final patho

NUR2063 Essentials of Pathophysiology Final Review: Modules 1-6

Module 2: Fluids and Electrolytes

Movement of Water

• Diffusion

  • Definition: Movement of solutes from an area of higher concentration to an area of lower concentration.

• Osmosis

  • Definition: Movement of water from an area of lower concentration of solutes to an area of higher concentration of solutes.

• Active Transport

  • Definition: Movement of particles across the semi-permeable membrane that requires energy (ATP).

The Sodium-Potassium Pump

• Definition: A cellular mechanism that regulates the concentrations of sodium (Na+) and potassium (K+) ions across the cell membrane.

  • Function:

  • Push Na+ out of the cells.

  • Pull K+ into the cells.

• Energy Requirement: Requires ATP to function.

Fluid Imbalances

• Hypervolemia

  • Respiratory Symptoms: Shortness of breath (SOB), dyspnea, tachypnea, crackles.

  • Cardiovascular Symptoms: Tachycardia, hypertension, jugular vein distention (JVD), bounding pulses.

  • Neurological Symptoms: Headache (HA), confusion.

  • Extremities: Edema.

  • Other: Weight gain.

• Hypovolemia

  • Cardiovascular Symptoms: Tachycardia, hypotension, flat neck veins.

  • Neurological Symptoms: Altered level of consciousness (LOC), confusion.

  • Genitourinary Symptoms: Oliguria.

  • Skin: Decreased skin turgor, delayed capillary refill (>3 seconds), dry mucous membranes.

  • Other: Thirst, weight loss.

• Causes: Excessive fluid or blood loss, dehydration, excessive fluid accumulation, fluid overload.

Electrolyte Disorders

• Hypernatremia

  • Neurological Symptoms: Headache, agitation, confusion, restlessness, lethargy, seizures, altered LOC, coma.

  • Cardiovascular Symptoms: Hypotension, tachycardia.

  • Skin: Dry skin.

  • Other: Extreme thirst, dry tongue, dry mucous membranes.

• Hyponatremia

  • Neurological Symptoms: Similar to hypernatremia.

  • Cardiovascular Symptoms: Hypotension, tachycardia.

  • Musculoskeletal Symptoms: Muscle cramps, twitching, weakness.

  • Gastrointestinal Symptoms: Nausea and vomiting (N/V).

  • Genitourinary Symptoms: Oliguria and anuria.

Module 3: Immunity and Inflammation

Active Immunity vs. Passive Immunity

• Active Immunity

  • Natural: Immunity developed after infection.

  • Artificial: Immunity developed after vaccination.

• Passive Immunity

  • Natural: Maternal antibodies transferred to the fetus.

  • Artificial: Monoclonal antibodies administered for protection.

Hypersensitivity Reactions

• Type I Reaction

  • IgE-mediated, characterized by allergic reactions and anaphylaxis, leading to local inflammation.

• Type II Reaction

  • IgG or IgM-mediated, where antibodies mistakenly attack antigens on its own cells, for example, drug or blood transfusion reactions.

• Type III Reaction

  • IgG or IgM-mediated immune complex reaction, with circulating antigen-antibody complexes depositing in tissues, causing inflammation and damage.

• Type IV Reaction

  • T cell-mediated, leading to inflammatory responses and cell lysis.

Rheumatoid Arthritis

• Definition: Chronic, progressive inflammation of synovial tissue.

• Pathophysiology: Pannus formation over inflamed synovium leading to fibrosis.

• Results:

  • Cartilage destruction.

  • Bone erosion.

  • Deformed joints.

• Etiology: Autoimmune.

• Risk Factors: Hereditary; more common in women aged 20-40.

• Clinical Manifestations:

  • Stiffness worse in the morning or after inactivity.

  • Joint swelling, redness, warmth.

  • Pain at rest and with movement.

  • Joint effusion.

  • Systemic symptoms: fever, weight loss.

  • Specific hand deformities: swan neck and boutonniere deformity.

Module 4: GI Disorders

Gastritis

• Definition: Inflammation of the gastric mucosa; can be acute or chronic.

