systemic manifestations may also occur

lymphoma-diagnosis

hodgkin

• presence of Reed-Sternberg cells

non-hodgkin

• H&P exam

• lymph node biopsy

• chest and abdominal CT scan

lymphoma-treatment

hodgkin

• chemo

• radiation

• hematopoietic( production of new blood) stem cell transplant

non-hodgkin

• radiation

• chemo(aggressive forms)

Hypertention-patho

• >130/80

• progressive cardiovascular syndrome by an elevated in BP and/or prescence of organ damage due to persistent BP elevations

• primary (sometimes no cause) vs secondary (identifiable causes: kidney disease, endocrine disease, renal artery stenosis)

hypertension-risk factors

• family history

• aging

• black race

• decreased nephron count

• diabetes mellitus

• excessive Na+ intake

• obesity

• sedentary lifestyle

• smoking

• excessive alcohol

hypertension-clinical manifestations

asymptomatic w/ primary(essential)

when advanced:

• headache

• new-onset blurred vision

• N&V

• weakness

• fatigue

• mental status change

cardiovascular change:

• pulmonary edema and HR

renal insufficiency:

• poor urinary output

• problems w/ elimination

• hematuria

• proteinuria

hypertension-diagnosis

• H&P

• serial BP measurements

• Lab studies

• classification:

  • elevated: 120-129/less than 80

  • stage 1: 130-139/80-89

  • stage 2: 140-higher/ 90- higher

hypertension- treatment

• pharm

• lifestyle changes

  • weight reduction

  • decreased alcohol, salt, saturated fat

  • increased aerobic physical activity

  • inc. fruit and veg intake

  • smoking cessation

shock-patho

• circulatory failure and impaired perfusion of vital organs

• sources of impaired perfusion:

  • ineffective cardiac pumping: cardiogenic shock

  • decreased blood volume: hypovolemic shock

• massive systemic vasodilation

  • severe infection: septic shock

  • brain or spinal cord injury: neurogenic shock

  • IgE mediated allergic reaction: anaphylactic shock

shock-clinical manifestations

• tachycardia, tachypnea

• cool, clammy extremities; peripheral pulses

• decreased arterial BP

• cyanosis and/or pallor

• restlessness, apprehension, decreased mental function

• poor urinary output

• advance metabolic acidosis

shock-diagnosis

• no one test to completely diagnose

• H&P exam

• Lab studies:

  • renal-creatine & BUN

  • WBC

  • lactic acid

  • ABG

• diagnostic testing

  • BP(inc)

  • Resp rate

  • Temp

Icr BP and WBC will lead to shock

shock-treatment

medical emergency

• ABCs

treatment depends on type

• cardiogenic

• hypovolemic

• septic

• neurogenic

• anaphylactic

myocardial infarction-patho

• total occlusion of 1 or more coronary arteries → ischemia and death of tissue

• atherosclerosis is most common cause

• blood flow reduced

STEMI

note leads of elevation (ST elevation)

Non STEMI

in women and older ppl

MI -risk factors

• family history of CAD

• hypertension and smoking

• blood cholesterol levels

• concurrent diabetes mellitus

• high-sensitivity C-reactive protein(CRP)

• hyperhomocysteinemia

MI-clinical manifestation

• gender variability

• chest pain or crushing pressure; often radiating to L arm, shoulder, or jaw

• fatigue, weakness, syncope(fainting), anxiety

• dizziness, SOB(dyspnea)

• sweating, pallor

• indigestion

• N&V

MI-diagnosis

• H&P exam

• Lab studies( cardiac enzymes)

  • tropinin →ischemia

  • CKMB→ infraction

• ECG

• angiography

• echocardiography

• chest radiograph

MI-treatment

emergency management

• medical: ABCs

• Morphine,O₂,Nitro,Aspirin

surgical

• PCI, PTCA

long-term treatment

• pharm

  • antiplatelet, anticoagulant, beta, ACE inhibitor, statins

• lifestyle modifications

heart failure-patho

• inadequate heart pumping→ fails to maintain circulation of blood

• result of:

  • impaired cardiac functioning

  • excessive workload demand

L heart failure(lung problrm)

• L ventrical cant pump to systemic ventilation

R heart failure(systemic problem):

• back up in systemic

• comes from untreated L heart failure

LHF-clinical manifestations

• activity intolerance and signs of decreased tissue perfussion

• cyanosis, hypoxia

• cough w/ frothy sputum, crackles

• orthopnea(SOB when laying)

• paroxysmal nocturnal dyspnea(severe SOB at night when sleeping that makes you cough)

RHF-clinical manifestations

• edema and ascites

• anorexia, GI distress, weight loss

• signs related to impaired liver function

• peripheral edema

HR-diagnosis

• H&P exam

• chest radiography

• echocardiography

• ECG

• cardiac catheterization

HF-treatment

goals

• correct cause

• improve cardiac output

• reduce peripheral vascular resistance

• improve quality of life

treatment

• pharm(diuretics)

• surgery

• treat underlying cause

• supplement O₂

• lifestyle modifications

• smoking cessation

stroke-patho

• any clinical event that leads to impaired cerebral circulation

  • thrombotic, embolic, hemorrhagic

  • inflammation, ischemia, death of neurons

• cerebrovascular accident(CVA) vs transient, ischemic attack (TIA)

stroke-clinical manifestations

• focal brain injury

• abrupt onset of hemiparesis

• vision loss or field deficits

• dizziness, diplopia

• ataxia, aphasia

• sudden decrease in level of consciousness

stroke-diagnosis

• H&P exam

• Lab studies

• CT scan (see if intracranial bleeding)

  • no blood→ ischemic

  • blood→ hemorrhatic

stroke-treatment

• emergency management

  • reduce cerebral edema and increased intracranial pressure

  • TPA given for ischemic

• rehabilitation

disseminated intravascular coagulation(DIC)-patho

• complication from other disease

• uncontrolled activation of clotting factors

  • widespread thrombi formation→ depletion of coagulation factors and platelets leading to massive hemorrhage

• initiated by endothelial injury

• blood transfusion injury

DIC-clinical manifestation

• excessive hemorrhage

  • epistaxis(nosebleed)

  • bruising

• excessive clotting

  • headache

  • weakness

  • seizures, coma

• renal

  • poor urine output

  • renal failure

• respiratory

  • cough

  • SOB

  • chest pain

  • resp distress

DIC-diagnosis

• H&P exam

• lab testing

  • prothrombin time (PT)

  • activated partial thromboplastin time (aPTT)

  • platelet count low

  • fibrinogen level*

  • D-timer test(confirmatory)*

DIC-treatment

• correct underlying cause

• depends on presence of hemorrhage vs thromboses

• balance goal of proper coagulation

• platelet , blood, and plasma transfusion