Exam 3 PATHO

The Common Cold:

Viral infection of upper

No ANAs needed

• 2-3 colds/year (adult); 6-8 colds/year (child)

• Single “cold virus” or more:

  • Rhinovirus: most common

    • early fall → late spring

  • Parainfluenza: < 3 yrs

  • Adeno/coronavirus

    • Winter & spring

  • RSV: < 3 yrs

    • winter & spring

    • linked to asthma *

Transmission of Common Cold:

Fingers, cough, sneeze

• nasal mucosa + conjunctival surface: common portal of entry for viruses

s/s & t/x of Common cold:

s/s:

• Dryness & stuffiness

• Rhinitis

• Clear & watery secretions

• Post nasal drip  → cough + sore throat

• Headaches

• Chills & fevers

t/x:

• Rest

• Antipyretic drugs

• Decongestants

Rhinosinusitis/Sinusitis:

Rhinitis: nasal mucosa inflammation

Sinusitis: paranasal sinuses inflammation

You can have both

Sinuses Types:

Paranasal Sinuses

• Air-filled spaces connected to the nasal cavity by small openings (ostia).

• Linked with the nasal turbinates (superior, middle, inferior).

1. Maxillary Sinus

• Located below the eyes (orbit) and above the hard palate.

• Drainage opening is high (superior & medial) → makes drainage difficult.

2. Frontal Sinus

• Located in the forehead area.

• Opens into the middle meatus of the nasal cavity.

3. Ethmoidal Sinuses

• 3–15 small air cells on each side.

• Found between the eyes.

• Each has its own drainage path to the nasal chamber.

4. Sphenoidal Sinus

• Located behind the eyes, in front of the pituitary gland.

• Drains into the sphenoethmoidal recess (top of nasal cavity).

Rhinosinusitis classifications, d/x, t/x:

Acute: viral, bacterial, mixed

• 5-7 days; 4 weeks

Subacute: 4-12 weeks

Chronic: >12 weeks

D/x:

• physical examination

• Pain in head or when bent over or coughing/sneezing

• MRI for SEVERE cases

  • rules out neoplasm

T/x:

• Viral → rest for 1 week → >7days → ANA

• Antipyretics

• Mucolytic agents

Influenza:

Most common cause of upper

• direct contact/ aerosols (cough/sneeze)

• targets respiratory epithelium

• Highest death rate

Types: can have lots of mutations

• A: most common

  • infects animals

  • most severe

  • divides into

    • Hemagglutinin (H)

    • Neuraminidase (N)

• B: only humans

  • Less severe

  • No subtypes

t/x:

• fluids

• Antiemetics

• Antiviral drugs: <48 hrs; shortens time of flu

  • Amantadine

  • Rimantadine

  • Zanamivir

  • Oseltamivir

Acute Bronchitis:

Acute infection/inflammation of bronchi

• follows viral illness

• Pneumonia symptoms

  • EXCEPT pulmonary consolidation and chest infiltrates

Pneumonia:

Lower infection; happens more with pts who are virulent

• leading cause of death in uncs

• PJP (opportunistic infections) in immunocompromised/AIDS

c/x:

• Bacteria, virus, fungi, parasites

  • streptococcus/pneumococcal pneumonia

• gastric secretions aspirated → lungs

  • “aspiration pneumonia”

• Source → Community or hospital acquired

• Agent type → Typical/Atypical

  • Typical: infection → inflammation → productive cough

•  Infection Distribution → Lobar or Broncho

Community-Acquired Pneumonia:

Patient admitted → <48 hours → pneumonia s/s → infected facility → cooked

• (Hospital would be >48 hours & 20-50% mortality rate)

Typical vs Atypical Pneumonia:

Typical:

• death in uncs

• Pneumococcal pneumoniae 

• Marked inflammation of lungs

• Exudate (fluid + debris) fills alveoli → lung consolidation (clear 99)

• s/s:

  • Purulent (thick/yellow-green) sputum

  • Severe fever, chills, malaise, pleuritic pain

  • Egophony → aaa instead of eee

• Seen clearly on chest X-ray

Atypical (Walking):

• from viruses or Mycoplasma pneumoniae

• Patchy lung involvement → mainly affects alveolar septa & interstitium

• No alveolar exudate → No lung consolidation

• Symptoms:

  • Mild/moderate sputum

  • Mild fever, less severe illness (“walking”)

• Moderate increase in white blood cell count

Pneumonia s/s, a/x, d/x:

1. Sensorium changes

2. Cyanosis

3. Diaphoresis

4. Dyspnea

5. Fevers/chills

6. Headache

7. Malaise

8. Nausea/vomiting

9. Pleuritic chest pain

10. Productive cough

11. URI

Typical Assessment:

• Dullness in percussion

• ^ tactile fremitus in palpation

• Bronchophony, egophony, whispered pectoriloquy (not supposed to hear) in auscultation

d/x:

• CBC for WBC

• Gram stain

• Blood cultures BEFORE ANAs

• ABG values

TB:

Mycobacterium tuberculosis → affects lungs & other systems

• t/x of HIV → v TB

• Disseminated/Miliary TB: from lungs → brain, bones, GU, heart

Primary: first infection; airborne droplets

• - psi room

  • report to nurse before entering

  • N95 mask

• Attacks macrophages → cell-mediated response

Screen testing:

• Mantoux test

• TST (intradermal) → check for induration

  • positive signs

    • 5,10,15mm induration

    • Immigrants, IV drug users, working in shelters, [HIV + ppl, organ transplant, contact with TB + ppl (5mm)]

d/x:

• PPD

• Sputum & Blood culture

• CXR

t/x:

• Isoniazid (INH): 6 months if latent TB;

• Rifampin (RIF)

• Pyrazinamide (PZA)

• Ethambutol (EMB)

• NORMAL would be all for 2 months → 4 months of INH & RIF

TB pathogenesis:

Granuloma: ghon focus; macrophages that eat TB → dead tissue

• + LN = Ghon complex

Active TB s/s:

Low grade fvere

Night sweats

Anorexia

Hemoptysis

Dyspnea → SOB

Gas Exchange:

Dissolved Oxygen (PaO2/PO2)

• 80 -100

Oxyhemoglobin

• 95-100 sat

PaCO2: 35-45

• carbaminohemoglobin (10%)

• CO2 traveled in bicarbonate or CO2

Use of Chemoreceptors (O2, CO2, pH levels) and Lung receptors (monitors breathing patterns)

• central chemoreceptors: in brainstem; ^ RR due to v pH

• peripheral chemoreceptors: carotid & aortic bodies; measures PO2 & CO2 → ^ RR if PO2 < 60 mmHg

Insufficient O2 terms:

🔵 Hypoxemia

• ↓ Oxygen in arterial blood → PaO₂ < 80 mmHg

• Causes:

  • Hypoventilation

  • Diffusion problems (gas exchange issue)

  • Ventilation-perfusion (V/Q) mismatch

  • Right-to-left shunt

• Often leads to ↑ CO₂ (hypercapnia)

🩸 Hypoxia (Ischemia)

• ↓ Oxygen in body tissues/cells

• Can result from hypoxemia or poor blood flow

🔴 Hypercapnia

• ↑ Carbon dioxide in arterial blood (PaCO₂ > 45 mmHg)

