Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
183 Cards in this Set
- Front
- Back
|
MOA:
Beta Blockers |
Decrease activation of beta-1 receptors on heart to decrease cardiac output
This decreases BP and work load of heart Can help minimize effects of hyperthyroidism (but not treat it) Decrease renin production due to beta-1 receptors on JG cells Decreases angiotensin, decreases peripheral resistance to decrease BP Also decreases sodium and water retention |
|
|
What are the beta blockers?
|
-olol
Beta-1 selective: Atenolol Nebivolol Metoprolol Non-selective, also block alpha-1: Labetalol Carvedilol Non-selective: Propranolol Timolol Pindolol Nadolol |
|
|
What are the uses of beta blockers?
|
Reduce BP (antihypertensive)
Reduce work load of heart to prevent further damage Reduce sodium and water retention Maintenance therapy in CHF Minimize symptoms of hyperthyroidism |
|
|
Thiazides
|
Diuretics
Antihypertensive Block sodium uptake in DCT - increase sodium and water excretion Decreases blood volume, decreases cardiac output Adverse effects: Hypokalemia Hypercalcemia Hyperuricemia Most used: hydrochlorothiazide |
|
|
Adverse Effects:
Beta Blockers |
Fatigue
Insomnia Impotence Decreased HDL Increased triglycerides Non-selective: may exacerbate COPD or asthma (contraindicated) |
|
|
Calcium Channel Blockers
|
Antihypertensive
Block ability of calcium to enter the cell Calcium plays role in contraction, thus decreasing contraction force Results in vasodilation and decreased cardiac output with decrease in BP Diltiazem - affects both vasculature and heart, with more effect on heart Verapamil - affects both heart and vasculature Nifedipine - affects vasculature only Adverse effects: Constipation Vertigo Headache Fatigue Hypotension |
|
|
ACE Inhibitors
|
Antihypertensive
Blocks conversion of angiotensin I to II Increases vasodilation, decreases water and sodium retention Increases bradykinin activity - vasodilation -pril Captopril Lisinopril Enalapril Adverse effects: Dry cough (due to bradykinins) Rash Fever Altered taste Hypotension Hyperkalemia Angioedema First dose syncope Fetotoxic |
|
|
Alpha-Blockers
|
Antihypertensive
Block alpha receptors to cause arteriolar vasodilation Reduces peripheral resistance to decrease BP in arteries Prazosin Terazosin Adverse effects: Reflex tachycardia First dose syncope |
|
|
Angiotensin II Antagonists
(Angiotensin Receptor Blockers - ARBs) |
Antihypertensive
Block angiotensin II receptor to produce vasodilatoin and decreased aldosterone production Decreases sodium and water retention, decreases BP Do not block degradation of bradykinins - not as powerful as ACE inhibitors but eliminates dry cough side effect -sartan Losartan Candesartan Valsartan |
|
|
Clonidine
|
Antihypertensive
Central alpha-2 agonist Depresses sympathetic outflow, decreases BP by decreasing CNS sympathetic effects on CV system |
|
|
Hydralazine
|
Antihypertensive
Smooth muscle relaxant Decreases BP by causing vasodilation |
|
|
Alpha-Methyldopa
|
Antihypertensive
Central alpha-2 agonist Depresses sympathetic outflow, decreases BP by decreasing sympathetic CNS effects on CV system |
|
|
Sodium Nitroprusside
|
Antihypertensive
Vasodilator Poisonous if given orally - hydrolysis to cyanide Given IV - rapid and powerful vasodilation of both arteries and veins Treat adverse effects with sodium thisulfate - binds cyanide to produce less toxic product that can be excreted by kidneys |
|
|
Minoxidil
|
Antihypertensive
Vasodilator Adverse effect: hypertrichosis (excessive hair growth) |
|
|
What is the first line therapy for all patients to prevent or treat hypertension?
|
Lifestyle modification
Maintain optimal weight and healthy diet (DASH) Cessation of smoking Exercise Restriction of sodium Moderation of alcohol consumption |
|
|
What is the target blood pressure for all patients?
|
<140/90
If high risk for CAD: <130/80 If history of angina or MI: <130/80 If CHF: <120/80 |
|
|
What is the first line treatment for hypertension?
|
Thiazides
If stage 2 (>160/100), thiazide plus ACE/ARB or CCB If chronic renal disease or diabetes: ACE/ARB |
|
|
What is the treatment for hypertensive patients with history of angina or MI?
|
Target <130/80
Beta blocker + ACE/ARB If two agent regimen is not successful, add CCB or thiazide |
|
|
What is the treatment for hypertensive patients with CHF?
