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AdvancedPathophysiologyExam238pages

Advanced Pathophysiology Overview

  • Key topics covered include: Endocrine System, Hematology, Cancer, Immunity & Infection, Cardiovascular, Lymphatic Reviews

Endocrine System

Hormonal Regulations

  • Endocrine glands produce and secrete hormones into surrounding fluid.

Types of Hormones

  • Peptide Hormones

    • Water soluble, protein-structured hormones.

    • Synthesized as prohormones and stored in granules until release.

    • Example: Proinsulin - produced daily but only partially utilized.

  • Amine Hormones

    • Derived from amino acid tyrosine.

    • Includes thyroid hormones T3 and T4.

  • Steroid Hormones

    • Fat soluble, derived from cholesterol.

    • Released immediately as produced, not stored.

Alterations of Anterior Pituitary

  • Pituitary Adenomas

    • Slow-growing tumors in the pituitary gland.

    • Can be benign or invasive, most are benign.

  • Prolactinoma

    • Common pituitary tumor that secretes prolactin.

    • Symptoms include amenorrhea, infertility, and increased hair growth in women; erectile dysfunction in men.

Alterations of Posterior Pituitary

Diabetes Insipidus

  • Caused by insufficient antidiuretic hormone (ADH).

    • Symptoms include inability to concentrate urine, high serum osmolarity, and low urine osmolarity.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

  • Excess ADH leading to water retention.

    • Results in hyponatremia, hypervolemia, and weight gain (not edema).

Pancreas and Diabetes

  • Diabetes: Dysfunction of the pancreas impacting hormone insulin, which regulates fuel storage.

    • Fuel Sources:

      1. Carbohydrates (glucose) for nerve/RBC function.

      2. Fats (triglycerides) for energy needs.

      3. Proteins (amino acids) for protein synthesis.

Comparisons of Diabetes Type 1 and Type 2

  • Type 1

    • Genetic predisposition and environmental triggers.

    • Autoantibodies attack beta cells.

    • Complications include Diabetic Ketoacidosis (DKA).

  • Type 2

    • Most commonly caused by obesity;

    • Insulin resistance and reduced secretion.

    • Complications include Hyperosmolar Hyperglycemic Nonketotic State.

Insulin Resistance and Diabetes Management

  • Obesity alters cellular shapes, obstructing insulin receptors.

  • Initial insulin increase leads to downregulation of receptors, culminating in decreased beta cell function.

Factors Affecting Insulin Dosing

  • Somogyi Effect: Hypoglycemia followed by rebound hyperglycemia; management through nighttime insulin adjustments.

  • Dawn Phenomenon: Elevated morning glucose due to nocturnal hormone rise.

Thyroid Gland

  • Controls metabolism; produces/stores thyroid hormones (T3 & T4).

  • Negative Feedback System: Regulates hormone levels based on thyroid hormone concentrations in blood.

Thyroid Disorders

  • Hypothyroidism

    • Commonly caused by Hashimoto's (autoimmune).

    • Elevated TSH, low T3 and T4 levels.

  • Hyperthyroidism

    • Caused by Graves' disease (autoimmune), leads to increased T3 and T4 levels and low TSH.

Parathyroid Gland

  • Regulates calcium levels using PTH and vitamin D.

  • Hyperparathyroidism: Excess calcium and PTH.

  • Hypoparathyroidism: Low calcium and PTH.

Adrenal Gland

  • Zone Functions:

    • Glomerulosa: aldosterone production.

    • Fasciculate: cortisone production.

    • Reticularis: sex hormone production.

Adrenal Disorders

  • Hyperaldosteronism: High blood pressure and potassium deficiency.

  • Hypoaldosteronism: High potassium levels without other causes.

Cushing's Syndrome vs. Disease

  • Cushing's Syndrome: Excess cortisol regardless of cause.

  • Cushing's Disease: Overproduction of ACTH by pituitary adenoma.

Addison's Disease

  • Adrenal insufficiency; low aldosterone and cortisol levels leading to fatigue, weight loss, low blood pressure, etc.

Hematology Overview

Hematopoiesis

  • Formation of cellular elements; Erythropoietin from kidneys stimulates RBC production.

    • Requires Vitamin B12, Folate, and Iron for synthesis and maintenance.

    • Lifespan of RBCs ~120 days.

Clotting Cascade

  • Primary Response: Platelet activation stops bleeding.

  • Secondary Response: Formation of fibrin clot.

Anemia Types

  • Relative Anemia: Normal counts but poor oxygen delivery.

  • Microcytic Hypochromic Anemia: Often due to iron deficiency.

  • Macrocytic Anemia: Caused by B12 or folate deficiencies.

  • Aplastic Anemia: All cell lines affected due to marrow suppression.

Leukemias

  • Malignant blood disorders characterized by uncontrolled leukocyte proliferation; classified by origin and progression rate.

  • Common types: Acute Lymphocytic Leukemia (ALL) in children, Acute Myelogenous Leukemia (AML) in adults.

Cancer Overview

Cancer Symptoms

  • Common symptoms include fatigue, pain, cachexia, and changes in blood counts.

Tumor Markers

  • Utilize various markers for diagnosis and monitoring (e.g., PSA for prostate cancer).

HIV and AIDS

  • HIV is a retrovirus causing decrease in CD4 T cells.

  • Diagnosis of AIDS when CD4 lowers below 200.

Stress Response

  • Cortisol as a stress hormone; chronic elevation leads to systemic inflammation.

Cardiovascular System Review

  • Functions of heart circulation; distinctions between right and left heart operations.

Myocardial Infarction

  • STEMI vs. NSTEMI; healing phases after an MI include collagen matrix deposition.

Valvular Disease and Heart Failure

  • Various conditions affect heart valve functionality and cardiac output leading to heart failure symptoms.

Hypertrophic Cardiomyopathy

  • Common inherited heart defect; sudden death risk in athletes.

Peripheral Vascular Disease

  • Related to chronic lymphedema management and complications from conditions such as hyperlipidemia.