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Patho test 3
slides for patho midterm 3
188
Nursing
Undergraduate 2
10/17/2012
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Term
examples of monoamine neurotransmitters
 Definition
dopamine, norepinephrine, etc...
Term
amino acid neurotransmitter examples
 Definition
acetylcholine, glutamate
Term
Role of calcium channels in neurotransmitter release
 Definition
Located on presynaptic terminal, calcium influx leads to release of vesicles.
Term
Role of hypothalamus - as emphasized in class
 Definition
stimulates pituitary gland, temperature regulation, coordination of autonomic nervous system functions, blood CO2, osmoreceptors.
Term
ventral horn
 Definition
anterior extension of spinal chord - efferent motor neurons leaving chord.
Term
Dorsal horn
 Definition
Posterior extension of spinal chord - sensory neurons receiving afferent impulses
Term
Pyramidal motor system/Extrapyramidal system
 Definition
extends from sensiromotor areas of brain to motor neurons. Controls voluntary movement

Extrapyramidal system - basal ganglia, fine-tunes and stabilizes movement
Term
Consequence of:

the brain being profoundly glucose deprived (15 min)

Brain being deprived of oxygen for 5 minutes
 Definition
permanent damage
Term
Consequence of spinal chord injury above C3
 Definition
permanent parallization/possibility for instant death.
Term
Nervous system organization - Peripheral nervous system
 Definition
Somatic -
motor and sensory impulses
cranial nerves
spinal nerces (dermatomes, plexus formationa)

Autonomic
- preganglionic neurons
autonomic ganglion
postganglionic neuron
Term
glial scars
 Definition
Implicated in:
ALS, Sudden infant death syndrome
Term
Cerebral Palsy: definition, cause
 Definition
Group of neuromuscular
disorders

- Premature babies seem more at risk.

Cause: event during the antenatal
or postnatal periods damaging
upper motor neurons

*non progressive
Term
Cerebral Palsy: classification
 Definition
Motor
dysfunction type
Spastic **most common we will see in practice.
Athetoid/
dyskinetic (Basal ganglia)
Ataxic

Anatomic
involvement
Hemiplegia
Diplegia
Quadriplegia (more severe forms can compromise breathing)
Term
Cerebral Palsy clinical manifestations
 Definition
 Variable severity
Limited fine motor skills
Lack of coordination and balance
Impaired cognitive function
Speech disorder
Seizure disorder (can stay local or spread to both hemispheres)
Term
Area of the brain most sensitive to hypoxia
 Definition
Frontal lobes
Term
Diagnosis of cerebral palsy
 Definition
Diagnosis of exclusion
History
Physical exam
Neurologic exam
Motor skills
Reflexes
Developmental milestones
Term
Multiple Sclerosis
 Definition
CNS inflammation processes cause exacerbation. Some ideas for causes: problem with immune system, gap in BBB.

Central nervous system
demyelination
Etiology combines
Genetics
Triggering event (virus' really common)
Autoimmunity
Regional variation


Milk proteins - can mimic appearance of self antigens, bring on attack.

Alcohol can further stimulate inflammatory process.
Term
Some details of MS case study in class.
 Definition
fuzzy slipper feeling on feet
constipated
feels like she's drunk when she walks
had a bad cold

At 21 started feeling loss of sensation in tip of finger... pins and needles, symptoms resolved.

At 25 episode of vision difficulty.

Eye movements darting back and forth... not coordinated

reduction in sensation in extremeties
positive romberg... close eyes: looking for dizziness, swaying, etc..

normal lab test
Term
Spinal tap results for MS
 Definition
increased myelin basic proteins, leukocytes (Tcells), immunoglobins (specifically IgG), elevated protein
Term
Normal CSF glucose
 Definition
2/3 of systemic
Term
Areas of brain where plaques appear on MRI in MS patients:
 Definition
cerebellum, brain stem, paraventricular area.
Term
Drugs to use to treat flare ups of MS
 Definition
immunosupressants,
Term
Increased risk for MS (geographically)
 Definition
If you spent first 15 years in northern hemisphere chances are higher.
Term
Hydrocephalus noncommunicating vs communicating
 Definition
communication = impaired absorption, noncommunicating = some sort of blockage
Term
Hydrocephalus Pathophysiology
 Definition
Increased ventricular accumulation of
CSF
Ventricular enlargement
Increased intracranial pressure
 Classifications
Noncommunicating
Communicating
Congenital
Acquired
Term
Hydrocephalus causes
 Definition
 Causes
Intraventricular hemorrhage
Neural tube defect
Brain tumor
Meningitis
Traumatic injury
CSF flow obstruction
Impaired CSF absorption
Term
Hydrocephalus clinical manifestations
 Definition
Age-dependent
Infant
Enlarged head with bulging
fontanels
Scalp vein distention
Difficulty feeding
High, shrill cry
Older children/adults
Impaired motor and cognitive
function
•Increased blood pressure
•Altered heart rate
•Headache
•Vomiting
•Decreased level of
consciousness
•Papilledema (optic disk)
Term
Hydrocephalus Diagnostic criteria
 Definition
Head circumference
measurement
Transillumination
 Imaging studies
Term
Hydrocephalus treatment
 Definition
Establishment and maintenance
of normal CSF volumes and
pressure
Ventriculoperitoneal shunt
Ventriculoatrial shunt
Endoscopic third
ventriculostomy
Term
Depression Pathophysiology
 Definition
 Condition of altered mood, thoughts
and somatic complaints
 Altered neuronal communication due
to deficiency of neurotransmitter
amount or function in synapses of
critical areas of the brain
Term
Depression clinical manifestations
 Definition
Altered mood
Vegetative
Cognitive
Impulse control
Behavioral
Physical (somatic)
Term
Depression Diagnostic Criteria
 Definition
DSM-IV criteria
Major depressive episode
> 5 symptoms
Must include depressed mood or
loss of interest or pleasure
During a two week period
 Depression inventory
Term
Depression treatment
 Definition
 Counseling
 Psychotherapy
 Pharmacologic treatment
Term
Depression: low B12 low iron, tryptophan
 Definition
tryptohan = building block of seretonin in the brain, niacin also?

