Essentials of Pathophyslology Part 1

Essentials of Pathophyslology - Exam #1 Review Sheet Covers Modules 1,2, and З -Chapters 1, 2, 6, 12, and 13 Deflne pathophyslology. What does the study of pathophyslology include? -The study of the disorder or breakdown of the human body's function -Disease occurs when there is а disruption in homeostasis or deviation from normal -Тhе study of pathophysiology includes: ⇒ Etio/ogyj(study of causeфr reasons for phenomena, identifies casual factors that, acting in concert, provoke а particular disease or injury) ,:-⇒ Pothogenesis (development or evolution of disease, from initial stimulus to ultimate expression of manifestations of the disease- affected Ьу time, quantity, location) ⇒ Clinica/ manifesration (S&S) ⇒ Treotment (understanding the etiology, pathogenesis and clinical consequences of а particular disorder/disease/illness may determine which treatments could Ье helpful­ i.e. disease caused Ьу bacteria treated very differently than disease caused Ьу virus, does patient have heart disease, family hx, other coinarЫdities, etc.) Review the difference between signs and symptoms/objective versus subjective data \ f, ; 'i ⇒ Slgns- objective or 'abserved manifestation of disease (we сап see, hear, smell i.e. rash, 11110' J\ J, 1', inflammation,etc.)1111Y1)lfl!l:'r '5I/()\ ni ⇒ Symptoms- subjective feeling of abnormality in the body felt or described Ьу the patient (nausea, stiffness, pain) What is epidemiology? Revlew the different levels of disease prevention such as primary, secondary, and tertiary as well as examples for each. - The study of patterns of disease involving populations (how diseases аге spread, how ri'II I У.1 /J['\ 1 individuals are exposed, review information and study how to keep people healthy) li', 'г;•\/I i! 1Ь1 - Examine occurrence, incidence, prevalence, transmission, and distribution of diseases in large population/groups -Levels of Disease Prevention 1. '1 Primary: i 1 , 1 ; 1 1 ➔ ) '' 1 - Altering susceptiЫlity or reducing exposure for susceptiЫe persons - Focus оп disease prevention - Preventing illness Ьеfоге it happens - Example: lmmunizations/Vaccines, hand washing, social distancing, lowering stress levels, healthy eating Secondary: - Early detection, screening and management of the disease (in early stages) - Can't prevent disease but can try to catch early on to manage and prevent it from getting worse - Examp\e: Cancer screening, performing monthly breast exams, рар smears 3. Tertiary: - Preventing further complications from the initial disease/disorder - Focuses on rehabllitation, supportive саге, reducing disabllity, and restoring effective functioning - Example: PT/OТfollowing а stroke ··, , \\ ') ,1_,у 1 / !J, \ V r r П \' f Revlew the difference between homeostasls and allostasls ⇒ Homeostasis: а state in which all systems аге in balance, а state of equilibrium -Maintaining interna\ conditions staЫe- body works in optimal conditions in homeostasis (i.e. thermoregulation, endocrine system) ⇒ @lostasls: abllity to successfully adapt to challenges i• -Body's method of compensation to return to homeostasis (i.e, body's method of returning рН levels to normal range when ili respiratory acidosis) ,r. ('1� ' !0s\��-lntricate regu\atory processes orchestrated Ьу the brain \ • � -А dynamic process that helps the body achieve homeostasis in light of environmental f:-(\, ' \--'�'<: 1'}J� �>., \\ \ ,..f. and lifestyle changes °\ ") "'<-' "�Revlew the three dlfferent stages of the General Adaptation Syndrome (GAS) including the alarm stage, adaptatlon/resistance, and exhaustion stage, What complications сап occur 11 stressors are not resolved? -Stress is а physical, chemical or emotional factor resulting in tension of body ог mind -Сап Ье а real ог perceived threat to homeostasis -Direct