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Skin & Related Structures
- Epidermis
- Dermis
- Hair Follilcles
- Nails
- Sabaceous Glands
- Sweat Glands
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The skin is the ________ organ system in the Body.
Largest
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The skin is what percentage of body weight?
15-20%
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Key Functions of the skin (8)
- Protection against injury
- Secretion of oils that lubricate the skin
- Maintenance of homeostasis via fluid blance and body temp.
- Excretion of excess water, urea and salt via sweat
- Maintenance of body shape
- Cosmesis (preserves bodily beauty) and identity
- Vitamin D synthesis
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Epidermis: definition
(how many layers and what are they called)
*Which layer is the specialize layer?*
- Outer most superficial layer of the skin
- Five Layers in the lips, palms and soles of the feet with four layers elsewhere
- Stratum Basale
- Stratum Spinosum
- Stratum Granulosum
- Stratum Lucidum (specialized 5th Layer)
- Stratum Corneum
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Dermis
-What does it contain
-How does it differ from the epidermis
-Which glands does it contain
- Contains blood vessels, lymphatics, nerves, collagen and elastic fibers
- Deeper and thicker than the epidermis
- Contains sebaceous and sweat glands
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RETE PEG REGION
-What is it
-What is its purpose
-Why would it be absent
- Interface between the epidermis and the dermis that is characterized by structural ridges and valleys
- Increases surface area between epidermis and dermis (improved adherence)
- Ridges are absent in highly damaged skin (burn patients, chronic skin conditions)
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Abrasion
A wearing away of the upper layer of skin usually as a result of friction
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Contusion
- Blood vessels are broken as a result of a direct blow
- ex) punched in the arm=bruise
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Ecchymosis
- Skin discoloration caused by the escape of blood into the tisues from a small rupture in a blood vessel
- (Takes longer to form a bruise than would a contusion)
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Excoriation
Traumatic loss of epdermis; generally mild
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Laceration
Wound is deeper than the superficial skin layer
Penetration of the skin in which the wound is deeper than the superficial layer
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Ulcer
A lesion on the surface of the skin or mucous membrane produced by sloughing of inflammatory or necrotic tissue
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Cellulitis (bacterial infection)
- Acute inflammation with infection of the skin and subcutaneous tissue that spreads through tissue spaces
- patients with co-morbidities: increased risk for infection
- patients with failure of the lymphatics that lead to chronic lymphedema
- Treated w/ antibiotic usually but intavenous infusions
- Often occurs as a result of a primary injury
- May be iatrogenic (introduced to patient by physician activity, manner, therapy)
- Often has the appearance of red streaks
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Bacterial Infections
-what affects the ability of the bacteria to cause a clinical disease
- Skin normally caries bacteria
- invasiveness of the particular organism and the host resistance
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ACUTE NECROTIZING FASCITIS (bacterial infection)
-what kind of bacteria
-symptoms due to what
-delay in treatment can lead to what
-assosiated with a history of what
- Mixture of aerobic and anaeobic bacteria
- Severe inflammation and tissue necrosis (usually due to virulent strain of gram-positive, group A, beta-hemolytic streptococcus)(Bacteria secrete toxins that break down fascia and conn. tissue, causing massive tissue destruction)
- Often a history of minor trauma or infection in skin and subcutaneous tissue of an extremity
- Delay in treatment = greater tissue loss, potential amputation, and higher probability of mortality
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HERPES ZOSTER (shingles)-- VIRAL
-deals with which virus
-occurs when
-where does the virus remain
-which condition may follow leading to
discomfort
-after which age is the vaccine recommended for
- Reactivation of the varicella virus that causes chicken pox
- usually occurs during physiological sress particularily aging
- Following resolution of the chicken pox, the virus remains dormant in the dorsal root ganglion
- The skin eruptions usually occur along a specific dermatome commonly in the thorax
- Post herpatic neuralgia is a comon sequal of shingles and may lead to significant discomfort
- Vaccine is now recommended for all adults age 55 and older to prevent reactivation of thevirus
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PSORIASIS (autoimmune dissorder of the skin)
-Common/uncommon
-how is it characterized
-may be accompanied with______ what is the percentage
- Very common and benign condition
- Characterized by rapid proliferation of the skin cells resulting in raised plaques
- Often runs in families
- In about 10% of patients it is accompainied by arthritis--- PSORIATIC ARTHRITIS
- Mild cases are treated with topical medications
- Moderate cases respond well to reatment with ultraviolet light
- Severe cases are treated with Biologic Medications (also used to treat arthritis)
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Scleroderma = Systemic Sclerosis
-affects which parts of the body
-how are subtypes characterized
-what is the most common type
- A diffuse conn. tissue disorder that causes fibrosis of the skin, joints, blood vessels and internal organs Has several subtypes characterized by the extent of the disease
- Limited Sclerosis is the most common type
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Limited Sclerosis
-which syndrome
-where on the body would this be located
-progress quickly or slowly?
