Exam 1 Pathophysiology HSC4555 UCF

pathology

study and diagnosis of disease

physiology

study of physical and biochemical functions of living organisms

pathophysiology

study of abnormalities in physiologic functioning of living beings

four interrelated topics of pathophysiology

1) etiology

2) pathogenesis

3) clinical manifestations

4) treatment

etiology

study of the cause of disease

(why did this happen?)

two types of etiology

idiopathic (unknown cause)

iatrogenic (unwanted/accidental cause)

example of multifactorial disease

coronary heart disease

(many things cause It including: diet, cigarette smoking, mental stress, genetic, high BP...)

risk factor

factor present in pt. which increases chances of disease arising (helpful in disease prevention)

congenital disease definition and example

present at birth

spina bifida

degenerative disease definition and example

gets worse as time goes on

Alzheimers or MS (multiple sclerosis)

iatrogenic disease definition and example

accidental/ unwanted side effect of medical treatment

anemia caused by chemotherapy

idiopathic disease definition and example

unknown causes

some forms of epilepsy

immunologic disease definition and example

abnormal weakness/susceptibility of immune system

rheumatoid arthritis or HIV/AIDS

infectious disease definition and example

commonplace virus, bacteria entering body

TB, influenza (flu), measles, cholera, etc...

neoplastic disease definition and example

abnormal growth of cells

cancers

metabolic disease definition and example

processing of the metabolism

central obesity

nutritional disease definition and example

lacking in one/all nutritional category

iron deficiency anemia

physical agent-induced diseases definition and example

anything chemical that is airborne that can affect the human body

asbestosis, mold exposure, CO2 poisoning

something to keep in mind with etiology

"correlation does not imply causation"

Someone who's never smoked cigarettes can get lung cancer, or, someone who doesn't drink a lot can get liver cirrhosis.

pathogenesis

Development/ evolution of a disease.

(from stimulus to expression of disease via chain of cell --> tissue --> organ --> system)

clinical manifestations

signs and symptoms of disease

sign vs symptom

sign: SEEN (can be tested)

symptoms: FELT (only by pt.)

examples of signs

enlarged lymph nodes, vomiting, high BP, high BGL, bruising, swelling...

examples of symptoms

headache, anxiety, nausea, fatigue, sore throat....

syndrome

when causes (etiology) of signs/symptoms haven't been determined (obscure)

EX: AIDS when first discovered

which of the following is an example of a clinical manifestation SIGN?

A. nausea

B. bruising

C. headache

D. loss of appetite

B. Bruising

what are the 5 stages of clinical manifestation?

1) latent (incubation) period

2) prodromal period

3) acute phase

4) latent period

5) subclinical stage

stage 1 clinical manifestation

"latent period" or "incubation period"

from inoculation (exposure) to first showing signs/symptoms

stage 2 clinical manifestation

"prodromal period"

nonspecific signs and symptoms arise (these are linked to many types of sickness/disease/ailments...i.e. cough, fever, headache...)

stage 3 clinical manifestation

"acute phase"

disease/illness at full intensity

stage 4 clinical manifestation

"latent period" or "decline"

time when signs/symptoms become mild, silent, or disappear

stage 5 clinical manifestation

"subclinical stage"

time when "normal" functioning returns, disease processes can also simply be well established by this point (EX: chronic renal disease)

acute disease

signs/symptoms develop rapidly but the disease lasts only a short time

chronic disease

signs/symptoms develop gradually and continues over a long period of time

exacerbation

increase in the severity of a disease or its signs/symptoms

remission

the temporary, partial, or complete disappearance of the symptoms of a disease without having achieved a "cure"

convalescence

stage of recovery after a disease, injury, or surgical procedure

sequela

subsequent pathologic condition resulting from an acute illness

(EX: post acute rheumatic inflammation...heart having scaring/deformation forever)

