Exam 3 (v2): NSG 3850 / NSG3850 (2026 / 2027 Edition) Pathophysiology for Nurses II | 100% Correct Questions & Answers - Galen

Exam 3 (v2): NSG 3850 / NSG3850 (2026 / 2027 Edition) Pathophysiology for Nurses II | 100% Correct Questions & Answers - Galen Question: Which symptom suggests the presence of a hiatal hernia? a. Nausea b. Heartburn c. Diarrhea d. Abdominal cramps B. Heartburn Proton pump inhibitors may be used in the management of peptic ulcer disease to a. increase gastric motility. b. inhibit secretion of pepsinogen. c. neutralize gastric acid. d. decrease hydrochloric acid (HCl) secretion. D. decrease hydrochloric acid (HCl) secretion. Epigastric pain that is relieved by food is suggestive of a. pancreatitis. b. esophageal cancer. c. duodenal ulcer. d. dysphagia. c. duodenal ulcer. The most common cause of mechanical bowel obstruction is a. volvulus. b. intussusception. c. adhesions. d. fecal impaction. C. Adhesions Acute pain at McBurney's point is indicative of a. appendicitis. b. peritonitis. c. cholecystitis. d. gastritis. a. appendicitis. A silent abdomen 3 hours after bowel surgery most likely indicates a. peritonitis. b. mechanical bowel obstruction. c. perforated bowel. d. functional bowel obstruction. D. functional bowel obstruction. Ulcerative colitis is commonly associated with a. bloody diarrhea. b. malabsorption of nutrients. c. fistula formation between loops of bowel. d. inflammation and scarring of the submucosal layer of the bowel. a. bloody diarrhea An early indicator of colon cancer is a. rectal pain. b. bloody diarrhea. c. a change in bowel habits. d. jaundice. C. a change in bowel habits. A patient who should be routinely evaluated for peptic ulcer disease is one who is a. taking six to eight tablets of acetaminophen per day. b. being treated with high-dose oral glucocorticoids. c. experiencing chronic diarrhea. d. routinely drinking alcoholic beverages. b. being treated with high-dose oral glucocorticoids. Celiac sprue is a malabsorptive disorder associated with a. inflammatory reaction to gluten-containing foods. b. megacolon at regions of autonomic denervation. c. ulceration of the distal colon and rectum. d. deficient production of pancreatic enzymes. a. inflammatory reaction to gluten-containing foods. What clinical finding would suggest an esophageal cause of a client's report of dysphagia? a. Nasal regurgitation b. Airway obstruction with swallowing c. Chest pain during meals d. Coughing when swallowing c. Chest pain during meals Barrett esophagus is a a. gastrin-secreting lesion. b. preneoplastic lesion. c. benign condition. d. gastrin-secreting tumor. B. preneoplastic lesion. What finding should prompt diagnostic testing for inflammatory bowel disease (IBD) in a child presenting with diarrhea? a. Periumbilical discomfort b. Greenish, watery diarrhea c. Frequent, large-volume diarrhea d. Blood and mucus in the stools d. Blood and mucus in the stools The nurse notes a patient is on an oral vancomycin taper regime. Which disease is this patient being treated for? a. H. pylori infection b. C. difficile infection c. Pancreatic fistula d. Crohn disease b. C. difficile infection What finding would rule out a diagnosis of irritable bowel syndrome in a patient with chronic diarrhea? a. Negative stool leukocytes b. Intermittent constipation c. Abdominal pain and distention d. Bloody stools D. Bloody stools An urgent surgical consult is indicated for the patient with acute abdominal pain and a. vomiting. b. CVA tenderness. c. absent bowel sounds. d. borborygmi. C. Absent bowel sounds Constipation in an elderly patient can be best treated by a. maintaining a low-fiber diet. b. maintaining the current level of activity. c. fecal disimpaction. d. increasing fiber in the diet. d. increasing fiber in the diet A patient receiving chemotherapy may be at greater risk for development of a. gastroesophageal reflux. b. stomatitis. c. esophageal varices. d. Mallory-Weiss syndrome. b. Stomatitis Esophageal varices represent a complication of - hypertension. a. primary b. pregnancy-induced c. portal d. secondary c. portal A patient with chronic gastritis would likely be tested for a. Helicobacter pylori. b. occult blood. c. lymphocytes. d. herpes simplex. a. Helicobacter pylori Premature infants are at greater risk for developing a. necrotizing