Patho Patho Patho Patho

• tertiary - from the hypothalamus
• secondary - from the pituitary
• primary - from the gland

more protein uptake and synthesis, less glucose uptake, and an increase in fat breakdown

Increased glucose levels, free fatty acid release, obesity, and cortiso

can be eliminated intact or inactivatedcan be taken up then destroyedcan be destroyed in the liver and passed out in the bile

GH deficiencybody is in proportioncan be treated with GH therapy

Failure to thrive

• can occur by itself with no prior family history
• risk increases with father's age
• can be an autosomal dominant trait
• most are spontaneous

• longs bones do not develop
• fibula become overly long
• head disproportionately large

based on structure, peptides, amines, and steroids

causes bones to stop growing by replacing cartilage with calcium and phospahate

the cell makes less hormone receptors

negative feedback

hypoglycemia, fasting, starvation, stress

⇩ adipose tissue, decreases glucose uptake in cells

stimulates protein synthesis and makes the body retain carbohydrates, blood glucose will rise

derived from cholesterolsecreted by gonads, adrenal cortex and placentaonce synthesized, passed directly into the bloodstream, they are not stored

• Achondroplasia
• Turner Syndrome
• Pituitary
• Lack of nurture

Chromosomal abnormality, occurs only in femalesone X chromosome is either missing or defective

derived from Tyrisinesecreted from thyroid and adrenal medullastored as granules in the cytoplasm

majority of hormoneswater soluableexcreted from pituitary, parathyroid, heart, stomach, liver, kidneys

an increase in size and number in cells

the cell makes more hormone receptors

as secretory granules until they are released into the blood

released by anterior pituitaryreacts to hypothalamus releasing growth hormone releasing hormone

• GH deficiency
• body is in proportion
• can be treated with GH therapy

temperature, hunger, mood, release of hormones, sex drive, sleep, thirst

⇧ bone length and thickness by depositing cartilage to the end of the bones

• idiopathic - lacks hypothalamic GHRH
• pituitary tumors/agenesis - can't produce GH
• Laron-type dwarfism - hereditary defect in IGF production

Endocrine pancreas releases hormones into the bld stream (**where insulin is secreted)

exocrine releases digestive juices

• alpha
• beta
• delta

glucagon - used to break down glycogen

insulin and amylin

somatostatin

insulin

slows glucose absorption in small intestine; suppresses glucagon secretion

happens via active transport

decreases GI activity; suppresses glucagon and insulin secretion

• Glucagon: stimulates the liver to release stored glucose
• Glycogenolysis-break down of glycogen into glucose
• Gluconeogenesis-creation of glucose from fats and proteins

increases cells ability to take up glucose from the blood

• Insulin
• High= while eating
• Low= when you wake up

Gluca= Highest when you wake up

• Inc. transport of glucose into ms
• Dec. gluconeogenesis
• Inc. transport of fatty acids into adipose Inc. active transport of amino acids into cells.
• Dec. protein breakdown

• 1. inc b/c not transport into cells
• 2. inc b/c source of energy
• 3. dec. b/c acidic from increased amino acids
• 4. and 5. decrease b/c broken down as energy

***once diabetes starts, it is a life long disease with no cureit

is controllable though

• common in childhood
• autoimmune process
• body attacks its own pancreas
• **REQUIRES insulin injection to sustain life

**Beta cell destruction

• most common (90%), Adult onset
• **Inc. glucoe and insulin resistance
• **Diagnosed by blood glucose levels
• Pancreas is not producing enough insulin OR body won't respond to insulin

**combination of beta cell dysfunction and insulin resistance

Regular

• s= casual bld glucose >200mg/dL on 2 different occasions**
• f= glucose >126mg/dL
• t= drink the fasting solution and take bld test after 2 hrs >200mg/dL
• h= HbgA1C >7%

• fetus grows too fast for pancreas and it's unable to compensate
• baby pancreas takes over for both baby and mom causing the baby to get big in the womb

• associated with Type 1 diabetes
• inadequate insulin the results in increased acids and fats in the blood that we can measure

