PATHOPHYSIOLOGY EXAM 1

atrophy

decrease in cell size

hypertrophy

increase in cell size

hyperplasia

increase in number of cells

metaplasia

cell type is replaced by another cell type

dysplasia

deranged cell growth of tissue that results in cells that vary by size, shape, and organization

changes that occur in cell with swelling

decreased activity of Na/K ATPase pump-->sodium ions increase in cell-->osmotic pressure increases--> water diffuses in cell causing swelling--> cell bursts

reperfusion injury

reperfusion (large influx of O2)-->ischemic conditions-anaerobic metabolism-->oxidative enzymes produce reactive oxygen species (ROS)--> ROS damage cell membranes-liquid peroxidation-->cell death

cell necrosis

occurs in irreversibly damaged cells, cell death

benign tumors

grow slow
well differentiated
noninvasive
do not divide
do not metastasize
surrounded by fibrous capsule

malignant tumors

grow fast
poorly differentiated
invasive
divide
metastasis

metastasis

The spread of cancer cells beyond their original site

well differentiated vs poorly differentiated cells

well: looks like normal cells
poor: do not look like normal cells

how does cancer spread

direct invasion and extension, seeding of cancer cells into body cavities, metastatic spread through blood or lymph pathways

Carcinogenesis

process by which carcinogenic agents cause normal cells to become cancer cells

Carcinogenesis steps

initiation, promotion, progression

initiation

Exposure of cells to a carcinogenic agent that causes them to be vulnerable to cancer transformation

promotion

Allows for prolific growth of cells triggered by multiple growth factors and chemicals. Reversible if promoter substance is removed

progression

Manifests when tumor cells acquire malignant phenotypic changes that promote invasiveness, metastatic competence, autonomous growth tendencies, and increase karyotypic instability

physical carcinogens

tanning beds
UV rays

chemical carcinogens

Direct reacting agents or indirect reacting agents, alcohol, smoke

viral carcinogens

HPV and Hepatitis B

immune surveillance

- Immune system plays a central role in resistance against the development of tumors
- Provide a means for the detection, classification, and prognostic evaluation of cancers and as a potential method of treatment
- Suggested that development of cancer might be associated with impairment or decline in surveillance capacity of immune system

systemic manifestations of cancer

- anorexia and cachexia
- fatigue and sleep disorders
- anemia

tumor markers

- Antigens expressed on the surface of tumor cells or substances released from normal cells in response to the presence of a tumor
- Used for screening, establishing prognosis, monitoring treatment, and detecting recurrent disease

systemic manifestations of inflammation

Acute-phase response.
Alterations in WBCs
Fever

edema formation during inflammation

begins with momentary vasoconstriction
followed rapidly by vasodilation mediated in part by lipid mediators and vasoactive products
outpouring of protein rich fluid into extravascular spaces
loss of proteins causes reduced capillary pressure

macrophages

engulf large and great quantities of foreign material (more than neutrophils)

neutrophils

attack and ingest bacteria and cellular debris

phagocytosis

recognition and adherence, engulfment, intracellular killing

cells of phagocytosis

neutrophils, monocytes, macrophages

phases of wound healing

inflammatory, proliferative, remodeling

inflammatory phase

the initial phase of wound healing in which bleeding is reduced as blood vessels in the affected area constrict

proliferative phase

forms granulation tissue for scar tissue development
key cell: fibroblast

remodeling phase

scar tissue formed during healing

factors that influence wound healing

malnutrition, impaired blood flow and oxygen delivery, impaired inflammatory and immune responses, infection, wound separation, foreign bodies, age effects

labile cells

continue to divide and replicate throughout life (skin)

stable cells

normally stop dividing when growth ceases (liver and kidney

permanent or fixed cells

cannot undergo miotic division (nerve cells, cardiac cells)

acquired immunity

Immunity that develops during your lifetime

active immunity

acquired when host mounts an immune response to antigen

natural active immunity

antibodies developed in response to infection

artificial active immunity

antibodies developed in response to a vaccine

passive immunity

transferred from another source

natural passive immunity

acquired by a child through placenta and breast milk

artificial passive immunity

antibodies received from a medicine, from a gamma globulin injection or infusion

adaptive immunity

the ability to recognize and remember specific antigens and mount an attack on them

humoral immunity

mediated by antibodies produced by B lymphocytes

cellular immunity

immune response that relies on T cells to destroy infected body cells

innate immunity

body's first line of defense

innate immunity cells

neutrophils
macrophages
DCs
NK cells
phagocytes
monocytes

adaptive immunity cells

B and T cells
macrophages
DCs
NK cells

IgG

responsible for protection of newborn
only one that crosses placenta

IgA

protects mucous membranes

IgM

forms natural antibodies such as those for ABO blood antigens
activates complement