Dead space: Good ventilation; blocked perfusion

Silent: Blocked ventilation & blocked perfusion

Shunt: Blocked ventilation; Good perfusion

Types of Pleural Effusions:

Transudate (Hydrothorax)

• Clear, watery fluid

• Causes: Congestive heart failure (CHF), renal failure, liver failure

Exudate

• Creamy fluid with proteins and white blood cells

• Specific gravity > 1.020

• Contains inflammatory cells and lactate dehydrogenase (LDH)

• Causes: Bacterial pneumonia, malignancies

Empyema

• Pus-filled fluid with glucose, proteins, leukocytes, and cell debris

• Causes: Bacterial pneumonia, rupture of lung abscess

Chylothorax

• Lymphatic fluid in pleural cavity

• Milky appearance (contains chylomicrons)

• Causes: Trauma or inflammation of lymphatic vessels

Hemothorax

• Blood in the pleural cavity

Pleural pain effusion s/s, d/x, t/x:

Sudden onset, Unilateral, made worse w/chest movement

d/x:

• CXR, US, CT

t/x:

• Thoracentesis

• Fluid drainage

Pneumothorax:

Air accumulation in pleural space → partial or complete collapse

Types:

• Spontaneous Pneumothorax (Primary)

  • Air blister (bleb) on lung surface bursts

  •  young, healthy, tall ppl

  Traumatic Pneumothorax (Secondary)

  • Chest injury (rib fracture, stab, or gunshot wound)

  Open Pneumothorax (Communicating)

  • Air moves in and out of pleural space

  • Pressure inside = outside air pressure

  Tension Pneumothorax

  • Air enters but cannot escape

  • Pressure builds up in pleural space → compresses lung

  • Tracheal deviated to the unaffected side & mediastinal shift

s/s:

• Pain, SOB, Tachypnea, Hyperresonance, absent breath sounds

d/x: CXR, CT, O2, ABGs

t/x:

• chest tube or large bore needle

Atelectasis:

Collapsed lung → deflation

• Surgery, obstruction, pneumonia

• GET OUT OF BED

s/s:

• SOB, cough, fever, leukocytosis

d/x: CXR, CT

Prevention: deep breathing exercises, spirometer, ambulation

T/x: inflate & reduce obstruction

Asthma:

Chronic inflammatory disorder → inflammation & constriction of airways

• Airway remodels → structure changed

• SABA (albuterol) → opens airways; used for asthma attacks

• LABA: prevents attacks

s/s:

• chest constriction, wheezing, non productive coughing, tachypnea, tachycardia

t/x:

• SABA for Bronchospasms

• Theophylline: sim to caffeine → opens airways

• Inflammation:

  • Inhaled corticosteroids

  • Montelukast (leukotriene antagonists)

  • Mast cell stabilizers

  • Anti-Ige Antibodies

Asthma triggers:

Allergens, infections, exercise, drugs, hormonal changes, stress, smoke, cold air

• IgE Type 1 Hypersensitivity

Asthma Severity:

Step 1: Mild intermittent

• Uses inhaler <2x/week day

• <2/month night

Step 2: Mild persistent

• >2 weekly but not daily day 

• >2/month night

Step 3: Moderate persistent

• Daily during day

• >1/week night

Step 4-6: Severe persistent

• Symptoms are constant day

• more than once a week night

COPD:

Chronic bronchitis: obstruction from mucus

Emphysema: obstruction from destroyed alveoli

Emphysema:

Destruction of elastin → enlargement of airways

• elastin helps for alveoli recoil → v alpha 1 antitrypsin → elastase → elastin broken down

• can be genetic of alpha 1 antitrypsin deficiency or from smoking

s/s:

• 40-50

• barrel chest

• Weight loss

• v breath sounds

• normal ABG till late disease progression

• Cor pulmonale: RHF

d/x:

• pulmonary function test

• CXR

t/x:

• X smoking, avoid pollutants

• Bronchodilators

• v O2 Flow

• Anticholinergics

• Steroids for last measure

• Pursed lip breathing teaching

• Surgery, transplant

Chronic Bronchitis:

Mucus hypersecretion & chronic productive cough > 3monhts or 2 consecutive years

• Dramatic cyanosis

• Hypercapnia & hypoxemia

• SMOKING

s/s:

• dyspnea, productive coughing, HTN, wheezing, SOB

d/x:

• Pulmonary function test

t/x:

• Bronchodilators, corticosteroids, X smoking, vaccination

Emphysema vs Bronchitis:

Emphysema (Pink Puffers)

• Breathe faster to keep oxygen levels normal

• Shortness of breath (dyspnea)

• Use of accessory muscles and pursed-lip breathing

• Skin usually pink due to adequate oxygen

Bronchitis (Blue Bloaters)

• Cannot breathe fast enough to maintain oxygen levels

• Cyanosis (bluish skin) and polycythemia (high RBC count)

• Often develop cor pulmonale (right-sided heart failure)

Pulmonary Embolis:

• Blockage of pulmonary vessels by embolus

Types:

• Thrombus – from DVT (most common)

• Fat – after bone fracture or fat injury

• Amniotic fluid – enters blood after membrane rupture during delivery

VIRCHOWS TRIAD

• Hypercoagulability: Estrogen, Testosterones, smoking, obese

• Venous Stasis: A fib, immobilized, paralysis, long flight

• Endothelial injury: HTN, trauma, surgery

s/s:

• chest pain, dyspnea, tachypnea, tachycardia

d/x:

• CT, MRI, VQ, D-dimer, EKG

t/x:

• Prevent DVT, TPA for thrombus, Anticoagulants prevent, IVC filter for Inferior vena cavae for thrombus collection

Pulmonary Hypertension

• ^ psi in pulmonary arteries

c/x:

• Pulmonary arterial hypertension (unknown, genetic, drugs)

• LHF

• Lung diseases

s/s:

• Right ventricular hypertrophy

• Fatigue, chest discomfort

• Tachypnea

• SOB when exercising

• Thickened/hypertensive pulmonary arteries

Cor Pulmonale

• Right ventricular enlargement due to pulmonary hypertension

• Pressure overload → RV works harder → hypertrophy → dilation → RV failure

Effects:

• v lung ventilation

• Pulmonary vasoconstriction

• RV hypertrophy → increased heart workload

• Low oxygen levels → kidney makes more erythropoietin → more RBCs → polycythemia → thicker blood

• Overall increased strain on the heart

s/s:

• EKG shows right ventricle hypertrophy

• Chest pain

• Pulmonic & Tricuspid valves murmur

t/x: 

• v workload of RV → lowering pulmonary arterial psi

Acute Respiratory Distress Syndrome (ARDS) – Simplified Notes

• Fluid fills the alveoli → lungs can’t expand fully → less oxygen enters blood

• Caused by various conditions that injure the lungs

Key Lung Changes:

• Damage to alveolar epithelial cells → leaky alveolar-capillary membrane

• Protein-rich fluid in alveoli

• Sloughing of type I alveolar cells

• Dysfunction of type II cells → surfactant inactivated

• Inflammation: neutrophils, macrophages, platelets, oxidants, proteases

• Edematous interstitium, fibrin, hyaline membranes, and cellular debris

Causes: drowning, pneumonia, sepsis, stroke, massive burns, DIC, fat embolism

Progressive ARDS Manifestations:

1. Shortness of breath (dyspnea) and low blood oxygen (hypoxemia)

2. Rapid breathing → respiratory alkalosis

3. Poor tissue oxygen → metabolic acidosis

4. Increased WOB

5. Slow/shallow breathing → high CO₂ (hypercapnia) → respiratory acidosis

6. Respiratory failure

7. WHITE LUNGS from protein fluids

Acute Diarrhea:

>3 stool/day; loose & watery stool

• not bloody, purulent, greasy

• <14 (acute); >4 weeks (Chronic)

• Infection or poison

Types:

1. Large Volume: excessive water/secretions

   • Viral/Bacterial in large or distal s.i.

