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Patho for PC 1A

Patho for Primary Care, Module 1A

Atrophy decrease in cell size
Most significant adaptive changes in cells include... atrophy, hyperplasia, metaplasia
hyperplasia increase in number of cells
metaplasia reversible replacementof one mature cell type by another less mature cell type
dysplasia (deranged cellular growth) is not ........... considerred a true adaptation, but an atypical hyperplasia
Etiology of pathologic atrophy decrease in workload
Etiology of Physiologic atrophy Occurs in early development. e.g. thymus gland in childhood.
myofilaments part of muscle fiber which causes muscle contraction
autophagy self-eating process creating autophagic vacuoles
autophagic vacuoles membrane bound vesicles within the cell that contain cellular debris - small fragments of mitochondria and endoplasmic reticulum-and hydrolytic enzymes.
Hypertrophy Increase in the size of the cell
Hypertrophy is associated with.... increase in accumulationj of protien in the cellular components, not cellular fluid.
WOuld hypertrophy in the heart secondary to HTN be pathologic of physiologic? Pathologic
Where does hypertrophy appear as an adaptive response Heart and striated muscles as they cannot react by mitotic division and production of new cells to share the work.
physiologic hypertrophy occurs where skeletal muscle in relation to heavy work
Cardiac hypertrophy causes what peptide to be re-introduced? ANP - atrial natriuretic peptide (causes salt secretion by kidney, decreasing blood volume and pressure, and reducing hemodynamic load.
COmpensatory hyperplasia Allows certain organs to regenerate
Which cells do not regenerate? nerve cells, lens cells of the eye, skeletal muscle cells, myocardial cells
Cellular injury is caused by a lack of oxygen (hypoxia), free radicals, caustic or toxic chemicals, infectious agents, unintentional and intentional injury, inflammatory and immune responses, genetic factors, insufficient nutrients, or physical trauma from many causes.
List the manifestations of cellular injury. General sense of fatigue and malaise A loss of well being Altered appetite fever increased heart rate increase in leukocytes (because of infection) pain presence of cellular enzymes lactate dehydrogenase creatine kinase aspartate aminotransfe
What are the 2 main types of cell death? necrosis and apoptosis
Necrosis Necrosis is the sum of the changes after local cell death and includes the processes of inflammation and cellular lysis.
The 4 major types of necrosis are: coagulative, liquefactive, caseous, and fat. Different types of necrosis occur in different tissues
What are the structural signs that indicate irreversible injury and progression to necrosis? the dense clumping and disruption of genetic material and the disruption of the plasma and organelle membranes.
Gangrene necrosis/gangrene tissue necrosis caused by hypoxia and subsequent bacterial invasion.
Apoptosis a different type of cellular death, is a process of selective cellular self-destruction called programmed cell death.
Describe the water distribution in the human body. x 6 Body fluids are distributed among functional compartments and are classified as ICF or ECF
The sum of all fluids is... The sum of all fluids is the TBW, which varies with age and amount of body fat.
Water moves b/w the ___ and ___ compartments principally by _________. Water moves between the ICF and ECF compartments principally by osmosis.
How does water move b/w the plasma and interstitial fluid? Water moves between the plasma and interstitial fluid by osmosis and hydrostatic pressure, which occur across the capillary membrane.
What is movement across the capillary wall called and how is it described? Movement across the capillary wall is called net filtration and is described according to the Starling law.
What is edema? Edema is a problem of fluid distribution that results in accumulation of fluid within the interstitial spaces.
What is edema caused by? caused by arterial dilation, venous or lymphatic obstruction, loss of plasma proteins, increased capillary permeability, and increased vascular volume
The pathophysiologic process that leads to edema is related to... related to an increase in forces favoring fluid filtration from the capillaries or lymphatic channels into the tissues
The pathophysiologic process that leads to edema may be localized or generalized and usually is associated with weight gain, swelling and puffiness, tighter-fitting clothes and shoes, and limited movement of the affected area.
How are alterations in water balance classified? Alterations in water balance may be classified as isotonic, hypertonic, or hypotonic.
When do isotonic alterations occur? Isotonic alterations occur when changes in TBW are accompanied by proportional changes in electrolytes.
