Patho Topic 12

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Patho Topic 12
2010-12-15 15:13:03
patho stress

Patho Topic 12 Stress
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  1. What is GAS
    General Adaptation Syndrome (Selye)
  2. GAS- List Triad of Manifestations
    Enlargement of adrenal cortex

    Atrophy of thymus gland and other lymphoid organs

    Bleeding Ulcers
  3. GAS- Triad of manifestations
    Why enlargement of adrenal cortex
    Stress stimulates release of coritsol
  4. GAS Triad of manifestations

    Why Atrophy of Thymus gland and other lymphoid organs
    Cortisol supresses immune system
  5. GAS Triad of manifestations

    Why Bleeding ulcers of stomach
    Fight or Flight- Blood is redirected from stomach and over time the lack of blood causes damage
    • Stage 1- Alarm Fight or Flight- CNS aroused body's defenses are mobilized
    • Stage 2- Restistance Body selects most effective defenses
    • Stage 3- Exhaustion Burn out- cont. stress breaks down compensatory mech. Triad manifestations occur
  7. Physiological Stress
    Describe the process
    Stressor initiates the disturbance and causes chemical or physical change in body The body then adapts
  8. Reactive Response
    The body responding to psychological stressors
  9. Anticipatory Response
    Body mounts response in anticipation of physical action
  10. Stress Response

    Describe the chain of action
    Stressor > CNS > Hypothalamus > release of corticotropine releasing factor>stimulates secretion of cortisol
  11. Corticotropine Releasing Factor

    Where is it produced and what does it do
    Produced in Hypothalamus

    Induces secretion of ACTH from anterior pituitary

    ACTH stimulation secretion of coritsol
  12. Cortisol- Stress Hormone

    What are the Primary affects
    Stimulation of gluconeogenses (making glucose from non-carbs)

    Affects protein metabolism

    Affects Lipid metabolism

  13. Catecholamines

    Name the components and describe what happens
    Epinephrine- works on liver and skelatal muscle- opens blood vessels to skelatal muscle

    Norepinephrine- constricts blood vessels causes sweating and hairs to stand up
  14. What do endorphines do?
    diminish perception of pain and help surpress stress response
  15. How is Growth hormone affected by stress?
    initially have stress GH goes increases

    long term stress GH decreases
  16. How is prolactin affected by stress?
    increase in response to stress. can alter the affects of immune cells
  17. What is oxytocin responsible for?
    Responsible for contractions and emotion and bonding with baby. It's calming
  18. A pt. experiences a stressor that activates the stress response. In which location does this stress response initiate?
    Central Nervous System
  19. Define Vomiting
    froceful emptying of stomach and intestinal contents through the mouth.
  20. Name the 3 types of vomiting
    • Nausea
    • Retching
    • Projectile
  21. Describe Nausea
    subjective experience associated with many different conditions. usually precedes vomiting
  22. Describe Retching
    strong involuntary effort to vomit.
  23. Describe Projectile Vomiting
    Spontaneous vomiting not preceded by nausea or retching due to direct stinulation of vomiting center
  24. Name 3 types of diarrhea
    • Osmotic diarrhea
    • Secretory Diarrhea
    • Motility Diarrhea
  25. Describe Osmotic Diarrhea
    nonabsorbable substances in the intstine causes water to be drawn to the lumen by osmosis causing large volume diarrhea
  26. What causes Osmotic diarrhea
    Something in the intstine that is drawing water to it
  27. Describe Secretory Diarrhea
    large volume diarrhea caused by excessive muscosal secretion of fluid and electrolytes most of cause by toxins released by C.diff or ecoli
  28. Describe motility diarrhea
    if something triggers things to move more quickly through the intestines there is less time to absorb water. Causes recetion of SI, surgival bypass, diabetic neuropathy
  29. Causes for constipation
    unhealthy dietary and bowl habits combined with inadequate exercise and low fulid intake
  30. What is hematochezia
    frank bleeding from the rectum
  31. What is hematemsis
    presence of blood in the vomitus
  32. What is occult bleeding
    slow chronic blood loss that results in iron deficiency anemia
  33. What is dysphagia
    difficulty swallowing
  34. 3causes of dysphagia
    Mechanical obstruction of esophagus

    impairment of esophagealy motility

    neural or musular interference with sawllowing (Example MS)
  35. What is Achalasia
    loss of esophageal peristalisis and failure of lower esophageal sphincter to relax leading to distension
  36. What is a hiatal hernia
    protrusion of upper stomach through diaphragm into thorax
  37. Describe sliding hiatal hernia and causes
    tummy slides into thoracic cavity through hiatus

