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399 Cards in this Set
- Front
- Back
|
Chronic renal failure progresses to ____ ____ _____ _____
|
End stage renal disease
|
|
|
What are the 2 most common causes of chronic renal failure?
|
Diabetes and hypertension
|
|
|
In a patient with diabetes, what is the mechanism that leads to chronic renal failure?
|
Increased ROS (because of increased catabolism of fats and ketones)
|
|
|
In a patient with hypertension what is the mechanism that leads to chronic renal failure?
|
Increased BHP
|
|
|
What structure is damaged by hypertension and diabetes that leads to chronic renal failure?
|
Glomerular capillaries
|
|
|
When does reduced renal reserve occur?
|
When GFR is less than 50%
|
|
|
What are the symptoms in a patient with reduced renal reserve?
|
The patient is asymptomatic, but may have slight azotemia at this point.
|
|
|
What are the primary symptoms of Renal insufficiency?
|
Polyurea (because functioning portions of kidney are working overtime)
|
|
|
What are the symptoms of renal failure?
|
Azotemia, oligiourea, hypertension, acidosis, and hyperkalemia
|
|
|
What is the symptom that signals end stage chronic renal failure?
|
Anurea
|
|
|
List in order the four stages of chronic renal failure
|
Reduced renal reserve, renal insufficiency, renal failure and end stage
|
|
|
How are the reduced renal reserve and renal insufficiency stages of chronic renal failure diagnosed?
|
Test for specific gravity will show no change with reduced or increased H2O intake
|
|
|
What does it mean if the specific gravity test shows no difference with increased or decreased H2O intake?
|
The kidney tubules are not working properly to reabsorb H2O or Na+ based on hormones ADH and aldosterone
|
|
|
What is the mechanism that causes azotemia ina patient with chronic renal failure?
|
Decreased GFR
|
|
|
What are the mechanisms that cause hyperkalemia in a patient with chronic renal failure?
|
decreased GFR, cell death and acidosis
|
|
|
Why would a patient with chronic renal failure have acidosis?
|
H+ is normally secreted into filtrate, tubules are not working properly H+ is not secreted into filtrate and builds up in blood
|
|
|
What is the mechanism that causes hypertension in a patient with chronic renal failure?
|
Decreased GFR
|
|
|
What causes anemia in a patient with chronic renal failure?
|
Decrease in production of erythropoietin (made in the kidney)
|
|
|
List 10 functions of the kidney!
|
1.production of bile 2. vitamin storage 3. detox of drugs 4. glycogenesis, glycogenolysis, gluconeogenesis 5. makes proteins: albumins & globulins 6. makes cholesterol 7. makes angiotensin I 8. makes clotting factors 9. break down RBC's 10. break down hormones (ADH, aldosterone, estrogen, and testosterone)
|
|
|
What are 7 general manifestations of liver disease?
|
Portal hypertension, varicosities, splenomegaly, ascites, hepatic encephalopathy, jaundice and altered sex hormones
|
|
|
Where does portal hypertension occur?
|
In the portal vein
|
|
|
What is one cause of portal hypertension?
|
Inflammation of the liver cells causes central vein to be compressed increasing pressure in the portal vein
|
|
|
What problem with the veins in the GI tract is caused by liver disease?
|
Increased pressure from portal hypertension can back up and cause varicosities in veins in the GI tract.
|
|
|
What are 3 common places for varicosities caused by liver disease?
|
Abdominal varices, rectal varices, and esophageal varices
|
|
|
What is the mechanism that causes ascites in a patient with liver disease?
|
Increased BHP in abdomen (from portal hypertension and increase in ADH and aldosterone - broken down in liver) decreased BOP (because of lack of albumins - made in liver)
|
|
|
How does hepatic encephalopathy occur in a person with liver disease?
|
Proteins degrade into ammonia and then are converted to urea in liver. Diseased liver doesn't convert as much so ammonia builds up which is toxic to the brain.
|
|
|
What is the first symptom of hepatic encephalopathy?
|
Blindness
|
|
|
What symptoms other than blindness can occur in a person with hepatic encephalopathy?
|
Seizures and confusion
|
|
|
What type of bilirubin (conjugated/unconjugated) is found inside a macrophage?
|
Unconjugated
|
|
|
What type of bilirubin (cunjugated/unconjugated) is found in blood plasma?
|
Unconjugated
|
|
|
Where does bilirubin become conjugated?
|
In the liver
|
|
|
What type of bilirubin (conjugated/unconjugated) is found in bile?
|
Conjugated
|
|
|
If a patient is diagnosed with extrahepatic jaundice will there be an increase in conjugated or unconjugated bilirubin in their blood?
|
Conjugated
|
|
|
If a patient is diagnosed with intrahepatic jaundice will blood work show an increase in conjugated or unconjugated bilirubin?
|
Depends on the site of obstruction. It could be conjugated if obstruction in bile duct, unconjugated if there is a blood vessel obstruction. Most diseases inside the liver will cause BOTH to increase due to blood flow & bile ducts being affected
|
|
|
What type of hemoglobin does a fetus have?
|
Hemoglobin F
|
|
|
What type of hemoglobin do adults have?
|
Hemoglobin A
|
|
|
Why do many infants become jaundiced?
|
If the liver can't keep up with the increase in unconjugated bilirubin due to hemoglobin F being destroyed, bilirubin builds up in the blood.
|
|
|
What is the treatment for physiologic jaundice of the newborn?
|
Phototherapy - UV light conjugates the bilirubin in the blood stream
|
|
|
What type of jaundice is caused by hemoglobin F being replaced by hemoglobin A?
|
Physiologic jaundice of the newborn
|
|
|
What type of jaundice is caused by an autoimmune disease that destroys red blood cells?
|
Hemolytic jaundice
|
|
|
What is the mechanism that causes gynecomastia in men with liver disease?
|
Increase in estrogen
|
|
|
What is the mechanism that causes testicular atrophy in men with liver disease?
|
Increase in estrogen
|
|
|
What is the mechanism that causes hirsutism in women with liver disease?
|
Increase in testosterone
|
|
|
What is the disease caused by an increase in testosterone in women with liver disease?
|
Hirsutism
|
|
|
Why is it possible for a woman with liver disease to have an increase in testosterone?
|
Because the liver is responsible for the breakdown of testosterone and if the liver is not functioning properly testosterone levels will increase
|
|
|
What are some of the most common manifestations of liver disease?
|
Jaundice, ascites and portal hypertension
|
|
|
What is the name for the disease that involves a combination of fibrosis and regeneration of the liver tissues?
|
Cirrhosis
|
|
|
What are 4 causes of cirrhosis ?
|
Chronic alcoholism, chronic hepatitis (Hep C), Congestive Heart Failure, and Obesity
|
|
|
What is the liver condition which involves ROS's in the liver causing lipid peroxidation?
|
Hepatic lipidosis
|
|
|
What are the 3 stages of cirrhosis?
