Term 2 integrative cases
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How does heparin work?
activates antithrombin III which blocks the effects of thrombin
how does Warfarin work?
Blocks the effects of Vit K, which is needed in all the boxed entries of the clotting cascade
how does aspirin work as a blood thinner?
blocks platelet enzymes involved with the production of thromboxanes, preventing the recruitment of platelets into a platelet plug
how does elevated gastrin result in elevated HCl secretion?
- -gastrin stimulates parietal cells
- -gastrin stimulates ECL cells to release histamine, which stimulates parietal cells to release HCl
How does H. Pylori mess with stomach homeostasis?
- 1) they don't like acid, so they go the epithelial surface (in mucosal layer)
- 2) release urease to make it a more basic environment
- 3a) when in antrum: more basic environment stimulates G-cells to make gastrin, causing HCl hyposecretion
- 3b) when in corpus: they screw with the protective barrier, also cause hyposecretion
Why ask about NSAIDS in stomach ulcer cases?
inhibit prostaglandins needed to mediate pain. However, these prostaglandins are also needed to produce mucosal barrier
describe the formation and metabolization of bilirubin and where the process goes wrong in cirrhosis
- -formation: heme broken down by marcophage in spleen to make bilirubin. Albumin necessary to carry BR to the liver
- -metabolization: conjugated with glucoronic acid and glucoronal transferase to make it water soluble. Then it can be sent to the bile duct and SI
- -pathology: liver is damaged, so BR stays unconjugated and in the bloodstream, makes pee tea coloured.
How does lasix work as a diuretic
inhibits the NaK2Cl cotransporter in the ascending LOH. This later translates into less H2O being reabsorbed
How do thiazides work on the kidneys?
Inhibits the Na-Cl symporters in the DCT
How does spironolactone work on the kidney?
It is an aldosterone atagonist. Therefore means a reduction in the Na-K antiporters in the late DCT.
How does an ACE inihibitor work?
- -blocks the conversion of ANGI to ANG II
- -prevents vasoconstriction
- -lowers Na+ uptake in PCT directly
- -mostly lowers aldosterone production, which lowers the Na-K antiporters
- -may cause hyperkalemia
How is bicarbonate generated and recycled in the kidney?
- recycled: filters out of glom freely, combines with H+, water and CO2 are reabsorbed and then convert back to
- generated: glutamate converted to NH3 and HCO3- in PCT
How does excess cortisol account for the following symptoms: muscle atrophy, osteoporosis, easy bruising, increased appetite, central obesity
- muscle atrophy: increases proteolysis
- osteoporosis: decreases collagen synthesis, inhibits Vit D (decreasing Ca+ absorption)
- easy bruising: decreased collagen synthesis causes endothelium to rupture easily
- increased appetite: stimulated by cortisol
- central obesity: excess calories deposited centrally for unknown reasons
What can cause cortisol hypersecretion?
- -exogenous steroid treatments usually (like pregnosone)
- -pituitary and pancreatic tumors (produce ACTH)
- -adrenal gland tumors
What are the two main factors in the etiology of menopause?
- 1) decreased estrogen (because of decreased follicles)
- 2) The follicles that remain are increasingly resistant to FSH
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