Colon Cancer: risk factors, S&S
Risk factors: age (MC in 60s and 70s), obesity, diet (low fiber diet, low in fruits and veggies, high red meat and animal fat), smoking, physical inactivity
Family history: familial adenomatous polyps (caused by mutation in APC gene, near 100% risk of dev
Process of bilirubin
bilirubin is an excretion product and body does not control levels, levels (0.3-1.2mg/dl) reflect the balance between production and excretion thus there is no "normal" level of bilirubin, broken down by UV light, if bile ducts are obstructed direct bilir
Jaundice: general
clinical jaundice occurs with bilirubin level > 2-3 mg/dl, classic presentation is yellow skin and sclera, causes: overproduction of bilirubin, defective hepatic bilirubin uptake, defective conjugation, defective excretion
RBC's are the major source of bi
Jaundice: types
pre-hepatic: an increased rate of hemolysis (breakdown of RBC's), urine has no bilirubin present, serum has increased unconjugated bilirubin
Hepatic: causes include acute hepatitis, hepatotoxcity, and alcoholic liver disease, bilirubin present in urine, u
Viral Hepatitis: clinical presentation, lab, diagnosis
Clinical: asymptomatic, malaise and weakness, nausea and anorexia, jaundice (conjugated bilirubin) which can cause dark urine
Lab: elevated levels of ALT and AST (ALT>AST in viral hepatitis)
Diagnosis: serology
Acute vs chronic viral hepatitis
Acute:
definition: signs and symptoms < 6 mos, caused by any of the hep viruses
Pathology: lobular disarry, hepatocyte swelling (balloon cells), apoptoic death of a single liver cell (councilman's bodies), choleastasis (post-hepatic or obstructive jaundic
HepA
transmission: fecal-oral
severity: mild
chronicity: no
Clinical association: traveler's hep, IV drug user, homosexuals
Clinical: acute hep
Lab diagnosis: sypmtoms, anti-HAV IgM
Prevention: vaccine, hygeine
HepB
transmission: parentral, sexual
severity: occasionally severe
chronicity: yes
Clinical association:
Clinical: acute hepatitis, cirrhosis, hepatocellular cardinoma
Lab diagnosis: symptoms, serum levels of HBsAg, DBcAg, and anti-HBc IgM
Prevention: vaccine
HepC
transmission: parentral, sexual
severity: usually subclinical
chronicity: yes
Clinical association: most common cause of post-transfusion hep, common in alcoholic liver disease
Clinical: acute and chronic hep, cirrhosis, HCC
Lab diagnosis: symptoms, anti-
HepD
transmission: parentral, sexual
severity: Co-infection with HBV, occasionally severe, super-infection with HBV often severe
chronicity: yes
Clinical association: IV drug abuse, homosexuals
Clinical: acute and chronic hep, cirrhosis
Lab diagnosis: anti-HDV
HepE
transmission: fecal-oral
severity: normal patients=mild, pregs=severe
chronicity: no
Clinical association: poor prognosis in pregs
Clinical: acute
Lab diagnosis:IgM, anti-HEV, and IgG anti HEV
Prevention: hygeine
Alcoholic hepatitis
acute illness usually following a heavy drinking binge
clinically variable: no symptoms, RUQ pain, hepatomegaly, jaundice, malaise, and anorexia, fulminant liver failure, AST/ALT ratio is >1.5
Pathology: hepatoctye swelling (ballooning) and necrosis, Mall
Alcoholic cirrhosis
develops in 15% of alcoholics, micronodular cirrhosis, most common disease requiring liver transplantation in adults
Cirrhosis: definition and etiology
def: end stage liver disease characterized by disruption of the liver architecture by bands of fibrosis that divide the liver into nodules of regenerating liver parenchyma
Etiology: alcohol (MC in USA), chronic viral hep (HBV), biliary tract disease, hemo
Cirrhosis: histology, mechanisms
histology: micronodular (nodules < 3mm), macronodular (nodules > 3mm), mixed, at the end stages mixed pattern usually present and etiology may not be distinguished based on appearance
Mechanism: fibrosis (formation of scar tissue) is produced by the liver
Cirrhosis: S&S due to portal HTN
liver size: can be enlarged, normal, or shrunken
splenomegaly: due to congestion of the red pulp as a result of portal HTN
acites: accumulation of fluid in the perioneal cavity giving rise to flank dullness
caput medusa: crazy umbilical veins
fetor hepati
Cirrhosis: S&S due to increased sex hormones
spider angioma: lesions of smaller vessels due to an increase in estrogen levels
