Patho Final
Focus on patho patho
Ex: low dopamine high Ach
Broad terms
Intro to Patho
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Homeostasis
o Maintaining a stable internal environment regardless of external factors
 Maintained = good health
 Not maintained = possibility for disease
Health
o Holistic
 Physical
 Mental
 Social well-being
Disease
o Deviation from homeostasis
Health Indicators
o Normal ranges occur within a set a values
 Can differ from use of different technology
o Can change because:
 Age
 RR, HR, BP, Temp. can differ because of what age group the
patient is in
 Gender
 Hormones and body composition
o H&H differ from men and women
 Genetics
 Genetically linked diseases or predisposing factors
o Heart disease, Cystic fibrosis
 Environment
 Construction
o Asbestos
 Inner city
o Ingesting high levels of CO2
 Farmlands
o Hay-fever
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o Less CO2
 Activity Level
 Active
o Lower BP and HR, healthier over all
 Sedentary
o More likely to have high BP and be overweight. More
unhealthy
7 steps to health
o Be a nonsmoker and avoid second-hand smoke
o Healthy diet
 Eat 5 to 10 servings of veggies and fruits a day.
 Choose high-fiber and lower fat foods
 Fats to avoid:
o Saturated
 Raises both HDL and LDL
o Trans
 Raises LDL
 Lowers HDL
 Limit alcohol
o Physical activity on a regular basis
o Protection from the sun
 Sunscreen should be a minimum of SPF 15
 SPF 30 recommended
 Anything above 50? is the same thing
o Follow cancer screening guidelines
 Do monthly BSE and TSE
o Doctor or dentist visit if any changes in the normal state of health
o Follow health and safety guidelines at home and at work when using, storing,
and disposing of hazardous materials
Concept and scope of Patho
o Changes caused by disease
 Deviated from the normal anatomy and physiology
 Signs and symptoms indicate the disease
Prevention of disease
o Primary focus of health care
o Get vaxxx
o Participate in screenings
o Routine doctor visits
Stages of Research process
o Stage 1
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 “Basic science”
 Identify the technology being used
 Work done in a lab
 Could require animal or cell/tissue cultures
o Stage 2
 Small number or human subjects
o Stage 3
 Clinical trials
 Large number or participants with disease or risk to it
 “Double blind studies”
Medical History
o Current or prior illness
o Allergies
o Hospitalizations
o Treatments
o Specific difficulties
o Any type of therapy or drugs
 Prescription
 Nonprescription
 Herbal items
 Including food supplements
New Development
o Constantly updating information
o Improving testing
o Developing better drugs
o Extensive research
New Challenges
o Zika
 Discovered 1947
 Tropical Africa
 South East Asia
 Pacific Islands
 2015
 Cases arise in Brazil
 Now
 CDC identified it as an international threat
 Increase research
Basic Terminology
o Gross Level
 Organ or system level
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o Microscopic level
 Cellular level
o Biopsy
 Excision of small amount of living tissue
o Autopsy
 Examination of the body or organs after Death
o Disease Process
 Diagnosis
 Identification of a basic disease
o Evaluation of signs and symptoms
 Etiology
 Causative factors in a particular disease
o Congenital defects
o Inherited or genetic disorders
o Microorganisms
o Immunological dysfunctions
o Degenerative changes
o Malignancy
o Metabolic, nutritional changes
o Trauma, burns, and environmental factors
Causes of disease
o Idiopathic
 Unknown cause
o Iatrogenic
 Error/treatment/procedure may have caused it
o Predisposing factors
 Age
 Gender
 Inherited
 Factors
 Environment
 Ect.
o Prophylaxis
 Preserve health; prevent spread of disease
o Prevention
 Vaxxx
 Dietary/lifestyle modifications
 Prevention of potentially harmful activities
Characteristics of Disease
o Pathogenesis
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 Development of the disease
Onset of disease
 Sudden/Acute
 Insidious/Gradual : vague mild symptoms
Acute Disease
 Short
 Happens quickly
 High fever
 Severe pain
Chronic
 Gradual
 Milder symptoms
 Acute episodes may happen
Subclinical state
 Pathological changes
 No obvious manifestations
Latent state
 No symptoms/clinical signs
 In infectious disease, it is dormant
Prodromal period
 Early development of the disease
 Signs are nonspecific or absent
Manifestations
 Clinical evidence with signs and symptoms
 Local
o At the site of problem
 Systemic
o General indicators of illness
 Fever
Signs
 Objective indicators of a disease
 HR, RR
Symptoms
 Subjective indicators of a disease
 Pain level
Lesions
 Specific local change in the tissue
Syndrome
 A cluster of signs and symptoms not linked to disease
Diagnostic tests
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 Various laboratory tests
 Appropriate to manifestations and medical history
o Remissions and exacerbations
 Mark the course or progress of a disease
 Remission
o Period which manifestations subsides
 Exacerbation
o Worsening of severity
o Precipitating factor
 Condition that triggers an acute episode
o Complications
 New secondary of additional problems
o Therapy
 Measures to promote recovery/slow process
o Sequelae
 Potential unwanted outcomes
o Convalescence or rehabilitation
 Period of recovery and return to healthy state
Disease prognosis
o Morbidity
 Disease rates within a group
o Mortality
 Deaths caused by a disease
o Epidemiology
 Tracking the pattern or occurrence of disease
 WHO and CDC
 Major date collection centers
o Occurrence of disease
 Incidence
 Number of new cases in a given population at a given time
 Prevalence
 Number of new, old, or existing cases within a given population
and time
 Epidemics
 High number of unexpected cases of a disease in an area
 Pandemics
 High number of unexpected cases of a disease around the world
o Communicable diseases
 Infectious disease that can spread from person to person
o Notifiable or reportable diseases
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 Must be reported by the physician to designated authorities
 Authority varies with local jurisdiction
 Required diseases to be reported may change over time
 Reporting is intended to prevent further spread of the disease
Cellular Adaptations
o Atrophy
 Decrease in size of cell
 Results in reduced tissue mass
o Hypertrophy
 Increase in cell size
 Results in enlarged tissue mass
o Hyperplasia
 Increased number of cells
 Results in enlarged tissue mass
o Metaplasia
 Mature cell type is replaced by a different mature cell type
 Cancer metastasized
o Dysplasia
 Cells vary in size and shape within a tissue
Cell damage
o Anaplasia
 Undifferentiated cells, with variable nuclear and cell structure
o Neoplasia
 “new growth”
 Tumor
o Apoptosis
 Programed cell Death
o Ischemia
 Deficit of O2 to the cells
o Hypoxia
 Reduced O2 in tissues
 Nutritional deficits
o Pyroptosis
 Cells lysis because of nearby inflammation
o Physical damage
 Excessive heat or cold
 Radiation exposure
o Mechanical damage
 Pressure or tearing of tissue
o Chemical Toxins
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Exogenous
 From environmental factors
 Endogenous
 From inside the body factors
o Microorganisms
 Bacteria, virus, fungal
o Abnormal metabolites
 Genetic disorders
 Inborn errors of metabolism
 Altered metabolism
o Imbalance of fluids or electrolytes
Necrosis
o Dying cells cause further cell damage due to cellular disintegration
o Liquefaction necrosis
 Dead cells liquefy because of release of cell enzymes
o Coagulative necrosis
 Cell proteins are altered or denatured
o Fat necrosis
 Fatty tissue broken down into fatty acids
o Caseous Necrosis
 Form of coagulation necrosis
 Thick, yellowish, “cheesy” substance
o Infarction
 Area of dead cells because of O2 deprivation
o Gangrene
 Area of necrotic tissue that has been invaded by bacteria
Pain
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Causes of Pain
o Inflammation
o Infection
o Ischemia and tissue necrosis
o Stretching of tissue
o Stretching of tendons, ligaments, joints capsule
o Chemicals
o Burns
o Muscle spams
Somatic Pain
o From skin
o Bone muscle
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o Conducted by sensory fibers
Visceral Pain
o Originates in organs
o Conducted by sympathetic fibers
o May be acute or chronic
Pain Pathways
o Nociceptors
 Stimulated by:
 Temperatures
 Chemicals
 Physical means
Pain threshold
o Levels of stimulation required to elicit a pain response
o Does not usually vary among individuals
Pain fibers
o Afferent fibers
o Myelinated A delta fibers
 Transmit impulses very rapidly
 Acute pain
 Sudden
 Sharp
 Localized
o Unmyelinated C fibers
 Transmit impulses slowly
 Chronic pain
 Diffuse
 Dull
 Burning
 Aching sensation
Pain pathways
o Dermatome
 Area of skin affected by spinal cord
o Reflex response
 Inventory muscle contraction away from pain source/ To guard against
movement
o Spinothalamic bundles in spinal cord
 Neospinothalamic tract
 Fast impulses; acute pain
 Paleospinothalamic tract
 Slow impulses; chronic, dull pain
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 Spinothalamic tracts connect with reticular formation of brain
o Hypothalamus and limbic system
 Emotional factors
o Gate control theory
 Control systems
 What transmits message to spinal cord and brain
 Gates open
 Pain impulses transmitted from periphery to brain
 Gates closed
 Reduces or modifies the passage of pain impulses
Pain Control
o Put on ice
o Transcutaneous electrical nerve stimulation
 Increases sensory stimulation at site, blocking pain transmission
o Opiate-like chemicals
 Secreted by interneurons
 Blocks conduction of pain impulses
 Resemble morphine
 Enkephalins
 Dynorphins
 Beta-lipoproteins
S/S and diagnosis
o Location
o Descriptive terms
 Aching
 Burning
 Sharp
 Throbbing
 Widespread
 Cramping
 Constant
 Periodic
 Unbearable
 Moderate
o Timing
 Association with an activity
 Angina?
o Physical evidence
 Pallor and sweating
 High BP, tachycardia
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o Nausea and vomiting
o Fainting and dizziness
o Anxiety and fear
 Mainly with chest pain, impending doom
o Clench fists or rigid faces
o Restlessness or constant motion
o Guarding area to prevent stimulation of receptors
Youths & pain
o Infants respond physiologically
 Tachycardia
 Increased BP
 Facial expressions
o Great variations in different development stages
 Coping mechanisms
 Range of behavior
 Difficulty describing pain
 Withdrawal and lack of communication in older children
Referred Pain
o Source is difficult to determine
o Different spot than actual issue
Phantom Pain
o Pain that is not actually there
o Follows amputation
 Pain
 Itching
 Tingling
o Does not respond to common pain therapies
Pain Perception
o Pain tolerance
 Degree of pain, intensity, or duration
 May be increased by endorphin
 Stress or fatigue can reduce
 Varies
o Pain perception
 Subjective
o Response to pain
 Influenced by personality, emotions, and cultural norms
Acute
o Tissue damage
o Initiates physiological stress response
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 Increase BP and HR and RR and skeletal muscle tension
 Cool
 Pale
 Moist skin
o Vomiting
Chronic
o More generalized
o Feeling depressed, irritable, and fatigued
o Sleep disturbances
o Appetite affected
 Gain or lose weight
o Affects daily activities
Headache
o Congested sinuses, nasal congestion, eye strain
o Muscle spasms and tension
o Temporal area
 TMJ syndrome
o Migraine
 Abnormal blood flow and metabolism in the brain
o Intracranial headache
 Increased pressure
o Cancer-related pain
Methods for managing pain
o Remove cause
o Take Analgesics
 Orally
 Parenterally (injections)
 Transdermal patch
o Sedatives and antianxiety drugs
 Adjunct to analgesic therapy
 R&R
o Chronic and increasing pain
 With cancer
 Stepwise fashion
 Tolerance develops
o Severe pain
 Patients administer meds
 PCA, “Patient controlled analgesia”
o Intractable pain
 Cannot be controlled with meds
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Surgical intervention
 Rhizotomy
 Cordotomy
 Injections
Anesthesia
o Local
 Applied to skin or mucous membrane
o Spinal or regional
 Blocks pain from legs or abdomen
o General
 Causes loss of consciousness
o Neuroleptanesthesia
 Patients can respond to commands
 Unaware of procedure, no discomfort
