Pathophysiology Test 3 USF
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- Effect smoking has on cilia of respiratory system
- Paralysis, therefore you can't move the "gunk" out efficiently
- Upper respiratory System
- Everything but the lungs themselves
- Characteristics of Upper Respiratory Infections
-
acute inflammation
viral
self-limiting
they increase your susceptibility to bacterial infections:
streptococcal nasopharyngitis
bacterial sinusitis (inc. susceptibility to meningitis)
otitis media (eustachian tube) - Pleura
- thin, transparent, double layered serous membrane that lines the thoracic cavity (parietal) and encases the lungs (visceral)
-
Cell structures of Bronchial Tree:
Bronchus, Bronchiole, Alveolus -
Bronchus - goblet cells, mucous glands, mucous blanket, pseudostratified epithelium
Bronchiole - simple epithelium, no goblet cells, no mucous blanket
Alveolus - simple squamous cells, increased gas exchange - Pathways microorganisms use to enter the lungs and cause infection
-
inhalation
aspiration
dissemination from distant infection sites in the body (through blood) such as GI infection or any other organ - Are lungs normally a sterile environment?
- Yes
- First flu pandemic facts
-
1918-1919
20-40 million people killed
started in kansas w/ one person - Influenza caused by
-
orthomyxoviridae family of viruses
RNA genome - Influenza incubation period
- up to 4 days
- Flu symptoms
-
high fever
headache
extreme fatigue
dry, unproductive cough
sore throat
runny or stuffy nose
extreme muscle aches
ALMOST NEVER GI SYMPTOMS, THOUGH MORE COMMON IN CHILDREN - TYPE A Influenza Virus
-
most common, most severe
can infect multiple species
virtually all type A can affect birds - Type A influenza subtypes characterized by
- hemaglutinin and neuraminidase surface antigens
- 2006 influenza strains in vaccine
-
H3N2
H1N1 - Type B influenza
- very mild
- antigenic DRIFT
-
every flu season
very slight changes in surface antigens
last years antibodies may still protect you - antigenic SHIFT
-
different subtype of virus forming rapidly
new antigens
no previous immunity
spread quickly among birds in markets - Method of flu shot vaccine
- contains killed virus
- nasal spray flu vaccine
- live, weakened flu virus - not for the immune compromised. 5-49 years old, not pregnant, healthy.
- Bird Flu Strain
- H5N1
- Pneumonia Facts
-
one of the leading causes of death in the United States
Most common cause of death due to an infectious disease - Community Acquired Pneumonia
-
mostly viral
most commonly acquired viral pneumonia
If bacterial, most likely hospital acquired S. pneumoniae. Diplococcus w a slippery polysaccharide capsule makes it a hard bacteria to fight.
This bacteria also causes: otitis media, sinusitis, meningitis. - Pneumonia vaccine for adults
- 23-valent pneumococcal vaccine
- Pneumonia vaccine for children
- 7-valent pneumococcal vaccine
- Hospital acquired pneumonia
-
20-50% mortality - mostly immunocompromised patients in nursing homes, prisons, etc.
90% due to bacteria:
Pseudomonas aeruginosa, S. aureus, Serratia sp., Klebsiella sp. (alcoholics prone to this), E. Coli (infants prone to this) - Risk factors for hospital acquired pneumonia
-
Mechanical ventilation and airway instrumentation (both of these work against your innate immune systems goal to keep these areas sterile)
Immunocompromised
Chronic lung disease - Pneumonia is a major cause of death in the immunocompromised person because
- they have a decreased B-Cell count due to decreased humoral immunity, therefore they are at increased risk of bacterial infections
-
Nasopharyngeal defenses
Function & Factors that impair their effectiveness -
Fx - remove particles from the air, contact with IgA protects against infection
Impaired by - IgA deficiency, hay fever, common cold, trauma to the nose -
Glottic and cough reflexes
Function & Factors that impair their effectiveness -
Fx - prevent aspiration into tracheobronchial tree
Impaired by - loss of cough reflex for any reason (ie stroke), neuromuscular disease, abdominal or chest surgery, nasogastric tube -
Mucociliary blanket
Function & Factors that impair their effectiveness -
Fx - remove secretions, microorganisms, and particles from respiratory tract
Impaired by - smoking, viral diseases, chilling, inhalation of irritating gases -
Pulmonary Macrophages
Function & Factors that impair their effectiveness -
Fx - remove microorganisms and foreign particles from the lung
Impaired by - chilling, alcoholic intoxication, smoking, hypoxia - Mycobacterium Tuberculosis
-
3 million/yr. die worldwide from TB
rod shaped bacterium
waxy capsule (hard to phagocytize)
airborne via resp. droplets
can affect any organ
causes caseous (cheesy) necrosis
bacteria has evolved to be able to live inside macrophage - Tuberculin test indicates
- exposure, not active infection
- Diagnosis of active infection requires
- visual ID of organism in resp. tract secretions.