enterocolitis. b. pseudomembranous colitis. c. appendicitis. d. diverticular disease. a. necrotizing enterocolitis Dumping syndrome is commonly seen after - procedures. a. appendectomy b. intestinal biopsy c. colonoscopy d. gastric bypass d. gastric bypass Disorders of the esophageal smooth muscle function where dysphagia is a symptom include which of the following? (Select all that apply.) a. Esophageal stricture b. Achalasia c. Esophageal tumors d. Mallory-Weiss syndrome e. Hiatal hernia a. Esophageal stricture b. Achalasia c. Esophageal tumors Crohn disease is associated with what complications? (Select all that apply.) a. Perianal fissures b. Fistulas c. Green stool d. Abscesses e. Rectal pain a. Perianal fissures b. Fistulas d. Abscesses What is a pathophysiologic mechanism involved in the development of diarrhea? (Select all that apply.) a. Osmotic diarrhea b. Excessive flatus c. Secretory diarrhea d. Exudative diarrhea e. Motility disturbances a. Osmotic diarrhea c. Secretory diarrhea d. Exudative diarrhea e. Motility disturbances Which medication classes are used to treat Ulcerative Colitis (UC)? (Select all that apply.) a. Salicylic analogs b. Systemic chemotherapy c. Anti-TNF agents d. Janus kinase inhibitors e. Anti-interleukin 12/23 agents a. Salicylic analogs c. Anti-TNF agents d. Janus kinase inhibitors e. Anti-interleukin 12/23 agents Jaundice is a common manifestation of a. malabsorption syndromes. b. anemia. c. liver disease. d. cholecystitis. c. Liver disease Pathophysiologically, esophageal varices can be attributed to a. elevated bilirubin. b. diminished protein metabolism. c. fluid accumulation. d. portal hypertension. d. portal hypertension Hepatitis B is usually transmitted by exposure to a. hepatitis vaccine. b. feces. c. blood or semen. d. contaminated food. C. blood or semen. Hepatic encephalopathy is associated with a. hyperbilirubinemia. b. hyperuricemia. c. toxic effects of alcohol on brain cells. d. increased blood ammonia levels. D. increased blood ammonia levels. An increased urine bilirubin is associated with a. an increased indirect serum bilirubin. b. hemolytic reactions. c. Gilbert syndrome. d. hepatitis. D. Hepatitis Liver transaminase elevations in which aspartate aminotransferase (AST) is markedly greater than alanine aminotransferase (ALT) is characteristic of a. viral hepatitis. b. alcohol-induced injury. c. cirrhosis. d. acetaminophen toxicity b. alcohol-induced injury. A viral hepatitis screen with positive hepatitis B surface antigen (HBsAg) should be interpreted as - hepatitis B. a. recovered from b. immunity to c. chronic active d. acute d. acute What laboratory data would support a diagnosis of hemochromatosis? a. Deficient protease inhibitor b. Elevated ferritin c. Elevated urine copper d. Positive antinuclear antibody B. Elevated ferritin What form of viral hepatitis is likely to be transmitted sexually? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis E B. Hepatitis B Brain injury secondary to high serum bilirubin is called a. hepatic encephalopathy. b. hepatic meningitis. c. kernicterus. d. encephalitis. C. kernicterus. The most common causes of prehepatic jaundice are - and ineffective erythropoiesis. a. hemolysis b. metabolism c. fibrosis d. canalicular bilirubin transport a. hemolysis A patient with a history of alcoholism presents with hematemesis and profound anemia. The expected diagnosis is a. ascites. b. cerebral edema. c. hepatic encephalopathy. d. gastroesophageal varices. D. gastroesophageal varices. A patient admitted with bleeding related to esophageal varices could be expected to receive a continuous intravenous infusion of a. glucose. b. octreotide acetate. c. anticoagulants. d. proton pump inhibitors. B. Octreotide acetate A patient being treated for hepatic encephalopathy could be expected to receive a(n) - diet. a. low-protein b. high-protein c. high-sodium d. unrestricted a. low protein An infusion of mannitol would be prescribed to treat a. varices. b. encephalopathy. c. peritonitis. d. cerebral edema. d. cerebral edema Hepatitis with the presence of autoantibodies and positive antinuclear antibodies (ANA) is a. hepatitis D. b. autoimmune hepatitis. c. hepatitis A. d. hepatitis B. B. Autoimmune hepatitis - disease is a rare autosomal recessive disorder in which excessive amounts of copper accumulate