Neoplasms and Cancer
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Differentiation
o Each cell type differentiates and carries out functions
Neoplasms
o Deprives other cells of nutrition
o Consist of atypical or immature cells
Nomenclature
o Benign tumors have tissue name plus the suffix -oma
o Malignant tumors have -carcinoma
o Tumors of connective tissue have sarcomas
 Often malignant
o Several malignant tumors
 Hodgkin’s
 Wilms
 Leukemia
Benign vs Malignant
o Benign
 Usually differentiated cells that reproduce at a higher rate than normal
 Encapsulated
 Tissue damage
o Malignant
 Undifferentiated, nonfunctional cells
 Rapid reproduction
 Infiltrate or spreads
Malignant tumors: Cancer
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Lack control of mitosis and no apoptosis
No normal organization or differentiation
No contact inhibition
Altered surface antigens
Don’t adhere to each other
 Often break loose from mass
 Invade other tissues
o Mass compresses blood vessels
 Leads to necrosis and inflammation
o Secrete enzymes or hormones
 Break down proteins and cells
 Systemic effects
o Inflammation and loss of normal cells
 Lead to progressive reduction in organ integrity and function
o Angiogenesis
 Some tumor cells secrete growth factors
o Local effects
 Pain
 Obstruction
 Tissue necrosis and ulceration
o Systemic effects
 Weight loss and cachexia
 Anorexia, fatigue, pain, and stress
 Anemia
 Caused by blood loss
 Severe fatigue
 Effusions
 Inflammation causes fluid buildup
 Infections
 Bleeding
 Tumor erodes blood vessels
 Paraneoplastic syndrome
 Associated with different types of tumors
Diagnostic
o Routine screening
o Self-examination
o Blood tests
o Radiographic, ultrasound, MRI, CT
o Methods of visualizing change
o Cytological tests require biopsy or cell sample
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o Genomic Tumor Assessment identifies genetic mutations that are independent
of heredity but occur with the disease itself
Spread of malignant tumors
o Invasion
o Metastasis
Staging cancer
o Essential to standardize comparative studies of treatments and outcomes
o Used to estimate the prognosis
o Uses the TNM system
 Size of the tumor (T)
 Involvement of lymph nodes (N)
 Spread (metastasis) of tumor (M)
Carcinogenesis
o Process whereby normal cells are transformed into cancer cells
o Process varies
o Cancer thought to be multifactorial
 Environment
 Change in gene expression
 Infection
 i.e. cervical and hepatic cancer
o Some cancers have well-established risk factors
Stages in carcinogenesis
o Initiating factors
o Exposure to promoters
 Hormones and environmental factors
 Changes in DNA
 Less differentiation and increased rate of mitosis and/or lack of apoptosis
 Dysplasia or anaplasia may be evident
 Process leads to tumor development
Risk factors
o Genetic
o Viruses
o Radiation
o Chemicals
 Organic solvents
 Asbestos
 Heavy metals
 Formaldehyde
 Chemotherapy
o Biological
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 Chronic irritation and inflammation
 Age
 Diet
 Hormones
Risk Reduction
o Limit UV exposure from sun or tanning booths
o Regular medical and dental examinations
o Self-examination
o Diet
 Increase fiber
 Reduce fats
 Eat 5 to 10 servings of veggies and fruits a day.
 Choose high-fiber and lower fat foods
 Fats to avoid:
o Saturated
 Raises both HDL and LDL
o Trans
 Raises LDL
 Lowers HDL
Immunity and Cancer Risks
o Cell-mediated immunity recognizes some tumor cells and destroys them
o Immunization for cervical cancer and hepatitis is recommended to reduce risk
from infection
Treatment
o Depends
o Surgery
 Removal
 Radiofrequency ablation
 Not for lungs, for small tumors
o Radiation Therapy
 Cobalt machine
 Short periods of time
 Many treatments
 Most effective in fast acting cancers
 Some are radioresistant
 Internal insertion of radioactive material
 Instill radioisotope in solution into body cavity
o Adverse effects of radiation
 Bone marrow depression
 Decreased leukocytes
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 Decreased erythrocytes
 Decreased platelets
 Epithelial cell damage
 Hair loos
 Infertility
 Nonspecific fatigue and lethargy
 Can lead to mental depression
o Chemotherapy
 Antineoplastic drugs
 Can be alone or combined with another form of treatment
 Combination of two drugs
 Antimitotic
 Antimetabolites
 Alkylating agents
 Antibiotics
o Adverse effects of chemo
 Bone marrow depression
 Nadir is point of lowest cell count
 Nausea
 Epithelial cell damage
 Damage to specific areas
 Fibrosis in lungs
o Other drugs
 Blocking agents
 Blocks growth
 Biological response modifiers
 Natural immune response
 Angiogenesis inhibitors
 Inhibit growth of blood vessels
 Analgesics
 Relieves pain
Gene therapy
o Replace mutated genes with healthy copy of gene
Nutrition
o Contributing factors
 Change in taste sensation
 Anorexia
 Vomiting or diarrhea from treatment
 Sore mouth or loss of teeth
 Pain and fatigue
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 Malabsorption
Complementary therapies
o Massage
o Meditation
o Counseling
o Exercise
o Therapeutic touch
o Research based evidence has not been published for
 Raw food macrobiotic diet
 Use of insulin and glucose with chemo
Prognosis
o Cancer-free state generally 5 years survival without recurrence
o Some cancer such as childhood leukemias can be considered cured after 10 year
cancer free period
o Remission is no clinical signs of cancer
 May have several remission periods
Examples of malignant tumors
o Skin Cancer
 Visible
 Good prognosis
 Not malignant melanoma
o Ovarian cancer
 Hidden
 High mortality rates
o Brain tumor
 Both forms, benign and malignant, are life threatening
Cancer incidence
o Most common in men
 Prostate
 Lung
 Colorectal
o Most common in women
 Breast
 Lung
 Colorectal
Stress and Associated Problems
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Stress response
o General or systemic response to change
 Internal or external
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o Homeostasis
o Stressor
 Factor that creates significant change in body function
o Severe or prolonged stress can cause dysfunction
 Increased wear and tear on tissue
 Exhaustion of resources
 Exacerbation of chronic conditions
General Adaptation Syndrome (GAS)
o Alarm stage
 Mobilization of defenses
 Hypothalamus
 SNS
 Adrenal Glands
o Resistance stage
 Elevation of hormone levels
o Final stage
 Resolution or Death
Effects of stress
o High BP and HR
o Bronchodilation and increase RR
o Increased blood glucose levels
o Arousal of the CNS
o Decreased inflammatory and immune responses
Significant problems
o Headache
o Stomatitis and necrotizing periodontal disease
 Ulcers in mouth
o Prolonged vasoconstriction
 RT GI and kidneys
o Precipitating factors
 Chronic infections
 Physical and/or emotional distress
Prolonged Stress
o Renal failure
 Prolonged severe vasoconstriction
 Ischemia
o Stress ulcers
 Vasoconstriction and glucocorticoids
o Infection
o Slow healing
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Increased secretion of glucocorticoids
 Reduce protein synthesis and tissue regeneration
 Increased catecholamine
o Vasoconstriction, reduce nutrients and O2 to tissue
o PTSD
 High risk for depending on drugs and alcohol
Coping with stress
o Good rest and diet
o Creative solutions to minimize stressors
o Exercise
o Distracting activities
o Counseling
o Relaxation
Environmental Hazards and Associated Problems
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Damage becomes apparent as aging reduces physiological reserves of tissues
o Increases in childhood cancers and hypersensitivity
o Hypersensitivity to new chemical substances have increased
 Chemical in food processing
 Synthetic materials in buildings and furnishings
 Cosmetics and toiletries
 Microbes in water and food supply
Safety procedures
o OSHA
 Occupational Safety and Health Administration and similar agencies
establish protocols for:
 Safety procedures in workplace
 Safety procedures in the environment
 Infection control
 Protective equipment
 Exposure to harmful substances and hazardous material
Chemical
o Heavy metals
 Lead and Mercury
 Can accumulate in tissues after prolonged exposure
 Lead
 Can be ingested or inhaled
 Heavily used in industry
 Found in lead pipes and batteries
 Lead paint in toys
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 Common childhood poison
o Acids/Bases
o Inhalants
o Asbestos
o Pesticides
Toxic Effects of lead
o Hemolytic anemia
 Sickle Cell
 Thalassemia
o Inflammation and ulceration of digestive tract
o Inflammation of the kidney tubules
o Damage to the nervous system
 Neuritis
 Encephalopathy
 Seizures or convulsions
 Delayed development and intellectual impairment
 Irreversible brain damage
Acids/Bases
o Both can cause corrosive damage
 Burns
o Can be found in many household products
o Treatment depends on the chemical
Inhalants
o Particulates
 Asbestos
 Silica
o Pesticides
 Illness depends on type of pesticide, amount and duration of exposure
o Gases
 Sulfur dioxide
 Ozone
o Solvents
 Benzene
 Acetone
o Sources of toxic inhalants
 Factories, laboratories, mines, artists’ workshops
 Insecticides, aerosols
 Paints, glues
 Furniture, floor coverings
 Poorly maintained heating systems
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Smog
 Hydrogen Sulfide
 Particles from dust and smoke
 Carbon monoxide
Asbestos, iron oxide, silica
 Inhaled particles
 Lung damage in mine workers and other industries.
o Families can be affected by second hand exposure
Cigarette smoking
 Lung disease, including cancer
 Bladder cancer
 Cardiovascular disease
 Predisposition to number of other diseases
Pesticides
o May cause acute or chronic health problems
 Depends on type and dose
o Signs of exposure
 Diarrhea
 Nausea, vomiting
 Pinpoint pupils
 Rashes
 Headaches
 Irritation of eye, skin, or throat
Physical agents
o Temperature Hazards
 Hyperthermia
 High environmental temperature
 Strenuous activity on a hot day
 High risk
o Older people
o Infants
o Cardiac patients
 Syndromes
o Heat cramps with skeletal muscle spasms
o Heat exhaustion with sweating, headache, nausea, and
dizziness or fainting
o Heat strike, with shock, coma, and very high core body
temperature, the most serious complication
 Hypothermia
 Exposure to cold temperatures
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Localized frostbite
o Usually involves fingers, toes, ears, or exposed parts of the
face
 Systemic
o Submersion in cold water
o Lack of adequate clothing in cold weather
o Wet clothing on a windy day
o May affect many body tissues depending on length of
exposure
o Radiation Hazards
 Ionization radiation
 Including x-rays, gamma rays, protons, neurtrons
 Rays differ in energy levels and ability to penetrate body tissue,
clothing or lead
 Amount of radiation absorbed by the body is measured in rads
 Natural sources
o Sun and radioactive materials in soil
 Other sources
o Radon gas (homes), industry, nuclear reactors, diagnostic
procedures
 Damage may occur with a single large exposure
 May accumulate with repeated small exposures
o Not been well studied
 Exposure to large doses
o Leads to radiation sickness
 Light Energy
 Both visible light and ultraviolet rays may result in:
o Damage to skin and eyes
 May cause permanent eye damage
o Development of skin causes
o Noise Hazards
 Single loud noise
 Example: gunshot
 May rupture tympanic membrane
 Noise in workplace
 Cumulative damage
 Ear protection is now required in most noisy work environments
 Home or social environment may exceed safe levels for noise
o Food and Waterborne Hazards
 Contaminated food and water
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May be the result of heat-labile toxins produced in contaminated food
 Botulism poisoning
 May be the result of heat-stable toxins produced in contaminated food
 Staphylococcal contamination
 May be the result of infection with microbe
 Most common outbreaks are caused by strains of E. coli and
Salmonella.
o Biological Agents: Bites and Stings
 Direct injection of animal toxin into the body
 Neurotoxins by spiders or snakes
 Vascular agents in jellyfish
 Transmission of infectious agents through animal or insect vectors
 Rabies
 Malaria
 Lyme disease
 Allergic reaction to insect proteins
 Bee or wasp stings
Inflammation & Healing