- CREST syndrome
- Limited to distal extremities and face
- Progresses slowly and patients have a 70% survival rate at 10 years
- May ultimately progress to visceral involvement
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Diffuse Sclerosis
-affects the body where?
-progress quickly or slowly?
- Widespread skin involvement including proximal extremities, face and trunk
- Progresses quickly to visceral involvement
- Higher mortality rate
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SCLERODERMA--Raynaud's Phenomenon
-what is Raynaud's Phenomenon
-where does it occur in the body
-what is the characteristic symptom of Scleroderma... this can lead to what
- Raynaud's Phenomenon: Paroxysmal vasoconstriction of the blood vessels of the hands and feet (Common in conn. tissue disorders such as scleroderma but may be a benign stand alone condition)
- Skin thickening is the chracteristic symptom of Scleroderma
- Often leads to contractures that result in significant functional limitation
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Hematology
The branch of science tht studies the form and structure of blood and blood forming tissues
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Functions of Blood (3)
- Transport nutrients (O2 & glucose)
- Remove waste (CO2 & lactic acid)
- Transport cells and stubstances b/t organs
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Where does the formation and development of blood cells take place?
BONE MARROW
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Which hormone acts of the bone marrow to stimulate the maturation and proliferation of erythrocytes by hematopoiesis?
ERYTHROPOIETIN
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Erythropoiesis
-which hormone regulates this process?
-from where is it secreted?
- The direct control of erythrocyte production
- Erythropoietin is secreted from the KIDNEYS
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Lymphatic System
- Assists in the management of circulation by removing fluid not otherwise managed by the circulatory system
- Integrated w/ the function of the hematologic system & the immune system
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Edema
(Hematological System Dysfunction)
Buildup of excessive fluid w/in the intersitial tissues or w/in the body cavities
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Infarction
(Hematological System Dysfunction)
Not enough oxygen = localized necrosis
A localized area of necrosis caused by a reduction in O2 perfusion that is below the level necessary for cell viability
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Thrombus
presence of a solid mass of clotted blood w/in a vessel or chamber of the heart
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Embolism
Mass of solid liquid or gas that moves w/in a blood vessel to lodge at a site distant from its place of origin
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Lymphedema
A chronic swelling of an area due to buildup of interstitial fluid especially in the extremities secondary to the obstruction or absence of lymphatic vessels or nodes
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Hypotension & Shock
Dramatic reduction in arterial blood supply and oxygenation to an organ or tissue
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Lymphadenophathy
- Enlargement of the lymph nodes
- Common in viral conditions
- Malignant conditions
- May include enlargement of the spleen
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Hematological System Dysfunctions (8 Bullets)
- Edema
- Infarction
- Thrombus & Embolism
- Lymphedema
- Hypotension & Shock
- Bleeding & Bruising that is not consistnet with size and magnitude of injury
- Lymphadenopathy
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DIAGNOSTIC TESTS (8)
- CBC
- Differential Count for WBCs
- Morphology
- Hematocrit
- Hemoglobin
- Chemical Analysis
- Bleeding Time
- Prothrombin Time & Partial Thromboplastin Time
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Complete Blood Count (CBC)
-what does it include
-what are 3 indications from a CBC
- Includes total RBCs, WBCs, & Platelets
- Leukocytosis = Increased WBCs (associated with inflammation/infection)
- Leukopenia = Decreased WBCs (associated w/ some viral infections; radiation & chemotherapy)
- Increased Eosinophils: Common in allergic responses
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______________ is common in allergic responses
Increased Eosinophils
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Leukocytosis
- Increased WBCs
- Associated w/ inflamation/infection
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Leukopenia
- Decreased WBCs
- Associated w/ some viral infections; radiation & chemotherapy
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Morphology
- Observed with blood smears
- Shows size, shape, uniformity, & maturity of cells
- Different types of anemia can be distinguished
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Hematocrit
Percent by volume of cellular elements in blood
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Hemoglobin
Amount of hemoglobin per unit volume of blood
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Chemical Analysis
- Determine serum levels of components
- Iron, vitamin B12, folic acid, cholesterol, urea, glucose, ect.