Treatment Implications

understanding the etiology, pathogenesis, and clinical manifestations tell us which treatment is best

abnormal vs normal in health care

someones "abnormal" could be someone else's "normal" It is very important to compare disease in a carefully selected "population" (think stats)

reliability

test's ability to give same results repeatedly

(imagine a target, hitting the far right corner repeatedly is reliable not valid)

validity

degree to which that measurement is the "appropriate/correct" value

(imagine a target hitting the bullseye repeatedly is both reliable for its repetition AND valid for its "correct" value)

positive predictive value

disease is PRESENT if test is POSITIVE

(YES disease if +)

negative predictive value

disease is ABSENT if test is NEGATIVE

(NO disease if -)

sensitivity

chance that a test will be POSITIVE when applied to a person WITH a disease

EX: "strep throat swab with sensitivity of 80%" = 20% will test negative and HAVE strep (false negative)

specificity

chance that a test will be NEGATIVE when applied to a person WITHOUT a disease.

EX: "strep throat swab with specificity of 95%"

=

5% of people test positive to having when they don't (False Positive)

factors that influence "normality"

1) culture (poor vs rich)

2) age (infant HR vs elderly)

3) gender (hemoglobin in men vs women)

4) situational (high vs low altitude)

5) time (day vs night)

patterns of disease distribution types

endemic

epidemic

pandemic

endemic

native/confined to a particular region or people

EX: chicken pox outbreak in a classroom of children

epidemic

spread of a disease to many people at the same general time

EX: H1N1 influenza ("swine flu")

pandemic

spread to large geographic areas (world wide not just targeting one population)

EX: ebola when It came across seas to US/other countries

which of the following is an example of a factor that would affect the epidemiology of a particular disease?

A. predictive value

B. southeast Asian ethnicity

C. circadian rhythms

D. clinical manifestions

B. Southeast Asian ethnicity

Which of the following is an example of primary prevention?

A. Maintaining routine immunizations

B. Screening for cancer

C. Rehabilitating after a stroke

D. Performing monthly breast examinations

A. Maintaining routine immunizations

what are the three levels of prevention

primary, secondary, tertiary

primary prevention

lowering the susceptibility of a pt. getting a disease or reducing their ability to get exposed

EX: have pt. quit smoking

secondary prevention

early detection, screening, and management of disease

EX: early screening for breast cancer, getting lumps removed if potentially risky

tertiary prevention

rehab, supportive care, reducing disability, and restoring effective functioning

EX: oxygen and aspirin given to a pt. who's had past MI

3 ways cells respond to injury

1) withstand (reversible)

2) adapt (reversible)

3) cell death (irreversible)

Hydropic swelling (oncosis)

cellular swelling due to accumulation of water

results from broken/damaged sodium-potassium (Na+/K)...creates a gradient that makes water ENTER the cell = swelling

intracellular accumulation

Excess accumulation of substances in cells which leads to cell injury b/c of toxicity, immune response, taking up excessive space needed for functioning.

(anything from excess lipids, carbs, proteins, inorganic pigments, inorganic particles)

atrophy

decreased cell size, as well as reduced functioning (differentiation) in an attempt to save energy.

what can cause atrophy of cells

disuse, denervation, ischemia, nutrient starving, lack of endocrine signaling, persistent cell injury

hypertrophy

increase in cell mass/size in response to physiologic (body building) and pathophysiologic (heart muscle enlargement due to high BP) demands.

hyperplasia

increase in cell number (in cells capable of undergoing mitosis). Can be either physiologic or hormonal.

metaplasia

replacement of one differentiated cell type with another

adaptation: a cell is replaced by one that is better suited to tolerate injurious stimulation

(EX: ciliated columnar epithelium converts into squamous epithelium)

dysplasia

disorganized appearance of cells because of abnormal variations in size, shape, and arrangement

(adaptation gone wrong)

necrosis

cell death via rupture, messy, inflammation

(due to ischemia or toxic injury)

apoptosis

cell death via "suicide", clean, no inflammation

what are the 4 types of necrosis?