Low B12 and low Iron could also be cause of depressive symptoms.
Term
Hypertension
 Definition
A progressive cardiovascular syndrome detected by an elevation in blood pressure and/or the presence of organ damage due to persistent blood pressure elevations
Term
Primary vs Secondary Hypertension
 Definition
Secondary is hypertension caused by something else, i.e. Kidney disease.
Term
Risk factors for hypertension
 Definition
Family history of hypertension
Aging**shouldn't on it's own cause hypertension**
Diabetes mellitus
Obesity
Excessive dietary sodium intake
Smoking
Excessive alcohol intake
Sedentary lifestyle
Term
Single most important predictor for coronary artery disease
 Definition
Systolic >140
Term
Hypertension Diagnostic Criteria
 Definition
History and physical examination
Serial blood pressure measurements
Laboratory studies
Classification:
Prehypertension
Stage 1
Stage 2
Term
How does diabetes contribute to hypertension.
 Definition
Diabetic, doesn't control triggers, hyperglycemic states cause damage to blood vessels... leads to inflammation response.
Term
Hypertension Treatment
 Definition
Pharmacologic treatments

Lifestyle modifications
Weight reduction
Decreased alcohol, salt & saturated fat intake
Increased aerobic physical activity
Increased fruit and vegetable intake
Smoking cessation
Term
Shock Pathophysiology
 Definition
A condition of circulatory failure and impaired perfusion of vital organs

Sources of impaired perfusion:

Ineffective cardiac pumping : Cardiogenic Shock

Decreased blood volume: Hypovolemic Shock

Sources of impaired infusion (cont’d):

Massive systematic vasodilation:
Septic Shock
Neurogenic Shock
Anaphylactic Shock
Hypoadrenal

Compensatory mechanisms
Term
Blood pressure, signs of hypertension
 Definition
Prehypertension - 120-129/81-89
Stage I hypertension - >140/90+
Stage II - 160+/100+
Term
Shock clinical manifestations
 Definition
Tachycardia, tachypnea
Cool, clammy extremities with poor peripheral pulses
Decreased arterial blood pressure (a late sign indicative of decompensation)
Cyanosis and/or pallor
Restlessness, apprehension, decreased mental function
Poor urinary output
Term
MI Pathophysiology
 Definition
Total occlusion of one
or more coronary arteries
resulting in ischemia and
death of myocardial
tissues
Atherosclerosis is most
common cause
Term
MI Risk factors
 Definition
Major Risk Factors:

Family history of CAD
Hypertension and smoking
Blood cholesterol levels
Concurrent diabetes mellitus
High-sensitivity C-reactive protein (CRP)
Hyperhomocysteinemia
Term
MI Clinical Manifestations
 Definition
Gender variability
Chest pain or a crushing pressure, often radiating to the left arm, shoulder, or jaw
Fatigue, weakness, syncope, anxiety
Dizziness, shortness of breath
Sweating, pallor
Indigestion
Nausea, vomitingGender variability
Chest pain or a crushing pressure, often radiating to the left arm, shoulder, or jaw
Fatigue, weakness, syncope, anxiety
Dizziness, shortness of breath
Sweating, pallor
Indigestion
Nausea, vomiting
Term
MI Diagnogstic Criteria
 Definition
History and physical examination
Laboratory studies (cardiac enzymes)
ECG
Angiography
Term
Heart failure pathophysiology
 Definition
Reflects an inadequacy of heart pumping so that the heart fails to maintain the circulation of blood
Result of:
Impaired cardiac functioning
Excessive workload demands
Left Heart Failure
Right Heart Failure
Term
Heart Failure Diagnostic Criteria
 Definition
History and physical examination
Chest radiography
Echocardiography
ECG
Cardiac catheterization
Term
Heart failure treatment
 Definition
Correct cause, if possible
Provide supplemental oxygen
Improve cardiac output
Reduce peripheral vascular resistance
Overall goal: improving quality of life
Term
Stroke Pathophysiology
 Definition
Any clinical event that leads to the impairment of cerebral circulation
Thrombotic, embolic, or hemorrhagic
Inflammation, ischemia, death of neurons
Cerebrovascular accident (CVA) versus transient ischemic attack (TIA)
Term
Stroke Clinical Manifestations
 Definition
Focal brain injury
Abrupt onset of hemiparesis
Vision loss or field deficits
Dizziness
Ataxia
Aphasia
Sudden decrease in the level of consciousness
Term
Stroke Diagnostic Criteria
 Definition
History and physical examination

