NUR 545 Pathophysiology Exam Graded A 2025

Anatomy and function of the gi system components; normal intestinal flora (p1285) - - Know disorders of the gi tract and accessory organs of digestion; pathophysiology, etiology, prevention, clinical manifestations, diagnostics, treatment, and complications (p1318) - - What protects the stomach? (p1288) - -supporting structures: mesentery, peritoneum, and omentum. The interior is lined with mucosa which sits in folds called rugae when it is empty. (p1290) Gut microbiome (p1285) Mucus forms a protective barrier against acid and proteolytic enzymes which would damage the gastric lining (p1293) Causes of pyloric stenosis (p1326) - -caused by peptic ulcer disease, carcinoma, duodenal ulcers Infantile: narrowing and distal obstruction of the pylorus and a common cause of vomiting after a meal (postprandial), most common cause of intestinal obstruction in infancy. Unknown etiology. Bottle feeding, young maternal age, maternal smoking, and erythromycin administration in first 2 weeks of life are associated. Understand the process of digestion (p1285) - - 1. Ingestion of food 2. Propulsion of food and wastes from the mouth to the anus 3. Secretion of mucus, water, and enzymes 4. Mechanical digestion of food particles 5. Chemical digestion of food particles 6. Absorption of digested food 7. Elimination of waste products 8. Immune and microbial protection against infection Know dumping syndrome; pathophysiology, etiology, prevention, clinical manifestations, diagnostics, treatment and complications (p1334) - -rapid emptying of hypertonic chyme from the surgically created residual stomach (after resection) into the small intestine 10 to 20 minutes after eating; cramping, nausea, vomiting, osmotic diarrhea, hypotension, weakness, and pallor. Late dumping occurs 1 to 3 hours after eating a high carb meal and is related to hyperinsulinemia with hypoglycemia; weakness, diaphoresis, confusion. Respond to dietary management, eat small frequent meals high in protein and low in carbs. NUR 545 NUR 545 Saliva: what prevents tooth decay, immunoglobulin content (p1286) - -consists mostly of water with varying amounts of mucus, sodium, bicarbonate, chloride, potassium, and salivary alpha amylase (ptyalin; an enzyme that initiates carb digestion) The composition depends on rate of secretion Aldosterone can increase epithelial exchange Also contains mucin, iga and other antimicrobial substances Mucin provides lubrication Exogenous fluoride provides protection against tooth decay. Know hepatitis; pathophysiology, etiology, clinical manifestations, diagnostics, treatment, complications (p1392) - -inflammation of the liver Can lead to cirrhosis, cancer or death Etiology: toxic substances and viral, infections and autoimmune diseases Hep a (fecal/oral); incubation is 28 days; children younger than 6 do not have symptoms (70%). N/v/d Hep b (blood); risk factors are infants, immigrants, drugs or unprotected sex Hep c (from mother to baby) Hep d (can only occur if hep b is present) Chronic hep (b and c are main causes); malaise, anorexia, fever, gi bleeding, hepatomegaly, edema, joint pain Know different types of diarrhea and causes (p1320) (p1335) (p1390) - -loose, watery stools and may be acute, persistent, or chronic. 3 or more loose or liquid stools per day, or more frequent than normal. 1. Osmotic: nonabsorbable substance in the intestine draws excess water into the lumen of the intestine by osmosis and increases stool weight and volume. 2. Secretory: excessive mucosal secretions of chloride or bicarbonate rich fluid or overall inhibition of net sodium absorption. Viruses, bacterial enterotoxins, exotoxins. 3. Motile: excessive motility decreases transit time and the opportunity for fluid absorption caused by resection of small intestine etc. Complications of diarrhea in children (p1320) - -can have high rates of morbidity and mortality in children younger than 5 years old, especially in developing countries. Second leading cause of death in children younger than 5. Know meconium ileus - what is it associated with (p1380) - -intestinal obstruction in the neonatal period caused by meconium formed in utero that is abnormally thick and sticky which leads to a partial or complete obstruction at the level of the terminal ileum. NUR 545 NUR 545 Simple and complex Know intestinal obstruction; pathophysiology, etiology, prevention, clinical manifestations, diagnostics, treatment and complications (p1326) - -caused by any condition that prevents the normal flow of chyme through the intestinal lumen; in small or large intestines Know bilirubin, what is it? What is the bilirubin cycle? (p1306) - -byproduct of the destruction of aged red blood cells, gives bile a greenish black color and yellow tinge of jaundice Know kupffer cells and their function (p) - -phagocytic and batericidal, largest population