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Patho III final

GI, Neuro

QuestionAnswer
Cancer of the lower intestinal tract (colorectal cancer) is the second most frequent cause of death in the USA for both men and women (____% of all cancer deaths) 10-15
_____ are closely associated with development of cancer. Colorectal polyps
Most colorectal cancers are moderately differentiated ____ with a long preinvasive phase and a tendency to grow slowly. adenocarcinomas
On the right colon, ___ lesions along one wall of the cecum and ascending colon show pain, a palpable mass in the lower right quadrant, anemia, and dark red or mahogany blood mixed with stool polypoid
Tumors of the left colon start as a small, elevated, button-like mass which grow ____ and spread along the entire bowel wall eventually ulcerating in the middle as the tumor penetrates the blood supply. circumferentially
systemic lmyphatic spread occurs along the aorta to mesenteric and pancreatic lymph nodes and ___ follows invasion of the mesenteric veins (left colon) or superior veins (right colon) which drain into the portal circ. liver metastasis
rectal carcinomas are defined as tumors occurring _____-, which can spread through the rectal wall to nearby structures up to 15cm from the anal opening
a diet rich in ____, ___, ___ and ___ and low in ___ can modify cancer risk vegetables, grains, fruit, calcium, fat
The staging of colorectal cancer involves: preoperative testing and operative exploration
Stage A of the Dukes classification staging of colorectal cancer: cancer limited to the bowel wall
Stage B of the Dukes classification staging of colorectal cancer: cancer extending through the intestinal wall
Stage C of the Dukes classification staging of colorectal cancer: nodal metastases regardless of extension into bowel wall
Stage D of the Dukes classification staging of colorectal cancer: distant metastases regardless of primary size
Treatment for cancer of the colon is always____. surgical
resection and anastomosis can be performed for cancer of the ___, ___, ___ or ____ colon and upper rectum ascending transverse descending, sigmoid
____ is often given before surger to shrink the tumor and or alter the malignat cells so they will not survive after surgery Radiation therapy
____ is used to reat metastic disease and c Chemotherapy
____ and ____ are the most common disorders of the gallbladder obstruction , inflammation
Obstruction of the gallbladder is caused by ___. gallstones (cholelithiasis)
____ stones of the gallbladder are the most common and risk factors included obesity, middle age, female gender, american indian, and gallbladder, pancreatic, or ideal disease cholesterol
____ stones, which are common, occur later in life and are associated with cirrhosis pigmented
___ and ___ are the cardinal manifestations of cholelithiasis abdominal pain and icterus
vague symptoms include heartburn, flatulence, epigastric discomfort, and food intolerances, particularly to ___ and ____. fats and cabbage
icterus indicates that the stone is located in the _____. common bile duct
abdominal tenderness and fever indicate___. cholecystitis
___ or ___ can confirm a diagnosis of cholecystitis cholangiography or radioactive scan
is a rare disease which incidenc in the USA and Europe i s less than 1% of new cancers per year carcinoma of the esophagus
The clinical manifestations of esophageal carcinoma are chest pain and dysphagia
cancer of the ____ represents about 2% of all new cancer cases in the USA annually,more in men, but in countries such as Japan Stomach
is radiation therapy normally successful in gastric cancer? no
hepatocellular carcinoma can be ___, ___, ___ nodular, massive, diffuse
A sudden explosive disodrderly discharge of cerebral neurons characterized by a sudden transietn alteration in brain function, usually involving motor, sensory, autonomic, or psychic clinical manifestations A seizure
T or F. A seizure is a syndrome or symptom and not a specific disease entity True
The term convulsion, sometimes applied to seizures refers to the ____ movement associated with some seizures clonic tonic
The term ___ is applied to conditions in which no underlying correctable cause for the seizure is found so they recur without treatment epilepsy
Etiology factors in seizures: (there are four) cerebral lesions, biochemical disorders, cerebral trauma, epilepsy
seizures are also classified by: (four items) clinical manifestations, site of origin, response to therapy, EEG findings
Generalized seizures involve neurons bilaterally, often DO NOT have a local onset and usually originate from a _____ or deeper brain focus and consciousness is always lost or impaired subcortical
Partial seizures involve neurons only UNILATERALLY often have a local (focal) onset, and usually originate from ___ brain tissue (superficial focus). cortical
____ ____ is the experience of a 2nd, a 3rd and often subsequent Sz before the person has fully regained consciousness from the preceding Sz (postictal state) or a single Sz Lasting MORE THAN 5 MINS. Status epilepticus
An EPILEPTOGENIC FOCUS appears to be a group of neurons that evidence a ____ ______ shift and sudden changes in the usual membrane potential, making them more permeable and therefore more easily activated by the known factors. Paroxysmal depolarization
The firing of involved epileptogenic neurons reaches a threshold point, the discharge spreads to adjacent normal neurons & if uninhibited @ this point, the cortical excitation progresses to the ______, to the _____ of the basal ganglia, thalamus, & stem contraleteral cortex, subcortical areas
Define Tonic phase muscle contraction with increase muscle tone, associated with loss of consciousness
Define the Clonic phase alteration contraction and relaxation of muscle.