Body defenses
o First line
 Nonspecific
 Mechanical barrier
o Second line
 Nonspecific
 Phagocytosis
 Inflammation
o Third line
 Specific defenses
 Cell-mediated or antibodies
Physiology of inflammation
o Protective mechanism
o -itis
o S/S serve as a warning
o NOT SAME AS INFECTION
Causes
o Direct damage
 Cut, sprain
 Sprain is tear of ligament
o Caustic chemicals




 Acid
 Drain cleaner
o Ischemia or infarction
o Allergic reactions
o Extremes of heat or cold
o Foreign bodies
 Splinter, glass
o Infection
Steps of inflammation
o Release of bradykinin from injured cells
o Activation of pain receptors by bradykinin
o Mast cells and basophils release histamine
o Capillary dilation
o Increased blood flow and capillary permeability
o Bacteria may enter the tissue
o Neutrophil and monocytes come to injury site
o Neutrophils phagocytize bacteria
o Macrophages leave bloodstream for phagocytosis of microbes
Acute inflammation
o Same process
o Timing varies
o Chemical mediators affect blood vessels
 Vasodilation
 Hyperemia
 Increase capillary permeability
 Chemotaxis to attract cells of the immune system
Local effects
o Redness and warmth
o Swelling
 Edema
 Shifts of protein and fluid into the interstitial space
o Pain
o Loss of function
Exudate
o Serous
 Watery
o Sanguineous
 Bloody
o Serosanguineous
 Both




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
o Purulent
 Thick, yellow-green
 Abscess
Systemic Effects
o Mild fever
 Pyrexia
o Malaise
o Fatigue
o Headache
o Anorexia
Diagnostic tests
o Leukocytosis
 Increase WBC
o Differential count
 Distinguish btw bacterial and viral
o Erythrocyte sedimentary rate
 ERC
 Elevated
o C-reactive protein
 CRP
 Elevated
o Circulating plasma proteins
Potential Complications
o Infection
o Skeletal muscle spasm
Chronic Inflammation
o Less swelling and exudate
o More:
 Lymphocytes
 Macrophages
 Fibroblasts
o Continued tissue destruction
o Fibrous scar tissue
o Granuloma may develop
Complications
o Deep ulcers
 Cell necrosis and lack of cell regeneration
 Can lead to perforation or viscera
 Extensive scar tissue
Treatment




o Acetylsalicylic acid
 Aspirin
o Acetaminophen
 Tylenol
o Nonsteroidal anti-inflammatory drugs (NSAIDs)
 Ibuprofen
o Glucocorticoids
 Corticosteroids
R.I.C.E.
Types of healing
o Resolution
 Minimal tissue damage
o Regeneration
 Damaged tissue replaced with cells that are functional
o Replacement
 Functional tissue replaced by scar tissue
 Loss of function
Healing process
o First intention
 Close the wound
 Laceration that heals nicely
 Edges are well approximated
o Second intention
 Do not closer the wound
 Edges are not well approximated
 Risk for infection is great
 Scar tissue will occur
o Tertiary intention
 Wont close for a long period of time
 Dehiscence
Scar formation
o Loss of function
 Loss of structures
 Hair
 Nerves
 Receptors
o Contractures and obstructions
o Adhesions
o Hypertrophic scar tissue
 Overgrowth of fibrous tissue





 Can lead to keloids
o Ulceration
 Blood supple may be impaired
Burns
o Thermal
o Chemical
o Radiation
o Electricity
o Light
o Friction
Classification of burns
o First-degree
 superficial
o Second-degree
 Blisters
 To dermis
 Most painful
o Third and fourth degree
 Past nerves
 Not painful
 Destruction of all skin layers
Effects of burn
o Local and systemic
o Dehydration and edema
o Shock
o Respiratory problems
o Pain
o Infection
o Hypermetabolism during healing period
Healing of burns
o Hypermetabolism occurs
o Immediate covering
o Healing is a prolonged process
o Scar tissue develops
 Even with skin grafting
o Physiotherapy and occupational therapy may be necessary
o Surgery
Rule of 9’s
Infection



Microorganisms
o Examples
 Bacteria
 Fungi
 Virus
 Protozoa
o Can grow in artificial culture medium
o Nonpathogenic
 Usually does not cause disease
 Part of normal flora
 Beneficial
o Pathogen
 Normally causes disease
Bacteria
o Bacilli
 Rod shaped organisms
o Spirochetes
 Include spiral forms
o Cocci
 Spherical forms
 Diplococci
 Streptococci
 Staphylococci
o Toxins
 Exotoxins
 Gram positive
 Endotoxins
 Gram negative
 Released on death of bacterium
 Vasoactive compounds that can cause septic shock
 Enzyme
 Damage tissues
 Promotes infection
Viral infection
o Active
 When the virus can spread
 Attaches to host cell
o Latent
 Attached to host cell
 Dormant





Resident flora
o Where it resides
 Pretty much everywhere
Principles of infection
o Infection
 Able to reproduce in or on body tissue
o Sporadic
 In a single individual
o Endemic
 Continuous transmission in a population
o Epidemic
 Spreads to a new geographical area
o Pandemic
 Worldwide
Transmission
o Person to person
o Reservoir
 Source of infection
 Asymptomatic
o Carrier
 Carries but may not develop
Links in infection chain
o Agent: the microbe itself
o Reservoir
 Environmental source
o Infected person or animal
o Poral of exit
o Portal of entry
o Susceptible host
 Depends on
 Health status
 Immunity
 Age
 Nutrition
o Mode of transmission
 Air
 Water
 Food
Mods of transmission
o Direct contact






o Indirect contact
 Fomite
o Droplet
 Respiratory or salivary secretion
o Aerosol
 Small particles from respiratory tract
o Vector-borne
 Insect or animal is intermediate host
Nosocomial infection
o In health care facilities
o 10-15 percent of patients get an infection in hospital
Factors that decrease host resistance
o Age
o Pregnancy
o Genetics
o Immunodeficiency
o Malnutrition
o Chronic disease
o Severe physical or emotional stress
o Inflammation or trauma
o Impaired inflammatory responses
Virulence and pathogenicity
o Pathogenicity
 Capability of a microbe to cause disease
o Virulence
 Degree of pathogenicity
 Invasive qualities
 Toxins
 Adherence to tissue by pili, fimbriae, specific receptor sites
 Ability to avoid host defenses
New issues affecting infection and transmission
o Different strains
o Superinfections
 Drug resistant
 TB
Standard precautions vs specific precautions
Break the cycle
o Locate and isolate reservoir
o Restrict contaminated food
o Reduce contact





o Block portals
o Remove modes of transmission
o Reduce host susceptibility
Physiology of infection
o Incubation
o Prodromal
 Fatigue, loss of appetite, headache
 Nonspecific
o Acute period
Means of disinfection
o Chemicals
 Antiseptics
 Skin
 Disinfectants
 Fomites
o Heat
Patters of infection
o Local
o Focal
o Systemic
 Septicemia
 Bacteremia
 Toxemia
 Viremia
o Mixed
o Primary
o Secondary
S/S
o Local = inflammation
o Systemic
 Fever
 Fatigue
 Nausea
Methods of diagnosis
o Drug sensitivity test
o Blod tests
 Leukocytosis- bacteria
 Leukopenia- viral
o Differential count
o CRP

