NUR 2063 Pathophysiology Final Exam 2 2024

What is gastritis? - ANSWERSInflammation of the stomach lining. The lining will be red and inflamed and irritated What are the causes of gastritis? - ANSWERSIngestion of irritating substances such a alcohol, aspirin, NSAIDS, viruses and bacteria What is GERD? - ANSWERSthe back flow of gastric contents into the esophagus through the lower esophageal sphincter. The inflammation occurs from the reflex of highly acidic stomach acid that comes up. What are the causes of GERD? - ANSWERSAny condition or agent that alters closure of the lower esophageal sphincter or increases in abdominal pressure, fatty food, caffeine, large amounts of alcohol, smoking, pregnancy and anatomical features like hiatal hernia What are complications of GERD? - ANSWERSBarrett's esophagus where columnar tissue replaces normal squamous tissue in the distal esophagus that carries a high risk for cancer. Progression can lead to ulcers and scarring. Esophageal strictures, pulmonary symptoms such as cough, asthma and laryngitis from reflux in breathing passages. What are the signs and symptoms of peptic ulcer disease? - ANSWERSepigastric burning pain that is usually relieved by food or antacids (gastric ulcers present on empty stomach but can be after food, duodenal ulcers present 2-3 hours after food and is relieved by food). Can also be life threatening as GI bleeding can occur without warning and cause a drop in H/H and dark tarry stools and hematemesis. What is the role of H.pylori in peptic ulcer disease? - ANSWERSpromotes both gastric and duodenal ulcer formation and thrives in acidic areas. It slows down ulcer healing and can reoccur frequently, and taking it away can help ulcers heal. What is pseudomembranous colitis?(C.diff) - ANSWERSacute inflammation and necrosis of large intestine. The intestinal lining cannot absorb well. What is the cause of pseudomembranous colitis? - ANSWERSclostridium difficile, exposure to long term antibiotics that off set the and balance in intestine What are the manifestations of pseudomembranous colitis? - ANSWERSfoul smelling/bloody stool, abdominal pain, fever, leukocytosis, sepsis, colonic perforation. How do we treat pseudomembranous colitis? - ANSWERSstop current antibiotics, treat ischemia and contributing conditions, give oral antibiotics like metronidazole or vancomycin, fecal transplant or colectomy if severe How do we prevent the spread of pseudomembranous colitis? - ANSWERSwearing appropriate PPE and washing hands with soap and water only What are the signs and symptoms of appendicitis? - ANSWERSPeriumbilical pain, RLQ pain, presence of a positive McBurneys point with pain, nausea, vomiting, fever, diarrhea, RLQ tenderness, systemic signs of infection How do we assess for appendicitis? - ANSWERSMcBurney's point technique when pressing on the belly button and RLQ hip region and removing the pressure causes intense pain, indicates positive appendicitis What are the causes of bowel obstructions? - ANSWERSprevious surgery of the intestines with adhesions, congenital abnormalities of the bowel, metastatic cancer of the intestinal tract or female reproductive organs, accumulation of fluid, gas, water and electrolytes in the bowel. What is a functional bowel obstruction? - ANSWERSa problem with the act of the bowel actually moving, such as things that inhibit movement from surgery, medications, opioids, low fiber diets that can slow motility or shut off the GI system from the SNS stimulation. What is a mechanical bowel obstruction? - ANSWERSdue to adhesions, hernia, tumors, impacted feces, volvus or twisting of the intestines, intussusception What are the signs and symptoms of liver disease? - ANSWERShepatocellular failure (jaundice, decreased clotting, hypoalbuminemia, decreased vitamin D and K) and portal hypertension (GI congestion due to blockage of blood, more esophageal or gastric varies, hemorrhoids, enlarged spleen,) Explain what jaundice is? - ANSWERSgreen- yellow staining of tissues from increased level of bilirubin as the liver cannot metabolize extra bilirubin Where can you find jaundice on assessment? - ANSWERSeyes, skin, and mouth Explain what ascites is? - ANSWERSpathological accumulation of fluid in the peritoneal cavity due to the loss of albumin in the liver, causing fluid to be free amongst the cells. It can cause a lot of pain in the abdomen, and it must be drained with a parenthesis Explain hepatic encephalopathy? - ANSWERSneuropsychiatric syndrome from too much ammonia in the blood as the liver cannot break it down. results in dementia and psychotic symptoms common along with jerking What is another name for end stage liver disease? - ANSWERScirrhosis What are the signs and symptoms of gallstones? - ANSWERSsudden pain in the RUQ/ center of the abdomen, back pain, and nauseas and vomiting. Why do gallstones occur? - ANSWERSdue to often a blockage of a duct from a cholesterol filled stone What are the three stages of gallstone formation? - ANSWERSsupersaturation, nucleation, hypo motility Explain supersaturation phase - ANSWERSbile is saturated with cholesterol, causing precipitation of cholesterol Explain nucleation phase - ANSWERSthe bile crystals begin to stick together and become larger stones Explain hypo motility phase - ANSWERSthe bile is stasis allowing the stones to grow more What are some of the risk factors for gallstones? - ANSWERSprolonged fasting, rapid weight loss, pregnancy, estrogen, obesity What are the signs and symptoms of pancreatitis? - ANSWERSsteady and dull pain in the center or LUQ of abdomen, severe tenderness on palpation that radiates to the back, nausea and vomiting, abdominal distention with