Rasmussen Pathophysiology Exam 2

Inflammation of the stomach's mucosal lining (may involve the entire stomach or a region) - ANS Gastritis _________Can be a mild, transient irritation, or it cab be a severe ulceration with hemorrhage - ANS Acute Gastritis _________ Usually develops suddenly and is likely to be accompanied by nausea and epigastric pain - ANS Acute Gastritis _________ Gastritis develops gradually. - ANS Chronic Gastritis Gastritis can be further categorized as erosive or nonerosive - ANS Chronic Gastritis Symptoms of: Anorexia, nausea & vomiting, postprandial discomfort, and hematemesis. - ANS Acute Gastritis Symptoms of: May be asymptomatic, but usually accompanied by a dull epigastric pain and a sensation of fullness after minimal intake. - ANS Chronic Gastritis Inflammation of the stomach and intestines, usually because of an infection or allergic reaction - ANS Gastroenteritis Usually due to primary inflammatory disease such as crohns disease - ANS Chronic Gastroenteritis Commonly due to direct infection such as salmonella from raw or undercooked chicken or eggs - ANS Acute Gastroenteritis Signs & Symptoms: Diarrhea, abdominal discomfort, pain, nausea, and vomiting - ANS Gastroenteritis Most common cause of chronic gastritis - ANS Helicobacter pylori Embeds itself in the mucous layer, activating toxins and enzymes that cause inflammation. Genetic vulnerability and lifestyle behaviors (smoking and stress) may increase the susceptibility - ANS Helicobacter pylori Other causes of?: Organisms transmitted though food and water contamination, long-term use of nonsteroidal anti-inflammatory drugs, excessive alcohol use, severe stress, autoimmune conditions, and other chronic disease - ANS Gastritis Complications of?: Peptic ulcers, gastric cancer, and hemorrhage - ANS Chronic Gastritis Manifestations of?: Include indigestion, heartburn, epigastric pain, abdominal cramping, nausea, vomiting, anorexia, fever, and malaise. Hematemesis and dark, tarry stools can indicate ulceration and bleeding. - ANS Gastritis Chyme periodically backs up from the stomach into the esophagus. Bile can also back up into the esophagus. - ANS GERD (Gastroesophageal Reflux Disease) These gastric secretions irritate the esophageal mucosa - ANS GERD (Gastroesophageal Reflux Disease) Causes of?: certain foods (e.g., chocolate, caffeine, carbonated beverages, citrus fruit, tomatoes, spicy or fatty foods, and peppermint), alcohol consumption, nicotine, hiatal hernia, obesity, pregnancy, certain medications (e.g., corticosteroids, beta blockers, calcium-channel blockers, and anticholinergics), nasogastric intubation, and delayed gastric emptying - ANS GERD (Gastroesophageal Reflux Disease) Manifestations of?: heartburn, epigastric pain (usually after a meal or when recombinant), dysphagia, dry cough, laryngitis, pharyngitis, regurgitation of food, and sensation of a lump in the throat. - ANS GERD (Gastroesophageal Reflux Disease) Complications of?: esophagitis, strictures, ulcerations, esophageal cancer, and chronic pulmonary disease - ANS GERD (Gastroesophageal Reflux Disease) Often confused with angina and may warrant ruling out cardiac disease - ANS GERD (Gastroesophageal Reflux Disease) Lesions affecting the lining of the stomach or duodenum - ANS Peptic Ulcer Disease (PUD) Risk factors of?: being male, advancing age, nonsteroidal anti-inflammatory drug use (NSAIDs), H. pylori infections, certain gastric tumors, and those for GERD. - ANS Peptic Ulcer Disease (PUD) Vary in severity from superficial erosions to complete penetration through the GI tract wall. Develops because of an imbalance between destructive forces and protective mechanisms - ANS Peptic Ulcer Disease (PUD) Types of Peptic Ulcer Disease (PUD) - ANS Duodenal Ulcers Gastric Ulcers Stress Ulcers Most commonly associated with excessive acid or H. pylori infections. Typically present with epigastric pain that is relieved in the presence of food - ANS Duodenal ulcers Less frequent but more deadly. Typically associated with malignancy and nonsteroidal anti-inflammatory drugs. Pain typically worsens with eating. - ANS Gastric Ulcers Develop because of a major physiological stressor on the body due to local tissue ischemia, tissue acidosis, bile salts entering the stomach, and decreased GI motility. - ANS Stress ulcers Stress ulcers associated with burns - ANS Curling's ulcers Stress ulcers associated with head injuries - ANS Cushing's ulcers Most frequently develop in the stomach; multiple ulcers can form within hours of the precipitating event. - ANS Stress ulcers Often hemorrhage is the first indicator because the ulcer develops rapidly and tends to be masked by the primary problem - ANS Stress ulcer Complications of?: GI hemorrhage, obstruction, perforation, and peritonitis - ANS Peptic Ulcer Disease (PUD) Manifestations of?: epigastric or abdominal pain, abdominal cramping, heartburn, indigestion, nausea, and vomiting - ANS Peptic Ulcer Disease (PUD) Acute inflammation and necrosis of large intestine; it affects the mucosa and sometimes other layers - ANS Pseudomembranous Colitis (C. Diff) Causes of?: Exposure to antibiotics, patients with cancer, or post abdominal surgery susceptible, mediated by bacterial toxins - ANS Pseudomembranous Colitis (C. Diff) Manifestations of?: Diarrhea (often bloody), abdominal pain, fever, and leukocytosis - ANS Pseudomembranous