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185 Cards in this Set
- Front
- Back
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parts of skeletal system
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Bones
* Joints * Cartilage * Ligaments |
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2 divisions of the skeleton
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Axial
* Appendicular |
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names of bones, joints, ligaments, cartilage in a joint
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**muscle
*bursa *tendon *cartilage * synovium * ligament |
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functions of bones:
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support the body
* protect the organs * movement due to attached muscles * store minerals and fats * blood cell formation |
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Bone shapes |
Long bones: femur *short bones: carpal * flat bones: skull * irregular: pelvis bones |
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types of bone cells |
osteocytes: mature bone cells* osteoblasts: bone forming * osteoclasts: bone destroying * (break down bone matrix for remodeling and release of calcium++bone remodeling is done by clasts and blasts) |
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Human skeleton development
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in embryos skeleton is most hyaline cartilage
** during development, most of the cartilage is replaced by bone ** cartilage remains in some areas such as nose bridge, parts of ribs and joints |
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Bone fractures
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closed / simple (does NOT penetrate the skin)
** open / compound (breaks thru skin) ** greenstick (frays, hard to repair) |
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types of joints
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fibrous (immovable: connect bones: skull pelvis)
** cartilaginous (slightly moveable: bones attached by cartilage: spine / ribs) ** synovial (move freely: knee joint) |
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types of joints
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hinge: elbow/knee : extend & retract
** ball and socket: radial movement almost any direction: hip & shoulder ** gliding: allows to slide: hands & feet ** saddle: concave & convex at touching surface: thumb |
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diseases and conditions of the skeletal system
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arthritis
** bursitis ** carpal tunnel ** osteoporosis (porous bones) ** Rickets: soft / weak bones ** Gout ** Spina Bifida ** |
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arthritis
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* inflammation of joint
* symptoms: joint pain, stiffness, swelling, redness, decreased ROM (range of motion) * forms: osteoarthritis ; rheumatoid |
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osteoarthritis
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causes cartilage to break down due to wear & tear damage
** most common form of arthritis |
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rheumatoid |
* lining is called: synovial membrabe * RA usually affect joint symmetrically; most frequently attacks the wrist, hands, elbows, shoulders, knees, ankles * RA starts worsening joint erosion ** * bone erosion * swollen synovial membrane |
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arthritis risk factors |
* age * sex * previous joint injury * obesity |
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Lab testing
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X-ray
* CT scan * MRI * Ultrasound * rheumatoid factor (in blood) |
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management of arthritis
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analgesics (tylenol, percocet, lortab, ultram)
* NSAIDS (motrin, aleve) * Disease modifying antirheumatic drugs (methotrexate) * corticosteroids * physical therapy * surgery: joint replacement or fusion |
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Bursitis
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inflammation of the bursa (fluid filled sac surrounding the joint)
* bursa can become inflamed from injury, infection, or due to underlying rheumatic condition * symptoms: localized pain or swelling, tenderness, and pain with motion of the tissues |
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carpal tunnel syndrome
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cause: pinched nerve
* symptom: tingling, numbness, weakness * results from: compression of median nerve * treatment: wrist splint, NSAIDS, corticosteroids * possibly surgery |
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osteoporosis
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porous bones
* causes bone to become weak and brittle * most common fractures: hip, wrist, spine * occurs when new bone creation doesn't keep up with removal of old bone * loss of calcium * symptoms: back pain (fractured or collapsed vertebrae), loss of height, stooped posture |
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spine problems
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scoliosis: abnormal curvature of spine
* kyphosis: hump back: develops b/c of a degenerative disease; ie: arthritis of spine * lordosis: swayback: curvature of the low back |
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rickets
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softening and weakening bones in children due to prolonged and extreme deficiency of Vitamin D
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Gout
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Overload of Uric acid that leads to production of tiny crystals of urate which deposit in tissues of the body
* causes recurrent attacks of joint inflammation (arthritis) |
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Spina Bifida
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birth defect that involves incomplete development of the spinal cord or the coverings of the spinal cord
* occurs at the end of the first month of pregnancy when 2 sides of the embryo's spine fail to join together leaving an open area * some cases happen to where the spinal cord or membrane push through the opening in the back while others are mild and only noticed on X-ray |
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Muscular tissue |