Pt's smell fruity and have severe dehydration

• REGULAR insulin and fluid replacement (hypotonic solution, then switch to iso)
• Check electrolyte levels throughout

• p= impaired insulin secretion
• i= carbohydrate absorption
• L= increased basal hepatic glucose production
• m= decreased insulin-stimulated glucose uptake

• Type 2 diabetes
• used to be called Hyperglycemic, Hyperosmolar Non-ketotic coma
• ***do no develop DKA
• Polyuresis

it causes vascular and neuro problems, which happen (especially in type 2) before diabetes is ever diagnosed

• macro= MI, stroke
• micro= retinopathy

• auto= GI and bladder dysfunction
• sensory= parethesias (hypersensitivity)

• hypoglycemia (which is more dangerous that hyper)
• somogyi (type of hypo)
• dawn effect (also type of hypo)

• "rebound hypoglycemia"
• liver is still working ok
• liver over-produces bld sugar when it detects low bld levels
• usually happens during the night

• nothing Pt does to cause this
• cortisol and growth hormone release affect glucose levels

Tx= wake them up and give insulin between 5-9 AM

• neuropathy
• vascular disease
• infections

86,000

• somatic
• autonomic

hypersensitivity to light touch is one S & Sx

impaired motility of GI tract --> similar to IBS S & Sx

it does not mean that we stop enjoying sex!

giggity giggity!

intracellular osmoles

• rapid acting
• intermediate acting
• long acting
• continuous infusion pump

• w/n 15 min
• peaks 30-45
• gone in 2 hours

• "short acting"
• w/n 30 mins
• peaks 1-2 hrs
• gone 6-8 hrs

• w/n 60-90 min
• peaks 8 hrs
• gone 18-24 hrs

most common is NPH

• w/n almost immediately, but subtle
• does not peak at all (continuous base line for hours)

best given at night

• not quite diabetes, more of a precursor to diabetes
• "apple belly" abdominal obesity
• inc. triglycerides
• insulin resistance

puts pressure on the liver

• control skeletal muscle movement
• regulate cardiac and smooth muscle
• reception, integration, and perception of sensory
• intelligence, anticipation, and judgement
• adjusts to ever-changing environment

Protection

• oligodendroglia
• astroglia
• microglia
• ependymal

• form myelin in CNS
• link bld vessels to cns

intercellular ion transport system (messaging)

phagocytic

produce CSF

• Schwann
• Satellite

sch= layers of myelin around axons

sat= separate nv cells from supporting tissue

outter most layer of the entire PNS

• oxygen***
• glucose***

nerve cells can not store glucose, so they need a constant supply

• electrical
• chemical - require specific membrane structures

the synapse

• neurotransmitters
• neuromodulators
• neurotrophic factors

• amino acids
• peptides
• monoamines

***GABA= mediates most inhibitions on the CNS

bind to receptors and change their response to neurotransmitters

Na+

K+

• dorsal root
• ventral root

• **Afferent
• **Sensory
• **Ascending

• **Efferent
• **Motor
• **Descending

negative feedback

rapid and automatic response to a specific stimuli

***occur with predictability and little variability

• withdrawl
• myptatic/stretch reflex

Oh, Oh, Oh, Tiny Tits And Furry Vaginas Give Victor A Hardon

CN X (10)

intervate the somatosensory feeling, motor and autonomic functions of the digestion, respiration, and cardiac systems

CN V(5)

intervate somatosensory for the face, head, and chewing muscles

system of membrane that envelope and protect the entire nervous system

innermost layer of the meninges that actually sits on the spinal cord and nerves

**contains the blood supply

NO proteins or peptides

• a= sympathetic NS
•  = primary are Epi, Norepi, dopamine
•  = **Excitatory 

• c= parasympathetic NS
•  = primary is Acetylcholine
•  = **Inhibitory

heart and BP

*constrict

• lungs and respiration
• tend to relax ans smooth muscles
• also make liver release glucose into bld and make muscles break glucose down for energy