|
When stable:
Beta blocker + ACE/ARB + diuretic (loop or thiazide) If severe, + aldosterone antagonist Verapamil, diltiazem, clonidine, alpha blockers contraindicated African Americans: + hydralazine or isosorbide dinitrate Acute exacerbation: stop beta blocker until cardiac output is restored, treat with digoxin |
|
|
What is a hypertensive emergency?
|
>210/150 (130 if preexisting condition)
BP must be lowered quickly to avoid end organ damage TX: sodium nitroprusside (IV), diazoxide, or labetalol |
|
|
Which beta blocker can prevent reflex tachycardia?
|
Labetalol - both alpha and beta blocker
|
|
|
Spironolactone
|
Aldosterone antagonist
Prevents sodium and water uptake - lowers BP Potassium sparing - works at DCT where potassium is normally exchanged for sodium Adverse effects: Hyperkalemia Metabolic acidosis Hormone-related side effects (due to structural similarity to sex hormones) |
|
|
Ergot Alkaloids
|
Vasoconstrictive - treat migraines
Ergotamine: 5-HT2 (serotonin) antagonist Used in prodromal period (prevention) Contraindicated in pregnancy, PVD, CAD Methysergide: Used for prevention - prophylactic, not used for active attack |
|
|
Triptans
|
Vasodilator - used to treat migraines
Generally more powerful than ergot alkaloids Can be used for prevention or treatment of acute attack Cannot be used with Prinzmetal's angina, PVD, uncontrolled hypertension Should not be used with SSRIs, SNRIs, or MAOIs - could cause serotonin syndrome |
|
|
Cyproheptadine
|
Used for prevention of migraine or cluster headache (more common use)
Triptans generally considered superior 5-HT2 receptor blocker |
|
|
Ondansetron
Granisetron Dolasetron Palonosetron |
5-HT3 antagonists
Powerful anti-emetic agents |
|
|
Metoclopramide
|
5-HT4 agonist
Anti-emetic - causes increased GI motility |
|
|
Buspirone
|
5-HT1 agonist
Antianxiolytic |
|
|
Holoenzyme
|
Prokaryotic
Core enzyme plus sigma-factor |
|
|
Sigma Factors
|
Prokaryotic
Bind to RNA polymerase Depending on factor, RNA polymerase recognizes certain promoters but not others |
|
|
Cistron
|
Prokaryotic
Region of DNA that encodes a single protein |
|
|
Polymerase I
(Eukaryotic) |
Makes rRNA
|
|
|
Polymerase II
(Eukaryotic) |
Makes mRNA
|
|
|
Polymerase III
(Eukaryotic) |
Makes tRNA
|
|
|
What steps of eukaryotic mRNA are processed in the nucleus?
|
Addition of 5'-cap of methylated GTP
Poly A tail added to 3' end Introns removed and exons spliced together |
|
|
What does "semiconservative" mean in DNA replication?
|
Parent strands separate and each serves as a template for a newly synthesized one
Replication of eukaryotic DNA is semiconservative |
|
|
In which direction is DNA read during replication? In which direction is the new strand produced?
|
Read: 3' to 5'
Produced: 5' to 3' |
|
|
Helicase
|
Prokaryotic
Separates parental DNA strands |
|
|
Primase
|
Prokaryotic
RNA polymerase that copies parental strand and makes RNA primer |
|
|
Polymerase III
(Prokaryotic) |
Major DNA polymeras in prokaryotes
Replicates both parental strands Has proofreading ability Has 3' exonuclease activity to remove wrong nucleoties |
|
|
Polymerase I
(Prokaryotic) |
Removes primer and fills gap with DNA
5' exonuclease activity |
|
|
Polymerase II
(Prokaryotic) |
DNA repair
3' exonuclease activity |
|
|
Ligase
|
Prokaryotic and eukaryotic
Joins Okazaki fragments of lagging strand |
|
|
DNA Replication:
Delta |
Eukaryotic
Major DNA polymerase Produces leading strand Has helicase activity No proofreading No exonuclease activity |
|
|
DNA Replication:
Alpha |
Eukaryotic
DNA polymerase Produces lagging strand Has primase activity |
|
|
DNA Replication:
Beta, Epsilon |
Eukaryotic
Minor DNA polymerase DNA repair 3' exonuclease activity |
|
|
DNA Replication:
Gamma |
Eukaryotic
Mitochondrial DNA polymerase |
|
|
Endonuclease
|
Incision of DNA
|
|
|
Exonuclease
|
Removal of nucleotides from incised end
|
|
|
Which malignancies develop in organs derived from each germ layer?
