Questions on Pathology of water salt metabolism and acid base balance

Patient K., 52 years old, was hospitalized with complaints of pain in the right hypochondrium, itching, nosebleeds, jaundice. Objectively: the skin is icteric, there are traces of scratching, hemorrhage, a symptom of”vascular asterisks”. The abdomen is enlarged in volume, there is a symptom of “Medusa’s head” (expansion of collateral veins on the anterior abdominal wall). Percussion-signs of free fluid in the abdominal cavity. The liver is reduced in size, dense to the touch. The spleen is enlarged and dense. In blood tests: anemia, leukopenia, thrombocytopenia, hypoproteinemia, dysproteinemia, violation of liver function tests. It is known from the anamnesis that the patient suffered from severe viral hepatitis.
What type of edema (etiology) was formed in the patient and what are the mechanisms of its development?
Increased pressure in the portal vein can accumulate fluid in the legs (edema) and stomach (ascites). Edema and ascites may also result from the liver’s inability to make certain blood proteins, such as albumin. Systemic viral infection ( SVI ) and collateral damage in the liver in which the liver is involved in infection by hepatotropic viruses which can replicate in the liver. These include hepatitis A, hepatitis B, hepatitis C, and hepatitis E virus. Here hepatitis A is the most common virus which can cause acute viral hepatitis. Hepatitis A, hepatitis B, hepatitis D, and hepatitis E are the most common viruses for acute liver failure. Hepatitis B, hepatitis C, and hepatitis D are those viruses which can cause chronic hepatitis. 
In the United States, viral hepatitis is most commonly caused by hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). These three viruses can cause an acute illness with symptoms of nausea, abdominal pain, fatigue, malaise, and jaundice. Additionally, acute infection with HBV and HCV can lead to chronic infection. Patients who are chronically infected may go on to develop cirrhosis and hepatocellular carcinoma (HCC). In addition, chronic hepatitis carriers remain contagious and can transmit the disease for many years.
As soon as blood is exposed to HBV, the body measures a cell-mediated immune response by sending the virus to cytotoxic T cells and natural killer cells and releasing inflammatory cytokines. The higher the immune response, the greater the chances of fighting the virus.
Patient L., 37 years old, has been suffering from systemic lupus erythematosus since her youth. During the last exacerbation of the disease, massive, rapidly increasing edema appeared on the face, trunk, and limbs for the firs t time. Laboratory test s revealed pronounce d proteinuria, hypoproteinemia, hyperlipidemia.
What is the name of the syndrome formed in the patient and what are the mechanisms of edema development?

Nephrotic syndrome may be a kidney disorder that causes your body to pass an excessive amount of protein into your urine. nephrosis is sometimes caused by damage to clusters of small blood vessels in your kidneys that filter waste and excess water from your blood. There is no cure for nephrotic syndrome, but there are treatments that can help you manage the symptoms and prevent kidney damage. If your kidneys stop working, you will need dialysis or a kidney transplant to stay.
Common primary causes of nephrotic syndrome include kidney-related diseases such as minimal change nephropathy, membranous nephropathy, and focal glomerulosclerosis. Secondary causes include systemic diseases such as diabetes mellitus, lupus erythematosus, and amyloidosis.
Patient P., 20 years old, after suffering a traumatic brain injury, began to complain of constant thirst, frequent and copious urination (the amount of urine 10-15 liters per day). Worries about weakness, headaches, heart palpitations. Notes a sharp dryness in the mouth. Objectively: dry skin, lack of perspiration, poor saliva, microcracks, inflammatory changes, ulceration in the gums.
1. What is the typical form of disease developed at the patient? Explain the answer.
Acute head trauma can (directly or indirectly) cause dysfunction of hypothalamic neurons due to degeneration of antidiuretic hormone (ADH) or posterior pituitary gland that causes post-traumatic DI (PTDI). PTDI is usually diagnosed in the first days after presenting trauma with hypotonic polyuria.
