Exam 3 Pathophysiology Kaminski

retching

rhythmic spasmodic movements of the diaphragm, chest wall, and abdominal muscles. responses are protective to the extent that they signal the presence of disease. action of vomiting - removes noxious agents from GI tract, contributes to impaired intake or loss if fluids and nutrients

dysphagia

difficulty in swallowing

odynophagia

painful swallowing

achalasia

failure of the esophageal sphincter to relax

GERD

heart burn: 30 to 60 minutes after meals, evening onset, pain in the epigastric area that radiates to the throat, shoulder, or back. preventions: avoiding large meals, avoiding alcohol use and smoking, eating meals sitting up, avoiding recumbent position several hours after a meal, avoiding bending for long periods, sleeping with head elevated, losing weight if overweight

squamous cell carcinoma

alcohol and tobacco use

adenocarcinoma

barrett’s esophagus

esophageal cancer clinical manifestations

dysphagia, weight loss, anorexia, fatigue, painful swallowing

acute gastritis

a transient inflammation of gastric mucosa, most commonly associated with local irritants such as bacterial endotoxins, alcohol, and aspirin, can become chronic with long-term exposure

chronic gastritis

characterized by the absence of grossly visible erosions and the presence of chronic inflammatory changes, leads eventually to atrophy of the glandular epithelium of the stomach

methods for establishing presence of H. pylori infection

c urea test using radioactive carbon isotope, stool antigen test, endoscopic biopsy for urease feasting, blood tests to obtain serologic titers of H. pylori antibodies

peptic ulcer

ulcerative disorders that occur in areas of the UPPER gastrointestinal tract that are exsposed to acid-pepsin secretions, spontaneous remissions and exacerbation. common causes: h. pylori, aspirin, age, warfarin, smoking

hemorrhage

caused by bleeding from the granulation tissue or from erosion of an ulcer into an artery

obstruction

caused by edema, spasm, and or contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or adjacent areas

perforation

occurs when an ulcer erodes through all layers of the stomach or duodenum wall

upper GI bleed

pre-pyloric sphincter bleed, digested coffee ground like consistency

lower GI bleed

post-pyloric sphincter bleed, classic bloody appearance, small intestine

hematemesis

blood in the vomitus, may be bright red or have coffee ground appearance

melena

blood in the stool, ranges in color from bright red to tarry, may be hidden

c diff

spore, must wash hands with soap and water, malodorus, meds: vancomucin (antibiotic) and flagul (antifungal)

crohns disease

a recurrent, granulomatous type of inflammatory response than can affect any area of the gastrointestinal tract from the mouth to the anus, autoimmune disease

ulcerative colitis

a chronic inflammatory bowel disease characterized by ulcers in the colon and rectum, causing abdominal pain and diarrhea. It primarily affects the innermost lining of the colon.

symptoms of diverticulitis

pain in the lower left quadrant, nausea and vomiting, tenderness in the lower left quadrant, a slight fever, and elevated white blood cell count

large volume diarrhea

osmotic and secretory

small volume diarrhea

inflammatory bowel disease, infectious disease, irritable colon

clinical manifestations of celiac disease

failure to thrive, diarrhea, abdominal distention, occasionally, severe malnutrition

healthy amount of poop

at least 3 bowel movements in 7 days

mechanical obstruction

result from post=operative causes: external hernia and postoperative adhesions

paralytic (dynamic) obstruction

results from neurogenic or muscular impairment of peristalsis

intussusception

a condition where part of the intestine folds into another section, causing obstruction.

volvulus

a condition in which the intestine twists around itself, leading to obstruction and compromise of blood flow.

inguinal hernia

a condition where a portion of the intestine bulges through a weak spot in the abdominal muscles, typically in the groin area

peritonitis

protective body mechanism to control peritonitis perforation, decreased peristalsis, formation of thick exudates to seal off the perforated bowel

intestinal malabsorption

failure to transport dietary contents from intestinal lumen to extracellular fluid. causes: celiac disease, neoplasm, colorectal cancer. symptoms: diarrhea, steatorrhea, flatulence, bloating, abdominal pain, cramps, weakness, muscle wasting, weight loss and abdominal distention

colorectal cancer

risks: age, family history, crohn disease, ulcerative colitis, familial adenomatous polyposis, diet. testing: stool occult blood test, digital rectal examination, x-ray studies using barium, flexible sigmoidoscopy and colonoscopy Colorectal cancer is a malignancy originating from the colon or rectum, often linked to various risk factors and detected through multiple screening methods.

