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patho ch 5 & 4

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eyeball layers
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sclera (outermost), choroid (middle), retina (innermost)
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conjunctiva
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covers anterior externally visible portion of the eye
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anterior chamber is between the iris and anterior cornea
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vitreous body is behind the lens
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refraction
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bending light rays
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Light rays
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– Rays enter the eye and pass through the cornea, aqueous humor, lens, and the vitreous humor – Adjustments are made in the eye to facilitate the image in relation to the viewer’s distance – Intrinsic muscles respond to light levels and change pupil size
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diagnostic tests for eye conditions
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– eye charts and vision field tests – tonometry to measure intraocular pressure – eye cultures to identify viruses or bacteria – electronystagmography to measure the direction and degree of nystagmus – electroretinography to measure electric activity of the retina
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hyperopia
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farsightedness, light focused behind the retina
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myopia
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nearsightedness, causes blurred vision
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astigmatism
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irregular focusing of the light rays
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presbyopia
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loss of elasticity in the lens
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refractive errors
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hyperopia, myopia, astigmatism, presbyopia – may be genetic, treatment involves artificial lenses or surgery
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nystagmus
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– symptoms are repetitive or involuntary eye movements – comprehsnive ophthalmic exam is needed – can be congenital or acquired – treatment: treat the underlying cause and if its congenital use the Kestenbaum procedure (surgical procedure on the extraocular muscle)
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strabismus
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– symptoms in adults: diplopia, and in children esotropia (one or both eyes turn inward, cross-eyed) and or amblyopia (lazy eye) – diagnosis by examination, radiographic studies, blood tests – should be treated asap – corrective glasses, treatment to minimize amblyopia, or surgery
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hordeola (bacterial stye)
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– symptoms are pain, swelling, reddness and pus – styes are the result of staphylococcal infection and can be secondary to blepharitis (chronic inflmattion of the eyelid) – treat with warm compresses or antibiotics – recurrence can be common
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Chalazion (bigger stye)
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– symptoms are redness, swelling and [ain – caused by blockage of fluid originating from one of the meibomian glands – treated with warm compresses and topical antibiotics – large chalazion may need surgery
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keratitis
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– symptoms are decreased visual acuity, irritation, tearing, photophopia, and mild redness – caused by herpes simplex virus – administration of broad-spectrum antibiotic – prompt treatment reduces risk of ulceration – patients should adhere to strict hand hygiene
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blepharitis
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– symptoms are redness and crust of the eyelid; itching or burning – ulcerative form of blepharitis is usually result of staphylococcal infection – nonulcerative blepharitis can be cuased by allergies or exposure to smoke, dust, or chemicals – use wet compresses and baby shampoo and water to treat
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entropion
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– symptoms are the sensation of a foreign body in the eye, tearing, itching and redness – entropion most often affects older people – in diagnosis, visual examination reveals and inversion of the eyelid – a minor surgical procedure on the eylid usually corrects the problem – don’t rub eyes to avoid infection – eye lid folds into eye
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ectropion
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– symptoms are eye dryness and tearing – usually occurs in the elderly as a result of decreased elasticity of the lower eyelid – the problem can be detected easily by visual examination – minor surgery to correct the condition – teach proper technique for instilling ophthamic (relating to eye and diseases) ointment and eye drops – eyelid folds/ falls away from eye
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blepharoptosis
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– drooping eyelid – can occur at any age, is often familiar, and if severe obstructs the vision of the affected eye – caused either by weakness of the muscle that raises the eyelid – blood tests and imaging may be ordered – an operation can be performed to elevate the eyelid position