Diabetes is caused by problems with a chemical called insipidus vasopressin (AVP), also known as an antidiuretic hormone (ADH). AVP is produced by the hypothalamus and stored in the pituitary gland for as long as necessary.
2. What are the main links in the pathogenesis of this condition?
Diabetes insipidus occurs when your body is not able to properly balance the body’s fluid levels. When your fluid regulation system is functioning properly, your kidneys help maintain this balance. The kidneys drain fluids from your bloodstream. This fluid waste is temporarily stored in your bladder in the form of urine until you urinate.
Pathophysiology A) Central diabetes insipidus:- 1) Loss of vasopressin-producing cells, 2) Causing deficiency in antidiuretic hormone (ADH) synthesis or release; 3) Deficiency in ADH, resulting in an inability to conserve water, 4) leading to extreme polyuria and polydipsia. B) Nephrogenic diabetes insipidus 1) Depression of aldosterone release or inability of the nephrons to respond to ADH, 2) causing extreme polyuria and polydipsia
3. Explain the mechanisms of development of these symptoms.
The body detects an increase in the blood pressure and inhibits the release of vasopressin (also known as antidiuretic hormone (ADH)), due to an increase in the production of urine. The pressure component is caused by the hydrostatic pressure of the water directly increasing blood pressure.
Patients of DI are unable to concentrate on urine and then they have polyuria means they pass the urea in the large amounts resulting in experiencing polydipsia. In mild PTDI cases with preserved consciousness and thirst sensation, these would indicate a thorough investigation. However, most patients with PTDI are in poor condition upon admission to the intensive care unit, and their ability to express their thirst or feeling of drinking is impaired. In such severely affected subjects, impaired consciousness (direct traumatic effects, cerebral edema, intracranial bleeding or sedative drugs used in the intensive care unit), impaired thirst stimulation, inability to consume fluids (e.g., Due to associated lesions) oropharyngeal area) often occur. The inability to consume fluids and compensate for renal water loss results in increasingly severe dehydration and hypovolemic hypernatremia (with hypotension and reduced cerebral perfusion pressure). The symptoms of dehydration (skin weakness, dry mucous membranes, hypotension, tachycardia, tachycardia, confusion, hypovolemic shock, renal failure) require constant monitoring and interpretation regarding the adequacy of fluid replacement. In addition, given that the neurological symptoms of hypernatremia (confusion, disorientation, hyperrelaxia, seizures, lethargy, coma) are difficult to differentiate from other causes of altered neurological status, monitoring is always supported by fluid input and output and routine evaluation Should be Concentrations of plasma electrolytes (especially sodium).
4. What are the principles of treatment of these patients?
Typically, this form is treated with a man-made hormone called desmopressin (DDAVP, minirin, others). This medicine replaces the missing anti-diuretic hormone (ADH) and reduces urination. You can take desopressin as a nasal spray, in oral tablets, or by injection.
the treatment: –
1. Intranasal or I.V. Replacement vasopressin therapy with. DDAVP (Desmopressin Acetate)
2. Dehydration and correction of electrolyte imbalance
3. A thiazide diuretic eliminates sodium and increases renal water renal function.
4. Restriction on the intake of salt and protein
The patient, 56 years old, suffers from emphysema of the lungs and respiratory failure.
Indicators of Аcid-Base  and electrolyte balance:
рН  а.blood = 7,37;
раСО2 = 56 мм рт. ст.;
НСО3 = 32 ммоль/л;
ВЕ = 7,5 ммоль/л;
Nа+ = 142 ммоль/л;
 К + = 4 ммоль/л;
Cl– = 88 ммоль/л.
Make a conclusion about the nature of violations of the Аcid-Base Вalance.
