PATHO Final Exam (untested content)

nephron

filtering units composed of the glomerulus, Bowman’s capsule, the renal tubule (PCT, loop of Henle, DCT), and the collecting tubules

• kidneys are filled with million of these

• “Renal Assembly Line”

glomerulus

component of the nephron that filters waste and excessive fluid from the blood

Bowman’s capsule

component of the nephron that encloses the glomerulus

proximal convoluted tubule (PCT)

component of the nephron that reabsorbs ions and nutrients (bicrabonate, vitamins, small proteins)

• part of the renal tubule

Loop of Henle

component of the nephron that concentrates urine by drawing out water

• part of the renal tubule

distal convoluted tubule (DCT)

component of the nephron that is repsonsible for further reabsorption of ions and nutrients (actions of angiotensin II and aldosterone)

• part of the renal tubule

collecting tubule

component of the nephron that causes ADH to further reabsorb water

juxtaglomerular apparatus

Regulates the function of each nephron; ultimately regulates blood pressure and glomerular filtration

• Stimulates the release of Renin → Increase in blood volume and blood pressure

• Tubulo-Glomerular Feedback → Regulates rate of glomerular filtration

eryhtropoietin (EPO)

A hormone secreted by the kidneys to regulate the production of red blood cells

Vitamin D conversion

function of the kidneys that helps convert Vit. D into its active form, allowing the body to use it

creatinine

biproduct of muscle metabolism that is 100% filtered

renal agenesis

congenital disorder in which there is an absence of one or both kidneys

• intra-renal disorder

• unilateral vs. bilateral (Potter’s Syndrome —> usually fatal)

cystic disease (PKD)

congenital disorder in which cysts (fluid-filled sacs) form in and/or around the kidneys

• intra-renal disorder

• recessive vs. dominant types

recessive PKD

type of PKD that is:

• rare

• childhood diagnosis

• asymmetrical

• no systemic involvement

dominant PKD

type of PKD that is:

• more common

• diagnosed in mid-late adulthood (40-50yo)

• asymmetrical

• usually systemic involvement

nephroblastoma

congenital renal disorder that is a cancer known as Wilms tumor

• Intra-renal disorder

• genetic etiology

• associated w/ genitourinary abnormalities

• 4th most common pediatric malignancy

ascending infection (UTI)

renal infection most commonly caused by E. coli

lower urinary tract infection (UTI)

genitourinary tract infection

S/Sx:

• different issues w/ urination

• dysuria, pyuria, hematuria, frequency/urgency

hematogenous spread

infection from somewhere else in the body spreads to kidneys

pyelonephritis

inflammation of the kidneys

• often due to E. coli; can be a complication of a UTI

• s/sx: CVA tenderness, fever, N/V, urgency/frequency/dysuria

nephrotic syndrome

glomerular disorder that results from damaged glomeruli (can’t filter protein well)

• more proteinuria —> >3-3.5g protein/day

• hyperlipidemia

• edema

nephrolithiasis

kidney stones

• most commonly calcium

  • also uric acid, struvite, cystine

  • severe pain (ureter spasm)

nephritic syndrome

glomerular disorder that results from inflammation of the glomeruli

• less proteinuria —> <3g protein/day in urine

• hematuria (can’t filter RBCs)

• edema

pre-renal AKIs

type of acute kidney injury that results from reduced blood flow to kidneys

• Causes:

  • volume issues —> hypovolemia, hypotension HF

  • vascular resistance —> renal artery stenosis, drug-induced (ex. NSAIDs)

intra-renal AKIs

type of acute kidney injury that is a result of a problem of the kidney itself

• Causes:

  • acute glomerulonephritis

  • diabetic/hypertensive kidney disease

  • nephrotoxic drugs/chemicals

  • ischemia

  • kidney failure

  • acute tubular necrosis (ATN)

post-renal AKIs

type of acute kidney injury that is a result of an obstruction in the kidney (prevents draining, waste builds up in kidenys)