palmar erythema: redness of palms due to altered sex hormone metabolism
gynocomastia
hypgonadism: manifested as impotence, infertility, decreased libido, and testicular atrop
Cirrhosis: S&S due to decrease synthesis
hypoalbuminemia and edema: due to decreased synthesis of albumin or globulin
bleeding diathesis due to decreased synthesis of clotting factors and thrombocytopenia
infection due to dysfunction of immune system caused by decreased synthesis of complements
Cirrhosis: S&S due to decreased detoxification
jaundice: cell necrosis reduces the liver's ability to metabolize and excrete bilirubin leading to buildup in the blood
Hepatic encephalopathy: abnormal metabolism leads to increased toxins like ammonia which causes damage to brain cells and changed level
Cirrhosis: S&S/other manifestation and consequences
other manifestations: jaundice, itching due to bile products deposited in the skin, asterixis, clubbing of nails, weakness, fatigue, anorexia, weight loss
Other consequences: hepatorenal syndrome (acute renal failure without visible gross or microscopic a
Cirrhosis: diagnosis
Lab findings: AST and ALT elevated with AST>ALT, alkaline phosphatase usually slightly elevated, bilirubin may elevate as cirrhosis progresses, decreased albumin, increased PTT and PT due to decreased production of clotting factors, hyponatremia (due to i
Cirrhosis: treatment and prognosis
usually progressive, formation of scar tissue remains indefinitely, no cure, poor prognosis, liver transplantation
Gallstones: def and types
def: collections of solid crystals in the gallbladder or in the bile ducts, cholelithiasis is when stones are in the gallbladder and choledocholithiasis is when stones are in the bile ducts
3 types of stones:
cholesterol stone (80%, mostly cholesterol mon
Gallstones: presentation and dx
clinical presentation: often silent and asymptomatic, develop symptoms when stones reach a certain size, fatty food intolerance, gallstone "attack": biliary colic presents with RUQ pain due to impacted stones, N&V may occur
Dx: ultrasound is gold standard
Gallstones: complications, treatment
complications: cholecystitis (acute RUQ pain within 15-30 minutes of eating), pancreatitis, cholangitis (bacterial infection of the biliary tract), choledocholithiasis (gallstones in the common bile duct, causes jaundice and liver cell damage, medical eme
Acute pancreatitis: def, etiology, mechanism, patho, presentation
def: acute inflammation of pancreas
etiology: gallstones (MC), alcohol, hypercalcemia, drugs (diuretics such as furosemide, AIDS drugs), shock, infections, trauma, scorpion stings
Mechanism: cell injury results in activation enzymes and enzymatic descruct
acute pancreatitis: lab test, dx, tx, complications, prognosis
lab: increased serum amylase and lipase
Dx: S&S, history of gallstones, gallbladder diease or alcohol consumption, lab findings, CT scans
Tx: analgesics (mild), hospitalization (moderate to severe)
Complications: local (pseudocyst) or systemic (hypovolemi
pancreatic carcinoma
epidemiology: 4th most common cause of cancer death amongst both men and women in the US, incidence is increasing, most common between ages 60-80, risk factors include smoking, diets high in meat, obesity, DM, chronic pancreatitis,
Presentation: vague sig
dominant hemisphere of brain
left side is dominant in most people (95% of the right-handed and more than 50% of left handed people), responsible for production and comprehension of language, mathematical ability, and the ability to problem solve in sequential, logical fashion, both m
Non-dominant hemisphere of brain
right side is non-dominant for most people
responsible for musical ability, recognition of faces and tasks requiring comprehension of spatial relationships
Performs better at understanding humor, emotion, and metaphor
Frontal lobe
executive functions"
cognition and memory
prefrontal area has the ability to concentrate and conducts elaboration of thought, the gatekeeper for judgement and inhibition, personality and emotional traits reside here
movement: motor cortex controls volunt
Parietal lobe
receives and evaluates most sensory information (temperature, pain, touch, and pressure involving the skin) excluding smell, hearing, and vision