Colitis (C. Diff) Inflammation of the vermiform appendix. Most often caused by an infection. Triggers local tissue edema, which obstructs the small structure. As fluid builds inside the appendix, microorganisms proliferate - ANS Appendicitis The appendix fills with purulent exudate and area blood vessels become compressed - ANS Appendicitis Ischemia and necrosis develop. The pressure inside the appendix escalates, forcing bacteria and toxins out to surrounding structures. - ANS Appendicitis Complications of?: abscesses, peritonitis, gangrene, and death - ANS Appendicitis Manifestations of?: Vary from asymptomatic to sudden and severe. Sharp abdominal pain develops, gradually intensifies (over about 12-24 hours), and becomes localized to the lower right quadrant of the abdomen (McBurney point). Pain may occur anywhere in abdomen. Pain will temporarily subside if the appendix ruptures, and then the pain will return and escalate. - ANS Appendicitis Manifestations of?: Nausea, vomiting, abdominal distension, and bowel pattern changes. indications of inflammation and infection (fever, chills, leukocytosis). Indications of peritonitis (abdominal rigidity, tachycardia, and hypotension) - ANS Appendicitis Conditions related to the development of diverticula, outwardly bulging pouches of the intestinal wall that occur when mucosa sections or large intestine submucosa layers herniate through a weakened muscular layer. - ANS Diverticular Disease May be congenital or acquired. Thought to be caused by a low-fiber diet and poor bowel habits that result in chronic constipation. The muscular wall can become weakened from the prolonged effort of moving hard stools. More common in developed countries where processed foods and low-fiber diets are typical. - ANS Diverticular Disease Asymptomatic diverticular disease, usually with multiple diverticula present - ANS Diverticulosis Diverticula have become inflamed, usually because of retained fecal matter. Can result in potentially fatal obstructions, infection, abscess, perforation, peritonitis, hemorrhage, and shock. Often asymptomatic until the condition becomes serious - ANS Diverticulitis Manifestations?: abdominal cramping followed by passing a large quantity of frank blood, low-grade fever, abdominal tenderness (usually left lower quadrant), abdominal distension, constipation, obstipation, nausea, vomiting, palpable abdominal mass, and leukocytosis - ANS Diverticular Disease Consist of physical barriers, whereas functional obstructions result from GI tract dysfunction. Partial or complete blockage of small or large bowel. - ANS Mechanical Bowel Obstruction Caused by?: foreign bodies, adhesions, hernia, tumors, impacted feces, volvulus, intussusception, strictures, Crohn's Disease, diverticulitis, Hirschsprung's disease, and fecal impaction. - ANS Mechanical Bowel Obstruction Also called paralytic ileuses, usually result from neurologic impairment; intra-abdominal surgery complications; chemical, electrolyte, and mineral disturbances; intra-abdominal infections; abdominal blood supply impairment; renal and lung disease; and use of certain medications - ANS Functional Obstructions Most commonly occurs as a secondary tumor that he metastasized from the breast, lung, or other GI structures - ANS Liver Cancer Causes of primary tumors in ____: chronic cirrhosis and hepatitis - ANS Liver Cancer Manifestations of?: Similar to those of other liver diseases. Include anorexia, fever, jaundice, nausea, vomiting, abdominal pain (usually in the upper right quadrant), hepatomegaly, splenomegaly, portal hypertension, edema, third spacing, ascites, paraneoplastic syndrome, diaphoresis, and weight loss. - ANS Liver Cancer Inflammation of the pancreas that can be acute or chronic. - ANS Pancreatitis Causes of?: Cholelithiasis, alcohol abuse, biliary dysfunction, hepatotoxic drugs, metabolic disorders, trauma, renal failure, endocrine disorders, pancreatic tumors, and penetrating peptic ulcer. - ANS Pancreatitis ______ causes pancreatic enzymes to leak into the pancreatic tissue and initiate autodigestion, resulting in edema, vascular damage, hemorrhage, and necrosis. - ANS Pancreatic Injury _____ is replaced by fibrosis, which causes exocrine and endocrine changes and dysfunction of the islets of Langerhans - ANS Pancreatic Tissue ______ is considered a medical emergency. Mortality increases with advancing age and comorbidity. - ANS Acute Pancreatitis Complications of?: Acute respiratory distress syndrome, diabetes mellitus, infection, shock, disseminated intravascular coagulation, renal failure, malnutrition, pancreatic cancer, pseudocyst, and abscess. - ANS Acute Pancreatitis Manifestations of?: usually sudden and severe. Upper abdominal pain that radiates to the back, worsens after eating, and is somewhat relieved by leaning forward or pulling the knees toward the chest. Nausea and vomiting. Mild jaundice. Low-grade fever. Blood pressure and pulse changes. - ANS Acute Pancreatitis Manifestations of?: upper abdominal pain. Indigestion. Losing weight without trying. Steatorrhea. Constipation. Flatuence. - ANS Chronic Pancreatitis Inflammation or infection in the biliary system caused by calculi - ANS Cholecystitis Varies in severity depending on size. May obstruct bile flow and cause gallbladder rupture, fistula formation, gangrene, hepatitis, pancreatitis, and carcinoma - ANS Cholecystitis