As corticol excitation is projected downward to the spinal cord neurons and the clonic phase begins as inhibitory neurons in the ____, ____, and _____ begin to inhibit the cortical excitation, interrupting the Sz discharge. (clonic) cortex, anterior thalamus, and basal ganglia
Maintenance of Sz activity demands a ___% increase in ATP and cerebral O2 consumptiom is increased by __% and although cerebral blood flow also increases ___%, availlable glucose and O2 are depleted 250, 60, 250
As the combined deficiency of ATP, O2 and glucose occurs, ____ accumulates in the brain tissues. Lactate
Severe Sz thus may produce secondary hypoxia, acidosis, and ____ all of which are imbalances that may result in progressive brain tissue injury and destruction lactate accumulation
____, a partial Sz experienced as a peculiar sensation preceding the onset of a generalized Sz that may take the form of gustatory, visual, or auditory experiences; a feeling of dizziness, numbness, or funny feeling. Aura
___, early clinical manifestations, such as malaise, h/a, or a sense of depression that may occur hours to a few days before the onset of a Sz Prodroma
_______ is the most critical aspect in diagnosing a Sz disorder and establishing the cause health history
The ___ is useful in assessing the type of seizure and may help to determine its focus EEG
Treatment of Sz include antiSz medications, a ____ diet, biofeedback, and surgery. ketogenic
Severe Sz thus may produce secondary hypoxia, acidosis, and ____ all of which are imbalances that may result in progressive brain tissue injury and destruction lactate accumulation
____, a partial Sz experienced as a peculiar sensation preceding the onset of a generalized Sz that may take the form of gustatory, visual, or auditory experiences; a feeling of dizziness, numbness, or funny feeling. Aura
___, early clinical manifestations, such as malaise, h/a, or a sense of depression that may occur hours to a few days before the onset of a Sz Prodroma
CVA are classified according to ____ as thrombotic, global hypoperfusion (shock), embolic, or hemorrhagic. pathophysiology
_______ is the most critical aspect in diagnosing a Sz disorder and establishing the cause health history
The ___ is useful in assessing the type of seizure and may help to determine its focus EEG
Treatment of Sz include antiSz medications, a ____ diet, biofeedback, and surgery. ketogenic
Thrombotic strokes may be further subdivided on the basis of CLINICAL MANIFESTATION into: TIA, strokes in evolution, and completed strokes.
_______ is the most frequently occurring neurologic disorder ( >50%) consisting on any abnormality of the brain caused by a pathologic process in the blood vessels cerebrovascular disease
The common clinical occurrence of cerebrovascular disease is a _____. Cerebrovascular accident/ stroke
_____, a sudden non-convulsive focal neurologic deficit which in its mildest form, is so minimal as to be almost unnoticed, and in its most severe state, hemiplegia, coma, and death result cerebrovascular accident
CVA are classified according to ____ as thrombotic, global hypoperfusion (shock), embolic, or hemorrhagic. pathophysiology
Thrombotic strokes arise from arterial occlusions caused by thrombi formed in the arteries supplying the brain with risk factors like: arteriosclerosis, hypothyroidism, oral contraceptives, SSD, Polycythemia vera, arteritis, subclavian steal syndrome, chronic hypoxia, dehydration
Thrombotic strokes may be further subdivided on the basis of CLINICAL MANIFESTATION into: TIA, strokes in evolution, and completed strokes.