in the liver. a. Kayser-Fleischer b. Wilson c. Reye d. Byler b. Wilson Steatohepatitis is caused by an accumulation of - in the liver cells. a. fat b. bile c. acetaminophen d. ferritin a. fat Urge incontinence risk factors Risk factors include aging, bladder infections, bladder outlet obstructions attributable to prostate enlargement, and drugs that increase urine flow (diuretics and alcohol). Neurogenic bladder incontinence diseases Diseases include Multiple sclerosis (demyelination of neurons), Parkinson disease, stroke, disorders affecting the autonomic innervation of the bladder (spinal cord injury), and neuropathy of diabetes mellitus. Stress incontinence weak muscles Weak pelvic floor muscles lead to increased intra-abdominal pressure, which can be precipitated by effort/exertion, such as lifting heavy objects, coughing, sneezing, or bending. Cystitis signs in elderly vs younger adults Elderly patients may experience confusion and delirium; they should return to their normal level of functioning after treatment with antibiotics. Causes of bladder and urethral infections The most common cause is E. coli, often due to poor hygiene in women and STDs or immunosuppression in men. Risk factors for acute pyelonephritis Risk factors include diabetes mellitus, anatomic abnormalities of the urinary tract (especially vesicoureteral reflux in children), untreated lower urinary tract infections, enlarged prostate in men, obstructive causes (renal calculi), and pregnancy. Acute pyelonephritis causative organism E. coli is the causative organism in a large majority of acute pyelonephritis cases. Acute pyelonephritis signs and symptoms Signs include costovertebral angle tenderness (CVA), chills, nausea, vomiting, anorexia, and sudden onset of fever. Cystitis signs and symptoms Signs include suprapubic pain, frequency, urgency, dysuria, and dyspareunia; pain is often relieved by voiding. Septicemia risk in pyelonephritis Septicemia can occur in acute pyelonephritis but is not seen in chronic pyelonephritis due to the body's adaptation. Complications of acute pyelonephritis Complications include abscesses, sepsis, acute respiratory distress syndrome, recurrent/chronic pyelonephritis, and chronic kidney disease. Chronic pyelonephritis characteristics Characterized by small atrophied kidneys with diffuse scarring, noted on renal imaging. Chronic pyelonephritis pathophysiology Pathophysiology involves chronic reflux of infected urine into the renal pelvis and anatomical abnormality of the urinary tract. Chronic pyelonephritis risk factors Risk factors include renal calculi, neurogenic bladder, vesicoureteral reflux, or underlying intrarenal disease. Chronic pyelonephritis clinical manifestations Clinical manifestations include flank or abdominal pain, fever, malaise, or anorexia; symptoms may be vague or similar to acute pyelonephritis. Interstitial cystitis symptoms Symptoms include relief of pain after voiding, frequency, urgency, and dysuria, with an absence of a UTI. Interstitial cystitis prevalence Interstitial cystitis occurs more often in women. Dehydration It will make the urine more concentrated. Nephrolithiasis Stones formed in the kidneys. Hydronephrosis An enlarged kidney because the stone is blocking the urine from flowing down through the ureters. Acute-on-chronic kidney disease The most common causes are systemic infections, nephrotoxic medications, dehydration, and urinary tract obstruction. Acute glomerulonephritis It is due to the antigen-antibody response of group A beta-hemolytic streptococcus. Hematuria Abrupt onset of blood in urine. Proteinuria Classic clinical manifestation of acute glomerulonephritis. Oliguria Decreased urine output. Azotemia Abnormally high levels of nitrogen-containing compounds. Edema Swelling due to increased circulating volume and loss of serum albumin. Glomerular Filtration Rate (GFR) Decreased due to inflammation of the glomeruli. Nephrotic syndrome Increased permeability of the glomerular membrane causes excessive protein leakage. Hypoalbuminemia Low levels of albumin in the blood. Hyperlipidemia Increased levels of lipids in the blood, which gives the patient an increased risk for thrombus formation. Polycystic kidney disease A genetic disorder with a dominant and recessive type. Autosomal-Recessive Polycystic Kidney Disease Identified