Gallstones. A common condition that affects both genders and all ethic groups relatively equally. - ANS Cholelithiasis Risk factors of?: advancing age, obesity, diet, rapid weight loss, pregnancy, hormone replacement, and long-term parenteral nutrition. Calculi vary in size and shape. - ANS Cholelithiasis Manifestations of?: biliary colic, abdominal distension, nausea, vomiting, jaundice, fever, and leukocytes - ANS Cholelthiasis Sudden loss of renal function. Generally reversible. Most commonly occurs in critically ill, hospitalized patients. - ANS Acute Renal Failure Risk factors of?: advanced age, autoimmune disorders, and liver disease. - ANS Acute Renal Failure Causes of Acute Renal Failure: ______. Extremely low blood pressure or blood volume. Heart dysfunction - ANS Prerenal Conditions Causes of Acute Renal Failure: _____. Reduced blood supply within the kidneys. Hemolytic uremic syndrome. Renal inflammation. Toxic injury. - ANS Intrarenal Conditions Causes of Acute Renal Failure: _____. Ureter obstruction. Bladder obstruction and dysfunction. - ANS Postrenal Conditions The four phases of Acute Renal Failure. - ANS Asymptomatic Phase, Oliguric Phase, Diuretic Phase, and Recovery Phase Daily urine output decreases to approximately 400 mL or less, such that waste products begin to accumulate. - ANS Oliguric Phase Daily urine output increases to as much as 5 L. - ANS Diuretic Phase Glomerular function gradually returns to normal. - ANS Recovery Phase Manifestations of?: decreasing urine output, electrolyte disturbances, fluid volume excess, azotemia, and metabolic acidosis - ANS Oliguric Phase Manifestations of?: increased urine output, electrolyte disturbances, dehydration, and hypotension - ANS Diuretic Phase Manifestations of?: symptoms begin resolving - ANS Recovery Phase Gradual loss of renal function that is irreversible. - ANS Chronic Kidney Disease Causes of?: diabetes mellitus, hypertension, urine obstructions, renal diseases, renal artery stenosis, ongoing exposure to toxins and nephrotoxic medications, sickle cell disease, systemic lupus erythematosus, smoking, advancing age. - ANS Chronic Kidney Disease How many stages are there for Chronic Kidney Disease - ANS 5 Kidney damage is present, but GFR is 90 - ANS Stage I CKD Kidney damage worsens as the GFR falls (60-89). - ANS Stage II CKD Kidney function is significantly impaired as GFR is between 30 and 59 - ANS Stage III CKD Kidney function is barely present with GFR dropping between 15 and 29 - ANS Stage IV CKD Kidney failure as the GFR drops to less than 15 or the patient begins dialysis - ANS Stage V CKD Manifestations of?: hypertension, polyuria with pale urine (early), oliguria or anuria with dark-colored urine (late), anemia, bruising and bleeding tendencies, muscle twitches and cramps, electrolyte imbalances, pericarditis, pericardial effusion, pleuritis, and pleural effusion, congestive heart failure, respiratory distress and abnormal breath sounds, sudden weight change, edema of the feet and ankles, azotemia, peripheral neuropathy, restless leg syndrome, seizures, nausea and vomiting, anorexia, malaise, fatigue and weakness, headaches that seem unrelated to any other cause, sleep disturbances, decreased mental alertness, flank pain, jaundice, persistent pruritus, recurrent infections - ANS Chronic Kidney Disease Infection that has reached on or both kidneys - ANS Pyelonephritis E. coli is the most common culprit. Kidneys become grossly edematous and fill with exudate, compressing the renal artery. Abscesses and necrosis can develop, impairing renal function and causing permanent damage. May be acute or chronic - ANS Pyelonephritis Complications of?: renal failure, recurrent UTIs, and sepsis - ANS Pyelonephritis Manifestations of?: severe UTI symptoms, flank pain, and increased blood pressure - ANS Pyelonephritis Inflammation of the bladder. The bladder and urethra walls become red and swollen - ANS Cystitis Causes of?: infection and irritants - ANS Cystitis Manifestations of?: UTI symptoms, abdominal pain, and pelvic pressure - ANS Cystitis A condition in which the urethra, or the tube that carries urine from the bladder to outside the body, becomes inflamed and irritated - ANS Urethritis Inherited disorder characterized by numerous grape-like clusters of fluid-filled cysts in both kidneys - ANS Polycystic Kidney Disease Cysts enlarge the kidneys while compressing and eventually replacing the functional kidney tissue. The exact trigger is unknown. Prognosis and progression vary widely depending on the type. - ANS Polycystic Kidney Disease What are the 2 types of Polycystic Kidney Disease? - ANS Autosomal Dominant PKD, Autosomal Recessive PKD Mutation on the short arm of chromosomes 4 and 16. Occurs in both children and adults, but is much more common in adults. Symptoms often do not show up until middle age. - ANS Autosomal Dominant PKD Less common and more serious. Appears in infancy or childhood. Progresses rapidly, resulting in end-stage kidney failure and generally causing death in infancy or childhood. - ANS Autosomal Recessive PKD Complications of?: pyelonephritis, cyst rupture, retroperitoneal bleeding, renal failure, anemia, hypertension, and renal calculi - ANS Polycystic Kidney Disease Bilateral inflammatory disorder of the glomeruli that typically follows a streptococcal infection. Affects men more than women. Leading