- Miliary
- TB is miliary, meaning that it seeds all over the lung. This is the most severe form of TB, and easily disseminates to other organs.
- Cavitary TB
- essentially eats craters in lung tissue
- FALSE NEGATIVES in HIV+ and TB+ people are due to
- decreased T-cell count, you cannot see the body reacting to the TB
- Ghon's complex
- Caseous necrosis in the center, T-cells and macrophages cannot destroy so they wall it off. Creates a dormant lesion that can come back later under stressful conditions
- Primary TB
-
T cell response - development of cell-mediated immunity - positive skin test
granulomatous inflammatory response
Ghon's complex
Healed dormant lesions
under stress, this can move to reactivated or secondary TB - Secondary TB
- can begin with stressful conditions and Ghon's complex, or upon reinfection
- Treatment for active TB infection
- Rifamate and Rifater
- Treatment for exposure but not active TB infection
- Calmette-Guerin vaccine - attenuated strain of TB - high dose gets immune system going strong
- Chronic Obstructive Pulmonary Disease
-
Characterized by difficult expiration, air trapping
includes asthma (type 1 hypersensitivity), chronic bronchitis, emphysema
ALL COPD'S have DIFFICULT EXPIRATION in common - Manifestations of COPDs (mostly related to emphysema and bronchitis)
-
inflammation, fibrosis, hypertrophy of submucosal glands (all of these cause obstructions)
loss of elastic tissue (lungs can't recoil, more likely to trap air)
loss of alveolar tissue - can't exchange gases well, hypoxia, excess CO2 - Emphysema
-
enlargement of airspaces distal to the terminal bronchioles with destruction of the alveolar and capillary walls
affects smokers, those genetically deficient in alpha1-antitrypsin (early onset, non-smokers) - chronic bronchitis
-
excess production of tracheobronchial mucus causing productive cough FOR AT LEAST 3 MONTHS DURING 2 CONSECUTIVE YEARS
inflammation of the bronchi caused by irritants or infection (smoking) - Emphysema appearance
- barrel shaped chest (caused by air trapping)
- chronic bronchitis appearance
-
possibly cyanotic
bloated
difficulty with inhalation as well as exhalation - Tumors of the respiratory tract
- very poor survival rate, 14% for 5 year survival.
- Respiratory tract tumor risk factors
-
Lifetime smoker has 20-30% inc. risk compared to nonsmoker
more smoking = more risk (dose response relationship)
20+ components in tobacco modify DNA, and all cancers are due to DNA error - Manifestations of resp. tract tumor
-
cough
wheezing
upper respiratory infections
superior vena cava syndrome (lung tumor suppresses superior v.c., which slows blood return to the heart)
shoulder and scapular pain (brachioplexus nerves - tumor sometimes metastasizes here, causes great pain!) - Squamous cell carcinoma
-
alveolar
signif. tumore growth and lymphatic spread before diagnosis
hyperparathyroidism (a manifestation - alveolar cell begins to fx as a parathyroid cell, which leaves you with increased calcium levels) - Adenocarcinoma
-
glandular
most common RT tumor
early metastasis
non smokers
peripheral (solitary periph. lesion)
mostly women - Large Cell carcinoma
-
rapid growth rate in RT
early and widespread metastasis - Small Cell carcinoma
-
very serious, usually systemic by time of diagnosis
paraneoplastic manifestation (will behave like a number of diff. cell types - ACTH, ADH, PTH, etc.)