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conjunctivitis
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– Symptoms include redness, swelling, foreign body sensation and itching of the conjunctiva; eyes may tear excessively and be extra sensitive to light – Conjunctivitis can be caused by infection and also by irritation resulting from allergies or chemicals – To identify bacterial or viral organisms, samples of the discharge can be taken – Treatment varies depending on the causative agents – Avoiding the offending agents can result in resolution of the symptoms
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corneal abrasion or ulcer
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– Cornea is susceptible to infection Symptoms include pain, redness, and tearing, vision impairment – Prompt medical care is indicated – Causes Abrasions: Foreign bodies being trapped between the cornea and eyelid, by direct trauma to the cornea, dirty/scratched contacts – Treated with antibiotic ointment
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episcleritis/scleritis
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– episcleritis usually presents as redness and irritation in an isolated portion of the eye – scleritis – intense redness in one or more areas of the sclera and are more commonly associated with pain and blurred vision – episcleritis is not usually associated with any other concommitant systemic disease; scleritis is often associated with autoimmune disorders – a thorough ophthalmic examination is needed, and blood tests may be necessary to determine underlying causes – both, episcleritis and scleritis respond well to topical steroid eye drops – artificial tears and lubricating eye ointments may be used – emphazie the importance of hand washing; if surgery is required use visual aids
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cataracts
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– symptoms: patient may report poor night vision, a yellowing or fading of colors, loss of bightness of color – more common cause is opacificaton of the lens caused by againg – may also be congenital, or caused by trauma or disease, often have familial occurence – sugery is advisded when cataracts begin to interfere with the lifestyle of the patient
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glaucoma
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– major cause of blindness – risk factors include age older than 60, nearsightedness, blood relatives with glaucoma, and african-american descent – by the time symptoms appear, damage has already occured – in chronic open-angle glaucoma, a block at the trabecular meshwork impairs aqueous humor reabsoption (there is also closed angle glaucoma) – diagnosis is done with patient history and several exams – usually treated with medication to decrease the production of aqueaous humor – best way to detect is periodtic routine ophthalmic exams
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macular degeneration
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– symptoms are mild distortion of central vision, seeing wavy lines or opaque spots in visual field – age, genetic factors, and prolonged expsue to bright light are al causative factors – thorough examination is needed for diagnosis – no definitive medical cure is known – demonstrate the use of amsler grid ( grid to monitor a person’s central visual field)
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diabetic retinopathy
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– characterized by microaneurysm, hemorrhages, dilation of retinal veins, macular edema and formation of abnormal vessels – occurs about 8-10 years after the onset of diabetes mellitus – treatment with laser photocoagulation is usually effective – stress the importance of good diabetic care
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retinal detachment
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– may be partial or complete and usually is associated with a retinal tear or hole in the retina – the patient is brought to the physican’s attention for immediate dilated examination – commonly associayed with severe diabetic retinopahth – treatment consists of either photocoagulation or surger
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Uveitis
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– pain, photophobia, blurred vision and redness can occur – It affects the middle layer of tissue in the eye wall – a complete ophthalmic examination is necessary – can be associated with autoimmune disorders, infections or inflammatory bowel disease – treatment consists largely of topical or, in severe causes, systemic steroid use
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exophthalmous
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– abnormal protrusion of the eyeball or eyeballs – patients report dryness, a gritty feeling in the affected eye(s), double vision and movemnt restriction – caused by enlarged extraocular muscles, retrobulbar mass, or edema of the soft tissue that lines the bony orbit of the eye – diagnosis determines thearpy needed – surgery may be needed in severe causes – explain purpose and dosage schedule of medication
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cancer of the eye
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– may involve the globe, the orbit, the optic nerve or the eyelids – tumors of the eyelid generally present as visible lesisons – seborrheic keatosis presents as a skin tag on the eyelid, ocular melanoma may present as a growing pigmented spot on the iris – infants and young children should be evlauted for leukokoria and strabismus – ocular tumors include retinoblastoma, ocular melanoma, and intraocular lymphoma – orbital tumors include rhabdomyosarcoma, capillary hemangioma and cavernous hemangioma – eyelid tumors include skin cancers and benign squamous papillomas – optic pathway glioma is a low grade tumor of the optic nerve that usual occurs in children – the lesions of ocular melanoma may first be identifed on routine eye exam, but ultrasound helps make the diagnosis + biopsy