1) coagulative

2) liquefactive

3) fat (adipose)

4) caseous

Coagulative necrosis

degradation of cell structures (nucleus, membrane, etc)

"black"

marked by mitochondrial dysfunction (begins with ischemia)

EX: bed sores, necrosis from diabetes in feet

liquefactive necrosis

produced by liquification of lysosomal enzymes which creates a cyst/abscess of dead tissue

"wet"

EX: brain cysts

fat "adipose" necrosis

death of adipose tissue as a result of trauma or pancreatitis

"chalky"

fats are hydrolyzed into glycerol and fatty acids

caseous necrosis

"clumpy cheese"

EX: lung damage from TB

gangrene

cell death in a large area of tissue which occurs when there is no blood supply to a part of the body

what are the three types of gangrene

1) dry (dry, black, wrinkled)

2) wet (liquefactive)

3) gas (anaerobic bacteria)

apoptosis by external pathways

neighboring cells give signals for each other to stay alive

if these signals are removed, cell death program is activated (fas ligand

apoptosis by internal pathways

DNA damage that is beyond repair, mitochondrial damage with leakage apoptosis activators, high levels of p53 protein

which type of irreversible cell injury initiates an inflammatory response?

A. apoptosis

B. necrosis

C. hydropic swelling

D. intracellular accumulations

B. necrosis

ischemia and hypoxic injury

ischemia (low blood supply) causes hypoxia (low O2 levels)

poor perfusion = low levels of power (ATP) in cell

ischemia - re perfusion injury

restoring O2 can cause cell injury rather than reversing it

calcium overload (due to low ATP, ion pumps don't work!) which leads to apoptosis

nutritional injury

need adequate fats, proteins, carbs, vitamins for cell functioning and ATP

some cells more likely to get injury than others (low iron intake affects RBCs and anemia or vitamin D with bones)

infectious and immunologic injury

-bacteria: release of endo- or exotoxins which triggers body's immune system to self attack

-virus: gain entry into host and replicate its own DNA to cause cell injury (ex: Hep. B virus)

chemical injury

toxic chemicals, poisons, or pollutants cause cellular injury (direct or indirect)

direct: lead poisoning (on neural tissue)

indirect: carbon tetrachloride (in cleaning agents) converts into CCl3- in liver, causing liver failure

physical and mechanical injury

-Extremes in temperature

-Abrupt changes in atmospheric pressure

-Mechanical deformation

-Electricity

-Ionizing radiation

in what two ways does radiation effect cells

1) genetic damage (changes the DNA code)

2) acute cell destruction (gonadal, mucosal, fetal, hematopoietic)

somatic death

death of the entire body

-cool, pale, diaphoretic (clammy), blood pooling, rigor mortis, etc

congenital disorder

disorder present at birth

(can be genetic or environmental)

congenial malformation

structural defects caused by errors in fetal development

(typically genetic, but can also be environmental)

diploid (2n)

two copies of each chromosome (23 + 23 = 46)

haploid (n)

unpaired chromosomes (23) (get one set from egg and one from sperm)

autosomes

first 22 pairs of chromosomes

sex chromosomes

last pair of chromosomes (#23) what differentiates a man (XY) vs a woman (XX)

four types of genetic disorders

1) chromosomal abnormalities

2) mendelian single-gene disorders

3) non-mendelian single-gene disorders

4) polygenic / multifactorial disorders

chromosomal abnormalities

wrong NUMBER of chromosomes (called aneuploidy)

change in shape of one or more chromosomes

aneuploidy

wrong number of chromosomes (either >46 or <46)

(caused by nondisjunction)

monosomy

gamete lacking 1 chromosome

polysomy

gamete having too many chromosomes

Example of Autosomal Aneuploidy

-Trisomy 21 (Down Syndrome)

-Trisomy 18 (Edwards Syndrome)

-Trisomy 13 (Patau Syndrome)

"Trisomy" meaning

having 3 sets of a chromosomal "pair" (should only be 2 in a pair not 3)

Example of Sex Chromosome Aneuploidy

-Klinefelter Syndrome (extra X in males: so its XXY or XXXY)

-Turner Syndrome (monosomy X in females: one X no Y)