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Bleeding Time
Measures platelet function
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Prothrombin Time & Partial Thromboplastin Time
- Measures function of various factors in coagulation process
- INR is a standardized version--how quickly blood clots
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Anemia
- Abnormality in the ability of the blood to transport oxygen
- May be a symptom of many other disorders
- Causes a reduction in oxygen transport
- Basic problem is a hemoglobin deficit
- Oxygen defitic leads to...
- >less energy production in all cells: cell metabolism & reproduction diminished
- >Compensation mechanisms: Tachycardia and peripheral vasoconstriction
- >General signs of anemia: Fatigue, pallor (pale face), dyspnea, tachycardia
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IRON DEFICIENCY ANEMIA
- Insufficient iron impairs hemoglobin synthesis
- Microcytic, hypochromic RBCs
- Result of low hemoglobin concentration in cells
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IRON DEFICIENCY ANEMIA
--signs & symptoms--
- Pallor of skin and mucous membranes
- Fatigue, lethargy, cold intolerance
- Irratabiity
- Degenerative changes
- Menstral Irregularities
- Delayed Healing
- Tachycardia, heart palpitations, dyspnea, snycope
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IRON DEFICIENCY ANEMIA
--Etiology--
- Dietary intake of iron below min. requirement
- Chronic blood loss: Bleeding, ulcer, hemorrhoids, cancer, etc.
- Impaired duodenal absorption of iron: In many disorders-malabsorption syndromes
- Sever liver disease: may affect iron absorption as well as storage
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APLASTIC ANEMIA
IMPAIRMENT or FAILURE OF BONE MARROW
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PERNICIOUS ANEMIA
VITAMIN B12 DEFICIENCY
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SICKLE CELL ANEMIA
- Genetic condition
- Sicle-shaped cells are too large to pass through microcirculation
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SIGNS & SYMPTOMS OF SICKLE CELL ANEMMIA CRISIS
- Severe pain due to ischemia of tissues and infarction
- Pallor, weakness, tachycardia, dyspnea
- Hyperbillirubinemia = JAUNDICE
- Splenomegaly
- Vascular occlusions and infarctions
- Delay of growth and development
- Congestive Heart Failure
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HEMOPHILIA A
- Classic hemophilia
- Deficit or abnormality of factor VIII
- Most common inherited clotting disorder (x-linked recessive trait, manifested in men, carried by women)
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COMPLICATIONS OF LEUKEMIA
- Opportuistic infections including pneumonia
- Sepsis
- Congestive Heart Failure
- Hemorrhage
- Liver Failure
- Renal Failure
- CNS Depression and Coma
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Differentiation
- Normal tissue contains cells of uniform size, shape and nuclear struture
- Cells undergo changes as they develop to form the different tissues of the body
- In malignant cells differentiation is altered and the malignant cell may not look anything like its parent tissue.
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Dysplasia
- Adult cells change to indicate a disorganization of shape or size
- Dyspasia is often viewed as pre-cancerous condition although in many cases, it may reverse itself
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Hyperplasia
- An increase in the number of cels in tissue
- May be a normal occurrence or it may be neoplastic which is suggestive of tumor formation
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Tumors
- Abnormal growths of tissue that serve no useful purpose
- May compete with healthy tissue for vital blood supply and nutrients
- May be benign or malignant
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Primary Tumors
Arise locally
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Secondary Tumors
Result from (metastasis) or spread from another area
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Tumors are classified according to...