2. Small Volume: excessive motility

   • frequent loss of small stools

3. Other s/s:

   • Fever, headache, vomit, abd pain, malaise

Constipation:

Change of frequency, size, consistency, ease of stool; <once every 3 days

• Very subjective

c/x:

• Dehydrated, delayed GI motility, sedentary, low fiber/residue diet, Psychogenic, Drug side effects

t/x:

• ^ fluid (>6 8oz/day), ^ fiber, exercise, bowel training

• If lifestyle changes dont work:

  • Laxatives, stool softeners, enemas, suppository

• Check for impaction in uncs → bowel obstruction

Anorexia:

Loss of appetite to eat despite feeling of hunger

• from other GI issues, drug side effects, cancer s/s

Nausea

Unpleasant sensation preceding vomiting

• subjective

• Irritation/distention in GI tract

• Simulated by higher brain center (traumatic injury)

Vomiting (Emesis)

Forceful emptying via mouth; complex reflex from medulla oblongata (vomiting center); nausea, tachycardia, diaphoresis cause this

• Excessive distention, chemical stimulation, pain

• Projectile Vomiting: from stimulation of vomiting center; ^ ICP

Abdominal Pain Types:

Parietal: stimulation of pain receptors in parietal peritoneum/abd wall

• localized, sharp, intense, & lateralized (one-sided)

Visceral: stimulation of abd organs; inflammation

• Vague, diffused (non-localized), dull

Referred: localized at some point along afferent nerve pathway of organ/tissue

Intestinal Obstruction:

Mechanical: problem of bowel lumen movement patency → distention & electrolyte imbalances → bowel ischemia, acidosis, perforation shock, sepsis

• Tumor, scar/adhesion tissue, constipation

• intussusception, volvulus

• s/s:

  • nausea/vomiting, anorexia, diarrhea, fever, colicky pain

  • reduced bowel sounds or borborygmus (hyper active sounds)

  • Peritonitis: fluid escape → peritoneal cavity → board-like rigidity; EMERGENCY

Nonmechanical (Ileus): complete stop of intestinal movement; no blockage (48-72hrs)

• Abd surgeries, blood supply disruption there, narcotics/morphine

• s/s:

  • Abd cramping/distention

  • Nausea/Vomiting

  • Failure of gas/stool passage

  • No bowel sounds

• t/x:

  • NPO & NG tube (to decompress)

Acute Abdomen:

Episode of sudden/severe abd pain (hours or longer)

Causes:

• Surgical, diagnose early

• Gynecological: Lower Q, PID, Fibroids, ovarian cyst

• Medical: pneumonia, acute MI, DKA, Hepatitis

• Appendicitis: triad of RLQ pain, anorexia, leukocytosis

Peritonitis:

Peritoneum inflammation

c/x:

• after perforation of gut/organ → cavity

• Ulcer, appendix rupture, diverticulum, PID

s/s:

• Pain (inflamed & rebound)

• Nausea/Vomiting

• Board-like rigidity of abdomen

• Tachycardia, fever, ^ WBC

Peptic Ulcer Disease (PUD):

Break/ulceration in mucosal lining of esophagus/stomach/duodenum

• Gastric protective mechanism & irritating factors (acid-pepsin, NSAIDs, H. pylori) imbalances

• v PG → v bicarb production → ulcer

• Acid= 2pH; ^ production after meal

c/x:

• H pylori (gram -): lives in stomach → inflammation, dmg, bleeding

• Excessing NSAIDs (aspirin) usage

  • X PG synthesis

• Zollinger-Ellison (idiopathic disease): Acid hypersecretion from tumors

• Too much acid delivery in duodenum → v protective layer here

r/x: Age, warfarin & NSAIDs, corticosteroids, smoking

Types:

• Duodenal ulcer: Epigastric burning 2-3 hrs after eating;

  • 4x more common > GU; in younger ppl

  • Relieved with food or antacids (buffer)

  • ^ Weight; symptoms at 1-2am

• Gastric ulcer:

  • in NSAIDS users and uncs

  • Pain after meal

  • v Weight

s/s:

• Dyspepsia

• Pain when stomach empty (duodenal)

• Pain after meal (gastric)

• Hematemesis (Upper GI bleed)

• Melena: black tarry stools

• Perforation & Hemorrhage

d/x:

• Endoscopy (gold standard test)

• Blood → H. Pylori

t/x:

• Avoids ^ acid secretion foods

• X alcohol, caffeine, NSAIDS, smoking

• v Stress

• Antacids (PPI), Antihistamines (H2 blockers) → ^ bicarb; antibiotics

Gastroesophageal Reflux Disease (GERD):

Reflux → esophagus w/w/out inflammation

• HCl acid/pepsin

c/x:

• Incompetent lower esophageal sphincter (LES): relaxes and cannot put psi → esophagus → backflow

  • due to CCB, narcotics, ETOH, nicotine, chocolate, peppermint

• v esophageal peristalsis & gastric emptying

s/s:

• Heartburn (75-80%)

• Regurgitation of food/fluid

• Chronic cough

• Barret Esophagus → metaplasia → dysplasia; indication of major issue

d/x:

• Rule out neoplasm with dysphagia, orophagia, weight loss, occult blood loss

• Endoscopy: gold-standard test, more specific

t/x:

• Weight loss, small frequent meals

• X high-fat, chocolate, alcohol, peppermint, caffeine, onions, garlic, citrus, tomatoes, smoking

• X tight clothes

• Sleep with head of bed elevated (not pillows)

• H2 Blockers, PPI, surgery

Hiatal Hernia:

Stomach protrude through diaphragm

• GERD or asymptomatic

d/x: Barium swallow/endoscopy

t/x: Same as GERD and surgery if large

Diverticulosis:

Herniation outpouchings of mucosa/submucosa layers; sigmoid colon

• Asymptomatic

• ^ in pts w/v fiber diet & uncs

Diverticulisis:

Inflammation of diverticula in bowel wall

• perforation & abscess formation

• LLQ pain in uncs lasting several days

• Low grade fever, nausea/vomiting, anorexia

D/x:

• CBC: slight leukocytosis

• SER is high

• Urine normal

• CT scan, abdominal films

• NO Barium enema or Colonoscopy

Appendicitis:

