Pathophysiology T2 Notes

CVA

Cerebrovascular Accident, commonly known as a stroke.

Ischemic Stroke

A type of stroke caused by blockage of an artery leading to the brain, often due to atherosclerotic plaque.

Hemorrhagic Stroke

A type of stroke caused by damage to a blood vessel that supplies the brain, leading to bleeding.

Global Hypoperfusion

A condition where blood flow to the brain is drastically diminished, affecting multiple organs.

TIA

Transient Ischemic Attack, a temporary deficit due to a lack of blood flow, which is reversible.

TBI

Traumatic Brain Injury, a brain injury resulting from trauma, commonly caused by falls or motor vehicle accidents.

GCS

Glasgow Coma Scale, a scale used to assess the level of consciousness and severity of brain damage.

ADH

Antidiuretic Hormone, a hormone that reduces urine output and promotes water retention, released from the posterior pituitary.

SIADH

Syndrome of Inappropriate Antidiuretic Hormone, a condition characterized by excessive water retention and low sodium levels.

Diabetes Insipidus (DI)

A condition characterized by increased urine output due to low levels of ADH.

Thyroid Hormone

Hormones produced by the thyroid gland that regulate metabolism.

Hyperthyroidism

A condition characterized by excessive thyroid hormone production, leading to increased metabolism and symptoms like weight loss and irritability.

Hypothyroidism

A condition characterized by low thyroid hormone production, leading to decreased metabolism and symptoms like weight gain and fatigue.

Cushing’s Syndrome

A condition caused by excessive cortisol production, leading to symptoms like muscle wasting and high blood pressure.

Addison’s Disease

A condition characterized by low cortisol production due to adrenal cortex problems.

Aldosterone

A hormone that regulates sodium and potassium levels, affecting blood volume and blood pressure.

Diabetes Mellitus (DM)

A disorder related to insulin deficiency or resistance, leading to high blood glucose levels.

Three P’s of Diabetes

Polyuria, polydipsia, and polyphagia, which are common symptoms of diabetes.

Macrovascular Complications

Complications related to large blood vessels, such as coronary artery disease and cerebrovascular disease.

Microvascular Complications

Complications related to small blood vessels, such as retinopathy, nephropathy, and neuropathy.

Type 1 Diabetes

A form of diabetes characterized by absolute insulin deficiency due to beta cell destruction.

Type 2 Diabetes

A form of diabetes characterized by relative insulin deficiency and tissue resistance to insulin.

T/F: stroke is reversible

False

what are the three common causes of CVA?

ischemic, hemorrhagic, global hypoperfusion

what causes ischemic CVA?

blockage of an artery leading to the brain

what is the most common cause of CVA?

ischemia

what is the most common cause of ischemic CVA?

atherosclerotic plaques

who are most at risk for ischemic CVA?

smokers, diabetics, …

what causes hemorrhagic CVA?

damage to a vessel that directly supplies the brain

who is most at risk for hemorrhagic CVA?

those with uncontrolled HTN and those with blunt trauma to the head

what dictates the clinical manifestation of CVA?

location and size

T/F: strokes can expand but they can’t be reversed

True

T/F: any brain damage is slow to heal

true

T/F: TIA is reversible?

true

what are the most common causes of TBI?

falls and motor vehicle accidents

For hormones to produce their desired effects, what must they interact with?

their specific receptors on the tissues/cells

T/F: each hormone has many receptors which aren’t specific

false

t/f: hormones are continuously produced and not only made as needed

false

t/f: if its a primary hormone disorder, then the issue is with the gland

true

t/f: if the issue is a secondary disorder then it originates with the gland

false

t/f: for a secondary hormone disorder, the problem occurs outside of the gland

true

what are the major effects of ADH?

raises BV, acts as vasoconstrictor, causes water retention, raises blood pressure

what is too much ADH called?

SIADH: syndrome of inappropriate adh

what is too littlel ADH called?

DI: diabetes insipidus

what are the effects of SIADH

too much water retension; ECF becomes hypotonic; water flows from the ECF to the ICF; cells expand; possible hyponatremia; blood volume increases blood pressure

what is our primary concern with SIADH?

the water buildup in the ECF which results in a fluid shift

what are the two types of DI?

central (1*) and nephrogenic (2*)

t/f: central DI is due to a gland issue

true

t/f: ndi is due to a receptor problem

true

how do we tell the difference between NDI and CDI?

get a blood test of the ADH levels; cdi has low levels and ndi has normal or elevated levels

what are the effects of DI?

increased urine output!!!
reduction in water retention
extreme thirst
blood volume decreased
hypertonic ECF
hypernatremia
extremely dilute urine

