NR507- Midterm Advanced Patho- cardiac, pulmonary, hematology, renal exam with complete solution

Hematopoiesis - ANSWER-blood cell formation Fetus- liver and spleen Adult- bone marrow Anemia - ANSWER-A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume. Erythropoiesis - ANSWER-formation of red blood cells In kidney in response to hypoxia macrocytic normochromic anemia - ANSWER-Large RBC's, normal hemoglobin Folic acid or Vitamin B12 deficiency microcytic hypochromic anemia - ANSWER-small, abnormally shaped erythrocytes that are not able to carry normal hemoglobin Thalassemia- mediterranean normocytic normochromic anemia - ANSWER-Characterized by red cells that are relatively normal in size and normal hemoglobin Aplastic, hemorrhagic, hemolytic, sickle cell iron deficiency anemia - ANSWER-anemia resulting when there is not enough iron to build hemoglobin for red blood cells Affects children, poverty, child bearing age Erythrocytes - ANSWER-red blood cells Most abundant cell in the body Responsible for tissue oxygenation Mitotic division- 100-120 days sickle cell anemia - ANSWER-A genetic disorder in which erythroctyes take on an abnormal curved or "sickle" shape (Hb-s) Thalassemia - ANSWER-Inherited defect in the ability to produce hemoglobin, usually seen in persons of Mediterranean background. pernicious anemia - ANSWER-Lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream hemolytic anemia - ANSWER-Characterized by an inadequate number of circulating red blood cells due to the premature destruction of red blood cells by the spleen Pancytopenia- reduction in all 3 types of blood cells (RBC, WBC, Plt) Erythropoietin (EPO) - ANSWER-Hormone secreted by the kidney to stimulate the production of red blood cells by bone marrow In response to hypoxia In the fetus the liver produces this Hemoglobin - ANSWER-Iron-containing protein in red blood cells that carries oxygen for delivery to cells 4 molecules of O2 Made of polypeptide, heme, iron anemia due to gastrectomy - ANSWER-Iron def anemia is major cause after this Removal of stomach often leads to marked decrease in production of gastric acid. This acid is necessary to convert dietary iron to a form that is more readily absorbed by the duodenum hemolytic anemia causes - ANSWER-Sickle cell disease, ABO or Rh incompatibility, drug induced Role of macrophages - ANSWER-Innate: 1. Phagocytosis PRR or opsonization w/ complement 2. Secrete Cytokines: Recruit more cells, inflammation, fever, etc. Adaptive: 1. Phagocytosis: opsonization with complement or Abs 2. Secrete cytokines: recruit more cells etc. 3. Antigen presentation: peptides from the broken down pathogen are displayed on surface of the cell. Note: macrophages and dendrites are the majoy antigen processing and antigen presenting cells that initiate immune response - Present antigen to memory (Th) cells in order to initiate a rapid response to antigens (secondary immune response) Anticholinergic drugs for asthma - ANSWER-Atrovent & Spiriva both prevent the muscle bands around the airways from tightening thus reduce in exacerbation Albuterol is short acting Asthma - ANSWER-A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing. T2HIGH eosinophilic inflammation Airway responsiveness Albuterol - ANSWER-Beta 2 Agonist, Short-Acting acute bronchitis - ANSWER-infection and inflammation of bronchial tubes (bronchi) chronic bronchitis - ANSWER-inflammation of the bronchi persisting over a long time 3 or more months atleast 2 years Acid/ base disturbance- COPD - ANSWER-chronic obstructive pulmonary disorder. Causes air trapping. Increasing CO2 retention and respiratory acidosis. Perfusion - ANSWER-The passage of fluid to an organ or a tissue, usually referring to the delivery of blood to an area. Blood flow of heart - ANSWER-Enters the right side inferior/superior vena cava- emptying deoxygenated blood to right atrium- right ventricle, through tricuspid valve, pulmonary valve, pulmonary artery to lungs (where it is oxygenated). Pulmonary vein empties oxygen rich blood to left atrium/ left ventricle, through mitral valve, aortic valve, aorta----to the body. bronchioles function - ANSWER-passage of air to alveoli- gas exchange polycythemia vera - ANSWER-condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels. Blood clots can lead to stroke and heart attack. Gene mutation in the protein janus kinase 2. stroke volume - ANSWER-The amount of blood ejected from the heart in one contraction. Determined by: preload/ afterload/ contractility cor pulmonale - ANSWER-right-sided heart failure arising from chronic lung disease. can be caused by long term pulmonary hypertension Causes of heart failure - ANSWER-"MI, afib, infection, shock/trauma, thyroid disease, PE, excess salt, medication noncompliance, beta blockers, NSAIDs" Over time, reduces contractility right sided heart failure - ANSWER-1. Jungular Vein Distention 2. Ascending Dependent Edema 3. Weight Gain 4. Hepatomegaly (Liver Enlargement) Left sided heart failure symptoms - ANSWER--Left = lungs (and heart) -Crackles, increased HR, SOB, palpitations, dizzy, lightheaded, confused, restless, cough, dyspnea Hypertension - ANSWER-consistent elevation of systemic arterial blood pressure, increases in cardiac output or total peripheral resistance or both. CO is increased by any condition that increases HR or SV, whereas peripheral resistance is increased by any factor that increases blood viscosity or reduces vessel diameter (vasoconstriction) primary hypertension - ANSWER-Essential or idiopathic hypertension Genetic and environmental factors Affects 92% to 95% of individuals with hypertension secondary hypertension - ANSWER-high blood pressure caused by the effects of another disease. Example (renal artery stenosis, kidney atrophy, increase in plasma renin) calcium binding - ANSWER-Binding of calcium to subunit of troponin Induces conformation change in troponin Troponin-tropomyosin complex moved Myosin binding sites of actin exposed Troponin - ANSWER-regulatory protein that binds to actin, tropomyosin, and calcium. Integral to muscle contraction in skeletal muscle and cardiac muscle, but not smooth muscle Cardiac Output (CO) - ANSWER-volume of blood ejected by each ventricle per minute CO= HRx SV factors that affect cardiac output - ANSWER-preload after-load heart rate myocardial contractility Ejection Fraction (EF) - ANSWER-calculation of how much blood a ventricle can eject with one contraction SV / EDV 55-70% of ventricular blood ejected/ systole cardiac contractility (inotropic) - ANSWER-Force generated at any given end diastolic volume Increased: sympathetic stimulation (anxiety, increased thyroxine) Decreased: low ATP levels (inschemia, hypoxia, acidosis) preload (venous return) - ANSWER-volume of blood in ventricles at end of diastole Increased: CHF, hypervolemia Decreased: cardiac tamponade, hypovolemia AFTERLOAD (arteries) - ANSWER-resistance to left ventricular ejection (systole) Increased: COPD, hypertension, valve dx (all r/t pulm htn) Decreased: hypotension, vasodilation (shock) Laplace's Law - ANSWER-Wall tension = (pressure x radius)/ (2 x wall thickness) heart must work harder- increased tension Systole (OUT) - ANSWER-ventricular contraction that ejects blood out of the ventricules to the pulmonary and systemic circulation. Diastole (IN) - ANSWER-Relaxation period when blood fills the relaxed ventricles AV valves - ANSWER-tricuspid- right side/ pulmonary bicuspid- left side/ aortic side semilunar valves - ANSWER-pulmonary and aortic S1 - ANSWER-When AV (mitral and tricuspid) valves close S2 - ANSWER-When semilunar close (pulmonic and aortic) aortic stenosis - ANSWER-calcification/ narrowing of aortic valve cusps that restricts forward flow from left ventricle to aorta (during systole) crescendo- decrescendo systolic heart murmur mitral stenosis - ANSWER-narrowing of the mitral (bicuspid) valve, impairs blood from LA to LV. Most common rheumatic heart disease Low rumbling diastolic murmur heard at apex and radiating to axilla. Heard during S1 anatomy and physiology of kidney - ANSWER-consists of 3 distinct areas: *Located in posterior region of the abd cavity behind peritoneum. cortex (outer) medulla (middle) renal pelvis (inner) hilum - ANSWER-depression in an organ where blood vessels and nerves enter and leave renal artery - ANSWER-blood vessel that carries blood IN to the kidney renal vein - ANSWER-blood vessel that carries blood away from the kidney and toward the heart (reabsorption) renal medulla (of kidney) - ANSWER-inner portion of the kidney, called pyramids renal columns - ANSWER-Inward extensions of the cortex tissue separating the renal pyramids. minor calyces - ANSWER-cup-shaped areas that collect urine draining from pyramidal papillae major calyces - ANSWER-areas