NURS:3518 UIOWA Exam One (Pathology)

stress

- Stress is a real or perceived threat to homeostasis that exceeds a person's coping abilities, activating physiological and psychological responses

- interactions between the brain, endocrine system, and immune system

stages of the general adaptation syndrome

1. Alarm

2. Resistance/adaptation

3. Exhaustion/allostatic overload

alarm stage of the GAS

fight or flight response. Stressor activates the HPA-axis and SNS

resistance/adaptation stage of GAS

body mobilizes resources through adrenal hormones (cortisol,epi, and norepi) trying to restore balance

exhaustion/allostatic overload stage of GAS

if stress continues and adaptation fails→ breakdown of compensatory mechanisms → creates disease risk

real stressor

physical/biological (infection, injury, trauma)

perceived stressor

psychological/ anticipatory (fear of exam/possible harm)

What systems initiate the stress response?

CNS and endocrine system

what is the first step in the HPA axis during a stress response?

the hypothalamus releases corticotropin-releasing hormone

After the hypothalamus releases CRH, what happens next in the HPA axis (stress response)?

The pituitary gland releases adrenocorticotropic hormone (ACTH).

What does the adrenal cortex release in response to ACTH (stress response)?

cortisol

What happens simultaneously through the sympathetic nervous system (SNS) during stress?

the adrenal medulla releases catecholamines epi & norepi

What are the main effects of cortisol and catecholamines during a stress response?

Increased glucose, increased heart rate and blood pressure, immune modulation, altered mood and cognition.

How is a "stressor" defined in the context of the stress response?

Anything that elicits a stress response through the actions of the nervous and endocrine systems.

Where are catecholamines released from, and what are the two main types?

Released from chromaffin cells of the adrenal medulla; the main types are epinephrine (major) and norepinephrine (minor).

Key effects of epinephrine during stress?

Increases cardiac output, dilates vessels to heart/brain/skeletal muscle, dilates airways, and mobilizes glucose.

Key effects of norepinephrine during stress?

Constricts peripheral blood vessels (raises BP), dilates pupils, causes piloerection and sweating.

define the elements of the stress-age syndrome

- lower adaptive reserve, decreased coping capacity, and higher disease risk

increased catecholamines, ADH, ACTH, cortisol

- decreased testosterone, thyroxine, and other hormones

- changes in opioid peptides

- excitability changes in limbic system

- immunodepression and lipid alterations

- hyper-coagulation, free radical damage

Overall effect of chronic cortisol on health?

Immunosuppression and higher susceptibility to disease

what are the short-term affects of cortisol on the body?

Anti-inflammatory, mobilizes glucose, and helps recovery

What are the long-term effects of chronic cortisol elevation on the immune system?

- Suppresses cellular (Th1) immunity

- Shifts toward humoral (Th2) immunity

- Causes poor wound healing and increased infection risk

- Stimulates gluconeogenesis, raising blood glucose

- Acts as a powerful anti-inflammatory and immunosuppressor

How does stress affect growth hormone?

Can be suppressed, impairing tissue repair and growth.

how does stress affect prolactin and oxytocin?

- Prolactin increases, supporting immune function and lactation.

- Oxytocin has anti-stress effects, promoting bonding and positive emotions.

How does stress affect testosterone?

Decreases with chronic stress, leading to reduced libido and reproductive function.

How do endorphins and enkephalins respond to stress?

they are released, providing pain relief and euphoria.

How are female reproductive hormones affected by stress?

Stress can disrupt cycles and fertility.

Cellular adaptations

temporary, reversible changes that occur due to a change in the environment

Atrophy

decrease in cell size

Hypertrophy

increase in cell size

Hyperplasia

increase in the number of cells

Metaplasia

reversible replacement of a mature cell type by another mature cell type with a different function

Dysplasia

- change in the size, shape, or organization of mature cells

- same cell type

- not a true adaptation

Hypoxia

lack of oxygen in tissue

what is the most common cause of cellular injury?

- hypoxia (often due to ischemia, respiratory disease, or poisoning)

- leads to ATP depletion, failure of sodium/potassium pump, etc.

What is the mechanism of cellular injury from hypoxia?

Decreased oxygen → decreased ATP → pump failure → mitochondrial damage, cell swelling, and other dysfunctions.

How do free radicals cause cellular injury?

Unpaired electrons make them unstable → oxidative damage to DNA, proteins, and lipids.

What are reactive oxygen species (ROS), and what do they do?

ROS include superoxide, hydroxyl radicals, and H2O2; they can trigger apoptosis or necrosis.

How does physical trauma injure cells?

Mechanical disruption from burns, fractures, or frostbite.

How does infection cause cellular injury?

Pathogen invasion triggers immune responses and bacterial toxins that damage cells.

How does inflammation lead to cellular injury?

Cytokines, ROS, and enzymes from inflammation damage cells; chronic inflammation or autoimmune disease worsens this.

How do chemicals cause cellular injury?

Direct toxicity or metabolic activation (e.g., alcohol, chemotherapy) damages cells.

What are the types of substances that can accumulate in cells during injury?

- Normal cellular substances (water, lipids, proteins, carbs)

-abnormal substances (exogenous like viruses, endogenous from abnormal metabolism/mineral deposits).

What is the most common and first manifestation of cellular injury?

Water accumulation → cellular swelling (due to hypoxia, decreased ATP, etc.).

How do lipids and carbohydrates manifest in cellular injury?

