Exam 1 Human Pathophysiology

pathophysiology

functional changes in the body that result from disease processes (structural and metabolic)

pathology

study of physical changes in organs, tissues, and cells related to disease

autopsies, biopsies, IHC, diagnoses

Diagnosis

taking info we have and figuring out the cause

Differential Diagnosis

looking at history, physical exam, lab/imaging results, looking at what else it could be

VITAMIN D acronym (not in detail, just what each one stands for)

Vascular

Infectious

Traumatic

Autoimmune

Metabolic/Toxic/Nutritional

Idiopathic/Iatrogenic

Neoplastic

Developmental/Degenerative

What slice does MRI/CT scans see

Anatomical planes and what their slices are

“vascular”

rupture/damage to vessel, blood clots

anuerysm, coronary artery disease

“infectious”

caused by infectious agent (virus, bacterium, fungi)

COVID

“Traumatic”

caused by physical force

broken arm, chronic traumatic encephalopathy (repeated head trauma)

autoimmune

immune system mistakes own tissues as foreign

MS, rheumatoid arthritis

Metabolic/Toxic/Nutritional

metabolic: not a structural cause, if someone born without a specific enzyme

toxic: kidney failure

nutritional: not having enough vitamin c

idiopathic/iatrogenic

idiopathic: we dont know what the cause is

iatrogenic: caused by healthcare (malpractice, staying in hospital for a while→ can get sick)

neoplastic

cells that escape cell cycle control

cancer

developmental/degenerative

developmental: happened during embryonic development/childhood

degenerative: structure that develops normally but breaks down over time, Alzheimer’s, arthritis

diagnostic techniques (xray studies)

radiography

computed tomography (CT)

contrast studies

contrast studies

xray studies

administer something in IV or orally so things light up easier on CT

barium-upper and lower GI series

iodinated IV contrast

xray characteristics/positioning

high energy electronegative radiation that penetrates tissues

penetrate tissues at varying degrees

exposes photographic plates

ionization and distruption of molecules like DNA

→damage dna, generate free radicals, cause cancer

not 3D, they pancake everything into 2D

radiolucent

tissues that dont block the radiation→lungs full of air dont deflect xray

radioplaque

bone blocks/reflects xray

CT scan

computed tomography

patient doesnt move, CT scanners rotate 360 degrees

xray rotates around very fast

a lot more radiation than xrays, dont want these often

a lot more detail of internal

usually get axial/horizontal sections and computers can change into diff planes

ultrasound

no radiation

can actively see how things are functioning

uses sound waves echoing off surfaces, density of material changes echoing, dense materials have lots of bounce back

cheap and convenient

poor resolution and depth penetration

MRI

magnetic resonance imaging

body exposed to intense magnetic field

emits radiowaves

highest resolution, no radiation

expensive

direct visualization techniques

endoscopy (colonoscopy(anus), bronchoscopy(bronchi), cystoscopy(urethra to look at bladder)

laproscopy (abdomen or uterus)

laboratory tests

blood (hematology-blood, chemistry, immunologic-antibody, drug levels)

fluids→urine, joint, peritoneal

feces

blood tests

CBC (complete blood count)

Chemistry panel

CBC

complete blood count (main 3 cell types)

1. RBC count (size, hemooglobin and hematocrit)

2. WBC count with differential

3. Platelet count

chemistry panel

na+, k+, cl- (big 3 electrolytes), ca+, hco3-

BUN and creatinine (kidney function)

glucose (blood sugar, diabetes)

blood tests

liver function tests

cardiac enzymes

LFTs(liver function tests)

blood test

for GI system

Bilirubin (liver responsible for metabolizing)

total protein

cardiac enzyme

blood test

CPK, CK-MB, troponin-I (if high, most likely had heart attack)

microbiology tests

gram stain (bac +/-)