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

o ERC
Drug therapy
o Take full dose of drugs for full time period
o Do not save for later
o Use only for purpose
Classification of antimicrobials
o Antibiotics
o Antimicrobial
 Bacterial
 Viral
 Fungal
o Bactericidal
 All bacteria
o Bacteriostatic
 Inhibits reproduction of bacteria
o Broad spectrum
 Both gram
o Narrow
 One or the other gram
o First gen
 OG drug class
o Second gen
 Later version
Mode of action of antibiotics
o Interfere with call wall
 Penicillin
o Increase permeability
 Polymyxin
o Protein synthesis
 Tetracycline
o Interfere with synthesis of essential metabolites
 Sulfonamides
o Inhibits nucleic acids
 Ciprofloxacin
Mode of action antivirals
o Blocks entry
o Inhibits gene expression
o Inhibits assembly
Antifungal agents
o Mitosis in fungi affected

o Increase permeability
o Topical
o Strict medical supervision
Antiprotozoal agents
o Needs several different agents
o Similar to antifungal
Immunity

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Lymphoid structures
o Spleen
o Tonsils
Immune cells
o Lymphocytes
o Macrophages
Tissues
o Bone marrow
 Maturation of B lymphocytes
o Thalamus
 Maturation of T lymphocytes
o Chemical mediators
 Histamine, interleukins
Antigens
o Self vs non-self
Macrophages
o Eats foreign particles
o Develop from monocytes
o Secrete chemicals
Lymphocytes
o T lymphocytes
 Bone marrow stem cells
 Cytotoxic T killer cells
 Helper T
 Memory T
o B lymphocytes
 Responsible for antibody production
 Humoral immunity
 Born with
 Mature in bone marrow
 Plasma cells
 B memory
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Types of immunity
o Humoral
o Cell mediated immunity
 Programed to attack non self cells
Antibodies and immunoglobulins
o IgG
 Most common
o IgM
 First to increase in immune system
o IgA
 In secretions
o IgE
 Allergic response
o IgD
 Attaches to B cells
Immunity
o Innate
o Adaptive
o Primary
o Secondary
o Active natural immunity
 Natural exposure
o Active artificial immunity
 Antigen purposefully introduced to body
o Passive natural immunity
 IgG
 Across placenta
 Breast milk
o Passive artificial immunity
 Injection of antibodies
o “herd immunity”
Bioterrorism
o Anthrax
Transplant rejection
o Hyperacute
o Acute
o Chronic
Type 1 hypersensitivity
o Allergens
o Anaphylaxis



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
Type 2 hypersensitivity
o Cytotoxic hypersensitivity
 Antigen is present on cell membrane
 IgGs react
 Phagocytosis
Type 3: Immune complex hypersensitivity
o Antigen combines with antibody
 Forms immune complexes
 Activation of complement system
Type 4
o Delayed response by sensitized T lymphocytes
o Release of lymphokines
o Inflammation
o Destroys antigen
o Ex:
 TB test
 Contact dermatitis
 Allergic skin reaction
Autoimmune
o Body attacks itself
Systemic Lupus Erythematosus (SLE)
o Chronic inflammatory disease
o Facial rash
 Butterfly rash
o Affect young women mainly
o Large number of circulating autoantibodies
o Forms immune complexes
o Inflammation and necrosis
o Vasculitis develops in many organs
o S/S
 Arthralgia, fatigue, malaise
 Cardiovascular problems
 Polyuria
AIDS
o Secondary to HIV
o HIV destroys helper T cells – CD4
o Prolonged immune response
The agent
o HIV
o Retrovirus


o HIV-1
o HIV-2
Transmission
o Bodily fluids
 Blood
 Semen
 Vaginal fluids
o Clinical S/S
 Lymphadenopathy
 Fatigue and weakness
 Arthralgia
o Encephalopathy
 AIDS dementia
Secondary infection
o Main cause of death
o Lungs
o Herpes
o Candida
o TB
o Cancer
Blood and Circulatory Disorders
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Composition of blood
o Erythrocytes
 Life span 120 days
Blood clotting-hemostasis
o 3 steps
Clot formation
Blood typing
Diagnostic
o CBC
RBC indices
o MCV (size)
Blood therapies
Anemias
o Anemia leads to poor O2 transport
 Compensation
 Tachycardia and peripheral vasoconstriction
 General S/S
 Fatigue



Pallor
Dyspnea
Tachycardia
o IDA


Poor iron which impairs hemoglobin synthesis
Common
 Pregnant women
 Needs supplements
 Impairs duodenal absorption
 Malabsorption
 Liver disease
 S/S
 Pallor
 Fatigue
 Irritability
 Degenerative
 Stomatitis and glossitis
 Menstrual irregularities
 Delayed healing
 Tachycardia, heart palpations, dyspnea, syncope
o Megaloblastic anemia (pernicious anemia)
 B12 deficiency
 Needs injections
 Causes symptoms in the peripheral nerves
 Enlarged red sore and shiny tongue
 Beefy red
 Digestive discomfort
 Nausea and diarrhea
 Pins and needles
 Diagnostics
 Microscopic examination
 Bone marrow examination
 Presence of hypochlorhydria or achlorhydria
 Presence of gastric atrophy
o Aplastic
 Failure in bone marrow
 Idiopathic but could be myelotomies or hepatitis C
 Blood count shows pancytopenia
 Anemia
 Leukopenia
 Thrombocytopenia
 Erythrocytes appear normal
 Bone marrow recovery
o Hemolytic anemia
 Destruction of RBC
 Causes
 Genetic defects
 Immune reaction
 Blood chemistry
 Infections like malaria
 Toxins in blood
 Sickly Cell
 Genetic
o Homozygous recessive
 More common in Africans
 S/S
o Severe pain r/t ischemia
o Pallor, weakness, tachycardia, dyspnea
o Hyperbilirubinemia- jaundice
o Splenomegaly
o Vascular occlusions
 Lungs
 Smaller blood vessels
 Hand-foot
 Delay growth
 Crescent shaped
o Causes clotting
o Reduced O2
 Thalassemia
o Polycythemia
 Polycythemia vera
 Increase production of RBS and others in bone marrow
 Neoplastic disorders
 Erythrocytosis
 Increase in RBC bc of hypoxia
 S/S
 Distended blood vessels
 Increased BP
 Hypertrophied heart
 Hepatomegaly




 Splenomegaly
 Dyspnea
 Headaches
 Visual disturbances
 Thromboses and infarction
Indication of blood clotting disorders
o Bleeding of guns
o Epistaxis
o Petechia
 Red spots, pin point, on skins and mucous membrane
o Purpura and ecchymosis
o Hemarthroses
o Hemoptysis
o EX:
 Hematemisis
 Blood in feces
 Anemai
 Feeling faint
 Low BP
 Rapid pulse
Hemophilia A
o Factor VIII
o X-linked recessive trait
 Manifested in men
 Carried in women
o Prolonged bleeding
o Diagnosis
 Pt normal
 PTT and aPTT prolonged
Von Willebrand
o Hereditary
o S/S
 Skin rashes
 Frequent nosebleeds
 Easy bruising
 Abnormal menstrual bleeding
o On Von Willebrand factor
DIC
o All clotting factors used up
o Widespread hemorrhage
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


Thrombophilia
o Risk of abnormal clots in veins and arteries
Myelodysplastic syndromes
o Inadequate production of cells by bone marrow
o S/S
 Anemia
Leukemias
o Overproduction of WBC
o Acute
 Infection
 Petechiae and purpura
 Signs of anemia
 Bone pain
 Weight loss
 Elarged lymph nodes, spleen, and liver
 Headache, visual disturbances, drowsiness, vomiting
 AML
 Most deadly
 ALL
 Kids
 Immature nonfunction cells
o Chronic
 Insidious oncet
 High proportion of mature cells with reduce function
 CML
 Most Seen
 CLL
o Complications
 Opportunistic infections
 Sepsis
 Congestive heart failure
 Hemorrhage
 Liver failure
 Renal failure
 CNS depression and coma
Multiple myeloma
o Neoplastic disease
o Idiopathic
o Production of other blood cells impaired
o Multiple tumors in bone

Bone pain
Lymphatic Disorder

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
Structures
Function
o Return excessive interstitial fluid into cardiovascular system
o Right vessels- right subclavian
o Left vessels- left subclavian
Lymph
o Clear, watery, isotonic fluid
Lymphomas
o Hodgkin
 T- lymphocytes seem to be defective
 Has Reed-Sternberg cells
 Painful
 Moveable
 Curable
 S/S
 Splenomegaly
 General cancer
o Non-Hodgkin
 No Reed
 Painless
 Stationary
 No cure
 Partially caused by HIV
Multiple Myeloma
o S/S
 Impaired kidney function and eventually failure
Lymphedema
o Extremities swell
Elephantiasis
o Lymphedema
 Caused by parasite
o Extreme swelling of extremities and breasts
Castleman Disease
o Never talked about?
Skin Disorder

Epidermia

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
o Keratin
o Melanin
o Albinism
o Vitiligo
o Melasma
Dermis
Hypodermis
Resident Flora
Skin Lesions
o Systemic disorders
 Liver disease
o Systemic infections
 Chicken pox
o Allergies
o Localized factors
o Types
o Physical appearance
Pruritus
o Allergic response
o Chemical irritation by insect bites
General Treatment
o Topical agent
o Avoid allergens
o Precancerous
 General cancer
Contact dermatitis
o Exposure to allergen
o Sensation
o Subsequent exposure leads to manifestation
o S/S of allergic dermatitis
 Pruritic area
 Erythematous area
 Edematous area
 Chemical irritation
Urticaria (Hives)
o Type 1 Hypersensitivity
 Iodine, shellfish
o Eruption of hard, raised erythematous lesions
o Highly pruritic
Eczema
o Chromic inflammation from allergens





 Eosinophilia and increased IgE
o Affected areas become sensitive to irritants
Psoriasis
o Chronic skin disorder
o Marked by remission and exacerbation
o Abnormal T cell activation
 Excessive proliferation of keratinocytes
o S/S
 Red spots covered with silvery scales
 Deep cracks
 Itching and burning
 Thickened pitted or ridged nailed
 Swollen and stiff joints
Pemphigus
o Autoimmune
 Vulgaris
 Foliaceous
o Autoantibodies disrupt cohesion between epidermal cells
 Causes blisters
 Bullae
 Skin sheds
 S/S
 Blisters in mouth
 Spreads to skin
 Blisters painful not pruritic
 Breathing difficult
Scleroderma
o Can affect viscera
o Increased collagen
o Inflammation and fibrosis
o May cause renal failure
o S/S
 Hard, shiny, tight skin
 Raynauds
 Loss of facial expression
Bacterial infection
Cellulitis
o Infection of dermis and subcutaneous tissue
o Secondary
o Mainly on lower trunks and legs
o S/S