strong assoc. with smoking
death possible w/in 3 mos. of onset - PTH
-
parathyroid hormone
regulates calcium levels in the body - ACTH
- adrenocorticotropic hormone - acts on cortex of the adrenal gland and controls release of glucocorticoid hormones
- ADH
-
anti-diuretic hormone
water retention in body, more ADH = less urine output - most common metastasis sites for respiratory tract tumors
- Bone, brain
- Laryngeal cancer
-
voice box inserted
1-2% of all cancers in US
men, smokers, 50-75 years
squamous cell carcinoma of larynx
progressive hoarseness
generally good prognosis if caught early - layers of the GI tract
- Lumen - mucosa - submucosa - muscularis serosa
- dysphagia
- difficulty swallowing
- Causes of dysphagia
-
tumors
diverticular herniations (esophageal)
scleroderma (autoimmune attack on smooth muscle of esoph)
neural disorders (CVA - esp. if stroke altered function of cranial nerve v, IX,X or XII) and (Parkinson's Disease)
achalasia - achalasia
- paralysis (no peristalsis) of the lower 1/3 of the esophagus, w/o peristalsis, stomach doesn't open properly, food backs up
- Mallory-Weiss Syndrome
-
Alcoholics and Bulemics mostly
longitudinal tear in the mucosa or submucosa near the gastroesophageal junction
due to incomplete relaxation of the esophageal sphincter during vomiting
administer vasopressin into the superior mesenteric artery to stop the bleeding post-tear - Gastroesophageal Reflux
-
GERD
manifestations: heartburn, chest pain, regurgitation
inflammation and ulceration of the epithelium of the esophagus
increased risk of metaplasia (Barrett's esophagus) and fibrosis (can lead to dysphagia)
normal esophagus = stratified squamous epithelium
GERD esophagus = simple columnar epithelium (this is Barrett's esoph - takes on characteristics of stomach lining to handle the acid contents) - Hiatal Hernia
-
protrusion of the stomach through the diaphragm and into the thorax
2 types - sliding and paraesophageal - sliding hiatal hernia
-
most common, less severe, part of stomach slips through diaphragm opening at esophagus
caused by high abdominal pressure - pregnancy, obesity - paraesophageal hiatal hernia
-
idiopathic - trauma maybe??
diaphragm tears slighty, new opening, a bit of stomach slips through opening.
more severe - Carcinoma of the esophagus
-
could be squamous cell carcinoma or adenocarcinoma
95% die w/in 2 years of Dx - squamous cell carcinoma of esophagus
-
90% of esophageal cancers
most originate in middle to lower regions, discovered during investigation of nonspecific upper GI discomfort
usually chronic smokers et alcoholics - adenocarcinoma of the esophagus
- usually those with Barrett's esophagus (lining has changed to simple columnar from simple squamous to handle the acidity fo the stomach contents)
- Stomach
-
secretes pepsin and HCl (HCl secreted by parietal cells)
chief cells and parietal cells make all gastric juices
pepsin breaks down proteins - stomach mucosal barrier
-
epithelial cells - tight junctions
parietal cells - secrete H+ and HCO3- at 1:1 ratio
Mucus - protects against actions of pepsin - Acute gastritis
-
aspirin and/or alcohol compromise epithelial barrier in stomach, change consistency of mucus blanket
vague abdominal discomfort
some bleeding
may involve some erosion - Chronic Gastritis
-
inflammation, thinning and degeneration of the stomach wall - gastric atrophy
usually elderly - autoimmune gastritis
-
fundus and body of stomach
more severe
pernicious anemia
hypochlorhydria - more basic
increased risk of developing gastric cancer
chief or parietal cell antibodies might be present - Helicobactor pylori
-
gram neg rod shaped bacteria
multiple flagella
colonizes the mucus-secreting epithelial cells of the stomach, secretes urease which produces ammonia - eradicate H. pylori
-
acid-neutralizing agents, acid-inhibiting agents (proton pump inhibitors)
avoid NSAIDs
bland diet - Helicobactor Pylori Gastritis
-
most common cause of gastritis
may lead to gastric atrophy, peptic ulcer, gastric adenocarcinoma
antibiotic therapy removes risk - Peptic Ulcer Disease
-
not confined to stomach - anywhere that can come in contact with peptic secretions
mucosal ulceration (caused by h. pylori, NSAIDs and aspirin) that may extend through the muscularis of the:
lower esophagus
stomach
duodenum - Complications of Peptic Ulcer Disease
-
hemorrhage
perforation - can perf. adjacent organs as well (ie duodenum to pancreas)
intestinal stenosis - scar tissue narrows lumen of duodenum - Carcinoma of the Stomach
-
caused by nitrosamines??