|
1. Fatty liver (no symptoms) 2. Hepatitis (inflammation and necrosis) 3. Cirrhosis (dead cells cause fibrosis)
|
|
|
At what stage of cirrhosis does the condition become irreversible?
|
3rd stage - Cirrhosis
|
|
|
What are some of the early clinical signs of the second stage of cirrhosis - hepatitis?
|
Abdominal pain, fever, vomiting, fatigue (due to lack of glucose), blood values - ALT and AST will increase, and anorexia (not eating)
|
|
|
Why does a patient in the inflammation stage of hepatitis have an increase in ALT and AST in their blood?
|
They are enzymes that are released from dead liver cells.
|
|
|
What 2 things happen in the hepatitis stage of cirrhosis?
|
Inflammation and necrosis
|
|
|
What are the signs that there is necrosis in the liver cells in a person in the hepatitis stage of cirrhosis?
|
jaundice, ascites, hepatic encephalopathy, portal hypertension, hypertension, gynecomastia and/or testicular atrophy - men, hirsutism - women.
|
|
|
Why could a person with cirrhosis possibly have hepatic encephalopathy?
|
Decrease in protein waste metabolism leads to increase in ammonia in the blood which is toxic in the brain - hepatic encephalopathy
|
|
|
Why could a person with cirrhosis have difficulty clotting?
|
The liver stores vitamin K. If not functioning properly then vit K stores are depleted and there is difficulty with clotting
|
|
|
What are the signs that a person with cirrhosis has reached the stage of fibrosis?
|
Jaundice due to increase in conjugated bilirubin because of obstruction of bile flow AND/OR increase in unconjugated bilirubin due to obstructed blood flow. Ascites and varicosities due to portal HTN
|
|
|
How many strains are there of viral hepatitis?
|
6
|
|
|
How many strains of viral hepatitis do we currently have vaccines for? Which ones?
|
2 - HepA &HepB
|
|
|
Which type of hepatitis can become chronic in 50-80% of people who have it?
|
Hepatitis C
|
|
|
Which type of hepatitis has severe symptoms but a short duration of illness?
|
HepA
|
|
|
What is the transmission of HepA?
|
Fecal/oral and blood
|
|
|
What type(s) of Hepatitis are transmitted as a STD?
|
HepB and Hep C
|
|
|
What type of hepatitis can become chronic in 15-30% of people and others can be carriers with no symptoms at all?
|
HepB
|
|
|
Which type of hepatitis has the mildest symptoms but has no vaccine and is a STD?
|
Hepatitis C
|
|
|
What are the 4 phases of illness with Hepatitis?
|
Incubation, prodromal, icteric, recovery
|
|
|
What happens during the hepatitis incubation phase?
|
Virus is replicating - no symptoms
|
|
|
What happens during the hepatitis prodromal phase?
|
Flu-like symptoms, contagious
|
|
|
During what phase(s) of hepatitis are you contagious?
|
Prodromal, icteric and recovery
|
|
|
What happens during the hepatitis icteric phase?
|
There is some hepatocellular death but many people are not aware of this at the time because the liver regenerates - some become jaundiced
|
|
|
What happens during the hepatitis recovery phase?
|
Lasts 6-8 weeks, liver regeneration. Virus can remain and cause further damage later
|
|
|
During which phase of hepatitis does a person have flu-like symptoms?
|
Prodromal phase
|
|
|
During which phase of hepatitis is a person asymptomatic and the virus is replicating?
|
Incubation phase
|
|
|
During which phase of hepatitis is there hepatocellular death which may or may not lead to jaundice?
|
Icteric
|
|
|
During what phase of hepatitis does regeneration of the liver occur?
|
Recovery
|
|
|
|
|
|
|
Chronic renal failure progresses to ____ ____ _____ _____
|
End stage renal disease
|
|
|
What are the 2 most common causes of chronic renal failure?
|
Diabetes and hypertension
|
|
|
In a patient with diabetes, what is the mechanism that leads to chronic renal failure?
|
Increased ROS (because of increased catabolism of fats and ketones)
|
|
|
In a patient with hypertension what is the mechanism that leads to chronic renal failure?
|
Increased BHP
|
|
|
What structure is damaged by hypertension and diabetes that leads to chronic renal failure?
|
Glomerular capillaries
|
|
|
When does reduced renal reserve occur?
|
When GFR is less than 50%
|
|
|
What are the symptoms in a patient with reduced renal reserve?
|
The patient is asymptomatic, but may have slight azotemia at this point.
|
|
|
What are the primary symptoms of Renal insufficiency?
|
Polyurea (because functioning portions of kidney are working overtime)
|
|
|
What are the symptoms of renal failure?
|
Azotemia, oligiourea, hypertension, acidosis, and hyperkalemia
|
|
|
What is the symptom that signals end stage chronic renal failure?
|
Anurea
|
|
|
List in order the four stages of chronic renal failure
|
Reduced renal reserve, renal insufficiency, renal failure and end stage
|
|
|
How are the reduced renal reserve and renal insufficiency stages of chronic renal failure diagnosed?
|
Test for specific gravity will show no change with reduced or increased H2O intake
|
|
|
What does it mean if the specific gravity test shows no difference with increased or decreased H2O intake?
|
The kidney tubules are not working properly to reabsorb H2O or Na+ based on hormones ADH and aldosterone
|
|
|
What is the mechanism that causes azotemia ina patient with chronic renal failure?
|
Decreased GFR
|
|
|
What are the mechanisms that cause hyperkalemia in a patient with chronic renal failure?
|
decreased GFR, cell death and acidosis
|
|
|
Why would a patient with chronic renal failure have acidosis?
|
H+ is normally secreted into filtrate, tubules are not working properly H+ is not secreted into filtrate and builds up in blood
|
|
|
What is the mechanism that causes hypertension in a patient with chronic renal failure?
|
Decreased GFR
|
|
|
What causes anemia in a patient with chronic renal failure?
|
Decrease in production of erythropoietin (made in the L)
|
|
|
List 10 functions of the liver!
|
1.production of bile 2. vitamin storage 3. detox of drugs 4. glycogenesis, glycogenolysis, gluconeogenesis 5. makes proteins: albumins & globulins 6. makes cholesterol 7. makes angiotensin I 8. makes clotting factors 9. break down RBC's 10. break down hormones (ADH, aldosterone, estrogen, and testosterone)
|
|
|
What are 7 general manifestations of liver disease?
|
Portal hypertension, varicosities, splenomegaly, ascites, hepatic encephalopathy, jaundice and altered sex hormones
|
|
|
Where does portal hypertension occur?
|
In the portal vein
|
|
|
What is one cause of portal hypertension?
|
Inflammation of the liver cells causes central vein to be compressed increasing pressure in the portal vein
|
|
|
What problem with the veins in the GI tract is caused by liver disease?
|
Increased pressure from portal hypertension can back up and cause varicosities in veins in the GI tract.
|
|
|
What are 3 common places for varicosities caused by liver disease?