- Tissue of origin
- Being BENIGN or MALIGNANT
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Epithelial Tumor
- External body surfaces and the lining of the internal spaces and cavities
- CARCINOMA
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Connective Tissue Tumor
- Elastic, fibrous and collagenous tissues
- SARCOMA
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Nervous Tissue Tumor
- Brain, spinal cord and related structures
- Named for the specific type of cell involved
- GLEAL CELLS = GLEAPHOMA
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Lymphoid Tissue Tumor
- Anywhere in the body where lymph tissue is present
- LYMPHOMA-- very common
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Hematopoietic Tumor
- Blood and bone marrow
- LEUKEMIA and MYELOMA
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Benign tumors use the suffix...
-oma
adenoma
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Malignant Tumors (cancers) use the suffix...
-carcinoma
adenocarcinoma
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Tumors of Connective Tissue are termed ___________ and are often ___________.
sarcomas, malignant
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Unique Names of Malignant tumors
- Hodgkin Disease
- Wilms tumore
- Leukemia
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Benign Tumor
-characteristics
-risks associated
- Usually differentiated cells that reproduce at a higher rate than normal
- Encapsulated
- Tissue damage is a result of compression of adjacent structures, this can be life-threatening in the brain.
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Malignant Tumor
- undifferentiated, non-funtional cells
- Rapid reproduction--abnormal mitotic figures
- Infiltrate/spread into surrounding tissue
- Spread to distant sites
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The endocrine system is composed of __________ located throughout the body.
Glands
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Glands synthesize and release _____________ which are transported by the blood stream to the cells and organs that require hormones for proper function.
HORMONES
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What are hormones?
Chemical Mediators
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Target cells
~what do they have that makes them unique
~How are they inactivated and where are they secreted from?
- Specific receptor sites for hormones
- After acting on the target tissue the hormones are metabolized or inactivated by the cells of the liver and excreted by the kidneys
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5 Functions of the endocrine system
- Acting on the developing fetus to differentiate the reproductive system and the nervous system
- Stimulate growth and development through childhood and adolesence
- Coordinate the male and female reproductive system
- Maintains optimal internal environment through the lifespan
- Initiates corrective responses to physiological emergency
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Hormones produced by the pituitary gland(2)
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Hormone produced by the thyroid gland (1)
Thyroxine
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Hormones produced by the adrenal gland (3)
- Aldosterone
- Cortisol
- Epinephrine
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Hormones produced by the gonads (2)
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Hormones produced by the pancreas (2)
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Endocrine Disorders: Hypofunction
~what is it
~ what are the 5 outcomes of it
- Deficient hormone levels...
- --Antagonistic hormone production is increased
- --Malnutrition
- --Tumor produces too little hormone
- --Atrophy, surgical removal of gland
- --Congenital deficit
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Endocrine Disorders: Hyperfunction
- Excess hormone Levels...
- --Tumor produces high levels (happens when tumor takes on gladular function)
- --Excretion by liver or kidney is impaired
- --Congenital condition produces excess hormone
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Causes of Endocrine Dissorders
- Benign tumors
- Deficit in target cells
- Signs and symptoms of endocrine pathology vary depending on the gland affected and wheather it is hypo or hyper function
- Blood tests are commonly used to measure levels of circulating hormone
- The effectiveness of hormones can also be measured through blood test
- Various types of scans and diagnositc ultrasound may be used to examine structural changes in glands that lead to dysfunctions
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Thyroid Disorders
- VERY common
- Have genetic link
- More common in women
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Goiter
-what is it
-what could it indicate
-what are adverse affects
- Enlargement of the thyroid gland caused by various conditions of the thyroid--may indicate malignancy or malfunction
- Easily palpable in teh anterior neck
- May compress other structures if it is very large (trachea, esophagus, blood vessels)
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Hyperthyroidism
- Graves Disease
- More common in women
- Manifested by hypermetabolism and goiter
- Most often treated with RAI (radioactive iodine) which destroys the hyper secreting tissue
- patients usually require life long maintenance with medication
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Hypothyroidism
- A deficiency in thyroid hormone that results in slowed body metabolism
- Early symptoms are diffuse and poorly recognized
- (2 types): Hashimot's Thyroiditis & Myxedema
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Hashimoto's Thyroiditis
-what is it & what could it lead to
-what form of condition is it
- Inflammatory autoimmune disorder that leads to diminished thyroid function
- Most common form of hypothyroidism
- Easily managed by a pill
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Myxedema
- A severe form of thyroid dysfunction that may lead to coma
- Type of hypothyroidism
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How are thyroid dissorders diagnosed?