IgD

needed for maturation of B cells

IgE

allergic reactions

classification of immune disorders

primary
secondary
hypersensitive
autoimmunity

primary

congenital or inherited as sex linked, autosomal dominant, or autosomal recessive traits

secondary

develop later in life because of other pathophysiologic states such as malnutrition, disseminated cancers, infection of cell of immune system (HIV)

hypersensitive

abnormal and excessive response of the activated immune system that causes injury and damage to host tissues

autoimmunity

heterogenous group of disorders that occur when the body's immune system fails to differentiate "self" from "nonself" and mounts an immunologic response against host issues

pathophysiologic mechanisms in HIV

takes over CD4 T cells

Type 1 hypersensitivity

- IgE mediated
- Onset within 1 hour
- Ex: Anaphylaxis
- Allergies

Type 2 hypersensitivity

- IgG or IgM cytotoxic mediated
- Onset in hours to days
- Ex: Hemolytic anemia

Type 3 hypersensitivity

- Immune complex mediated
- Onset within 1-3 weeks
- Ex: serum sickness SLE

Type 4 hypersensitivity

- T cell mediated
- Onset from days to weeks
- Ex: Rash SJS

components of host defense

skin and mucous membranes

host

any organisms capable of supporting the nutritional and physical growth requirements of another

factors affecting host defense

- Weakened by illness, malnutrition, or medical therapy

symptom production in neutropenia

decreased neutrophil count
first signs are skin lesions, pharyngitis, diarrhea

Acute Lymphocytic Leukemia (ALL)

most common in children
structural changes in chromosomes of leukemic cells

Acute Myelocytic Leukemia (AML)

mainly in older adults
affects myeloid precursor cells in bone marrow

Chronic Lymphocytic Leukemia (CLL)

immune incompetent B cells due to failure of apoptosis

Chronic Myelocytic Leukemia (CML)

overgrowth of mature granulocytes in bone marrow
specific chromosome abnormality: Philadelphia chromosome

Non-Hodgkin's Lymphoma manifestations

slow growing: painless lymphadenopathy
more aggressive: fever, weight loss, night sweats

Hodgkin's lymphoma manifestations

painless enlarged lymph nodes, chest discomfort, fevers, chills, night sweats, weight loss, fatigue, anemia

hemostasis

stoppage of blood flow

mechanisms of hemostasis

vascular constriction, platelet plug formation, coagulation

manifestations of thrombocytopenia

- History of bruising, bleeding from gums, epistaxis, melena, and abnormal menstrual bleeding in those with moderately reduced platelet counts
- Splenic enlargement may occur

effect of vascular disorders on hemostasis

- Bleeding resulting from vascular disorders is sometimes referred to as nonthrombocytopenic purpura.
- May occur from structurally weak vessel walls or because damage to vessels by inflammation or immune responses
- Easy bruising or petechia and purpura of skin

manifestations of anemia

- Impaired oxygen transport, compensatory mechanisms, decrease in HGM and RBC indices, weakness, chest pain, cold hands and feet, headache, lightheaded
- Causes: loss of RBCs from bleeding, destruction (hemolysis) of RBCs, defective RBC production, inadequate RBC production from bone marrow failure
- Compensatory mechanisms

TNM best

Tis
N0
M0

TNM worst

T4 N4 M4

T

tumor

N

nodes

M

metastasis

B-12 deficiency anemia

cause: pernicious anemia which causes failure to absorb B12

iron deficiency anemia

anemia caused by inadequate iron intake

apoptosis

programmed cell death

When does HIV become AIDS?

when the CD4 count goes below 200

opportunistic infection

occur as immune system becomes severely compromised

sickle cell anemia screening

made on the basis of clinical findings and hemoglobin solubility results
newborn screening

anemia that handles bone marrow

aplastic anemia

petechiae

small, pinpoint hemorrhages

multiple myeloma

B-cell malignancy of terminally differentiated plasma cells