|
Abdominal varices, rectal varices, and esophageal varices
|
|
|
What is the mechanism that causes ascites in a patient with liver disease?
|
Increased BHP in abdomen (from portal hypertension and increase in ADH and aldosterone - broken down in liver) decreased BOP (because of lack of albumins - made in liver)
|
|
|
How does hepatic encephalopathy occur in a person with liver disease?
|
Proteins degrade into ammonia and then are converted to urea in liver. Diseased liver doesn't convert as much so ammonia builds up which is toxic to the brain.
|
|
|
What is the first symptom of hepatic encephalopathy?
|
Blindness
|
|
|
What symptoms other than blindness can occur in a person with hepatic encephalopathy?
|
Seizures and confusion
|
|
|
What type of bilirubin (conjugated/unconjugated) is found inside a macrophage?
|
Unconjugated
|
|
|
What type of bilirubin (cunjugated/unconjugated) is found in blood plasma?
|
Unconjugated
|
|
|
Where does bilirubin become conjugated?
|
In the liver
|
|
|
What type of bilirubin (conjugated/unconjugated) is found in bile?
|
Conjugated
|
|
|
If a patient is diagnosed with extrahepatic jaundice will there be an increase in conjugated or unconjugated bilirubin in their blood?
|
Conjugated
|
|
|
If a patient is diagnosed with intrahepatic jaundice will blood work show an increase in conjugated or unconjugated bilirubin?
|
Depends on the site of obstruction. It could be conjugated if obstruction in bile duct, unconjugated if there is a blood vessel obstruction. Most diseases inside the liver will cause BOTH to increase due to blood flow & bile ducts being affected
|
|
|
What type of hemoglobin does a fetus have?
|
Hemoglobin F
|
|
|
What type of hemoglobin do adults have?
|
Hemoglobin A
|
|
|
Why do many infants become jaundiced?
|
If the liver can't keep up with the increase in unconjugated bilirubin due to hemoglobin F being destroyed, bilirubin builds up in the blood.
|
|
|
What is the treatment for physiologic jaundice of the newborn?
|
Phototherapy - UV light conjugates the bilirubin in the blood stream
|
|
|
What type of jaundice is caused by hemoglobin F being replaced by hemoglobin A?
|
Physiologic jaundice of the newborn
|
|
|
What type of jaundice is caused by an autoimmune disease that destroys red blood cells?
|
Hemolytic jaundice
|
|
|
What is the mechanism that causes gynecomastia in men with liver disease?
|
Increase in estrogen
|
|
|
What is the mechanism that causes testicular atrophy in men with liver disease?
|
Increase in estrogen
|
|
|
What is the mechanism that causes hirsutism in women with liver disease?
|
Increase in testosterone
|
|
|
What is the disease caused by an increase in testosterone in women with liver disease?
|
Hirsutism
|
|
|
Why is it possible for a woman with liver disease to have an increase in testosterone?
|
Because the liver is responsible for the breakdown of testosterone and if the liver is not functioning properly testosterone levels will increase
|
|
|
What are some of the most common manifestations of liver disease?
|
Jaundice, ascites and portal hypertension
|
|
|
What is the name for the disease that involves a combination of fibrosis and regeneration of the liver tissues?
|
Cirrhosis
|
|
|
What are 4 causes of cirrhosis ?
|
Chronic alcoholism, chronic hepatitis (Hep C), Congestive Heart Failure, and Obesity
|
|
|
What is the liver condition which involves ROS's in the liver causing lipid peroxidation?
|
Hepatic lipidosis
|
|
|
What are the 3 stages of cirrhosis?
|
1. Fatty liver (no symptoms) 2. Hepatitis (inflammation and necrosis) 3. Cirrhosis (dead cells cause fibrosis)
|
|
|
At what stage of cirrhosis does the condition become irreversible?
|
3rd stage - Cirrhosis
|
|
|
What are some of the early clinical signs of the second stage of cirrhosis - hepatitis?
|
Abdominal pain, fever, vomiting, fatigue (due to lack of glucose), blood values - ALT and AST will increase, and anorexia (not eating)
|
|
|
Why does a patient in the inflammation stage of hepatitis have an increase in ALT and AST in their blood?
|
They are enzymes that are released from dead liver cells.
|
|
|
What 2 things happen in the hepatitis stage of cirrhosis?
|
Inflammation and necrosis
|
|
|
What are the signs that there is necrosis in the liver cells in a person in the hepatitis stage of cirrhosis?
|
jaundice, ascites, hepatic encephalopathy, portal hypertension, hypertension, gynecomastia and/or testicular atrophy - men, hirsutism - women.
|
|
|
Why could a person with cirrhosis possibly have hepatic encephalopathy?
|
Decrease in protein waste metabolism leads to increase in ammonia in the blood which is toxic in the brain - hepatic encephalopathy
|
|
|
Why could a person with cirrhosis have difficulty clotting?
|
The liver stores vitamin K. If not functioning properly then vit K stores are depleted and there is difficulty with clotting
|
|
|
What are the signs that a person with cirrhosis has reached the stage of fibrosis?
|
Jaundice due to increase in conjugated bilirubin because of obstruction of bile flow AND/OR increase in unconjugated bilirubin due to obstructed blood flow. Ascites and varicosities due to portal HTN
|
|
|
How many strains are there of viral hepatitis?
|
6
|
|
|
How many strains of viral hepatitis do we currently have vaccines for? Which ones?
|
2 - HepA &HepB
|
|
|
Which type of hepatitis can become chronic in 50-80% of people who have it?
|
Hepatitis C
|
|
|
Which type of hepatitis has severe symptoms but a short duration of illness?
|
HepA
|
|
|
What is the transmission of HepA?
|
Fecal/oral and blood
|
|
|
What type(s) of Hepatitis are transmitted as a STD?
|
HepB and Hep C
|
|
|
What type of hepatitis can become chronic in 15-30% of people and others can be carriers with no symptoms at all?
|
HepB
|
|
|
Which type of hepatitis has the mildest symptoms but has no vaccine and is a STD?
|
Hepatitis C
|
|
|
What are the 4 phases of illness with Hepatitis?
|
Incubation, prodromal, icteric, recovery
|
|
|
What happens during the hepatitis incubation phase?
|
Virus is replicating - no symptoms
|
|
|
What happens during the hepatitis prodromal phase?
|
Flu-like symptoms, contagious
|
|
|
During what phase(s) of hepatitis are you contagious?
|
Prodromal, icteric and recovery
|
|
|
What happens during the hepatitis icteric phase?
|
There is some hepatocellular death but many people are not aware of this at the time because the liver regenerates - some become jaundiced
|
|
|
What happens during the hepatitis recovery phase?
|
Lasts 6-8 weeks, liver regeneration. Virus can remain and cause further damage later
|
|
|
During which phase of hepatitis does a person have flu-like symptoms?
|
Prodromal phase
|
|
|
During which phase of hepatitis is a person asymptomatic and the virus is replicating?