Temporal lobe
primary auditory cortex": receives auditory input, visual formation, involved in aspects of memory and learning and the comprehension of language
Wernicke's area plays a critical role in the ability to understand and produce meaningful speech, damage to
Occipital lobe
primary visual cortex", receives visual input
damage to the occipital lobe can result in cortical blindness
Limbic system
includes structures in the human brain involved in emotion, motivation, and emotional association with memory (emotional memory)
Particularly involved in aggressive, submissive, and sexual behavior with pleasure, memory, and learning
Includes: hippocampus
hippocampus
turns short-term into long-term memory
sensory stimulation goes to hippocampus and then cortex
critical decision making regarding importance of sensation
if destroyed, results in the inability to form new memories of facts and events (eg chronic alcoholis
amygdala
generates emotions from perceptions and thoughts, links fear and sense to memories, patterns social behavior appropriate to situation
stimulation causes rage, jealousy, fight or flight response, anxiety response
removal causes placidity
Hypothalamus
major control center for for the pituitary gland, for maintaining homeostasis
regulates autonomic nervous, endocrine, emotional and somatic functions eg cardiovascular regulation, body temp, body water, sexual activity, GI and feeding (satiety center), re
Five stages of sleep
Stage 1: 5%, light sleep
Stage 2: 45%, deeper sleep
Stage 3-4: 25% deepest sleep, sleep walking and night tremors happen in this stage
REM: 25%, dreaming, loss of motor tone, possibility a memory processing function, erection, increased brain O2 use
Brain function in REM sleep
Serotonergic neurons of raphe nucleus key to initiating sleep
ACh: higher during REM sleep, associated with inducing it
NE: lower during REM, associated with reducing REM sleep
Dopamine produces arousal and wakefulness, rises with waking
Serotonin interru
NE
ALTERED IN MOOD AND ANXIETY DISORDERS
located in the brain stem, can be excitatory or inhibitory, role in stress, attention, vigilance, mood, activated pleasure center in hypothalamus, altered in mood and anxiety disorders
Dopamine
PARKINSON'S AND SCHIZOPHRENIA
located mostly in brain stem, in limibic system it regulates emotions and pleasure, in frontal cortex it is associated with insight, judgement, problem solving, in the hypothalamus it is involved with circadian rhythms and en
Serotonin
SCHIZOPHRENIA, AD, MOOD AND ANXIETY
located in cell bodies of raphe nuclei of brain stem, generally inhibitory, role in arousal and activity of sleep, temp, and pain, mood, altered in Scheizophrenia, mood, anxiety and Alzheimer's disease
Glutamate
SCHIZOPHRENIA AND HUNTINGTON'S
found in cells of body, major exitatory NT in the CNS, altered in anxiety, Schizophrenia and Huntington's disease
GABA
ANXIETY
most neurons of the CNS have receptors, major inhibitory NT, altered in anxiety, drugs that increase GABA function such as benzos are used to treat epilepsy
Acetylocholine
DECREASED IN ALZHEIMER'S
located in the brain and spinal cord, can be excitatory and inhibitory, role in sleep-wakefulness, memory and cognition, decreased in Alzheimer's
Schizophrenia: def and epidemiology
Def: group of psychotic disorders characterized by disturbances in perception, behavior and communication that last longer than 6 months
Epidemiology: more often in males than females, blacks > whites, onset in late adolescence or early adulthood, with ma
Cause of schizophrenia
exact causes not known, genetic and environmental factors are involved
Genetics: risk in biological relatives 10 times greater than general population
Environmental: stressful life, poverty, discrimination
genetic factors outweigh non-genetic factors
Schizo: brain structure and development
abnormalities in prefrontal cortex, hippocampus, thalamus, and related limbic structures are through to be involved in developing schizophrenia, brain imagining in chronic schizophrenia show cortical atrophy with enlargement of cerebral ventricles, PET sc
Positive symptoms of schizophrenia
what patients have that normal people do not, eg delusions, hallucinations, bizarre behavior, associated with dopamine receptors