cause of renal failure. Inflammatory changes impair the kidney's ability to excrete waste and excess fluid. May be acute or chronic. Nephrotic and nephritic syndromes are the most prevalent forms. - ANS Glomerulonephritis Loss of urinary control - ANS Urinary Incontinence Involuntary urination by a child after 4-5 years of age - ANS Enuresis Bed-wetting - ANS Nocturnal Enuresis Urinary incontinence resulting from a temporary condition - ANS Transient Incontinence Causes of?: delirium, infection, atrophic vaginitis, use of certain medications, psychological factors, high urine output, restricted mobility, fecal impaction, alcohol, and caffeine - ANS Transient Incontinence Loss of urine from pressure exerted on the bladder by coughing, sneezing, laughing, exercising, or lifting something heavy. - ANS Stress Incontinence Occurs when the sphincter muscle of the bladder is weakened. Contributing factors: pregnancy, childbirth, menopause, cystocele, prostate removal, obesity, and chronic coughing - ANS Stress Incontinence Sudden, intense urge to urinate, followed by an involuntary loss of urine - ANS Urge Incontinence Causes of?: Urinary tract infections, bladder irritants, bowel conditions, smoking, Parkinson's Disease, Alzheimer's disease, stroke, injury, and nervous system damage. - ANS Urge Incontinence Urge incontinence with no known cause - ANS Overactive Bladder Urinary incontinence caused by trauma or damage to the nervous system. Urgency is generally absent - ANS Reflex Incontinence Increased detrusor muscle contractility that occurs even though there is no sensation to void - ANS Detrusor Hyperreflexia Inability to empty the bladder, or retention. Other indications include dribbling urine and a weak urine stream. - ANS Overflow Incontinence Causes of?: bladder damage, urethral blockage, nerve damage, and prostate conditions - ANS Overflow Incontinence Occurs because of a perceived inability to interrupt work to void that results in detrusor muscle areflexia and overflow incontinence - ANS Chronic Overdistension Occurs when symptoms of more than one type of urinary incontinence are experienced - ANS Mixed Incontinence Occurs in many older adults, especially people in nursing home, who have a physical or mental impairment that prevents toileting time - ANS Functional Incontinence A continuous leaking of urine, day and night, or the periodic uncontrollable leaking of large volume of urine. The bladder has no storage capacity. - ANS Gross Total Incontinence Causes of?: anatomic defects, spinal cord or urinary system injuries, and fistulas between the bladder and an adjacent structure, such as the vagina. - ANS Gross Total Incontinence Risk factors of?: being female, advancing age, being overweight, smoking, and other diseases - ANS Urinary Incontinence Complications of?: skin problems, recurrent urinary tract infections, negative psychological consequences, and interruption of usual activities - ANS Urinary Incontinence Enlargement of the prostate - ANS Benign Prostatic Hyperplasia Manifestations of?: Hesitancy (difficulty initiating a stream), decreased stream or dribbling, urinary retention, obstruction to flow, interruption of the stream, infection caused by retention - ANS Benign Prostatic Hyperplasia Most common in men, particularly African Americans. Slow-growing tumor. Second leading cause of cancer deaths. The exact cause is unknown. As the tumor grows, the prostate impedes the urethra - ANS Prostate Cancer Risk factors of?: history of STIs, family history, high-fat diets, and androgen hormone replacement - ANS Prostate Cancer Manifestations of?: urinary difficulties, erectile dysfunctions, bloody semen, and hematuria - ANS Prostate Cancer Inflammation of the epididymis - ANS Epididymitis Causes of?: ascending bacterial infections or sexually transmitted infections, tuberculosis, and the antidysrhythmic medication amiodarone (Cordarone) - ANS Epididymitis Risk factors of?: being uncircumcised, recent surgey or a history of structural problems in the urinary tract, urinary catheterization, and sexual intercourse with more than one partner and not using condoms - ANS Epididymitis Complications of?: abscesses, fistulas, infertility, testicular necrosis, and chronic epididymitis - ANS Epididymitis Manifestations of?: Indicators of infection; scrotal tenderness, erythema, and edema; penile discharge; bloody semen; painful ejaculation; dysuria; and groin pain - ANS Epididymitis Fluid accumulation between the layers of the tunica vaginalis or along the spermatic cord. Can affect one or both testes - ANS Hydrocele Causes of?: congenital defect, inflammation, infection, trauma, and tumors - ANS Hydrocele Abnormal rotation of the testes on the spermatic cord - ANS Testicular Torsion Causes of?: trauma, but can also occur spontaneously (Reproductive system) - ANS Testicular Torsion Manifestations of?: sudden scrotal edema and pain - ANS Testicular Torsion Endometrium grows in areas outside the uterus. Most commonly grows in the fallopian tubes, ovaries, and peritoneum, but the tissue can grow anywhere in the body. The abnormal endometrial tissue continues to act as it normally would during menstruation. Blood becomes trapped and irritates the surrounding tissue. - ANS Endometriosis Complications of?: pain, cysts, scarring, adhesions, and infertility - ANS Endometriosis Manifestations of?: dysmenorrhea, menorrhagia, pelvic pain, infertility, and pain during or after intercourse - ANS Endometriosis Descent of the uterus or cervix into the vagina - ANS Uterine Prolapse Causes of?: conditions that stretch or weaken the pelvic support - ANS Uterine Prolapse What degree? cervix has dropped into the vagina. - ANS First Degree What degree? cervix is apparent at the vaginal opening. - ANS Second Degree What degree?: cervix and uterus bulge through the vaginal opening. - ANS Third Degree Manifestations of?: asymptomatic, visualization of the cervix or uterus from the vaginal opening, feeling of fullness in the pelvis or vagina, difficult or painful sexual intercourse, vaginal bleeding, and difficulty with urination and defecation. - ANS Uterine Prolapse Infection of the female reproductive system. Bacteria usually ascend from the vagina. Can be either acute or chronic - ANS Pelvic Inflammatory Disease Causes of?: sexually transmitted infection; bacteria introduced during childbirth, endometrial procedures, and abortions; and bacterial invasion from the bloodstream - ANS Pelvic Inflammatory Disease Complications of?: reproductive structure obstructions, peritonitis, abscesses, septicemia, adhesions, strictures, chronic pelvic pain, ectopic pregnancies, infertility, and problems with surrounding structures - ANS Pelvic Inflammatory Disease Manifestations?: indications of infection; pain or tenderness in the pelvis, lower abdomen, or lower back; abnormal vaginal and cervical discharge; bleeding after sexual intercourse; painful sexual intercourse; urinary frequency; dysuria; dysmenorrhea; amenorrhea; metrorrhagia; anorexia; and nausea and vomiting - ANS Pelvic Inflammatory Disease Ninth most frequent cancer in women and fifth leading cause of cancer death. Prevalence and mortality rates are the highest in Caucasian women. - ANS Ovarian Cancer Risk factors of?: genetic predisposition (defects on the BRCA1 and BRCA2 genes), advancing age, infertility, excessive estrogen exposure, obesity, and androgen hormone therapy. - ANS Ovarian Cancer Manifestations of?: abdominal distention, pelvic pain, eating disturbances, bowel pattern changes, gastrointestinal discomfort, pain during sexual intercourse, malaise, urinary frequency, and menstruation changes - ANS Ovarian Cancer Rates have been declining in recent years with advancements in screening. Almost all cervical cancers are caused by HPV. Hispanic women have the highest cervical cancer prevalence, and African American women have the highest mortality rates. - ANS Cervical Cancer Manifestations of?: asymptomatic; continuous vaginal discharge; abnormal vaginal bleeding between menstruation, after intercourse, or after menopause; and menorrhagia. - ANS Cervical Cancer Infections that can be contracted through sexual contact. More than 30 different sexually transmissible bacteria, viruses, and parasites have been identified. Some can also be transmitted from mother to child during pregnancy and childbirth as well as through blood contact. Some of these are easily eradicated with appropriate treatment, whereas others remain for a lifetime. - ANS Sexually Transmitted Infection What are three type of STIs? - ANS Chlamydia, Gonorrhea, Syphilis Caused by Chlamydia trachomatis, an intracellular parasite that requires a host cell to reproduce. The most commonly reported STI in the United States. Prevalence rates have been on a steady incline in the United States for the past 20 years. - ANS Chlamydia Can be transmitted through sexual contact and from mother to child during childbirth. Complications: neonatal conjunctivitis, PID, epididymitis, prostatitis, infertility, and ectopic pregnancy. Increases the risk for contracting other STIs - ANS Chlamydia Caused by Neisseria gonorrhoeae, an aerobic bacterium with many drug-resistant strains. Rates have been declining but have started to increase again. Second most common STI. Rates are highest in men, American Indians and Alaskan natives, and those living in District of Columbia. - ANS Gonorrhea Transmissible through sexual contact and from mother to infant during childbirth. Complications: neonatal conjunctivitis, PID, epididymitis, prostatitis, infertility, ectopic pregnancy, arthritis, dermatitis, and endocarditis - ANS Gonorrhea Ulcerative infection caused by Treponema pallidum, a spirochete that requires a warm, moist environment to survive. Transmitted from skin or mucous membrane contact with chancres and from the mother to child through the placental barrier. Prevalence rates have remained constant for the last 50 years. Rates are highest in men, men who have sex with men (MSM), African Americans, and those living in District of Columbia. - ANS Syphilis How many stages are there in Syphilis? - ANS 3 Stages Painless chancres (usually one) form at the site about 2-3 weeks after infection and often go unnoticed and disappear about 4-6 weeks later, even without treatment. Bacteria become dormant, and no other symptoms are present. May not test positive, so testing should be repeated at a later date. Contagious during this stage. - ANS Primary Syphilis Occurs about 2-8 weeks after the first chancres form. Treatment in the primary stage can decrease the likelihood of developing this stage. Manifestations: generalized, nonpruritic, brown-red rash; malaise; fever; and patchy hair loss. Symptoms will often go away without treatment, and