Clinical Pathophysiology Midterm

Atrophy

decrease in cell size

Hypertrophy

increase in cell size and volume

Hyperplasia

increased cell production (number of cells)

Metaplasia

transformation of one differentiated cell type to another differentiated cell type (less likely to lead to cancer than dysplasia)

Dysplasia

increase in abnormal cell growth or development (pre-cancerous)

Anaplasia

a loss of normal cell organization and differentiation; “to form backward”

Neoplasia

an abnormal growth of tissue that can be benign (noncancerous) or malignant (cancerous)

neo = new, plasia = tissue or cells

irreversible

Apoptosis

programmed cell death

Necrosis

death to 1+ cells or portion of tissue/organ as a result of severe or irreversible damage

not programmed

Calcification

calcium entry into dead or dying cells

Ischemic cell injury

oxygen deprivation

Reactive Oxygen Species

chemicals containing oxygen that are chemically reactive, like peroxides

causes oxidative stress

Ionizing radiation

energy that is high enough to cause the radiolysis of water and form OH- (Hydroxide), which interferes with DNA replication

Telemeres

short nucleotide sequences located that the ends of chromosomes which shorten after each cell division

p53

a tumor suppressor; molecules of DNA that determine the viability of a cell, preserving life if the DNA of an injured cell is repaired, but causing apoptosis if the cell is irreparable

Body’s natural line of defense

• 1st: Mechanical barriers and their secretions (nonspecific)

• 2nd: Phagocytosis and inflammation (specific)

• 3rd: Production of antibodies or sensitized leukocytes (specific)

Signs of tissue injury; inflammation

1. Rubor (Redness)

2. Calor (Heat/warmth)

-Both caused by increased blood flow to area

3. Tumor (Swelling)

-Caused by shift of protein & fluid into interstitial space

4. Dolor (Pain)

-Caused by increased pressure of fluid & local irritation on nerves

Acute inflammation sequence

I. Injury

II. Cells release chemical mediators

• Bradykinin, Histamine, Prostaglandin

III. Local vasodilation – increased blood flow

IV. Increased capillary permeability

V. Formation of exudate

VI. Leukocytes move to site of injury (chemotaxis)

VII.Phagocytosis – removal of debris in preparation for healing

Histamine

immediate vasodilation & increased capillary permeability to form exudate

Platelet activating factor

• Phospholipid mediator of inflammatory response – blocked by corticosteroids

• Active neutrophils and platelet aggregation

Cytokines

increase plasma proteins, induce chemotaxis, induce fever

Prostaglandins

vasodilation, increased capillary permeability, pain, fever, potentiate histamine effect

Kinins

• Increase the inflammatory response by causing vasodilation, increased capillary permeability, pain, chemotaxis

• Activates pain receptors (Bradykinin)

Complement

• Response to infection

• Vasodilation, increased capillary permeability, chemotaxis, increase histamine release

Local signs of acute inflammation

• Cardinal signs (Red, Warm, Swelling, Pain)

• Edema

• Transudate (or the fluid that leaves the blood stream and enters the interstitial tissues)

• Exudate (or Effusion, the Collection of interstitial fluid formed in inflamed area

Serous exudate

clear, thin, watery fluid

Fibrinous exudate

thick and sticky fluid

Purulent exudate

smelly, thick, yellow or green fluid (often called pus)

sign of bacterial infection

Serosanguinous exudate

serous drainage with small amounts of blood present

Abscess

pocket of pus

Hemorrhagic exudate

a type of exudate that is bloody because of the large component of red blood cells released from ruptured blood vessels

Systemic effects of acute inflammation

• Mild fever

• Malaise

• Fatigue

• Headache

• Anorexia

• Shock (cardiac)

• Lymphadenitis

Phases of healing process

• Cell Migration

• Repair & Reorganization of the Extracellular Matrix

• Proliferation of the Cells

• Maturation of the Tissues

OT’s role in healing process

• Reduce the effects of scar tissue (ROM, positioning, scar or edema management, pain management)

• Increase functional use of burned areas (ROM, MMT)

• Return to meaningful occupations (ADLs, IADLs*)

• Getting back into the community (psychological effects: self-esteem, confidence, self-efficacy)

Excitability

a muscle’s ability to respond to a received stimulus

Contractility

a muscle’s ability to shorten in response to a stimulus

Extensibility

a muscle’s ability to stretch

Elasticity

a muscle’s ability to return to its original shape after contracting or extending

Isometric contraction

muscle contraction without movement

Concentric contration

the total length of the muscle shortens as tension is produced

Eccentric contraction

the total length of the muscle increases as tension is produced

Isotonic contraction

the muscle tension remains the same while the length changes – the force is constant while the velocity changes

Isokinetic contraction

the muscle speed of movement remains the same while the length changes – the velocity is constant while the force changes

Myocyte

a muscle cell or muscle fiber

Fascicle

a bundle of myocytes or muscle fibers

Myofibrils

contractile fibers that make up myocytes

contain myofilaments

Actin

small, contractile filaments within muscle cells

Myosin

thick, contractile filaments within muscle cells

Ganglia

a group of nerve cell bodies located in the peripheral nervous system

Motor unit

A Motor Neuron and the muscle fibers it innervates

Alpha motor neurons

The size classification for most of the efferent neurons that innervate skeletal muscles