 Redness
 Edematous
 Pain
Furuncles (boils)
o Begins at hair follicles
o Face, neck, back
o Purulent exudate
o S/S
 Firm, red lesion
 Painful nodules
 Carbuncles
 Collection of furuncles
Impetigo
o Common in infants and children
o Common on face
o Physical contact or fomites
o S/S
 Small red vesicles
Acute necrotizing fasciitis
o Aerobic and anaerobic bacteria
o Necrosis
o S/S
 Painful
 Grows fast
 Dermal gangrene
o Systemic
 Fever
 Tachycardia
 Hypotension
 Mental confusion
 Organ failure?
Herpes
o HSV
o 1 face
o 2 genitalia
Verrucae (warts)
o HPV 1 to 4
o Plantar warts common
o Spreads by viral shedding
Fungal infection

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
Tinea
o
o
o
o
o
Scalp
Erythema
Body
Foot
Unguium
 Nails
Scabies
o Females burrow
 Lay eggs
o Brown lines
Pediculosis
o Lice
o Crabs
 Genital
Keratoses
o Benign lesions
Warning of skin cancer
o Sores doesn’t heal
o Change in shape, size, color, or texture
o New moles
o Skin lesions bleed
Guidelines to reduce risk of skin cancer
o Reduce sun
o Covering of clothing
o Sunscreen
Squamous cell carcinoma
o Painless malignant
o Lesions found in exposed areas
Malignant melanoma
o Melanocytes
o Multicolored
ABCD of melanoma
o Appearance
o Border
o Color
o Diameter
Kaposi sarcoma
o AIDS
o Can affect viscera
o Malignant arises from endothelium


Purplish
Nonpruritic
Eyes, Ears, & Sensory

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
Exteroceptors
o Touch, pressure, temperature, pain
Visceroreceptors
o Around viscera
Proprioceptors
o Muscle sense
Mechanoreceptors
o Same as exteroceptors
Chemoreceptors
o Taste, Smell
Thermoreceptors
o Temperature
Photoreceptors
o Light
Nociceptors
o Pain
Osmoreceptors
o Change in osmolarity of body fluids
Eye
o Know normal physiology
o Myopia
 Nearsightedness
o Hyperopia
 Farsightedness
o Presbyopia
 Age related farsightedness
o Astigmatism
 Irregular curvature
o Strabismus
 Cross-eyed
o Nystagmus
 Involuntary movement
o Diplopia
 Double vision
o Stye
 Infection of hair follicle
o Conjunctivitis



o
o
o
o
Inflammation of conjunctiva
Pink eye
Bacteria
 Puss-y
 Yellow-green
 Viral
 Clear purulent
 Allergic
 Yellow-green

Trachoma
 Follicles develop on inner surface of eyelid
 Scratchy eye
Keratitis
 Cornea is infected or irritated
 Can increase risk of ulceration eroding the cornea
 Scar tissue interferes with vision
Glaucoma
 Increased IOP
 Increased aqueous humor
 Most preventable
 Halos
 Acute
 Angle between cornea and iris is decreased
 Can be caused by aging
o Iris pushed forward and to side
o Block flow of aqueous humor
o Triggered by pupil dilation
 Chronic
 Thickening of trabecular network
 Pressure increase of time
o Can cause ischemia and damage to retinal cells
o Damage to optic nerve
o Irreversible
Cataracts
 Clouding of lens
 Size varies
 Change may be
 Age related
 Excessive exposure to sun

 Congenital
 Traumatic
 Blurred vision
o Detached retina
 Acute
 Emergency
 Retina tears away from choroid
 Retina ischemia
 Painless
 Scotomas
 Curtain
 Tears allow vitreous humor to shift
o Macular Degeneration
 Age related
 Common cause of vision loss
 Genetic factors as well as environment
 Dry or atrophic
 Deposits from in retinal cells
 Wet or exudative
 Neovascularisation
 Central vision becomes blurred then loss
Ears
o Know structures of external, middle and inner ear
o Hearing loss
 Two types
 Conduction
o Sound is blocked
o Otosclerosis
 Sensorineural
o Damage
o Infection
o Head trauma
o Neurological
o Ototoxic drugs
o Sudden loud noise
o Prolonged exposure to loud noise
o Presbycusis
 New bornsscreened
 Heaing aids
 Cochlear inplants
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Otitis media
 Inflammation of the middle ear
o Exudate builds in cavity
o Causes pressure on tumpanic membrane
o Prolonged infection can cause scar tissue
o Chronic infection can lead to mastoiditis
 Infection of temporal bone
Ear infections
 Can spread to nasopharynx and respiratory structures
 Can be asymptomatic
 Often severe pain
 Tympanic membrane is red and building
 Fever, nausea
Otitis externa
 Swimmers ear
 Often associated with swimming
o Irritation with cleaning
o Frequent wise of earphones and earplugs
o Pain when pina moved
Chronic disorders of ear
 Otosclerosis
o Imbalance in bone formation
 In middle ear
 Staples becomes fixed
 Blocks sounds to cochlea
 Meniere’s
o Inner ear labyrinth disorder cause vertigo and nausea
o Intermittent
o Excessive endoplymph
o Attacks last minutes or hours
o Balance test, electronystagmography,
electrocochleography, MRI
o Characteristics
 Severe vertigo
 Tinnitus
 Excess noise like ringing
 Unilateral hearing oss
 Nausea and sweating
 Inability to focus
 Nystagmus
Fluid, Electrolytes, & Acid-Base:
Fluid imbalance
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Isotonic
o
o Normal Saline
Hypotonic
Hypertonic
Electrolyte imbalance
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Sodium
o Hypernatremia
 X > 145 mEq/L
 Increase in Aldosterone
 Decrease in ADH
 Edema
o Hyponatremia
 X < 135 mEq/L
 Increase ADH
 Decrease Aldosterone
 Cerebral Edema
Potassium
o Hyperkalemia
 X > 5 mEq/L
 Renal Failure
 Decreased Aldosterone
 Paralysis
 Moves from Intra to Extra
 Peak T wave
o Hypokalemia
 X < 3.5 mEq/L
 Diarrhea
 Increased Aldosterone
 Polyuria
 Shallow respirations
 Added U wave after the T wave
Calcium
o Hypercalcemia
 Hyperparathyroidism
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
 Uncontrolled release of calcium ions from bones
 Tetany
 Weak heart contraction
o Hypocalcemia
 Hypoparathyroidism
 Malabsorption syndrome
 Renal failure
 Muscle weakness
 Increased strength in cardiac contraction
Magnesium
o Hypermagnesemia
 Renal failure
 Depresses neuromuscular function
 Decreased reflexes
o Hypomagnesemia
 Results from malabsorption or malnutrition (associated with alcoholism)
 Caused by use of diuretics, DKA, hyperthyroidism, hyperaldosteronism
Phosphorus
o Hyperphosphatemia
 Renal failure
o Hypophosphatemia
 Malabsorption syndrome, diarrhea, excessive antacids
Acid-base imbalance
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Normal Ranges
o pH: 7.35-7.45
o pCO2: 35-45
o HCO3: 22-26
o PaO2: 95-100
Respiratory Acidosis
o pCO2 would be above 45
o Hypoventilation
o
Respiratory Alkalosis
o pCO2 would be below 35
o Hyperventilation
o
Metabolic Acidosis
o HCO3 would be below 22
o Diarrhea
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


o
Metabolic Alkalosis
o HCO3 would be above 26
o Vomiting
Mixed
Compensation
o Fully
 Other organ is compensating, and the pH is within normal range.
o Partially
 Only the other organ is compensating, and the pH is not in range.
o Uncompensated
 The other organ is not compensating, and the pH is not in range.
Example
o pH: 7.49
o CO2: 56
o HCO3: 30
 Answer: Metabolic Alkalosis Partially Compensated
Cardiac:
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
Coronary artery disease, Ischemic heart disease, Acute coronary syndrome
Arteriosclerosis:
o General term for arterial change
o loss of elasticity
o lumen gradually narrows
 may become obstructed
o Increased BP
Atherosclerosis:
o Atheroma
o Plaques made of lipids, calcium, and clots
o Diet, exercise, and stress
angina pectoris:
o Chest pain
o deficit of O2 to the heart
o stable(predictable)/unstable(unpredictable)
o Levine sign (chest grabbing), pallor, diaphoresis(sweating), nausea, chest pain
myocardial infarction:
o Heart attack
o Coronary artery is totally obstructed
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o Arthrosclerosis is most common cause
o Anxiety and fear (very common)
o Females have atypical s/s
Cardiac Dysrhythmias
Normal heart conduction:
o SA node>AV node> Bundle of his>Purkinje fibers
Lethal rhythms:
o Ventricular tachycardia
o Ventricular fibrillation
o Asystole (flatline)
o Pulseless Electrical Activity (PEA)
Congestive heart failure:
o Heart unable to pump blood efficiently
o Secondary condition
o R-sided failure (cor pulmonale)
 Affect rest of body
 L-sided failure: affect lungs
Inflammation and infection in the heart
Rheumatic fever and rheumatic heart disease:
o Systemic
o Streptococcus
o Children 5-15
o Involves heart valves and joints
 Strep>rheumatic fever>rheumatic heart disease
o Leukocytosis
Infective endocarditis:
o Infection/inflammation of endocardium
Pericarditis:
o Inflammation to the pericardium
o Secondary
o Fluid accumulates in pericardial sac
Arterial disorders
Hypertension:
o High BP
o “Silent killer”
o Any age group
o More common in AA
o Sometimes classified as systolic or diastolic
o Over long time>damage to arterial wall
Peripheral vascular disease-Atherosclerosis:
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o Disease in arteries outside the heart
o Intermittent claudication (pain in calves)
o Common in abdominal aorta, carotid, and femoral and iliac arteries
o Increased incidence with diabetes
Aortic aneurysms:
o Weakening of arterial wall
o Shapes
 Saccular
 (bulging wall on side)
 Fusiform
 (circular dilation)
 Dissecting aneurysm
 (Tear in wall, continues to separate tissues)
 Bruit, pulse in abdomen, asymptomatic until large or ruptured
 Rupture>hemorrhage and death
Venous Disorders
Varicose veins:
o Enlarged vein appearing in the legs and feet
o Increased BMI and weight lifting are risks
o Typically asymptomatic
o PVD w/ this causes problems
Thrombophlebitis:
o Thrombus develops in inflamed vein (IV site)
Shock:
o 4 Classifications:
 Hypovolemic
 (Volume is issue)
 Cardiogenic
 (Something wrong w pump)
 Obstructive
 (blocks)
 Distributive
 (vol. is not where it needs to be)
o S/S:
 Anxiety
 Tachycardia
 Pallor
 light-headed
 syncope
 sweating
o
o
o
o
 oliguria
SNS compensates
Increased ADH
Progressive stage-when you’ll see changes
Complications:
 renal failure
 infections
 DIC
 Depression of cardiac function
Respiratory:
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Upper respiratory tract infections
Common cold (infectious rhinitis):
Viral (droplet)
Secondary infections may occur
o Infants/young kids= Respiratory sinusoidal virus (RSV)
Symptomatic treatment
S/S:
o Congestion
o Voice changes
o Sore throat
o Headache
o Fever
o Malaise
o Cough
o Infection may spread
 Pharyngitis
 Laryngitis
 Acute bronchitis
Sinusitis:
o Inflammation of the sinus cavities
 Usually bacterial
Croup:
o Viral
o Kids
o Braking cough
o Resolves itself
Epiglottitis:
o EMERGENCY
o Children 3-7
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o Rapid onset of fever and sore throat
o tripod position, drooling, anxiety
o Do not put anything in their mouth
 Can cause laryngeal spasms and lose airway
Influenza:
o Viral
o 3 types:
 A
 (Most common),
 B
 C
o Constantly mutate
o Worsens with secondary bacterial pneumonia
Scarlet fever:
o Strep
o “Strawberry” tongue
o Fever
o Sore throat
o Chills
o Vomiting
o Abdominal pain
o Malaise
o Untreated strep can cause disorder of the heart valves
Lower respiratory tract infections
Bronchiolitis:
o Caused by RSV
o Droplet transmission
o Virus causes necrosis and inflammation in small bronchi and bronchioles
o Signs:
 Wheezing
 SOB
 Rapid, shallow resp.,
 Cough
 Rales
 Chest retraction
 Fever
 Malaise
Pneumonia:
o Based on viral, bacterial, or fungal
o Can be in both or single lung
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
Lobar
 (Community)
 Bronchopneumonia
 (Aspiration)
 Legionnaires Disease
 (Nosocomial)
 Primary Atypical
 (Walking)
 Pneumocystis Carinii
 (AIDS)
Severe acute respiratory distress syndrome (SARS):
o Droplet
o First signs:
 Fever
 Myalgia (body pains)
 Chills
 Diarrhea
o Later signs:
 Dry cough
 Marked dyspnea
 Interstitial congestion
 Hypoxia
 Mechanical vent. may be required
o High fatality rate
 Active cases quarantined
Tuberculosis:
o Bacterial
o Airborne precautions
 neg. pressure rooms
 Crowded conditions
 Immunodeficiency
 Malnutrition
 Alcoholism
o Rust colored sputum
o Latent
 Noncontagious
 Active- contagious
 Organisms multiply and form necrosis
Anthrax:
o Bacterial
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