in the neonatal period, with progressive decline in kidney and liver function. Autosomal-Dominant Polycystic Kidney Disease Eventually results in end-stage kidney disease with cysts multiplying and expanding. Clinical manifestations of Autosomal-Dominant Polycystic Kidney Disease Include decreased ability to concentrate urine, hypertension, proteinuria, hematuria, and pain from bleeding within the kidney. Systemic diseases associated with nephrotic syndrome Include lupus, malignancies, infections, and vasculitis. Risk factors for kidney stones Include dehydration, reduced fluid intake, increased urine concentration, and decreased urine volume. Risk factors for acute-on-chronic kidney disease Include systemic infections, nephrotoxic medications, dehydration, and urinary tract obstruction. Anemia in chronic kidney disease Occurs because the kidneys stop producing erythropoietin, leading to fewer red blood cells being produced. Renal function damage threshold Renal function remains relatively normal until 75% to 80% of the nephrons are damaged and nonfunctional. End stage renal failure 90% damage is when we start to see end stage renal failure. Prerenal kidney injury Sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness. Causes of prerenal kidney injury Can be due to decrease in circulating volume or abnormalities of renal hemodynamics. RAAS system The RAAS system attempts to compensate and if not treated can lead to intrarenal kidney injury. Examples of prerenal kidney injury Hypotension, sepsis, burns, NSAIDS/aspirin, artery stenosis, atherosclerosis, or an MI. Intrarenal kidney injury Associated with acute tubular necrosis (ATN), which is the result of tubular cell injury, attributable to ischemia or exposure to nephrotoxic substances. Examples of intrarenal kidney injury Glomerulonephritis, bleeding in the kidney, pyelonephritis, lupus, chemotherapy, ischemia, and multiple myeloma. Clinical manifestations of intrarenal kidney injury Disruptions in fluid, electrolytes, acid-base balances, retention of nitrogenous waste products, increased serum creatinine levels, and decreased glomerular filtration rate. Postrenal kidney injury Caused from obstruction of the normal outflow of urine from the kidneys. Consequences of postrenal kidney injury If obstruction persists, the increasing retrograde pressure of urine will result in acute tubular necrosis. Examples of postrenal kidney injury Bladder cancer, cervical cancer, colon cancer, prostate cancer, enlarged prostate, kidney stones, neurogenic bladder, and blood clots in urinary tracts. Prodromal phase of acute kidney injury Normal or declining urine output and it varies in duration depending on the causative factors. Oliguric phase of acute kidney injury May last up to 8 weeks with a usual urine output of 50 to 400 mL/day. Postoliguric phase of acute kidney injury Diuresis occurs, tubular function remains impaired, and azotemia continues. Recovery duration after acute kidney injury Recovery can last up to 12 months and is characterized by normalization of serum creatinine and blood urea nitrogen (BUN) levels. RAAS system activation Activated when a person is dehydrated. Diagnostic tests for acute kidney injury Increase in serum creatinine by greater than or equal to 0.3 mg/dL within 48 hours. Baseline serum creatinine increase Increase in serum creatinine by greater than or equal to 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days. Urine volume criteria for acute kidney injury Urine volume of less than 0.5 mL/kg/h for 6 hours. Risk factors for chronic kidney disease Major risk factors are diabetes and hypertension. Compensation in chronic kidney disease The damaged nephrons cannot function properly, and remaining nephrons try compensating by enlarging and increasing their clearance capacity. Stages of chronic kidney disease Stage 1: Kidney damage with normal or increased GFR. GFR greater than 90. Stage 2 of chronic kidney disease Mildly decreased GFR between 60-89. Stage 3 of chronic kidney disease Moderately decreased GFR between 30-59. Stage 4 of chronic kidney disease Severely decreased GFR between 15-29. Start to think about dialysis in this stage. Stage 5 of chronic kidney disease End-stage kidney disease with GFR less than 15. Liver response in nephrotic syndrome The liver is going to increase its