adenocarcinomas - nonspecific symptoms, metastasize to lymph and liver, 5 yr survival rate 10-15%
very high in asian countries due to smoked fish in diet - Malabsorption Syndrome in small and large intestine
-
inadequate intraluminal digestion
mucosal absorptive defects
impeded transport of nutrients - Pancreas endocrine function
- insulin and glucagon
- pancreas exocrine function
-
amylase, lipase and trypsin produced by acinar cells of the pancreas
sent to duodenum through the pancreatic duct and help in lipid digestion - Cystic fibrosis complication with malabsorption
- normal enzymes are produced by the pancreas, but due to mucus blockage in the pancreatic duct, they never make it to the duodenum to assist in digestion and absorption
- liver function
-
makes bile, which goes to gallbladder then to duodenum through the hepatic duct.
bile emulsifies fats, breaks them down and makes it easier for the lipase from the pancreas to work - Inadequate intraluminal digestion
-
pancreatic insufficiency (cystic fibrosis, chronic pancreatitis, pancreatic carcinoma, pancreatic resection)
lactase deficiency - (congenital defect most common in blacks, fermentation of undigested lactose in intestine)
liver disease (affects bile formation) - Mucosal absorptive defect
-
celiac sprue - normal villi look like scrunched up sheet - with celiac sprue, look like its been flattened out
aka gluten-sensitive enteropathy
hypersensitivity (T-cell) to gliadin in dietary grains
symptoms appear early in childhood, possibly genetic component - Impeded transport of nutrients
-
lymphoma within the gastrointestinal wall increases lymphatic pressure which inc. BP
congestive heart failure causes backwards pressure which makes it harder for nutrients to move out of bloodstream, digestive tract
intestinal ischemia - inflammatory bowel disease
-
usually females Dx in highschool
ulcerative colitis, crohn disease
possibly life threatening
Common features:
inflamm. of bowel
unknown causitive agent
family tendencies
remissions and exacerbations of diarrhea and wt. loss
systemic manifestations: axial arthritis, hypercoagulation of blood - Crohn's Disease
-
creates cobblestone pathway appearance in LI and SI
granulomatous inflammation
genetic susceptibility locus: chromosome 16 ibd1 gene --> NOD2 protein (controls how you deal with LPS bacteria, can't take care of properly with macrophages)
Treated w/ infliximab (Remicade)
affects mucosa and submucosa - Ulcerative Colitis
-
Red velvet appearance in LI & SI
affects mucosa only
ulceration of the colonic mucosa in the rectum, sigmoid colon
risk fac: FH, jewish descent, caucasian - Diverticular disease
-
in LI, thin layer of longitudinal muscle w/ multiple weak areas.
diverticula = outpouchings of mucosa through the muscularis of the colon wall
prob. results from high intraluminal pressure on the areas of the weakness in the bowel wall
inflammation of diverticula = diverticulitis
rupture = intestinal contents in peritoneum = peritonitis
low fiber diets are the strongest linking factor due to unequal intraluminal pressure - appendicitis
-
most common surgical emergency of the abdomen
usually young adults
obstruction to the opening of the appendix leads to inflammation, leads to rupture, which leads to peritonitis - Intestinal neoplasms
-
20% genetic causes (like colon cancer)
rest dietary related - high fat, low fiber. fat possible carcinogen after digestion, low fiber means it sits there for a while - pathogenesis of intestinal neoplasm
-
epithelial cells do not divide properly
loss of tumor suppressor gene
deregulation of normal proliferation
means cells proliferating not just in the crypts of the LI epithelium, but all over
plus limited apoptosis
end result accumulated cells, create polyps
eventually, polyp cells continue to proliferate and lose control over that proliferation, become malignant -
colorectal cancer
risk factors -
advanced age (50-70 yrs, 90% over 50 yrs)
family Hx
ulcerative colitis
Chrons disease -
colorectal cancer
prognosis -
if limited to mucosa and submucosa, 80-100%
if all layers but no lymph 50-70%
if all layers and local lymph 30-50% -
colorectal cancer
tests -
(+) fecal occult test
blood test - carcinoembryonic antigen (CEA) normally only produced by embryo, not specific to colon cancer, but only present in blood when a cancer is present somewhere - Acute viral hepatitis
-
inflammation of the liver
differs in modes of transmission, incubation period, degree of damage and existence of a carrier state
most prevalent liver disease in the world - carrier of Hepatitis characteristics
-
harbor virus
asymptomatic
infectious -
Hepatitis A
transmission
symptoms
chronic?