Culture and sensitivity (exact identification; looks at resistance)

pharmacotherapy

treatment with drugs

drug

a substance causing notable change in the body

acute versus chronic toxicity (use a drug to describe)

acute: overdose on acetaminophen (all at once)

chronic: taking acetaminophen daily is hard on the liver

therapeutic index

ratio of toxic dose/effective dose

higher value= greater difference between effective dose=safer

no such thing as a safe drug, its all about the dose

route of drug administration, oral

tablet, capsule, liquid

most convenient

route of drug administration, sublingual

under the tongue (let dissolve, absorbed by tongue veins)

faster than oral

route of drug administration, subcutaneous injection

right under the skin

diabetes/allergy shot

anyone can

route of drug administration, intramuscular injection

skin→fat→muscle

usually deltoid or glute, vaccines given in arm muscle

nurse can, faster absorption than subcutaneous injection

route of drug administration, intravenous injection

“IV”, directly into bloodstream

route of drug administration, inhalation

inhale into respiratory tree

inhalers, anesthesia

route of drug administration, topical

gel, cream, spray, liquid

designed to stau onto skin or into for SLOW absorption

nicotine patch, topical acne meds

route of drug administration, suppository

give meds into rectum, many vessels so gets absorbed fast

why do some routes of drug administration get absorbed better/faster than others?

receptors

proteins on cell surfaces or within cells

ligand

molecule that binds to a receptor with some selectivity

agonist

ligand, attaches readily to the receptor and produces significant biological effect

if low BP, give IV dopamine to increase

antagonist

ligand, also fits the receptor but produces no cellular effect and blocks agonist from binding

for BP, a beta blocker which prevents epi/norepi from binding so keeps BP low

sits in receptor but not perfect so nothing happens

prescription notation

1. name of drug

2. strength of pill

   1. how to take it

other forms of therapy not drugs

lifestyle changes (diet, exercise)

surgery

acupuncture

cognitive behavior therapy

inflammation

series of events that occur when there is damage in the body

nonspecific response to tissue injury

good: brings in protection (WBCs, fibroblast)

bad: response to inflammation can damage normal cells and go from acute to chronic and its painful

causes? almost anything

acute vs chronic inflammation

acute: specific injury/damage

chronic: constant low level damage

signs of inflammation

1. redness/erythema (rubor)

2. heat (calor)

3. pain (dolor)

4. swelling (tumor)

inflammation is triggered and regulated by…

WBCs (leukocytes)

white blood cells (leukocytes)

spend short time in circulation

mostly located in loose/dense connective tissue where infections occur

can migrate out of bloodstream

-contact and adhere to vessel walls near injection site

-squeeze betw

attracted to chemicals that damaged tissues, pathogens, and other wbcs release to attract wbcs

granular leukocytes

wbc type

have cytoplasmic granules

-neutrophil

-eosinophil

-basophil

agranular leukocytes

wbc type

lacking visual cyoplasmic granules

-monocyte

-lymphocyte

leukocytosis

elevated wbc count

neutrophils

multilobed

phagocytic cells that engulf pathogens and debris

especially responsive to bacterial infection

1st ones to the scene

eosinophil

granules stain bright red

specialized to attack parasites

increase in abundance with allergies/asthma

basophils

granules generally stain blue

release histamine and other chemicals promoting inflammation

Monocytes

large cells with bean shaped nucleus

enter tissues and become macrophages and change shape

lymphocytes

slightly larger than rbc with large round nucleus

provide adaptive immunity

b and t cells

mast cells

similar to basophils (circular)

found in tissues

granules filled with histamine/heparin

mediate inflammation

allergy/anaphylaxis (excessive histamine release)

normal capillary exchange vs inflamm response

cut ourselves, rupture skin cells, releases contents (proteins, chemicals), activates mast and basophils to bring more chemical mediators and bring in immune cells and increase blood flow to the area, other cascades (increase pain simulation) increase permeability of capillaries to allow more fluid from vascular system to come in (makes tissue stretch which also triggers pain) and makes it easier for WBCs to come into the area