Muscular cells are called muscle fibers **every fiber contains thousands of myofibrils **inside each myofibril are many myofilaments that are made of two proteins called actin and myosin |
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Characteristics of muscles |
Contractibility **excitability **elasticity **and extensibility |
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Muscle tone |
Atrophy without development ** hypertrophy excessive development |
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Types of muscles |
Smooth , skeletal , and cardiac |
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Smooth muscle |
The muscle cells of smooth muscle are elongated and have one nucleus and form sheets rather than bundles of muscles *they form muscle layers in the walls of the digestive tract * bladder *various ducts *arteries and veins * they are involuntary |
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Skeletal muscles |
Most abundant tissue in the body** produces movement **muscles are cylindrical and contain many nuclei** bond together by connective tissues into bundles and then in turn bind together to form muscles **example: uterus *stomach *bronchi |
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Cardiac muscle |
Also known as heart muscle it is a cross between smooth and skeletal muscle **contracts involuntarily and rhythmically **very resistant to fatigue due to large number of mitochondria |
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Correct muscle fatigue |
Good nutrition eating schedule hydration endurance body mechanics rest and recovery |
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Fibromyalgia |
Widespread musculoskeletal pain described as a dull ache that has lasted at least 3 months pain must occur on both sides of the body above and below the waist ** symptoms: fatigue* sleep *memory and mood issues *depression* headaches *pain and cramping in lower abdomen *no lab tests to confirm *blood tests to rule out other conditions *there is no cure* control symptom *pain relievers, antidepressants anti seizure medication known as neurontin |
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Muscular dystrophy |
A group of diseases that cause Progressive weakness and loss of muscle mass **abnormal genes interfere with how proteins are formed and needed in order to form a healthy muscle **there are different forms of muscular dystrophy **they are more common in childhood boys and some types do not appear until adulthood there** is no cure |
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Most common type muscular dystrophy: Duchenne MD |
Main sign is progressive muscle weakness ** most common type is Duchenne muscular dystrophy ** begin around age 2** frequent falls** difficulty getting up from lying or sitting **trouble running and jumping **waddling gait **walking on toes **large calf muscles **muscle pain and stiffness and learning disabilities |
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Becker muscular dystrophy |
similar to those of Duchenne muscular dystrophy but symptoms are milder and progress slower ** symptoms usually do not begin until teens to mid-twenties |
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Muscular dystrophy complication |
Inability to walk **shortening of muscles and tendons **breathing difficulties some end up on a ventilator** scoliosis due to weakened muscles ** heart problems** swallowing problems** may need feeding tube |
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Two types of muscular dystrophy |
Duchenne muscular dystrophy * Becker muscular dystrophy |
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Test to diagnose muscular dystrophy |
Enzyme test **electromyography** genetic testing **muscle biopsy** lung function tests and heart monitoring test |
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Treatment of muscular dystrophy |
Corticosteroids *heart medication* physical therapy *braces *mobility aids canes*walkers * breathing assistance sleep apnea device** ventilator |
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Strain |
Stretching or tearing of muscles or tendons** remember that Tendons connect muscle to bones** symptoms: pain, swelling, muscle spasms, limited ability to move the affected extremity** ** treatment: OTC pain relievers** apply ice to minimize swelling** brace may be needed to immobilize area*** surgery only needed if there is a torn ligament or ruptured muscle |
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Sprain |
Stretching or tearing of ligaments*** remember ligaments connect bone to bone **symptoms: pain, swelling, bruising, limited ability to move, at the time of injury you hear a pop in the joint** treatment: OTC pain relievers, ice, and brace may be needed **surgery only if there is a torn ligament |
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Tetanus |
Serious bacterial disease affect your nervous system leads to painful muscle contractions particularly of your jaw and neck muscles **tetanus can interfere with your ability to breathe **ultimately tetanus can threaten your life **there is no cure **treatment focuses on managing complications until the effects of the tetanus toxin resolve ** fatality is highest in individuals who have not been immunized and in older adults with inadequate immunization *** signs and symptoms tetanus may appear anytime from a few days to several weeks after tetanus bacteria enters your body through a wound ** average incubation period 7 to 8 days ** signs according to order of appearance 1 spasms 2 stiffness and 3Joe muscles 4 stiffness in neck muscles 5 difficulty swallowing 6. stiffness in abdominal muscles 7 painful body spasms lasting several minutes 8 fever9 sweating 10elevated blood pressure 11 rapid heart rate |
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Clostridium tetany |
Bacteria that causes tetanus *found in soil dust and animal feces *enters the body through a flesh wound * clean the wound prevent growth of tetanus spores** medications ** antitoxin , antibiotics, vaccine ,sedative , magnesium sulfate, beta blockers , morphine * intensive care * rest *ventilator |
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Memorize muscle contraction |
Myoneural stimulation neuron stimulates all skeletal muscles within a motor unit neurons axon send samples by releasing acetylcholin attaches to the sarcolemma (a muscle cell membrane) at the neuromuscular junction allows the muscle fibers to become temporarily permeable to sodium ions which go rushing into the muscle cells this excess of positive ions from the rush of sodium create the electrical disturbance to allow muscle contractions |