Laboratory studies

CT scan
Term
Disseminated Intravascular Coagulation
 Definition
Uncontrolled activation of clotting factors resulting in widespread thrombi formation, followed by depletion of coagulation factors and platelets leading to massive hemorrhage
Initiated by endothelial injury
Term
Classification of hemorrhage
 Definition
Class I - 10-15% loss (well tolerated, no change in BP)

Class II - 20-30%
Class III - 30-40% - hypotension, tachycardia, confusion, pallor, oliguria
Class Iv - greater than 40% (cardiovascular collapse)
Term
DIC Clinical manifestations
 Definition
Excessive hemorrhage

Bruising
Petechiae
Epistaxis

Excessive clotting

Headache, weakness, seizures, coma
Poor urine output, renal failure
Cough, shortness of breath, respiratory distress, chest pain
Term
DIC Diagnostic Criteria
 Definition
History and physical exam
Laboratory testing
Prothrombin time (PT)
Activated partial thromboplastin (aPTT)
Platelet count
Fibrinogen level
D-dimer test (confirmatory)
Term
Amount of blood loss required for hypotension
 Definition
30% of circulating blood volume
Term
Intrinsic vs Extrinsic cardiogenic shock
 Definition
Heart attack, dysrhythmia.

Extrinsic
Cardiac tamponade, tension pneumothroax, PE, positive pressure ventilation
Term
DIC Treatment
 Definition
Correct the underlying cause
Dependent upon the presence of hemorrhage versus thromboses
Careful balancing act with a goal of proper coagulation
Term
ventilation
 Definition
Involves both acquiring oxygen
(inspiration) and removing carbon
dioxide (expiration) from the blood
Neuronal impulses are directed by lung
receptors, which map the current state
of breathing and lung function
Uses the intercostal muscles,
diaphragm, and sternocleidomastoid
muscles
Term
Inspiration
 Definition
Breathing in to acquire oxygen
Unidirectional from high pressure to
low pressure.
Chest cavity size changes to alter the
pressure gradient
Term
Expiration
 Definition
Removing carbon dioxide out of the
body through the lungs
The diaphragm and external
intercostal muscles relax
Lungs compress and increase the
pressure inside the airways
Term
Measurement of Ventilation
 Definition
Tidal volume (TV)
Vital capacity (VC)
Forced capacity (FVC)
Forced expiratory volume in 1
second (FEV1)
Residual volume (RV)
Total lung capacity
Term
Diffusion
 Definition
Oxygen and carbon dioxide are
exchanged at alveolar capillary
junctions
Two major process occur:
Oxygen is trying to get to all the cells
Carbon dioxide is trying to escape the
body through the lungs
Term
Partial Pressure
 Definition
The collision of oxygen and carbon
dioxide creates pressure
PaO2
PaCO2
Term
Oxygen Diffusion and Transport
 Definition
Oxyhemoglobin (HbO2)
Oxygen Saturation (SaO2)
Once saturation occurs, oxygen
continues to diffuse and dissolve in the
plasma
Term
Carbon Dioxide Diffusion and
Transport
 Definition
Dissolved in the plasma
Bound to hemoglobin
Diffused into the red blood cell as
bicarbonate
Term
Diffusing Capacity
 Definition
The measurement of carbon monoxide,
oxygen, or nitric oxide transfer from
inspired gas to pulmonary capillary
blood and is reflective of the volume of a
gas that diffuses through the alveolar
capillary membrane each minute.
Term
Impaired Ventilation
 Definition
A problem of blocking airflow in and out of the
lungs
 Two major mechanisms implicated:
 Compression or narrowing of the airways
 Disruption of the neuronal transmissions
needed to stimulate the mechanics of the
airways
Term
Impaired Ventilation-Perfusion
Matching
 Definition
Two possible scenarios:
Lung are ventilated, but not perfused
Lung is perfused, but not ventilated
Term
Impaired Diffusion
 Definition
Restricted transfer of oxygen and/or carbon
dioxide across the alveolar capillary junction
 Dependent upon:
 solubility and partial pressure of the gas
 surface area and thickness of the membrane
Term
The Effects of Impaired Ventilation
and Diffusio
 Definition
Hypoxemia (low concentration of O2 in blood)
Hypoxia (low O2 in tissue)
Hypercapnia (increased CO2 levels in blood)
Term
General Manifestations of
Impaired Ventilation and Diffusion
 Definition
Cough, mucus, hemoptysis
Dyspnea, orthopnea
Adventitious lung sounds
Use of accessory muscles
Chest pain
Barrel chest
 Systemic manifestations (fever, etc.)
Term
Laboratory and Diagnostic Tests
 Definition
History and physical examination
 Visualization (bronchoscopy, x-ray, CT, MRI,