When do hypertonic alterations develop? Hypertonic alterations develop when the osmolality of the ECF is elevated above normal, usually because of an increased concentration of ECF sodium or a deficit of ECF water.
What may be the cause of water deficit? Water deficit, or hypertonic dehydration, is rare but can be caused by lack of access to water, pure water losses, hyperventilation, arid climates, or increased renal clearance.
Discuss the etiology and clinical manifestations of hyperchloremia Hyperchloremia is caused by an excess of sodium or a deficit of bicarbonate.
Discuss the etiology and clinical manifestations of hypernatremia (sodium levels >147 mEq/L) may be caused by an acute increase in sodium or a loss of water.
Discuss the etiology and clinical manifestations of Hyponatremia (serum sodium concentration <135 mEq/L) usually causes movement of water into cells.
What is hyponatremia caused by? caused by sodium loss, inadequate sodium intake, or dilution of the body’s sodium level.
Water excess rare but can be caused by compulsive water drinking, decreased urine formation, or the syndrome of inappropriate secretion of ADH.
causes of metabolic acidosis an increase in noncarbonic acids or loss of bicarbonate from the extracellular fluid.
clinical manifestations of metabolic acidosis HA, lethargy, coma, Kussmaul respirations, anorexia, n/v, diarrhea, abd discomfort,
S/S of severe metabolic acidosis disrythmias, hypotension, death
Causes of metabolic acidosis an increase in bicarbonate usually caused by loss of metabolic acids from conditions such as vomiting, gastrointestinal suctioning, excessive bicarbonate intake, hyperaldosteronism, and diuretic therapy
Clinical manifestations of Metabolic alkalosis muscle cramps, hyperactive reflexes r/t volume depletion, weakness, parasthesas, numbness/tingling of fingertips & perioral area, tetany, seizures; Slow, shallow respirations= + CO2 = confusion, convulsions
S/S of severe Metabolic alkalosis atrial tachycardia, dysrhythmias
Causes of Respiratory Alkalosis occurs with alveolar hyperventilation and excessive reduction of carbon dioxide, or hypocapnia
Clinical manifestations of respiratory alkalosis dizziness, confusion, tingling of extremities, convulsions, coma, carpopedal spasm, tachypnea
Causes of respiratory acidosis decrease of alveolar ventilation and an increase in levels of carbon dioxide, which in turn causes hypercapnia.
Initial s/s of respiratory acidosis HA, restlessness, blurred vision, apprehension. Respiratory rate is initially rapid and gradually becomes depressed.
initial s/s of respiratory acidosis are followed by... Lethargy, muscle twitching, tremors, convulsions, coma
List the human defense mechanisms Innate immunity includes natural barriers and inflammation.
Natural barriers include... physical, mechanical, and biochemical barriers at the body's surface
Name the physical and mechanical barriers as the first lines of defense skin and mucous membranes
Name biochemical barriers as first lines of defense against invading pathogens Antibacterial peptides in mucous secretions, perspiration, saliva, tears, and other secretions
What role do Cathelicidins and defensins play in the first line of defense? two classes of antimicrobial peptides produced by epithelial cells.
How do normal bacterial flora fit into the first line of defense? provide protection by inhibiting colonization by pathogens and by releasing chemicals that prevent infection.
Does inflammation have memory cells? no
What does the vascular response in acute inflammation include? vasodilation, increased capillary permeability, and white blood cell adherence to inner vessel walls and their migration through vessel walls.
What are the 3 plasma protien systems which provide a biochemical barrier against invading pathogens in the circulation? complement system, clotting system, kinin system
What 3 pathways can the complement proteins be activated in? the classical pathway, the alternative pathway, and the lectin pathway.
Activation of the complement pathways results in ..... opsonization, activation of anaphylatoxins, cell lysis, and leukocyte chemotaxis.
The clotting cascade (coagulation) prevents... spread of microorganisms, contains microorganisms and foreign bodies at site of greatest inflammatory cell activity, and provides a framework for repair and healing.
What do the kinin system proteins promote? vasodilation and increased capillary permeability and induce pain.
Plasmin and Hageman factor (factor XII) interact to.... activate the clotting cascade, the complement system, and the kinin proteins.
What are some of the inhibitors in the plasma proteins? carboxypeptidase, histaminases, kinases, and C1 esterase inhibitor.