Inflammation of vermiform appendix

• obstruction w/fecalith, stricture, neoplasm

• Common with younger ppl; leading cause of abdominal surgery

s/s: umbilicus pain → RLQ pain; anorexia & N/V & low grade fever

• Maximal pain at McBurney’s point

• Rovsing’s sign: RLQ pain → LLQ palpation

• Psoas sign: pain w/R thigh extension

• Obturator sign: pain w/internal rotation of flexed R thigh

• >24 hours → perforation → peritonitis → board-like abdomen & its s/s

Irritable Bowel Syndrome (IBS):

abd pain w/ defecation/change in bowel habits → disorted defecation & distention

• common PCP visits; in women

• Altered gut motility & secretion & flora; hypersensitivity & hyperalgia

d/x: Rome III Diagnosis Criteria → defecation improvement & stool characteristics

t/x:

• Mild symptoms

• v Stress

• Warmth → abdomen

• ^ laxatives, fibers, prebiotics; X obvious foods

Inflammatory Bowel Disease:

Ulcerative Colitis: Chronic → affects colonic mucosa (rectum & sigmoid); AI disease → inflammatory ulceration

• 15-30 years; >60 years

• Hyperemic Mucosa → mucosal destruction → bleedings, pain, urge to defecate & passage of blood

• 10-20 stools/day (exacerbation); crampy abd pain & dehydration & anemia

• Risk for colon cancer

D/x: colonoscopy 

T/x:

• Anti-inflammatory meds, removal of colon parts

Chron’s Disease: Patchy inflammation of all GI layers (mucosa & submucosa); from mouth → anus

• Young adults & teens; familial

• Slowly w/remissions & exacerbations (stress-induced)

• Fissures, granulomas (cobblestone), fistulae in perianal area, strictures (narrowed intestine area) → obstruction

• Inflammatory lesions → granuloma formation → malabsorption (v weight)/ obstruction/ fistula & abscess formation → diarrhea & malnutrition

• 3-5 semisolid foul smelling stools/pain; nonbloody stool; urgent to defecate at night, IDA

• Perianal abscesses & fistulas (opening in rectum)

c/x: unknown; theories

d/x: CT scan, ^ WBC v RBC, ^ ESR, Sigmoidoscopy 

t/x: ^ calorie & protein diet, v fiber/residue

• stress management

• Anti-inflammatory drugs, ANAs, Vitamins, electrolytes

Jaundice:

Excessive destruction of RBCs; impaired bilirubin uptake via liver → v bilirubin conjugation 

• Bile flow obstruction from liver → gallbladder → duodenum

Liver functions

1. Production of bile salts

2. Elimination of bilirubin

3. Metabolism of steroid hormones

4. Metabolism of drugs

5. Carbohydrate metabolism

6. Fat metabolism

7. Protein metabolism

8. Storage of mineral and vitamins

9. Filtration of blood and removal of bacteria

Cholecystitis

Inflammation of gallbladder; 2ndary to previous cholelithiasis (gallstones)

• either bile or calculi

• Stones impacts cyctic duct → inflammation behind obstruction → ^ psi → distention, ischemia, gangrene, perforation

Acute:

• RUQ pain & tenderness → back/shoulder

• Biliary colic: pain starts from mild → severe

• N/V

• Recurrent attack after fatty meals

• + Murphy Sign: tenderness in RUQ & ^ breathing

Common duct stones from jaundice or F/S

Chronic: 

• Asymptomatic → 15-20yrs → symptomatic (20%) → mild dyspepsia after fatty meals

D/x: US (gold-standard test)

• Liver function tests → ^ AST & ALT & alkaline phosphatase

T/x:

• Cholecystectomy 

• Asymptomatic → conservative treatments

  • Avoid foods w/^ fat

  • Antacids

Viral Hepatitis Periods:

Prodomal/Preicterus period: X jaundice but flu-like symptoms (malaise, fatigue)

• Anorexia, N/V, fatigue

• Headache, aches

• ^ AST & ALT

Icterus Period: Jaundice (in HAV); RUQ tenderness

• Pruritus, brown urine, light/clay colored stools, spider angioma, v prodomal s/s

Recovery period: v Jaundice → normal urine & stool

• Enzyme lvs return normal; v pain

Hepatitis Types:

A: Caused by HAV; fecal-water/food (shell-fish, fresh fruits)

• v mortality rate

• Vaccine: dead virus; 2 injections 6 months apart

• Water. food, & hygiene safety

B: Exchange of body fluids (sex, IV, health care workers)

• Symptomatic (mild→ life-threatening)

• Clean needles, immunization, safe-sex

• Vaccine: recombinant HBV (not live virus)

• Hepatomegaly → RUQ tenderness; splenomegaly; X jaundice;

• 2-3 weeks of illness → chronic

C: Exchange of blood & body fluids

• IVDU via needle sharing

• Uncommon with sex & maternal-fetal

• Incubation period → 6-7 weeks

• No vaccine

D: always comes w/Hepatitis B

D/x: Check for antibodies

• A: Anti-HAV IgM → acute infection

  • Anti-HAV IgG → cured from HAV

• B: HBs-Ag → acute infection

  • HBsAb (Antibody) → cured from HBV

• C: Anti-HCV → acute infection

Cirrhosis:

Liver tissue replaced w/fibrous/scar tissue

• ETOH, Viral Hepatitis, Biliary Disease

• Scarring → liver flow disruption → portal HTN → liver failure

Portal vein: transport blood from stomach, intestines, spleen, & pancreas → liver

s/s:

• Weight loss, Ascites (v albumin)

• Hepatomegaly & Splenomegaly

• Jaundice

• Caput Medusae: enlarged veins around umbilicus

• Esophageal Varices → GI bleeding

• Hepatic Encephalopathy → v LOC from ^ ammonia

• Clay-stool & dark urine

• v weight, weakness,

d/x:

• Liver function test

• Coag studies, CBC, CT. ^ ammonia lvs

t/x:

• TIPS (Transjugular intrahepatic portosystemic shunt)

• Lactulose ammonia

• Prevent infection

• Liver Transplantation

Acute Pancreatitis:

Inflamed pancreas & surrounding tissue

• Enzymes auto-digest pancreas

• Alcohol, biliary tract disease, hyperlipidemia, infections, surgery, drugs

s/s:

• epigastric & abd intense pain → refractory to narcotics; radiates to back

• from activity

• N/V, tachycardic, kussmaul, ^ temp, high/low BP

d/x:

• Check ^ lipase levels

• Check ^ serum amylase (3x more)

• C-reactive protein ^ → ^ ESR

• Gallstone pancreatitis → US

t/x:

• IV fluids

• Pain control

• NPO & NG tube

• clear fluids when no pain & enzyme levels return normal

• Advanced diet

Estrogens

Made from cholesterol

Sexual maturation

Ovulation

Development and maintenance of female accessory organs

Cell division in breasts and endometrium

. Maintaining skin and blood vessels

Decreasing bone resorption

Increased HDL levels, decreased LDL and cholesterol

Moving fluid into tissues

Progesterone

Maintaining pregnancy

Endometrium and myometrium thickened

Promote growth of breast for lactation

Smooth muscle relaxation

. Prevent maturation of other follicles by suppressing FSH and LH

. Provide immune modulation (tolerance against fetal antigens)