|
Incubation phase
|
|
|
During which phase of hepatitis is there hepatocellular death which may or may not lead to jaundice?
|
Icteric
|
|
|
During what phase of hepatitis does regeneration of the liver occur?
|
Recovery
|
|
|
|
|
|
|
Where are insulin and glucagon produced?
|
In the Islets of Langerhans in the pancreas
|
|
|
What type of cells produce insulin?
|
Beta cells in the pancreas
|
|
|
What type of cells produce glucagon?
|
Alpha cells in the pancreas
|
|
|
What is the mechanism that causes type 1 diabetes?
|
Lack of insulin
|
|
|
What is the mechanism that causes type II diabetes?
|
Insulin resistant receptors
|
|
|
What is the purpose of insulin receptors ? Why would insulin resistant receptors be a problem?)
|
Insulin must bind to receptors before glucose can enter the cell. If insulin resistant glucose increases in the blood stream and decreased cellular glucose
|
|
|
What are 4 places that do not need insulin receptors in order for glucose to enter the cell?
|
Nervous cells, liver cells, muscle cells and RBC's
|
|
|
What are 2 things that are necessary for a diagnosis of diabetes without an oral glucose tolerance test?
|
Presence of symptoms and blood glucose over 200mgldl
|
|
|
What test is used to diagnose a person with diabetes if they have no apparent symptoms but they have a fasting blood glucose test over 126mgldl?
|
Oral glucose tolerance test
|
|
|
Why might a person who does not have diabetes have high blood glucose levels?
|
Stress increases sympathetic nervous system which stimulates glycogenolysis in the liver - increasing blood glucose level
|
|
|
What are the 2 forms of Type 1 diabetes?
|
Immune form and non-immune form
|
|
|
Which type of diabetes (SPECIFIC) is secondary to some other condition such as pancreatitis?
|
Type 1 diabetes - Non-Immune form
|
|
|
What type of diabetes (SPECIFIC) is caused by an autoimmune disease that attacks the beta cells in the pancreas?
|
Type 1 diabetes - Immune form
|
|
|
Chronic renal failure progresses to ____ ____ _____ _____
|
End stage renal disease
|
|
|
What are the 2 MAJOR symptoms of Type 1 diabetes ?
|
Hyperglycemia and cellular glucose starvation
|
|
|
What are the 2 most common causes of chronic renal failure?
|
Diabetes and hypertension
|
|
|
What are the 4 symptoms that accompany hyperglycemia in type 1 diabetes? List in order!
|
Glucosuria, Polyuria, Polydypsia, Dehydration & hypotension
|
|
|
In a patient with diabetes, what is the mechanism that leads to chronic renal failure?
|
Increased ROS (because of increased catabolism of fats and ketones)
|
|
|
Why would a patient with hyperglycemia due to type 1 diabetes have glucosuria?
|
The excessive glucose in the blood stream is filtered in the kidneys. It can't all be reabsorbed back into the blood so some is lost in the urine.
|
|
|
In a patient with hypertension what is the mechanism that leads to chronic renal failure?
|
Increased BHP
|
|
|
Why would a patient with hyperglycemia due to type 1 diabetes have polyuria?
|
The glucose in the urine (glucosuria) pulls water into the filtrate because of the increased osmolarity which makes them have to urinate more frequently
|
|
|
What structure is damaged by hypertension and diabetes that leads to chronic renal failure?
|
Glomerular capillaries
|
|
|
Why would a patient with hyperglycemia due to type 1 diabetes have polydypsia?
|
The hypothalamus receives the signal that there is increased solute and decreased plasma in the blood (due to the H2O being absorbed into filtrate) which triggers the thirst sensation
|
|
|
When does reduced renal reserve occur?
|
When GFR is less than 50%
|
|
|
Why would a patient with hyperglycemia due to type 1 diabetes have dehydration and hypotension?
|
The water loss in the filtrate causes dehydration which also lowers BP
|
|
|
What are the symptoms in a patient with reduced renal reserve?
|
The patient is asymptomatic, but may have slight azotemia at this point.
|
|
|
What are the symptoms that accompany cellular glucose starvation in a patient with type 1 diabetes?
|
Weight loss, polyphagia, ketoacidosis, fatigue
|
|
|
What are the primary symptoms of Renal insufficiency?
|
Polyurea (because functioning portions of kidney are working overtime)
|
|
|
Why would a patient with cellular glucose starvation due to type 1 diabetes lose weight?
|
Because the cells are not getting glucose they will catabolize fats and proteins instead which causes them to lose weight
|
|
|
What are the symptoms of renal failure?
|
Azotemia, oligiourea, hypertension, acidosis, and hyperkalemia
|
|
|
What is the symptom that signals end stage chronic renal failure?
|
Anurea
|
|
|
Why would a patient with cellular glucose starvation due to type 1 diabetes have polyphagia?
|
The cells think that they are being starved because of the lack of glucose and they trigger the sensation of hunger
|
|
|
What does the term polyphagia mean?
|
Excessive eating/hunger
|
|
|
List in order the four stages of chronic renal failure
|
Reduced renal reserve, renal insufficiency, renal failure and end stage
|
|
|
What is the emergency that can be caused by cellular glucose starvation in a patient with type 1 diabetes?
|
Ketoacidosis
|
|
|
How are the reduced renal reserve and renal insufficiency stages of chronic renal failure diagnosed?
|
Test for specific gravity will show no change with reduced or increased H2O intake
|
|
|
What is the mechanism that causes ketoacidosis in a patient with type 1 diabetes?
|
Increased fat and protein catabolism by the cells
|
|
|
What does it mean if the specific gravity test shows no difference with increased or decreased H2O intake?
|
The kidney tubules are not working properly to reabsorb H2O or Na+ based on hormones ADH and aldosterone
|
|
|
What is the mechanism that causes azotemia ina patient with chronic renal failure?
|
Decreased GFR
|
|
|
Why would a person with type 1 diabetes possibly have ketoacidosis?
|
The lack of glucose in the cells leads to increased protein and fat catabolism which leads to a buildup of ketones (a byproduct of this process)
|
|
|
Why would a person with type 1 diabetes possibly have the symptom of fatigue?
|
Cellular glucose starvation means there is not enough ATP production - leads to fatigue
|
|
|
What are the mechanisms that cause hyperkalemia in a patient with chronic renal failure?
|
decreased GFR, cell death and acidosis
|
|
|
How is type 1 diabetes treated?
|
Insulin injections, increased exercise, diet of complex carbs and protein
|
|
|
Why would a patient with chronic renal failure have acidosis?
|
H+ is normally secreted into filtrate, tubules are not working properly H+ is not secreted into filtrate and builds up in blood
|
|
|
Why would a person with type 1 diabetes be advised to exercise?
|
As they gain more muscle mass, there are more muscle cells that can uptake glucose from the bloodstream without the help of insulin - helps keep blood glucose levels down.
|
|
|
What is the mechanism that causes hypertension in a patient with chronic renal failure?