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Contracting muscle proteins |
Basic energy source is glucose in the form of ATP ** and Foster creatinine allows energy to be transferred to protein molecules in the muscle ** these protein molecules are actin and myosin **they run the entire length of the muscle ** releasing calcium ion that are stored inside muscle cells that attach to muscle filaments ATP energizes these myofilaments to slide across each other allowing the muscle to shorten |
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Skin layers |
epidermis is the outer layer dermis is the inner layer Body's first line of defense Largest organ |
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Sweat glands |
Excrete sweat thru pores |
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Sweat |
Urea, salt, water |
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Functions of the skin |
Protection * Temperature regulation * Sensations * Stores chemical compounds * Excretes wastes * Synthesis of compounds * Prevent water loss * Metabolic |
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Epidermis |
Outermost layer** Outer layer of dead skin cells (cuticle)** Ashiness---dead skin cells** Dust in my house can be made of dead skin cells. ** Under the cuticle are epithelia cells Which make up the rest of the epidermis** Epidermis is Avascular ** Epidermis receives it's nutrition from the dermis** Cells that are far away from nourishment die
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Cell of the epidermis |
Keratinocytes 90% (protects)** melanocytes 8% (produces melanin)** Merkel (slows mechanoreceptors)** Langerhans (immunological defense) |
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Glands |
Sebaceous * Sweat |
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Sebaceous glands |
Connect to hair follicles * Secrete a waxy oily substance which leads to blackheads * secretion increases at puberty |
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Sweat glands |
Found just about everywhere on the body ** produce perspiration which is water salt and metabolic wastes such as urea ** function is to cool the body |
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Burns |
Threat to life due to catastrophic loss of body fluids causing dehydration or circulatory shock and or infection *first degree *second degree *3rd degree |
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First degree burn |
Epidermal damage sunburn ** red |
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Second degree burn |
Epidermis and upper dermis blisters |
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3rd degree burns |
Entire thickness of skin ** Epidermis, dermis, and part of hypodermis |
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Rule of 9 |
Front of head four and a half percent ** back of head four and a half percent ***chest 9% **upper back nine percent **abdomen 9%** lower back nine percent ** front of leg 9% **back of leg 9% **front of arm four and a half percent **back of arm four and a half percent |
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Tissue repair |
1blood vessels dilate ** 2 white blood cells and clotting agents are released ** 3 scab forms ** 4 granulation tissue forms ** 5 capillary beds invade clot ** 6 scar area has contracted ** 7 epithelium regeneration begins |
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Tumors of the skin |
1 benign 2 cancer |
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Types of cancerous tumors |
Actinic keratosis premalignant ** basal cell most common** nonmelanoma ** squamous cell keratinocytes second most common non melanoma ** melanoma melanocytes most dangerous form must recognize early recognition ABCD |
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Melanoma |
Melanocytes Most dangerous form must recognize early A asymmetry B border irregularity C colors d diameter larger than 6 millimeters |
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Basal cell carcinoma |
Most often appears on Sun exposed areas such as face ears scalp chest back legs the most common appearance small dome-shaped bump that has a pearly white color blood vessels may be seen on surface basal cell cancer can also appear as a pimple like growth that heals only to come back again and again very common sign a sore that bleeds heels recurs again |
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Squamous cell carcinoma |
Firm red nodule appears on face lower lip ears neck hands arms flat lesion with scaly crust new ulceration or raised area on a pre existing scar or ulcer ulcer or flat white patch inside mouth a red raised patch or ulcerated sore in the anus or on your genitals |
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Melanoma |
Highly malignant skin cancer ** arises in melanocytes ** melanoma usually begins in a mole method for remembering signs and symptoms is the neumonic ABCD asymmetrical ** border irregularity ** color ** diameter greater than 6 millimeters |
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Eczema |
Dry red and skin that itches or burns ** appearance of eczema varies from person to person ** intense itching is generally the first symptom ** sometimes eczema can lead to blisters inducing lesions or dry scaly skin ** repeated scratching may lead to thick ** crusty skin |
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Contact dermatitis |
Inflammation of the skin skin ** becomes extremely itchy and inflamed causing redness swelling cracking weeping crusting and scaling ** dry skin is a very common complaint ** this usually occupationally related hair stylist or medical personnel |
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Tinea pedis athlete's foot |
Very common skin infection of the foot caused by fungus ** feet stay moist warm and irritated fungus can thrive and infect the upper layer of the skin ** athlete's foot is caused by the ringworm fungus ** can be found in gym locker rooms floors swimming pools nail salon socks and clothing ** can spread directly from person to person or by contact with objects |
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Urticaria also known as hives |
Red itchy raised areas of skin that appear in varying shapes and sizes range in size from few millimeters to several inches hives can be round or they can form rings or large patches welts red lesions with a red flare at the borders have can occur anywhere on the body trunk arms or legs |
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what is the nervous system?