conscious\y ог indirect unconsciously sensed threat to the staЫ\ity of the organism -Examples of stress: sweating when body is hot- cools down body to return to homeostasis ⇒ 3 Stages of GAS: Alarm Stage: Fight ог flight response as the result of the stressful stimulus (i.e. incoming саг in traffic, emotional response (stress) to thought of exam/new quarter "J), f, , J)'; ,(' tlf: , Г) • Hypothalamic-pituitary-adrenal (НРА) axis is fired -1, cL19rJ t rvr к • Provides а surge of energy and physical alterations to either evade ог confront danger (fight ог flight) 2.. Adaptation/Resistance Stage: Activity of the nervous and endocrine systems in returning the body to homeostasis • Body must Ье beyond alarm stage • Cortisol levels and the sympathetic nervous system retum to normal • Fight or flight symptoms begin to decline • The body either adapts ог alters its workings to limit ргоЫеms ог become desensitized to the stressor З. Exhaustion Stage: 11 stressor is not removed/overcome, this stage occurs • Point where body сап по longer return to homeostasis after prolonged exposure to the stressor - Body becomes depleted and damage may арреаг, homeostasis can no longer Ье maintained through compensatory mechanisms- decreased adaptation • Body's defenses are utilized (loss of resistance to stressor), disease ог death results • Examples: anxiety, depression, headaches, insomnia, infections and CVD t,I( 1 �/{lt � plip115 " d.1a.1a.J' Pituilary gland Conex Glucooortlcolds Pituitary-вdrenal вxls \ncreмe ln access lo 81181\JY slorage, Ьоdу metaЬolism epeeda up Sympothoadrel\Вl pa\hway AdrenaUne (eplnephrlne) lncreasвd heart rale, breathlng rate, Ыооd suga, The flght-o,.nl\jht reщюnse rigure 2·1 Physiological rвsponse to stress . -..�-� -- --·__ -------.._ ..- ...... ......... .,.,_.,....,_ ,,__, --=--=..:�•--� .... ........,_ �-ta-lfl�- 1,-,1........,.._ ........ 'lo!� [-..1--a(or...-- 1-i ____ lfl.,..,... ... �-ь- ........,.,..........,._..__ l.a.tl--."'-; .................... ---'-� � What hormones are released durlng the alarm stage and what effects do they have оп the body? ⇒ Steps of Alarm Stage; 1. НРА is fired, hypothalamus secretes corticotropin-releasing hormone (CRH) to activate the sympathetic nerve system (fight or flight) and adrenocorticotropic , 1 1/ hormone (АСТН) 1 ') \ r f) J) 1+ 2. SNS stimulates the adrenal medulla to release the catecholamines (norepinephrine AND epinephrine- release start system of increasing heart rate, increasing Ыооd pressure, etc.) 1t 1r 1 )1 tY 3. АСТН causes the adrenal cortex to release glucocorticoids (specifically cortisol­ increase Ыооd glucose, reduce inflammation, provide energy to organs in fight or flight) ... Main point: the SNS delivers nutrients to vital organs (heart, lungs) and diverts nutrients from non-vital nutrients (GI tract) Revlew the dlfferences between the sympathetlc vs the parasympathetic nervous systems. What happens to the body durlng "fight-or-fllght" response? '-) 1\•,,-, ⇒ Parasympathetlc Nervous System о Rest and digest о Constrict pupils о Stimulate saiiva о Slow heartbeat о Constrict airways о Stimulate activity of stomach о lnhiЫt release of glucose; stimulate gallЫadder о Stimulate intestine activity о Contract Ыadder о Promote erection of genitals ⇒ Sympathetic Nervous System о Fight ог flight о Dilate pupils о I nhiЫt salivation о lncrease heartbeat о Relax airways (bronchodilation key when delivering epinephrine during anaphylaxis} о lnhiЫt activity of stomach о Stimulate release of glucose; inhiЫt gallЫadder о lnhiЬit activity of intestines о Secrete epinephrine & norepinephrine о Relax Ыadder о Promote ejaculation and vaginal contraction PARASYМPAtнmc NERVES "Rmмddlgest" SYMPAtнmc NERVES "Rght or ffight" Conmtct puplls Dl18te pupUs Stlmut.te иllv. lnhlЫt uliY1tlon Slow hнr1Ьнt lnuuи