nuclear medicine, etc.)
 Pulmonary function tests
 Pulse oximetry
 Laboratory studies
Term
Treating Impaired Ventilation and
Diffusion
 Definition
Remove obstruction and restore
physical integrity of airways, lung
tissues
Decrease inflammation and mucus;
treat infection
 Supplemental oxygen
Mechanical ventilation
Term
Pneumonia Pathophysiology
 Definition
 Infectious process
 Respiratory droplet spread
Causes inflammation of the lungs
Occurs commonly in the bronchioles,
interstitial lung tissue and/or the alveoli
Products of inflammation accumulate
and cause consolidation
Term
Pneumonia Clinical Manifestations
 Definition
Sudden onset of
fever
Chills
Cough
 Sputum
production
 Fatigue
 Loss of appetite
Dyspnea
• Tachypnea
• Tachycardia
• Pleuritic pain
• Crackles in lungs
Term
Pneumonia Diagnostic Criteria
 Definition
History and physical examination
Complete blood cell count
Chest X-ray
Thoracic CT scan
Term
Pneumonia Treatment
 Definition
Restore optimal ventilation and
diffusion
 Identify pathogen and target with
appropriate pharmacologic treatment
 Supplemental oxygen
Term
Emphysema Pathophysiology
 Definition
Irreversible enlargement of the air
spaces beyond terminal bronchioles
destruction of the alveolar walls
obstruction of airflow
Chronic smoking most often implicated
Term
Emphysema Clinical
Manifestations
 Definition
Persistent cough
 Dyspnea
Wheezing
 Barrel chest
 Pursed lip
breathing
Term
Emphysema Diagnostic Criteria
 Definition
History and physical examination
Pulmonary function tests
Chest x-ray
Hypercapnia/hypoxemia
Term
Chronic Bronchitis
Pathophysiology
 Definition
Persistent, productive cough lasting three months
or greater, for two or more consecutive years
 Result of:
 Chronic inflammation and edema of the
airways
 Hyperplasia of the bronchial mucous glands
and smooth muscles
 Destruction of cilia
 Squamous cell metaplasia
 Bronchial wall thickening and development of
fibrosis
Term
Chronic Bronchitis Clinical
Manifestations
 Definition
Cough
Purulent sputum
Dyspnea
Adventitious lung sounds
Cyanosis
Term
Chronic Bronchitis Diagnostic
Criteria
 Definition
Chronic Bronchitis Diagnostic
Criteria
Term
Chronic Bronchitis Treatment
 Definition
Smoking cessation
Pulmonary rehabilitation
Pharmacologic therapy
Supplemental oxygen
Term
Asthma Pathophysiology
 Definition
Intermittent or persistent airway
obstruction due to:
 Bronchial hyperresponsiveness
 Chronic inflammation
 Bronchoconstriction
 Excess mucous production
Term
Asthma Clinical Manifestations
 Definition
Wheezing and tachypnea
Dyspnea and coughing
Chest tightness
Excessive sputum production
Anxiety
Term
Asthma Diagnostic Criteria
 Definition
History and physical examination
Pulmonary function tests
 Laboratory studies
Chest x-ray
Term
Asthma Treatment
 Definition
Monitor lung function
Control environmental triggers
Pharmacologic therapy
Patient and family education; action
plan
Term
Cystic Fibrosis Pathophysiology
 Definition
Autosomal recessive disorder of
electrolyte and water transport
affecting certain epithelial cells
(respiratory, digestive, and
reproductive lining)
Mutation of the CF gene
Associated with mucus plugging,
inflammation, and infection in the
lungs; also affects other body
systems
Respiratory failure is most common
cause of death
Term
CF Clinical Manifestations
 Definition
 Respiratory
 Gastrointestinal
 Reproductive
Term
CF Diagnostic Criteria
 Definition
History and physical examination
Sweat test
Genetic testing
Chest x-ray
Sputum analysis
Term
CF Treatment
 Definition
Respiratory
Chest physiotherapy
Pharmacologic treatment
Lung transplant
Gastrointestinal
Optimal nutrition
Pancreatic enzymes
Term
ARDS Pathophysiology
 Definition
Lung injury to respiratory distress
within 24-48 hours
 Severe acute inflammation and
pulmonary edema without evidence of
fluid overload or impaired cardiac
function
Mortality rate 30%-40% from multisystem organ failure in those untreated
Term
ARDS Clinical Manifestations
 Definition
Tachypnea
Dyspnea
Retractions
Crackles due to fluid accumulation
Restlessness, anxiety
Term
ARDS Diagnostic Criteria
 Definition
History and physical examination
Laboratory studies
Imaging studies
Term
ARDS Treatment
 Definition
Remove causative factors
Administration of 100% oxygen
Mechanical ventilation
Term
Giving O2 during COPD exarcerbation
 Definition
maintain pO2 - 60-65mmHg
Saturation 90-92%
monitor respiratory rate
wean asap