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the nervous system provides the means by which cell and tissue functions are integrated into an independant living organism
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functional tissues of the nervous system?
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neurons (afferent & efferent)
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afferent neurons
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transmit information TO the CNS
Sensory neurons |
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efferent neurons
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carry information AWAY from the CNS
motor neurons |
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cell body on the neuron
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soma
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soma
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nucleus, cytoplasm, etc.
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nerve processes
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goes from axons and the dendrites
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dendrites
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look like tree branches
* are receptors * designed to pick up on signals * neuron chemical: neurotransmitter |
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axons
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carry the stimulus away
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PNS: supportive tissue
Peripheral Nervous System |
schwann cells: provide insulation to the neurons in the PNS
Satellite cells: provide physical support to neuron |
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CNS: supportive tissue
Central Nervous System |
brain
* spinal cord * oligodendrocytes: provide insulation to the neurons in the CNS * astrocytes: star shaped =VERY IMPORT:: provide physical and nutritional support for the neurons including: cleaning up brain debris, transporting nutrients; holding neurons in place; digesting parts of dead neuronss; regulating content of extracellular space * Microglial cells: digest parts of the dead neurons * Ependymal (glial) cells: serve as lining for ventricles and production of CSF |
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special metabolic requirement is the fuel for neurons?
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glucose axons take info away from
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neuron must have ______ to function
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glucose
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Nerve cell communication
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nerve cell communication: neurotransmitters are chemicals that causechanges in the neuron. in the soma area(cell body) soma contains nucleus DNA info genetic material and the soma takesall the info from the dendrites and put it into the axon which is where theaction potential starts. Then once itgoes down that axon to the axon terminals and release moreneurotransmitters. the neurotransmittersare going to connect with the next neuron. then process starts all over again.(�m@�KJg�
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know this:
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: the action of a transmitter is determined bythe type of the receptor it is binding to.
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action potential
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actionpotential is a neurons way of transporting an electrical signal from one neuronto the next neuron. looking at a neuron,you have dendrites on one end and axon terminal on the other end. right in the middle of the neuron is the axon(in the middle) where the electrical signal travels down to the axonterminal. axon is like a bridge. If a mylon sheath is present the electricalimpulse can travel faster down the axon. Instead of having to activate every single ion schannel down the axon ,only the channels between the myelon sheath called the node of raneir are gonnabe activated. and that's gonna generatethat action potential. same slide youwill see ion channels, closed when cell is resting, ......between intracellularand extracellular space. (sodium /potassium pump comes into play here) (sodium / potassium pump : regulating the environment by pumping outabout 3 sodium ions in exchange for 2 potassium ions.
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know higher concentration of sodium on the outside the neuron
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of the neuron and higher concentration of potassium on the inside
*** so extracellular space will be more positive than on the inside |
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more positive on the inside
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will give you a voltage difference: -70 mv
millivolts |
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axon anatomy
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axon in middle
axon terminal is on the end |
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ion channels at Resting stage
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will be closed
so neuron can create an action potential |
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-70 milivolts (resting potential) *****
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milivolts are created by a leaky ion channel. a little more permeable to the potassium thanthe sodium. so it's easier for potassiumto leave the cell. and a little bit ofsodium to enter.
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depolarization
(more positive inside / less outside) |
the opposite is called depolarization. this creates about positive 40 milivolts.
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3 sodium ions in exchange for 2 potassium
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ion exchange
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repolarization (slide 7) picture
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where state becomes negative again and reaches a state of hyperpolarization when cell lets out way too many ions. now it's more negative than at resting. must be quickly corrected and how it'scorrected is the leaky ion channels.
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slide 8
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spinal cord part of Central Nervous System: gathers information about theenvironment from the peripheral nervous system. from the spinal nerves. thisprocesses information, organizes it, and reflexes and other behavioralresponses.
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grey matter
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found in cell bodies of neurons, dendrites,axon terminals and UN mylenated axons(where synapses occur between the neurons)
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white matter
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theycontain mylenated axons where white color comes from: carries info from placeto place.
