Unit 2 Pathology 201

Front 1

How much blood to the kidneys filter daily?

Back 1

170 L per day

Front 2

How much urine do the kidneys excrete?

Back 2

1.5 L per day

Front 3

Thirst center; manufactures ADH

Back 3

hypothalamus

Front 4

stores ADH; releases ADH as needed

Back 4

pituitary

Front 5

forms PTH; regulates calcium and phosphorous

Back 5

parathyroid glands

Front 6

gland that secretes aldosterone

Back 6

adrenal gland

Front 7

This hormone is made, stored, and secreted by muscle cells in the atria; released when BP is too high

Back 7

ANP (atrial natriuretic peptide)

Front 8

Also known as vasopressin, this hormone increases BP by causing the kidneys to retain more water

Back 8

ADH (anti diuretic hormone)

Front 9

How does aldosterone function?

Back 9

aldosterone promotes sodium retention; increased Na+=increased water=inc. BP

Front 10

Steps in RAAS & its signal

Back 10

1. Renin (from kidneys)
2. Angiotensinogen (from liver)
3. Angiotensin I
4. Angiotensin II (converted per ACE)
5. Vasoconstriction (+ aldosterone released)
**Process begins b/c of decreased renal perfusion

Front 11

baroreceptors--location & function

Back 11

atria; aortic arch; carotid sinus; kidneys
detect decreased arterial pressure

Front 12

osmoreceptors--location & function

Back 12

on surface of hypothalamus
sense change in Na+ concentration; release impulses to posterior pituitary; pituitary releases ADH

Front 13

perception of thirst is controlled by ___________

Back 13

hypothalamus

Front 14

Gland that releases/inhibits ADH

Back 14

pituitary

Front 15

releases aldosterone

Back 15

adrenal cortex

Front 16

4 causes of abnormal fluid movement

Back 16

1. incr. hydrostatic pressure
2. decr. oncotic pressure
3. increase in capillary membrane permeability
4. obstruction of lymphatic channels

Front 17

2 common causes of increased hydrostatic pressure

Back 17

1. venous obstruction
2. increased sodium & water retention

Front 18

Common cause of decreased oncotic pressure

Back 18

loss or decrease in plasma albumin

Front 19

causes of increased capillary membrane permeability

Back 19

inflammation; immune responses

Front 20

Why might lymph channels be obstructed?

Back 20

tumors; inflammation; surgery/surgical removal

Front 21

types of edema

Back 21

general
localized

Front 22

Causes of localized edema

Back 22

trauma; or somehow limited to a single organ system

Front 23

complication of edema

Back 23

pressure sores; infection
(life threatening if cerebral, pulmonary, or laryngeal)

Front 24

disorders involving ADH

Back 24

SIADH--too much
Diabetes Insipidus--too little

Front 25

SIADH:
too ___ ADH; permeability of renal tubules ____; fluid volume & water retention ____; fluid shifts ____ cells

Back 25

much; increases; increases; into

Front 26

signs & symptoms of SIADH

Back 26

thirst; confusion; lethargy; hyponatremia; vomiting & abdominal cramping; DOE

Front 27

Causes of SIADH

Back 27

cancer; injury to pituitary gland; medications

Front 28

3 types of diabetes insipidus & their causes

Back 28

1. neurogenic--insufficient production of ADH
2. nephrogenic--inadequate response of kidneys to ADH
3. water intoxication--ingesting extremely large amounts of water

Front 29

S/S of Diabetes Insipidus

Back 29

polyuria; polydipsia; hyponatremia; weight loss; tachycardia; shock

Front 30

causes of DI

Back 30

trauma to hypothalamus; surgery around hypothalamus; chronic renal insufficiency; lithium toxicity; hypercalcemia; hypokalemia; disease of renal tubules

Front 31

S/S of hypernatremia

Back 31

thirst; fever; dry mucous membranes; restlessness; muscle twitching; hyperreflexia; convulsions; pulmonary edema

Front 32

Causes of hypernatremia

Back 32

inappropriate administration of hypertonic saline solution; oversecretion of aldosterone; fever/respiratory infections; diabetes insipidus; diarrhea

Front 33

S/S of hypokalemia

Back 33

cardiac dysrhythmias; skeletal muscle weakness; loss of smooth muscle tone (leads to constipation, paralytic ileus)

Front 34

Causes of hypokalemia

Back 34

dietary deficiency; respiratory alkalosis; diarrhea or laxative abuse; vomiting/continuous NG suctioning; renal disorders; loop diuretic use

Front 35

Hypovolemic shock is caused by

Back 35

hemorrhage (loss of whole blood); burns (loss of plasma); loss of interstitial fluid (DI, emesis, diuresis, diaphoresis)

Front 36

hypovolemic shock begins when intravascular volume has dropped __% and is initially compensated for by _____

Back 36

15; increased heart rate

Front 37

S/S of hypovolemic shock

Back 37

rapid HR; thready pulse; thirst; oliguria; poor skin turgor; deteriorated mental status