In a true Transient Ischemic attack (TIA), all the neurologic deficits must be completely clear within _____, leaving no residual dysfunction 24 hours
____ are neurologic deficits that persist over 24 hrs but eventually disappear completely. Reversible ischemic neurologic defects (RINDS)
The Sx of thrombotic strokes occasionally have an Abrupt onset but tend to be slowly progressive, evolving in a step by step fashion over mins. to hours. The typical development of a thrombotic stroke causes the clinical syndrome ____. stroke in evolution (progressive stroke)
The ____ is a CVA that has produced neurologic deficits, although cerebral edema may not have reached its maximum. completed stroke
An _____ ( usually in the distribution of the MIDDLE cerebral artery) involves fragments that break from a thrombus formed outside the brain, usually involvoving small vessels and obstructing them at a bifurcation or narrowing, causing ischemia embolic stroke
Conditions associated with onset of ___ strokes include; A. fib, M.I, endocarditis, RHD, valvular prostheses, ASD's, and disorders of the aorta, carotids, or vertebral-basilar circulation. embolic
____ strokes (intracranial hemorrhage) mostly result from HTN,, ruptured aneurysms or AVM, bleeding tumor, and hemorrhage associated with bleeding disorders Hemorrhagic
Cerebral hemorrhages are described as ____ (several cm in diameter), ____ (1-2 cm), _____(lies in the subcortical area) or ____ ( the size of a pinhead). massive, small, slit, petechial
The most common sites for HTN hemorrhages are in the ______ (55%), the thalamus (10%), the cortex and subcortex (15%), the pons (10%) and the cerebellar hemisphere (10%). putamen of the basal ganglia
_______ results when an area of the brain loses blood supply because of vascular occlusion, either abruptly (embolus, hemorrhage) or gradually (thrombosis, atheroma). Cerebral infarction
Cerebral edema reaches its maximum in about ___ hrs and takes about ___weeks to subsided. Most pt survive initial hemispheric ischemic stroke unless massive cerebral edema develops. 72 hours, 2weeks
Massive brain stem infarcts caused by basilar thrombosis or embolism are almost always ____ FATAL
Individuals experiencing intracranial hemorrhage from a ruptured or leaking aneurysm have one of three sets of symptoms: 1. onset of an excruciating h/a, w/ almost immediate lapse into an unresponsive state. 2. h/a but with consciousness 3. sudden lapse into unconsciousness
if a hemorrhage is confined to the _____ space, there may be no local signs. If bleeding spreads into the brain tissue, hemiparesis/paralysis, dysphasia, or homonymous hemianopia may be present subarachnoid
warning signs of an impeding aneurysm rupture include: headache, transient unilateral weakness, transient numbness, and tingling, and transient speech disturbances.
Treatment of a stroke needs to be initiated in ___ hrs of symptom ONSET and included the adm. of agents for metabolic intervention by paramedics in the field, followed by perfusion therapy AFTER ER evaluation and brain scanning. 6 hrs
In ___ strokes treatment is directed at supportive management to control cerebral edema and increased ICP. thrombotic
ASA effectively reduces death and dependency at 6 mths when started within 48hrs of ischemic strokes as it's the case with systemic anticoags as long as there is a low risk of ____. Same for thrombolysis when given w/in 3hr. intra-extra cranial hemorrhage
In ____ strokes, treatment in directed at preventing further embolization by instituting anticoagulation therapy and correcting the primary problem Embolic
Clinical manifestations of aneurysms may arise from cranial nerve compression (__,__,__,__), but the signs vary depending on location and size III, IV, V, VI
The most common 1st indicator of an aneurysm is an acute ____, intracerebral or combined hemorrhage subarachnoid
Diagnosis of an aneurysm BEFORE bleeding episode is made through ____. but after a bleed, a tentative diagnosis of an aneurysm is based on clinical manifest., hx, CT and MRI ateriography
Treatment of choice for an aneurysm is surgical management
An ____ is a tangled mass of dilated blood vessels creating abnormal channels between the arterial and venous systems. Arteriovenous malformation (AVM)
AVM do not have a normal blood vessel structure, are abnormally thin and may be fed by one or several arteries which become dilated
_____ refers to a variety of conditions characterized by an excess of fluid within the cranial vault, subarachnoid space, or both . hydrocephalus
hydrocephalus occurs because of ____, _____, or _____. increase fluid production, obstruction within the ventricular system, or defective reabsorption of the fluid
Obstruction within the ventricular system called, _____ or internal hydrocephalus may result from congenital abnormalities in the ventricular system or mass lesions that compresses structures of the ventricular system. non-communicating hydrocephalus
Impaired absorption of CSF from the sub-arachnoid space occurs when and obstructive process disrupts the flow of CSF thru the subarachnoid space preventing it from reaching the CONVEX portion of the cerebrum, where the ____ are located arachnoid granulations
hydrocephalus from impaired absorption is termed ___ (extraventricular) hydrocephalus communicating
hydrocephalus from impaired absorption may be caused by: adhesions from inflammation, and compression of the subarachnoid space by a mass, congenital abnormalities of the subarachnoid space, or high venous pressure within the ______. sagittal sinus
The most common cause of communicating (extraventricular) hydrocephalus are: (four answers0 subarachnoid hemorrhage, developmental malformation, head injury, neoplasm.
one form of communicating (extraventricular) hydrocephalus is ____ which arises from cerebral atrophy and CSF fills the unoccupied space. The amount of CSF is increased but the fluid is NOT under pressure. Hydrocephalus ex vacuo
Another form of communicating hydroceph is ______ (low press, adult, or occult hydroceph) which occurs mostly in late MIDDLE AGE. Caused by arachnoid adhesions that obstruct the SAS as a complication of head injury and subarachnoid hemorrhage normal-pressure hydrocephalus
congenital hydroceph. is rare. Non-communicating hydorceph is more commonly seen in ___. and communicating hydroceph is commonly seen in ___. non-communicating common in KIDs. communicating common in ADults.