again, the bacteria become dormant. Will test positive (if untreated) and is contagious, especially with direct contact with the rash. - ANS Secondary Syphilis Begins when the secondary symptoms disappear and lasts 1-4 years. Can last for years as the infection spreads to the brain, nervous system, heart, skin, and bones. Complications: blindness, paralysis, dementia, cardiovascular disease, pathological fractures, and death. Will test positive (if untreated) and is only contagious during the early part of this stage - ANS Latent or Tertiary Syphilis Caused by the herpes simplex virus (HSV) - ANS Genital Herpes How many types are there of HSV? - ANS 2 Types Occurs above the waist and manifests as a cold. - ANS HSV Type 1 Occurs below the waist. - ANS HSV Type 2 How many stages are there of Genital Herpes? - ANS 4 Stages Begins at the actual time of infection and antibody development. May take 2 to 20 days to occur. Manifestations: asymptomatic, a painful lesion, malaise, low-grade fever, and groin lymph node enlargement - ANS Primary Herpes Genitalis Begins once the antibodies are formed. Antibodies do not protect against reinfection but make the recurrent episodes less severe. During this phase, the virus travels up the nerve root and becomes dormant. Asymptomatic while the virus is dormant. - ANS Latent Herpes Genitalis Virus is reactivated but produces no symptoms. Virus is excreted from the body and can be transmitted through sexual contact. This stage occurs infrequently. - ANS Shedding Herpes Genitalis Characterized by the reactivation of the virus and manifestations. Virus travels back down the nerve root to the skin and causes a blister at the same site as with the first stage. Number of reoccurrences varies from none to many in a lifetime. Factors that can trigger a reoccurrence include stress, menstruation, and illness. - ANS Recurrent Herpes Genitalis HPV is benign? - ANS True can lead to the development of reproductive and anal cancers. Prevalence has been rising for the last 50 years. Can occur on the external genitals, cervix, and anus. - ANS HPV An acute and life-threatening complication of pregnancy, characterized by tonic-clonic seizures, usually occurring in a patient who had developed preeclampsia. - ANS Eclampsia A potentially dangerous pregnancy complication characterized by high blood pressure. - ANS Pre-eclampsia A severe type of nausea and vomiting during pregnancy. - ANS Hyperemesis Gravidarum Tall stature caused by excessive growth hormone prior to puberty - ANS Gigantism Gigantism is caused by? - ANS Hyperpituitarism Increased bone size caused by excessive growth hormone in adulthood - ANS Acromegaly Acromegaly is caused by? - ANS Hyperpituitarism Increased renal water retention caused by excessive antidiuretic hormone - ANS Syndrome of Inappropriate Antidiuretic Hormone Excessive prolactin that results in menstrual dysfunction and galactorrhea - ANS Hyperprolactinemia Excessive cortisol that results from the increased ACTH levels - ANS Cushing's Syndrom Hypermetabolic state caused by excessive thyroid hormones from increased TSH - ANS Hyperthyroidism The pituitary gland secretes excessive amounts of one or all of the pituitary hormones. Most commonly caused by tumors that secrete hormone or hormone-like substances. - ANS Hyperpituitarism Progressive disorder that can occur suddenly but usually develops slowly. Manifestations: headache, visual field loss or double vision, excessive sweating, hoarseness, galactorrhea, sleep apnea, carpal tunnel syndrome, joint pain and stiffness, muscle weakness, and paresthesia - ANS Hyperpituitarism Short stature caused by deficient levels of growth hormone, somatotropin, or somatotropin-releasing hormone - ANS Dwarfism Rare, complex condition in which the pituitary gland does not produce sufficient amounts of some or all of its hormones - ANS Hypopituitarism Causes: congenital defects, cerebral or pituitary trauma, autoimmune conditions, tuberculosis, pituitary tumors, hemochromatosis, histiocytosis X, sarcoidosis, and hypothalamic dysfunction - ANS Hypopituitarism Excessive fluid excretion in the kidneys caused by deficient antidiuretic hormone levels - ANS Diabetes Insipidus Progressive disorder that can occur suddenly but usually develops slowly. Manifestations: fatigue, headache, cessation of menstruation, infertility (in women), decreased libido, low tolerance for stress, muscle weakness, nausea, constipation, weight loss or gain, anorexia, abdominal discomfort, cold sensitivity, visual disturbances, loss of body or facial hair, joint stiffness, hoarseness, facial puffiness, thirst, excess urination, hypotension, short stature, and delayed growth and development - ANS Hypopituitarism A condition in which the thyroid does not produce sufficient amounts of the thyroid hormones. Relatively common (1 out of 500 Americans has the condition). May be a result of hypothalamus, pituitary, or thyroid dysfunction. Risk factor: advancing age. Causes: autoimmune thyroiditis (also called Hashimoto's thyroiditis) and iatrogenic - ANS Hypothyroidism Manifestations: fatigue, sluggishness, increased sensitivity to cold, constipation, pale and dry skin, facial edema, hoarseness, hypercholesterolemia, unexplained weight gain, myalgia, arthralgia, muscle weakness, heavier than normal menstrual periods, brittle fingernails, hair loss or