|
Ectoderm and endoderm: adenomas and carcinomas
Mesoderm: sarcomas and fibromas |
|
|
Ectoderm
|
Neural tube -> CNS
Neural crest -> PNS Placodes -> sensory organs Surface epithelium -> skin |
|
|
Mesoderm
|
Somites -> muscles, vertebral column
Connective tissue Lymphatic tissues Blood cells |
|
|
Endoderm
|
Epithelium of GI tract
Liver Pancreas Thymus Thyroid |
|
|
What vessels are contained in the umbilical cord?
|
2 arteries (carrying deoxygenated blood)
1 vein (carrying oxygenated blood from placenta) |
|
|
What is connected by the yolk stalk?
|
Yolk sac to GI tract
|
|
|
What is connected by the urachus?
|
Urinary bladder to allantois
|
|
|
Remnants:
Umbilical Arteries |
Medial umbilical ligaments
|
|
|
Remnants:
Urachus |
Median umbilical ligament
|
|
|
Remnants:
Umbilical Vein |
Round ligament
|
|
|
Remnants:
Ductus Venosus |
Venous ligament
|
|
|
Remnants:
Ductus Arteriosus |
Ligamentum arteriosum
|
|
|
Remnants:
Yolk Stalk |
Meckel's diverticulum
Rule of 2s: 2% of people Located within 2 feet of ileocecal junction (at antimesenteric border of ileum) About 2 cm long Inflammation may mimic appendicitis |
|
|
Derivates of Branchial Arch 1
(Mandibular Arch, Meckel) |
Bones: malleus, incus
Muscles: muscles of mastication Arteries: facial artery Nerves: V3 |
|
|
Derivates of Branchial Arch 2
(Hyoid Arch, Reichert) |
Bones: stapes, styloid, lesser horn of hyoid
Muscles: muscles of facial expression Arteries: external carotid artery Nerves: VII |
|
|
Derivates of Branchial Arch 3
(Thyrohyoid Arch) |
Bones: body of hyoid
Muscles: stylopharyngeal muscles Arteries: internal carotid artery Nerves: IX |
|
|
Derivates of Branchial Arch 4
|
Bones: larynx
Muscles: pharyngeal muscles Nerves: X |
|
|
Tissues Derived from Pharyngeal Pouch 1
|
Tympanic cavity
Eustachian tube |
|
|
What is formed from the first pharyngeal cleft?
|
Forms external auditory meatus
Only cleft that does not disappear |
|
|
Tissues Derived from Pharyngeal Pouch 2
|
Palatine tonsils
|
|
|
Tissues Derived from Pharyngeal Pouch 3
|
Ventral: thymus
Dorsal: inferior parathyroids |
|
|
Tissues Derived from Pharyngeal Pouch 4
|
Ventral: nothing
Dorsal: superior parathyroids |
|
|
Tissues Derived from Pharyngeal Pouch 5
|
Ultimobranchial body -> parafollicular C cells of thyroid
|
|
|
What are cervical cysts?
|
Remnants of pharyngeal clefts
Uncommon Located in anterolateral part of neck 1-2 inches in diameter |
|
|
Urogenital Development
|
7th week
Male: Wolffian (mesonephric) ducts become epididymis and vas deferens Mullerian (paramesonephric) ducts disappear Wolffian (mesonephric) sustained by testosterone from Leydig cells Mullerian (paramesonephric) suppressed by MIF glycoprotein from Sertoli cells Female: Wolffian ducts disappear Mullerian ducts become fallopian tubes, uterus, vagina (down to hymen) Both: Allantois becomes urinary bladder and urachus Ureteric bud (inferior part of mesonephric duct, metanephric) becomes bladder trigonum, ureter, collecting tubule Pronephros and mesonephros diseappear (pro never functional, meso only temporarily) Metanephros becomes kidneys |
|
|
What Passes Through:
Optic Canal |
Optic nerve
Ophthalmic artery |
|
|
What Passes Through:
Superior Orbital Fissure |
Cranial nerves III, IV, V, VI
Sympathetic nerves Ophthalmic veins |
|
|
What Passes Through:
Foramen Rotundum |
Cranial nerve V (maxillary branch)
|
|
|
What Passes Through:
Foramen Ovale |
Cranial nerve V (mandibular branch)
Accessory meningeal artery |
|
|
What Passes Through:
Foramen Spinosum |
Middle meningeal artery
|
|
|
What Passes Through:
Foramen Magnum |
Spinal cord
Accessory nerve Vertebral arteries Spinal arteries |
|
|
What Passes Through:
Jugular Foramen |
Cranial nerves IX, X, XI
Internal jugular vein |
|
|
What Passes Through:
Hypoglossal Canal |
Cranial nerve XII
|
|
|
What Passes Through:
Internal Auditory Meatus |
Cranial nerves VII, VIII
Labyrinthine artery |
|
|
What is a sign of a basilar skull fracture?