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spinal cord
& nerve roots |
covered by pia matter
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spinal cord is divided into 5 different regions: know these::::
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spinal cord is divided into 5 different regionsand how many nerves come out of the cord at each region. cervical has 8 pairs of spinal nervesthoracic has 12 pairs of spinal nerveslumbar region has 5 pairs of spinal nervessacral region has 5 pairand the coxic has 1and there is ONE PAIR of spinal nerves that exitbefore the first vertebrae.total of 32 pair
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slide 9 picture
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picture of back and lumbar On right looking at back. on left is the white matter and the greymatter. ventral root is front, dorsalroot is the back. spinal cord containsthe grey matter. white matter surroundsthe grey matter. little hole in middleis the central canal, containing spinal fluid and it nourishes the nervoustissue.
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Spinal reflexes
slide 10 |
KNOW difference between withdrawreflex and myostatic or stretch reflex.
withdraw stimulated by pain ****** myotatic or stretch reflex: controls muscle tone, helps coordinateposture and walking |
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dermatone
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look at the part of the spine that goes down to the nerve that would be affecting you: ie: bladder problem: color of nerve goes right up to bladder
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The Brain:
slide 11 |
weighs 3 pounds,
takes 20% of cardiac output daily: 29% of oxygen & needs 400 Kcal daily* oxygen and glucosedemand is constant. |
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Brain Stem:
slide 12 |
brainstem: aka: hindbrain
controls these 3: 1.medullaoblongata 2.pons 3. midbrain help with: autonomic, breath, heartrate, swallow, blinking ****** cerebellum controls balance and posture |
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forebrain:
slide 13 |
largest most complex: consists of cerebrum, folds and grooves in pictures.
cerebrum controls our intelligence,. memory,persoanlity, emotions, speech, move and think on our own. forebrain also contains the telencephalon:end brain AND: diencephalon called thebetween brain. |
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hypothalamus monitors:
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hypothalamus monitors many different bodyfunctions, also blood pressure and temperature
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thalamus
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located at top of brian works like a two way relay, sorts and processesinformation
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diencephalon
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maintianing internal body conditionsand temperature
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cerebrum
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largest portion of the brain
* frontal, parietal, temporal, occipital lobes, * deep grove down center: * control all of sensory / motor activities, reason, memory, conscious thought * Left & Right hemispheres: contra-lateral control means left braincontrols right side of body; right brain controls left side of body. * many functional areas of the cerebral cortex have been identified |
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frontal lobe
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the last lobe to develope in young adulthood, organizes responses, lookat complex problems, look at things objectively, search memory for experiencesyou've had
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temporal lobe
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lobe that controls memory , emotion, hearing and on the left side of temporal lobecontrols you language
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parietal lobe
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lobe that helps to receive and process sensory information, such as calculatelocation or speed of objects
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Occipital lobe
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lobe that processes visual data and routesit to other parts of the brain to be able to identify and store it for later.
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cerebellum
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AKA: little brain**
controls: balance & posture & muscle coordination |
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Diencephalon
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: at inner core of cerebrum
** Thalamus, hypothalamus,subthalamus, epithalamus *** processes sensory information and coordinates body's response ** maintains internal body conditions |
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limbic system
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connection not specific area: control mood , emotion, sex drive and memory
* hippocampus; cingulate * |
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3 layers of meninges (CNS: protection)
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pia matter directly continuous with brain
* arachnoid: thin fibrous membrane * dura mater: tough, stiff tissue continuous with the skull |
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CFS: cerebral spinal fluid
ventricles |
four connected cavities within the brain, contain CSF
* CSF is secreted into ventricles by the choroid plexus, provides cushion and protection for ventricles * CSF is clear, mostly water, electrolyte, gases and glucose * circulates around the whole CNS, reabsorbed into blood through the arachnoid layer * color of (CSF) spinal fluid will change with meningitis |
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Blood Brain Barrier
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tight connections between endothelial cells of cerebral arteries
* prevent most molecules from exiting blood and entering neural tissue * water, carbon dioxide, oxygen, glucose and most lipid soluble substances (alcohol) can penetrate this barrier * most electrolytes, plasma proteins, large organic molecules cannot penetrate the blood brain barrier |
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autonomic nervous system
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controlled by hypothalamus & brainstem (at base of brain)
* sympathetic::: control of body temp, blood flow and pressure * parasympathetic::: energy conservation and storage, maintenance of organ function during rest * most organs have dual control |
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hypothalamus
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controls BP and Temp
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Motor Function