• *we like to 2 Breath with 2 Betas*
• *dilation*

they are both adrenergic/excitatory

• turn off digestive tract
• inhibit further norepi release

L= wide distribution

S= pain, touch, temperature

L= muscles, tendons, joints

S= position and body movement

L= visceral structures

S= fullness and discomfort

**the number of receptors and transmission through thalamus to the cerebral cortex

detect sensation

in the spinal cord

transmit message to the brain

are in the brain

carry message from thalamus to cortex

**highest quantity of neurons

from the 2nd-order neurons along the anterolateral system in the spinal cord

the amount of neurons increase with their order

1st < 2nd < 3rd

neuropathic pain

pain outside the body, in an organ, or just outside the nerve itself (where the pain originates) 

**activates C-nerve fibers

convert pain signal into action potentials

actually sending the pain action potentials

awarness and interpretation

control of pain

• glutamate
• substance P

• excitatory neurotransmitter
• acts instantly w/n milliseconds
• confined to immediate area

• acts slower --> seconds to minutes
• lasts longer
• diffuse to other areas
• **prolongs and enhances glutamate

• A-delta
• C Fibers

glutamate

fast pain, sharp and stabbing

Substance P

slow, dull, aching

• cutaneous= sharp, burning
• deep somatic= bones/muscles/tendons (dull)
• visceral= organs
• referred= originates at a visceral site

• sudden
• self limiting
• <6 months

• persistent
• >6 months

continued stimulation causes pain

pins and needles sensation of diabetic neuropathy

• partial loss of sensation
• distorted

reduced pain sensation

absence of pain

**the sensation of pain, NOT the source of pain

hypersensitivity

pain is from swelling that puts pressure on surrounding structures

• migraine
• cluster
• tension
• chronic daily

• only one side hurts and it is felt with the pulse
• people may have an aura or warning that it is coming on
• **recurent, moderate-severe that last days

• ASA
• NSAIDS
• anti-emetics
• beta-blockers

• episodic with remission
• 15min-4 hrs. 7-8 times a day
• can be from 7days to a year
• retro-orbital pain (behind the eye)

Tx= Ca channel blockers

MOST COMMON

• nonpharmalogical interventions work well
• ASA
• NSAIDS
• antihistamines

**reduce or eliminate other medications and caffeine

• Premotor
• Supplementary

• programmed patterned
• coordinated movement
• posture and positioning

planning and initiation of complex, skillful movements

any injury or what not can result in loss of muscle tone

• hypotonia
• hypertonia
• rigidity
• clonus

weakness to flaccid paralysis

spasticity where person can't relax

increased resistance to movement

***rythmic contraction and alt. relaxation of a limb that occur with upper motor neuron lesions such as spinal nerve injury

• very prolonged contraction of skeletal muscles only
• will result in contraction of muscles that become fatigued 

• 1. paralysis
• 2. loss of movement
• 3. weakness
• 4. one limb
• 5. both limbs on one side
• 6. top or bottom half of body
• 7. all four limbs

I= same side

C= opposite side

the neurons and the muscle fibers that they intervate

• U= in the brain and spinal cord
•  = ****associated with spastic neuropathy

L= send axons out of the ventral horn of the spinal cord to the PNS

• weakness and loss of voluntary control
• often the result of a stroke: rehab can take months to years

*spasticity results

neurons that directly intervate muscles are damaged

**flaccidity

*Irreversible

damage to surrounding tissues

*Small chance to get some neuron sensation back

the lowest point on cord where there is a decrease of feeling (sesnory level) and/or decrease in movement (motor level)

ex: this person is a T-4

usually C1-T1

**loss of head, neck, shoulders, arms, upper chest

• usually T5-S5
• chest, stomach, hips, legs and feet

higher= lose more feeling and function

lower= lose less feeling and function

duh!