Ans: – In this case, it can be respiratory acidosis which is caused by alveolar hypoventilation. CO2is produced rapidly due to more active to Hemoglobin and causes the failure of ventilation which are immediately increases the partial pressure of arterial CO2(PaCO2). The increasing in PaCO2 in turn decreases the HCO3−/PaCO2 ratio and due to this situation the pH are getting decreases.
Respiratory acidosis involves a decrease in vital sign and / or volume (hypoventilation). Common causes are impaired respiratory drive (eg, toxins, thanks to CNS disease), and airflow obstruction (eg, asthma, COPD [chronic obstructive pulmonary disease]], sleep disorder, airway edema).
Hyperventilation may be the cause of a compensatory mechanism for respiratory alkalosis or metabolic acidosis. Deep smelling respiration (Kusamul breathing) is a common feature of acidosis (hyperventilation in an attempt to remove carbon dioxide), but may take a few hours to appear.
The patient, who had been suffering from diabetes for many years, was admitted to the hospital in a comatose state. Indicators of CBS and electrolyte balance at receipt:
 рН  а.blood = 6,95;
раСО2 = 20 мм рт. ст.;
НСО3 = 5,5 ммоль/л;
ВЕ = –20 ммоль/л;
SB = 4 ммоль/л;
Кетоновые тела в плазме крови = 10 ммоль/л;
 К + = 7,5 ммоль/л;
ТК мочи = 60 ммоль/л; кетоновые тела в моче.
Make a conclusion about the state of the Аcid-Base Вalance  and possible approaches to its correction.
Ans: – Pathophysiology of metabolic acidosis. Metabolic acidosis occurs when either the production of non-anaerobic acid increases or the loss of bicarbonate from the body enhances the mechanism of acid-base homeostasis or when the renal acidification mechanism is compromised.
Causes: – 1) increased acid production, 2) loss of bicarbonate, and 3) Kidney are unable to secrete acids
Metabolic acidosis is a clinical disorder defined as less than pH 7.35 and below the HCO3 level. Anion gap helps determine the cause of metabolic acidosis.
It Occur dur to :- Untreated diabetes mellitus, Untreated diabetes mellitus, Lactic acid production, Circulatory failure/hypovolaemia
A patient with extensive trauma, accompanied by massive blood loss. My mind is numb , my skin is pale, cold, and sweaty. Blood PRESSURE 95 / 60mm Hg. Pulse 120 beats / min. Pronounced shortness of breath , thirst. Oliguria.
The following data were obtained from the Аcid-Base Вalance  study:
рН  а.blood = 7,26
раСО2 = 28 мм рт. ст.
SB = 14 ммоль/л
ВЕ = – 12 ммоль/л
Лактат = 6,8 ммоль/л
Make a conclusion about the nature of  Аcid-Base Вalance  violations and methods of correction.
Respiratory alkalosis: – Respiratory alkalosis is a medical condition in which increased respiration increases blood pH beyond the normal range (7.35–7.45) with a concurrent decrease in arterial levels of carbon dioxide. This condition is one of the four basic categories of dissolution of acid-base homeostasis.
Respiratory alkalosis occurs when you take very fast or very deep breaths and the carbon dioxide levels are very low. This increases the pH of the blood and becomes very alkaline. When the blood becomes very acidic, respiratory acidosis occurs.
The kidneys will attempt to correct for a primary metabolic alkali. In a metabolic alkali, more bicarbonate is filtered through the kidneys.
Generally, the respiratory system keeps these two gases in balance. Respiratory alkalosis occurs when you take very fast or very deep breaths and the carbon dioxide levels are very low. This increases the pH of the blood and becomes very alkaline. When the blood becomes very acidic, respiratory acidosis occurs.
Patient M., 54 years old, was taken to the hospital in a serious condition. Complains of General weakness, severe weight loss . In the last 5-6 days, almost after each meal , he feels pain in the epigastric region, accompanied by vomiting. In the study of Аcid-Base Вalance  revealed:
 рН арт. крови = 7,55
рСО2 = 60 мм рт. ст.