Menstrual Cycle:

GnRh: begins cycle → Anterior P → FSH & LH secretion (secreted at different times)

• FSH → matures ovarian follicles → strongest survives → estrogen

• LH → induces ovulation → oocyte released to fallopian tube & follicle cells → corpus luteum → progesterone ^ (luteal phase) → drop → restarts cycle

• Then estrogen produced → X FSH → Activates LH

Alterations:

• Puberty:

  • 2nd sex characteristics, rapid growth, reproduction; 8-13

• Delayed Puberty: (13 girls/14 boys); 95% is normal; 5% is X hypothalamic-pituitary-gonad axis or systemic disease

• Precocious Puberty: (<7 girls/<9 boys)

  • Obese, ^ protein consumption, household products, CNS tumors

• Abnormal uterine bleeding: irregular menstrual cycle & bleeding

  • Dysfunctional uterine bleeding (DUB)

    • No organic disease, unpredictable, lack of ovulation, perimenopausal

    • IDA

    • T/x: NSAIDs → v PG → vasoconstriction

      • contraceptives, levonorgestrel, intrauterine device (IUD), ablation, hysterectomy

Pelvic Inflammatory Disease (PID):

STD induced from vagina → uterus → fallopian tube → ovary → peritoneal cavity

• Chlamydia & Gonorrhea

• R/x: previous STD NOT treated, many sexual partners, douches, IUD → birth control

• s/s: lower abd & cervix pain, ^ WBC & C-reactive protein & ESR, purulent discharge, fever

  • Chandelier sign: severe cervical motion tenderness

• t/x: ANAs, if IUD → remove it

External Genitalia Disorders:

Bartholin: cyst & abscess; fluid-filled sac → occlusion of duct

• from bacterial, chlamydial or gonococcal infection

• tender & pain

• t/x: moist heat, ANAs, I & D

Vulvodynia: chronic pain syndrome → vulvar area

Vulvar Carcinoma:

• younger women: before vulvar intraepithelial neoplasia or HPV infection

• Older women: before non-neoplastic disorders

  • Lesions → itching & repeated injury

  • Healing cells mutate

  • NOT HPV

Vaginitis:

s/s: Discharge, redness, swelling, pain urinating, intercourse, ^ WBC

• Normal vagina pH (4-4.5) → protects against infection

• Disruption through:

  • Abnormal estrogen lvs, STDs, ^ Glycogen (DM, pregnant)

  • Douching, soap, spermicides, tampons

  • ANAs

Cervicitis:

Acute/chronic; purulent discharge os/endocervical bleeding

• Chlamydia, gonorrhea, trichomoniasis

• Abnormal flora ← v Estrogen

Anatomic female Abnormalities:

Pelvic organs

Cystocele: herniation of bladder → vagina; dropped

• Weak supporting muscles

• s/s: bearing down, difficulty emptying bladder, frequent urination

Rectocele: herniation of rectum → vagina

• s/s: difficulty defecating

Uterine Prolapse: bulging uterus → vagina

• t/x: surgery, pessary (plates to provide support), Kegel, estrogen therapy (menopausal women only)

Endometrial Disorders:

PID

Endometritis: uncommon but from infection

• Abortion, delivery, instrumentation

• Vagina bleeding, tender, foul-smelling discharge

• ANAs

Endometriosis: Ectopic Endometrial Implants outside of uterus

• unknown

• R/x: early menarches, longer duration & flow, menstrual pain (cue to abnormal hormone cycle); retrograde menstruation (goes up instead of down)

• Can occur anywhere; very painful

• Infertility

• t/x: stop cycle, remove implants,

Uterine Leiomyomas: myomas/uterine fibroids; smooth muscle benign tumors

• Asymptomatic → enlarge → vaginal bleeding, pain, pressure

• t/x myomectomy/hysterectomy

Endometrial Cancer

Ovarian Disorder:

Cysts: common form of tumors (benign)

• Functional: follicle/luteum

• → enlarged → dull aching pain

• Fluid-filled

• Corpus luteum cyst: cells left behind from ovulation

PCOS: most common endocrine disorder

• Anovulatory menstrual cycles; ^ androgens (male) & polycystic ovaries

• Follicles do NOT ovulate after ^ LH → immature follicles ^/Amenorrhea (no menses)

  • Primary Amenorrhea: never menstruated in life or 15/13 (no sex characteristics)

    • Congenital/h-p-o- axis

  • Secondary: had menses → stopped (>6 months)

    • Pregnancy, PCOS, Fat-muscle ration alteration: exercise/anorexia nervosa

    • H-p-o axis; infection

• Hyperinsulinemia, Obese, DM, HTN, Hyperlipidemia, Menstrual irregularities, Hirsutism, acne, infertile

• t/x oral contraceptives; lock in

Dysmenorrhea:

Painful menstruation:

• Primary:  ^ PG

  • T/x w/NSAIDs

• Secondary: structural problems throughout cycle

Premenstrual Syndrome:

Physical, emotional, behavioral changes associated w/cycle → v relationships & affects ADLs

• mild (PMS) → regular (PMS)→ PMDD ( premenstrual dysphoric disorder)

• PMS: >300 s/s:

  • Swollen breasts, bloat abd pain, headache, backache

  • Depression, anger, fatigue → SSRIs

Menopause:

X ovarian function; vv estrogen

• v Breast tissue, body hair, elasticity, SQ fat, Ovaries & uterus

• Friable cervix & vagina

• Hot flashes, palpitations, dizzy, headache

• Insomnia, Irritability, anxiety, & depression

• HTR if NEEDED → osteoporosis

Male Anatomy

Androgens:

• Testosterones: from Leydig ← ^ LH

• Dihydrotestosterone: → peripheral tissues; produced by enzyme 5-alpha reductase

FSH → Sertoli cells → Spermatogenesis

Erection: when corpus cavernosum + spongiosum → filled w/blood

• Veins constrict to maintain erection

• even start with baby

• Erectile Dysfunction: v sexual satisfaction

  • Organic:

    • Neurogenic: stroke, Parkinson’s

    • Hormonal: v Testosterones 

    • Vascular: DM, atherosclerosis

    • Drug induced (SSRIs & BB (v BP))

  • Psychogenic

  • Mix

Penile Disorders:

Inflammation based

• Balanitis: inflammation of penis gland

  • Poor hygiene & phimosis (cannot retract foreskin) & DM

• Peyronie Disease: fibrous scar tissue → pain and curvature during erection

  • localized + progressive; palpable

  • 50% goes away

  • Inflammation happens after plaque formation
    

Priapism: involuntary, prolonged penile erection (4-6 hrs)

• painful; X sexual arousal

• Emergency

• Any age; 60% → idiopathic; 40% → spinal cord trauma, sickle cell disease, leukemia, infections, trauma