Front 38

If blood glucose is low, insulin release is ____, and glucagon release is ____

Back 38

decreased; increased

Front 39

If blood glucose is high, insulin release is ____, and glucagon levels ____

Back 39

increased; decrease

Front 40

Insulin is produced by the ____ cells, located in the ____ in the _____

Back 40

beta; islets of Langerhans; pancreas

Front 41

Type I diabetes--insulin producing cells have ____

Back 41

been destroyed

Front 42

increased circulatory levels of glucose without insulin to aid entrance into cells

Back 42

hypoglycemia

Front 43

When the body is starving for energy (no glucose uptake into cells) it turns to ____ for energy. This leads to ____

Back 43

reserve fat stores & protein; ketoacidosis

Front 44

Excess intravascular glucose attracts water into the vasculature. This is called _______

Back 44

osmotic diuresis

Front 45

A systemic effect of osmotic diuresis

Back 45

dehydration

Front 46

How does hyperglycemia affect the immune system?

Back 46

undermines WBC formation; promotes infection; impairs wound healing

Front 47

Ultimately dehydration from hyperosmotic plasma (2ndary to diabetes) can lead to ____

Back 47

hyperglycemic coma

Front 48

glycosuria

Back 48

urine has high levels of glucose

Front 49

S/S of type 1 DM
When do they appear?

Back 49

polydipsia, polyuria, polyphagia, fatigue, lethargy, weight loss, blurred vision
when 80-90% of the beta cells have been destroyed

Front 50

Decreased tissue/cellular sensitivity is a problem in what type of DM?

Back 50

Type 2

Front 51

Is decreased insulin a problem in type 2 DM?

Back 51

Yes, it can be.

Front 52

What is the #1 environmental factor related to Type 2 DM?

Back 52

obesity

Front 53

Deranged insulin release from the ____ (genetically influenced?) leads to ____ glucose output from the ____ and ____ glucose uptake from the muscles (e.g.)

Back 53

pancreas; increased; liver; decreased

Front 54

How does obesity contribute to DM2?

Back 54

promotes peripheral insulin resistance

Front 55

Free fatty acids and cytokines from adipose tissues ____

Back 55

interfere with insulin uptake at receptors
(prohibit insulin from "doing its job")

Front 56

Overweight people need ____ insulin as the body becomes ____

Back 56

extra; resistant

Front 57

With high serum lipids, fat can be deposited in the ____, causing further complications for the pt with type II DM

Back 57

pancreas

Front 58

S/S of type 2 DM

Back 58

often nonspecific; some cases have the classic "3 Ps"; most are related to the long-term complications of the disease

Front 59

Long-term complications of type 2 DM

Back 59

visual changes (diabetic retinopathy); kidney function changes (diabetic nephropathy); coronary artery disease; peripheral vascular disease; recurrent infections; neuropathy

Front 60

Causes of secondary DM

Back 60

chemical agents; drugs; hormonal disease; pancreatic disease

Front 61

any type of glucose intolerance that develops during pregnancy

Back 61

gestational diabetes; usually temporary; may lead to type 2 DM; occurs due to insulin resistance and inability of pancreas to increase insulin production

Front 62

2 main causes of hypoglycemia

Back 62

too much insulin (too much given)
too little glucose (not eating; used up with strenuous exercise; vomiting; infection)

Front 63

Hypoglycemia is especially problematic for ____

Back 63

the brain and nervous system

Front 64

S/S of hypoglycemia

Back 64

blurred vision; cool/clammy skin; confusion; difficulty with speech; dizziness; extreme hunger; headache; lack of coordination; poor concentration; staggering gait

Front 65

hypoglycemia causes which SNS reactions?

Back 65

Increased pulse, palpitations, sweating, anxiety, tremors

Front 66

Hypoglycemia, if left untreated, can lead to...

Back 66

loss of consciousness, seizures, coma, death

Front 67

Causes of diabetic ketoacidosis

Back 67

too little insulin
severe hyperglycemia
Leads to metabolic acidosis and severe osmotic diuresis

Front 68

DKA develops over a few days and is triggered by ....

Back 68

severe stress, infection, overeating, pregnancy, or inadequate insulin administration

Front 69

s/s DKA

Back 69

same as type 1 diabetes, PLUS--
abdominal pain/vomiting, Kussmaul respirations, sweet/fruity odor to breath (ketones), tachycardia, hypotension, can lead to loss of consciousness/coma/death

Front 70

S/S of HHNK
(Hyperglycemic Hyperosmolar Nonketotic Syndrome)

Back 70

Type 2 diabetics-->high blood sugar, but no ketosis,
3 Ps, weight loss, weakness, signs of dehydration
may also have renal impairment, neurologic changes

Front 71

Somogyi effect

Back 71

Rebound hyperglycemia due to insulin-induced hypoglycemia

Front 72

Blood glucose is higher when one wakes than it was upon going to sleep. Why is that & what is this called?