local effects of inflammation and why

redness and warmth→ caused by increased blood flow to damaged area

swelling (edema)→shift of protein and fluid into the interstitial space

pain→increased pressure of fluid on nerves, release of chemical mediators (bradykinins)

loss of function→may develop if cells lack nutrients, edema may interfere with movement

systemic effects of inflammation

inflation can spread all over the body

fever (pyrexia)→ common if inflammation is extensive, release of pyrogens, tissues and bacterias (IL1) makes way to hypathalamus to reset internal body temp

malaise→tired and feel like shit

fatigue→tired

headache

anorexia/loss of appetite

how does a fever occur, what are pros and cons of running a fever, why is fever accompanied by chills, should we treat fever

pros: increase in temp increases molecular speed and metabolic rate, means WBCs are getting to the area quicker, using their enzymes or phagocytosis to destroy pathogens

cons: proteins could denature, its annoying and uncomfortable

chills are muscles generating more energy and heat bc we wanna increase body temp in a pinch

treatment depends on if we know why they have one and if it isnt problematic or if its causing us problems

chronic inflammation cycle

chronic inflamm causes tissue damage which causes acute inflamm which brings more swelling

inflammation drug treatments

ASA (aspirin)

acetaminophen

nonsteroidal anti-inflammatory drugs (NSAIDs)

glucocorticoids/corticosteroids

ASA (aspirin)

blocks cyclooxygen pathway, antiplatelet effects (keeps them from clotting together)

GI bleeding, impaired clotting, reye syndrome (why its never given to anyone under 18), acidosis (overdose)

acetaminophin (tylenol)

poor anti-inflamm

doesnt work in peripheral body area

works well in brain and with pain

liver toxicity

nonsteroidal anti-inflammatory drugs (NSAIDs)

ibuprofen, naproxen (aleve), diclofenac (Rx)

mostly over the counter, very good at treating inflammation and inflammation related pain

GI bleeding(interferes with stomach producing mucus lining), impared clotting, kidney toxicity (over years and years)

block cycloogenase which prevents arachidonic acid from being broken down

glucocorticoids/corticosteroids

best for inflammation, mocks cortisol hormone that adrenal releases

prednisone (bee sting)

steroids are better antinflammatorys because they block the pathway higher up (block both sides), preventing arachidonic acid from even being produced

can be dangerous

different inflamm drug pathways

issues with corticosteroids

causes impaired wound healing/immune response bc suppresses immune systen bc of how it shuts down and takes over itself,

sodium retention (water retention, edema, elevated BP),

osteoporosis w calcium and phosphate in deposition of bones, cushingoid appearance (increased fat deposition),

adrenal withdrawal syndrome (if taking for a long time, adrenals stop producing them on their own, so you can get sick if you go off it cold turkey)

RICE

rest→get off of it

ice→reduces inflamm

compression→interferes with swelling to keep edema down

elevation→aid in venous and lymphatic drainage of fluid

types of healing of inflammation (3 Rs)

resolution→minimal tissue damage (sunburn), damaged cells recover

regeneration→damaged tissue replaced with cells by mitosis(significant cut/laceration in epidermis)

replacement→functional tissue replaced by scar tissue (if stem cells not in the area), loss of function

things that dont heal very well

cardiac muscle

tendons/ligaments (low blood supply)

neurons

glomeruli in kidneys

healing first intention

first pathway to healing, best way

sutured surgical wound or straight laceration

healing second intention

if cannot close wound (not enough skin to close open infection)

healing complications

stenosis-narrowing of esophagus

adhedions-operating in abdominal cavity, result causes intestines to stick together, can lead to blockage

keloid-abnormal healing of the skin, exaggerated response, giant lesions of collagen, surgically remove but then another keloid will form

somatic pain

from skin, bone, muscle

conducted by sensory fibers (afferent)