 Viable for long periods of time
o Transmitted multiple ways:
 Skin (cutaneous)
 Respiratory (inhaled)
 Digested (gastrointestinal)
o Used as a bioterrorism chemical
Obstructive Lung Diseases
Cystic fibrosis:
o Genetic
 Chromosome 7
o large amount of mucus
o Seen in the lungs
 (Obstructs airflow, permanent damage to bronchial walls)
o Pancreas
 (Obstructed and occluded ducts)
o S/S:
 Meconium ileus at birth
 Salty skin
 Steatorrhea (gray stool)
 Chronic cough and resp. infections
 Failure to meet growth milestones
 Shorter lives> early 50s
Lung cancer:
o 90% related to smoking/vaping
o Early signs:
 Persistent cough
 Detection on radiograph
 Hemoptysis
 Pleural involvement
 Chest pain
 Hoarseness
 Edema
 Headache
 Dysphagia
 Atelectasis
Aspiration:
o Foreign material into trachea and lungs
o Results in obstruction, inflammation, or predisposition/pneumonia
o S/S:
 Coughing
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 Choking
 Dyspnea
 Hoarseness
 Stridor (UR)
 Wheezing (LR)
 Tachycardia
 Tachypnea
 Nasal flaring
 Chest retractions
 Hypoxia
 Cardiac/resp. arrest
Obstructive sleep apnea:
o Pharyngeal tissue collapse during sleep
o Men more affected
o Obesity and aging are common predisposing factors
o CPAP
Asthma:
o Bronchial obstruction
o Hypersensitive to allergies or hyperresponsive to anxiety
o S/S:
 Wheezes
 Cough
 SOB
 Thick mucus
 Tachycardia
 Hypoxia
o Status asthmaticus:
o EMERGENCY
 severe asthma attack, cannot be controlled, may be fatal because of
severe hypoxia and acidosis
Chronic Obstructive Pulmonary Disease
Emphysema:
o COPD related to smoking
o Destruction of alveolar walls
o Septae
 (loss of elasticity and surface area)
o Leads to hyperinflated alveolar spaces
o Progressive difficulty with expiration
o Barrel chest
o Clubbed fingers
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Chronic bronchitis:
o Inflammation
o Obstruction
o Repeated infection
o Coughing for 3 mo. or longer in 2 years
o S/S
 Cough
 SOB
 Thick secretions
 Hypoxia
 Hypercapnia
 Polycythemia (secondary)
 Signs of cor pulmonale
Bronchiectasis:
o Secondary
o Dilation of medium bronchi leads to build up of excess mucus
o Increased risk for infection
o S/S
 Cough
 Large amounts of sputum
 Rales/rhonchi
 Foul breath
 Dyspnea
 Hemoptysis
 Weight loss
 Anemia
 Fatigue
Vascular Disorders
Pulmonary edema:
Fluid in alveoli and interstitial area
Impaired gas exchange
Interferes w lung expansion
S/S:
o Cough
o Orthopnea
o Rales
o Pink frothy sputum
o Tachypnea
o Hypoxemia
Pulmonary embolus:
o
o
o
o
o
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
blood clot that obstructs pulmonary artery or any of its branches
Small emboli may be “silent”
Large emboli may cause sudden death
90% come from deep vein thromboses in legs
S/S:
 Chest pain
 Dyspnea
 Hemoptysis
 Anxiety/restlessness
 “Impending doom”
 Massive emboli
 Severe crushing chest pain (elephant)
 Low BP rapid weak pulse
 Loss of consciousness
 Code
Expansion disorders
Atelectasis:
o Partially Collapse of alveoli
o S/S
 Small areas are asymptomatic
 Large areas Dyspnea
 Increased HR and RR
 Chest pain
Pleural effusion:
o Fluid in the pleural cavity
o Exudative (inflammation)
o Transudative (increased hydrostatic pressure or decreased osmotic pressure)
o S/S
 Dyspnea
 Chest pain
 Increased HR and RR
 Dull percussions
 Absence of breath sounds (affected area)
 Tracheal deviation
 Hypotension
Pneumothorax:
o Collapsed lung
o Air in pleural cavity
o Closed-
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

 Air from internal airways
 No opening in chest wall
 Rupture of bleb
o Open “Sucking wound”
 Air enters through an opening
o Tension Most serious
 Air enters through an opening on inspiration but cannot escape on
expiration
 trapped air>increased pleural pressure
o S/S:
 Atelectasis
 Dyspnea
 Cough
 Chest pain
 Reduced breath sounds
 Unequal chest expansion
 Hypoxia
 Hypotension
Flail chest:
o Fractures in 2+ ribs broken in 2 or more places
o Move freely
o During inspirations ribs move inward
 Prevents lung expansion
o Expiration
 Ribs move outward by increasing intrathoracic pressure
 alters airflow
Acute respiratory distress syndrome:
o Results from injury to the alveolar wall and capillary membrane
o Fluid buildup in the alveoli and interstitial area
o S/S:
 Extreme dyspnea
 Restlessness
 Rapid shallow resp.
 increased HR
 Combo of metabolic and resp. acidosis
Acute respiratory failure:
o Results from acute or chronic disorders
o Fluid buildup in the alveoli and interstitial area
o Signs may be masked or altered by primary problem
New Lab Values:
BUN, Creatinine, LFTs (ALT & AST), Urinalysis, Amylase, & Lipase
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BUN- 8-21 mg/dL
Creatinine- 0.5-2.3 mg/dL
ALT & AST- liver function tests—if elevated, the liver is not functioning
Amylase- 23-85 U/L
Lipase- 0-160 U/L
Immobility:
Immobility and associated problems (musculoskeletal, cutaneous, cardiovascular, respiratory,
digestive, urinary, and neurologic)
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Musculoskeletal
o Contractures
Cutaneous
o Pressure injuries
Cardiovascular
o DVT
Respiratory
o Lazy lungs
o Atelectasis
o Pneumonia
 Aspiration
Digestive
o Peristalsis is affected
o Constipation
o Segmentation of small intestine
Urinary
o Incontinence
o Retention
 UTI
Neurotologic
o No sensation
o The -plegias
Musculoskeletal:
Trauma (fractures, dislocations, sprains, strains, tears)

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
Dislocation- separation of two bones at a joint.
o Significant tissue damage to ligaments and tendons
Sprains- tear in a ligament
Strains- tear in a tendon
Avulsion- ligaments or tendons become completely separated
Fractures
o Complete, incomplete, open, closed, simple, comminuted (multiple fractures and
bone fragments), compression (crushed or collapsed into pieces).
o Impacted (one end is forced into adjacent bone), pathologic (happens from
weakness). PICS ON SLIDE 21
o Healing-- Bleeding causes hematoma, phagocytes remove debris, then fibrin clot
forms, chondroblasts form new cartilage, osteoblasts create bone.
o Complications- nerve damage, failure to heal or deformity, infections, ischemia.
Bone disorders (osteoporosis, rickets/osteomalacia, Paget disease, osteomyelitis, spine
curvatures, and tumors)
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Osteoporosis- decrease in bone mass and density.
o Bone resorption exceeds bone formation
o Can cause compression fractures or lead to kyphosis and scoliosis
o Caused by deficits in vitamin D, old age, excessive PTH, excessive caffeine intake
Rickets and Osteomalacia- result from deficit of vitamin D and phosphates
o Caused by dietary deficits, malabsorption, lack of sun exposure.
Paget disease- bone destruction replaced by fibrous tissue.
o No known cause. Pathologic fractures are common.
Osteomyelitis- bone infection caused by bacteria or fungi
o Fever and sweating, chills, bone pain
Spine curvatureso Lordosis- curves inward at lower back (pregnant women)
o Kyphosis- Humpback
o Scoliosis- s or C shaped. Sideways curve
Tumors- common secondary site to breast, lung prostate tumors.
o Osteosarcoma is most common primary neoplasm of bone
o BONE PAIN AT REST
Disorders of muscle, tendons, and ligaments (muscular dystrophy and fibromyalgia)