• Causes:

  • benign prostatic hypertrophy (BPH)

  • calculi (kidney stones)

  • strictures

  • tumors

  • obstructed catheters

chronic kidney disease (CKD)

progressive, irreversible decline in renal function

• clinical manifestations don’t present until 75% of nephrons are damaged

  • end-stage renal disease (ESRD) presents when 90% nephrons are damaged (HTN & diabetes are leading causes)

• Consequences:

  • HTN, cardiovascular disease

  • metabolic acidosis

  • electrolyte imbalances

  • renal osteodystrophy

  • malnutrition

  • anemia (normocytic)

  • uremic syndrome

uremic syndrome (ESRD)

retention of metabolic waste products creating toxicity 

• Clinical Manifestations --> encephalopathy, neuropathies, cardiovascular disease, anorexia, nausea/vomiting, itching 

hyperthyroidism

thyroid disorder

• Etiology:

  • Grave’s Disease

  • Hashimoto’s

  • tumors

  • drugs (exogenous T3/T4)

• Clinical Manifestations:

  • warm, moist skin

  • exophthalmos

  • heat intolerance

  • increased GI motility

  • sleeplessness

  • silky hair

  • weakness

hypothyroidism

thyroid disorder

• Etiology:

  • primary —> dysfunction of thyroid gland (Hashimoto’s)

  • secondary —> drug-induced (lithium)

• Clinical Manifestations:

  • dry skin

  • myxedema

  • cold intolerance

  • weight gain

  • lethargy

  • constipation

  • coarse hair

  • weakness

Addison’s Disease

adrenocortical deficiency; slow onset

• Etiology:

  • primary —> idiopathic, autoimmune, congenital adrenal hyperplasia (pediatrics)

  • secondary —> long-term steroids

• Clinical Manifestations:

  • hyperpigmentation

  • lethargy

  • weight loss

  • GI distress

  • volume depletion

  • salt cravings

• acute crisis: vascular collapse (shock), abdominal pain, high fever

Cushing’s disease

adrenocortical excess

• Etiology:

  • primary —> pituitary dysfunction

  • secondary —> steroids in chronic disease management

• Clinical Manifestations:

  • round face (moon face)

  • thin arms/legs

  • fatigue

  • weight gain (abdomen)

  • muscle weakness

  • purple/pink stretch marks

  • fine hair

hypercalcemia

parathyroid excess

• Etiology:

  • primary (less common) —> abnormal parathyroid activity

  • secondary (more common) —> bone disease, renal disease

• Clinical Manifestations

  • can be asymptomatic

  • kidney stones

  • osteoporotic fractures

  • constipation

  • cardiac abnormalities

hypocalcemia

parathyroid deficiency

• Etiology:

  • primary (less common) —> abnormal parathyroid gland activiy

  • secondary (more common) —> bone disease, renal disease

• Clinical Manifestations:

  • paresthesias (numbness, tingling)

  • muscle cramps

  • fatigue

  • cardiac abnormalities

SIADH

anti-diuretic hormone (ADH) excess

• Etiology:

  • primary —> ectopic production of a tumor

  • secondary —> drug-induced

• Clinical Manifestations: Soaked Inside (water excess)

  • concentrated urine

  • retention of urine

  • cellular swelling

  • hyponatremia

  • weakness

  • muscle cramps

  • lethargy

  • N/V

diabetes insipidus (DI)

anti-diuretic hormone (ADH) deficiency

• Etiology:

  • primary —> brain surgery, trauma, tumor, idiopathic

  • secondary —> nephrogenic (kidneys)

• Clinical Manifestations: Dry Inside (water deficit)

  • excessive thirst, drinking

  • excessive urination

  • cellular shrinking

  • hypernatremia

  • dehydration

  • lethargy

  • seizures

type I diabetes

Immune system attacks insulin-producing cells in the pancreas,
causing a deficiency in insulin

• Typically autoimmune, juvenille onset

• Clinical Manifestations:

  • general —> Micro and macro vascular disease, diabetic neuropathy, immunosuppresion

  • specific —> DKA

• Treatment:

  • insulin

type II diabetes

Acquired, the body doesn't use insulin properly

• Usually adult onset, preceded by Metabolic Syndrome (Obesity, hypertension, insulin resistance, dyslipidemias)

• Clinical Manifestations:

  • general —> Micro and macro vascular
    disease, diabetic neuropathy, immunosuppresion

  • specific —> non-ketonic hyperosmolar coma (NKHC)

• Treatment:

  • Weight control and dietary measures (first
    line), oral anti-hyperglycemic (Metformin),
    Insulin

diabeteic ketoacidosis (DKA)

acidosis resulting from breakdown of fat (keto-acids) due to complete lack of insulin and total lack of glucose availability to cells 

• Treated w/ aggressive hydration & insulin 

• associated w/ type I diabetes

non-ketotic hyperosmolar coma (NKHC)

lack of glucose availability to cells and keto-acid production, but no acidosis 

• Treated w/ aggressive hydration & insulin 

• associated w/ type II diabetes

diarrhea

Increase in frequency and fluidity 

• Infection 

• Stress 

• Irritants 

• Food allergies 

• Chemicals (caffeine) 

constipation

Small, infrequent, or difficult bowel movements 

• Lack of exercise/hydration 

• Lack of dietary fiber 

• More common in women 

achalasia

Failure of lower esophageal sphincter to relax properly 

• Dysphagia w/ sensation of food being “stuck” behind the sternum 

• Usually first noted w/ food, but may progress to liquid 

Mallory-Weiss Syndrome

Tear in the mucosa of upper stomach or esophagus 

• Forceful and prolonged vomiting 

• 75% cases involve alcoholics or use of aspirin 

gastritis

Inflammation of the stomach 

• Acute --> drugs, pathogens, alcohol 

• Chronic --> H. Pylori, autoimmunity 

• Clinical Manifestations: 

  • Asymptomatic 

  • Anorexia 

  • N/V 

  • Pain/discomfort  

gastroenteritis

Inflammation of the stomach and the small intestines 

• Acute --> pathogens, toxins 

• Chronic --> IBD 

• Clinical Manifestations: 

  • Anorexia 

  • N/V 

  • Pain/discomfort 

  • Diarrhea  

diverticular disease

Very common condition in older adults, characterized by the formation of multiple “outpouchings,” or diverticulae, in the colon 

• Areas of weakness in bowel wall (blood vessel involvement) 

• Clinical Manifestations:

  • Left lower quadrant abdominal pain 

  • Fever & malaise 

  • Constipation or diarrhea (less common) 

  • Bleeding (red blood in stool) 

appendicitis

Inflammation of the appendix  

• Common cause of acute abdomen 

• Unknown etiology 

• Usually young adults 

• Surgical removal 

Clinical Presentation 

• Periumbilical pain which migrates to lower right quadrant (McBurney’s) 

• Fever & malaise 

• N/V 

irritable bowel syndrome

 Characterized by presence of alternating constipation and diarrhea, with “crampy” type abdominal pain; no identifiable pathological explanation 

• Extremely common (20% US population) 

• Unknown etiology 

• Probably the result of multiple etiologies (inflammatory, infectious, autoimmune, etc.) 

pseudomembranous colitis

“C. Diff" colitis or antibiotic associated colitis 

• Antibiotic exposure is the most common etiology for C. diff infection 

• Classically associated with Clindamycin, but may occur following exposure to many different antibiotics 