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arranged in heirarchy:
spinal cord: brainstem: ultimate control by motor cortex: cerebellum & basal ganglia: |
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spinal cord
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lowest unit of organization / has rhythm to movement
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brainstem
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facial nerves groups of neurons from grey matter
* eye and head movement |
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motor cortex
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highest level of motor function
* cerebellum (timing / coordination) * basal ganglia (gracefullness) |
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upper motor neurons (UMN)
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neuron
that originate in the higher region of the brain like the: motor cortex |
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lower motor neurons (LMN)
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motor unit
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muscle tone
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normal state of muscle tension
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hypotonia (low muscle tone)
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floppy baby
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Flaccidity
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absence of muscle tone
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hypertonia / rigidity / spasticity
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interchangeable : higher than normal muscle tone
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paralysis
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loss of movement or muscle function
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paresis
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incomplete or partial paralysis
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hemi
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left or right side
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para
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paritial paralysis in lower limbs
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quadri
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weakness in all 4 limbs
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basal ganglia
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group of deep nuclei that control and coordinate higher level movements
* located around the thalamus (at top of brain) * overall effect is to control excess movement and acheive preciseness * basal ganglia disorders disrupt movement but don't cause paralysis |
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Parkinson's Disease
(test: lewey bodies present: microscopic) |
1. symptoms often go un-noticed
2. one side of body 3. remain worse on that one side once both sides are affected 4. drag feet when walk *** disorder of dopamine production in the basal ganglia *** lack of dopamine disrupts purposeful movement * rigidity, tremor (hand esp.), akinesia, bradykinesia, loss of postural reflexes * shuffling gait, mask like face * arms may not swing when walk * no cure : treat symptoms only * nerve cells break down and die * symptoms are due to loss of neurons * possibly genetic * |
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possible test question:
A patient was unable to gesture while talking and they suddenly weren't blinking anymore |
Parkinson's disease
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Multiple Sclerosis
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areas of myelin in CNS are destroyed and replaced by astrocytes
* TEST: immune sys. attacks myelin sheath that covers nerves * average age of onset : 30 * more common in women * autoimmune response after viral infection * result is hard, yellow, plaques around nerves in the CNS *** severe MS, may lose ability to walk independently * no cure / treat symptoms * as myelin sheath is progressively destroyed, motor and sensory function decreases * pattern is usually repeated attacks with remissions in between * overall, symptoms gradually worsen with more permanent loss of function after each attack * location of lesions determines specific symptoms * sensory disorders: eye movement pain * electric shock with head movement * spasticity and weakness * cerebellar signs: dizzy, no coordination * bladder / bowel dysfunction * mood disorders: depends what part of brain is affected |
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vertebral and spinal cord injuries
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often due to MVA ( motor vehicle accidents), falls or sports injuries
* vertebral column unable to withstand much rotation, extension , or flexion * vertebrae damage often affects spinal cord * injuries often between "segments" of the spine * mechanical injury causes compression of the spinal cord and disruption of blood supply |
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acute SCI : spinal cord injury
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Primary and secondary injuries
* primary: occurs at the time of injury, direct damage to the spinal cord, is permanent (tear / gunshot) * secondary: continued tissue damage due to inflammation, hypoxia, etc. ::::: spread of damage from original site enzymes & vessels damaged swelling * causes both motor and autonomic nervous system dysfunction * complete transection causes complete loss of all functions below level of injury * inclomplete : some of one or both is retained |
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Cervical Injuries: motor problems
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described by location of injury C1-C7
* higher injuries are often more devastating * C1: often fatal: no respiratory or voluntary motor control * C2-3: some neck control, ventilator!! * C4-C7: better respiratory control, more use of upper extremities |
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Thoracic - Lumbar - Sacral: motor problems
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often from compression factors
* T2 - T12: full upper extremity use, limited trunk * L1-L5: full upper extremity and trunk use, progressive lower extremity use * S1-S5: may have foot control, bladder/bowel incontinence |
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Disruption of ANS function
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connection between spinal ans nerves and the brain is lost (below level of SCI: spinal cord inj)
* SCI's at or above T6 especially problematic ** possible problems: spinal shock ** excessive vasovagal response / neurogenic shock (can cause hypotension) ** autonomic dysreflexia (can cause EXTREME HBP) HTN |
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Autonomic dysreflexia