production of lipids (hyperlipidemia), exposing them to an increased risk for clots. Hypertension A condition in which the blood pressure in the arteries is persistently elevated. Cardiovascular disease A general term for conditions affecting the heart and blood vessels. Uremic syndrome A collection of symptoms associated with kidney failure, including fatigue, nausea, and confusion. Metabolic acidosis A condition characterized by an increase in acidity in the body due to the accumulation of acids or loss of bicarbonate. Electrolyte imbalances Disruptions in the balance of electrolytes in the body, which can affect various bodily functions. Mineral/bone disorders Conditions affecting the bones and minerals in the body, often seen in chronic kidney disease. Osteodystrophy A bone disorder that occurs due to imbalances in calcium and phosphorus, often seen in patients with kidney disease. Malnutrition A condition resulting from an inadequate or unbalanced intake of nutrients. Anemia A condition in which there is a deficiency of red blood cells or hemoglobin in the blood. Dialysis A medical procedure to remove waste products and excess fluid from the blood when the kidneys are unable to do so. Transplantation The process of transferring an organ from one body to another or from a donor site to a recipient. Elevated BUN/Creatinine Increased levels of blood urea nitrogen (BUN) and creatinine indicate impaired kidney function. Increased serum potassium Higher levels of potassium in the blood, which can be dangerous and is often seen in kidney disease. Increased serum phosphorus Elevated phosphorus levels in the blood, commonly associated with kidney dysfunction. Decreased serum calcium Lower levels of calcium in the blood, which can lead to osteodystrophy and increased risk of fractures. Increased serum magnesium Elevated magnesium levels in the blood, which can occur in renal failure. Decreased bicarbonate Lower levels of bicarbonate in the blood, often indicating metabolic acidosis. Decreased pH A lower pH level in the blood, indicating increased acidity. Decreased PaCO2 Lower levels of carbon dioxide in the blood as a compensatory mechanism for metabolic acidosis. Hemodialysis A dialysis method where an artificial kidney filters waste from the blood. Arteriovenous (AV) fistula A surgical connection between an artery and a vein, used for access in hemodialysis. Peritoneal Dialysis A dialysis method where the peritoneum acts as the dialyzing membrane. Continuous Renal Replacement Therapy A dialysis method used in hospitals for patients with acute kidney injury who are unstable. Ulcerative colitis A chronic inflammatory bowel disease causing ulcers in the colon. Constipation A condition characterized by infrequent bowel movements or difficulty passing stools. Crohn's disease A type of inflammatory bowel disease that can affect any part of the gastrointestinal tract. Stomatitis Inflammation of the mucous membrane in the mouth. Duodenal ulcer A sore that forms on the lining of the duodenum, often causing pain after meals. GERD Gastroesophageal reflux disease, a chronic digestive condition where stomach acid flows back into the esophagus. Signs and symptoms of GERD Reflux esophagitis, heartburn, regurgitation, chest pain, and dysphagia. Complications of GERD Esophageal strictures, Barrett esophagus, dysphagia, and pulmonary symptoms related to reflux esophagitis. Esophageal varices Esophageal portal hypertension as a result of cirrhosis or viral hepatitis. Signs of esophageal varices Hemorrhage within 2 years, hematemesis, anemia, shock, melena. Gastritis Inflammation of the stomach lining triggered by excessive alcohol, caffeine, carbonated beverages, viral, bacterial, or autoimmune illness. Pathogenesis of gastritis Helicobacter pylori leads to gastritis and can be transmitted from person to person via fecal-oral route and water sources. Inflammatory bowel diseases Ulcerative colitis and Crohn's disease. Types of bowel obstruction Mechanical and functional. Examples of mechanical bowel obstruction Adhesions, hernia, tumor, inflammation, stricture, impaction, volvulus, or intussusception. Functional bowel obstruction Loss of propulsive ability by the bowel that may occur after abdominal surgery. Signs and symptoms of gastroenteritis Diarrhea, abdominal discomfort, pain, nausea, vomiting, elevated