• Often a problem in hospitalized pts  

• CM: pain, fever, bloody diarrhea 

cholecystitis

Gallstones in gallbladder may cause inflammation 

cholangitis

Bacterial infection in pt w/ biliary obstruction 

• Fever, jaundice, abdominal pain 

• Treated w/ antibiotics & biliary drainage 

osteoblast

immature, brand-new cells that are starting to grow

osteoclasts

cells that breakdown existing bone (help reabsorb calcium for calcium homeostasis in body)

endochondral formation

Bone forms from a cartilage model 

• Long bones 

intramembranous

Bone forms with no cartilage model 

• Flat bones of skull, mandible, maxilla, clavicle 

compartment syndrome

elevated pressure in a muscle compartment (closed space); compartment pressure > arterial pressure = ischemia and necrosis 

• Clinical Manifestations (5Ps): 

  • Pain 

  • Pallor 

  • Pulselessness (decreased/absent pulse) 

  • Paresthesia (diminished sensation) 

  • Polar (cold distal extremity) 

fat embolism syndrome

Rare complication in which fat globules enter through bone marrow vasculature 

• Typical embolism “stopping points”/manifestations: 

  • Lungs (most common) 

  • Brain 

  • Heart 

  • Other organs 

• Petechial rash 

rhabdomyolysis

Release of myoglobin into circulation, which introduces substances that are harmful to the kidneys and have additional secondary effects 

• Creatine kinase, excessive electrolytes, vasoconstriction, dehydration 

• Causes: 

  • Trauma 

  • Medications 

  • Ischemia 

scoliosis

lateral deformity of the spine 

kyphosis

excessive thoracic curvature

lordosis

excessive lumbar curvature

osteoporosis

Most common bone disease; bone resorption > bone formation 

• Specific cause is unknown 

• Prevalence: 

  • 1/2 women >60 

  • 1/5 men >60 

• Clinical Findings: 

  • Non-traumatic fractures 

  • Radiolucency 

• Risk factors: 

  • Family history 

  • Menopause 

  • Medications (steroids) 

  • Poor nutrition (Ca/Vit. D) 

  • Chronic inflammatory disease (RA) 

rickets

vitamin D deficiency that occurs in children & leads to weak, poorly calcified bones 

osteomalacia

vitamin D deficiency that occurs in adults & leads to abnormally soft bones and some pain 

• Decreased sun exposure 

• Intestinal malabsorption 

• Renal disease 

Paget Disease of bone

Metabolic bone disease characterized by excessive bone resorption followed by excessive bone formation 

• Disorganized, abnormal bone matrix 

• Cranial bone thickening 

  • Vertigo/hearing changes 

  • Headaches  

osteomyelitis

Infection of the bone 

• Hematogenous (blood-borne) spread is most common 

• Fever & other vague symptoms (malaise, night sweats, weight loss) 

• Pain  

osteochondroma

bone neoplasm that is benign; most common bone tumor

enchondroma

bone neoplasm that is benign; small bones of hands/feet

osteoid osteoma

bone neoplasm that is benign & painful; often tibia or femur

giant cell tumor

bone neoplasm that is long bones of adults; pain may be the only symptoms

osteosarcoma

bone neoplasm that is very malignant (most common malignant tumor) & most commonly affects long bones

chondrosarcoma

bone neoplasm that is a malignant tumor of the cartilage

Ewing Sarcoma

bone neoplasm that is malignant; long bones of children

multiple myeloma

Not a sarcoma of bone, but often presents w/ lytic bone lesions 

• Bone pain in back/chest 

• Most commonly thoracic or lumbar spine 

• Evidence of pathological (atraumatic) fractures 

• Hypercalcemia 

• Kidney dysfunction 

fasciitis

Inflammation of the sheath surrounding muscles 

bursitis

Inflammation of a synovial “pocket” in a joint  

• Hip, shoulder, knee, elbow  

tendonitis

Inflammation of a tendon (connects muscle to bone) 

• Knee, quads, hamstring, Achilles 

myasthenia gravis

A chronic autoimmune disease affecting neuromuscular function of voluntary muscles 

• Antibodies attack ACH receptors on the motor endplate 

• Muscle weakness & fatigability 

• Adult onset 

poly/dermato-myositis

Idiopathic inflammatory myopathies associated with muscle fiber necrosis, usually in proximal limbs and neck 