SB = 50 ммоль/л
ВЕ = 18 ммоль/л
Make a conclusion about the nature of the violation of the Аcid-Base Вalance.
What is the possible cause of the Аcid-Base Вalance  violation in this patient?
What is the reason for the increase in pCO2?
Metabolic alkalinity
Metabolic alkalinity is the primary increase in bibacarbonate (HCO3 with), with or without a compensatory increase in carbon dioxide partial pressure (Pco2); The pH may be high or nearly normal. Common causes include prolonged vomiting, hypovolemia, use of diuretics, and hypokalemia. Metabolic alkalosis is corrected with aldosterone antagonist spironolactone or with other potassium-sparing diuretics (eg, amiloride, triamterene). If the cause of primary hyperaldosteronism is an adrenal adenoma or carcinoma, surgical removal of the tumor should correct the alkalinity. It can also be caused by some kidney diseases. Hypochloremic alkalosis is caused by excessive deficiency or loss of chloride, such as from prolonged vomiting.
Hydrogen ions can be lost through the kidney or GI tract. Vomiting or nasogastric (NG) suction induces metabolic alkalosis by loss of gastric secretions, which are rich in hydrochloric acid (HCl). Whenever hydrogen ion is emitted, a bicarbonate ion is obtained in outer space.
Tumor growth
Patient 3., 62 years old, a former Stoker, entered the clinic with complaints of General weakness, rapid weight loss, hoarseness of voice, difficulty breathing, bad breath, dry cough. During laryngoscopy, a lumpy ulcerated tumor is found in the larynx, which covers more than half of the larynx. The tumor sprouts the vocal cords and epiglottis. The cervical lymph nodes are enlarged, dense to the touch, and painless. A blood test revealed severe anemia.
How to explain changes in the General condition of the patient?
Some sign Are present in patients like A sore throat, Dry cough and a lump on neck and throat, hoarseness which causes voice changing in patients, difficulty to take breath and weakness, weight loss. Conditions of patients are depend on the size of tumor. Mostly, Smoking and drinking heavy amount of alcohol are the reason for tumor. Some kind for Pathogens like dust, some chemicals.
What is the name of the described character of tumor growth and for which neoplasms it is characteristic?
Malignancy Laryngeal Glottic cancer which is occurs in larynx which the involving of true vocal cord which affect on the breathing, swallowing, bad breath, and dry cough. Tobacco, smoking and alcohol are increasing the effect or risk of the cancer. Laryngeal cancer is starts from a larynx tissue and sprouts to the vocal cord and epiglottis and it cover more part of larynx. Lymph nodes getting enlarged with painless. Then due the damage of the lymphatic nodes is affects the bone marrow. Then blood circulation getting affected. Due to deep or bed breathing it can causes lack of oxygen in blood which transfer in blood by lung. Due to Bed breathing, Lack of oxygen is getting occur and tissue are unable to get proper oxygen for keep continue work. It can causes severe Anemia.
Is metastasis typical for such tumors?
It can spread by the bloodstream to another organ. It spread locally and by the help of lymph nodes before the Bloodstream.
Laryngeal Cancer metastasis or spreading are depend on the site of origin. It along tissue planes, by lymph nodes it spread by the boundaries between embryological anlagen.

Patient K., 32 years old, was repeatedly operated on for 5 years for recurrent liposarcoma of the right hip. The patient came to the next examination with complaints of an increase in the volume of the abdomen. In the abdominal cavity, a huge spherical dense tumor was found, occupying almost the entire right half of the abdomen and passing over the middle line. The tumor is recognized as inoperable due to its large size and small displacement. Appointed trial telehomecare. Two months after the treatment, the tumor was reduced by half and became freely mobile. The patient was operated on.
Did the patient have a benign or malignant tumor? Justify your answer.