Acute hydroceph. contributes significantly to increased ____ ICP
The obstruction of CSF flow associated with hydrocephalus produces dilation of the ventricles ___ to the obstruction. proximal
Obstructed CSF IS under Pressure, causing atrophy of the cerebral cortex and degeneration of the ___ ____ ____. white matter tracts
There is a SELECTIVE preservation of gray matter. When excess CSF a defect caused by ___, ___, or a surgical incision, this fluid is NOT under pressure; therefore atrophy and degenerative changes are NOT induced atrophy, degenerative disorders
Clinical manifestations of acute hydrocep is one of rapidly devoloping ___ ___ ___ with the person deteriorating rapidly into a deep coma if not promptly treated increased intracranial pressure
____ hydroceph. had a long-term presentation and develops slowly over time with the individual of family complaining of declining memory and cognitive function normal -pressure
A ____ _____ may be performed to diagnosed normal-pressure hydrocephalus radioisotopic cisternogram
In normal pressure hydroceph., excision or coagulation of teh choroid plexus is needed occasionally when a ____ is present papilloma
Hydrocephalus can be treated with: (2 answers) 1. surgery- to resect cyst, neoplasms, or hematomas 2. Ventricular bypass into the normal intracranial channel or into an extracranial compartment using a shunt
In normal -pressure hydroceph. reduction of CSF through a ____ regimen is often used diuresis
An early clinical manifestation such as malaise, h/a, or a sense of depression, that may occur hours to a few days before the onset of a Sz. Prodroma
a degenerative disorder of the basal ganglia (corpus striatum) involving the dopaminergic nigrostiatal pathway producing a syndrome of abnormal movements Parkinson's Disease
Primary or idiopathic Parkinson disease is described as loss of pigmented neurons in the substantia nigra
Secondary Parkinson's disease or secondary Parkinsonism is due to trauma, inflection, neoplasm, atherosclerosis, toxins, drug intoxication
____ parkinsonism caused by neuroleptics, antiemetics, and antiHTN is the MOST COMMON cause of the secondary form and is usually REVERSIBLE Drug induced
Parkinson disease DOES NOT show a hereditary pattern or familial tendency and epidemiologic data suggest genetic, ___, and envrionmental toxins as possible causes. viral
an acute form of peptic ulcer that tends to accompany severe illness, systemic trauma, or neural injury. Usually multiple sites of ulceration are distributed within the stomach or duodenum. a stress ulcer
The primary clinical manifestion of a stress ulcer is? Bleeding; and they rarely become chronic
The most common indications for ulcer surgery is? bleeding and or perforation
chronic inflammatory disease causing ulceration of the colonic mucosa, usually in the rectum and sigmoid segments. The lesions appear in susceptible individuals between 20 and 40 years of age ulcerative colitis
The course of ulcerative colitis consists of intermettent periods of remission and exacerbation and the
The risk of left-side colon cancer increases significantly after many years of which digestive disease? ulcerative colitis
TREATMENT of ulcerative colitis depends on the severity of symptoms and the extent of mucosal involvement. The disease is often treated with ? sulfasalazine, steroids and salicylates. Broad-spectrum antibiotics may be prescribed if bacterial infection is suggested.
For unknown reasons ___may have a protective effect against ulcerative colitis nicotine
a type of diaphragmatic hernia, is the protrusion (herniation) of the upper part of the stomach through the diaphragm and into the thorax. hiatal hernia
sliding hiatal hernia (direct) is associated with gastroesophageal reflux and esophagitis because the hernia diminishes the resting pressure of the ____.. LES
presents herniation of the greater curvature of the stomach through a secondary opening in the diaphragm. Paraesophageal (rolling)
Reflux is ____ in paraesophageal hernia uncommon
_____ drugs are contraindicated because they relax the LES and delay gastric emptying. Anticholinergic
Surgery that may be performed if medical management fails to control symptoms of hiatal hernias fundoplication
__ or ___l pain is the cardinal symptom of acute pancreatitis. It may radiate to the back and is caused by edema, chemical irritation and inflammation of the peritoneum; and irritation or obstruction of the biliary tract. epigastric or midabdominal
Created by: Bvaleris