• T12-L1 
• above or below determines 

sensation or motor in EITHER the S4, S5, or anal area

spasms are not a sign of recovery from spinal cord injury

if it is not voluntarily repeated, then that is spacisity

• central cord syndrome
• anterior cord syndrome
• Brown-Sequard syndrome

• arms affected more than legs
• Usually happens in the Cervical regiono

• motor functions affected
• touch and sensory NOT affected

• damage to 1 side of the cord
• Motor loss on SAME side of injury (ipsilateral)
• pain/temp sensation loss on OPPOSITE side (contralateral)

**1st is to stabilize Pt.

• hyper-sympathetic response
• is a neurological emergency

interesting symptom: Only sweat above the site of injury

damage to one peripheral nerve

**Back pain is most often mono

damage to many peripheral nerves

Guillian-Barre syndrom

• Idiopathic
• ***Injury ascends bottom up
• Can be reversed

• Degeneration of Dopamine receptors of Basal Ganglion
• *pt. can stop walking until you kick their heels

• S= rigidity
• tremor
• loss of posture (muscle tone)
• bradykinesia
• dementia
• ANS

• Inc. levels of Dopamine in brain
• (Dopamine does not cross Bld Brain Barrier)

give Levadopa combined with carbidopa, a precursor to dopamine

• H2O is cells
• CSF
• blood volume

if tissue swells, other 2 will try to compensate

brain ischemia

decrease cranial pressure

projectile!

Nice

<8

decorticate = arms are crossed like and "O"

• extensor or decerebrate = arms are extended
•   = from brain stem injury

• sudden occlusion of cerebral artery
• can be a recovery

most often associated with arthrosclerosis, and hypercoagability states

rupture of blood vessel

most often fatal b/c of rapid increase of ICP

**direct result of spontaneous rupture of a cerebral bld vessel into the brain tissue

• epidural= talk and die
• subdural= venous-ish
• subarachnoid= arterial-ish

• from trauma
• b/w skull and dura
• can relieve pressure via surgery

• b/w dura and arachnoid membrane
• involves veins, so bleeding is slower

• b/w arachnoid membrane and pia mater
• arterial, so bleed quicker

• from aneurysms usually
• can have a re-bleed which is most often fatal
• NO blood thinners, even Aspirin

D= inability to fall and stay asleep

P= undesirable phenomena such as sleep walking

during REM sleep (cycle 5)

• increase BP, resp., and heart rate
• vivid dreaming
• etc.

• obstruction of the pharynx that occurs during the REM cycle
• unable to increase respiration rate because in the REM cycle

interrupted sleep caused by disordered breathing

• 1st= weight loss
• 2nd= rid alcohol and sedatives

H= the eyeball has lengthened and the person is farsighted

M= the eyeball has shortened and this person is near sighted  (I only see Myself in Myopia)

Ketatits= inflammation of the cornea

• imbalance between aqueous humor production and drainage, increasing pressure
• Inc. pressure and cause Optic Nerve damage.

angle-closure is seen in younger peeps

when an old guy moves the newspaper backward and forward to read it

lens thickens and becomes less elastic

proteins clumping in the lens of the eye.

smoking bad... mmkay

• damage to small retinal blood vessels
• bleeding can cause the retina to detach

**Diabetics need tight glycemic control to prevent this

• ret seperates from the choroid blood vessels, breaking them
• this causes a lack of bld and O2, stops fuctioning, and loss of vision
• caused by retinopathies, trauma, botched surgery, and inflammation
• Pt. needs to lay PRONE after corrective surgery to keep retina in proper place

• loss of central vision as well as visual acuity
• **responsible for the majority of vision loss as we age
• causes= smoking, poor nutrition, heredity

• patent and/or obstructed Eustachian tube
• acute otis medias= fluid in middle ear. can cause scaring and loss of hearing

• adhesive otitis media
• otosclerosis= hereditary, formation of more spongy bone
•   =preventing proper vibration perception
•   =***identified 1st by the whisper test
•   = ***Causes Early hearing loss