|
Bruising over mastoid process or periorbital region
|
|
|
Eye Muscle:
Medial Rectus |
Moves eye nasally
Innervation: III |
|
|
Eye Muscle:
Lateral Rectus |
Moves eye temporally
Innervation: VI |
|
|
Eye Muscle:
Superior Rectus |
Moves eye up and nasally
Rotates medially Combines with inferior oblique to raise eye upward Innervation: III |
|
|
Eye Muscle:
Inferior Oblique |
Moves eye up and temporally
Rotates laterally Combines with superior rectus to raise eye upward Innervation: III |
|
|
Eye Muscle:
Inferior Rectus |
Moves eye down and nasally
Rotates laterally Combines with superior oblique to move eye downward Innervation: III |
|
|
Eye Muscle:
Superior Oblique |
Moves eye down and temporally
Rotates medially Combines with inferior rectus to move eye downward Innervation: IV |
|
|
Abducens Paralysis
|
Unable to abduct eye on affected side
Diplopia (double vision) |
|
|
Trochlear Paralysis
|
Slight vertical double image
Patient compensates by tilting head |
|
|
Dilator Pupillae
|
Internal eye muscle
Function: mydriasis (dilation of pupil) Innervation: sympathetic |
|
|
Sphincter Pupillae
|
Internal eye muscle
Function: miosis (constriction of pupil) Innervation: parasympathetic |
|
|
Ciliary Muscle
|
Internal eye muscle
Function: accommodation (contraction of muscle relaxes ligaments to allow lens to become round for near vision) Innervation: parasympathetic |
|
|
Levator Palpebrae Superior
|
Eyelid muscle
Function: raises lid Innervation: III |
|
|
Muller's Muscle
|
Eyelid muscle
Function: raises lid Innervation: sympathetic |
|
|
What happens to the eyelid muscles in drowsiness?
|
Reduced sympathetic tone
Muller's muscles relax Eyelid droops |
|
|
Horner's Syndrome
|
Caused by neck injuries or tumors interrupting cervical sympathetic chain
Miosis Ptosis Red and dry facial skin on affected side (cannot sweat) |
|
|
What are the muscles of the tongue and their functions?
|
Genioglossus - pulls tongue out
Styloglossus - pulls tongue in and up Hyoglossus - pulls tongue down |
|
|
What is caused by damage to the hypoglossal nerve (CN XII)?
|
Genioglossus muscle of healthy side becomes dominant
Tongue will deviate toward side of damage |
|
|
What is the sensory innervation of the tongue?
|
Anterior 2/3: taste - VII, touch/temp - V3
Posterior 1/3: taste - IX, touch/temp - IX |
|
|
What are the muscles of the mandible and their functions?
|
Lateral pterygoid, digastric, geniohyoid - open mouth
Masseter, medial pterygoid, temporalis - close mouth Lateral pterygoid - protrudes mandible, lateral displacement Temporalis - retracts mandible |
|
|
What may be fractured by a blow to the jaw?
|
Neck of mandible
Region of opposite canine tooth |
|
|
What are the muscles of the larynx, their functions, and their innervations?
|
Posterior cricoarytenoid - opens glottis - recurrent nerve
Lateral cricoarytenoid - closes glottis - recurrent nerve Thyroarytenoid - relaxes vocal cords - recurrent nerve Cricothyroid - tightens vocal cords - superior laryngeal nerve |
|
|
What happens with damage to the recurrent nerves of the neck?
|
Unilateral damage - hoarseness
Bilateral damage - dyspnea Left wraps around aortic arch Right wraps around right subclavian artery High risk procedures: thyroidectomy, carotid endarterectomy, operations in anterior triangle of neck |
|
|
What nerves are responsible for the sensation of the larynx?
|
Above glottis - superior laryngeal nerve
Below glottis - recurrent nerve Important to initiate cough reflex |
|
|
What are the muscles of the shoulder, their functions, and their innervations?
|
Pectoralis major - adduction - C5-T1
Deltoid and serratus anterior - abduction (first 60 deltoid, then serratus) - long thoracic nerve Deltoid - anteversion - axillary nerve Teres major - retroversion - subscapular nerve Infraspinatus - external rotation - suprascapular nerve Subscapularis - internal rotation - subscapular nerve |
|
|
Scapular Winging
|
Medial border of scapula stands out when person presses arm anteriorly against a wall
Causes: Paralysis of anterior serratus muscle Damage to long thoracic nerve |
|
|
Rotator Cuff
|
Supraspinatus
Infraspinatus Teres minor Subscapularis Hold head of humerus in glenoid cavity Injury causes instability of shoulder joint |
|
|
What exacerbates pain with inflammation of subacromial bursa?