    Causes: congenitally short esophagus, trauma, weakinging of diaphram muscles at the gas. junction
  38. Describe Paraesophageal hiatal hernia
    greater curvature of tummy herniates through 2nd opening in diaphragm and lies alongside the esophagus
  39. What is a hernia
    protrusion of intestine through weakness in abdominal wall
  40. What is Intussusception
    telescoping of one part of intstine into another
  41. What is volvulus
    twisting of instestine
  42. what is diverticulitis
    inflammed herniations of mucosa
  43. what is paralystic ileus
    loss of peristalic activity
  44. What is the cardinal sign of pyloric Stenosis
  45. Etiology of Jaundice and manifestations
    • Too high bilirubin in blood from:
    • Increased RBC destruction
    • Decreased conjigated bilirubing
    • Obstuction of bile flow

    Yellowed skin and sclera
  46. What is ascites
    accumulation of fluid in peritoneal cavity
  47. Describe portal hypertension and what manifestations
    • increased resistance to flow in pirtal venous system
    • Thombosis, compresseion to to cancer, rt sided hear failure impedes out flow, alcoholic cirrhosis is major cause because of fibrous liver

    vomiting of blood, splenomegly, ascites
  48. Definitation of encepholopathy
    Altered brain function in response to liver dysfuncation
  49. Description of why encephalopathy happens
    accumulation of neurotoxins including amonia because liver can't detoxify blood

    % of peeps with a portosystemic shunt get it because nothing does to liver so no filtration
  50. Manifestations of encephalopathy
    slowed speech and thought, impaired memory, concentraion, attention, flapping tremor, restlessness, coma
  51. Effects of alcohol and aspirin on stomach
    ulcers, gastritis
  52. Causes of acute gastritis
    injury of mucosal barrier from drugs or checmicals Alcohol
  53. Petptic Ulcer # 1 cause
    H Pylorie
  54. Cause and manifestations of Lactose intolerance
    Cause-lactases deficiency- which inhibits the breakdown of lactose into monosaccharides and prevents absorption

  55. What is the function of bile salts
    to help absorb fat and fat soluble vitamins ADEK

    When there is a definciancy there is poor absorption which leads to increased fat in stool leading to diarrhea
  56. What is irritable bowel
    Chronic reoccurant intestinal syptoms with no physical problems
  57. Manifestations of irritable bowel
    abdominal pain, diarreah constipation or alternating diarreah/constipation, gas and bloating
  58. Etiology of irritable bowel and treatment
    Psychological stress and tx is stress management
  59. Define Crohn Disease
    inflammation of small and large intestine
  60. Manifestation of Crohns
    abdominal pain, diarrhea, abdonminal mass, small instestine malabsorbsion, skip lesions
  61. Define Ulcerative colitis
    Chronic inflamation that causes ulcer in colon and rectum
  62. Manifestations of Ulcerative colitis
    abdomincal pain, darrhea, bloody stools, no skip lesions
  63. Manifestions of Appendicitis
    Symptoms of the flu, comes on suddenly, referred pain about the belly button
  64. Complications of Anorexia and bulimia
    • decreased heart rate
    • constipation
    • hypothermia
    • malnutrition
    • pitted teeth
    • cachexia (wasting)
  65. Characteristics of Hepatitis A
    Poor appetite, sweating, fatigue, body aches, fever, nausea, vomiting, green-tinted foamy urine, clay-colored stools and jaundice are typical signs
  66. Route of infection of Hepatisis A

    urine, seman, tears, patenteral

  67. Route of infection Hepatitis B
    • Parenteral
    • semen, saliva

    urine, breast milkd other secreations

  68. Type hepatitis likely to cause cirrhosis/liver cancer/chronic hepatitis
    Type C
  69. What is Cholelithisis
    gall stone formation
  70. Etiology of Cholelithiasis
    bile that is supersaturation with cholestrol
  71. Manifestations of Cholelithiasis
    abdonminal pain and jaundice are cardnial signs
  72. Gallstones=
    aggregates of substances in the bile
  73. Causes and manifestations of Chronic pancreatitis
    cause- alcohol abuse, smoking increases risk

    man- intermittent abdominal pain with usually intensifies after a meal
  74. Definitation of contusion
    bruising produced by force of impact, the smaller the area of impact the greater the severity of injury.