carriers?
vaccine available? -
transmission: fecal/oral, parentoral, body fluids
fever, malaise, dark urine, jaundice
not chronic
no carriers
vaccine available (3rd world travel) -
Hepatitis B
transmission
symptoms
chronic?
carriers?
vaccine available? -
trans: body fluids,parentoral
fever, malaise, dark urine, jaundice
possibly chronic, yes carriers, yes vaccine -
Hepatitis C
transmission
symptoms
chronic?
carriers?
vaccine available? -
trans: parentoral, body fluids
asymptomatic, nonspecific
chronic possible, yes carriers, no vaccine avail. - Hepatitis B
-
250K new cases/yr, 1 mill. carriers
if mother has, can kill fetus/infant
Blood marker test - HB surface antigens produced by infected hepatocytes and
then released into serum
when chronic, only liver transplant can cure. messes up bile formation, glycogen storage, metabolism - living liver donors
- possible! thanks to compensatory hyperplasia, you regenerate the donated portion of your liver
- mechanism of injury from viral hepatitis
- direct cellular injury to each hepatocyte
- Cirrhosis
-
can be caused by viral hep, alcoholism
irreversible inflammatory disease disrupts liver fx and structure
scar tissue and liver cell nodules formed (cobblestone) replace normal parenchyma (normal cells)
incurable except by liver transplant - Portal Hypertension
-
complication of cirrhosis
portal takes nutrition rich blood from intestines through liver to be cleaned then dumps in vein to go to heart. whhen liver messed up, increased pressure due to nodules
inc. pressure in peritoneal cavities can lead to ascites or abnormal abdominal fluid, or portosystemic shunting of blood. - portosystemic shunting of blood
-
this is not good, cause collateral blood routes are formed, but then blood isn't cleaned by liver before dumping into circ. system
causes caput medusa (blood vessels look like snakes)
esophageal varices (varicose veins on esophagus) which cause blood backup
collateral circ - hemorrhoids
increased ammonia in circ. toxic to CNS, hepatic encephalopathy - Splenomegaly
-
complication of cirrhosis
anemia due to RBC's blocked up, Thrombocytopenia due to platelets backed up
leukopenia due to WBC backup - alcoholic cirrhosis
-
15+ yrs heavy drinking
smooth ER in hepatocytes makes "microsomal - ethanol oxidizing system" which makes
alcohol --> acetalaldehyde + free radicals
acetalaldehyde promotes collagen synthesis which is an ingredient of fibrotic tissue, which causes cirrhosis
acetalaldehyde prevents mitochondria from producing ATP, so can't run active processes like ion pumps
H+ ions accumulate w/o operating pumps, H+ ions used to make lipids, leads to fatty liver (steatosis) - why does liver failure cause hypoglycemia?
- normal liver responsible for glycogen storage. if you can't store the glycogen, you will be hypoglycemic
- why does liver failure cause encephalopathy?
- in liver failure you can't metabolize excess amino acids, which leads to a buildup of ammonia, which causes encephalopathy
- why does liver failure cause hypoalbumenia?
-
liver makes albumin normally, when not functioning it doesn't.
albumin normally prevents edema, so w/o it you get edematous, ascites.
dec. clotting factors not being produced by liver causes excess bleeding - why does liver failure cause improper absorption of fat soluble vitamins?
- liver norm. produces bile salts which help break down lipids. if not producing, lipids don't break down and then can't dissolve these vitamins
- why does liver failure cause jaundice?