|
Abduction
|
|
|
Brachial Plexus
(Basic Details) |
Rami C5-C6 - upper trunk - musculocutaneous nerve
Ramus C7 - middle trunk - axillary nerve and radial nerve (posterior cord) and median nerve Rami C8-T1 - lower trunk - ulnar nerve |
|
|
Upper Brachial Plexus Injury
|
Forceful separation of neck and shoulder (motorcycle accidents, football tackling)
Arm hangs in medial rotation ("waiter's tip position") |
|
|
Posterior Cord Injury
|
Radial nerve injury
Compression by too long crutches "Wrist drop" |
|
|
Lower Brachial Plexus Injury
|
Forceful pull of arm/shoulders (such as in birth)
Ulnar nerve injury "Claw hand" |
|
|
Radial Nerve Injury
|
"Wrist drop"
Loss of triceps reflex Sensory loss to posterior arm and dorsal hand |
|
|
Median Nerve Injury
|
No flexion of thumb, index and middle fingers
No thumb opposition Thenar atrophy Sensory loss to radial 2 1/2 fingers (palm and tips) |
|
|
Ulnar Nerve Injury
|
"Claw hand"
No flexion of 4th and 5th fingers Apothenar atrophy Sensory loss to ulnar 1 1/2 fingers (palm and tips) |
|
|
Musculocutaneous Nerve Injury
|
No elbow flexion
No supination Loss of biceps reflex Sensory loss to extensor aspect of forearm |
|
|
Carpal Tunnel Syndrome
|
Compression of median nerve by carpal ligament
Pain/tingling in distribution area of median nerve |
|
|
What nerve is most at risk of injury from a humerus fracture?
|
Radial nerve (spirals down near humerus)
|
|
|
What is a Colles' fracture?
|
Fracture of radius near wrist
Dorsal/lateral position of hand |
|
|
Tennis Elbow
|
Repetitive stress, especially backhand play
Due to inflammation of lateral epicondyle (origin of extensor muscles of forearm) Elbow joint and olecranon not involved |
|
|
What are the muscles of the elbow, their functions, and their innervations?
|
Biceps brachii - flexion, supination - musculocutaneous nerve
Triceps brachii - extension - radial nerve Pronator teres - pronation - median nerve |
|
|
What are the muscles of the hip, their functions, and their innervations?
|
Gluteus maximus - external rotation, extension - inferior gluteal nerve
Gluteus medius and minimus - internal rotation - superior gluteal nerve Iliopsoas - flexion - femoral nerve Gluteus medius - abduction - superior gluteal nerve Adductor magnus and minimus - adduction - obturator nerve |
|
|
What is the major risk in pelvic fractures?
|
Risk of severe internal bleeding
Cause: car accidents |
|
|
What is the major risk in femoral neck fractures?
|
Risk of femur head necrosis
Significant morbidity and mortality Common in elderly women with osteoporosis |
|
|
What is jaundice?
|
Also called icterus
Yellowish pigmentation of skin, tissues, and certain body fluids due to deposition of bilirubin pigments |
|
|
What is the first evidence of jaundice?
|
Scleral icterus
>5mg/dL, sublingual icterus can be seen (indication of elevated bilirubin due to biliary or hepatic causes) |
|
|
What are the steps in bilirubin formation?
|
RBCs die or lyse and release hemoglobin
Heme (heme oxygenase) Biliverdin (biliverdin reductase) Unconjugated bilirubin Binds to albumin to be delivered to liver via serum Conjugated in liver by uridine diphosphate glucuronosyl transferase Conjugated bilirubin released to intrahepatic bile ducts |
|
|
What are the primary causes of jaundice?
|
Hemolysis (elevated unconjugated/indirect)
(G6PD deficiency, sickle cell, autoimmune hemolytic anemia) Deficiency of glucuronosyl transferase (elevated unconjugated/indirect) (Gilbert's syndrome, Crigler-Najjar) Defects in transport of bilirubin from hepatocyte to bile duct (elevated conjugated/direct) (viral hepatitis, infectious mononucleosis, Rotor syndrome, Dubin-Johnson syndrome) Obstruction of biliary system (elevated conjugated/direct) (choledocholithiasis, sclerosing cholangitis, primary biliary cirrhosis) |
|
|
Gilbert Syndrome
|
Congenital cause of jaundice
Mildly decreased expression of uridine diphosphate glucuronosyl transferase Causes elevated indirect bilirubin at times of physical stress |
|
|
Crigler-Najjar Syndrome
|
Congenital cause of jaundice
Type 1: Autosomal recessive Absent UGT expression (no conjugation occurs) Lethal Type 2: Autosomal dominant Decreased expression of uridine diphosphate glucuronosyl transferase Chronic elevation of indirect/unconjugated bilirubin |
|
|
Rotor Syndrome
|
Congenital cause of jaundice
Impaired hepatocellular secretion secondary to carrier defect Causes elevated direct/conjugated bilirubin |
|
|
Dubin-Johnson Syndrome
|
Congenital cause of jaundice
Impaired hepatocellular secretion secondary to carrier defect Darkly pigmented liver Elevated direct/conjugated bilirubin |
|
|
Hepatitis A
|
Only acute, never chronic (no carriers)
RNA virus (picornavirus) Fecal/oral transmission via contaminated food and water Acute: HAV IgM Late: HAV IgG - can last for years, protective Incubation: 2-6 weeks |
|
|
Hepatitis B
|
"Serum hepatitis"
DNA virus (hepadnavirus) HBs-Ag is earliest marker - indicates current or chronic infection HBe-Ag indicates highly infective state 10% become chronic Parenteral, sexual, vertical transmission Incubation: 2-6 months |
|
|
What is a Dane Particle?