hetlrtЬelt Conltrlct alrways Relu alrw1,s Stlmulate artlvlty ofstomach lnhlblt actlvlty ofstomlll \( .; 1 {-; and phospholipids found in cellular membranes о Smooth ER functions: detoxification, lipid metabolism, synthesis of hormones, calcium storage 1 ::} ,i, l 1н,,1Jl(•fi(,•;..l Review the dlfferences between extracellular fluld and intracellular fluid. Which electrolytes are found ln hlgh concentration outside the cell versus lnslde the cell? ⇒ •Extra'cellular fluid (ECF)- outside of се\I, 25% of fluid, plasma and interstitial fluid (sodium, chloride, Ыcarbonate) -Saline solution (NaCI) commonly administered. Want to mimic the electrolyte composition of the Ыооd to avoid electrolyte/fluid disturbances "',, J -i I н· r 1·11 llntracellular fluid (ICF)- inside the cell, 75% of fluid (potassium, magnesium and hydrogen phosphate) lnterstltlal fluid (IF)- fluid between cells Review how fluld ls transported across the plasma membrane of the cell. Review the dlfference between diffusion and osmosis. ⇒ Passive Transport: substances move down concentration gradient (high to low), по АТР required о Osmosis-movement of water (fluid) throughout the body -Osmolality: concentration of so\utes (high osmolality = high concentration of so\utes low of water, low osmolality= low concentration of solutes high of water) о Diffusion- movement of electrolytes, nutrients \ \IC"]\ ; ·\ IJ ) Uc J ⇒ Active Transport: substances move against their concentration gradient (low to high), requires АТР Review ways that fluids enter the human body (intake) versus ways fluld 1s excreted (output) out of the body. - Water intake: most water enters the body through ingested liquids and solid foods, some produced Ьу cellular metabolism (metabolic water), also сап Ье administered iruravenously , \J �1 1tJ Ь 1 !--.11J Water output: urine (60%), sweat, f�ces, and water уа рог from lung via exhaled air, , 1 1[ ! 1 ! 1 , 1 wounds,.5Q11/tC1,d1C1rt')iCO 11(1 \11\11· i 1 .. *ldeally, water intake = water output Revlew conditions that result in ECF volume deflcit (dehydratlon) versus ECF volume excess (hypotonic hydration). What are signs, symptoms, and causes for each? ⇒ Dehydratlon = water output exceeds intake over а period of time, ECF volume deficit / l-) \ 1 tl 1 11 •11 гr - Common occurrence among hemorrhage, severe burns, prolonged vomiting/diarrhea, profuse sweating, water deprivation and diuretic abuse, diabetes mellitus ог diabetes insipidus - water from ICF travels to ECF to try to restore depletion, causes imbalance -5&5: - dry ог cotton mouth - extreme thirst - dry flushed skin - L)('ГY(i'J\( 1' .fnlil)LI(: 1Г L •!fflPirJ1 ' - decreased urine output {oliguria) - prolonged dehydration may lead to weight loss, fever and mental confusion, hypovolemic shock (decreased Ыооd volume) ⇒ Hypotonic Hydration -over ydration aka water intoxication \,О \lltF �, r , 'l t 1 \.\ 1 \ 1 , \ i"' -occurs when too much water is taken in too rapidly ог renal activity is decreased -concentration of ECF increases, causing ECF osmolality to drop {hyponatremia) -inhiblts release of ADH (antidiuretic hormone), less water is reabsorbed and excess water is quickly flushed from the body in urine -water moves from ECF to ICF, causing cells to swel\ and potentially burst- becomes dangerous if brain cells are affected {cerebral edema)-"7tllj\'O r/(1 �П)1 ,С\ -Leads to severe metabolic disturbances in: N/V, muscular cramping, cerebral edema {convulsions, сота and death) , t1tl \! • 1 -Сап Ье treated Ьу IV administration of hypertonic saline solution to pull water out of cells What is edema1 Revlew the varlous factors that сап contribute to edema. ⇒ Edema: accumulation of fluid in the interstitial space, leading to tissue swelling - сап Ье localized ог generalized - can Ье due to an increase in the forces that move