temperature, and malaise. Infectious agent of gastroenteritis C. diff is the infectious agent usually causing the diarrhea. Peptic ulcer disease Disorders of the upper GI tract caused by the action of hydrochloric acid and pepsin. Major factor in peptic ulcer disease Inappropriate secretion of acid; H. Pylori is a key factor in ulcer formation. Priority signs and symptoms in GI disorders Decreased circulation due to vomiting/diarrhea: Dry mucus membranes, decreased blood pressure, increased pulse, melena stool, bloody stool, hematemesis, or coffee ground vomit. Location of ulcerative colitis Disease of the colon and rectum. Pathophysiology of ulcerative colitis Begins as inflammation at the base of the crypts of Lieberkuhn, forming abscesses in the epithelium. Location of Crohn's disease Occurs anywhere from the mouth to the rectum. Cause of Crohn's disease Result of the lymphoid and lymphatic structures of the GI tract becoming blocked. Granulomas A cardinal feature of Crohn's disease on histopathological analysis, diagnostic of this disorder. Toxic megacolon A life-threatening condition in which the colon becomes massively enlarged, requiring urgent treatment and may necessitate emergency colectomy. Short bowel syndrome A condition resulting from the removal of portions of the small intestine, leading to diminished ability to absorb water, electrolytes, protein, fat, carbs, vitamins, and minerals, causing malabsorption. Pseudomembranous colitis Another name for antibiotic associated colitis, where the large intestine is exposed to a bacterial toxin (C. diff) resulting in mucosal necrosis. Appendicitis symptoms Signs include pain in the lower right abdomen (McBurney point), generalized periumbilical pain, nausea, possible diarrhea, and rebound tenderness. Leukocytosis An increased white blood cell count often noted in blood work for pseudomembranous colitis, which may also present with bloody diarrhea, abdominal pain, fever, toxic megacolon, and perforation. Irritable bowel syndrome A disorder of bowel motility with an unclear pathogenesis, believed to involve altered myoelectric activity resulting in hyperactivity of peristaltic action. Clinical manifestations of irritable bowel syndrome Symptoms include constipation/diarrhea (or a mixture of both), cramping abdominal pain, nausea, and mucus in stool. Causes of intestinal obstruction Can be due to abdominal surgery with adhesions, congenital abnormalities, and cancer tumors, particularly metastatic carcinoma. Celiac disease An immune disorder triggered by gluten intolerance, characterized by villus atrophy and malnutrition due to atrophy of intestinal villi. Dumping syndrome Occurs after all or part of the stomach is removed (gastrectomy), leading to hypovolemia and low blood pressure due to fluid shifts into the small intestine. Signs and symptoms of dumping syndrome Includes hypoglycemia 1 to 3 hours after eating, abdominal pain, diarrhea, and symptoms of hypovolemia. Peptic ulcer disease pain location Mid-epigastric pain that occurs on an empty stomach, usually relieved by food intake or antacids, with duodenal ulcer pain occurring 2 to 3 hours after a meal. Complication of peptic ulcer Peritonitis, which can occur if the peptic ulcer perforates. Urination requires both ______ and _______ capabilities physiologic cognitive PATH OF URINE: Urine enters the bladder which makes the internal pressure rise Stretch receptors are then triggered in the bladder wall, sending _______ signals to the ________ afferent spinal cord The signals stimulate the ________ muscle and causes it to contract detrusor There is enough _________ pressure to hold enough urine in the bladder, about 350-500mL sphincter At the sensation of voiding, there will be an inhibition of the contraction of the ________________ external sphincter During urination, the _____________ contract abdominal muscles URETHRITIS: May result from bacterial, fungal, or parasitic infections; chemical irritants; foreign bodies; or trauma __________ is normally cleared from the bladder by the flushing and dilutional effects of voiding Bacteria The high _____ with high osmolarity along with the ______ of urine, act as a natural barrier to pathogens urea low pH ________________ is responsible for 85% of community cases of bacterial cystitis E. coli Infections