• Often complaints of difficulty getting up steps or rising from chair (proximal muscle weakness in legs/hips) 

• If skin changes --> called dermatomyositis 

fibromyalgia

Chronic pain syndrome of unknown cause/mechanism, with strong female predominance (75%) 

• Diffuse muscular pain which may be associated with insomnia, fatigue, headache, depression, IBS 

• Physical exam usually reveals multiple tender points 

osteoarthritis

type of arthritis characterized by:

• Non-inflammatory 

• Localized 

• Pain increases w/ activity 

• Hips, knees, hands, spine 

Rheumatoid Arthritis (RA)

type of arthritis characterized by:

• Autoimmune inflammatory 

• Systemic & symmetrical 

• Significant pain & morning stiffness 

• Presence of rheumatoid factor and/or other acute phase reactants 

• Limited effect on distal interphalangeal joints (DIP) 

gouty arthritis

A genetic disorder or uric acid metabolism leading to hyperuricemia and crystal formation/deposition into joints 

• Often presents in big toe, followed by ankles and knees 

  • May also affect hands, wrists, elbows 

enteropathic arthritis

type of arthritis that occurs in people w/ Crohn’s disease and ulcerative colitis 

• 10-20% of people w/ IBD 

• Peripheral or axial

• Ankylosing spondylitis & bone-fusing effects (HLA B27) 

reactive arthritis

type of arthritis with a clinical triad of arthritis, urethritis, and conjunctivitis 

• “can’t see, can’t pee, can’t climb a tree” 

• Bacterial infections 

  • C. trachomatis 

  • Salmonella 

  • Shigella 

  • Yersinia 

  • campylobacteria

shingles

dermatomal rash caused by reactivation of Varicella-Zoster virus (chickenpox)

impetigo

Acute bacterial infection of the skin caused by staph or step 

• Very contagious 

leprosy

Chronic disease caused by intracellular organism mycobacterium leprae 

• 11 million people worldwide 

syphilis

bacterial skin disease caused by T. palladium

• Primary --> painless chancre on genitals 

• Secondary --> disseminated rash 

lyme

tick-borne bacterial skin disease characterized by:

• Classical skin lesion is a bull’s eye rash 

• Borrelia burgdorferi 

• Constitutional symptoms --> fever/chills, muscle & joint pains 

RMSF

tick-borne bacterial skin disease characterized by:

• Rickettsia rickettsii 

• Rash appears on hands and wrists & spread to rest of body 

• Constitutional symptoms  

acne vulgaris

Obstruction of the follicular canal leading to excessive oil production and bacterial growth 

• Extremely common 

• Multiple factors 

  • Hormones 

  • Heredity 

  • Stress

psoriasis

Common chronic skin condition characterized by papules and plaques with an overlying silvery scale  

• Predilection for knees & elbows, lower back, scalp, nails 

lichen planus

Relatively common, pruritic papular eruptions of skin and mucous membranes  

• Oral lesions occur as white, lacy plaques 

pemphigus

Group of disorders with P. vulgaris having the worst prognosis; likely autoimmune 

eczema

atopic dermatitis

• Very pruritic 

• May be caused by many various irritants 

drug eruptions

category of allergic disorders of the skin; various types

• Most common is a widely disseminated, pruritic, red, maculopapular rash  

• Stevens-Johnson Syndrome 

• Photosensitivity

Stevens-Johnson Syndrome (SJS)

type of drug eruption allergic disorder of the skin

• Erythema multiforme (toxic epidermal necrolysis) 

• Life threatening 

• Triggered by infections & medications (especially antibiotics & sulfa drugs) 

• Fever, sore throat, fatigue, ulcers/lesions in mucous membranes 

• Conjunctivitis in 1/3 patients  

vasculitis

allergic disorder of the skin

• Drug allergies 

• Autoimmune diseases (SLE/RA) 

• Polyarteritis Nodosa (PAN)