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Ear
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outer ear (external ear and auditory canal), middle ear (tympanic membrane and three ossicles, eustachian tube and oval window), inner ear (contains 2 membraine-lined chambers called the cochlea and labryinth)
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central deafness
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the CNS cannot interpret impulses due to a cerebrovascular accident or brain tumor
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disorders of conduction (ear)
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– impacted cerumen – infective otitis externa – swimmer’s ear – otitis media – otosclerosis
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impacted cerumen
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– packed ear wax – If secretion accumulates excessively, a gradual loss of hearing may occur and feeling of a plugged ear, tinnitus, and earache – Can be caused by dryness and scaling of the skin or by excessive hair in the ear canal – Impacted cerumen must be removed – May have to be softened first with oily drops and then irrigated with water – Reinforce not putting anything into the ear that would push or pack the earwax
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infective otitis externa
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– ear infection – severe pain, a red swollen ear canal, hearing loss, fever and pruritus (severe itching) are common – accumulation of the cerumen in the ear canal, when mixed with water, acts as a culture medium for bacteria or fungi – otologic exmaniation and history of symptoms confirm the diagnosis – keep the canal clean and free from water
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swimmer’s ear
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– Severe pain; a red, swollen ear canal; hearing loss; fever; and pruritus are common symptoms – Accumulation of cerumen in the ear canal when mixed with water acts as a culture medium for bacteria or fungi – Antibiotic or steroid eardrops and systemic antibiotics may be prescribed – Encourage compliance with any drug therapy
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otitis media
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– build up of fluid in the middle ear -Otitis media is classified as either serous or suppurative, according to the composition of the accumulating fluid Serous: Fluid is clear, feeling of fullness or pressure, impacted hearing Suppurative: Infection, fever, chills, nausea, and vomiting – With acute serous otitis media, cause is usually a virus from an upper respiratory infection (URI) that has spread through the eustachian tube into the middle ear – Chronic otitis media can develop from an acute attack, hypertrophy of the adenoids, or chronic sinus infections – Suppurative otitis media is caused by bacteria – Analgesics and decongestants may be ordered to provide pain relief and to promote drainage – Provide patients and family with information regarding the care of the ear with myringotomy tubes
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ostosclerosis
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– abnormal growth of spongy bone forms around the oval window causing ankylosis (abnormal stiffening and immobility of a joint due to fusion of the bones) of the stapes – symptoms are tinnitus and a gradual hearing loss of low or soft sounds – otosclerosis is idopathic, but familiar tendency – only treatment is a stapedectomy (remove stapes and put an implant in)
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meniere disease
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– disease of the inner ear, affects the labrynth – marked by recurring syndrome of veritgo, tinnitus, progressive hearling loss, and a sensation of fullness or pressure – the disease procsess seems to involve the destricton of the tiny hair cells inside the cochlea – testing with audiometry, balance stdudies, radiographic studies may be needed – physical usually prescribes medication to control nausea and vomiting – predisposing factors: noise pollution, trauma
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Benign Paroxysmal Position Vetigo (BBPV)
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– Patients experience a spinning sensation with movement of the head – Nausea, vomiting, involuntary eye movement, and difficulty with standing/walking may occur – The spinning sensation usually is the result of balance or equilibrium disorders – Antihistamines and benzodiazepines(psycosis medication) prescribed to reduce symptoms of vertigo Take medicine and do prescribed exercises
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labyrinthitis
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– The onset of infection is often acute and is associated with fever; main symptom is extreme vertigo – Usually the result of a virus but can be caused by a bacterial infection that has spread from the middle ear – Bed rest and prescriptions for a tranquilizer, an antiemetic (antinausea) agent, and an antibiotic may be necessary
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ruptured tympanic membrane
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– Symptoms usually slight pain and partial loss of hearing and may include a slight discharge or bleeding from the ear – The four most common causes are insertion of sharp objects into the ear canal, a nearby explosion, a severe middle ear infection, and a blow to the ear – An antibiotic may be prescribed to prevent infection, and a patch may be applied to the eardrum to aid healing, can heal in 1-2 weeks