• Etiology:

  • Chemical irritants: Smoking, alcohol (ETOH), NSAIDs, caffeine, stress.

  • Infection: Helicobacter pylori (H. pylori) leading to Peptic Ulcer Disease (PUD).

• Clinical Manifestations:

  • Anorexia, nausea/vomiting (N/V), abdominal pain.

  • Symptoms include dyspepsia, hematemesis, melena.

Module 5: GU & Reproductive Disorders

Endometriosis

• Pathophysiology: Endometrial tissue located outside of the uterus.

• Etiology: Unknown.

• Clinical Manifestations:

  • Dysmenorrhea (painful menstruation).

  • Dyspareunia (painful intercourse).

  • Irregular menses.

  • Infertility.

Menopause

• Pathophysiology: Complete cessation of ovarian activity; ovaries no longer produce estrogen and progesterone.

• Etiology: Natural aging process.

• Clinical Manifestations:

  • Hot flashes.

  • Night sweats.

  • Mood changes.

  • Insomnia, irritability.

  • Vaginal atrophy, reduced vaginal secretions.

  • Dyspareunia.

Pelvic Inflammatory Disease (PID)

• Pathophysiology: Infection of female reproductive organs such as cervix, uterus, fallopian tubes, and ovaries.

• Etiology: Resulting from sexually transmitted infections (STI) such as Chlamydia trachomatis and Neisseria gonorrhoeae.

• Clinical Manifestations: Can be asymptomatic in early stages; symptoms include lower abdominal pain, cervical/vaginal discharge, cervical motion tenderness.

Polycystic Ovarian Syndrome (PCOS)

• Pathophysiology: Characterized by high levels of luteinizing hormone (LH) from the pituitary gland leading to excess androgen production by the ovaries and anovulation; follicles develop but do not mature, becoming cysts.

• Etiology: Unknown; believed to have genetic factors.

• Clinical Manifestations: A leading cause of infertility with symptoms such as amenorrhea (absence of menstruation), irregular menstrual cycles, hirsutism (excessive hair growth), obesity, acne, acanthosis nigricans.

Cryptorchidism

• Pathophysiology: Failure of the testes to descend into the scrotum.

• Etiology: Unknown, may involve genetic or prenatal factors.

• Clinical Presentation: Typically asymptomatic and detected at birth; part of newborn examination.

Benign Prostatic Hyperplasia (BPH)

• Pathophysiology: Non-malignant growth of prostate tissue leading to enlargement of the prostate gland.

• Etiology: Unknown, potential hormonal influences and aging process.

• Clinical Manifestations:

  • Urinary frequency and urgency.

  • Dribbling and hesitancy (difficulty starting urination).

  • Urinary retention.

Erectile Dysfunction

• Pathophysiology: Defined as the inability to achieve or maintain an erection suitable for satisfactory sexual performance.

• Etiology: Often due to vascular problems, specifically narrowed blood vessels that restrict blood flow.

• Risk Factors: Include BPH (especially after surgery), coronary heart disease (CHD), diabetes mellitus (DM), hypertension (HTN), and certain medications (e.g., beta-blockers).

Testicular Cancer

• Pathophysiology: Malignant growth of testicular tissue.

• Etiology: Unknown.

• Risk Factor: History of cryptorchidism.

• Clinical Manifestations: Usually presents as a firm, painless testicular mass; may result in slight enlargement of the testicle or overall scrotal enlargement.

Urinary Incontinence

• Definition: Involuntary urine leakage occurs when pressure is exerted on the abdomen or bladder, such as during coughing, sneezing, laughing, or exercising.

  • Types of Urinary Incontinence:

  • Stress Incontinence: Occurs with physical activities that increase abdominal pressure.

  • Urge Incontinence: Characterized by a sudden, intense urge to urinate followed by involuntary loss of urine.

  • Functional Incontinence: Involuntary urination in a person with normal bladder and sphincter control, usually due to physical impairment preventing timely access to the bathroom.

  • Overflow Incontinence: Leakage occurs from an overfilled bladder; urine volume exceeds bladder capacity.