fluid from the capillaries to into the interstitial compartment OR а decrease in forces that move fluid from the interstitial compartment into the capillaries о Factors that contribute: , , : , \ 111 Lj � • • lncrease in hydrostatic pressure {Ыооd vessel Ыockage, incompetent venous valves) • lnflammation {increased capillary permeabllity) • Congestive heart failure 1 ),..1 (' \ у ( 1 J \ C'1t 1 [1 high-Ъfood'volume/hypertension ) г----·---- _____ _ '> Kt'l'),.i \ , • decrease in plasma proteins (albumin) - important protein produced Ьу • 1 1, , liver, helps water retention, without its water escapes Ыооd vessels and ,J J \1' 1 ' ) /'\ 1 i (11/' gets into interstitial fluid, often seen with cirrhosis of the liver or alcoholism, will present as ascites ог increase of fluid in the abdominal cavity • Ыockage of lymphatic drainage {due to cancer ог removal of lymph tissue) Review the signs and symptoms of hypernatremla/hyponatremia, hyperkalemla/hypokalemla, hypercalcemia/hypocalcemia, hypomagnesemla/hypermagnesemla, hypophosphatemia/hyperphosphatemla. What electrolyte lmbalance would result ln positive trousseau's and Chvostek's slgn? ⇒ Sodium: Normal range 135-145 mEq/�, - Most significant/prevalent electrolyte of ECF, controls serum osmolality and water balance -facilitates muscles and nerve impulses -main source = dietary intake -excreted through the kidneys and GI tract о Hypernatremia: levels > 145 mEq/L • caused Ьу dehydration, loss of water from ECF • S&S: excessive thirst, lethargy, muscle twitching and convulsions о Hyponatremfa: fevels < 125 mEq/L • caused Ьу water retention, loss of Na+ from D/V, burns, excess water intake • can cause cerebral edema ⇒ Potassium: Normal range: 3.5-5 mEq/t -\ 1lflY � ( (''J Y[I 1 '1( 1' ',\) r J - Primarily found ICF, plays role in electrical conduction, acid-base balance and metabolism -main source = dietary intake - excreted through kidneys and GI tract - heart has high sensitivity to potassium, not much fluctuation сап оссuг without causing serious issue, levels оvег 6 сап cause lethal cardiac arrhythmia (V-Tac) о Hyperkalemla - levels > 5.5 mEq/l • caused Ьу renal failure, severe burns, crushing injury, оvег ingestion of potassium supplements ог IV potassium • burns cause excess fluid in the cells and therefore they burst, releasing it into the Ыoodstream • S&S: intestinal cramping, diarrhea, irregular heartbeat о Hypokalemia- levels <3.5mEq/l • caused Ьу D/V, improper diet, NPO (nothing Ьу mouth- pt. w/o food ог water fог days), loop diuretic use, increased insulin and epinephrine (causes К+ to shift into cells from ECF) • S&S: muscle weakness, paralysis, irregular heartbeat ⇒ Calclum: normal range l 8.5-1D.2 mEq/l - Plays а role in Ыооd clotting, hormone secretion, гесерtог functions, nerve transmission and muscular contraction - Mostly found in teeth and bone . 1 ,. , ,[ [Ql[ill'fY-1 jГi/('i.• ел 1�1 н, - lnverse relationship with phosphorous levels-'\ iiD3pr1ГJ\'I.I S IПI С 1 ; rн f У�' LY ' p v1rr v 1 ·,_,r, о Hypercalcemla: levels > 1D.S mEq/l • caused Ьу hyperparathyroidism (over release of paгathyroid hormone causes оvег release of osteoclasts), excessive vitamin D, leukemia/bone tumors • S&S: diminished reflexes, headache, confusion, lethargy, muscle weakness {due to decreased neuromuscular excitaЫlity), renal calculi and cardiac arrhythmias) Hypocalcemia: levels < 8.SmEq/l • caused Ьу deficiency in vitamin D, burns, роог nutrition, alkalosis, hypoparathyroidism • S&S: increased excitaЫlity of muscles, hyperactive reflexes, tingling sensation in muscles, tetany (stiffening), POSITIVE Trousseau sign, POSIТIVE Chvostek sign, cramps and tremors • Chvostek: tap оп the pts face where the jaw meets the cheek • positive: еуе will twitch due to overactive reflexes • negative: по twitch • Trousseau: tap