thinning, bradycardia, hypotension, constipation, depression, and goiter - ANS Hypothyroidism Rare and life-threatening advanced hypothyroidism. Manifestations include marked hypotension, respiratory depression, hypothermia, lethargy, and coma - ANS Myxedema Causes: excessive iodine, Graves' disease, nonmalignant thyroid tumors, thyroid inflammation, and taking large amounts of thyroid hormone replacement - ANS Hyperthyroidism Manifestations: sudden weight loss, tachycardia, hypertension, increased appetite, nervousness, anxiety or anxiety attacks, irritability, tremor (usually a fine trembling in the hands), diaphoresis, changes in menstrual patterns, increased sensitivity to heat, diarrhea, goiter, difficulty sleeping, and exophthalmos - ANS Hyperthyroidism Also called thyrotoxicosis. A sudden worsening of hyperthyroidism symptoms that may occur with infection or stress. Fever, decreased mental alertness, and abdominal pain may occur. Medical emergency - ANS Thyroid Crisis (Storm) Condition in which the parathyroid gland does not produce sufficient amounts of PTH. Causes: congenital defects (a lack of one or more of the four parathyroid glands) and damage (e.g., surgery, radiation, or autoimmune conditions). Complications: hypocalcemia, hyperphosphatemia, hypomagnesemia, and metabolic alkalosis - ANS Hypoparathyroidism Manifestations of?: Paresthesias of the fingertips, toes, and lips. Muscle twitching or spasms (tetany). Fatigue or weakness. Dysrhythmias. Hypotension. Abdominal cramping. Diarrhea. Painful menstruation. Patchy hair loss. Dry, coarse skin. Brittle nails. Anxiety or nervousness. Headaches. Depression or mood swings. Memory loss - ANS Hypoparathyroidism Condition of excessive PTH production by the parathyroid glands. Causes: tumors, hyperplasia, and chronic hypocalcemia (renal failure). Complications: hypercalcemia, hypophosphatemia, hypermagnesemia, and metabolic acidosis - ANS Hyperparathyroidism Manifestations: osteoporosis, renal calculi, polyuria, abdominal pain, constipation, fatigue, weakness, flaccid muscles, dysrhythmias, hypertension, depression, forgetfulness, bone and joint pain, nausea, vomiting, and anorexia - ANS Hyperparathyroidism Condition of excessive amounts of glucocorticoids. Causes: iatrogenic from ingestion of glucocorticoid medications, adrenal tumors that secrete glucocorticoids, pituitary tumors that secrete ACTH and cortisol, and paraneoplastic syndrome. Manifestations: obesity (especially around the trunk), "moon" face, "buffalo hump," muscle weakness, delayed growth and development, acne, purple striae, thin skin that bruises easily, delayed wound healing, osteoporosis, hirsutism, insulin resistance, hypertension, edema, hypokalemia, mood changes, and psychosis - ANS Cushing's Syndrome Deficiency of adrenal cortex hormones (glucocorticoids, mineralocorticoids, and androgens). Causes: autoimmune conditions, infections, hemorrhage, tumors, and pituitary dysfunction that results in insufficient ACTH levels. Manifestations: hypotension, changes in heart rate, hypoglycemia, chronic diarrhea, hyperpigmentation, pallor, extreme weakness, fatigue, anorexia, mouth lesions on the inside of a cheek, nausea, vomiting, salt craving, slow and sluggish movement, unintentional weight loss, mood changes, depression, and hyperkalemia - ANS Addison's Disease Previously called insulin-dependent and juvenile-onset. Develops when the body's immune system destroys pancreatic beta cells. Must have insulin. Usually strikes children and young adults, although disease onset can occur at any age. Exact cause unknown, but most likely a viral or environmental trigger in genetically susceptible people that causes an autoimmune reaction. Cannot be prevented - ANS Type I Diabetes Previously called non-insulin-dependent and adult-onset. In adults, accounts for about 90-95% of all newly diagnosed cases. Usually begins as insulin resistance. The pancreas gradually loses its ability to produce insulin. - ANS Type 2 Diabetes Risk factors: advancing age, obesity, family history of DM, history of gestational diabetes, impaired glucose metabolism, physical inactivity, African Americans, Hispanics, Native Americans, Asians, Native Hawaiians, and other Pacific Islanders. Usually managed initially with oral antidiabetic medications that increase insulin production and action. As the condition progresses, supplemental insulin is often necessary as pancreatic production declines. - ANS Type 2 Diabetes pH imbalance characterized by increased ketones in the urine caused by insufficient insulin; if cells are starved for energy, the body may begin to break down fat-producing toxic acids (ketones). - ANS Diabetic Ketoacidosis A defect in the diaphragm allowing part of the stomach to pass through into the thorax. Associated with conditions that increase intrabdominal pressure such as ascites, pregnancy, obesity, chronic straining or coughing SIGNS/SYMPTOMS - Heartburn, chest pain, and dysphagia - ANS Hiatal Hernia Inflammation of the liver. - ANS Hepatitis spread by fecal oral route; most adults develop jaundice o SIGNS/SYMPTOMS: malaise, anorexia, nausea, low grade fever, and right upper quadrant pain - ANS Hepatitis A Spread by parental contact with infected body fluids o SIGNS/SYMPTOMS - can have no symptoms to moderate illness to fulminant hepatitis; major risk factor for hepatocellular cancer - ANS Hepatitis B spread through blood