causes of juandice

excessive destruction of red blood cells, imapired uptake of bilirubin by the liver cell, decreased conjugation of bilirubin, construction of bile fllow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts

preheptic jaundice

occurs before bilirubin reaches the liver, often due to hemolysis of red blood cells which leads to increased levels of unconjugated bilirubin in the bloodstream. major cause is excessive hemolysis of RBCs

intraheptic jaundice

caused by disorders directly affecting liver abilitly to remove the bilirubin from the blood or conjugate it so it can be eliminated in the bile. conjugated bilirubin

posthepatic jaundice

occurs when bile flow is obstructed between the liver and the intestine. Conjugated bilirubin accumulates in the bloodstream, often due to bile duct obstruction, gallstones, or tumors.

cholestasis

decreased bile flow through the intrahepatic canaliculi and reudction in secretion of water, bilirubin, and bile acids by hepatocytes

serum aminotransferase (liver function tests AST/ALT)

assess injury to liver cells

serum bilirubin, GGT, and alkaline phosphate

measure hepatic excretory function

ultrasonogrpahy, CT scans, and MRI

evaluate liver structures

angiography

visualizes the haptic or portal circulation

liver biopsy

used to obtain tissue specimens for microscopic examination

early symptoms of intrahepatic biliary disease

unexplained pruritus, weight loss, fatigue

later symptoms of intrahepatic biliary disease

dark urine and pale stools, jaundice

cirrhosis clinical manifestations

weight loss, weakness, anorexia, diarrhea or constipation, hepatomegaily, jaundice, abdominal pain, portal hypertension, ascites, esophageal varices, splenomegaly

manifestation of liver failure

hematologic disorders, endocrine disorders, skin disorders, hepatorenal syndrome, hepatic encephalopathy

portal hypertension

ascites (increased pressure in peritoneal capillaries), esophageal varices (portosystemic shunting of blood → development of collateral channels), splenomegaly

hepatocellular carcinoma

arises from the liver cells

cholangiocarcinoma

a primary cancer of bile duct cells

cholelithiasis

gallstones

cholecystitis

gallbladder inflammation

cholangitis

common bile duct inflammation

common causes of acute pancreatitis

gallstones, alcohol abuse, hyperlipidemia, hyperparathyroidism, viral infection, abdominal and surgical trauma, drugs such as steroids and thiazide diuretics

acute pancreatitis defined

reversible inflammatory process of pancreatic ancini brought about by premature activation of pancreatic enzymes

acute pancreatitis clinical presentations

1. symptoms consistent with pancreatitis

   1. epigastric pain

2. serum amylase or lipase level three times or more normal range

3. radiologic imaging consistent with pancreatitis (CT or MRI)

acute pancreatitis clinical manifestations

abdominal pain, epigastric or periumbilical pain and may radiate to back, chest, or flank area, fever, tachycardia, hypotension, severe abdominal tenderness, respiratory distress, and abdominal distension

warning signs of severe impending disease in acute pancreatitis

thrist, poor urine output, progressive tachycardia, tachypnea, hypoxemia, agaitation, confusion, increasing hematocrit level, and lack of improvement in symptoms within the first 48 hours

hunger sensation

associated with several sensory perceptions

• rhythmic contractions of the stomach and that “empty feeling” in the stomach that stimulates a person to seek food

BMI

• >18.5 classified → underweight

• between 25 to 29.9 → overweight

• >30.0 → diagnosed as obesity

  • class I (BMI 30.0 to 34.9)

  • class II (BMI 35.0 to 39.9)

  • class III or extreme obesity (BMI >40)

upper body obesity

central, abdominal, or male obesity

lower body obesity

peripheral, gluteal-femoral, or female obesity

effects of malnutrition and starvation

loss of muscle mass, imaiokorpired wound healing, impaired immunilogic function, decreased appetite, loss of calcium and phosphate from bone, anovulation and amenorrhea, decreased testicular function

kwashiokor

secondary protein-energy malnutrition, hypermetabolic acute illnesses (trauma, burns, and sepsis)

marasmus

secondary protein-energy malnurtrition, chronic illnesses (COPD, congestive heart failure, cancer and human immunodeficiency virus infection)

anorexia nervosa

refusal to maintain normal body weight

intense fear of gaining weight or becoming fat

disturbance in the way their body is preceived

causes amenorrhea

bulimia nervosa

recurrent binge eating

inappropiate compensatory behaviors

self-evalulations unduly influenced by body body shape and weight

determination of eating disorder does not occur exclusively during episodes of anorexia nervosa