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a danger with SCI's at T6 or above
* risk of occurrence after spinal shock has resolved * initiated by visceral distension, pain, etc (below level of SCI) * S/SX: vasospasm (HTN), pallor, bradycardia, sweating, HA, anxiety * figure 36-18 in textbook |
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Other SCI effects
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loss of temperature regulation (d/t hypothalamus disruption)
* risk of DVT's and edema * skin breakdown (pressure ulcers: bed sore) |
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mechanisms of brain injury
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hypoxia
* ischema (either local or affect entire brain) * excitatory amino acid injury (glutamate may be released after injury causing hypoglycemia) * cerebral edema (vasogenic & cytotoxis) * vasogenic: interstitial fluid * cytotoxic: intercellular fluid |
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Intracranial pressure
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normal intracranial pressure: 0-15 mm Hg
* brain tissue + CSF volume + blood volume = ICP * Monro-Kellie hypothesis * causes of increased ICP: tumors, injury, EDEMA, bleeds, CSF accumulation (hydrocephalus) * |
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CPP: Cerebral Perfusion Pressure
KEY::::: maintenance of CPP reduces mortality!!! |
measures the adequacy of capillary hydrostatic pressure pushing nutrients out into the brain tissue
* CPP = MABP - ICP (normal CPP 70 - 100 mmHg) * MABP : mean arterial Blood Pressure |
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increase pressure = decrease volume of one your elements
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know
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Steps for determine ICP (intracranial pressure)
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1. measure BP (120/80)
2. multiply the distolic by 2 (80X2)=(160) 3. add systolic to total from step 2 (120+160) 4. divide total from step 3 by 3 (280/9)=(93)MABP 5. central venous pressure seen on machine in hospital (ex: 7) 6. 93-7=86 CPP (this is normal) |
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Increases ICP: Clinical S/sx
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sustained increased ICP leads to hypoxia,
*change in level of consciousness most sensitive, headache, papilledema, projectile vomiting late: CNS ischemic response "cushing's reflex" -- extremely high BP (wide pulse pressure) -- bradycardia * eventual death of neurons another late effect: herniation |
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Herniation (of ICP)
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displacement of brain tissue due to increased ICP, from area of higher pressure to lower pressure:::: moved or pressed away :::::
d/t swelling from tumor or stroke, typically go thru foramen magnum |
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Force injuries
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TBI: leading cause of death in <24 year-olds
* greater force causes greater damage * blunt trauma (MVA) causes general injury (sudden deceleration causes coup and contrecoup injuries) brain bounces back and forth inside the head: brain slam into skull and back from sudden stop * tissue and vessel damage possible * secondary swelling, edema, ischemia begin soon after ...... leading to ICP related problems * AKA: acceleration / deceleration injury * |
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mild head injury
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concussion: forget what happened
* may have amnesia surrounding injury and extended confusion * post concussion syndrome: confusion, headaches,dizziness, sleep problems lasting days to weeks * cumulative effect of multiple concussions: leads to death |
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moderate head injury
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moderate: more extensive vascular damage, causes loss of consciousness, cognitive and motor deficits possible, contusions often visible on CT
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severe head injury
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significant mechanical damage, often causing hemorrhages, significant neuro deficits and loss of function
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Epidural Hematomas
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between the dura
* usually in the parietal or temporal lobes, arterial often following a skull fracture * often follow a TBI severe enough to cause loss of consciousness * temporal lobe forced downward / inward by growing hematoma * heriation occurs - unconsciousness, cranial nerve dysfunction, weakness, reflex changes * ICP gradually increases to severely high level |
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Subdural Hematomas
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Often due to a tear in the bridging veins on surface of cortex
* acute: s/sx within 24 hours of injury * subacute: s/sx 2 - 10 days after injury * chronic: s/sx may take several weeks |
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Diffuse Brain injury Manifestations
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consciousness is coordinated by cerebral hemispheres and reticular activation system
* altered LOC and behavior changes * confusion, delirium, obtundation, stupor, coma |
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confusion:
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disoriented, disturbance of consciousness
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delirium
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hallucinations, disorientation, delusions
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obtundation
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decrease alertness to what's going on @ them
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stupor
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not unconscious but little or no activity: reduced level of consciousness
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coma / glascow coma scale
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glasgow coma scale
* eye opening 1-4 motor response 1 - 6 verbal response 1-5 decorticate posturing (flexion) *** arms flexed but will not extend decerebrate posturing (extension) extended will not flex *** respiratory changes (indicate sign. brain damage) * loss of pupillary refelxes (also sign. brain damage) |
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infectious meningitis
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viral or bacterial
* viral cases are milder, shorter * general symptoms: headache, nuchal rigidity, fever (bacterial), pain thru body, nausea / vomit * Lumbar puncture necessary to diagnose and distinguish between viral or bacterial * viral : milder / shorter |
