Patho-Exam 2

• Posterior pituitary
• secretion of ADH, pxytocin
• water retention
• hyponatremia
• hyperoosmolarity

• posterior pituitary
• insufficient ADH
• polyuria, polydipsia

pituitary infarction (Sheehan syndrome, hemorrhage, shock)

• cyclic physical/behavioral changes that impair interpersonal relationships or interfere with usual activities
• luteal phase
• abnormal nervous, immunologic, vascular, GI, etc.

• heavy/irregular bleeding without disease
• perimenopause
• changes in hormonal levels
• ovaries don't release egg

• oligo-ovulation/anovulation
• elevated androgens
• infertility
• multifactorial (hyperinsulinism)
• dysfunction of follicle development

painful menstruation associated with prostaglandin release in ovulatory cycles

• -functioning endometrial tissue or implants outside uterus
• -In endometriosis, displaced endometrial tissue continues to act as it normally would — -it thickens, breaks down and bleeds with each menstrual cycle
• responds to hormone fluctuations of menstrual cycle
• -Causes: retrograde menstruation

• inability to conceive after 1 yr
• structural/hormonal
• adhesions from pelvic inflammation cause obstruction
• hormones disrupt ovulation.

• enlargement of prostate gland
• urethral compression
• aging

This type can form when ovulation doesn't occur, and a follicle doesn't rupture or release its egg but instead grows until it becomes a cyst, or when a mature follicle involutes (collapses on itself

• low LH and pogesterone
• inadequate development of corpus luteum
• fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst

• regressed form of the corpus luteum
• As the corpus luteum is being broken down by macrophages, fibroblasts lay down type I collagen, forming the corpus albicans.

• increase risk when hormonal imbalances are common (puberty or menopause)
• common
• causes: corpus luteum cysts and follicular cysts.

• acromegaly (during adulthood): cardiac hypertrophy, hypertension, atherosclerosis, type 2 diabetes, coronary heart disease. enlargement of facial bones and hands and feet, kyphosis
• giagantism (children/adolescents)

• ACTH-cortisol
• TSH-decreased metabolic rate
• FSH/LH-amenorrhea, atrophic vagina, breast, uterus
• GH-dwarfism
• ...all deficiencies.

• female: amenorrhea, osteopenia
• males: erectile dysfunction, impaired libido, hypogonadism

• hyperthyroidism; increased TH
• graves goiter, thyroid cancer, increased TSH
• increased metabolic rate, increased tissue sensitivity to sympathetic stimulation, goiter, bruit over thyroid

• primary: excess TH by thyroid gland
• secondary: by TSH secreting pituitary (pathway)

• hyperthyroidism
• autoimmune
• groiter, opthalmopathy, dermopathy
• pretibial myxedema (subQ swelling on anterior of legs and indurated and erythemous skin.

• not enough TRH and TSH
• hashimoto disease
• decreased metabolism, reduced heat production
• myxedema (nonpitting, boggy edema)- pronounced around eyes, feed, hands, tongue thickens and pharynx=slurred speech

iodine deficiency

• hypercalciuria
• alakaline urine
• hyperphosphaturia-kidney stones

secondary: renal failure

• hypo: opposite- low calcium, high phosphate
• low calcium leads to muscle spasms

• pancreatic atrophy, loss beta cells
• macrophages, T and B lymphocytes, NKC
• autoimmune
• genetic, environmental
• hyperglycemia
• polydipsia, polyuria, polyphagia, weight loss, fatigue

• metabolic syndrome
• reoccurring infections, vision, neuropathy
• insulin resistance
• decreased beta cell response with abnormal glucagon secretion
• islet dysfunction due to decreased beta cell mass
• hypoglycemia, diabetic ketoacidosis

• absolute or relative deficiency of insuline
• type 1 diaetes
• decreased insulin=fat metabolism=release fatty acids (stimulate gluconeogenesis and ketogenesis)
• by product of fat metabolism: ketones
• vomit, dehydration, kussmal respiration, coma.

• hypoglycemia followed by hyperglycemia
• type 1 diabetes
• glucose high in morning due to stimulation of glucose conteregulation (epinephrine, GH, cortisol, glucagon release) gluconeogenesis from other sights at  night- peripheral glucose use is inhibited.