• It affects balance and hearing loss
• don't know the cause
• combination of vertigo, visual changes, headaches, tinnitus (constant noise)
• try to keep their environment quiet b/c they have trouble with space perception and vertigo

a chronic inner ear syndrome marked by attacks of vertigo, progressive deafness, tinnitus, and a sensation of fullness in the ears. The condition usually appears in persons between ages 40 and 50. The cause is unknown, but the disease process appears to destroy the hair cells within the cochlea." S/Sx include severe vertigo, tinnitus, and sensorineural hearing loss

• support tissue
• support CNS structures
• participate in formation of new blood cells

appendicular

calcitonin and PTH

**express surface receptors that bind hormones (Vit. D) to help build bone

Stimulate osteoclasts to release Ca+ from bone when serum levels drop to low

Calcium and Phosphate have an inverse relationship

• inc. intestinal Ca absorption
• inc. renal secretion of P
• inc. bone resorption and formation

• dec. blood calcium levels
• ***dec. bone resorption
• released by thyroid when Ca is high
• inhibits osteoCLASTS

• lubricates the joint
• should be clear, pale-yellow
• consistency of egg white
• very slippery
• should not clot nor have granules in it

• ribs
• vertebrae
• sternum
• illium

sprain= injury to ligaments

strains= injury to muscles

**RICE

• Rest
• Ice
• Compression
• Elevation

partial joint dislocation

by their appearance on an X-Ray

• T= single strait line, completely through the bone
• O= single line, diagonal, completely through the bone
• S= sign of abuse, twisted bone
• C= shattered
• S= a piece of the bone has come away (large piece, not shrapnel)
• B= a chuck of bone, not completely through
• I= bone pushes up against itself

• numbness
• loss of function
• muscle spasms
• bruising
• edema
• pain

preserve and restore function

compartment syndrome= increased pressure in a very limited space. inflam process cause increase swelling, crushing blood vessels, leading to necrosis

yellow bone marrow can release fat as emboli into the blood stream

• metabolic disorder with rate of bone resorption accelerates while bone deposition decreases
• loss of bone mass
• associated with lazy lifestyle

Tx= weight baring exercise to prevent muscle atrophy and enhance osteoblasts

• **defective mineralization w/o loss of bone matrix
• *Doesn't cause breakdown like porosis
• "bone softening"
• Calcium and/or phosphate deficiency will cause this
• Diet is important

• Autoimmune disorder
• *systemic, chronic, progressive, autoimmune disease that involves inflamm of synovial membrane
• leads to Pannus (abnormal joints)
• all major joints of the body are involved, bilaterally

• systemic inflammation
• autoimmune disease
• skin lesions (butterfly rash)

• It can cause Arthralgia= pain in joint and/or muscles
•  = ***1st symptoms of SLE is joint/muscle pain

vs.

Arthritis= inflammation

Pt. with SLE can have both

• most common form of arthritis
• "wear and tear"
• *unilateral
• from injury to weight baring joints
• starts with destruction of cartilage

*NOT systemic like rheumatoid arthritis

• hair
• nails
• glands

• like mosqutio bite
• contained borders, raised area on skin
• can be red, but is not always red

• filled with pus
• acne, impetigo

palpable solid mass

deeper and firmer than papule

still very contagious no matter how long they are on antibiotics

• Anti-depressants
• Antivirals
• Analgesics 

• superficial partial thickness burn
• pink, NO blisters
• heal in 3-10 days with no intervention

• partial thickness burn affecting epidermis and dermis
• red, painful, moist, formed Blisters
• important to keep blisters intact

can also be full-thickness burn

full thickness that continues into the subQ, muscles, bone, and bld vessels

NO pain in the area

can be 1st and 2nd

• depend on the severity and level of burn
• can cause hypovolemia

IV fluids can lead to hypervolemia

****most severe complications of 3rd degree burn is decrease in circulating bld volume from plasma seepage into interstitial spaces from the damaged bld vessels which result in a systemic vasoconstriction

• pressure
• shear= capillaries ripping away for the skin (underlying)
• friction= like rug burn
• moisture

stage 4 ulcers will NEVER upgrade to a 3,2, or 1 even when it heals