Gamma motor neurons

regulate the gain of the stretch reflex by adjusting the level of tension in the intrafusal muscle fibers of the muscle spindle

Muscle spindles

wrap around intrafusal fibers of skeletal muscle and detect rate and amount of stretch on muscle

induce contraction of muscles

Golgi tendon organs

upon being stimulated, the associated muscles are caused to relax by the interruption of their contraction

inhibits muscle contraction

Joint kinesthetic receptors

sensory endings in joint capsules similar to integument and Golgi receptors

detect sensory signals and send messages to the brain's sensory cortex via the nervous system. The brain then perceives the movement and position of the joint or limb

Lower motor neuron injury

Spinal Nerve Disease – Poliomyelitis

Nerve Root Compression – Ankylosing Spondylitis

Axonal Injury – Knife Wound or Autoimmune Neuritis

Axonal Branch Injury – Ischemia from Diabetes

Upper motor neuron injury

Cortical Neuron Injury – CVA or Amyotrophic Lateral Sclerosis

Cortical Tract Injury – CVA

Spinal Tract Injury - Trauma

Proximal Femoral Focal Deficiency

a complex birth defect in which the upper part of the femur bone (in the thigh) is either malformed or missing, causing one leg to be shorter than the other

Radial club hand

a congenital hand anomaly where the radius bone in the arm is missing or underdeveloped, causing the hand to be bent towards the body (radially deviated)

Hip dysplasia

occurs when the hip joint has not developed properly and the socket (acetabulum) is too shallow. This allows the ball (femoral head) to slip partially or completely out of the joint

Polydactyly

a condition in which a person has more than five fingers or toes on one, or on each, hand or foot

Torticollis

the muscles of your neck spasm (cramp) and cause your neck to twist to one side

Metatarsus Adductus

Clubfoot

a condition where the metatarsal bones are turned toward the middle of the body

Arthrogyposis Multiplex Congenita

a variety of non-progressive conditions that are characterized by multiple joint contractures (stiffness) and involves muscle weakness found throughout the body at birth

Legg-Calvé-Perthes Disease

a rare condition in which the femoral head temporarily loses its blood supply

Slipped Capital Femoral Epiphysis

occurs when the femoral epiphysis is abnormally displaced posteriorly and inferiorly relative to the femoral head and neck

Tibia Vara

causes a child's lower leg to turn inward and bend to resemble the curve in the letter C

Down Syndrome

extra chromosome #21

Klinefelter’s syndrome

extra X for men-XXY

Turner’s syndrome

missing X in women-0X

Fragile X

typically cognitive deficit in males

Normal WBC range

4,500 to 10,000/mcL

Normal RBC range

Men: 4.7 to 6.1 million cells/mcL

Women: 4.2 to 5.4 million cells/mcL

Normal platelets range

150,000 to 450,000/mcL

Normal hemoglobin range

Men: 13.8 to 17.2 gm/dL

Women: 12.1 to 15.1 gm/dL

Normal hematocrit range

Men: 40.7 to 50.3%

Women: 36.1 to 44.3%

Anemia

not enough erythrocytes or hemoglobin to carry oxygen

Polycythemia

too many erythrocytes

Leukocyte Disorders

Leukocytosis- too many leukocytes

Leukopenia- not enough leukocytes

Leukemia- abnormal leukocytes

Platelet Disorders

Thrombocytosis- too many thrombocytes

Thrombocytopenia- not enough thrombocytes

Coagulation Disorders

Hemophilia

- Acute Hemarthrosis

- Muscle Hemorrhage

Heart rate

Beats per minute (beats/minute)

Normal = 60 to 100; Around 70 at rest

Stroke volume

Amount of blood pumped per contraction ML/beat

Normal = 60 to 120; 60 to 80 at rest

Cardiac output

Amount of blood pumped per minute, L/minute

Normal = approximately 5L/min

Arteriosclerosis

Thickening and hardening of the arteries

Atherosclerosis

a type of arteriosclerosis where arteries narrow due to a buildup of plaque

Thrombus

a traveling clump that could lead to a clot

Spasm

due to sudden constriction of one of the coronary arteries

Coronary Artery Disease

caused by plaque buildup in the wall of the arteries that supply blood to the heart

Angina

chest pain

Myocardial Infarction

caused by decreased or complete cessation of blood flow to a portion of the myocardium

heart attack

Cardiac Arrest

occurs when the heart suddenly and unexpectedly stops pumping

Pericarditis

inflammation of the lining around the heart

Congestive Heart Failure

a long-term condition that happens when your heart can't pump blood well enough to give your body a normal supply

right ventricular failure causes swelling in lungs and legs

left is more likely to cause heart failure

Aneurysm

An abnormal protrusion in the wall of the artery

• Cardiac Valvular Disease

• Rheumatic Fever

• Endocarditis

• Lupus Carditis

• Congenital Valvular Disease

• Mitral Valve Prolapse

Conditions affecting the heart valves

Cardiac valvular disease

stenosis, insufficiency, prolapse

Rheumatic fever

a condition that can inflame or make the heart, joints, brain, and skin swell

caused by streptococcal bacteria

Endocarditis

Inflammation of the endothelium

Lupus Carditis

Pericarditis typically found with lupus patients