|
Hepatitis B viral particle
|
|
|
Hepatitis C
|
Leading infectious liver disease of Western world
Most important cause of transfusion hepatitis (90%) RNA virus (flavivirus) Causes episodic increases in transaminases (ALT, AST) with normal intervals Parenteral transmission 50-70% become chronic Incubation: 1-2 months |
|
|
Hepatitis D
|
Delta virus
RNA virus Occurs only in conjuction with HBV - requires HBV's antigen coat for replication 2 types: Coinfection - HBV and HDV acquired simultaneously Superinfection - HBV established before HDV acquired (significantly increases mortality associated with HBV) Parenteral and sexual transmission |
|
|
Hepatitis E
|
Self-limited - never chronic (but often fulminant in pregnant women)
Occurs primarily in SE Asia and middle East Fecal/oral transmission via contaminated water |
|
|
Hepatitis G
|
Exact role in acute or chronic disease is not yet understood
Caused by GB virus-C (GBV-C) - RNA virus (Flaviviridae family) |
|
|
What are some non-infectious etiologies of acute hepatitis?
|
Drugs
Poison mushrooms |
|
|
What are some non-infectious etiologies of chronic hepatitis?
|
Wilson's disease
Alpha-1-antitrypsin deficiency Chronic alcoholism Drugs Autoimmune disease |
|
|
HBs-Ag
|
Surface antigen of hepatitis B
Indicates current infection Appears weeks prior to symptom onset Persists 3-4 months (if >6 months, indicates carrier state/chronic HBV) |
|
|
Anti-HBc
|
Antibody to core of hepatitis B virus
Indicates exposure (past or present infection) Appears 4 weeks after HBs-Ag appearance Remains elevated for years after infection Present during the "window" period Is not protective |
|
|
HBe-Ag
|
Appears after HBs-Ag appears, disappears before HBs-Ag disappears
Secreted by actively infecting virus Indicates state of extreme infectiousness |
|
|
HBV DNA
|
Present in serum of those with current infection
Used to determine viral load after diagnosis Higher value = more infectious Present during "window period" |
|
|
Anti-HBs
|
Antibody to hepatitis B surface antigen
Appears after symptoms disappear Indicates immunity - is protective |
|
|
Toxic Hepatitis
|
Inflammation of the liver (hepatitis) due to toxin (poison or drug)
Can develop over weeks to months Looks the same as chronic viral hepatitis histologically Major causes: Methotrexate Chloramphenicol Halothane Isoniazid |
|
|
Cirrhosis
|
Diffuse disorganization of normal hepatic structure by regenerative nodules surrounded by fibrotic tissue
End stage of many liver diseases One of top causes of death of 45-65 year olds in USA |
|
|
Symptoms of Cirrhosis
|
Weakness
Malaise Weight loss Anorexia Fat malabsorption Bleeding problems Ascites Caput medusa Infections Fat soluble vitamin deficiencies Hepatic encephalopathy Portal hypertension with varices |
|
|
Alcoholic Cirrhosis
(Laennec's Cirrhosis) |
Irreversible
Most common cause of cirrhosis End stage of alcoholic hepatitis Initiated by alcoholic hepatitis, which progresses to fatty change, focal necrosis, neutrophil infiltrates, presence of Mallory bodies Continued inflammation leads to cirrhosis by causing hepatocyte destruction and scar formation Liver becomes increasingly fibrotic, leading to central vein obstruction and fibrosis surrounding individual liver cells Early stage: micronodular Late stage: macronodular |
|
|
Cirrhosis due to Viruses or Toxins
|
Typically initiated by toxic or infectious hepatitis
Common etiologic agents: Methotrexate Amiodarone Hepatitis B Hepatitis C |
|
|
Primary Biliary Cirrhosis
|
No symptoms in early stage
First sign is increased alkaline phosphatase First symptom is pruritis, especially at night Peak age: 40-60 years Female >>>> Male Micronodular Autoimmune disease with anti-mitochondrial antibodies |
|
|
Hemochromatosis
|
"Bronze diabetes"
Male > Female symptomologically in early years (menses is "protective" from effects) Autosomal recessive Increased iron absorption leads to iron deposits in liver, heart, pancreas, and skin in form of hemosiderin Triad: Cirrhosis New-onset diabetes Skin pigmentation (Cardiomyopathy is also a frequent outcome) |
|
|
Wilson's Disease
|
Also called hepatolenticular degeneration