Negative symptoms of schizo
what normal people have that patients do not, inculding flat affect, motor retardation, apathy, mutism, anhedonia (can't experience or even imagine any pleasant emotion), low energy, lack of interest in life, low motivation, alogia (difficulty or inabilit
S&S of schizo
psychotic symptoms: delusions (irrational beliefs), illusions (misperception of real external stimuli), hallucinations (most common)
cognitive impairment (disordered thinking): disorganized thinking, slow thinking, difficulty understanding, poor concentra
Diagnosis of schizophrenia
A) two or more of the following, each present for a significant portion of time during a one month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, "negative" symptoms
B) social/occupational dysfunction
C
Schizophreniform
same symptoms as schizo, but lasts <6 mos
Schizoaffective disorder
concurrent symptoms of schizo and depression or mania
Brief psychotic disorder
presence of delusions, hallucinations or disorganized speech and behavior, symptoms last 1-30 days, return to full former functioning, not a cultural response pattern, not due to substance abuse or organic cause
Delusional disorder
psychotic mental illness that involves holding one or more non-bizarre delusions (have certain plausibility, often quite logical) for at least one month in the absence of other symptoms of schizo
Drug induced pscyhosis
certain chemical substances such as amphetamines, cocaine, PCP can induce psychosis, prescription medications such as certain antibiotics, cardiovascular drugs, and anticholinergics can also induce
Major depression: def, causes, prevelence, neurochemical changes
aka unipolar disorder
definition: severely depressed mood characterized by loss of interest in typical activities, self-deprication, inability to concentrate
Causes: exact cause is unknown
Prevelence: more common in women, onset has a mean of 20yoa
Neuroc
Major depression: diagnosis
A) symptoms include 5 or more of the following: depressed mood most of the day, markedly diminished interest or pleasure in all or almost all activities for more of the day, change in appetite or weight, change in sleep (hypersomnia or insomnia), decrease
Major depression: treatment
SSRI are first line therapy, normally takes 2-3 weeks for antidepressents to have effect
MAOIs: decreased degradation of NE and serotonin
TCA: oldest drug, block reuptake of NE and serotonin
Psychotherapy
ECT may be used when chemical treatment fails
hypomaniac episodes
episode of manic symptoms that does not meet all of the criteria for a manic episode, distinguished from mania by the absence of psychotic symptoms and by lower degree of impact on functioning
dysthymic disorder
mild form of major depression, depressed mood or loss of pleasure, chronic (>2 years), not severe enough for hospitalization, 30-50% of alcoholics have this
cyclothymic disorder
mild form of bipolar, chronic, alternating states, often unrecognized by person
If alternates within 48-72 hrs it is called "rapid cycling bipolar disorder
Seasonal affective disorder
depressive symptoms during winter months, caused by abnormal melatonin metabolism, treatment is phototherapy, symptoms include increased sleep, increased appetite, decreased energy
Postpartum blues
mild and transitory form of moodiness suffered by up to 80% of postpartum women, considered a normal part of early motherhood, symptoms typically last from a few hours to several days and include tearfulness, irritability, hypochondirasis, sleeplessness,
postpartum depression
depressive episodes with onset occurring one month postpartum
postpartum psychosis
severely depressed women after childbirth, characterized by hallucinations or delusions and severe anxiety
Bipolar disorder
disorder that causes unusual shifts in a person's mood, energy, and ability to function, symptoms of major depression plus symptoms of mania (period of abnormal and persistent elevated, expansive, or irritable mood), alternates between depression and mani
Maniac symptoms, neuro changes, sleep changes
maniac: increased self esteem or grandiosity, low frustration tolerance, decreased need for sleep, flight of ideas, excessive involvement in activities, weight loss/anorexia, erratic or uninhibited behavior, increased libido