- can't get rid of the bilirubin if liver not functioning, builds up and spills into tissue and causes jaundice
- Primary liver cancer
-
rare - liver cancer usually metastasized from elsewhere
risk fact: aspergillus in moldy hay, cirrhosis, chronic hepatitis B,C,D, p53 tumor suppressor gene mutation
very poor prognosis
serum alphafetoprotein blood marker produced by cancerous liver cells - Gallstones (cholelithiasis)
-
cholesterol stone - bile supersaturated w/ cholesterol. most common stone, amer. indian descent, overweight and high cholesterol risk fact., look like hard piece of indian corn
Pigmentary stones - not as common, exclusive to sickle cell population, look like pieces of charcoal. bile supersaturated w/ bilirubin - complications of gallstones
-
obstructions of common bile duct (normally bile from GB and liver goes through here) by stones leads to obstructive jaundice
infection and obstruction of outflow from degraded mucosa leads to rupture which leads to bacterial peritonitis - Cholecystitis
-
inflammation of gall bladder when gallstones injure mucosa ultimately leads to entry of enteric bacteria into the gall bladder through irritated area
could rupture, lead to bacterial peritonitis - acute pancreatitis
-
could be life threatening
acinar cells produce enzymes which go through panc. duct to duodenum.
rapid onset of inflammation of pancreas leads to rupture, releases enzymes which then start breaking down your other organs that are proteins and lipids
older than 50, alcoholic risk factor
increased serum amylase and lipase = positive
exocrine insufficiency - Chronic pancreatitis
-
injury --> inflammation --> repair over and over, tons of fibrotic tissue replacing normal pancreatic parenchyma (normal cells)
high fat diet, alcoholics risk
in a few cases preceded by actue pancreatitis, but not usually
endocrine insuff. - enzymes leak out of duct, insuff.
exocrin insuff. - lost islet cells means not enough insulin made means can't make glucagon means hypoglycemia - pancreatic cancer
-
bad, painful way to go. poor prognosis
95% adenocarcinomas (glandular) of pancreatic duct
significant cause of death in US
lack of enzymes, can't digest food properly, death within 2 yrs of diagnosis
risk: smoking, alcohol, high fat diet, chronic pancreatitis, age 50+
painful because it entraps nerve fibers - hormones - receptor cell locations
-
some receptor cells are on the surface of the plasma membrane
some cholesterol based hormones like estrogen and testosterone travel through plasma membrane to receptors in the nucleus - "releasing hormone"
- this means it comes from the hypothalamus
- hormone travel from hypothalamus
- through the cell bodies and down the long axon - swollen ends of the axons in the neurohypophysis store the hormones in the hypothalamus
- Hypothalamus hormones:
-
ADH - antidiuretic hormone
Oxytocin - acts on smooth muscle of the uterus - hypothalamus protected by:
- sella turcia, bone saddle. when absent, parts of pituitary gland missing, hormone deficiency present
- neurohypophysis
-
axons form stores of hypothalamus hormones
posterior lobe of pituitary gland - adenohypophysis
-
anterior lobe of pituitary gland
endocrine cells - make AND secrete hormones, can dump directly into bloodstream. If there is ischemia in this area, it is the adenohypophysis that is affected first
makes GH, TSH, ACTH, FSH, LH and prolactin - GH
- growth hormone - acts on muscles, bones, cartilage and all body organs, promotes protein synthesis and fat metabolism
- TSH
-
thyroid stimulating hormone - secretes follicle cells T3 and T4
increase metabolism, necessary for fetal growth and development, increase protein and bone turnover - FSH
- follicle stimulating hormone. target ovaries, controls stimulation of follicle to release egg
- LH
- leutinizing hormone, controls sperm production, ovulation cycle
- Prolactin
- targets mammary glands and controls lactation functions
- when does adenohypophysis (anterior pituitary gland) secrete hormones?
- after receiving a releasing hormone from the hypothalamus
- hypopituitarism
-
tumor or infarction in the anterior pituitary "pan hyperpituitarianism"
causes - tumor, infarctions, empty sella turcia syndrome, hypothalmic disorders: GRH growth releasing hormone deficiency (stroke damages hypothalamus, GRH not released so GH can't be secreted) - order in which hormone production is lost in hypopituitarism
-
Go Look For The Adenoma
GH
LH
FSH
TSH
ACTH - Pituitary Dwarfism
-
not enough GH to cause growth
proportionally correct
can be managed if caught early before epiphyseal plates close off - given recombinant GH - Old method of giving GH
- used to grind up cadaver pituitary glands and feed, people got Cruetzfeld Jakob disease (human mad cow)
- Gigantism
-
hypersecretion of GH before epiphyseal plates close off
8-9' tall
if not treated, will develop acromegaly - thickening of bones, organs, etc., when GH continues to be released in adulthood
drugs can counteract early on - Acromegaly
-
slowly progressive
increased connective tissue and bone proliferation
hypersecretion of GH during adulthood
untreated lowers life expect. due to hypertension and DM
DM due to glycogen breakdown even when not necessary, inability to take glucose into cell, means high serum glucose or hyperglycemia
deep voice, tongue hanging out - thyroid gland
-
anterior to trachea
T3 (tri-iodothyronine) and T4 (thyroxine)secreted depending on # of iodide, and in response to thyrotropin releasing hormone TRH from hypothalamus - hypothalamus - pituitary - thyroid feedback system
- hypothalamus secretes TRH to the anterior pituitary, which secretes TSH to the thyroid gland which sends t3 and t4 to the target organs. when t3 and t4 levels are high, the hypothalamus and anterior pit are inhibited from secreting more
- actions of thyroid hormone
-
increased metabolism:
rate of protein, fat and glucose use increases
increased oxygen consumption
inc. metabolic waste products
high metabolism = increased respiratory rate
in kids:
inc protein synthesis
necessary for mental dev.