Module 6: Endocrine Disorders

Overview of the Endocrine System

SIADH (Syndrome of Inappropriate Antidiuretic Hormone)

• Pathophysiology: Condition of excessive antidiuretic hormone (ADH) leading to water retention.

• Clinical Manifestations:

  • Hypervolemia.

  • Hyponatremia (low sodium levels).

  • Cardiovascular: Changes in heart rate, blood pressure, jugular vein distension.

  • Neurological: Headache, irritability, confusion, seizures, coma.

  • Genitourinary: Decreased urine output (u/o) and increased urine specific gravity.

Diabetes Insipidus

• Pathophysiology: Condition of insufficient ADH, resulting in the inability to concentrate or retain water.

• Clinical Manifestations:

  • Hypovolemia.

  • Hypernatremia (high sodium levels).

  • Cardiovascular: Tachycardia, hypotension.

  • Genitourinary: Polyuria (dilute urine) and decreased urine specific gravity.

  • Symptoms of dehydration include sunken eyes, dry mucous membranes, decreased skin turgor, delayed capillary refill.

  • Other: Polydipsia (excessive thirst).

Cushing’s Syndrome

• Pathophysiology: Condition of excess cortisol hormone, typically from an overproduction of adrenocorticotropic hormone (ACTH) by the pituitary gland or prolonged use of steroids.

• Clinical Manifestations:

  • Symptoms include moon facies, buffalo hump, truncal obesity.

  • Skin changes: striae (purple stretch marks), thin and fragile skin.

  • Other symptoms: edema, osteoporosis, mood changes, increased susceptibility to infections, hyperglycemia.

Addison’s Disease

• Pathophysiology: Condition of insufficient cortisol hormone due to autoimmune adrenal gland insufficiency.

• Clinical Manifestations:

  • Cardiovascular: Tachycardia, hypotension.

  • Skin: Hyperpigmentation leading to bronze skin.

  • Gastrointestinal: Anorexia, N/V/D (nausea, vomiting, diarrhea), dry mucous membranes.

  • Hair: Sparse axillary and pubic hair.

  • Symptoms of general weakness, fatigue, weight loss, hypoglycemia, hyponatremia, hyperkalemia.

Hyperthyroidism

• Pathophysiology: Condition of excess thyroid hormones (T3 and T4) often due to autoimmune conditions such as Graves disease.

• Complications: Thyroid storm.

• Clinical Manifestations:

  • Cardiovascular: Tachycardia and palpitations.

  • Neurological: Insomnia, nervousness, tremors.

  • Metabolic: Increased appetite, weight loss, diarrhea, heat intolerance.

  • Physical: Moist skin, exophthalmos (bulging eyes), goiter.

Hypothyroidism

• Pathophysiology: Condition characterized by insufficient levels of T3 and T4, often due to autoimmune Hashimoto's thyroiditis.

• Complications: Myxedema coma.

• Clinical Manifestations:

  • Cardiovascular: Bradycardia and hypotension.

  • Symptoms include lethargy, weakness, fatigue, weight gain (with decreased appetite), constipation, cold intolerance, dry skin, and goiter.

Diabetes Mellitus

• Type 1 Diabetes

  • Definition: Complete absence of insulin production, typically autoimmune in nature.

  • Clinical Manifestations:

  • Symptoms include polydipsia (extreme thirst), polyuria (frequent urination), and polyphagia (increased hunger).

  • Complication: Diabetic ketoacidosis (DKA) resulting in metabolic acidosis and ketonuria.

• Type 2 Diabetes

  • Definition: Condition characterized by insufficient insulin production or insulin resistance.

  • Clinical Manifestations:

  • Symptoms include similar to Type 1: polydipsia, polyuria, polyphagia.

  • Complication: Hyperglycemic hyperosmolar syndrome (HHS).

  • Remark: The A1C test is used to monitor diabetes, reflecting the patient’s average blood glucose levels over the past 3 months.

References

• Nath, J., Braun, C., & Anderson, C. (2023). Applied pathophysiology: A conceptual approach (4th ed.). Wolters Kluwer.