|
Decreased GFR
|
|
|
Why would a person with type 1 diabetes be advised to eat a diet with plenty of complex carbs and protein?
|
So that there is less of a spike in blood glucose levels. (complex carbs are harder to break down)
|
|
|
What causes anemia in a patient with chronic renal failure?
|
Decrease in production of erythropoietin (made in the L)
|
|
|
List 10 functions of the liver!
|
1.production of bile 2. vitamin storage 3. detox of drugs 4. glycogenesis, glycogenolysis, gluconeogenesis 5. makes proteins: albumins & globulins 6. makes cholesterol 7. makes angiotensin I 8. makes clotting factors 9. break down RBC's 10. break down hormones (ADH, aldosterone, estrogen, and testosterone)
|
|
|
What is the test used to measure the amount of sugar that is attached to hemoglobin? (Tells the doctor how well sugars have been controlled in the past 3 months)
|
Glycosylated hemoglobin levels (A1C)
|
|
|
What are 7 general manifestations of liver disease?
|
Portal hypertension, varicosities, splenomegaly, ascites, hepatic encephalopathy, jaundice and altered sex hormones
|
|
|
What are the 3 risk factors for type II diabetes?
|
Obesity, family history, and metabolic syndrome
|
|
|
What is the term that means too much insulin in the blood?
|
Hyperinsulinemia
|
|
|
Where does portal hypertension occur?
|
In the portal vein
|
|
|
What does hyperinsulinemia mean?
|
Excessive insulin in the blood
|
|
|
What is one cause of portal hypertension?
|
Inflammation of the liver cells causes central vein to be compressed increasing pressure in the portal vein
|
|
|
What problem with the veins in the GI tract is caused by liver disease?
|
Increased pressure from portal hypertension can back up and cause varicosities in veins in the GI tract.
|
|
|
What happens to the insulin levels in type II diabetes early in the disease?
|
Insulin receptors quit working so insulin levels increase because it can't enter cells and pancreas continues to produce more
|
|
|
What are 3 common places for varicosities caused by liver disease?
|
Abdominal varices, rectal varices, and esophageal varices
|
|
|
What happens to the insulin levels in type II diabetes late in the disease?
|
As body continues to make more and more insulin, the pancreas starts to wear out and decreases the amount of insulin produced.
|
|
|
What is the mechanism that causes ascites in a patient with liver disease?
|
Increased BHP in abdomen (from portal hypertension and increase in ADH and aldosterone - broken down in liver) decreased BOP (because of lack of albumins - made in liver)
|
|
|
At what point in type II diabetes is the disease irreversible?
|
When pancreas is worn out and doesn't produce any more insulin - insulin injections are necessary
|
|
|
How does hepatic encephalopathy occur in a person with liver disease?
|
Proteins degrade into ammonia and then are converted to urea in liver. Diseased liver doesn't convert as much so ammonia builds up which is toxic to the brain.
|
|
|
What is the treatment for type II diabetes if caught early in the disease?
|
Exercise, weight loss, oral hypoglycemic drugs
|
|
|
Why would a patient with type II diabetes take oral hypoglycemic drugs?
|
They increase the sensitivity of the insulin receptors so that more insulin can be taken into cells
|
|
|
What is the first symptom of hepatic encephalopathy?
|
Blindness
|
|
|
What symptoms other than blindness can occur in a person with hepatic encephalopathy?
|
Seizures and confusion
|
|
|
Why would a patient with type II diabetes be advised to lose weight?
|
Weight loss would decrease the size of the cells that need insulin - decreasing some of the need for insulin production
|
|
|
What is the name of one oral hypoglycemic drug?
|
Metaformin
|
|
|
What type of bilirubin (conjugated/unconjugated) is found inside a macrophage?
|
Unconjugated
|
|
|
What is the treatment for a patient with type II diabetes that has reached the point in the disease where the pancreas has stopped producing insulin?
|
Insulin injections
|
|
|
What type of bilirubin (cunjugated/unconjugated) is found in blood plasma?
|
Unconjugated
|
|
|
Where does bilirubin become conjugated?
|
In the liver
|
|
|
These cells make glucagon
|
Alpha cells
|
|
|
What type of bilirubin (conjugated/unconjugated) is found in bile?
|
Conjugated
|
|
|
These cells make insulin
|
Beta cells
|
|
|
If a patient is diagnosed with extrahepatic jaundice will there be an increase in conjugated or unconjugated bilirubin in their blood?
|
Conjugated
|
|
|
This hormone decreases blood sugar
|
Insulin
|
|
|
This hormone increases blood sugar
|
Glucagon
|
|
|
If a patient is diagnosed with intrahepatic jaundice will blood work show an increase in conjugated or unconjugated bilirubin?
|
Depends on the site of obstruction. It could be conjugated if obstruction in bile duct, unconjugated if there is a blood vessel obstruction. Most diseases inside the liver will cause BOTH to increase due to blood flow & bile ducts being affected
|
|
|
These cells in the pancreas produce hormones
|
Alpha and beta cells
|
|
|
What type of hemoglobin does a fetus have?
|
Hemoglobin F
|
|
|
This hormone increases glycogenolysis
|
Glucagon
|
|
|
What type of hemoglobin do adults have?
|
Hemoglobin A
|
|
|
This hormone increases gluconeogenesis
|
Glucagon
|
|
|
Why do many infants become jaundiced?
|
If the liver can't keep up with the increase in unconjugated bilirubin due to hemoglobin F being destroyed, bilirubin builds up in the blood.
|
|
|
A patient with liver failure might become fatigued because of a lack of what substance in the blood?
|
Glucose
|
|
|
What is the treatment for physiologic jaundice of the newborn?
|
Phototherapy - UV light conjugates the bilirubin in the blood stream
|
|
|
Which type of diabetic (Type I or Type II) is more likely to have diabetic ketoacidosis?
|
Type I
|
|
|
What type of jaundice is caused by hemoglobin F being replaced by hemoglobin A?
|
Physiologic jaundice of the newborn
|
|
|
Which type of diabetic (Type I or Type II) is more likely to have Hyperosmolar Hyperglycemia Nonketotic Syndrome? (HHNKS)
|
Type II
|
|
|
What type of jaundice is caused by an autoimmune disease that destroys red blood cells?
|
Hemolytic jaundice
|
|
|
Which type of diabetic (Type I or Type II) is more likely to have hypoglycemia?
|
BOTH! Type I and Type II can have hypoglycemia
|
|
|
What is the mechanism that causes gynecomastia in men with liver disease?
|
Increase in estrogen
|
|
|
Why might a person with hypoglycemia have tachycardia, sweating and/or tremors?
|
Because the sympathetic nervous system is activated
|
|
|
What is the mechanism that causes testicular atrophy in men with liver disease?
|
Increase in estrogen
|
|
|
What is the mechanism that causes hirsutism in women with liver disease?
|
Increase in testosterone
|
|
|
Why might a person with hypoglycemia show signs such as hunger, confusion, headache and/or grumpiness?