In clinic, people are afraid that client will stop breathing if given high O2 so they will be hesitant to treat. Theoretically this is a valid concern but in reality you treat acute respiratory arrest but you make sure you monitor their respirations.
Term
ISCT Pathophysiology
 Definition
Spinal cord injury altering neuronal
transmission
 Categories
Complete transection
Partial transection
Central cord syndrome (Loss of motor power and sensation at one level, incomplete loss below it)


Anterior cord syndrome (Loss of motor power, pain, and temperature sensation, with preservation of position, vibration, and touch sense)

Brown-Séquard syndrome (Loss of voluntary motion on same side as chord damage, loss of pain and temperature sensation on opposite side)
Term
ISCT Clinical Manifestations
 Definition
Variable
Spinal segmental level
Type of injury
Degree of cord transection
Term
ISCT Diagnostic Criteria
 Definition
Physical exam
Cognitive function
Motor function
Sensory function
 Imaging studies
Term
ISCT Treatment
 Definition
 Immobilization of the spine
 Pharmacologic
Anti-inflammatory medication
 Promotion of functional abilities
Term
Perfusion
 Definition
Forcing blood or other fluid to
flow through a vessel and into the
vascular bed of tissue to provide
oxygen
Term
Requirements for Effective perfusion
 Definition
 Adequate ventilation and diffusion

 Intact pulmonary circulation

 Adequate blood volume and
components

 Adequate cardiac output

 Intact cardiac control center

 Intact receptors
 Intact parasympathetic and
sympathetic nervous systems

 Intact cardiac circulation

 Intact coronary circulation

 Intact systematic circulation

 Adequate tissue uptake of oxygen
Term
Altered Perfusion
 Definition
The inability to adequately oxygenate
tissues at the capillary level
 Factors that could alter perfusion
include:
◦ Ventilation-perfusion mismatching
◦ Impaired circulation
◦ Inadequate cardiac output
◦ Excessive perfusion demands
Term
Ventilation/Perfusion Mismatching
 Definition
Inadequate ventilation in well perfused
areas of the lungs

 Inadequate perfusion in wellventilated areas of the lungs
Term
Impaired Circulation: Causes
 Definition
 Injury to vessels
 Obstruction
 Inadequate blood movement
 Inadequate blood volume
Term
Inadequate CO causes
 Definition
Changes in blood

 Impaired ventricular pumping

 Structural heart defects

 Conductions defects

 Changes in peripheral vascular
resistance
Term
General Manifestations of Altered Perfusion
 Definition
Variable depending upon source of
altered perfusion
 Cyanosis, pain, pallor, coolness,
edema, shortness of breath, impaired
growth, tachycardia, tachypnea, and
fatigue
 Hypotension or hypertension
 Bleeding, bruising
 Heart murmur
Term
Diagnosing Altered Perfusion
 Definition
 Echocardiography or Doppler
ultrasonography
 ECG
 Chest x-ray
 Cardiac catheterization
 Pressure measurements
 Stress test
Term
Characteristics of Hormones
 Definition
Control
 Feedback
 Patterns of secretion, metabolism,
elimination
 Receptor binding
 Effects on target cells, tissues,
organs
Term
Pineal Gland
 Definition
Secretes meletonin, sets circadian rhythm
Term
Anterior Pit/Posterior Put
 Definition
Ant - e.x. GH ---> cell growth

Post. e.x. ADH --> Water balance
Term
Thyroid (hormone released)
Parathyroid
 Definition
Thyroid: T3/T4, regulates metabolism
Calcitoni - lowers blood Ca

Parathyroid - PTH ---> raises blood Ca

Parathyroid:
Term
Pancreas
 Definition
Insulin --- lowers blood sugar
Glucagon - Raises blood sugar
Term
Adrenal Cortex/Medula
 Definition
Cortex :Glucocorticoids --- anti-inflammatory

Medula: epinephrine ---- fight or flight
Term
Ovary/Testes
 Definition
Ovary - estrogen
Testes - Testosterone
Term
Negative/Positive Feedback Mechanisms
 Definition
Example of negative feedback - Body temperature

Example of Positive Feedback - Oxytocin
Term
paracrine/autocrine
 Definition
paracrine - cells release chemicals that act on nearby cells.