• early morning rise in glucose
• noncturnal elevations of GH=increase glucose
• via fat and muscle metabolism

• excessive ACTH (disease), cortisol (syndrome)
• adrenal cortex
• rapid weight gain, moon face, glucose intolerant, bone, muscle wasting, immunosuppression, hyperpigmentation

• primary adrenal insufficiency
• autoimmune
• elevated ACTH, inadequate corticosteroid synthesis

increased sodium retention, increased extracellular fluid=increased blood pressure=decreased renin, increased potassium

hypersecretion of estrogen=development of female sex characteristics

• hypersecretion of androgens
• male sex characteristics.

• posterior: ADH and oxytocin
• anterior: prolactin, LH, FSH, TSH,GH

Benign: slow growth, well defined, encapsulated, not invasive, well differentiated, low mitotic index, not metastized

malignant: fast growth, undefined, non ecapsulated, invasive, poorly differentiated, high mitotic index, metastize

• epithelial malignant tumors
• have not broken through basement layer
• preinvasive

absence of differentiation

• self renew
• multipotent (differentiate into different cell types)

• mutant genes
• direct protein synthesis/cell growth
• "gas"

• encode genes proliferation
• "breaks"

if mutation=unregulated cell growth

• stop tumor suppressor genes
• loss of heterozygosity (unmask mutations)
• gene silencing (shut off regions)
• decrease apotosis

in all...cause cancer

• protein repair damaged DNA
• if inhibit=increase cancer risk

• growth of new vessels
• feed cancer cells

• end of chromosome for protection (with each division gets shorter)
• in cancer: production enzyme rebuild telomere

• heritable changes in gene expression
• lifestyle modifications and pharm

• methylation: silence tumor suppressing gene
• histone modification: chromatin altered
• micro RNA: stimulate gene expression

• cytokine stimulate enzyme cox-2= cancer
• free radicals= mutations
• decreased response to DNA damage

• helicobacter pylori
• peptic ulcer, stomach carcinoma, lyphomas

virus: hep b and c, HPV

spread to distant site via lymph, blood

• pain, fatigue, anemia, infection
• cachexia: severe malnutrition (anorexia, early satiety, weight loss, anemia)
• leukopenia: decresed WBC
• thrombocytopenia: decreased platelets

severe malnutrition (anorexia, early satiety, weight loss, anemia)

• toxic, mutagenic, carinogenic
• diet

• phase I activation enzyme=stimulate
• phase II detox enzyme= inhibit

• BMI
• adipose tissue stimulates endocrine=release free fatty acids, increase insulin resistance=hyperinsulinemia
• plus inflammatory factors

child: <1% of cancers, nonepithelial/messendyrmal, short latency, ecogentic, few prevention, detect on accident, metastized at dx, responsive to tx, long term consequences of tx, >70% cure

adult: >99% of cancers, organs, carcinomas, long latency, environmental/lifestyle, 80% preventable, screen (early detection), local at dx, not responsive to tx, few long term consequences to tx, <60% cure

• origin of most childhood cancers
• give rise to connective tissue, bone, cartilage, etc

• genetic; oncogenes, tumor suppressor genes, chromosomal
• environementa: prenatal, parental age incrased, childhood exposures.

• complexities of pain. chronic
• pain transmission to spinal cord via fibers
• inhibit interneurons=stimulate CNS=close pain gate

leads to diminished pain perception.

• A-delta: fast, thick myelinated
• Type C: small, unmyelinated throbbing, chronic pain
• A-Beta: large, non-nociceptice (pain receptors)
• inhibt a-delta and type c

• pain excitatory: aspartame, glutamate
• pain inhibitory: serotonin, GABA, endorphin

point at which a stimulus is perceived as pain

pain in one location may decrease threshold in another location

• duration of time and intensity of pain that person endures
• cultural, physical/mental health
• decreased with repeated pain, fatigue, anger, bored, sleep deprived
• increased with alcohol, warmth, faith

• normal tissue
• somatic(body)/visceral (organ)

• neurpathic, pain receptors
• chronic

• can be nociceptive but long term (3 months)
• decreased endorphins
• c neuron stimulated

• is pain caused by damage or disease that affects the somatosensory system
• chronic
• PNS: diabetes, cancer, HIV
• CNS: spinal cord, MS, tumors

• via thermoregulators in hypothalamus
• radiation, conduction, convection, vasodialation, decreased muscle tone, evaporation, incrased respirations

infants: increased surface area, thin subQ layer

• adjust heat production, conservation, maintain core temperature
• stimulate sweat, decreased muscle tone, flushed skin, peripheral vasodilation
• benefits: kill microorganisms, lysosomal breakdown, phagocytosis, decrease zing, iron, copper, autodestructing, lymphocytes