  75. Coup-Contrecoup injuries
    Rebound injury.

    Hit your head brain sloshes forward then sloshes back and injury to back too
  76. Venous vs. arterial hematoma
    Artierial more serious
  77. Epidural Hematoma
    usually caused by head injury in which skull is fractures. Artierial bleed which means serious

    as hematoma accumulates, HA of increasing severity, vomiting, drowsiness, confusion, seizure and hemiparesis
  78. Subdural Hematoma
    most often due to tearing of bridging vein

    Subdural space gradually fills with blood and herniation can result
  79. Intracerebral hematoma
    shearing forces tramatized small blood cessels. Hematoma expands - increases intracranial pressure with compression of breain tissues

    sudden rapidly progressive decreased leversl of consciousness with pupil dilation Posturing
  80. What does TIA stand for
    Transient Ischemic Attack
  81. What is happening during TIA
    thrombotic particles that cause a temporary blockage of circulation.
  82. What does TIA indicate
    Warning sign that the person is at risk for stroke
  83. Describe Hemorrhagic storke
    • most common causes are hypertension
    • ruptured aneurysms or anteriovenous malformation and hemorrhage assoc. with bleeding disorders

  84. Stroke Management- Clot or Blood
    Clot- Thromblitic Agent to break up clot

    Hypertension- Get blood pressure down
  85. Characteristics of Right Sided Stroke
    • Left hemiplegia or hemiparesis
    • Spatial-Perceptual deficits
    • Poor Judgement
    • Distractibility
    • denial of deficits of affected side
    • left visual field defect
  86. Characteristics of Left Sided Stroke
    • Right sided hemiplegia or hemiparesis
    • slow and cautious behavior
    • right visual field defect
    • expressive, receptive or global dysphasia
    • Frustration
    • Speech problems
  87. Most Frequent Fatal Stroke
    hemorrhagic stroke
  88. Viral vs Bacterial Meningitis
    Bacterial meningitis treated with appropriate antibiotic therapy and other supportive measures.

    Viral meningitis is managed pharmacologically with antiviral drugs and steroids.
  89. Spinal Cord Injury
    Spine is forced backwards

    Blow to chin or face like falling down stairs
  90. Spinal Cord Injury
    Spine bend forward passed normal

    Hit from back of the head
  91. Spinal Cord Injury

    Axial Compression=
    Blow to top of head or land on head and the spine is compressed

  92. Spinal Cord Injury
    Rupture of supporting ligemints of spinal cord

    Sports injury
  93. Location of most often spinal cord injury and why
    • C1-C2
    • Less stbility
  94. Why T12-L2 less injury
    because of rib cage protection has more stability
  95. Spinal Shock Manifestations
    • Lose function below injury.
    • Loss of normal activity- reflex function of skeletal muscle, bladder, bowel, sexual funcation autonomic control.
  96. Spinal Shock- Other manifestations

    and why risk for hypothermia
    If you don't have intervation can't keep blood vessel constricted

    • red
    • hot
    • decreased blood pressure
    • heart can't adjust because it's not geting signal from nervous syetem
    • Risk for hypothermia because of dilated vessels
  97. Symptoms of Autonomic Dysreflexia
    Paroxysmal Hypertension- Pressure highest below injury

    Pounding HA- reduced blood flow to brain

    • Blurred VA
    • Sweating about level of injury
    • Flushing of face and neck
    • Nasel Congestion
    • Bradycardia
    • Nausea
    • Pupil Dilation
  98. Cause of Autonomic Dysreflexia
    Most common cause- Foley cath gets plugged

    uncompensated cardio response to stimulation of SNS
  99. Causes of Encephalitis
    Mosquitoes, herpes simplex 1 complications of systemic viral disease (polio, rabies mono)
  100. Result of encephalitis
    nerve cell degeneration and increased ICP
  101. Myasthenia Gravis= MG description
    Grave muscle weakness.

    weakness of fatigability of voluntary muscles

    ocular movements, respiration. gacial expression, swallowing and chewing
  102. Manifestations of MG
    weakness of skeletal muscles

    Ptosis of lids and difficulty closing eyes

    expressionless face

    weak voice


    inability to hold head up or close mouth

  103. Treament of MG
    Drugs stoping immune response

    thymectomy may be performed
  104. Parkinsons Disease Etiology
    Basial ganglia are not functioning well the excitatory areas become overactive and inhibitory areas become under active
  105. Parkinsons Cardnial signs
    • Muscle Rigidity
    • Tremors
    • Akinesia
    • Postural difficulty
    • Mask like face
    • Mental Depression

    Autonomic symptoms---constipation, drooling, dysphagia
  106. Mutiple Sclerosis MS etiology
    The etiology still unclears

    Characterized by wiespread patches of myelin destruction of the CNS
  107. Guillain Barre etiology
    still unclear alrhough thought to be auto-ammune in natures (a cell mediated immunologic reaction directed at the peripheral nerves)