Autocrine - chemicals released by cell that act on itself.
Term
General Adaptation Syndrome
 Definition
 Alarm stage

 Resistance stage

 Exhaustion stage
Term
weight gain and stress
 Definition
Cortisol keeps glucose levels high, fat storage, retaining water.
Term
Altered Hormone function
 Definition
 Impairment of endocrine gland (Diabetes caused by pancreatic infection)

 Lack of/excessive hormone
synthesis
 Impaired receptor binding
 Impaired feedback mechanisms
 Impaired cell response to
hormones
Term
General Manifestations of Altered Hormone Function
 Definition
Variable depending upon the specific
hormone and activity of the target
tissue
 Common excesses or deficits can be
detected in relation to
◦ Growth
◦ Reproductive function
◦ Metabolism and energy level
Term
Detecting Altered Hormone Function
 Definition
History and physical examination
 Laboratory: serum or urine hormone
levels and hormone suppression or
stimulation tests
 Imaging studies
 Genetic testing
Term
Treating Altered Hormone Function
 Definition
Dependent upon cause
 Hormone excesses
◦ Remove tumor secreting ectopic
hormone
◦ Remove part or all of endocrine gland
◦ Medications that block effects
 Hormone deficits
◦ Medications that stimulate release or
replace hormone
Term
Syndrome of Inappropriate ADH
 Definition
Excess production and release of ADH
 Most common cause: ectopic secretion
 ADH promotes excessive water retention
where it accumulates intracellularly and
promotes altered cell function
 Eventually sodium is diluted from
extracellular space
 Result: hypotonic hyponatremia
Term
SIADH Clinical Manifestations
 Definition
Decreased urine output (concentrated)
 Severity of symptoms dependent upon
serum sodium levels
◦ Anorexia, nausea, vomiting,
headache
◦ Irritability, disorientation, weakness
◦ Psychosis, seizures, coma
Term
SIADH Treatment
 Definition
 Remove cause
 Water restriction
 Isotonic or hypertonic IV fluid
replacement
 Pharmacologic treatment
Term
Diabetes Insipidus Pathophysiology
 Definition
 Insufficient ADH; inability to
concentrate or retain water
 Causes
◦ Insufficient ADH production
◦ Inadequate kidney response to ADH
◦ Water intoxication
Term
Diabetes Insipidus Diagnostic Criteria
 Definition
History and physical examination
 Laboratory tests
◦ Serum osmolality
◦ ADH levels
◦ Urine specific gravity
Term
Diabetes Insipidus Treatment
 Definition
Treat cause
 Hydration
 Pharmacologic treatment
Term
Hyperthyroidism Pathophysiology
 Definition
Condition of excess thyroid hormone
due to
◦ Excess stimulation of thyroid gland
◦ Excess production of TSH
 Graves disease is most common form
of hyperthyroidism in U.S.
◦ Autoimmune; IgG binds to TSH
receptors
◦ Cause unknown
Term
Hyperthyroidism Clinical Manifestations
 Definition
Goiter
 Excess metabolic rate
◦ Weight loss, tremors
◦ Agitation, palpitations, tachycardia,
weakness
◦ Heat intolerance, sweating
◦ Diarrhea
◦ Fine hair, oily skin
 Exophthalmos
Term
Graves Disease Diagnostic Criteria
 Definition
History and physical examination
 Laboratory tests
◦ TSH, T3
and T4
levels
◦ Free thyroxine level and increased
uptake of radioactive iodine by the
thyroid gland confirms diagnosis
Term
Graves Disease Treatment
 Definition
 Pharmacologic treatment
 Destruction of all or part of gland
with radioactive iodine
 Surgical removal of all or part of
gland
Term
Hypothyroidism Pathophysiology
 Definition
 Congenital or acquired deficiency of
thyroid hormone (TH) from:
◦ Deficient synthesis of TH
◦ Destruction of thyroid gland
◦ Impaired secretion of TSH or TRH
 Many potential causes such as
autoimmunity, genetic defects, injury
to gland, iodine deficiency
Term
Hypothyroidism Clinical Manifestations
 Definition
Fatigue, weakness, lethargy
 Cold intolerance
 Constipation
 Dry skin, course hair
 Impaired reproduction
 Impaired memory
 Myxedema
Term
Hypothyroidism Diagnostic Criteria
 Definition
 History and physical examination
 Laboratory studies
◦ TSH
◦ Free T4
◦ Total T3
and T4
uptake
◦ Thyroid autoantibodies
◦ Antithyroglobulin
Term
Hypothyroidism Treatment
 Definition
Lifelong thyroid hormone replacement
therapy
Term
Cushing Syndrome Pathophysiology
 Definition
 Excess glucocorticoids secreted from
adrenal cortex
 Affects metabolic function, stress response,
inflammatory and immune responses
 Causes
◦ long term administration of exogenous
glucocorticoids
◦ Tumors of pituitary, adrenals, or distant
sites (ectopic hormone secreted)
Term
Cushing Syndrome Clinical Manifestations
 Definition
Metabolic alterations; obesity of trunk,
face, and upper back
 Glucose intolerance
 Suppression of
inflammation/immunity
 Behavioral changes
 Impaired stress response
Term
Cushing Synbdrome Diagnostic Criteria
 Definition
Cortisol levels in 24-hour urine