Neurochemical changes: increas
Bipolar treatment
lithium is the drug of choice, reduces the formation of NE and serotonin which are transmitters for the limbic system (side effect: nephrogenic diabetes insipidus), many individuals are able to live full and satisfying live with treatment
Overview of anxiety disorders
the most common psychiatric disorders in women of all ages
fear and anxiety are ubiquitous emotions, fear is a normal reaction to a known, environmental source of danger, anxiety causes an individual to experience apprehension but the source of the danger
Anxiety disorders: NT, anatomy
NT: major NT's associated with anxiety include decreased GABA activity, increased NE activity, decreased serotonin
Anatomy: locus ceruleus and raphe nuclei are ares of brain likely to be involved in anxiety disorders, limib system which received informati
Panic disorder
identified by episodic periods of intense anxiety that occur suddenly and usually last about 30 minutes without clear circumscribed stimulus
three attacks in 3-week period, abrupt onset of symptoms, peak within 10 minutes
epidemiology: mean age of onset i
Panic disorder: treatment
Benzos (alprazolam, clonazepam), TCA, SSRI, CO2 for hyperventilation
Phobias
persistent or irrational fear of objects, social or environmental situations because of the fear the object or situation is avoided, phobias more common in women than men
Public speaking is most common phobia
specific phobias: fear of specific object, anx
phobias: treatment
discrete performance anxiety (stage fright) is the most common phobia and is treated with atenolo or propranolol (BB) or paroxetine (SSRI)
Patients with phobias often have secondary morbidity like employment impairment, school dropout, etc
OCD
characterized by obsessions (focusing on one thought, usually to avoid another) and compulsions (repetitive action shields person from thoughts, action "fixes" bad thought)
found equally in males and females, major depression among 2/3rds over lifetime
Et
Generalized anxiety disorder
persistent anxiety lasting at least 6 months with tension, sympathetic, and parasympathetic symptoms and insomnia
develops more frequently in women and during 30's
symptoms of anxiety are unrelated to a specific person or situation, is closely associated
Post traumatic stress disorder
people how have had a severe physiological of psychological trauma are at risk for PTSD, symptoms must be exhibited for more than 1 month, if less it is diagnosed as acute stress disorder
Manifestations: re-experiencing the even, avoidance of associated s
Alzheimer's Disease: def and etiology
def: progressive, neurodegenerative disease characterized by loss of function and death of nerve cells in several areas of the brain leading to dementia in patient
Etiology: no cause is know by associations have been made with reduces ACh in the brain esp
Pathological findings in AD
Neuritis/senile plaques: one of the hallmark signs, accumulation of amyloid plaques between neurons in the brain, fragments of beta amyloid, which are normally eliminated by the body, accumulated and form hard, insoluble plaques
Neurofibrillary tangles: i
10 warning signs of Alzheimer's diease
1) misplacing things
2) abstract thinking
3) trouble performing familiar tasks
4) changes in personality and behavior
5) poor or decreased judgement
6) inability to follow directions
7) problems with language and communication
8) impaired visual and spati
Multi-infarction dementia
aka vascular dementia related to cerebral atherosclerosis
clinical manifestations: sudden onset, intermittent signs of dementia and motor deficits
Second most common form of dementia
Diffuse Lewy body disease
aka dementia with Lewy bodies with an unknown cause
clinical manifestations: lewy bodies with neurons of substantia nigra, basalis of meynert and limbic cortex, memory loss, parkinsonism, and visual hallucinations
Exhibits clinical overlap between AD and
Pick's disease
frontotemporal lobar degeneration, AR, clinically resembles AD, pick's bodies seen, marked cortical atrophy in the frontal and temporal lobes, onset 50-60 years of age, more common in women
Personality problems more common with pick's disease, memory prob