D027 – Advanced Pathopharmacology 2023
1. Celiac Disease
a. Lining of the small intestine, intolerant of gluten. (avoid BROW) Barley, Rye, Oat,
... [Show More] Wheat
i. More pronounced in the duodenum and jejunum.
b. Signs and Symptoms - abdominal pain/distention; diarrhea (pale, greasy, bulky, foul)
i. Malnutrition complications - rickets, occult blood, anemia (early bleeds and/or bruises)
ii. Hypomagnesemia and hypocalcemia = Irritability, tremors, convulsions, tetany, bone
pain, osteomalacia
c. Lab Value: IgA-tTg, total IgA, IgA-EMA, HLA-DQ2 or HLA-DQ8; IgG maybe too.
d. IgA is associated with Celiac disease, diagnosis via endoscopy with small intestine biopsy
2. Sjogren’s Syndrome - Dry eyes and dry mouth
a. Mostly in older women, primarily those with Rheumatoid arthritis or SLE
b. Testing: SSA+ and SSB+
3. Herbs
a. Cinnamon - ↓ blood glucose, ↓ cholesterol, ↓ hypertension, ↓ risk for bleeding
i. Adverse Effects - no breastfeeding, no DM drugs/anticoagulants/heart medications.
b. Gingko Biloba - ↓ dementia, ↓ erectile dysfunction. ↑ bleeding, ↓ seizure threshold.
c. Glucosamine - osteoarthritis
d. Green Tea - lose weight, mental clarity. can cause hepatotoxicity. may ↓ the effects of
warfarin.
i. Avoid taking with vasodilators, stimulants, and psychoactive medications.
e. Lavender - ↑ relaxation, ↓ anxiety, stress, and insomnia
i. Adverse Effects - constipation, HA, ↑ appetite. may ↓ BP (no antihtn). no
depressants
f. Saw Palmetto - used for BPH
g. Kava - used for anxiety. hepatotoxic
h. Comfrey - topical OK, PO is not
i. Ma Huang - ephedra/epherdrine. stimulant.
4. Hypoplastic Left Heart Syndrome HLHS - Birth Defect. born with OPEN foramen ovale & ductus
arteriosus, ↓developed L ventricle & ↓developed valves (mitral, aortic) (hole
between L&R atria)
a. Survival rates - 3 to 5y survival is 70% with Stage I repair, 90% survival once they hit 12m.
b. Testing: prenatal U/S and echo, after birth s&s (after ductus arteriosus & foramen ovale close).
c. Treatment: Surgery. Fetal shunts
i. Patent ductus arteriosus: shunt to pulm artery created (from aorta or R ventricle). stage
1 at <2weeks (Norwood). shunt removed at 4-6months (stage 2)
ii. patent foramen ovale: hole connecting R atrium to L atrium closed.
iii. Stage III (Fontan) at 18-36m - IVC connected to Pulm artery, hole made from the IVC
conduit attached to the right atrium.
d. S/SX - Tachypnea, SOB, ↑HR (or pounding heart), poor suckling/feeding, poor
extremities (cold and cyanotic), weakness, clammy skin
e. Medications - tube feedings, meds to strengthen heart muscles, ↓ blood pressure, diuretics
5. Parathyroid - Secretes/regulates serum Ca. ↑ PTH hormone released = ↑ ca released from the
bones into the bloodstream, ↓ density/hardness. Maintain low/normal Ca level.
a. Hyperparathyroidism S/S - Low PTH (because excess was released into the blood) causes
osteoporosis, kidney stones, ↑ urination, abdominal pain, fatigue, forgetfulness, bone/joint
pain
i. Calcimimetics, to help bones retain calcium, bisphosphonates to slow/prevent bone loss
1
b. Hypoparathyroidism: High PTH (because not released into the bloodstream), low T3/T4,
paresthesia, muscle cramps, mood changes, dry/rough skin, twitching facial muscles
c. Tests - U/S, Bone densitometry, body CT/MRI; Lab Values - Ca (8.6-10.3), PTH: 11-51
6. Hutchinson-Gilford Progeria Syndrome - genetic. rapid aging (10xs faster), no cure, appears by age
2, live to 13 on average (up to 20)
a. LMNA gene protein mutation (protein-progerin). Causing cells to die prematurely.