What are the types of cells involved in the inflammatory process? mast cells, neutrophils, monocytes/macrophages, eosinophils, NK cells, platelets, and nonleukocytic cells.
What are the names of the 5 biochemical mediators that are responsible for the vascular changes associated with inflammation and for modulating thelocalization and activities of other inflammatory cells? histamine, chemotactic factors, leukotrienes, prostaglandins, and platelet-activating factor
Inflammatory response is intiated upon... tissue injury or when PAMPs are recognized by PRRs on cells of the innate immune system.
What do the PRRs include? TLRs, complement, scavenger, glycan, and mannose receptors
What do the TLRs recognize? PAMPs, complement receptors recognize complement fragments, and scavenger receptors promote phagocytosis.
What do the central cells of inflammation release? histamine, chemotactic factors, cytokines, leukotrienes, prostaglandins, growth factors, and other mediators
What do H1 histamine receptors promote? inflammation
What do H2 histamine receptors do? inhibit the inflammatory response
What is phagocytosis? the destruction of microorganisms and cellular debris
What are the stages of phagocytosis? recognition and adherence, engulfment, lysosomal fusion, and destruction.
phagocytic killing can be... oxygen-dependent with the production of reactive oxygen intermediates or oxygen-independent with lysosomal enzymes.
Basophils granulocytes that are very similar to mast cells
Cytokines soluble factors that regulate the inflammatory response and include interleukins, interferons, and tumor necrosis factor.
What are ILs? biochemical messengers primarily produced by macrophages and lymphocytes and significantly help regulate the inflammatory response.
What do INFs do? provide protection from viral infection in uninfected cells
Tumor necrosis factor is primarily produced by macrophages and promotes inflammation with both local and systemic effects.
Chemokines synthesized by a number of different cells and induce leukocytes chemotaxis, and are classified as either CC or CXC, depending on their amino acid arrangement.
CC chemokines affect monocytes, lymphocytes, and eosinophils.
CXCchemokines generally affect neutrophils.
Complement proteins can be activated in what 3 pathways? classical, alternative, lectin
Activation of the complement pathway results in: opsonization, activation of anaphylatoxins, cell lysis, and leukocyte chemotaxis
The clotting cascade prevents... spread of microorganisms, contains f) microorganisms and foreign bodies at site of greatest inflammatory cell activity, and provides a framework for repair and healing.
Kinin system proteins promote... vasodilation and incrased capillary permiability and induce pain.
Neutrophils the predominant phagocyte of early inflammation. They are attracted to the inflammatory site by chemotactic factors.
Monocytes/Macrophages arrive at the inflammatory site later than neutrophils and remain longer to clean up debris and promote wound healing
Eos help control mast cell vascular mediators and defend against parasite infection
NK cells Recognize and eliminate viruses, cancer cells, and other abnormal cells.
Platelets interact with the coagulation cascade to stop bleeding and release a number of mediators that promote and control inflammation.
Cytokines soluble factors that regulate the inflammatory response and include interleukins, interferons, and tumor necrosis factor
Local manifestations of acute inflammation are.... the result of vascular changes associated with the inflammatory processk including vasodilation and increased cap permeability.
S/S of local manifestations of acute inflammation redness, heat, swelling, pain
Fx of vascular changes r/t acute inflammation are: to dilute toxins, carry plasma proteins and leukocyts tothe injury site, carry bacterial toxins and debris away from the site.
Sytemic manifestations of acute inflammation are: fever, leukocytosis, and increase in levels of circulating plasma proteins.
Chronic inflammation is characterized by... a dense infiltration of lymphocytes and macrophages. The body may wall off and isolate the inf to protect against tissue damage by formation of a granuloma
Resolutioin (regeneration) return of tissue to nearly normal structure and fx
Repair healing by scar tissue formation
Healing by Primary Intention Inflammatory lesions proceed to resolution, meaning original tissue structure and fx have been restored if little tissue has been lost or injured tissue is capable of regeneration.
Mast cells are found in what parts of the body? skin, GI system, lining of respiratory system
What are the causes of mast cell activation? Physical injury,chemical agents, Immunologic means (anaphylatoxins), activation of TLRs by bacteria and viruses, allergic reaction
What is the mast cell's response to stimuli? release of histamine, chemotactic factors, cytokines