|
Lack of glucose to the brain
|
|
|
What is the disease caused by an increase in testosterone in women with liver disease?
|
Hirsutism
|
|
|
What acute complication of diabetes results from gluconeogenesis?
|
Diabetic ketoacidosis
|
|
|
Describe what happens with DKA
|
Decrease in cellular glucose causes alpha cells to continue releasing glucagon even though blood glucose is high
|
|
|
Why is it possible for a woman with liver disease to have an increase in testosterone?
|
Because the liver is responsible for the breakdown of testosterone and if the liver is not functioning properly testosterone levels will increase
|
|
|
Explain the potassium status of a patient with DKA in the early stages
|
hyperkalemia because ketones are acidic - diabetics break down fats and ketones for energy when they can't get enough glucose - makes the blood acidic - H+ enters cells - K+ leaves cells into blood.
|
|
|
What are some of the most common manifestations of liver disease?
|
Jaundice, ascites and portal hypertension
|
|
|
What is the name for the disease that involves a combination of fibrosis and regeneration of the liver tissues?
|
Cirrhosis
|
|
|
Explain the potassium status of a patient with DKA in the later stages.
|
Hypokalemia due to polyuria. More glucose in the urine pulls water with it as well as potassium
|
|
|
What are 4 causes of cirrhosis ?
|
Chronic alcoholism, chronic hepatitis (Hep C), Congestive Heart Failure, and Obesity
|
|
|
What is the sodium status of a patient with DKA?
|
Hyponatremia - due to polyuria
|
|
|
What is the liver condition which involves ROS's in the liver causing lipid peroxidation?
|
Hepatic lipidosis
|
|
|
If a diabetic patient is passed out do you administer glucose or insulin?
|
GLUCOSE! Insulin could kill them if they have hypoglycemia
|
|
|
What are the 3 stages of cirrhosis?
|
1. Fatty liver (no symptoms) 2. Hepatitis (inflammation and necrosis) 3. Cirrhosis (dead cells cause fibrosis)
|
|
|
What are the symptoms of HHNKS? Hyperosmolar Hyperglycemia Nonketotic Syndrome
|
Severe polyuria, hypotension, hypokalemia, hyponatremia, neurological symptoms
|
|
|
At what stage of cirrhosis does the condition become irreversible?
|
3rd stage - Cirrhosis
|
|
|
Why might a Type II diabetic with HHNKS have confusion or seizures?
|
The increased blood osmolarity pulls H2O from brain cells and they crenate.
|
|
|
What are some of the early clinical signs of the second stage of cirrhosis - hepatitis?
|
Abdominal pain, fever, vomiting, fatigue (due to lack of glucose), blood values - ALT and AST will increase, and anorexia (not eating)
|
|
|
How is HHNKS treated?
|
Fluids and insulin
|
|
|
Why does a patient in the inflammation stage of hepatitis have an increase in ALT and AST in their blood?
|
They are enzymes that are released from dead liver cells.
|
|
|
Who is more likely to have chronic complications of diabetes (Type I or Type II)?
|
BOTH equally likely to have chronic complications
|
|
|
What are 2 microvascular diseases that diabetics may have as a chronic complication of the disease?
|
Diabetic retinopathy (retinal damage) and diabetic nephropathy (glomerular nephritis)
|
|
|
What 2 things happen in the hepatitis stage of cirrhosis?
|
Inflammation and necrosis
|
|
|
What is the mechanism that causes vascular problems in a diabetic patient?
|
Increased ROS, increased glycosylated collagen, increased blood glucose
|
|
|
What are the signs that there is necrosis in the liver cells in a person in the hepatitis stage of cirrhosis?
|
jaundice, ascites, hepatic encephalopathy, portal hypertension, hypertension, gynecomastia and/or testicular atrophy - men, hirsutism - women.
|
|
|
Why could a person with cirrhosis possibly have hepatic encephalopathy?
|
Decrease in protein waste metabolism leads to increase in ammonia in the blood which is toxic in the brain - hepatic encephalopathy
|
|
|
What is the mechanism that causes nerve damage in a diabetic?
|
Increased glucose in the nerve cells
|
|
|
Why could a person with cirrhosis have difficulty clotting?
|
The liver stores vitamin K. If not functioning properly then vit K stores are depleted and there is difficulty with clotting
|
|
|
Explain the process by which a diabetic can get neuropathy
|
Increased glucose in the blood enters nerve cells (0 insulin needed!) & is converted to fructose. Fructose pulls in H20, causes nerve swelling - swollen nerve eventually demyelinates - conduction more difficult.
|
|
|
Explain why a diabetic might have vascular problems
|
Increased ROS damages endothelium. Glycosylation results in decreased nitrous oxide, leads to decreased vasodilation.
|
|
|
What are the signs that a person with cirrhosis has reached the stage of fibrosis?
|
Jaundice due to increase in conjugated bilirubin because of obstruction of bile flow AND/OR increase in unconjugated bilirubin due to obstructed blood flow. Ascites and varicosities due to portal HTN
|
|
|
How many strains are there of viral hepatitis?
|
6
|
|
|
What is the most common cause of death in diabetics?
|
Macrovascular diseases such as CAD, Stroke and MI
|
|
|
Why do diabetics have problems with vision?
|
Most of them by the time they are diagnosed have some sort of retinal damage. Many capillaries in retina - vasoconstriction causes ischemia to retina
|
|
|
How many strains of viral hepatitis do we currently have vaccines for? Which ones?
|
2 - HepA &HepB
|
|
|
What are the early symptoms of diabetic nephropathy?
|
Polyuria, hematuria, proteinuria due to increase in capillary permeability.
|
|
|
Which type of hepatitis can become chronic in 50-80% of people who have it?
|
Hepatitis C
|
|
|
What is the mechanism that causes diabetic nephropathy?
|
Glycosylation - glycosylated proteins get stuck in glomerular capillaries
|
|
|
Which type of hepatitis has severe symptoms but a short duration of illness?
|
HepA
|
|
|
What are the late symptoms of diabetic nephropathy?
|
Decreased GFR causes - azotemia, HTN, edema, acidosis, and possible anuria
|
|
|
What is the transmission of HepA?
|
Fecal/oral and blood
|
|
|
Diabetes causes coronary artery disease because of what mechanism?
|
Increased ROS, Increased glycosylation, decreased Nitrous Oxide
|
|
|
What type(s) of Hepatitis are transmitted as a STD?
|
HepB and Hep C
|
|
|
Explain why diabetics are prone to getting CAD
|
Increased ROS results in atherosclerosis, increased glycosylation binds sugars to proteins which decreases nitrous oxide production - decreased vasodilation
|
|
|
What type of hepatitis can become chronic in 15-30% of people and others can be carriers with no symptoms at all?
|
HepB
|
|
|
What is the term for the type of diabetes that a woman may get when pregnant?