Autosomal recessive Accumulation of copper, which may lead to fulminant hepatitis and later cirrhosis Marked by decreased serum ceruloplasmin so copper deposits inappropriately in: Brain (psychosis, athetosis, incoordination) Kidney (high urinary copper) Cornea (Kayser-Fleischer rings - orange rings visible in cornea) Liver (cirrhosis) |
|
|
Amyloidosis
|
Disease marked by accumulation of amyloid
Affects liver 50% of the time |
|
|
Metastatic Liver Cancer
|
Most common type
Primary sites: breast, lung, colon |
|
|
Hepatocellular Carcinoma
|
Primary liver cancer
Associated with massive hepatomegaly at tumor site Massively elevated alkaline phosphatase, modest elevations in ALT and AST Tumor marker: alpha fetoprotein Most common causes: chronic HBV or HCV, aflatoxin exposure |
|
|
Cholangiocarcinoma
|
Bile duct carcinoma
Greatest risk factor: infection with liver fluke (Clonorchis sinensis) Starts in intrahepatic bile ducts More common in Asia |
|
|
Pancreatitis
|
Major causes: alcoholism, gallstones (obstructing pancreatic duct system), hypertriglyceridemia
Severe epigastric pain with radiation to back Elevated amylase and lipase Hypercalcemia can occur (calcium binding to fats being digested by pancres) Inappropriate activation of pancreatic enzymes leading to autodigestion of pancreas - can be life threatening |
|
|
Intussusception
|
One part of bowel telescopes into neighboring bowel
Usually involves terminal ileum intussuscepting into ascending colon Risk age: up to 7 years old, highest risk is 5-10 months old Most significant risk: adenovirus infection Symptoms: Vomiting Palpable right upper quadrant sausage-shaped mass with vacant lower right quadrant Currant jelly stool |
|
|
Midgut Volvulus
|
Duodenum and colon malrotate around mesentery during fetal development, causing constriction of bowel and vasculature
Age: neonates (under 30 days old) Symptoms: Vomiting Bloody diarrhea Abdominal distention |
|
|
Necrotizing Enterocolitis
|
Bowel mucosa necroses, eventually deeper bowel tissues
Age: neonates Risks: maternal NSAID use, prematuturity, comorbid disease at birth |
|
|
Hirschprung's Disease
|
Due to lack development of Auerbach's and Meissner's plexuses in focal regions of colon
No peristalsis occurs in affected areas Age: neonates Symptoms: Vomiting Obstipation Chronic abdominal pain |
|
|
Osteoarthritis
|
#1 articular disorder
Disorder of hyaline cartilage and subchondral bone - all surrounding tissues hypertrophied Cartilage is lost, joint spaces narrow, subchondral bone increases in density, osteophytes form Slow, progressive Etiology: use, trauma Starts in teens-20s (asymptomatic), most people have it by age 40 (usually still asymptomatic), universal in population by age 70 Female > Male (symptomologically) Joint stiffness after inactivity Stiffness lasts less than 1 hour after waking Knees, hips, spine (weight bearing joints) most affected - DIPs of hand and great toe also affected Heberden's nodes and Bouchard's nodes (palpable osteophytes at interphalangeal joints) No serologic marker Eburnation (polished appearance of bone due to wearing) Joint mice common (bits of bone in joint space from osteophyte fractures) |
|
|
Rheumatoid Arthritis
|
Must have 4 of 7 criteria for diagnosis
Characterized by non-specific, usually symmetric inflammation of peripheral joints Abrupt onset with multiple joint involvement Synovial membrane proliferation (pannus formation) with erosions of cartilage and subchondral bone, also soft tissue swelling Etiology: autoimmune Primarily females, 20-50 years at onset Tenderness in all active (inflamed) joints Stiffness lasts more than 1 hour after waking Starts in small joints, especially PIP and MCP Rheumatoid nodules (palpable subcutaneous soft tissue nodules on extensor surfaces, particularly of hands and arms) Increased ESR or CRP, Rheumatoid factor, HLA-DR4/Dw4/Dw14 Erosions in bone secondary to destruction via membrane attack complex |
|
|
7 Criteria for Rheumatoid Arthritis
|
Need 4 for diagnosis
Morning stiffness > 1 hour Arthritis in 3 or more joints simultaneously Arthritis in hand joints Symmetrical arthritis Rheumatoid nodules Serum rheumatoid factor Erosions or bony decalcification identifiable on Xray |