that collect urine from minor calyces, empty urine into renal pelvis renal pelvis - ANSWER-funnel-shaped reservoir that collects the urine and passes it to the bladder ureter - ANSWER-tube that carries urine from the kidney to the urinary bladder the lobe - ANSWER-structural unit of the kidney, 14 lobes nephron - ANSWER-Functional unit of the kidney filtration collection Types of Nephrons: - ANSWER-superficial midcortical juxtamedullary (concentration of urine) glomerulus - ANSWER-A ball of capillaries surrounded by Bowman's capsule in the nephron and serving as the site of filtration in the vertebrate kidney. Bownman's capsule - ANSWER-cup shaped structure surrounding the glomerulus mesangial cells - ANSWER-control blood pressure and filtration within glomerulus. they also have phagocytic properties similar to monocytes and release inflammatory cytokines and growth factor. renal corpuscle - ANSWER-glomerulus and bowman's capsule glomerular - ANSWER-filtration proximal convoluted tubule - ANSWER-reabsorption 65% of salt and water and most organic substances are reabsorbed in the PCT Remainder absorbed throughout tubule system- ADH and aldosterone influence amounts antidiuretic hormone (ADH) - ANSWER-promotes retention of water by kidneys Aldosterone - ANSWER-Hormone that stimulates the kidney to retain sodium ions and water Loop of Henle - ANSWER-The part of a kidney tubule that forms a long loop in the medulla of the kidney, from which water and salts are resorbed into the blood. distal convoluted tubule - ANSWER-reabsorption and secretion collecting duct - ANSWER-reabsorption of water/ secretion Formation of urine steps - ANSWER-1. glomerular filtration 2. tubular reabsorption 3. tubular secretion function of kidneys - ANSWER-Filter blood and produce urine maintain homeostasis PH BP Waste (urea) glomerular filtration - ANSWER-the movement of substances from the blood within the glomerulus into bowman's space nephron damage - ANSWER-1 thing that causes an increase in creatinine. number of nephrons decrease with age. Change in renal vasculature causing shunt between efferent and afferent arterioles. specific gravity in elderly tends to be low. renal failure - ANSWER-loss of kidney function resulting in its inability to remove waste products from the body and maintain electrolyte balance Elevated blood urea and creatinine levels homeostasis in kidneys - ANSWER-remove waste from blood, leave nutrients alone, maintaining the acid-base, regulating water and electrolyte balance renal calculi - ANSWER-calcium stones that lodge in the renal pelvis or pass through the ureters supersaturation of one or more salts in the urine Struvite stones - ANSWER-Ammonium magnesium phosphate Uric acid stones - ANSWER-patients who excrete uric acid in the urine (gouty arthritis) Treatment of renal calculi - ANSWER--treat pain, eradicate infection if necessary -Surgery, ultrasound destruction BPH (benign prostatic hyperplasia) - ANSWER-Age-associated prostate gland enlargement that can cause urination difficulty. non-cancerous BPH treatment - ANSWER--Alpha blockers [relax bladder neck muscles in the prostate making urination easier]; alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), and silodosin (Rapaflo), -5-alpha reductase inhibitors [shrink your prostate by preventing hormonal changes that cause prostate growth]; finasteride (Proscar), dutasteride (Avodart) prerenal causes - ANSWER-Severe decrease in perfusion to the kidneys Caused by: hypovolemia trauma n/v/d shock massive PE renal artery/ vein occlusion Intrarenal causes (intrinsic) - ANSWER-Systemic disease or drug toxicity DIC tumor growth antibiotics malignant hypertension *ATN caused by ischemia is the most common cause usually after surgery/ sepsis Postrenal causes - ANSWER-Obstruction of urine leaving the kidney Enlarged prostate Stones glomerulonephritis - ANSWER-inflammation of the glomeruli within the kidney (immune response) blood hydrostatic pressure - ANSWER-The pressure exerted by the water in the blood against the inside wall of a capillary of the bowmans capsule. essential for blood pressure in the glomerulus. role of angiotensin converting enzyme - ANSWER-lower urine protein excretion and control BP Juxtuglomerular Cells - ANSWER-Secrete RENIN which in turn: Increases blood volume increases sodium reabsorption constricts blood vessels increases blood pressure