Liposarcoma is a malignant tumor resulting from deep soft tissue fat. What triggers the development of liposarcoma is unknown. Risk factors for liposarcoma may include radiation, familial cancer syndrome, a damaged lymph system and / or exposure to certain chemicals. Liposarcoma does not develop from normal lipomas (benign tumors of fat cells). Liposarcoma is a malignant tumor that arises from mesenchymal cells (in particular, abnormal fat cells in deep soft tissues that multiply in an irregular manner), mainly in sites such as the thigh, gluteal region, retroparitoneum, and the foot and shoulder. But affects middle-aged people. Area. Occasionally, liposarcoma may be very large.
Many liposarcoma patients do not initially feel ill, so patients seek delayed help in the disease process if other symptoms occur. Symptoms depend on the location of the tumor and the extent of its spread in the body. Symptoms and signs that may occur later in the disease may include Painful swelling and growing lumps into skin, Numbness, vein enlargement, Fatigue, weakness, Abdominal pain, although some patients experience no pain, others may experience constipation, a feeling of fullness soon after eating, and blood in the stool (these symptoms develop in patients with abdominal liposarcoma More likely), Pain in chest, Urinary difficulty and pain, difficulty swallowing; Nausea, Vomiting, And Decreased range of motion in organs.
What explains the positive effect of telehomecare?
Telehomecare refers to worry delivered by providers from a foreign location (facility) to the receiver’s location (home). Thus, it’s a variety of telemedicine that’s located during a patient’s home and a electronic communication and clinical information ecosystem that uses voice, video, and health-related data exchange using the most effective available telecommunications technologies Enables Although the term is commonly related to remote patient monitoring, it’s not strictly. Telehomecare (THC) is a form of telemedicine that is located in the patient’s home. It uses voice and health-related data a communication and diagnostic information system to enable the use of simple telephone lines or the Internet. Benefits of THC, when compared to general home care for patients with chronic diseases such as heart failure (HF), chronic obstruction (when compared) pulmonary disease (COPD) and diabetes mellitus (DM), are wide ranging including: quality of life, improved access to care, all cause mortality, emergency department (ED) visits.
It is known that patients with xeroderma pigmentosa and Fanconi aplastic anemia have an extremely high risk of malignant tumors.
How do I explain this phenomenon?
Xeroderma pigmentosum (XP) could be a very rare disease where an individual is very sensitive to sunlight, has premature skin aging and is in danger of carcinoma. xerodermia is caused by cellular hypersensitivity to ultraviolet (UV) radiation as a results of a defect within the DNA repair system. Xeroderma is caused by a mutation in the pigmentosum gene that is involved in damaged DNA repair. UV rays from the sun and toxic chemicals found in cigarette smoke such as DNA can cause damage. Normal cells are usually able to fix DNA damage before it becomes a cause of the problem. Two XP-C patients were neurologically and cognitively intact despite mild brain atrophy, as seen by neuroimaging. Patients with XP-G had sensoryural hearing impairment, laryngeal dystonia, and peripheral neuropathy. It is characterized by photo sensitivity, pigment changes, premature skin aging and therefore the development of malignant tumors. These manifestations are caused by a cellular hypersensitivity to ultraviolet (UV) radiation due to defects in DNA repair.
Fanconi aplastic anemia could be a rare disease that goes through families (inherited) that mainly affect the bone marrow. This leads to reduced production of every kind of blood cells. it’s the foremost common inherited style of aplastic anaemia.
They may exhibit symptoms such as: Unexplained fatigue, Recurrent colds or viral infections, Recurrent nosebleeds, Easy bruising, Blood in the stool or urine., Shortness of breath, Poor growth  and short stature. Aplastic anemia occurs due to damage to the stem cells inside the bone marrow, which is a sponge-like tissue within your bones. Many diseases and conditions can damage stem cells in the bone marrow and after that bone marrow form very low red blood cells, white blood cells and platelets. And then it causes Anemia.

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