Fatty liver and CNS dysfunction; common in liver, spleen, CNS, especially with alcohol use or obesity.

How does urate accumulation manifest in the body?

Urate crystals form in joints → gout; occurs when urate oxidase enzyme is absent.

How does calcium accumulation manifest?

Calcium salts deposit in injured tissues → tissue calcification (e.g., heart valves, arteries).

What is apoptosis and its characteristics?

Programmed, regulated cell death; does not cause inflammation; can occur for self-defense or normal development.

What is necrosis and its characteristics?

Accidental or pathologic cell death after progressive injury; caused by ischemia, infection, toxins, trauma, etc.; usually associated with inflammation.

Reversible hypoxia

- obstruction causes a decrease in oxygen supply

- acute cellular swelling occurs

- impairs cell function but does NOT result in cell death

Ischemia

loss of blood supply to tissue

Necrosis

premature cell death

Apoptosis

programmed cell death

Pathologic apoptosis

occurs when rate of apoptosis is too fast or too slow

Common triggers of physiologic apoptosis

- severe cell injury

- accumulation of misfolded proteins

- infection

- obstruction in tissue duct

What is the median age of cancer diagnosis?

66 yo

What are major behavioral/lifestyle risk factors for cancer?

Smoking, alcohol, sedentary lifestyle, obesity, diet high in fat, protein, calories, or red meat.

What are key environmental cancer risk factors?

UV/sunlight exposure, medical radiation, chemicals in water/air/soil.

What genetic factor increases cancer risk?

family history of cancer

Which viral infections are linked to cancer?

HPV, hepatitis B/C, H. pylori, EBV.

What are prevention strategies to lower cancer risk?

Avoid tobacco, limit alcohol, exercise regularly, maintain a healthy diet, reduce UV exposure, get recommended vaccinations.

What are the characteristics of benign tumors?

Slow growth, localized/non-invasive, well-defined capsule, well-differentiated, does not metastasize, regular shape, named "tissue + -oma."

What are the characteristics of malignant tumors?

Rapid growth, invasive, no capsule, poorly differentiated, can metastasize (via blood/lymph), irregular shape, named "cell type + -oma."

In the TNM system, what does T stand for?

size/extent of primary tumor

In the TNM system, what does N stand for?

regional lymph nose involvement

In the TNM system, what does M stand for?

presence of distant metastasis

What is Stage 0 cancer?

Carcinoma in situ; abnormal cells present but no spread- is not cancer yer

What is Stage 1 cancer?

small, localized tumor

What is Stage 2 cancer?

larger tumor with limited spread to nearby tissue

What is Stage 3 cancer?

Larger tumor with local tissue and/or lymph node spread.

What is Stage 4 cancer?

Cancer with distant metastasis.

What are the 10 hallmarks of cancer (capabilities that allow survival & proliferation)?

- Sustaining proliferative signaling

- Evading growth suppressors

- Avoiding immune destruction

- Enabling replicative immortality

- Tumor-promoting inflammation

- Activating invasion & metastasis

- Inducing angiogenesis

- Genome instability & mutation

- Resisting cell death

- Deregulating cellular energetics

How do cancer cells sustain proliferative signaling?

Autocrine stimulation of growth factors.

How do cancer cells evade growth suppressors?

Mutation of tumor-suppressor genes (e.g., RB, TP53).

How do cancer cells achieve replicative immortality?

Activation of telomerase to maintain telomeres.

How do cancer cells induce angiogenesis?

Secretion of VEGF, PDGF, and bFGF to stimulate new blood vessel growth.

What is the function of proto-oncogenes?

They promote controlled cell growth.

What happens when a proto-oncogene mutates into an oncogene?

It promotes unregulated cell proliferation.

What is the role of tumor-suppressor genes?

They regulate the cell cycle and promote apoptosis.

What happens when tumor-suppressor genes lose function?

Leads to unchecked cell growth

Where do somatic mutations occur?

in body (non-germline) cells

are somatic mutations inherited?

no

What type of mutation is responsible for most cancers?

somatic mutations

Where do germline mutations occur?

in sperm or egg cells

Are germline mutations inherited?

yes, they are passed to offspring

What is a key feature of germline mutation cancers?

Early onset with strong family history (e.g., BRCA gene).

What is angiogenesis?

development of new blood vessels

how do tumors stimulate angiogenesis?

By secreting angiogenic factors that stimulate new capillary growth.

Why is angiogenesis important for cancer progression?

Supports tumor growth and metastasis.

What are the main angiogenic factors secreted by tumors?

VEGF, PDGF, and bFGF.

What is the role of surgery in cancer treatment?

Physical removal of tumor; best for localized, non-metastatic disease.

What is the role of radiation therapy?

High-energy radiation to kill tumor cells; localized or adjuvant.

What is the role of chemotherapy?

Systemic drugs targeting fast-growing cells; prevents spread/treats metastasis.

What is the role of immunotherapy?

Boosts immune system to attack cancer.

What is combination therapy?

Use of multiple treatments together for best outcome.

SPACER

Main electrolytes of extracellular fluid

- sodium

- calcium

Main electrolyte of intracellular fluid

potassium

Diffusion

the movement of particles from an area of high concentration to an area of low concentration

Osmosis

- the movement of fluid between two divided compartments to balance the concentration of solutes

- WHY: due to the solutes not being able to cross the semi-permeable membrane

Filtration

the movement of fluid from the capillary to the interstitial space