b. Signs and Symptoms - Slow growth (height, hair), alopecia, joint abnormalities, wrinkles, dry
skin, FTT, delayed tooth development.
c. Treatment - NSAIDs, Statins, Bone health meds. OT/PT
7. Diabetic Neuropathy Treatments - Gabapentin/Neurontin, Duloxetine/Cymbalta, Pregabalin/Lyrica,
8. Hydrotherapy - Used for multiple sclerosis (MS) and Myasthenia Gravis (MG)
9. Pneumothorax vs hemothorax – both decreased or absent lung sounds.
a. Patient with Post MVA, with right side decreased lung sounds? PNEUMOTHORAX
i. PNUEMOTHORAX (air between lungs and chest cavity) ↑ percussion
ii. HEMOTHROAX (blood btwn lungs and chest cavity) ↓ percussion.
iii. Tension Pneumothorax- mediastinal shift, decrease Cardiac output, increase HR
b. Tx: chest tube Thoracostomy
10. Tuberculosis
a. Testing - PPD Tuberculin skin test: forearm. in 48-72h, >15mm induration is positive.
i. >5mm for immunocompromised, >10mm for high risk/from countries with TB - prison,
nursing homes, etc.
ii. Chest Xray or CT scan - White spots in lungs. Immune system walls off TB.
b. Medications - Isoniazid, Rifampin (avoid oral contraceptives), Ethambutol, Pyrazinamide
i. If BCG vax given for TB - PPD expected to be >10mm but not positive
11.Thyroid labs - TSH: .5 - 5 (with treatment 0.5 to 4), T3: 80-220, T4: 5-12
a. Thyroid peroxidase antibodies (TPO)
1. Hashimoto disease – ↑TSH. hypothyroidism. High thyroglobulin (Tg)/TPO.
a. initially high T3, then low T3
2. Graves’ disease – autoimmune. hyperthyroidism.
b. Hyperthyroidism - Low TSH, High T4/T3
i. s/s - (thyrotoxicosis), ↑HR/dysrhythmia/angina, Stimulated CNS – nervousness,
insomnia, rapid thought flow, rapid speech; weakness/atrophy; ↑ metabolic
rate/appetite; Warm/moist skin, Intolerant to heat/↑ body temperature;
ii. treatment - Propylthiouracil (PTU) and Methimazole (Papazole), iodine, BB’s
c. Hypothyroidism - High TSH, Low T3/T4
i. s/s - Pale, puffy, expressionless face; Cold/dry skin; brittle hair/hair loss; ↓ HR/ temp;
Lethargy, fatigue, cold intolerance
ii. treatment - Levothyroxine (Synthroid)
d. Thyroid storm- death<48hr from internal stress *post thyroid surgery, High T4 T3 levels from
stress S&S *Atrial tachy dysrhythmias
12.Crohn’s (worse after meals) vs Ulcerative Colitis
a. Crohn’s - Inflammation/scarring of all digestive tract. generally just small intestines.
i. Patients with atopic dermatitis/eczema are ↑ risk of inflammatory bowel
disease.
ii. S/S - Skip lesions (cobblestones), intestinal bleeding/diarrhea/cramping, fistula,
fissure, ileus, mouth ulcers; worse after eating c pain by navel or ↓ R
abdomen. Malabsorption (anemia)
iii. Tests
1. ASCA protein, CBC, H/H, occult blood for bleeding. CRP, ESR inflammation;
Electrolytes if diarrhea chronic; Iron, B12 absorption [Show Less]