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bacterial meningitis
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Streptococcus pneumonia
* H. influenza * Neisseria meningitidis (the meningococcus) * Additional S/sx of meningococcal meningitis include a rash on extremities, possible gangrene, organ failure * Vaccine available for meningococcal meningitis |
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Patho of bacterial meningitis
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1. bacteria invades CSF, releasing endotoxins
2. endotoxin release stimulates release of inflammatory mediators in the subarachnoid space, meningeal layers 3. Neutrophils arrive, bind to and damage the endothelial cells of the blood-brain barrier 4. This damage allows fluid and more pathogens to move across capillary walls into the CSF 5. vessels within the meninges become inflamed and dilated, increased volume and viscosity of CSF---increased ICP |
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Encephalitis
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generalized infection of parenchyma of brain and spinal cord causing edema, necrosis, breakdown of neurons
* common causes in US: herpes simplex virus, also mosquito virus (west Nile), rabies virus, HIV * other causes: may also be caused by bacteria and fungi * S/sx: fever, HA, nuchal rigidity and LOC changes |
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Seizure Disorders
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1 in 10 people will have at least one seizure in their lifetime
* febrile seizure ??? * Excessive "firing" of neurons in the brain, either primary or secondary * Epilepsy: disorder of repeated, idiopathic seizures * many different levels and categories ***** fever from 99 to 103 in 1/2 hour: will cause seizures ****** |
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Patho of seizures
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excessive , paroxysmal discharge of cerebral neurons
* cellular-level problems: membrane instability , hypersensitive, neurons, neurotransmitter or electrolyte imbalances * metabolic effects of seizures |
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Partial Seizures
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start in a specific area of the brain
* simple: partial: maintain consciousness but may have small motor or sensory effects ** complex and secondarily generalized partial: consciousness is impaired or lost, more likely to have visible motor effects, confusion following the seizure |
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Generalized Seizures
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Involve both hemispheres, lose consciousness
*** tonic-clonic: aka grand mal, rapid loss of consciousness, falls to ground, jerking of whole body, loss of bladder/bowel function ---- postictal period * absence: aka petit mal |
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Status Epilepticus
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continued seizure activity that doesn't resolve on its own generally labeled SE after about 20 minutes
*** Emergency ** complications: hyperpyrexia, bronchial obstruction, aspiration of vomitus, breakdown of cardiovascular function (dysrhythmias) |
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Dementia
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(not a specific disease)
* definition: a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning. *** most common cause is Alzheimer's DAT * Other causes include infection, nutritional deficiencies, stroke, toxic substances * initial testing should be done to rule out other causes, if no other causes found, diagnosed with Alzheimers |
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Alzheimer's Disease
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AD causes loss of neurons in hippocampus and cerebral cortex * AD causes lesions in neurons: Neurofibrillary tangle (distorted protein) Senile (amyloid-beta) plaques (coats neurons) * Familial and sporadic * Genetics, free radicals, inflammation * degenerative, progressive (3 - 10 years) disease of the brain that destroys neurons** Initial changes: short-term memory loss and personality changes * then loss of language and reasoning, more erratic behavior * finally loss of all conscious functions * More common after 65 |
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Headaches
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very common disorder
* Primary (migraine) * Secondary (benign) * most secondary headaches are benign ---- signs of problems * common types of primary headaches: ----migraines, tension, cluster, chronic daily headaches **** migraine WITH aura: 15% have signs before migraine begins 5 to 20 minute aura: last 5 minutes to an hour **** migraine WITHOUT aura: pulse throb 1 to 2 days, Nausea / Vomiting, hallucination |
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Migraine Headaches
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more common in women (possibly genetic)
* migraine without aura (85%) * ---- throbbing, unilateral, severe headache, often with n/v, light / sound sensitivity * Migraine with aura (15%) ---- all the above plus "predictive" signs such as visual or other sensory changes |
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Patho of migraines
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Not clearly established
** the trigeminal nerve (CN V) becomes over-activated, resulting in inflammation and dilation of cerebral blood vessels * changes in hormone levels also related * Drug therapy is geared toward reversing vascular inflammation and dilation |
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cluster headaches
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uncommon (80-85%) are men vs. women
* repeated clusters of headaches over a few weeks / months * severe, constant unilateral pain around the orbital area, peaks quickly, lasts <2-3 hours * treatment: supplemental oxygen or injected migraine medicine |
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Tension headaches
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variable pain, less intense than migraines or clusters
* a milder form of migraines? * May relate to muscle tension, overuse of caffeine * Over-the-counter meds such as tylenol and NSAIDS usually effective * Non-medication treatments also effective * 3 times a day for 3 days::: use Ice Packs |
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Chronic Daily Headaches
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greater than or equal to: 15 days per month
* May be related to overuse of headache medication * Often combination therapy is necessary to reduce frequency and intensity |
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neurotransmitter
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chemical that causes signals to stimulate a change in a neuron
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