where you would normally take ВР in the wrist • positive: hand will cramp • negative: по cramp ⇒ Magnesium: normal range 1.8-2.5 mEq/L - mostly stored in the bone and muscle - plays а role in muscle and nerve function, cardiac rhythm, immune function, bone strength, Ыооd glucose management, Ыооd pressure, energy metabolism, and protein synthesis - main source is dietary intake - excreted through kidneys о Hypermagnesla: tevels > 2.5mEq/L • causes: renal failure, excessive laxative and antacid use • 5&5: similar to hypercalcemia о Hypomagnesia: levels < l.8mEq/L • causes: inadequate intake, chronic alcoholism, malnutrition, pregnancy, diarrhea, diuretics, stress • S&S: similar to hypocalcemia ⇒ Phosphorous: normal range 2.5-4.5 mg/DL - mostly found in the bones, small amounts аге in the Ыoodstream - plays а role in bone and tooth mineralization, cellular metabolism, acid-base balance, and cell membrane formation - main source is dietary intake - excreted through kidneys - inverse relationship with Calcium о Hyperphosphatemia: levels > 4.5 mg/dl • causes: deficient excretion due to renal failure, hypoparathyroidism, adrenal insufficiency, hypothyroidism, laxatives, hypocalcemia and acidosis • S&S: rarely seen alone, similarto hypocalcemia о Hypophosphatemia: levels < 2.5 mEq/dL • causes: hyperpaгathyroidism, alkalosis, deficient intake, vitamin D deficiency, alcoholism • 5&5: similar to hypercalcemia What are electrolyte reservoirs? What electrolytes are found ln bones? ч\ Where in the body excess electroJytes аге stored that сап Ье accessed in times of need. {1.е. calcium, magnesium and phosphate аге stored in the bone) l1 r t· '> 11. )1 С •U\I, ,,.,1,,,,:{_·1--1 \.,,; li nLJt'\'lru',tu.1,s What are the cardinal slgns and symptoms of inflammatlon? What lab tests сап detect inflammation in the body? :::::> 2 Types of lnflammation: о Acute (short in duration, lasts less than 2 weeks) о Chronic (longer term, may result in scar tissue formation ог deformity :::::> S&S: о localized: occur with acute and chronic, сап lead to systemic involvement о Cardinal signs: redness, heat, swelling, pain, loss of functionl' 11, r' 11 1 ( !,i� 'i JI, '(ll 1 о Systemic: • Fever, neutrophilia, lethargy, muscle catabolism :::::> Lab tests that сап Ье used to detect inflammation: ESR (Erythrocyte sedimentation rate­ increases with inflammation), C-Reactive protein (inflammation marker) ra �; ) :)\:' Review the role of histamines, bradykinin, prostaglandins, and leukotrienes. What effect do they have on the body during an immune response? г) 11'' Г(11 \�(' These chemicals known as 'Medi�tors'-activate an inflammatory response. Steps: о Break in skin -> causes injury to capillaries -> release of bradykinin from injured cells о Bradykinin- Ьinds to pain receptors, causes paln response. Causes mast cells and basophils to release the other mediators. о Prostaglandins, histamines, leukotrienes: these chemical mediators cause vasodilation (increased Ыооd flow and capillary permeabllity, allows for movement ofleukocytes to site oftissue injury) ,, , ··,r ,. • 11 о these аге felt as heat and Capillary leaking occurs. ' 1 ' J·l Review the differences b!!tween lnnate and adaptive immunity? Whlch is specific? Which is • 1 С IIY>i !· i t" 1 • • ,.. nonspeclfic? i�'" >У J1 /"'t <:,�\'(\ ,��r11 1 � . �: 11\ 1;,. ,'. 1'":, :::::> lnnate- engra1ned, non-spec1fic ; ( V! , . 1 1, 1 r,:, 1 , ,1 r • 1 L А.'