 Imaging studies to detect tumors
Term
Cushing Syndrome Treatment
 Definition
Remove cause of excess cortisol
secretion

 Gradually taper exogenous
glucocorticoid medications

 Surgical removal of tumors,
chemotherapy, radiation
Term
Addison Disease Pathophysiology
 Definition
Autoimmune destruction of the
adrenal cortex
 Adrenal gland cannot produce
glucocorticoids, mineralocorticoids, or
androgens
 ACTH levels increase to stimulate
secretion of these hormones from the
adrenal glands
Term
Addison Disease Clinical Manifestations
 Definition
Darker pigmentation of skin (high ACTH)
 Glucocorticoid deficiency
◦ Hypoglycemia, weakness, poor stress
response, fatigue, anorexia, nausea,
vomiting, weight loss, personality
changes
 Mineralocorticoid deficiency
◦ Dehydration, hyponatremia,
hyperkalemia, hypotension, weakness,
fatigue, shock
Term
Addison Disease Diagnostic Criteria
 Definition
Darker pigmentation of skin (high ACTH)
 Glucocorticoid deficiency
◦ Hypoglycemia, weakness, poor stress
response, fatigue, anorexia, nausea,
vomiting, weight loss, personality
changes
 Mineralocorticoid deficiency
◦ Dehydration, hyponatremia,
hyperkalemia, hypotension, weakness,
fatigue, shock
Term
Addison Disease Treatment
 Definition
 Fluid replacement
 Pharmacologic treatment
 Dietary changes: increased sodium
intake due to excess sodium losses
(sweating)
Term
Ovulation - two stages
 Definition
Follicular Phase
Luteal Phase
Term
Endometrial Growth
 Definition
Proliferative Phase
Secretory Phase
Menstrual Phase
Term
Male Reproductive anatomy
 Definition
Testes
 Epididymis
 Vas Deferens
 Seminal vesicles
 Prostate
 Penis
Term
Male Sex Hormones
 Definition
 GnRH
 FSH
 LH
 Testosterone
 Inhibin
Term
Reasons for Altered Reproductive Function
 Definition
 Hormonal imbalance
 Motility impairment
 Immune problems
Term
General Manifestations of Altered Reproductive Function
 Definition
 Infertility

 Amenorrhea

 Pain
Term
Detecting Altered Reproductive Function
 Definition
History and physical examination
 Determination of ovulation
 Sperm analysis
 Laboratory hormone levels,
antibodies
 Imaging studies
 Genetic testing
Term
Treating Altered Reproductive Function
 Definition
Dependent upon cause
◦ Infection
◦ Hormone imbalance
◦ Motility problems
◦ Immune problems
 Supportive counseling and education
 Reproductive technologies
Term
Pelvic Inflammatory Disease Pathophysiology
 Definition
The result of a sexually transmitted
infection of the reproductive tract
 Inflammation and immune response
 Fallopian tubes obstructed with
purulent exudate
 Scar formation
Term
Pelvic Inflammatory Disease Clinical Manifestations
 Definition
Asymptomatic in early stages
 Pelvic and lower abdominal pain
 Purulent cervical discharge
 Cervical tenderness
 Fever
 Malaise
Term
Pelvic Inflammatory Disease Diagnostic Criteria/Treatment
 Definition
History
 Physical examination/laparoscopy
◦ Lower abdominal tenderness
◦ Adnexal tenderness
◦ Cervical motion tenderness
 Laboratory studies
◦ ESR or CRP
◦ STD screening
Treat infected patient and
partners
 Hospitalize, if high risk
Term
Polycistic Ovarian Syndrome (PCOS)
 Definition
A condition of excess androgen
production from the ovaries
 Exact cause unknown; genetic?
 Anovulation due to lack of follicular
maturation produces bilaterally
distended and cystic ovaries
 Relationship between high androgen
levels and insulin resistance
Term
PCOS Clinical Manifestations
 Definition
 Menstrual irregularities
 Hirsutism
 Acne
 Male-pattern baldness
 Obesity
 Acanthosis nigricans
Term
PCOS Diagnostic Criteria
 Definition
No definitive diagnostic test
 Hormone analysis
 Ovarian ultrasound
Term
Ovarian Cancer Pathophysiology
 Definition
Several types and variations
 BRCA-1 and BRCA-2 genes implicated
 Risk corresponds to ovarian trauma,
such as with monthly ovulation
Term
Ovarian Cancer Clinical Manifestations
 Definition
 Often absent in early stages
 Vague abdominal bloating
 Large tumors may manifest as
abdominal distention, pressure, or
pain
Term
Ovarian Cancer Diagnostic Criteria
 Definition
 History
 Physical examination
 Laparoscopic or other surgical
exploration of the peritoneal
cavity
 Cytologic examination of ovarian
epithelial cells
 Serum tumor marker levels
Term
Ovarian Cancer Treatment
 Definition
Treatment based on stage
 Surgery
 Chemotherapy
 Radiation
Term
Menopause Pathophysiology
 Definition
 Cessation of ovarian activity around
age 48-55 years
 Loss of trophic stimulation of the
hormones associated with ovarian
cycles precipitates atrophic changes in
the cells of the reproductive organs
and the symptoms commonly
associated with menopause
Term
Menopause Clinical Manifestations
 Definition
Manifestations involve the menstrual
cycle, internal and external genitalia,
sexual functioning, breasts,
vasomotor response (hot flashes),
mood, sleep, bone mineralization
 Menses cessation
Atrophic changes in estrogenstimulated tissues
◦ Breasts
◦ Skin, body hair, subcutaneous fat
◦ Reproductive organs
◦ Bladder
Term
Menopause Diagnostic Criteria
 Definition
 No single, reliable biological marker
 In the average time it takes to reach
menopause, the pituitary-stimulating
hormone FSH becomes elevated, with
a gradual decline in the ovarian
hormones estrone and estradiol
Menopause is often confirmed
through absence of menses for a 12-
month period with a corresponding
increase in FSH
 Pregnancy must be ruled out as the
cause for amenorrhea
Term
Menopause Treatment
 Definition
Hormone replacement therapy