|
Gestational diabetes
|
|
|
Which type of hepatitis has the mildest symptoms but has no vaccine and is a STD?
|
Hepatitis C
|
|
|
What are the risks of gestational diabetes (if any) to the mother and baby after the baby is born?
|
Diabetes typically resolves upon birth of the baby, however both are prone to diabetes later in life because of the exposure to increased blood glucose
|
|
|
What are the 4 phases of illness with Hepatitis?
|
Incubation, prodromal, icteric, recovery
|
|
|
What happens during the hepatitis incubation phase?
|
Virus is replicating - no symptoms
|
|
|
Why are diabetics prone to infections? 6 reasons!
|
Decreased vision, decreased perfusion to extremities, neuropathy, decreased WBC's, Abnormal WBC function due to increased BG, rapid pathogen multiplication - they love sugar!
|
|
|
What is the most common type of infection in a diabetic patient?
|
Skin infections. UTI's second most common infection
|
|
|
What happens during the hepatitis prodromal phase?
|
Flu-like symptoms, contagious
|
|
|
Which nerves are typically affected first in a patient with diabetic neuropathy? WHY?
|
Peripheral nerves - nerves are longer
|
|
|
During what phase(s) of hepatitis are you contagious?
|
Prodromal, icteric and recovery
|
|
|
What is the cause of foot drop in a diabetic?
|
Neuropathy
|
|
|
What happens during the hepatitis icteric phase?
|
There is some hepatocellular death but many people are not aware of this at the time because the liver regenerates - some become jaundiced
|
|
|
|
|
|
|
What happens during the hepatitis recovery phase?
|
Lasts 6-8 weeks, liver regeneration. Virus can remain and cause further damage later
|
|
|
During which phase of hepatitis does a person have flu-like symptoms?
|
Prodromal phase
|
|
|
During which phase of hepatitis is a person asymptomatic and the virus is replicating?
|
Incubation phase
|
|
|
During which phase of hepatitis is there hepatocellular death which may or may not lead to jaundice?
|
Icteric
|
|
|
During what phase of hepatitis does regeneration of the liver occur?
|
Recovery
|
|
|
|
|
|
|
Where are insulin and glucagon produced?
|
In the Islets of Langerhans in the pancreas
|
|
|
What type of cells produce insulin?
|
Beta cells in the pancreas
|
|
|
What type of cells produce glucagon?
|
Alpha cells in the pancreas
|
|
|
What is the mechanism that causes type 1 diabetes?
|
Lack of insulin
|
|
|
What is the mechanism that causes type II diabetes?
|
Insulin resistant receptors
|
|
|
What is the purpose of insulin receptors ? Why would insulin resistant receptors be a problem?)
|
Insulin must bind to receptors before glucose can enter the cell. If insulin resistant glucose increases in the blood stream and decreased cellular glucose
|
|
|
What are 4 places that do not need insulin receptors in order for glucose to enter the cell?
|
Nervous cells, liver cells, muscle cells and RBC's
|
|
|
What are 2 things that are necessary for a diagnosis of diabetes without an oral glucose tolerance test?
|
Presence of symptoms and blood glucose over 200mgldl
|
|
|
What test is used to diagnose a person with diabetes if they have no apparent symptoms but they have a fasting blood glucose test over 126mgldl?
|
Oral glucose tolerance test
|
|
|
Why might a person who does not have diabetes have high blood glucose levels?
|
Stress increases sympathetic nervous system which stimulates glycogenolysis in the liver - increasing blood glucose level
|
|
|
What are the 2 forms of Type 1 diabetes?
|
Immune form and non-immune form
|
|
|
Which type of diabetes (SPECIFIC) is secondary to some other condition such as pancreatitis?
|
Type 1 diabetes - Non-Immune form
|
|
|
What type of diabetes (SPECIFIC) is caused by an autoimmune disease that attacks the beta cells in the pancreas?
|
Type 1 diabetes - Immune form
|
|
|
What are the 2 MAJOR symptoms of Type 1 diabetes ?
|
Hyperglycemia and cellular glucose starvation
|
|
|
What are the 4 symptoms that accompany hyperglycemia in type 1 diabetes? List in order!
|
Glucosuria, Polyuria, Polydypsia, Dehydration & hypotension
|
|
|
Why would a patient with hyperglycemia due to type 1 diabetes have glucosuria?
|
The excessive glucose in the blood stream is filtered in the kidneys. It can't all be reabsorbed back into the blood so some is lost in the urine.
|
|
|
Why would a patient with hyperglycemia due to type 1 diabetes have polyuria?
|
The glucose in the urine (glucosuria) pulls water into the filtrate because of the increased osmolarity which makes them have to urinate more frequently
|
|
|
Why would a patient with hyperglycemia due to type 1 diabetes have polydypsia?
|
The hypothalamus receives the signal that there is increased solute and decreased plasma in the blood (due to the H2O being absorbed into filtrate) which triggers the thirst sensation
|
|
|
Why would a patient with hyperglycemia due to type 1 diabetes have dehydration and hypotension?
|
The water loss in the filtrate causes dehydration which also lowers BP
|
|
|
What are the symptoms that accompany cellular glucose starvation in a patient with type 1 diabetes?
|
Weight loss, polyphagia, ketoacidosis, fatigue
|
|
|
Why would a patient with cellular glucose starvation due to type 1 diabetes lose weight?
|
Because the cells are not getting glucose they will catabolize fats and proteins instead which causes them to lose weight
|
|
|
Why would a patient with cellular glucose starvation due to type 1 diabetes have polyphagia?
|
The cells think that they are being starved because of the lack of glucose and they trigger the sensation of hunger
|
|
|
What does the term polyphagia mean?
|
Excessive eating/hunger
|
|
|
What is the emergency that can be caused by cellular glucose starvation in a patient with type 1 diabetes?
|
Ketoacidosis
|
|
|
What is the mechanism that causes ketoacidosis in a patient with type 1 diabetes?
|
Increased fat and protein catabolism by the cells
|
|
|
Why would a person with type 1 diabetes possibly have ketoacidosis?
|
The lack of glucose in the cells leads to increased protein and fat catabolism which leads to a buildup of ketones (a byproduct of this process)
|
|
|
Why would a person with type 1 diabetes possibly have the symptom of fatigue?
|
Cellular glucose starvation means there is not enough ATP production - leads to fatigue
|
|
|
How is type 1 diabetes treated?
|
Insulin injections, increased exercise, diet of complex carbs and protein
|
|
|
Why would a person with type 1 diabetes be advised to exercise?
|
As they gain more muscle mass, there are more muscle cells that can uptake glucose from the bloodstream without the help of insulin - helps keep blood glucose levels down.
|
|
|
Why would a person with type 1 diabetes be advised to eat a diet with plenty of complex carbs and protein?
|
So that there is less of a spike in blood glucose levels. (complex carbs are harder to break down)
|
|
|
What is the test used to measure the amount of sugar that is attached to hemoglobin? (Tells the doctor how well sugars have been controlled in the past 3 months)
|
Glycosylated hemoglobin levels (A1C)
|
|
|
What are the 3 risk factors for type II diabetes?