necessary for attainment of sexual maturity - Congenital hypothyroidism
-
qenetic malfunction prevents body from making and or secreting a thyroid hormone
decreased thyroid tissue, didn't completely grow
can lead to cretinism
treatable w/ supplemental hormones, part of standard newborn screening - cretinism
- untreated congenital hypothyroidism, preventable mental retardation
- acquired hypothyroidism
-
most common disorder of thyroid function
more common in women
manifest: sluggish, fatigued, intolerance of cold, low BMR, bradycardia, impaired memory, low t3 and t4 levels
can lead to myxedema
treatable with thyroid supplements - myxedema
-
untreated acquired hypothyroidism
can lead to a coma. accumulated polysaccharides under eyes in advanced state - look droopy - graves disease
-
lead cause of hypothyroidism
due to stim. of the thyroid w/ antibodies against the TSH receptor which leads to overproduction of thyroid hormones.
TSH receptor actually being activated by an antibody, which causes increased production of T3 and T4 even though you have plenty of it already
more common in women (5:1)
develop. linked to predisposition to autoimmune disorders, external stressors - Graves disease blood test results
-
T3 and T4 - high (still being made because TSH receptors being triggered by antibody)
TSH - low (no longer being released because of high t3/t4 levels)
TRH - low (also not being released) - graves disease manifestations
-
neurologic: irritable, restless
reproductive: amenorrhea, impotence
cardiovascular: tachycardia, heat intolerance
sensory: exopthalmus (large eyes) due to hyperstimulation of extrinsic eye muscles and lipopolysaccharide accumulation behind eyes - treatment of graves disease
-
radioactive iodine, destroys part or all of the thyroid gland
subtotal thyroidectomy (removal of portion of thyroid) - thyroid carcinoma
-
most common endocrine malignancy
rare
less than 1% of all cancers in US
risk: exposure to ionizing radiation, esp. during childhood - so leukemia and lymphoma patients would be at increased risks from their previous treatment plans - Adrenal cortex zones
-
glomerulosa
fasciculata
reticularis - glomerulosa of adrenal cortex
- secretes mineral corticoids such as aldosterone - controls potassium and sodium levels
- fasciculata of adrenal cortex
- secretes glucocorticoids such as cortisol which regulates glucose metabolism
- reticularis of adrenal cortex
- secretes gonadocorticoids such as adrenal estrogens and androgens which initiate puberty
- pathway of Adrenal stimulation
- hypothalamus releases CRH (corticotropic releasing hormone) which makes the anterior pituitary release ACTH, which binds to receptors in the cortex of the adrenal gland and causes release of corticoids
- medulla of adrenal gland
- in charge of epinephrine and norepinephrine
- cushing syndrome
-
hypercortical disease
too much cortisol released, possible adrenal tumor - cushing disease
-
hypercortical disease - too much cortisol specifically due to too much ACTH (prob. caused by pituitary tumor)
could be a result of many years of asthma steroid treatment
excessive production of cortisol causing adrenal or pituitary tumor
manifest: moon shaped vface, thin skin, accumulation of fat, altered sex characteristics - endocrine fxs of pancreas
-
pancreas is 1% endocrine
islets of langerhans-
beta cells sec. insulin
alpha cells sec. glucagon
delta cells produce somatostatin - glucagon
-
release inhibited by high glucose levels
primary target is hepatocytes for glycogenolysis, gluconeogenesis
inc glucose inhibits alpha cells from releasing glucagon, because response to glucagon is to lyse glycogen which would increase serum glucose - glycogen to ATP chain
- glycogen broken down through glycogenolysis which results in glucose which is broken down by glycolysis which then enters kreb's cycle and the electron transport chain and results in ATP
- glucose metabolism
-
energy requirements predominantly met by glucose
produced from glycogen stores
manufactured from substrates
supplied from diet - insulin
-
hormone of "fed" state, causes uptake of glucose by cells
secretion stimulated by high conc. of glucose in the blood
facilitates transport of amino acid into target cell --> protein synthesis - high level of blood glucose
-
stimulates depolarization in the beta cell of the pancrease, which causes insulin secretion