. р! ;f'" 1 . , i (' j' 1 :::::> Adaptive- acquired, specific, constantly evolving and changing -Recognizes, destroys and retains memory of foreign invaders l Jr 1\ 1 r'rJui 1 ·, ✓ -в cell and Т cells (2 types of Т cell - helper and cytotoxic) involved, must differentiate r, between self/nonself -В cells circulate freely and Ьind to bacteria, toxins and viruses, mark them for destruction Ьу phagocytes, produce antibodies in response to their specific antigen -Cytotoxic cells directly attack and kill other cells -Helper cells interact with В cells, recognize antigens that аге presented to them Ьу macrophages ог dendritic cells, mobllize lymphocytes and macrophages to site of infection What factors contribute to antimicroblal resistance in microorganisms? How сап we prevent r thespreadofmicroorganisms?�Y1l}IГ,tJ:!,t /r, i, rr r lu • )1, , - Mutation of virus, not taking antiblotics as prescribed ог full duration of prescription, 1 /overuse of antiblotics \ r, \ ,,-, (\1 ltli ,.1 � LI' '- 1 1 r , , ' 1 ' • ; � Revlew the difference between active anJ passive immunity, know examples for each type. Г) \1' ' r •1 ·r r L' 1 , , lt , , • , ⇒ Passlve- antibodieJ аге passed оп from protected to unprotected, short term efficacy­ individual does not produce memory cells from transfer (ех: immunity passed оп from r \ mother to fetus ог child, serotherapy- direct injection/infusion of antibodies) ⇒ Active- body has to fight off infection and develop immune response, long term efficacy, leads to production of memory В and Т cells, second exposure yields quicker immune response (ех: vaccines)-'1 , •. , , 1 ч ',\: • 1·, What 1s а hypersensitivity? Revlew the four different types of hypersensitivities: Туре 1 (Anaphylactic), Туре 11 (Cytotoxlc), Туре 111 (immune complex), Туре IV (Delayed cell­ mediated). Know examples and mediating factors for each type. г'J ",1· lir' t 1(tf,..,pl Hypersensitivity: Over active antigen response to an environmental factor beyond what is considered normal ⇒ Туре 1: Anaphylactic .,,,, [ :(. j ,, J г rrri, ( ' 1I11rl о occurs within 2-30 minutes of antigen exposure о antigen Ьinds to lg attached to mast cells and basophils, causing degranulation, r н 1\ , r .. which releases mediators • Clinical manifestations: • Mild: Hives, Seasonal allergies, Eczema • Moderate: Throat constriction, Localized edema, Wheezing, Tachycardia , (-,\'Г' 1 i '· \ :.li I У • Severe: - Anaphylaxis, life threating • Treatment: о Antihistamines (Ыосk effects of histamine) о Beta-adreneгgic (decrease bronchoconstriction) о Corticosteroids (decrease inflammatory response) о lgE therapy (inhiblts Ьinding of lgE to mast cells) ·1 о Epinephrine '\.' , ' \)11, '' r .. *REMEMBER: lgE Ьinds and Epinephrine treats ⇒ Туре 11: Cytotoxic о lnvolve lgM or lgG antibodies о Examples include: Ыооd transfusion reactions, hemolytic disease of the newborn (remember Rh- mother and Rh+ ЬаЬу, maternal antibodies attack fetus) • Cytotoxic autoimmune reactions- antibodies react with cell-surface antigens • Graves' disease: thyroid gland is attacked Ьу antibodies, causes hyperthyroidism • Myasthenia gravis: antibodies attach acetylcholine receptors at neuromuscular junction, Ыосk АСН from Ыnding to receptors on muscle cells •••REMEMBER: lgM and lgG antibodies are formed and both Mom and Grandma could pass оп hemolytic disease of the newborn ::::> Туре 111: lmmune Complex о lgG antibodies and antigens form immune complexes which circulate in the Ыооd and сап become lodged in basement membranes beneath cells о Activate inflammatory response which сап cause tissue damage о Examples: rheumatoid arthritis (RA), glomerulonephritis (inflammation of the kidneys), SLEI'• i1�, ! ·,,: ... REMEMBER: lgG antibodies and antigens cause inflammatory response, Grandma has RAI ::::, Туре IV: Delayed cell-mediated о Cell mediated immune responses caused Ьу Т cells о Antigens аге phagocytized and presented to receptors оп Т cells, causing sensitization о Reexposure to antigen cause memory cells to release destructive cytokines о Examples include: Mantoux screening test for ТВ, contact dermatitis (poison ivy, certain metals, latex) •••REMEMBER: Т cells cause immune response, example of this is ТВ test