“fast” (localized, sharp, intense, right when cut finger) and “slow” (inflammation, aching) components

acute or chronic

visceral pain

originates in organs

conducted by sympathetic fibers

acute or chronic

caused by pathology (trauma, toxins, metabolic disease)

transmitted to spinal cord and spinothalamic tract by sympathetic fibers of autonomic NS

may present as referred pain

usually responds to pain control meds

nociceptors

nociceptors (pain receptors) are free sensory nerve endings

may be stimulated by:

-temp (extremes)

-chemicals (acids, histamine, bradykinin)

-physical means (pressure)

myelinated A-delta fibers

afferent fibers

transmit impulses very rapidly

fast pain (sudden, sharp, localized)

a larger cable (A sized) and myelination make it go very fast

fast pain doesnt persist

unmyelinated C fibers

transmit impulses slowly

slow pain (diffuse, dull, burning, aching, throbbing)

inflam mainly

touch and pain

1. enter neuron in spinal cord

2. crosses over up to thalamus

3. neuron from thalamus (gatekeeper, sometimes feels things sometimes doesnt) to cortex (if comes into cortex comes into consciousness)

referred pain

weird innervation patterns where somatic pain enters at same spot as visceral pain

feeling “phantom” pain

they meet at the same point so they act the same

neuropathic pain

when sensory neurons get damaged

caused by pathology (trauma, toxins, metabolic disease) that directly damages peripheral nerves

burning, tingling, shock-like

poorly responsive to analgesics (not gonna respond bc they block analgesics)

treated with anticonvulsants/antidepressants

anticonvulsants treat to prevent neurons from firing in sudden bursts

*diabetic neuropathy, chronically increases blood sugar and can damage nerve cells

pain treatments (meds, therapy, surgery)

meds: ASA, acetaminophen, NSAIDs (first line for musculoskeletal inflam), opiates (good but have bad side effects), sedatives (not good but dull senses)

therapy: physiotherapy, acupuncture, hypnosis

surgery (if absolutely miserable pain): cordotomy (cutting part of spinal cord), rhizotomy (blading part of dorsal root ganglion to kill all sensation in an area)

opioids/opiates

used to be all natural but they completely changed what its made of and now its entirely synthetic

very powerful, very addictive bc activates reward pathwaya

adverse effects of opioids

dysphoria (negative feelings)

restlessness/anxiety if not used to them

nausea and vomiting if not used to them (stimulates CTZ in brainstem bc recognized as toxins)

constipation (GI opiate receptors slow intestinal motility, overactivated opiates make it slow down, if food moving more slowly, more water gets absorbed and dries/hardens feces

itching (histimine response)

opioids at highest doses, what happens

unconciousness, hypothermia(hard to maintain body temp), hypotension(low BP), pinpoint pupils, respiratory failure due to brain stem depression (control centers dont fire fast enough so you dont breathe fast enough)

opioids and pain (tolerance for different areas)

tolerance occurs rapidly with opioids, but not at the same rate as all effects

analgesia and euphoria: rapid tolerance (over a few weeks, not enough anymore)

nausea itching: fairly rapid

respiratory depression-moderate (not tolerant to same level as euphoria, so easy to overdose)

constipation and constricted pupils-little to no tolerance

opioid receptor agonist

Naloxone (narcan)

blocks opiate receptor, prevents activation, blocks basically everything

SC/IM/IV, intranasal

rapidly reverses opiate intoxication

precipitates withdrawal symptoms

what does bone do

supports body

protects vital structures

movement (at articulations)(leverage for muscles and tendons)

fat storage (inside bone has yellow marrow which is fat tissue)

mineral storage (calcium, phos)

blood cell production (bone marrow, red bone marrow aka where rbcs are produced)

why does bone heal faster than tendons/ligaments

bone is very vascular and innervated, it heals faster than those avascular structures

osteoblast

immature bone cell that secretes organic components of matrix, as it matures, cells get trapped in bony matrix