|
Obesity, family history, and metabolic syndrome
|
|
|
What is the term that means too much insulin in the blood?
|
Hyperinsulinemia
|
|
|
What does hyperinsulinemia mean?
|
Excessive insulin in the blood
|
|
|
What happens to the insulin levels in type II diabetes early in the disease?
|
Insulin receptors quit working so insulin levels increase because it can't enter cells and pancreas continues to produce more
|
|
|
What happens to the insulin levels in type II diabetes late in the disease?
|
As body continues to make more and more insulin, the pancreas starts to wear out and decreases the amount of insulin produced.
|
|
|
At what point in type II diabetes is the disease irreversible?
|
When pancreas is worn out and doesn't produce any more insulin - insulin injections are necessary
|
|
|
What is the treatment for type II diabetes if caught early in the disease?
|
Exercise, weight loss, oral hypoglycemic drugs
|
|
|
Why would a patient with type II diabetes take oral hypoglycemic drugs?
|
They increase the sensitivity of the insulin receptors so that more insulin can be taken into cells
|
|
|
Why would a patient with type II diabetes be advised to lose weight?
|
Weight loss would decrease the size of the cells that need insulin - decreasing some of the need for insulin production
|
|
|
What is the name of one oral hypoglycemic drug?
|
Metaformin
|
|
|
What is the treatment for a patient with type II diabetes that has reached the point in the disease where the pancreas has stopped producing insulin?
|
Insulin injections
|
|
|
These cells make glucagon
|
Alpha cells
|
|
|
These cells make insulin
|
Beta cells
|
|
|
This hormone decreases blood sugar
|
Insulin
|
|
|
This hormone increases blood sugar
|
Glucagon
|
|
|
These cells in the pancreas produce hormones
|
Alpha and beta cells
|
|
|
This hormone increases glycogenolysis
|
Glucagon
|
|
|
This hormone increases gluconeogenesis
|
Glucagon
|
|
|
A patient with liver failure might become fatigued because of a lack of what substance in the blood?
|
Glucose
|
|
|
Which type of diabetic (Type I or Type II) is more likely to have diabetic ketoacidosis?
|
Type I
|
|
|
Which type of diabetic (Type I or Type II) is more likely to have Hyperosmolar Hyperglycemia Nonketotic Syndrome? (HHNKS)
|
Type II
|
|
|
Which type of diabetic (Type I or Type II) is more likely to have hypoglycemia?
|
BOTH! Type I and Type II can have hypoglycemia
|
|
|
Why might a person with hypoglycemia have tachycardia, sweating and/or tremors?
|
Because the sympathetic nervous system is activated
|
|
|
Why might a person with hypoglycemia show signs such as hunger, confusion, headache and/or grumpiness?
|
Lack of glucose to the brain
|
|
|
What acute complication of diabetes results from gluconeogenesis?
|
Diabetic ketoacidosis
|
|
|
Describe what happens with DKA
|
Decrease in cellular glucose causes alpha cells to continue releasing glucagon even though blood glucose is high
|
|
|
Explain the potassium status of a patient with DKA in the early stages
|
hyperkalemia because ketones are acidic - diabetics break down fats and ketones for energy when they can't get enough glucose - makes the blood acidic - H+ enters cells - K+ leaves cells into blood.
|
|
|
Explain the potassium status of a patient with DKA in the later stages.
|
Hypokalemia due to polyuria. More glucose in the urine pulls water with it as well as potassium
|
|
|
What is the sodium status of a patient with DKA?
|
Hyponatremia - due to polyuria
|
|
|
If a diabetic patient is passed out do you administer glucose or insulin?
|
GLUCOSE! Insulin could kill them if they have hypoglycemia
|
|
|
What are the symptoms of HHNKS? Hyperosmolar Hyperglycemia Nonketotic Syndrome
|
Severe polyuria, hypotension, hypokalemia, hyponatremia, neurological symptoms
|
|
|
Why might a Type II diabetic with HHNKS have confusion or seizures?
|
The increased blood osmolarity pulls H2O from brain cells and they crenate.
|
|
|
How is HHNKS treated?
|
Fluids and insulin
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Who is more likely to have chronic complications of diabetes (Type I or Type II)?
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BOTH equally likely to have chronic complications
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What are 2 microvascular diseases that diabetics may have as a chronic complication of the disease?
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Diabetic retinopathy (retinal damage) and diabetic nephropathy (glomerular nephritis)
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What is the mechanism that causes vascular problems in a diabetic patient?
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Increased ROS, increased glycosylated collagen, increased blood glucose
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What is the mechanism that causes nerve damage in a diabetic?
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Increased glucose in the nerve cells
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Explain the process by which a diabetic can get neuropathy
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Increased glucose in the blood enters nerve cells (0 insulin needed!) & is converted to fructose. Fructose pulls in H20, causes nerve swelling - swollen nerve eventually demyelinates - conduction more difficult.
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Explain why a diabetic might have vascular problems
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Increased ROS damages endothelium. Glycosylation results in decreased nitrous oxide, leads to decreased vasodilation.
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What is the most common cause of death in diabetics?
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Macrovascular diseases such as CAD, Stroke and MI
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Why do diabetics have problems with vision?
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Most of them by the time they are diagnosed have some sort of retinal damage. Many capillaries in retina - vasoconstriction causes ischemia to retina
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What are the early symptoms of diabetic nephropathy?
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Polyuria, hematuria, proteinuria due to increase in capillary permeability.
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What is the mechanism that causes diabetic nephropathy?
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Glycosylation - glycosylated proteins get stuck in glomerular capillaries
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What are the late symptoms of diabetic nephropathy?
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Decreased GFR causes - azotemia, HTN, edema, acidosis, and possible anuria
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Diabetes causes coronary artery disease because of what mechanism?
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Increased ROS, Increased glycosylation, decreased Nitrous Oxide
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Explain why diabetics are prone to getting CAD
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Increased ROS results in atherosclerosis, increased glycosylation binds sugars to proteins which decreases nitrous oxide production - decreased vasodilation
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What is the term for the type of diabetes that a woman may get when pregnant?
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Gestational diabetes
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What are the risks of gestational diabetes (if any) to the mother and baby after the baby is born?
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Diabetes typically resolves upon birth of the baby, however both are prone to diabetes later in life because of the exposure to increased blood glucose
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Why are diabetics prone to infections? 6 reasons!
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Decreased vision, decreased perfusion to extremities, neuropathy, decreased WBC's, Abnormal WBC function due to increased BG, rapid pathogen multiplication - they love sugar!
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What is the most common type of infection in a diabetic patient?
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Skin infections. UTI's second most common infection
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Which nerves are typically affected first in a patient with diabetic neuropathy? WHY?
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Peripheral nerves - nerves are longer
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What is the cause of foot drop in a diabetic?
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Neuropathy
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