 Treat symptoms as they arise

 General health maintenance
Term
Erectile Dysfunction
 Definition
Inability to achieve or maintain an erection
sufficient for satisfactory sexual performance
 Related to problems with one or more of the
following:
◦ Arousal
◦ Parasympathetic nervous stimulation (S2-4 level)
◦ Smooth muscle relaxation
◦ Venous occlusion
◦ Androgen activity (hypothalamus and anterior
pituitary
Term
ED Clinical Manifestations
 Definition
 Inability to achieve and maintain
erection
 Other clinical manifestations
dependent upon cause
◦Hormonal
◦Neurologic
◦ Psychologic
◦Vascular
Term
ED Diagnostic Criteria
 Definition
History and physical examination
 Serum hormone levels
◦ Testosterone
◦ LH
◦ Thyroid
◦ Prolactin
Term
ED Treatment
 Definition
Psychosocial support
 Pharmacologic treatment
 Penile implants
Term
Benign Prostate Hypertrophy
 Definition
Cause unknown; aging is largest risk
factor
 Reduced testosterone levels result in
higher proportions of estrogen and
dihydrotestosterone, which promotes
prostatic cell proliferation and growth
 Not considered a prostate cancer
precursor
Term
Benign Prostate Hypertrophy Clinical Manifestations
 Definition
 Urinary frequency
 Incontinence
 Hesitancy
 Urgency
 Retention
Term
Benign Prostate Hypertrophy Diagnotic Criteria
 Definition
Digital rectal examination
 Urodynamic testing
 Prostate-specific antigen
 Biopsy
Term
Benign Prostate Hypertrophy Treatment
 Definition
Pharmacologic

 Laser/heat-based treatments

 Surgery
Term
Prostate Cancer Pathophysiology
 Definition
Exact cause unknown, age is a major
risk factor

 More than 95% of primary prostate
cancers are classified as
adenocarcinomas
Term
Prostate Cancer Clinical Manifestations
 Definition
Often asymptomatic until
advanced
 Urinary frequency
 Hesitancy
 Incontinence
 Urgency
 Retention
Term
Prostate Cancer Diagnostic Criteria
 Definition
Digital rectal examination
 Transrectal ultrasound
 Prostate specific antigen
 Biopsy
Term
Prostate Cancer Treatment
 Definition
Surgery
 Radiation
 Chemotherapy
 Androgen-deprivation hormone
therapy
 “Watchful waiting”
Term
Testicular Cancer Pathophysiology
 Definition
Exact cause often unknown; alteration
in chromosome 12 may be implicated;
cryptorchidism a major risk factor
 Germ cell tumors
◦ Seminomas
◦ Non-seminomas
Term
Testicular Cancer Clinical Manifestations
 Definition
Small, painless, testicular mass
 Slight enlargement of testicle
 Heaviness or enlargement of scrotum
 Mild discomfort in testicle
Term
Testicular Cancer Diagnostis Criteria
 Definition
Self-testicular examination
 Tumor marker
 Direct visualization
(MRI/CT/ultrasound)
 Radical orchiectomy
Term
Testicular Cancer Treatment
 Definition
Surgery

 Radiation

 Chemotherapy
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