Pt: Complaints of being unable to make it to Fayetteville now because they keep stopping to pee. What could be a possible diagnosis? (List 4)

1. DI (either CDI or NDI)

2. DM (would be most common)

3. intense water increase

4. diuretics

what is thyroxicosis?

the excess of TH from any source

what are some common symptoms of hyperthyroidism?

increased SNS sensitivity, weight loss, heat intolerance, irritability, fatigued, increased BP, tachycardia

what is the difference between primary and secondary hyperthyroidism?

primary is caused by an issue with the thyroid gland and secondary is a cause outside of the gland, usually a tumor on the anterior pituitary gland

Pt:

• TH elevated

  • means that this patient has hyperthyroidism

• TSH is at normal or even low level

  • this is the expected response to elevated TH

what is the diagnosis?

primary hyperthyroidism

Pt:

• TH elevated

  • means the pt has hyperthyroidism

• TSH levels are elevated

  • the thyroid is reacting as expected to the TSH levels and producing more TH

What is the diagnosis?

secondary hyperthyroidism

what are common manifestations of hypothyroidism?

weight gain, cold intolerance, fatigue, lethargic

Pt:

• low TH

  • means pt has hypothyroidism

• decreased TSH

  • not the normal ant. pit. response

  • would expect the ant. pit. to produce MORE TSH to counter the low TH levels

what is the diagnosis?

secondary hypothyroidism

pt:

• low TH

  • means pt has hypothyroidism

• increased TSH

  • normally response by ant. pit. to low TH

what is the diagnosis?

primary hypothyroidism

what is the stress hormone?

cortisol

what is Cushing’s Syndrome?

condition where the body has too much cortisol, either through producing too much or by the target receptors not accepting it

what are common symptoms of Cushing’s Syndrome?

muscle wasting, humping, moon face, …

pt:

• cortisol elevated

• ACTH decreased

  • the normal response by the ant. pit.

  • if ACTH decreased, then would expect the cortisol levels to decrease as well

what is the diagnosis?

1* hypercortisolism

pt:

• cortisol elevated

• ACTH elevated

  • abnormal response by the ant. pit.

  • ant. pit. is overproducing ACTH which is causing an abnormal amount of cortisol production by the adrenals

what is the diagnosis?

Cushing’s Disease

Cushing’s Disease

hypercortisolism caused by excess ACTH; secondary hypercortisolism

t/f: low cortisol will cause a suppressed stress response

true

what is the name for primary hypocortisolism?

Addison’s Disease

Addisonian Crisis

when you suddenly stop taking steroids and go into a state similar of Addison’s Disease because the cortex is messed up…; due to it taking months for the adrenal cortex to wake back up

what does aldosterone do?

lower K, retains Na, higher BP, higher BV

RAAP

renin-angiotensin-aldosterone-pathway

what does the RAAP do?

blood pressure in the kidney causes release of renin which turns angiotensinogen into angiotensin 1 then ACE turns a1 into a2 which then stimulates the release of aldosterone which then constricts the blood vessels

t/f: aldosterone can be released if renin is not present

false

t/f: in primary hyperaldosteronism renin is increased

false

what are common effects of hypoaldosteronism?

hyperkalemia, hyponatremia, hypovolemia

pt:

• ALDO low

• Renin high

what is the diagnosis?

primary hypoaldosteronism

pt:

• ALDO low

• Renin low

what is the diagnosis?

secondary hypoaldosteronism

what are some common effects of hyperaldosteronism?

hypokalemia, increased blood volume, increased blood pressure

t/f: renin levels should decrease if aldosterone levels increase

true

pt:

• ALDO high

• Renin high

what is the diagnosis?

secondary hyperaldosteronism

pt:

• ALDO high

• Renin low

what is the diagnosis?

Conn’s Disease

what is Conn’s Disease?

primary hyperaldosteronism

what is the typical presentaion in a pt with diabetes?

polyuria: due to the kidneys trying to pee off the excess glucose
polydipsia: excessive thirst due to the polyuria and decrease in ECF dilution because excess glucose increases the concentration
polyphagia; excessive hunger due to too much sugar staying in the blood and not going into the cells to provide the body with energy
weight loss

t/f: a person can stop being diabetic

false

what are common treatments for diabetes?

diet, exercise, medication, watching your sugar intake

A1C

measure of long-term glucose control; want to be less than 7.0%

t/f: complications occur in DM due to uncontrolled glucose

true

what are the macrovascular DM complications?

coronary artery disease (MI Risk), cerebrovascular disease (stroke risk), peripheral artery disease (amputation risk)

what are the microvascular complications of DM?

retinopathy, nephropathy, neuropathy

what is the most common type of diabetes?

type 2 DM