D027 study-guide Advanced Pathopharmacological Foundations

1. Celiac Disease a. Lining of the small intestine and intolerant of gluten. i. More pronounced in the duodenum and jejunum. b. Signs and Symptoms i. Abdominal pain and distention ii. Diarrhea – pale, greasy, bulky, foul iii. Malnutrition complications 1. Rickets 2. Occult blood 3. Anemia iv. Early bleeds and/or bruises v. Hypomagnesemia and hypocalcemia 1. Irritability, tremors, convulsions, tetany, bone pain, osteomalacia c. Lab Value: i. IgA-tTg ii. IgA-EMA iii. Total IgA 1. If deficient, IgG, IgA-DGP, or IgG-AGA may also be ordered. d. Testing: i. Serologic measurements of IgA antibodies and HLA-DQ2 or HLA-DQ8 ii. Endoscopy with small intestine biopsy iii. Duodenal biopsy e. Avoid BROW i. Barley, Rye, Oats, Wheat 2. Sjogren’s Syndrome a. Mostly in older women but can occur at any age and affects primarily those with Rheumatoid arthritis or SLE b. Dry eyes and dry mouth c. Testing: SSA+ and SSB+ 3. Herbs a. Cinnamon i. Uses 1. Lowers blood glucose 2. Lowers cholesterol 3. Lowers hypertension 4. Lowers risk for bleeding ii. Adverse Effects 1. Breastfeeding women should avoid as treatment. 2. Avoid with diabetic drugs, anticoagulants, and heart medications. b. Gingko Biloba i. Uses 1. Halt progression of dementia. 2. Used for erectile dysfunction ii. Adverse Effects 1 1. Increases bleeding a. Avoid anticoagulants and antiplatelets. 2. Lowers seizure threshold. c. Glucosamine i. Uses 1. For osteoarthritis d. Green Tea i. Uses 1. Lose weight, mental clarity ii. Adverse Effects 1. Hepatotoxicity. 2. Avoid taking with vasodilators, stimulants, and psychoactive medications. 3. Contains small amount of vitamin K – may decrease effects of warfarin. e. Lavender i. Uses 1. Increases relaxation 2. Used for anxiety, stress, and insomnia ii. Adverse Effects 1. Constipation, HA, and increased appetite 2. Caution when using CNS depressants. 3. May decreased blood pressure. Avoid taking with anti- hypertensives. 4. Hypoplastic Left Heart Syndrome a. Structures i. LEFT ventricle is underdeveloped or too small. ii. Mitral valves are not formed or are very small. iii. Aortic valve is not formed or is very small. iv. Ascending aorta is underdeveloped or very small. v. Atrial septal defect – a hole between the left and right atria. b. Fetal shunts i. Patent ductus arteriosus: artery connecting aorta to pulmonary artery. ii. Patent foramen ovale: hole connecting right atrium to left atrium. c. Survival rates i. 3–5-year survival rates of 70% for infants who have the Stage I repair. ii. Children who survive to 12 months have 90% survival rate. d. Testing: echocardiogram e. Treatment: 3 stages of surgical procedure i. Stage I (Norwood Procedure): 1-2 weeks old 1. Enlarges aorta and connect to the right ventricle. 2. Shunt to the pulmonary artery is created (either from aorta or right ventricle). 3. Patent ductus arteriosus is closed. ii. Stage II (Glenn Procedure): 4-6 months old 1. SVC is connected to the pulmonary artery. 2 2. Shunt from Norwood is removed. iii. Stage III (Fontan Procedure): 18 to 36 months old 1. IVC is connected to the pulmonary artery. 2. Hole made from the IVC conduit attached to the right atrium. f. Signs and Symptoms: oxygen-rich blood bypasses poorly-functioning left heart through the PDA and PFO. i. Cyanosis of the skin, lips, and nails ii. Pallor iii. Sweaty, clammy, or cool skin iv. Trouble breathing v. Rapid or pounding heart rate vi. Cold feet vii. Poor pulses in the feet viii. Poor feeding g. Tests i. During pregnancy 1. Prenatal tests to check for birth defects and other conditions 2. Ultrasound to identify HLLS 3. Echocardiogram to show the structures of the heart and how it’s working with the defect. ii. After birth 1. Based on signs and symptoms through pallor and cyanosis. 2. Newborn will experience signs and symptoms once ductus arteriosus and foramen ovale close. h. Medications i. Tube feedings ii. Medications to strengthen heart muscles, lower blood pressure, and remove extra fluid. 5. Parathyroid a. Function i. Produces parathyroid hormone that regulates calcium in the bloodstream and tissues. 1. The more PTH hormone released, the more calcium the bones release to the blood stream, losing density and hardness. b. Lab Values i. Calcium (8.6-10.3 mg/dL) ii. PTH: 11-51 pg/mL c. Signs and Symptoms i. Hyperparathyroidism 1. Osteoporosis 2. Kidney stones 3. Excessive urination 4. Abdominal pain 5. Fatigue, tiring easily 6. Forgetfulness 7. Bone and joint pain 3