in men can be a result of ___________________________ or _______________________ sexually transmitted infections immunosuppression What is the main causative organism for acute pyelonephritis? E.Coli For acute pyelonephritis, Obstruction or ureteral reflux that allows _______________ to enter the kidney contaminated urine What are the main risk factors for acute pyelonephritis? DM Anatomic Abnormalities of the urinary tract Especially vesicoureteral reflux in children renal calculi Pregnancy Characterized by small atrophied kidneys with diffuse scarring and blunting of the calices (interior aspects of the kidneys) secondary to persistent or recurrent infection of the kidney Kidney atrophy and scarring noted on renal imaging Chronic pyelonephritis Main causes for chronic pyelonephritis -Chronic reflux of infected urine into the renal pelvis -Anatomical abnormality of the urinary tract - Risks: renal calculi, neurogenic bladder, vesicoureteral reflux (kids), or underlying intrarenal disease - Obstruction (EX: renal calculi, prostate) can cause stasis (stagnant) and this leads to bacteria growth How to diagnose chronic pyelonephritis A renal ultra sound, where it will show a small, atrophied kidney or even both kidneys Risk factors for Nephrolithiasis Reduced fluid intake, dehydration, increased urine concentration, and decreased urine volume How does hyperparathyroidism contribute to nephrolithiasis? As blood Ca+ levels rise, PTH release stops In hyperparathyroidism this "stop" is ignored - Ca+ in blood continues to rise - complications - kidney stones An increase of uric acid , ___________, can also increase your risk for nephrolithiasis gout Edema associated glomerulonephritis is due to the loss of ____________ and this changes the ________________ in the blood vessel and fluids "leak" into the interstitial space serum albumin oncotic pressure What population will be affected by chronic glomerulonephritis? DMII HTN Toxins Medications Viral (HIV, Hep) Bacterial (Strep-A) IgA nephropathy SLE In nephrotic syndrome, there is an _______________ in the urine occurs with damage to the glomerular basement membrane and slit pore proteins that normally block protein filtration excessive amount of protein Nephrotic syndrome is a condition that can develop when there is excessive _______________ over time protein loss In nephrotic syndrome, what is excreted in the urine and how does it look? Lots of albumin in the urine frothy urine Nephrotic syndrome is caused by ______________ with urinary elimination of 3 - 3.5 grams of protein/day caused by _________________ due to increased permeability to the glomerular membrane Glomerulopathy glomerular leakiness protein leaking out of membrane Increased glomerular permeability causes proteinuria Proteinuria causes hypoalbuminemia hypoalbuminemia causes stimulation of hepatic synthesis, causing hyperlipidemia and clotting factor production hypoalbuminemia also causes decreased plasma oncotic pressure which caused the generalized edema What two diseases are associated with nephrotic syndrome? DM and SLE Identified in the neonatal period, and when accompanied by pulmonary hypoplasia, may result in death. If survives adulthood, retain some renal function, but progressive decline in liver function Autosomal-Recessive (KIDS) Polycystic Kidney Disease (ARPKD) In ARPKD, what organ will also become cystic? the liver What is the most accurate way of diagnosing ARPKD over ADPKD? Liver biopsy Eventually results in end-stage-kidney disease Autosomal dominant polycystic kidney disease What are the ways to diagnose intrarenal kidney injury -Increase in serum creatinine by 0.3 mg/dL within 48 hours -Increase in serum creatinine to 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days -Urine volume 0.5mL/kg/h for 6 hours Caused from obstruction of the normal outflow of urine from the kidneys. Post renal kidney injury If obstruction persists, the increasing retrograde pressure of urine will result in _____________________ (intrinsic AKI). acute tubular necrosis What are examples of urine flow obstruction? Bladder, cervical, colon, and prostate cancer Enlarged prostate Kidney stones Neurogenic bladder Blood clots AKI occurs in someone with preexisting CKD Acute on Chronic kidney disease Most common caused of acute on chronic kidney disease Systemic systems (Infection) Medications (nephro-toxic) Dehydration (water the beans!) Urinary Tract Obstruction (stones) What are the major risk factors for CKD? unmanaged diabetes uncontrolled HTN smoking Damaged nephrons cannot function properly, and remaining nephrons try compensating by _________________________________________ enlarging and increasing their clearance capacity Renal function remains relatively normal until _______________ of the nephrons are damaged and nonfunctional. 