Muscular Dystrophy- autosomal recessive disorders. Degeneration of skeletal muscle
o Duchenne MD- early motor weakness
o Gower maneuver- pushing up in erect position
o Cardiac myopathy occurs

o Weakness at pelvic girdle- waddle and difficulty climbing stairs.
Fibromyalgia- pain and stiffness of soft tissues
o Onset is higher in women aged 20-50
o s/s- general aching pain, marked fatigue, some may have IBS or urinary
symptoms
Joint disorders (osteoarthritis, rheumatoid arthritis, gout, ankylosing spondylitis)

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

Osteoarthritis- degeneration/wear and tear of joints
o Can be result of weight bearing or lifting.
o Articular cartilage is damaged- becomes rough and worn
o Subchondral bone may be exposed
o Cysts, osteophytes, or bone spurs may develop.
o Loss of ROM bc joint space is narrower.
o Caused by weight bearing, obesity, aging, trauma, repetitive use.
o Aching pain with weight-bearing, walking is difficult.
o TMJ syndrome- mastication and speaking are difficult.
Rheumatoid Arthritis
o Affects all age groups- women are more prone to get it
o Synovitis (inflammation of synovium), Pannus formation (granulation tissue
spreads), loss of cartilage, Ankylosis (joint fixation and deformity).
o BOUTONNIERE DEFORMITY- knuckles deform
o ULNAR DRIFT- Pinky drifts to the ulnar bone in forearm
o s/s- inflammation of fingers and wrists, joints red and swollen, joint stiffness,
malocclusion of teeth if TMJ is involved.
Gout- results from deposits of uric acid and crystals in the joint!!!!!
o Formation of tophi- large nodules of urate crystals
o Because of inadequate renal excretion, chemo, or genetics
Ankylosing Spondylitis- chronic progressive inflammation
o Occurs in men 20-40 yrs old
o Vertebral joints become inflamed; joints are fused by calcification.
o S/S- low back pain, morning stiffness, spine becomes rigid as calcification
progresses.
Neurologic:
General effects of neurological dysfunction

LOC- decreased level of consciousness or responsiveness. Can be confused or
disoriented, memory loss, coma, etc.
o Vegetative state- loss of awareness and mental capabilities
o Locked in syndrome- aware and capable of thinking but cannot communicate
due to paralyzation.
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visual loss, language disorders, seizures, increased intracranial pressure.
Signs of increased intracranial pressure- lethargy, vomiting, headache, increased BP.
Broca area- speaking and writing
Wernicke area- comprehension of speaking and writing
Motor dysfunction- includes decorticate and decerebrate posturing
o Damage to upper motor neurons- interferes with voluntary movement.
Weakness on contralateral side of body.
o Damage to lower motor neurons- weakness or paralysis to the same side of the
body. Occurs at or below the damage to the spinal cord.
o DECORTICATE- legs straight, hands bent over chest.
o DECEREBRATE- legs straight, arms by side and fists poked out.
Acute neurological problems (tumors, TIA, CVA, aneurysms, meningitis, encephalitis, head
injuries, spinal cord injuries)
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Tumors- both benign and malignant can be life-threatening. Gliomas are the largest
category of primary malignant tumors. Secondary brain tumors metastasize from breast
and lung tumors.
o Seizures are often the first sign.
o Headaches, vomiting, lethargy, behavioral changes, unilateral facial paralysis, or
visual issues
Transient Ischemic Attack- result from temporary localized reduction of blood flow.
o Numbness and paresthesia, transient aphasia or confusion, repeated attacks
may indicate obstruction r/t atherosclerosis.
Cerebrovascular Accidents- an infarction of brain tissue that results from lack of blood.
o (5 mins ischemia can cause irreversible nerve damage)
o Central area of necrosis develops
o Types- hemorrhagic or ischemic
o Risk factors- smoking, hypertension, diabetes, atherosclerosis, heart disease,
sedentary lifestyle, history of TIA
o Lack of voluntary movement on the opposite side of body, flaccid paralysis
Aneurysms- weakness in wall of artery. Rupture leads to increased ICP and death.
o s/s- loss of visual field, headache, neck pain, intermittent periods of dysfunction
Meningitis- BACTERIA reaches brain. Infection spreads rapid through meninges.
o Increased ICP, sudden onset, Kernig sign (can’t extend leg while hip is flexed),
Brudzinski sign (can’t keep legs straight when neck is flexed), neck pain.
Encephalitis- infection of the parenchymal or connective tissue in brain and spinal cord\
o VIRAL
Brain injurieso Concussion- minimal brain trauma-mild blow or whiplash. Amnesia or headaches
follow

o Contusion- bruising of brain tissue.
o Depressed skull fractures- displacement of bone below the level of the skull.
Compression of brain tissue and blood supply is impaired.
o Basilar fractures- occur at base of skull- leakage of CSF through ears and nose.
o Contrecoup- area of brain contralateral to the site of direct damage. Brain
bounces off skull
Spinal injuryo Incomplete (partial)-sensory or motor, has an opportunity to possibly come back.
o Complete- fully severed and will never regain function or senses below the area.
o Compression- great force crushes spinal cord.
o s/s- release of norepinephrine, serotonin, histamine. Use a dermatome map.
o Spinal shock- initial period after injury—ANS reflexes are absent. No
communication with higher levels of brain. Control of reflexes below damaged
area is lost.
Seizure disorders
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
Uncontrolled, excessive discharge of neurons in the brain.
Many disorders are idiopathic. Can be caused by loud noises, bright lights, stress,
hypoglycemia, etc.
General seizureo Prodromal period hours before
o Feel an aura then lose consciousness.
o Tonic- muscle contraction. Clonic- shaking back and forth
Chronic degenerative disorders (Parkinson’s, MS, MG, ALS, HD)

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Parkinson’s- progressive degenerative disorder—motor function
o Pill rolling, masked face. Shuffling gait with tremors. Chewing and swallowing
become difficult. Drooling may occur.
o low dopamine- high ach.
o Develops after age 60 usually.
Amyotrophic Lateral Sclerosis- Lou Gehrig disease.
o Affects both upper and lower motor neurons.
o Cognition is impaired, loss of motor coordination, progressive muscle weakness.
Death occurs because of respiratory failure.
Myasthenia Gravis- Autoimmune disorder
o Dysphasia and Aspiration are huge issues
o Skeletal muscle weakness. Facial and ocular muscles affected first.
o Autoantibodies to Ach receptors form.
Huntington Disease- inherited progressive atrophy of brain
o Levels of Ach are reduced.