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Cholesteatoma
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– cyst-like mass or ball in the ear that becomes infected – Most common symptom of cholesteatoma is a mild to moderate hearing loss – Often begins to develop in infancy or it may be the result of chronic ear infection – Inflation of the eustachian tube may produce some improvement, and treatment with steroids and antibiotics helps to prevent recurrence
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mastoiditis
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– inflammation of your mastoid bone or mastoid process – Pain and occasionally edema are present over and around the mastoid, fever and chills, headache and hearing loss – Acute mastoiditis is the result of neglected acute otitis media Streptococcus is the usual causative organism – Antibiotic or sulfonamide therapy is prescribed Stress the importance of prompt medical treatment of otitis media
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sensorineural hearing loss (occupational hearing loss)
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– acquired hearing loss – nerve impulses are not transmitted to the brain – Symptoms include tinnitus and partial to severe hearing loss – Many times the hearing loss is detected during a routine medical examination – The cause is nerve failure or damage to the cochlea or the auditory nerve – Regardless of the amount of damage to the cochlea, steps must be taken to prevent further damage – cause: viral infections, aging, trauma, constant loud noises
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Cancer of the ear
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– Symptoms of these neoplasms include progressive hearing loss, chronic otic discharge, a visible mass or lesion on ear examination, loss of equilibrium, and tinnitus – Some cancers, such as squamous cell carcinoma of the middle ear, are quite painful – Glomus (component of the dermis layer of the skin, involved in body temperature regulation) tumors cause a pulsatile tinnitus – Benign tumors of the ear include acoustic neuromas, facial neuromas, and glomus tumors – The most common malignant tumors of the external ear are skin cancers – Another type of tumor found in the external auditory canal is the ceruminal gland neoplasm – Treatment for these tumors is surgical excision
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myringotomy tube
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A surgically placed tiny incision in the eardrum. Any fluid behind the eardrum can then drain and usually thickened secretions can be removed. A small plastic ear tube (a tympanostomy tube) is often inserted into the eardrum to keep the middle ear aerated for a prolonged period of time
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ankylosis
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no vibrations, conductive deafness
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posterior pituitary secretes
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created in the hypothalamus and then they fall down, oxytocin, ADH (vasopresin promotes water retention)
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anterior pituitary secretes
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created in the anterior pituitary gland, growth hormones, thyroid stimulating hormone, acth (cortical hormones), lutenizing hormone, fsh, prolactin
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major glands of the endocrine system
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anterior and posterior pituitary, thyroid and parathyroid, adrenal cortex and adrenal medulla, pancreas, ovaries, and testes, thymus
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exocrine
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duct
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endocrine
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ductless
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tropic hormones stimulate secretion of other hormones
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gigantism
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– too much growth hormone – proportionately long, sexual and mental retardation – treatment: surgery to reduce the size of the pituitary gland and hormone therapy
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acromegaly
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– gigantism but the onset is after puberty – things are not proportional – thick bones, excessive growth – caused by pituitary tumors or adenoma – seen in older ages 30 – treatment: remove tumor, reduce GH secreted
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hypopituitarism
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– deficiency or absence of any of the pituitary hormones produced in the anterior pituitary gland – caused by tumor
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dwarfism
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– deficiency of growth hormone – adults under 4feet 10 inches – child doesn’t develop secondary sex characteristics (body hair, breasts) tumors or hemorrhage after birth
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diabetes insipidus
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– disturbance of water metabolism resulting in extreme thirst and excessive secretion of dilute urine, resulting in polyuria – issue with ADH (vasopressin) – hereditary or tumor in hypothalamus – treatment: vasopressin injection, nasal spray, oral, ADH replacement
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simple goiter
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– enlargement of the thyroid gland – may be asymptomatic – hyperplasia – weight loss and heat intolerance may occur
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hashimoto thyroiditis