75% to 80% GFR declines with age Laboratory Profile for Renal Disease: BUN and Creatine elevated Sodium normal of decreased Potassium increased Phosphorus increased Calcium decreased Magnesium increased Bicarb decreased pH decreased PaCO2 decreased Complications for CKD Weakness or fatigue risk of bone fracture due to decreased vit D In CKD, patients will develop anemia due to the decreased erythropoietin production Considerations for hemodialysis patients Never take a blood sample from the AV fistula/graft site Never take a BP on the arm with an AV fistula or graft Review meds to give before dialysis CM of stomatitis -Skin - herpetic gingivostomatitis (HSV) (cold sores) -Mucus membranes -Nervous system -Latent in the dorsal ganglia of the spinal cord (triggered by stress) Clinical manifestations Hemorrhage within 2 years Hematemesis (He-ma-tem-e-sis) -Anemia -Shock Melena: dark tarry sticky stools (upper GI bleed) Gastroenteritis is the Acute/chronic inflammation of the _____________________________________ due to an imbalance of normal GI bacteria flora stomach and small intestine Infectious agents (C. diff) = Diarrhea CM of gastroenteritis Diarrhea Can hear loud rushing bowel sounds due to diarrhea Abdominal discomfort Pain N/V Elevated temp Malaise Peptic ulcer disease (PUD) refers to disorders of the upper GI tract caused by the action of _________________________________. hydrochloric acid and pepsin Breakdown of the protective epithelial lining of the stomach. PUD CM of PUD Hematemesis Mid epigastric pain Epigastric burning pain Nausea Dyspepsia Chest discomfort Asymptomatic to GI Bleeding Does the pain get worse or better when intaking food with PUD? Better pain in worsened on an empty stomach Duodenal ulcer pain classically occurs _____________ after a meal 2 to 3 hours What two diseases makes up IBD? UC and Crohns IBD is characterized by exacerbations and remissions Begins as an in inflammation at the base of the crypts of Lieberkuhn (Lee-ber-kon) leading to formation of abscesses in the epithelium of the crypts. Ulcerative colitis CM of ulcerative colitis Abdominal pain Diarrhea Rectal bleeding Increased risk for colon cancer due to the constant inflammation However, _____________of those with UC experience an intermittent series of exacerbations and remissions. 65% to 75% Toxic megacolon îs a rare complication with ulcerative colitis Complications of Crohn's disease Perianal fissures, fistulas, and abscesses are common in Crohn disease and may be the symptoms that lead individuals to seek health care. Result of outpouchings of the colon due to weakness of the bowel wall Diverticulitis CM of diverticulitis Intestinal obstruction Perforation Abscesses of the bowel wall Peritonitis Acute lower left abdominal pain Fever Leukocytosis Constipation/diarrhea Myoelectric activity is altered resulting in hyperactivity of peristaltic action - Wave activity of colon is increased Irritable bowel syndrome CM of celiac disease Malnutrition Due to atrophy of intestinal villi May lead to anemia r/t vitamin/mineral deficiencies Severe debilitation Physiologic response to rapid emptying of gastric contents into small intestine because of impaired gastric emptying Reservoir function of the stomach is impaired Dumping syndrome S/s of hypoglycemia 1 to 3 hours after eating a meal. Abdominal pain Diarrhea Due to rapid movement of food and water into the small intestines S/S of hypovolemia - see above flow chart CM of dumping syndrome Severe diarrhea and significant malabsorption developing after surgical removal of large portions of the small intestine Short bowel syndrome Removal of portions of the small intestine result in the diminished ability to absorb -Water, electrolytes, protein, fat, carbs, vitamins and minerals -This leads to malabsorption. Reduced surface area for absorption Short bowel syndrome