|
|
Still's Disease
|
Systemic juvenile arthritis, juvenile rheumatoid arthritis
Acutely febrile Polyarthritis Rheumatoid factor negative Micrognathia Occurs before age 16, complete remission by adulthood |
|
|
Psoriatic Arthritis
|
Like rheumatoid arthritis but also associated with psoriasis of skin and/or nails
No rheumatoid factor Affects primarily DIPs Sausage digits HLA-B27 |
|
|
Felty's Syndrome
|
Polyarticular rheumatoid arthritis
Splenomegaly Leukopenia (specifically with neutropenia) Leg ulcers Increased infections Severe variant of RA |
|
|
Osteogenesis Imperfecta
|
Abnormal fragility of bone due to disorder of collagen synthesis
Increased number of fractures Blue sclera (thin connective tissue reveals underlying vessels) Newborn type is most severe (skull feels like "bag of bones" - soft with Wormian bones) |
|
|
Osteopetrosis
|
Also called Marble Bones or Albers-Schonberg Disease
Sclerosis of vertebral endplate ("rugger jersey" vertebrae on Xray) Increased density and abnormal skeletal modeling Very brittle bones Many forms - can be fatal (though most are not) |
|
|
Achondroplasia
|
Type of chondrodystrophy - defective cartilage synthesis and decreased epiphysis formation
Type of dwarfism Autosomal dominant Short limbs with normal sized head and trunk |
|
|
Aseptic Necrosis
|
Due to cut in blood supply
Can be secondary to trauma at head of femur, tibial tuberosity, scaphoid bone Osgood-Schlatter disease - aseptic necrosis of tibial tuberosity Legg-Calve-Perthes Disease - aseptic necrosis of femoral head in children without trauma history |
|
|
Osteoporosis
|
Thinned cortical bone and enlarged medullary cavity
Diffuse radiolucency No serum markers or abnormalities - test with bone density or DEXA scan Fragile bones that are inadequate for weight bearing or mild trauma Patients easily fracture bones with falls, suffer commonly from compression fractures of vertebrae (from weight bearing) Risk groups: Caucasians, women, petite individuals |
|
|
Etiologies of Osteoporosis
|
Estrogen deficient state:
Post-menopausal, post-overiectomy, ovarian failure Physical inactivity: Being bedridden Hypercortisolism: Cushing's, chronic steroid therapy Hyperthyroidism Subclinical calcium deficiency |
|
|
Types of Osteoporosis
|
Primary:
Idiopathic - children and adolescents Type I - postmenopausal women Type II - men and women over 70 Secondary: All other causes |
|
|
Osteomalacia
|
Due to inadequate bone mineralization
In children known as rickets when caused by vitamin D deficiency Serum findings: low calcium, low phosphate, high alkaline phosphatase Radiologic findings: diffuse radiolucency with occasional "Looser's Zones" (radiolucent bands that run perpendicular to periosteal surface, due to pseudofractures) Results in bone pain, skeletal deformities (especially long bone bowing), frequent fractures |
|
|
Etiologies of Osteomalacia
|
Vitamin D deficiency
Severe liver disease of any type: Liver is needed to convert Vitamin D3 (second to last step in making active vitamin D) Anticonvulsant drugs Renal osteodystrophy: Kidney completes last step of creating active vitamin D Fanconi's Syndrome (disorder affecting renal tubules, causing loss of phosphate and calcium) Malnutrition/Malabsorption: Anything that limits availability of calcium, phosphate, vitamin D |
|
|
Osteitis Fibrosa Cystica
|
Von Recklinghausen disease of bone
Focal bony damage caused by severe hyperparathyroidism Results from microfractures and secondary hemorrhages that cause ingrowth of fibrous tissue along with hemosiderin deposition "Tumors" often undergo cystic degeneration |
|
|
Paget's Disease
|
Osteitis deformans
Increased uncontrolled bone turnover with formation outpacing resorption and formation being of disorganized bone Results in frontal bossing, deafness, bone pain, pain secondary to compression fractures, chalkstick fractures of lower extremities, high output cardiac failure Lab findings: extremely high alkaline phosphatase, possible occasional hypercalcemia (at times of "remission" of bony overgrowth) Radiologic findings: enlarged thickened bones with coarse thickened cortices |