• Impaired blood flow → corpora cavernosa

• t/x: analgesics, sedation, hydration (sickle cell), needle aspiration

Penile cancer

Testicular Disorders

Disorders of the Testicular Tunica

Hydrocele: excess fluid → tunica vaginalis

• congenital, infection, trauma, testicle torsion

• smooth, tense, transilluminates

Hematocele: accumulation of blood → tunica vaginalis

• Dark red/purple skin

Spermatocele: painless sperm containing cyst epididymis ←> testis

• solitary/multiple

• Small

Varicocele: abnormal enlargement of testicular vein draining testis

• Bag of worms like

• Blood pools in veins → venous system → v b.f. in testis → X spermatogenesis → infertile

Testicular torsion: twisting of spermatic cord

• exercise, trauma

• testicular pain, N/V, tachycardia

• large & tender; X cremasteric reflex

• surgery ← <6 hrs > → loss of testis

Inflammations

Epididymitis: inflammation of epididymis 

• Primary: nonsexual infection; congenital

• Secondary: Anal sex; STIs

• s/s:

  • Unilateral pain

  • Inflammation

  • similar to torsion

  • + reflex

  • ^ WBC

• t/x: scrotal elevation & support (phren’s sign); ANAs, Analgesics, Antipyretics

Orchitis: inflammation of the testis

• Precipitated from primary UTI → reach testes via blood, lymph, urethra

• Mumps Orchitis: most common cause

  • Sudden onset

  • 3-4 days after onset of parotitis

  • High fever, erythema, edema, tenderness of scrotum & leukocytosis

  • Risk for sterility if both testicles involved

Testicular Cancer: 15-35

• Excellent prognosis

• Unknown cause

• R/x: undescended testes

• First sign: slight testicle enlargment

• D/x: physical examinations, U/S, CT scans, MRI, Tumor markers

Prostate Disorders:

Prostatitis:

• Different kinds

Benign Prostatic Hyperplasia (BPH): compresses urethra; accelerate and nonmalignant

• Nodules → compressed → urethra → narrow slit

• UTI, retention → incontinence; nocturia

• can be treated 

• DO NOT TAKE anticoligernic meds 

Prostate cancer: most common male cancer

• second to lung cancer

• Screening: PSA & digital rectal exam

• Unclear, r/x → Age & high fat diet

• s/s: asymptomatic → similar BPH s/s → metastasis

Childhood Disorders:

Hypospadias: opening of urethra → ventral penis surface

• Undescended 10%

Epispadias: opening on dorsal sides

• Less common

Phimosis: tightening of prepuce → X retraction

• Erections help remove adhesions → if not → surgery

Paraphimosis: foreskin is retracted and cannot go back

• Restricts glans blood supply → ischemia & necrosis

Cryptorchidism (Undescended Testes)

• 1 + testes fail to move down into sac

• R/x: premature babies

• Infertility malignancy

Skin Lesion Types

Macule: circumscribed flat skin areas

• Different in color

• <1cm

• Petechiae, flat nevi

Patch: Large macule; >1 cm

• cade au lait spot, mongolian spot

Papule: small, solid, elevated lesion

• <1cm

• Elevated nevus (mole), wart, bug bite

Plaque: skin elevation

• >1cm

• silvery/scaly

• Psoriasis

Pustule: visible purulent fluid below skin

• <1cm

• Acne, impetigo

Vesicle: circumscribed skin elevation; serous fluid

• <1cm

• Herpes simplex, Varicella, zoster

Nodule: solid skin mass

• >1 cm

• Palpable (epi → dermis)

• Dermatofibroma, Xanthoma

Bulla: elevation w/fluid

• >1 cm

• only to epidermis

• Burns, Blisters

Wheal: Elevated pink/white area with papule/plaque

• Following allergic response

• Red; axon-mediated

• PPD test; urticaria

Cyst: closed cavity/scar

• Semisolid + fluid

• Sebaceous cyst cystic acne

Pressure Ulcers:

Ischemic ulcers from unrelieved skin psi → dmg

• Decubitus ulcer: pressure interrupts normal skin b.f.

• Psi, Shearing force (friction + gravity), friction, moisture

• prone in sacrum, heels, ischia, trochanters

• Do frequent skin assessment; reposition every 2 hours; educate; v moisture, ^ nutrition & hydration

There are stages:

1. Intact but erythema

2. Partial-thickness loss (epi, dermi)

3. Full thickness loss → subcut fat

4. Full loss → exposure of bone, muscle; irrevirsible

Deep tissue injury: discolored (purple/maroon) intact skin/blood filled blister

Unstageable: full-thickness loss w/ulcer & slough/eschar or both

Skin disorders:

Atopic Dermatitis (Eczema): Type 1 Hypersensitivity

• Inflammatory process → erythema

• Severe pruritus, lesions w/indistinct borders; epidermal changes

• Chronic → skin thickens → leather → hyperpigmented → scratching & itching → lichenification

• IgE AXAs

• h/x of asthma or high fever

Contact Dermatitis: allergic & irritant; Type 4 hypersensitivity

• inflmmatory on CD4 & CD8 → alergen → skin → carrier protein → non-IgE antigen

• Allergic agents:

  • Antimicrobials, hair dyes, latex, plant adhesives

• Irritant agents: soap, detergents, organic solvents

• s/s: Erythema, swelling, pruritus, vesicular lesions; poison ivy

Papulosquamous Disorders:

Psoriasis: Chronic, relapsing, proliferative, inflammatory disorder

• complex interactions between → macrophages, fibroblasts, dendritic cells, NK cells, CD4, CD8

• Dermal & epidermal thickening

• Scalp, knees, ass, back, elbow

• Turnover from 14-20 days → 3-4 days

• No time to mature/keratinize

• Erythematous plaques → thick/silvery scales → hard to remove → bleed when removed/Auspitz’s sign

• T cells activated → growth facts → papule creations & neutrophil/monocyte attraction → inflammatory process

Pityriasis Rosea: benign, self-limiting inflammatory disorder from virus

• Herald patch: circular, demarcated, salmon-pink; 3-10 cm → 14-21 days → secondary lesion (smaller) → trunk & upper extremities

• Winter month

Skin Infections:

Fungal:

• Tinea: superficial; dermatophytes

  • Ringworm, athlete’s food → attack dead cells

  • Candidiasis: attacks living tissue; on skin, mucous membranes, vagina, GI tract; NOT an STD

• Mycoses → dermatophytes → termed tinea

  • Tinea capitis → scalp

  • Manus → hand

  • Pedis → foot; athlete’s foot

  • Corporis → ringworm

  • Cruris → groin, jack itch

  • Unguium → nails/onychomycosis (ugly ass nails; systemic treatment)

Bacterial

• Cellulitis: infection of dermis & subcut tissue

• Impetigo: superficial skin infection; staphylococcus/Streptococci

  • Highly contagious; honey-colored crust; moist erythematous base

Viral:

• HPV: common warts (1 & 2); children on fingers; plantar warts (bottom of feet)

  • Condylomata acuminata: Anogenital wars (6 & 11); sexual transmitted

  • 16 & 18 → 70% of cervical cancer causes

• Herpes Simplex virus (HSV):

  • 1 → oral infection or cornea, mouth, orolablast

  • 2 → genital infections

• Herpes zoster (shingles) & Varicells (chicken pox)

  • Same virus

  • Primary infection followed years after activation (shingles)

  • Latent virus & dorsal root ganglia

Benign Tumor:

Actinic Keratosis: premalignant lesion of aberrant proliferations of epidermal keratinocytes

Nevi (mole/birthmarks)

Skin Cancer:

Basal Cell carcinoma: most common cancer in world

• Red macule/papule → depressed cancer

• Grows slowly → ulcerates & crust

• rare metastasis

Squamous cell carcinoma: sun exposure induced; 2nd common skin cancer

• in site/invasive

• Result of actinic keratosis → premalignant lesions → proliferations → epidermal keratinocytes

Malignant melanoma: malignant tumor of skin

• Most serious

• ABCD(>6mm)E

• Changing nevi, new swelling, redness, scaling, oozing

Sun exposure: ^ r/x for basal or squamous cell carcinoma

• severe → malignant melanoma

Burns:

Injury resulting from contact/thermal exposure, radiation, chemical, electrical agents

• Cardiovascular response: fluid evaporation → ^ WBC, hematocrit, & hypoproteinemia

• Cellular response: 

  • Transmembrane potential X: impairs Na-K pump → ^ intracellular Na & H20 v K

  • Metabolic response: hypermetabolic state → needs ^ energy

• Immunologic: immunosuppressant state

• Control airway, fluids adequate, control airway, nutrition (^ protein, fat, Cals)

• Wound management, grafting

• Infection & sepsis t/x

• Thermoregulate

• Monitor circumferential burns for COMPARTMENT SYNDROME: ^ muscle psi → nerve & b.v. damage → swelling & edema

  • hypoxia → dearth

  • Intense pain in arms & legs

  • t/x: escharotomy/fasciotomy: open the skin → v psi

First degree:

• Superficial (epidermis)

  • Local pain & erythema & blanches w/psi

  • No blisters; 3-6 day heals

  • Mild → moderate sunburnt

• Superficial partial thickness: epidermis & some dermis

  • Blisters & heals in 10-21 days

Second Degree:

• Deep partial thickness: epidermis & deeper dermis

• Blisters & heals → 2-6 weeks; w/out scars

• Do NOT remove blisters

• Wet/waxy dry

• MOST PAINFUL

Third Degree:

• Full thickness: epidemis + dermis + subcut

• Wound dry & leathery → eschar

• W/out blister; painless

• Escharotomies → releases psi & prevents compartment syndrome

• Flames, explosions

4th degree: full thickness & deeper tissue (muscles & burns)

Rule of Nines: look at image

• >20% = major burn injuries

  • Massive evaporative water loss & large # of fluid, ^ blood concentration

Lund & Broward chart is another way to estimate burn injury

Nervous System

SNS: catecholamines (epi, norepi, dopamine) connected → adrenergic receptors (a1 a 2 b1 b2 b3)

PNS: Acetylcholine; connected → cholinergic receptors (muscarinic & nicotinic)

Dendrites ← stimuli → axons

• Schwann cells: myelin/white matter (^ speed)

Cell firing:

• stimulus → Na channels → threshold → ^ Na channels → Na enters cell → depolarization → K channels open → K diffuses out → repolarization

Meninges:

• Dura: venous drainage

  • subdural space

• Arachnoid: waterproof

  • subarachnoid space (w/CSF)

• Pia: Holds cerebral arteries

CSF: sim to blood plasma

• 600ml/day produced from choroid plexuses

• Inside brain ventricles → s.c.

• leaks → out capillaries → arachnoid villi → venous circulation

-plegia: stoke/paralysis

Paresis: weakness

Hemi: both limbs on 1 side

Di/para: both limbs

Quadri: all limbs

Pain

Gate Control Theory: non-painful input closes gait → reduces pain → CNS

• Pain threshold: lowest pain # one can feel

• Pain Tolerance: greatest pain # on can endure

• Nociceptive Pain: injury → tissue; visceral (cavity lining & organs), somatic/ (skin, joints, muscles)referred

  • Many pain types

• Neuropathic/non-nociceptive pain: chronic (>6 months) pain from primary lesion → leads to long term pain pathway changes → abnormal sensory info processing

  • Central/peripheral

  • Tingling, numbing, burning

Headaches:

Migraine: episodic & repeated lasting 4-72 hrs

• Familial

• Women 22-55

• D/x: unilateral, throbbing, worse w/movement, N/V, photophobia or phonophobia

• Phases:

  • Premonitory (few days; feeling u gonna get it)

  • Aura (smth right before)

  • Headache

  • Recovery

• R/x: altered sleep, overexertion, weather, skipping meals, before period, alcohol/nitrates

Cluster: period of days → spontaneous remission for long period

• minute → hours

• Men 20-50

• Autonomic X & trigeminal activation

• D/x: unilateral, severe pain

  • Ipsilateral eye, red eye, stuff nose

Tension-type: most common; bilateral headache like a tight band around head

• Gradual pain; 2nd decade

• Episodes (hours → days)

• D/x: 15 days/month; 3 months

Myasthenia Gravis:

AI; type II hypersensitivity (xtra AcH AXAs)

• Gradual destruction of AcH receptors (only striated muscles)

• Nerve impulse transmission defect in neuromuscular junction

• Thymus tumor/Hyperplasia

• Women 3x > men

• Gradual weakness (proximal → distal)

s/s: Insidious onset, progressive weakness, ptosis (dropping eyelids), diplopia, dysphagia

• Crisis: Diaphragmatic involvement → difficulty breathing → intubation → myasthenia crisis → quadriplegia → vvv dysphagia & respiratory failure arrest

• vs Cholinergic Crisis: too much anticholinesterase drug → toxicity → ^^^ AcH

  • ^ GI, SMC contraction, salivation; v CV, v RR

D/x: Tensilon test: provide meds → if improved quickly → positive

T/x:

• Anticholinesterase inhibitors: builds up AcH in nerve ending

• Corticosteroids

Guilliain-Barre Syndrome:

Demyelinating disorder →peripheral & cranial nerves

• ascending motor paralysis (feet → up)

• Resp/GI infection precedes 1-4 weeks before

• C/x: Infection, surgery, vaccination

• s/s: muscle weakness, paresthesia, resp. arrest/ cardiovascular collapse

  • recovery possible

  • severe when it reaches diaphragm 

• t/x: supportive care, ventilator, plasmapheresis, Immunoglobin

Parkinsons:

Chronic & progressive; degenerative & debilitating

• basal ganglia & substantia nigra affected → loss of dopamine producing neurons & intracellular inclusions (Lewy bodies) → X dopamine (normal AcH & v dopamine)

• Genetic + environment; 40 → peaks 58-62 years; males

• s/s: TRAP

  • Tremors at rest

  • Rigidity

  • Bradykinesia/akinesia

  • Postural disturbance (flexed, forward leaning)

  • Pill-rolling, dementia, depression, shuffling steps

• D/x: H & P

• T/x: replace dopamine & anticholinergic drugs (lowers AcH)

  • Dosage ^ after 5 years

  • Deep brain stimulation

  • X AntiHTN, Neuroleptics, Antiemetics

Amyotrophic Lateral Sclerosis (ALS)