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– autoimmune disorder where antibodies attack the thyroid leads to hypothyroidism – leading cause of goiter – treatment – lifelong treatment of thyroid hormone – mild hypothyroidism is common and usually responds well to treatment
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hyperthyroidism (graves disease)
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– too much thyroid hormone – rapid heart rate, palpations, increased metabolism, sweating, loss of hair, exopthalmous – autoimmune – treatment: thyroid antagonist, or radioactive iodine (makes them become hypothyroid)
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simple nontoxic goiter
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– iodine deficient – thyroid looking for iodine so it enlarges
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cretinism
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– congential hypothyroidism – thyroid gland is absent or not working – child develops as a dwarf, lack muscle tone, no sex organs – early treatment with thryoid hormone growth
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hypothyroidsim
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cold, weight gain, fatigue, depression and mental apathy, heredity plays a prominent role
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myxedema and myxedma coma
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– disease characterized by clinical manifestation associated with a low metabolic rate due to deficient thyroid hormone – severe untreated hypothyroidism exacerbated by an acute event or myocardial infarction, infection or use of sedatives
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thyroid cancer
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– Includes primary thyroid tumors, thyroid lymphoma, and metastases from breast, colon, kidney, or skin cancers – Signs include a hard, painless lump on the thyroid gland, vocal cord paralysis, obstructive symptoms, and cervical lymphadenopathy – Causes include multinodular goiter, Hashimoto thyroiditis, cysts, follicular adenomas – The four main types of thyroid cancer are papillary, follicular, medullary, and anaplastic – A genetic susceptibility to tumors is indicated – Thyroid nodules are usually discovered by the patient or found on physical examination TSH is measured in all patients with thyroid nodules Fine-needle aspiration (FNA) and histologic exam of the nodule tissue are needed to confirm – Primary therapy for papillary, follicular, and medullary thyroid cancers is surgery – After surgery, patients are started on levothyroxine therapy to prevent TSH stimulation and to prevent hypothyroidism – Anaplastic tumors require nonsurgical treatment – Most recurrences of any type of thyroid neoplasm appear within 5 years
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hyperparathyroidism
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– Hyperparathyroidism increases demineralization, resulting in hypercalcemia Hypercalcemia reduces the irritability of nerve and muscle tissue, which causes muscle weakness, atrophy, gastrointestinal (GI) pain, and nausea Bone tenderness, arthritis type of pain, and easy fracturing of the bones – Primary hyperparathyroidism cause – Increased activity of the parathyroid gland, hyperactive parathyroid – Secondary hyperparathyroidism cause – Increased secretion of PTH induced by a low level of serum calcium or vitamin D level, low blood calcium and vitamin D – The treatment plan for hyperparathyroidism varies with the cause and is individualized
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parathyroid
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– 4 parathyroids – stimulates osteoclasts (which break down bones and increase calcium in your blood)
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hypoparathyroidism
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– When the level of PTH is insufficient, circulating levels of calcium are reduced, resulting in hypocalcemia – Initial symptoms include numbness and tingling of fingertips, toes, ears, or nose, followed by muscular spasms or twitching of the hands/feet – Emotional changes, confusion, and irritability occur – Most common cause of hypoparathyroidism is surgical destruction of the parathyroid glands Acquired hypoparathyroidism can result from injury to the parathyroid glands, ischemia from an infarct, accidental radiation, neoplasia Treatment – Calcium replacement therapy with vitamin D
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cushing syndrome
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– increase in chronic corisol levels – Symptoms: Fatigue, muscular weakness, weight gain, and changes in body appearance Skin becomes thin, has a tendency to bruise easily, and develops red or purple striae – Salt and water retention result in hypertension and edema, and in the characteristic moon face – Excessive levels of cortisol can be caused by: Hyperplasia of the adrenal gland Excessive secretion of corticotropin from the pituitary gland A tumor of the adrenal cortex Production of corticotropin in another organ – Treatment depends on the cause of oversecretion
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addison disease
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– partial or complete failure of adrenocortical function – Symptoms of fatigue, weakness, anorexia, agitation, confusion, weight loss Depression, anxiety, and emotional distress are often experienced – Can result from an autoimmune process, tuberculosis, hemorrhage, fungal infections, neoplasms, or surgical resection – Treatment includes replacement of the natural hormones with glucocorticoid and mineralocorticoid drugs, and correction of salt and potassium levels – Early diagnosis and strict adherence to regimen can result in a good prognosis and the patient’s resistance to infection