• 41 degrees: nerve damage
• 43 degrees: death

• heat cramps (loss sodium),
• heat exhaustion (dehydrate, dec plasma vol., hypotension=weak, N&V, dizzy),
• heat stroke (cardio and thermoreg. may cease=increased temperature=cerebral edema, degeneration of CNS, swollen dendrites)

• inherited muscle disorder
• increased calcium release or decreased calcium uptake by muscles for contraction
• increased oxygen consumption and lactic acid production

• 35 degrees
• decreased viscosity of blood, decreased chemical reactions
• accidental
• therapeutic: ischemia is risk

• multiphase process
• restorative and memory consolidation
• REM (20%) (rapid eye movement)
• and NREM (majority 70%)

peds 16-17 hs of sleep, most in REM

with age: decreased total sleep, longer to fall asleep, aware more often, decrased stage 4

• upper airway resistance:
• obstructive sleep apnea: obesity: blockage
• obesity hypoventilation syndrome: obese short thick neck, impaired resp mechanism
• leptin

awake from REM or arousal NREM

sleep walking

• dolls eyes
• abnormal: don't turn in conjugate
• absent: eyes don't turn as heat position changes

arousal: awake, alteration. assess: LOC, pupil, motor, oculomotor

awareness: cognitive functions, aware of self, environment, mood.

• caloric ice water test
• abnormal: asymmetric eye movement
• absent: no eye movement (brain dead)

• brain stem death: irreversible
• cant maintain homeostasis
• criteria: unresponsive coma (motor/reflex), apnea, no cephalic reflexes, isoelectric EEG, completion of all app therapeutic procedures, signs present for 1 hr and 6 hrs after onset.

• irreversible coma
• no behavioral/environmental response
• body continues with normal respirations, cardio, temp control, GI

• wake from unconscious state
• period of eye opening
• potential response to physio stimulus
• occasional eye movement with tracking
• sleep/wake cycles
• normal respirations/GI function

• no local (focal) onset, form deep brain, neurons bilaterally
• result from cellular, biochem, structural abnormalities
• consciousness always impaired/ lost

• focal
• neurons unilaterally
• consciousness may be maintained.

may go into secondary generalized

• partial seizure become generalized
• involves neurons from other hemisphere
• consciousness lost

state of continuous seizures lasting more than 5 minutes or rapidly reoccurring before person fully regain consciousness from previous

• increase ATP
• increased oxygen consumption
• increased cerebral blood flow
• glucose and oxygen depleted

• cant recognize objects
• pattern recognition

• loss of total comprehension or production of language
• stroke

• impaired comprehension or production of language
• expressive: cant get words out
• transcortical: cant understand

• progressive failure of cerebral functions, not caused by LOC
• mental abilities impaired, decreased memory, language, altered behavior, orientation

alzheimers

• form of dementia
• genetic. early and late onset (non hereditary)
• forgetfulness, emotional upset, disorientation, confused, lack of concentration

5-15 mmHg is normal

• most common
• uncus from hippocampal gyrus shift from middle fossa through tentorial notch-posterior fossa

downward shift of diencephalon through tentorial notch

gyrus shift under falx cerebri

decrease/increase muscle tone

• chorea
• heridetary
• severe degeneration of basal ganglia and frontal cortex (GABA reduced)
• disrupt thought process

• hypokenesia
• severe degeneration of basal ganglia
• rigidity, bradykinesia, termor, posture abnormal, depression, disorientation, confusion, momroy loss

• decreased movement
• akinesia
• bradykinesia

• base of skull (face)
• temporal bone, occipital bone, sphenoid bone, ethmoid bone
• raccoon eyes
• battle sign (ecchymosis)

• shaking
• rotation acceleration/deceleration
• sheer, tear and stretch of nerve fibers
• disabled

• contusions
• extra dural hematoma: in temperal fossa. artery bleeding
• subdural hematoma: skull fractures, below dura
• intracerebral hematoma: 3-10 days, increase ICP and compression leads to edema. decreaed LOC

• temporary. increase in ICP
• attention/memory deficits
• 1(confusion/disorientation), 2 (momentary confusion with retrograde amnesia) 3 (with amenia retrograde/ anterograde)

• grade 4
• physio/neuro dysfunction
• LOC less than 6 hrs
• retrograde and anterograde amensia

• thrombotic stoke: arterial occlusion by thromby (transient ischemic attacks)
• embolic stroke: fragment breaks from thrombus formed outside braine
• Hemorrhagic stoke: rupture in aneurysm

• autoimmune
• progressive, inflammation, demylination