of tissue macrophages in the body, central to innate and adaptive immunity, identify and present foreign antigens to immune system, important for healing injury to the liver and biliruibin production, lipid metabolism. Macrophages which destroy aged red blood cells Know portal htn in adults and children; what causes it and what happens because of it; what other structures are affected by portal htn (p1342) (p1394) - -abnormally high blood pressure in the portal venous system caused by resistance to blood flow. Normal pressure is 3mmhg, portal htn is at least 10mmhg. Caused by disorders that obstruct or impede blood flow through any component of the portal venous system or vena cava. Most common cause is fibrosis and obstruction caused by cirrhosis of the liver. Long term causes problems that are difficult to treat and can be fatal. Varices, splenomegaly, ascites, hepatic encephalopathy, hepatopulmonary syndrome (hps) Gi tract; lower esophagus and stomach, abdominal wall known as caput medusae and rectum, spleen. Know gerd in adults and children; pathophysiology, etiology, prevention, clinical manifestations, diagnostics, treatment, complications (p1324) (p1381) - gastroesophageal reflux disease is the reflux of acid and pepsin or bile salts from the stomach into the esophagus, causing inflammation. Increasing age, obesity, hiatal hernia, drugs, chemicals. Trigger for asthma or chronic cough. Know vitamins - water soluble/fat soluble; absorption, iron cycle, common deficiencies (p1300) - -deficiencies of enzymes needed for digestion or inadequate secretion of bile salts and reabsorption of bile in ileum; maldigestion. Fat soluble vitamins (a, d, e, and k) (p1335) Vitamin a deficiency = blindness Vitamin d deficiency = low calcium (osteoporosis, bone pain, fractures) NUR 545 NUR 545 Vitamin k deficiency = bruising Vitamin e deficiency = testicular atrophy and neurologic defects in children Vitamin c = cholesterol issues (p1353) Kwashiorkor (low in protein) (p1387) Marasmus (low in all nutrients) Where are nutrients absorbed in the body? (p1335) - -small intestines by intestinal mucosa. Know cirrhosis in adults and children; pathophysiology, etiology, prevention, clinical manifestations, diagnostics, treatment, complications (p1348) (p1392) - -irreversible inflammatory, fibrotic liver disease, obstructing flow of blood and bile Complications: portal hypertension, varices, growth failure, developmental delay Know cystic fibrosis (effects on gi system) (p1383) - -autosomal recessive disease of exocrine glands with multiple organ systems (mostly gi and respiratory) Shortened lifespan Obstruction, infection, inflammation Celiac sprue; pathophysiology, etiology, prevention, clinical manifestations, treatment (including diet) (p1385) - -celiac disease; autoimmune disease that damages small intestinal villous epithelium when gluten (gliadin) is ingested. Know vomiting; trigger zones, different types, treatments (p1318) - -involuntary, forceful emptying of stomach and intestinal contents (chyme) through the mouth Know all enzymes, hormones and secretions of the gi system; what cells secrete them, what do they do, what happens if there is not enough? Too much? (p1335) - -pancreatic enzymes (lipase, amylase, trypsin, chymotrypsin) Are required for digestion. Disaccharidase at brush border of small intestine caused by genetic defect (lactase) is lacking, inhibits breakdown of lactose (milk sugar) Bile acids/salts; fats Hormones table 40.1 (p1291) Know anatomy of bone, know bone cycle (p1407) - - Know bone growth in children (p1476) - - What lab value is associated with muscle mass? (p1423) - -serum creatine kinase (ck) NUR 545 NUR 545 Enteric plexus - -intrinsic nerves are located solely within the gi tract and are controlled by local and autonomic nervous system stimuli through the enteric plexus, which comprises 3 nerve plexuses located in different layers of the gi walls. -these enteric nerve circuits regulate motility reflexes, blood flow, absorption, secretions, and immune responses. Know osteogenesis imperfecta (p1482) - -brittle bone disease is inherited bone dysplasia related to synthesis of collagen Know osteoarthritis (p1452) - -most common form of age-related joint disease with synovial joints Changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat Degenerative disease (not inflammation) Know rheumatoid arthritis (p1456) - -chronic, systemic, inflammatory autoimmune disease by joint swelling, tenderness, and destruction of synovial joints leading to disability Characteristics of rhabdomyolysis (p1434) - -rapid breakdown of muscle Muscle pain, weakness, dark urine (protein pigment myoblobin) Know gout (p1460) - -systemic disease of uric acid Formation of crystals around joints Know osteoporosis; what will you see on xray (p1437) - -porous bone Low bone mineral density; increased risk for fractures