hypospadias

terminal end of urethra → ventral surface of penis

1 in 350 male infants

10% have undescended testes and inguinal hernia may accompany the disorder

treatment - surgical repair

epispadias

urethral opening → dorsal surface of the penis

phimosis

tightening of the prepuce (penile foreskin) that prevents it retraction over the glans

paraphimosis

foreskin constriction that cannot cover glans

clinical manifestations

• swollen, tender penis

• multiple skin folds under the glans

peyronie disease defined

a localized and progressive fibrosis of unknown origin that affects the tunica albuginea, 1% of males impacted, common after 40 years of age

peyronie clinical manifestations

initially characterized by inflammation in dense fibrous plaque formation, painful erection, so-called bent erection, presence of a hard mass at the site of fibrosis

peyronie diagnosis

doppler ultrasonography and surgical intervention

erectile dysfunction defined

persistent inability to achieve and maintain an erection sufficient to permit statisfactory sexual intercourse

erectile dysfunction prevalence

ED impacts approximately 30 million aged 40 - 70 years old in the USA

erectile dysfunction psychogenic causes

performance anxiety, strained relationship with sexual partner, depression, overt psychotic disorders such as schizophrenia

erectile dysfunction organic causes

neurogenic (parkinsons disease, multiple sclerosis, spinal cord injury, stroke, heavy metal poisoning, cerebral trauma)

hormonal / endocrine (diabetes, 30% to 50% of diabetic males have ED)

vascular (hypertension, arterioclerosis)

drug-induced (antidepressants, antiphysocitcs, antiandrogens, glaucoma eye drops, chemotherapy, antihypertensive)

penile-related etiologies

priapism defined

prolonged erection without sexual stimulation (4 or more hours)

urologic emergency → prolonged erection can result in ischemia and fibrosis of erectile tissue with the risk of impotence

low flow (ischemic) priapism (nonsexual)

stasis of blood flow in the corpora cavernosa with a resultant failure of detumescence

high flow (nonischemic) priapism (nonsexual)

involves persistent arterial flow into the corpora cavernosa

primary priapism

the result of conditions such as trauma, infections, and neoplasms

secondary priapism

hemtaologist conditions such as leukemia, sickle cell disease, and thrombocytopenia

neurological conditions such as stroke, spinal cord injury, and pther central nervous system lesions

balanitis

an acute or chronic inflammation of the glans penis

balanoposthitis

inflammation of the glans and prepuce (foreskin)

usually encountered in males with phimosis or a large, redundant prepuce that interferes with cleanliness and predisposes to bacterial growth in the accumulated secretions and smegma

balanoposthitis clinical manifestations

erythema of the glans and prepuce

itching

soreness

blisters

ulcers

painful urination

foul-smelling discharge

Cryptorchidism (Undescended Testes) consequences

infertility, malignancy, testicular torsion

hydrocele

collection of fluid in scrotum without an obvious inguinal hernia

noted shortly after birth as unilateral or bilateral swelling in scrotum

scrotal swelling with fluid and may be bluish

hematocele

accumulation of blood in space the parietal and visceral tunica vaginalis, which causes the scrotal skin to become dark red or purple

may develop due to abdominal surgical procedure, scrotal trauma, a bleeding disorder, or a testicular tumor

spermatocele

painless, sperm-counting cyst that forms at end of epididymis

variocele

variosities of pampiniform plexus, at network of veins supplyign the testes

testicular torsion

• twisting of spermatic cord and loss of blood supply to ipsillateral testicle

  • urologic emergency → early diagnosis and treatment are critical to preserving testicle and fertility

  • viability decreases rapidly after 6 hours from symptom onset

  • most common acute scrotal disorder in pediatric and young adult population, occurring in 1 in 4000 males under 25 years of age

  • torsion → acute onset of severe testicular pain

Epididymitis defined

inflammation of the epididymis

Epididymitis diagnosis

• lab - leukocytosis

• obtain urinalysis and urine culture

• cause differentiated by Gram stain exam or culture of a midstream urine/urethral

• doppler ultrasound may note increased blood flow to the affected testis

acute epididymitis

pain, swelling, and inflammation of less than 6 weeks

chronic epididymitis

same symptoms for 6 weeks or more

clinical manifestations epididymyitis

• gradual onset of posterior testicular pain → usually unilateral

• pain radiation to lower abdomen

• discharge, dysuria, frequency, urgency, erythema of scrotal skin, and fever

• physical elevation of testicle or scrotum when standing decreases pain of epididymitis but does not decrease pain of testicular torsion

stage I testicular cancer

tumor confined to testes, epididymis, or spermatic cord