Neurodegenerative → lower & upper MOTOR neurones

• Sensory & ANS NOT INVOLVED

• Progressive muscle weakness → atrophy, splasciticy

• Excessive glutamate; X inflammation

• Men (3:2) Women

s/s: weakness in any or all; paralysis (progressive atrophy)

• Normal intellectual & sensory function sustained till death

d/x: H & P

T/x: little t/x available

• Riluzole

• Rehab

• 2-5 years life expectancy

MS:

Demyelinating; CNS associated (myelin); AI

• T & B cells cross blood brain barrier → myelin become foreign → inflammation triggered → Myelin producing cells (oligodendrocytes) destroyed

• 20-40; Male (1:2) Female; white ppl

• s/s: crisis & remission; paresthesia, weakness, impaired gait

  • Optic neuritis; motor ocular nerves X

  • Dysphagia

• d/x: lesions in CNS, CT, CSF (^ IgG)

• T/x: anti-inflammatory & immunosuppresantws

  • treat pain, depressions, GI problems

  • Avoid EXTREME temps

  • Plasma exchange

Spinal Cord Injury & Shock:

Motorcycle crashes, sports, penetrating, elderly falls

• 16-30

• Vertebral injuries (flexion, extension, compression) → compresses tissue

Spinal/Neurogenic Shock:

• normal s.c. activity ceases → below level of injury

• Complete reflex, motor, sensory, ANS activity

  • X bladder/rectal control

• Ends when reflexes are regained

  • 7-20 days; 3 months

  • ER

Autonomic Dysreflexia/Hyperreflexia:

• Injury above T6

• After shock → X bladder/rectum emptying → SNS activation → ^BP (arteriolar spasms) & v HR → life threatening → stroke

s/s: headache, blurred vision, distended rectum/bladder, sweating & flushed skin

^ICP: 

• normal 5-15

• Due to blood, CSF, brain tissue → arteries collapse → X blood flow

• C/x: brain swelling, hydrocephalus, Tumors

  • Hydrocephalus: too much CSF in ventricles

    • C/x: ^ production, obstruction, defective reabsorption

      • Children is noncommunication (obstruction of ventricle system) whilst Adults is communicating (v reabsorption)

• Monroe-Kelli Hypothesis: theory where volume and pressure are balanced

• s/s: >2 years of age; headaches, v LOC, sluggish & dilated pupils

  • Cushing’s Triad: ^ SBP, bradycardia, irregular respirations

  • Brain Herniation against bone, dura matter → oculomotor nerve compression

Traumatic brain injury (Hematoma-related):

• Whiplash: stopping too quickly

• COUP injury: directly in injury site

• Counter COUP: opposite injury site

• BRAIN HEMATOMEAS: collection of blood

  • Epidural: between skull & dura mater; rapid bleeding (meningeal artery tearing) → unconscious → lucid period

    • Brain compression; good prognosis

    • HA, V, confusion, drowsy

  • Subdural: dmg in bridging veins (dura -arachnoid mater)

    • Bleeding progresses quickly → ^^^ ICP → high mortality

  • Intracerebral: anywhere in brain (trauma or hemorrhagic stroke)

    • size & location → Vomiting

    • resolves by itself of through surgery

  • Subarachnoid: (arachnoid-pia mater)

    • From cerebral aneurysm/trauma; rapid onset

    • R/xL intracranial aneurysm, HTN, smoking, ETOH, cocaine

    • s/s: vomiting, AMS, fever, seizure

Glasgow Coma Scale (GCS)

Describes injury severity; 3-15

• 8 = intubation

• decorticate flexion: 3 points

• decerebrate flexion: 2 points

CBA-stroke:

Sudden loss of brain function from X blood supply to part of brain

• Ischemic: clot blockage → vO2; thrombotic/embolic

  • Thrombotic: Thrombus ← arterial occlusion ← brain vessel blood clot

    • TIA: clots causes intermittent blockage (24 hrs)

  • Embolic: clot travels TO brain → blocks brain supply

• Hemorrhagic: bleeding inside or around (cerebral artery)

  • C/x: HTN, ruptured aneurysm

• r/x:

  • age, sex, genes, race

  • HTN, Hyperlipidemia, Smoking, ETOH, DM, a-fib, obese, cocaine

Stroke s/s:

• Hemiparesis, hemisensory loss

• LOC, Headache, slurred speech

• ALWAYS OPP SIDE OF BODY

Intracranial Aneurysm:

From HTN, arteriosclerosis, cocaine, birth; 50-59

s/s: Asymptomatic, Dizzy, HA, CN (3, 4, 5, 6) compression

• Berry (saccular) or Giant (fusiform)

Meningitis:

Inflammation of meninges; stiff neck

• Bacterial: Meningococci/pneumococci → CSF or Resp infection (sinusitis, otitis media)

  • s/s: fever, ^HR, chills, petechiae

    • Nuchal rigidity, HA, photophobia

    • Brudzinski sign: reflex when moving neck above → flexes knees

    • Kerning sign: 90 degree leg elevation → unable to do it from pain

  • Check CSF: Turbid appearance, >1 protein; <2.2 glucose

  • t/x: ANAs; aseptic treated w/ antivirals/steroids

    • Vaccination (ppl that live in dorms)

• virus

  • Clear appearance; <1 protein; normal glucose

• fungi, parasites, toxins

Seizures:

Sudden/explosive discharge of cerebral neurons

• Epilepsy: periodic & unpredictable seizure occurrences

• Seizure: disorders, synchronized, rhythmic brain neuron firing; types:

  • Focal: specific neural focus; simple/complex (vLOC, bad senses, psychomotor phenomena “chewing movements”) partial

  • Generalized: entire cerebral cortex

    • Absence: staring at smth for few seconds → then lock back in

      • Mistaken for ADHD

    • Tonic-Clonic: tonic (stiff) → clonic (limb jerking) → post-ictal (body limps)

    • Myoclonic: brief shock-like contraction (face, trunk)

      • Myoclonus: falling in ur sleep

    • Atonic: sudden muscle tone loss; limb & head dropping

      • 1-2 seconds; LOC v; no postictal confusion

  • Secondary: Focal → Generalized

Status Epilepticus: Seizures lasting > 5mins

• ^ Hypoxia & v glucose; acidosis

• ER

• Common in jits/uncs

• t/x: diazepam, lorazepa, life support, prognosis

• Convulsion: jerky, contract–relax (tonic-clonic) movements seen in some seizures.

• Epilepsy: seizures with no correctable underlying cause.

• Prevalence: affects 5–10 people per 1,000.

• Aura: a warning sign that appears right before a seizure.

• Prodrome: early signs (malaise, headache) occurring hours to days before a seizure.

• Postictal phase: period after the seizure; person feels fatigued and has no memory recall.

Alzheimer Disease:

neuritic plaques + Amyloid plaques + neurofibrillary tangles; can only see after u die

• most are dementia; >65 & 2x/5 years; gradual

• cortical atrophy & neural loss (parietal + temporal)

• v ACH → cholinergic deficit

• s/s: impaired short-term memory; retrieve distant memories better

  • Sundown syndrome: later stages; worse during the evening

  • Death from pneumonia & Pulmonary embolism

• d/x: 10 warning signs

• t/x: ACH precursors (little benefit); AChE inhibitors