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diabetes mellitus (disregulation of glucose levels)
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– Insulin normally reduces blood glucose levels by transporting glucose into the cells as energy and storage as glycogen – secretion of insulin process is inhibited, resistant to insulin – Reduction in insulin results in hyperglycemia and deprives cells of fuel – Ketonuria develops as excess ketone bodies are excreted in the urine, which leads to acidosis – Type 1- autoimmune, non-functioning beta cells in the pancreas, Has an early, abrupt onset, usually before 30 years of age, with little or no insulin being secreted by the patient – Type 2- resistance to insulin, Some pancreatic function remains, permitting control of symptoms by dietary management The disease is often familial but may be acquired – Type 1 diabetes Infection early in life may trigger an autoimmune process that produces antibodies that destroy the pancreatic cells – Type 2 – Tends to occur in older, overweight adults – Type 1 diabetics require insulin replacement therapy that correlates closely with calculated carbohydrate intake – Type 2 diabetics usually do not necessarily require insulin injections to control blood glucose levels Regimen includes restricted caloric intake and exercise, or oral hypoglycemic medications – The sulfonylureas and meglitinide drugs (oral hypoglycemic drugs) stimulate insulin production – Metformin primarily prevents the liver from producing hepatic glucose but also helps enhance the benefits of insulin – Acarbose works in the Gl tract to delay the digestion of carbohydrates – Today people with diabetes mellitus are living longer – The precise causal mechanism of diabetes mellitus remains unknown – Prediabetes has been identified as a risk factor for progression to type 2 diabetes – Diabetes is monitored daily by a glucose meter – actos – insulin sensitizer – causes fatty acids to stay in the adipocytes – forces your body to metabolize carbohydrates
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insulin shock and diabetic coma
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– The patient must be educated to recognize the symptoms of diabetic coma (high blood glucose with the release of ketone levels) – Insulin shock (excessive insulin) – Take immediate action to correct these serious complications
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insulin pump therapy
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– Small computerized device that delivers small doses of insulin at regular intervals 24 hours a day – It is necessary to test the blood sugar throughout the day and then enter the data into the pump – The pump is monitored by the patient or a trained caregiver
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gestational diabetes
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– fetus eating all the sugar – messing with the blood sugar – Detected between 24 and 28 weeks of gestation – Pregnant patient may be asymptomatic or she may exhibit the usual signs of diabetes mellitus – Increased destruction of insulin by the placenta plays a role in causing GDM – Management of GDM is surveillance of mother and fetus because of the increased risk of complications, control of the diet, and limits on simple sugars – Oral hypoglycemic agents may be prescribed – The risk of cesarean delivery and neonatal complications is increased
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metabolic syndrome
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– collection of signs and or conditions that exist together may increase an individual’s potential for type 2 diabetes and cardiovascular disease – Early recognition of this syndrome can help determine suitable interventions – Main components Central obesity Blood pressure greater than 130/85 Abnormal triglycerides levels above 150 mg/dl Abnormal high-density lipoprotein cholesterol Fasting glucose above 100 mg/dl
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hypoglycemia
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– Occurs when excessive insulin enters the bloodstream or when the glucose release rate falls below tissue demands – The symptoms include sweating, nervousness, weakness, hunger, dizziness, trembling, headache, and palpitations – Major cause is insulin overdosage in a diabetic subject – In acute hypoglycemia, the priority is to restore a normal blood glucose level through intravenous infusion of glucose – Hypoglycemia associated with tumors may require surgery – The diet is modified to correct hereditary fructose (fruit sugar and corn) intolerance
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Precocious Puberty: Males
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– Manifested by early development of secondary sex characteristics, gonadal development, and spermatogenesis – Pubic hair and the beard begin to grow, the gonads and the penis increase in size, and sebaceous gland activity increases – Idiopathic precocity may be transmitted genetically – Therapy depends on the cause of precocious puberty – When idiopathic, take hormones to suppress sexual maturation until the appropriate time – When the cause is testicular tumor or brain tumor, the treatment is more invasive, and the prognosis is guarded
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Precocious Puberty: Females
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– Marked by increased growth rate, breast enlargement, and the appearance of pubic hair and underarm hair before 8 years – In most cases, precocious puberty in girls is idiopathic, without associated abnormalities – Uncommon causes include intracranial tumors, encephalopathy, meningitis, and endocrine disorders Treatment of precocious female puberty depends on the cause – Tumors, if treatable, may require surgery or radiation – Hormone therapy may be used to suppress the secretion of gonadotropins and to prevent menstruation