Blood tests
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Why are enlargements of teh thyroid scanned further?
For presence of TUMORS
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Thyroid cancer is relatively common/rare but usually responsibe to treatment with a very high/low success rate.
RARE, HIGH
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Hypothyroidism is easily treated with _________.
THYROXINE -very cheap
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Hyperthyroidism is often a secondary cancer to people who had _____________ as a child.
LEUKEMIA
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What causes Cushing Syndrome
- Excessive level of glucocorticoids
- ex) taking a lot of steroid-based medications--cortisone (like people with athsma)
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Appearance changes associated with Cushing Syndrome
- Round face w/ ruddy color
- Truncal obesity with fat pad between scapulae
- Thin limbs
- Thin hair
- Fragile skin
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Addison's Disease
- Deficiency of adrenocorticoid secretions
- Also called Primary Adrenal Insufficiency
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Manifestations of Addison's Disease (5 main, 3 sub)
- Decreased blood glucose levels
- Inadequate strees response
- Fatigue
- Weight loss; frequent infections
- Low serum sodium concentration
- --Decreased blood volume
- --Hypotension
- --High potassium levels (may cause cardiac arythmias)
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Diebetes Mellitus
- A chronic systemic disorder characterized by hyperglycemia and insulin deficit.
- Results in abnormal carbohydrate, protein, and fat metabolism
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Incidence of Diabetes Mellitus
- American Diabetes Association: more than 14.6 million Americans diagnosed w/ millions more not diagnosed
- More than 40 million American may have pre-diabetes or early stages of meatabolic disorder
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Insulin
-what is it responsible for?
-where is it secreted from?
- Responsible for appropriate carbohydrate metabolism
- Secreted by the pancreas
- Islets of Langerhans
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Two Types of DM
- Type 1 (Juvenile Diabetes/Insulin Dependent Diabetes Mellitus-IDDM) 10% of diabetes
- Type 2 (Adult Onset/Non-Insulin Dependent Diabetes Mellitus) 90% of diabetes
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Type 1 Diabetes
-what does it result from
-who does it affect
-patients have low levels of _______ which means they require ________ ______ __________ _______
- Results from the auto immune destruction of islet cells of the pancreas
- usually effects children and young adults
- Sudden onset
- Genetic component
- Patients have very low levels of circulating insulin
- Require life long exogenous inslinPatients do not secrete adequate insulin to sustain necessary physiological functions
- Insulin is required to facilitate the movement of glucose from the blood stream into the cells Patients with type 1 diabetes will have high levels of circulating glucose (blood sugar) because the glucose cannot move into the cells to be metabolized
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Type 2 Diabetes
-which kind of medications are used
-what may the 2 causes be?
-associated with what
- Non-Insulin Dependent
- Oral hypoglycemic medications may be used
- Caused by decreased production of insulin/increased resistance by body cells to insulin
- Onset is slow and insidous and usually in 50+ ages
- Associated with obesity
- Increased incidence in teens and young adults
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General Manifestations of Diabetes
- Insulin deficit results in decreased trasportation and use of glucose in many cells (polyphagia & fatigue)
- Blood Glucose levels rise --hyperglycemia
- Excess glucose in urine glucosuria (dehydration results from hypersmolar filtrate--polyuria--polydipsia)
- Diagnosed with a blood test (fasting blood glucose test-- 70-110mg)
- Glycosylated hemoglobin test (HbA1c)--clinical and subclinical diabetes--monitor glucose levels over several months
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Treatment of Diabetes
- Maintenance of blood glucose levels in normal range (reduced complications)
- Diet & Exercise (reduces blood glucose as skeletal muscle uses glucose)
- Oral medication (increases insulin secretion & reduces blood glucose levels)
- Insulin replacement
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