and blood product; major risk factor for hepatocellular cancer - ANS Hepatitis C Most common form of liver cancer; usually occurs in patients with underlying chronic liver disease and cirrhosis SIGNS/SYMPTOMS - Weight loss, upper abdominal pain, jaundice, anorexia TREATMENT- surgery, transplant, freezing or heating the cancer cells, and chemotherapy - ANS Hepatocellular Carcinoma Cancer of the stomach RISK FACTORS? - Smoking, diets low in fruits and vegetables, and twice the risk if H. Pylori is found in stomach SIGNS/SYMPTOMS - no early signs or symptoms; Later symptoms: anorexia, weight loss, and GI bleeding; hidden blood in stool (occult) and anemia - ANS Gastric Carcinoma Congenital disorder of large intestine- inadequate innervation of colon; with absent autonomic nerve ganglia in smooth muscle or very reduced if present CAUSES? - Genetic mutation; Cause unknown SIGNS/SYMPTOMS - no bowel movement within 48 hours in a newborn, swollen belly, gas, failure to thrive, fatigue, vomiting, chronic constipation, or diarrhea in children - ANS Hirschsprung Disease Reflux of urine from the bladder to ureter and renal pelvis; urine is allowed to flow backwards into the ureters and possibly into the kidneys CAUSES? - Shortened ureteral tunnel through the bladder wall resulting in lateral displacement of valvular mechanism making it incompetent TREATMENT? - About 80% of cases resolve spontaneously as a child grows; conservative treatment is management of cystitis with antibiotics, sometimes continuously - ANS Vesicoureteral Reflux Absence or suppression of menstruation in females age 16 or older; if female misses or more periods in a row PRIMARY - failure to begin menses by age 16 SECONDARY - cessation of established, regular menstruation for 6 months or longer CAUSES - Usually due to abnormal pattern of hormonal functioning which causes interruption of normal sequence of events of endometrial tissue lining the uterus proliferating and sloughing - ANS Amenorrhea "Hidden testis"; is when the testicle or testes are not in the scrotum and are considered to be in an extrascrotal position CAUSE? - Unknown CAN CAUSE IF LEFT UNTREATED? - Infertility, Increased risk of testicular malignancy, tubes can become fibrotic, deficiency of spermatogenesis TREATMENT- surgery to bring testes into normal scrotal position; also known as an orchiopexy - ANS Cryptorchidism Enlarged kidney - ANS Hydronephrosis WHAT IS IT? - Progressive process, results from chronic kidney disease, is the irrevocable loss of functional nephrons SIGNS/SYMPTONS - Headaches, edema, decreased ability to concentrate urine, polyuria turns into oliguria, increased BUN and serum creatine, GFR progressively decreases from 90 to 30 ml/min, mild anemia, high blood pressure, weakness and fatigue TREATMENT - Dialysis; used in stage 5 CKD to remove metabolic wastes and correct fluid and electrolyte abnormalities Hemodialysis - 3X/week, AV fistula Peritoneal Dialysis - peritoneum serves as the dialyzing membrane; access is a dialysis catheter surgically placed in the abdomen; can be done at home Continuous renal replacement therapy (CVVH) - done in the hospital through a central line - ANS Chronic Renal Failure Decreased ability to accomplish the initial steps of swallowing in an orderly sequence• Inability to initiate swallowing. Sensation that swallowed solid/liquids "stick" in esophagus. Pain w/ swallowing (odynophagia) may occur - ANS Dysphagia Pain with swallowing - ANS Odynophagia A - Acid-base balance • W - Water balance • E - Electrolyte balance • T - Toxins removal • B - Blood pressure control • E - Erythropoietin production • D - D vitamin activation - ANS Kidney Function painful menstruationa) Primary: not related to any pathological condition, develops 1-2y after menarche• Results from prostaglandin that promotes uterine contractions and ischemia of endometrial capillaries• S/S: suprapubic cramping severe enough to limit activity, N/V, diarrhea, H/Ab) Secondary: associated w/ pelvic disorders such as endometriosis or pelvic adhesions. Dull quality and may increase w/ age - ANS Dysmenorrhea Development or reproductive organs during puberty Development of secondary sex characteristics. Cyclic preparation of endometrium for implantation of an ovum - ANS Estrogen Cyclic preparation and maintenance of endometrium for implantation of an ovum• Stimulation of development of breast lobes and alveoli - ANS Progesterone Urethra opens on the dorsal aspect of thepenis; more disabling• Etiology and Tx: -Correlates w/ exstrophy of the bladder, because of failure of the abdominal wall to form- May extend proximally to involve urinary sphincter- urinary incontinence, Staged surgical procedures - ANS Epispadias Urethral meatus located on ventral undersurface of penis• Etiology and Tx: - Incomplete fusion of urethral folds- Meatus located anywhere between perineum and glans- 85% involve glans or corona- Evaluate for conditions of intersex- Tx is Sx repair - ANS Hypospadias Increased menstrual blood flow amount (approximately 80 mL per menstruation) and duration (usually 8-10 days) - ANS Menorrhagia vaginal bleeding between menstrual periods in premenopausal women - ANS Metrorrhagia short (less than 21 days) menstrual cycle, resulting in frequent menstruation - ANS Polymenorrhea long (more than 42 days) menstrual cycle, resulting in infrequent menstruation - ANS Oligomenorrhea