Back 72

blood glucose levels rise steadily during the night (while sleeping)
"dawn phenomenon"

Front 73

Microvascular disease associated with diabetes affects...
(4 of 5 patients)

Back 73

eyes (retinopathy will cause blindness in 2% of diabetics),
kidneys (nephropathy affects 30%),
nervous system (neuropathy affects 60%)

Front 74

Macrovascular disease associated with diabetes affects...

Back 74

brain (cerebral vascular disease--diabetics 2-4 times more likely to have a stroke); heart (cardiovascular disease--2-4 times more likely to have heart disease, 2-8 times more likely to have heart failure); limbs, esp. legs and feet (peripheral vascular disease)

Front 75

Diabetic retinopathy leads to

Back 75

cataracts, blindness

Front 76

diabetic nephropathy leads to

Back 76

ESRD

Front 77

The hypothalamus secretes hormones which

Back 77

make other glands secrete hormones

Front 78

I'm the main link between nerves & hormones. Who am I?

Back 78

hypothalamus

Front 79

Produces ADH & Oxytocin (then sends to posterior pituitary)

Back 79

hypothalamus

Front 80

What does oxytocin do?

Back 80

stimulates uterine contractions, mammary glands

Front 81

What does ADH do?

Back 81

promotes reabsorption of water in kidney tubules

Front 82

growth hormone, prolactin, melanocyte-stimulating hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, follicle stimulating hormone, and leutinizing hormone ARE ALL produced/released by

Back 82

anterior pituitary gland

Front 83

What is released by the posterior pituitary?

Back 83

oxytocin and ADH

Front 84

The thyroid gland receives _____ from the _____ and releases _____ which controls _____

Back 84

TSH; anterior pituitary; thyroxin; metabolic rate

Front 85

The adrenal cortex receives _____ from the _____ and releases cortisol which _____

Back 85

ACTH; anterior pituitary; ; raises glucose levels in the blood

Front 86

Hypothalamic disorders could result from...

Back 86

surgical transection
head injury
tumor affecting stem to pituitary gland

Front 87

Where is the pituitary located?

Back 87

Just below the hypothalamus; middle of head (looks like it's hanging from a short stalk)
anterior to brain stem; very close to the optic chiasm

Front 88

pituitary hormones affect which body systems/organs/glands?

Back 88

kidneys (Post. pituitary--ADH works on kidney tubules)
uterus/mammary glands (Post. pituitary--oxytocin)
bone (growth hormone); adrenal cortex (ACTH); thyroid gland (TSH); testis/ovary (gonadotropic hormones--FSH & LH); mammary glands (prolactin)

Front 89

True/False
The pituitary gland is poorly vascularized.

Back 89

FALSE! Highly vascularized, blood flow is abundant.

Front 90

Hypopituitarism ranges from absence of certain hormones to complete failure of hormone functions.
CAUSES include...

Back 90

diabetes mellitus, sickle cell disease, shock, head trauma, infections (meningitis, TB, syphilis), ablation due to tumor removal

Front 91

Because it is so vascular, the pituitary is vulnerable to ______

Back 91

infarction

Front 92

During pregnancy the pituitary gland ______

Back 92

enlarges (even more vascular)

Front 93

S/S of hypopituitarism

Back 93

dwarfism (in children only)
decreased or absent lactation
loss of body hair; decreased libido
hypothyroidism

Front 94

What is a pituitary adenoma?

Back 94

a slow growing tumor from the anterior pituitary; may cause hyperpituitarism

Front 95

A pituitary adenoma may put pressure on the ______ & may metastasize to the ______

Back 95

optic chiasm; hypothalamus

Front 96

What effect does a pituitary adenoma have on hormone secretion?

Back 96

Pituitary secretes hormones regardless of body's needs. (At least this is the usual result. Adenoma may eventually compress hormone secreting cells, causing hypopituitarism.)

Front 97

S/S of hyperpituitarism

Back 97

headache; fatigue; neck pain/stiffness; seizures; temporary blindness
(all related to tumor growth)

Front 98

GH hypersecretion is called...

Back 98

acromegaly (adult onset)
giantism (childhood--epiphyseal plates not yet closed)

Front 99

Distinguishing physical features of acromegaly

Back 99

enlarged bones in face, hands, feet (spade shaped); lower jaw & forehead protrude
Also causes DM, HTN, left ventricular HF (unrestrained myocardial growth), hypertrophy of sebaceous glands, visual problems, arthrosis, peripheral neuropathy

Front 100

What are the most common hormonally active pituitary tumors?

Back 100

Prolactinomas (pituitary tumors that secrete prolactin)
In women--causes galactorrhea (nonpuerperal milk production), amenorrhea, and hirsutism
In men--hypogonadism & ED

Front 101

Where are the parathyroid glands?

Back 101

Behind the thyroid (2 on each side, like spots on a butterfly)

Front 102

What are the thyroid hormones?

Back 102

T3, T4, Calcitonin

Front 103

What do thyroid hormones affect?

Back 103

metabolism of all cells, body heat production, muscle tone, serum calcium levels (parathyroid??), secretions in GI tract, cardiac rate and force

Front 104

Most common cause of hyperthyroidism?

Back 104

Graves disease