o S/S- mood swings, restlessness, intellectual impairment with learning and
problem solving. Moving becomes more difficult and dementia progresses
causing behavioral disturbances.
Multiple Sclerosis- Progressive demyelination of neurons.
o Earliest lesions- inflammatory response, loss of myelin in white matter.
o Plaques- large areas of inflammation & demyelination.
o s/s – progressive weakness, paresthesia, loss of coordination, bladder, bowel.
Gastrointestinal:
Common disorders (vomiting, diarrhea, constipation, pain, malnutrition, F/E imbalances)
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Vomitingo Glottis closes, respirations cease, gastroesophageal sphincter relaxes, abdominal
muscles contract, reversing peristaltic waves,
o Hematemesis- blood
o Yellow- bile from duodenum
o Deep brown- lower intestine bleed
Diarrhea- excessive frequency of stools
o Cramping pain
o May be acute or chronic
o Prolonged diarrhea can cause dehydration, acidosis, and malnutrition
o Steatorrhea- Fatty stool with foul odor. May indicate malabsorption syndromes
like celiac, cystic fibrosis, or Crohns.
Constipation- No bowel movement for 3+ days / small hard stools
o Decreased peristalsis
o Chronic constipation may cause hemorrhoids, anal fissures, or diverticulitis
o Caused by inadequate dietary fiber, inadequate fluid intake, immobility, meds
F/E imbalances
o Dehydration and hypovolemia are common complications
o Electrolytes are lost in diarrhea and vomiting.
 Metabolic acidosis- diarrhea (loss of HCO3)
 Metabolic alkalosis- vomiting (loss of HCl
Paino Referred pain- pain is perceived at a site different from origin
o Visceral pain- smooth muscle spasms or contractions
 Cramping, aching, dull pain. Response to severe inflammation or
obstruction
o Somatic pain- linked directly to spinal nerves.
 Rebound tenderness
 Steady, intense, well-localized pain in abdomen
Malnutrition- may be limited to a specific nutrient deficit or generalized
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Vitamin B12- pernicious anemia
Iron deficiency
Chronic anorexia, vomiting, or diarrhea
Can be systemic causes like cancer treatments, lack of available nutrients,
chronic inflammatory bowel disorders.
Upper GI disorders (dysphagia, esophageal cancer, hiatal hernia, GERD, gastritis/gastroenteritis,
PUD, gastric cancer, and dumping syndrome)
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Dysphagia- difficulty swallowing
o Achalasia- failure of lower esophageal sphincter to relax
o Stenosis- narrowing of esophagus
o Congenital atresia- upper and lower esophageal segments are separated.
o Mechanical obstructions esophageal diverticulitis
 compression tumor
 fibrosis of esophagus
Esophageal cancer- squamous cell carcinoma
o Chronic irritation in the distal esophagus
o Poor prognosis- late manifestations
Hiatal Hernia- part of stomach protrudes into thoracic cavity
o Common sign is indigestion/hearburn or pyrosis, frequent belching, pain
o Sliding- more common type. Stomach and gastroesophageal junction slide up
above the diaphragm.
o Rolling or paraesophageal- part of fundus of stomach moves up through an
enlarged or weak hiatus in diaphragm
GERD- gastric contents into distal esophagus causes erosion and inflammation.
o Caffeine, fatty and spicy foods, alcohol, smoking, and certain drugs should be
avoided
Gastritis/gastroenteritiso Acute gastritis- gastric mucosa is inflamed. May be ulcerated and bleeding.
 Basic signs- anorexia, nausea/vomiting, hematemesis, epigastric pain
 Usually self-limiting
o Chronic gastritis- atrophy of stomach mucosa
 Usually caused by H-Pylori
 Loss of secretory glands and reduction of intrinsic factor
o Gastroenteritis- inflammation of intestine and stomach.
 Caused mainly by infections, but can be caused by allergic reactions to
food or drugs
 Self-limiting
Peptic Ulcer Disorder- H. Pylori infections
o Duodenal ulcer- proximal duodenum
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 Vomiting is not common
 Feels better when you eat
o Gastric ulcer- antrum of stomach
 Vomiting is common
 Worsened by eating
o Complications- hemorrhage, perforation, obstruction
o S/S- epigastric burning usually following stomach emptying
Gastric Cancer- arises in mucous glands
o Mostly in antrum or pyloric area
o Asymptomatic in early stages. Survival rate is less than 20%
o Diet is a key factor—smoked foods, nitrites, and nitrates.
Dumping Syndrome- control of gastric emptying is lost and gastric contents are
“dumped” into duodenum without complete digestion.
o Bp drops from hyperosmolar chyme draws fluid from vascular compartment into
intestine
o Hypoglycemia 2-3 hours after meal---FREQUENT SMALL MEALS- Low in protein
and high in simple carbs.
Liver & Pancreas disorders (gallbladder, jaundice, hepatitis, cirrhosis, pancreatitis, liver cancer,
and pancreatic cancer)
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Gallbladder
o Cholelithiasis- Formation of gallstones
o Cholecystitis- Inflammation of gallbladder and CYSTIC duct
o Cholangitis- inflammation related to infection of BILE DUCTS
o Choledocholithiasis- obstruction of biliary tract by gallstones
o Gallstones- form in bile ducts, gallbladder, or cystic duct
 Consist of cholesterol or bile pigment / mixed w/ calcium salts
 Referred pain in the subscapular area
 Women are more likely to develop them
Jaundice
o Prehepatic – excessive destruction of red blood cells
o Intrahepatic- occurs with disease or damage to hepatocytes
o Post-hepatic- obstruction of bile flow into gallbladder
o Bilirubin is measured in the blood and if increased- indicates jaundice
o Light colored stool caused by absence of bile
Hepatitis- inflammation of the liver
o A- fecal oral
o B- sexual transmission/needles
o C- blood transfusion
o D- blood
o E- Fecal oral
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 Preicteric Stage- fatigue and malaise
 Icteric stage- jaundice
 Posticteric- recovery stage- includes weakness
Cirrhosis- progressive destruction of the liver
o Initial stage- fatty liver- enlargement (hepatomegaly)
o Second stage- alcoholic hepatitis- inflammation and cell necrosis
 Irreversible
o Third- end stage cirrhosis
 Fibrotic tissue replaces normal tissue
 Little normal function remains
o Functional losses with cirrhosis
 Decreased removal of toxic substances
 Backup of bile in the liver
 Leads to portal hypertension
o Manifestations Increased bruising, esophageal varices, jaundice, ascites/edema,
encephalopathy (brain enlargement)
Pancreatitis- inflammation of pancreas
o Autodigestion of tissue
o Pancreas lacks fibrous capsule
o 2 main causes are gallstones and alcohol abuse
o Diagnosed by Amylase and lipase
 Lipase is more sensitive to acute pancreatitis
o Hypovolemia, low grade fever, decreased bowel sounds
Liver Cancer- hepatocellular carcinoma.
o Usually in cirrhotic livers
o Initial signs are mild and general- not diagnosed until late stages
Pancreatic Cancer- Adenocarcinoma
o Very painful and fast.
o Mortality is close to 95%
o Arises in the ducts.
Lower GI disorders (celiac disease, Crohn disease, ulcerative colitis, IBS, appendicitis,
diverticular disease, colorectal cancer, obstruction, peritonitis)
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Celiac Disease- malabsorption of gluten products
o Primarily in children
o First signs appear when cereals are added
o Manifestations- steatorrhea, failure to gain weight, muscle wasting
Crohn disease- inflammation and fibrosis of small intestine
o SKIP LESIONS- loops and fistulas may form
o Impair process of absorbing and processing foods
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o Delayed growth and sexual maturation
Ulcerative Colitis- inflammation starts in rectum and progresses through the colon
o UP TO 12 STOOLS A DAY (bloody diarrhea)
o Mucosa and submucosa are inflamed
IBS- overgrowth of flora, allergy, postinfectious, hypersensitivity
o low abdominal pain, diarrhea, bloating and nausea
o no single cure
Appendicitis- Fluid builds up inside appendix causing inflammation
o Ischemia and necrosis of the wall
o Bacteria and toxins escape – WBC would be raised
o Localized infection or peritonitis develops around the appendix
o When it ruptures it can be life threatening- goes into peritoneal cavity
o LRQ – rebound tenderness
Diverticular Disease-development of diverticula in the colon
o Diverticulosis-Asymptomatic diverticular disease
o Diverticulitis- Inflammation of diverticula
o Form gaps between muscle layers
o Cramping, nausea, tenderness, elevated WBC count
Colorectal Cancer- adenomatous polyps
o Change in bowel habits, bleeding, weight loss.
o Risk factor includes Ulcerative colitis
Obstruction- lack of movement of intestinal contents through the intestine
o More common in small intestine- MEDICAL EMERGENCY
o Causes
 Hernia, volvulus (twisting), intussusception, tumor, diverticulitis
o Gases and fluid accumulate proximal to the blockage, distending the intestine
o Leads to persistent vomiting, necrosis and ischemia, paralytic ileus
o Functional or Mechanical
 Functional- follows surgery, spinal shock, inflammation
 Mechanical- adhesions, masses, intussusception, volvus.
Peritonitis- inflammation of peritoneal membranes
o Organ opens and releases contents into cavity
o S/s- decreased BP, high HR, localized tenderness, sudden severe pain, abdominal
distension and vomiting, dehydration, and hypovolemia
o PID- when infection reaches the cavity through fallopian tubes
Genitourinary:
Incontinence and retention
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Incontinence- loss of voluntary control of the bladder
o Enuresis- involuntary urination of child older than 4
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o Stress incontinence- increased intra-abdominal pressure forces urine through
sphincter (pregnancy, coughing, laughing, lifting)
o Overflow- incompetent bladder sphincter
Retention- Inability to empty the bladder.
o Spinal cord injury, following anesthesia
Dialysis (HD & PD)
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Hemodialysis- patients’ blood moves from an implanted shunt or catheter in artery to
machine.
o Exchanges fluids, wastes, and electrolytes
o Blood cells and proteins remain in the blood
o 3-4 hours long for 3 days a week
Peritoneal dialysis-usually done on outpatient basis/during night when sleeping
o Catheter with entry and exit points is implanted into peritoneal cavity
o Dialyzing fluid (hypertonic) is instilled into the cavity by a drip bag and drained by
gravity back out into a container.
o Takes more time than hemodialysis and requires loose clothing.
Sustains life during kidney failure until kidney transplant
Disorders or urinary system (UTI, cystitis, urethritis, pyelonephritis, glomerulonephritis,
nephrotic syndrome)
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UTI- caused by E. Coli
o Lower- cystitis and urethritis
o Upper- pyelonephritis
o More common in women bc of shortness of urethra
o BPH in men can cause UTI bc it stagnates the urine
Cystitis/urethritis - bladder wall and urethra are inflamed
o Dysuria, urgency, frequency, nocturia, fever, cloudy with unusual odor.
Pyelonephritis- one or both kidneys involved
o Infection travels from ureter into kidney
o More systemic signs
o Dull aching pain in low back/flank pain
Glomerulonephritis- inflammatory response in glomeruli
o Activates the complement system
o CRP and ESR will be increased. Proteins spill into urine
o Decreased GFR
o Dark, cloudy urine. Facial and periorbital edema, high BP, flank pain, decreased
urine output.
o Would show elevated Urea and creatinine levels
o Metabolic acidosis
o Would be put on sodium restrictions
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Nephrotic Syndrome- abnormality in glomerular capillaries, increased permeability.
o PLASMA PROTEINS SPILL INTO URINE ) ****Protein Urea****
o High blood cholesterol, lipiduria/milky urine.
o s/s massive edema, sudden increase in girth of abdomen
Urinary tract obstructions (urolithiasis, hydronephrosis, tumors [non-specific])
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urolithiasis- (renal calculi) stones may form anywhere in the tract
o composed of calcium salts
 struvite stones- magnesium
 uric acid stones- high purine diets
o may lead to obstruction of urine flow causing infection
o want them to reach the bladder to get out of kidney tubule (get stuck)
o cause spasms and pain in flank area, possible nausea and vomiting, cool moist
skin, rapid pulse
o asymptomatic until it obstructs tubules
Hydronephrosis- excessive amount of urine being formed in kidney and not being
excreted.
o Can lead to chronic renal failure
o Secondary problem to
 Complication of calculi
 Tumors and scar tissue in kidney or ureter
 Untreated prostate enlargement
o Asymptomatic in early stages
Tumors- kidney has to be removed.
o Causes dull, aching flank pain
o Unexplained weight loss, painless bloody urine, anemia
o Palpable mass
o Wilms- most common tumor in children
Renal failure (acute & chronic)
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Acute- bilateral kidney diseases
o Caused by severe, prolonged circulatory shock or heart failure, obstructions, or
nephrotoxins (drugs, chemicals, toxins)
o Sudden onset- elevated BUN and creatinine levels along with metabolic acidosis
and hyperkalemia
o DARK TEA COLORED URINE
Chronic- gradual irreversible destruction of the kidneys over long period of time
o Decreased GFR, renal insufficiency, retention of nitrogen wastes
o Dilute urine is excreted in large volumes
Reproductive:
Disorders of male reproductive system (epispadias, hypospadias, cryptorchidism, hydrocele,
spermatocele, and varicocele, prostatitis, balanitis, BPH, cancer [prostate & testes])
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Epispadias
o Urethra dorsal
Hypospadias
o Urethra by scrotum
Cryptorchidism
o Testes did not descend
Hydrocele
o Watery scrotum
Spermatocele
o Sperm and fluid filled cysts
Varicocele
o Vein around testes
Prostatitis
o Inflammation of prostate
o Acute bacterial
 Contains bacteria
o Nonbacterial
 Has leukocytes
o Chronic bacterial
 Slightly enlarged
 Dysuria
 Frequency
 Urgency
o S/S
 Dysuria
 Frequency
 Urgency
 BPH
 Lower back pain
 Systemic signs
 Anorexia
 Muscle ache
Balanitis
o Yeast infection of glans penis (tip)
BPH
o Compressed urethra
o Nocturia
o Dribbling
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o Slow start
o Dysuria if infection is present
Prostate cancer
o Both invasive and metastatic
o Recurrent prostatitis
o S/S
 Hard nodule
 Hesitancy
 Decreased urine stream
 Frequent UTI
o PSA
Testicular cancer
o Malignant tumor in cancer
o How to do TSE
o Hereditary
o Cryptorchidism
o S/S
 Hard, painless, unilateral
 Feel heavy
 Hydrocele or epididymitis
 Gynecomastia