hypoactive bowel sounds, low grade fevers What are the causes of pancreatitis? - ANSWERSalcoholism is most causes, biliary tract disease where the enzymes attack the pancreas, hypertriglyceridemia What are the three function of the kidneys - ANSWERSexcretion, elimination, regulation Explain what excretion is? - ANSWERSremoval of organic waste products from body fluids Explain what elimination is? - ANSWERSdischarge of the waste products from the body Explain what regulation is? - ANSWERSregulating blood volume, ion concentration, blood pH and nutrients What are signs and symptoms indicating one may have a renal disorder? - ANSWERSpain in the back flank area that is felt at the CVA angle on percussion, tenderness, abnormal urinalysis findings What types of things are abnormal regarding urinalysis? - ANSWERSdark, strong smelling urine, bacteria in the urine, cloudy urine, ketones or glucose or proteins in the urine, blood in the urine (except during menses) What is polycystic kidney disease? - ANSWERSan inherited condition of the kidney resulting in one having fluid filled cysts on one or both kidneys. if left untreated renal failure with need for dialysis or kidney transplant occurring What causes polycystic kidney disease? - ANSWERSit is inherited genetically What are the types of polycystic kidney disease? - ANSWERSautosomal recessive and dominant What is a nephron(s)? - ANSWERSthey are in the kidney and helps to filter blood and remove waste products How many nephrons do the kidneys have? - ANSWERS1-2 million What is hematuria? - ANSWERSblood found in the urine not due to menstruation What is proteinuria? - ANSWERSprotein found in the urine What does it mean when one has ketones in their urine? - ANSWERSthey have type 1 diabetes What is nephrolithiasis? - ANSWERSkidney stones that obstruct the ureters and kidneys that cause lots of pained urinary stasis What is another term for kidney stones? - ANSWERSrenal calculi What are kidney stones made up of? - ANSWERScalcium deposits and uric acid What is pyelonephritis? - ANSWERSinfected and inflamed kidneys What causes pyelonephritis? - ANSWERS from the lower urinary tract that ascends What are the signs and symptoms of pyelonephritis? - ANSWERSCVA tenderness most common, fever, chills, N/V, anorexia or not willing to eat What can we do the prevent pyelonephritis? - ANSWERSremove catheters are early as possible to prevent UTIs and possible spread What are the signs and symptoms of post infectious acute glomerulonephritis? - ANSWERSSmoky or coffee colored urine, proteinuria, edema as they cannot urinate, decreased output What is the cause of post infectious acute glomerulonephritis? - ANSWERStype b hemolytic strep; follows impetigo and strep throat What age group is most affected by post infectious acute glomerulonephritis? - ANSWERSchildren in developing countries What are the signs and symptoms of acute kidney injury? - ANSWERSSudden reduction in kidney function, decreased urine output, although occasionally urine output remains normal Fluid retention, causing swelling in your legs, ankles or feet Shortness of breath Fatigue Confusion Nausea Weakness Irregular heartbeat Chest pain or pressure Seizures or coma in severe cases What are the 3 stages of causes of acute kidney injury - ANSWERSpre renal, intrarenal or intrinsic, post renal What are the pre renal causes of AKI? - ANSWERSdisruption in renal perfusion and blood flow. It can cause low blood pressure, low blood volume, heart failure, renal artery obstruction, fever, vomiting, diarrhea, burns that lead to dehydration, Drugs such as ACE inhibitors or angiotensin 2 blockers, NSAIDs that can drop the blood pressure or cause bleeding What are the intrarenal/intrinsic causes of AKI? - ANSWERSdamage or disruptions within the kidney blood vessels, tubules, or glomeruli. It can cause reduced blood supply within the kidneys, toxic injury with medications, chemo, and contrast medias, renal inflammation, or prolonged prostate/ stones/ in the post renal stage What are the post renal causes of AKI? - ANSWERScaused by an obstruction in the urinary collecting system, urethra, bladder, or ureters due to stone, tumor, or enlarged prostate that results in elevated pressure in the Bowman's capsule that impedes glomerular filtration. Prolonged injury can lead to intrinsic injury and irreversible damage What are the 3 stages of AKI presentation? - ANSWERSprodromal, oliguric, postoliguric Explain what happens during prodromal presentation of AKI - ANSWERSnormal or declining urine output, The BUN and creatinine levels rise, showing there is a problem. Duration of this phase depends on cause of injury, amount of toxin, duration of hypotension Explain what happens during oliguric presentation of AKI - ANSWERSlasts up to 8 weeks with usual urine output being 50ml-400 mls, when normal output is 30 ml per hour. Characterized by oliguria, lower GFR, and hypovolemia. S/S of fluid excess, hyperkalemia, uremic syndrome. Dialysis may be needed. Explain what happens during postoliguric presentation of AKI - ANSWERSUrine volume increases, leaving patient at risk for dehydration and electrolyte imbalances they are ridding themselves of too much fluids. Higher GFR, and can last 1 week-1 year. Full recovery when BUN and creatinine levels are normal, but renal insufficiency may occur. (early recovery of the condition, but not all recover) What happens if AKI does not resolve? - ANSWERSchronic kidney disease What are the causes of chronic kidney disease? - ANSWERSoutcome of progressive and irrevocable loss of the nephrons, associated with hypertension, diabetes, recurrent pyelonephritis, glomerulonephritis, polycystic kidney dise