cell membranes impermeable to glucose, require the glucose transporter - glucose transporters
-
GLUT -1, GLUT -2, and GLUT-4
facilitated diffusion - GLUT-1
- NOT insulin dependent glucose transporter, found on all cells (especially at blood/brain barrier)
- GLUT-2
- NOT insulin dependent glucose transporter, found on hepatocytes and beta cells of pancreas
- GLUT-4
- Insulin DEPENDANT glucose transporter found especially on skeletal muscle and adipose tissue
- action of insulin dependent transporter
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insulin mobilizes Glut-4 to the membrane surface to allow glucose transport across membrane and into the cell
exercise helps, skeletal muscle opens up like a drain and naturally takes in glucose from blood for energy - naturally lowering blood glucose levels - Diabetes Mellitus
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6th leading cause of death
when poorly managed, increased risk for:
heart disease, end stage renal dis, blindness, amputation, compl. of pregnancy, stroke - Type 1 DM
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immune mediated, idiopathic
charact. by destruction of beta cells in the pancreas
most common diag. between 5 and 20 yrs, sudden onset
more prev. in caucasians, male to female ratio approx. equal
low twin concordance, low serum insulin - immune mediated type 1 DM
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this is the major form of type 1
autoimmune attack on the beta cells,
genes of MHC (major histocompatability comples) on chromosome 6
exogenous insulin required - idiopathic type 1 DM
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no evidence of autoimmunity at all, but still destroying beta cells, method unclear
exogenous insulin required - Type 2 DM
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resistance to the action of insulin on periph tissues and/or secretory defect in insulin production
too much of the same message, not listening anymore
non caucasians and over 30 yrs
more prev. in women
risk: age, sedentary lifestyle, obesity
indentical twins: 100% concordance
hyperglycemic
diet and exercise controlled, oral hypoglycemics or exogenous insulin - poorly managed diabetes - starving in a sea of plenty
- plenty of glucose available in the blood, but no way to take it into the cells properly
- polyuria
- excess urination
- polyphagia
- excess hunger
- polydipsia
- excess thirst
- complications of DM
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damage may be due to:
excess intracellular sorbitol? normally glucose breaks down into sorbitol and then fructose, but the second step of sorbitol to fructose is very slow, which leads to high sorbitol levels
formation of adv. glycation end products? abnormal metabolite - glycation end products build up in the capillaries and cause damage
decreased oxygen delivery? RBC oxygen unloading errors - glucose possibly linked to RBC oxygen unloading mechanism? - Macrovascular complications of unmanaged DM
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cardiovascular disease
stroke
not managing DM lowers HDL's which causes cholesterol accumulation and forms atheromas
resp. for 1/2 of all deaths in diabetics - Microvascular complications of unmanaged DM
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thick basement membrane which compromises 02 delivery
retinopathy - macular degeneration, hemorrhages and aneurysms
nephropathy - thick BM = damaged glomerular capillaries which don't filter well, too many holes eventually end up with protein in urine - Neuropathic complications of unmanaged DM
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diabetic neuropathy produces symptoms in 60-70% of diabetics
GI disturbances (slow motility)
bladder dysfunction
sexual dysfunction
lack of sensation in feet - leads to foot ulcers - Gestational DM
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2-5% of pregnancies
while pregnant, require 2-3 times the insulin normally required
this is an inability to meet that increased insulin requirement
placental hormones occasionally interfere with the insulin response mechanism
can cause macrosomia (big baby)
baby may be hypoglycemic after birth because glucose crosses placental barrier and baby used to high glucose levels which suddenly aren't there anymore