Exam 1 Pathology

What are the eight cellular functions?

1. Movement

2. Conductivity

3. Secretion

4. Excretion

5. Metabollic absorption

6. Reproduction

7. Communication

8. Respiration

Give me a cell specified for Secretion

Mucous Gland Cells

Do all cells remove waste?

YES (excretion)

What cells perform metabolic absorption?

ALL

Is communication vital?

Yep

Anabolism:

Building up; uses energy

Catabolism:

Breaks down; macros→ energy

Passive Transport:

Diffusion; high → low conc.

What are the 2 types of passive transport?

1. Facilitated Diffusion: Use of membrane protein

2. Passive Diffusion: O2, Alcohol, CO2

Osmosis:

Water movement from down gradient; high → low

Use of semipermeable membrane

Active Transport:

Energy + membrane p.

low→ high

Potassium in, sodium out

What are all the types of Tissues:

1. Epithelial

2. Connective

3. Nerve

4. Muscle

Epithelial tissue:

most internal & external body surfaces

• Simple

  1. Squamous

  2. Cuboidal

  3. Columnar

• Stratified

  1. Squamous

  2. Columnar

• Transitional

Connective Tissue:

Binds tissues to organs

• Bones

• Blood

• Cartilage

• Adipose

Nerve Tissue:

Specialized cells

• Neurons

• Glia: Building blocks of n.s.

Muscle Tissue:

Composed of Myocytes

• Striated

• Cardiac

• Smooth

What are the 2 types of Cellular Adaptation

• Physiologic (adaptive)

• Pathologic

Atrophy:

Decrease in cellular size

• Thymus gland

• Gonads

• Disuse Atrophy

Hypertrophy:

Increase in cell size; mechanical stimuli

Cardiac Hypertrophy: Myocyte enlargement ← hypertension levels

Hyperplasia:

Increase in # of cells

• Hepatocytes: Liver removal

Metaplasia:

Replacement of mature cell with another

• Columnar ciliated epi. cells changed to stratified squamous epi cells

  • Loses protective mechanism

  • Can be reversed if smoking stopped

Dysplasia:

Mature cells undergo abnormal changes in Size, Shape, Organization

• Not a true adaptive change

• Either low/high grade

• Epithelial tissue of cervix

What are the three Tumor types?

1. Benign

2. Malignant

3. Carcinoma in situ (CIS)

Benign tumor:

Stays in place; may progress to cancer

• “-oma” suffix

• lipoma, meningioma

Malignant Tumor:

Rapid growth rates with microscopic alterations

• Named according to point of origin

Carcinoma in situ:

Pre-invasive epithelial malignant tumors of glands/epi origin

• Early stage cancer

• Has not broken through basement membrane and stroma

What causes Cell injury/death?

• Physical Agents:

  • Contusions, lacerations, fractures, incised, stab, puncture wound

• Radiation Injury

• Chemical Injury: over-the-counter & prescribed drugs

  • Leading cause of child poisoning

• Nutritional Imbalances

• Hypoxic Injury: most common cause of injury

  • Ischemia: Low blood flow

Apoptosis

Programmed death in aged/injured cells

Two Processes:

• Normal Physiological Process

• Pathologic Process

Normal Physiological Process in Apoptosis:

• Endometrial cells during menses

• Breast tissue regression after breast feeding

• embryonic process → cell destruction

Pathologic Process in Apoptosis:

• Dysregulated apoptosis

• Carcinogenesis

• Autoimmune disorders

Dysregulated apoptosis:

too much or little apoptosis

• ALS

• Alzheimers

• Parkinsons

Carcinogenesis:

Anormal cell survival

“Cancer”

Necrosis:

Death in a cell still alive

• Loss of plasma membrane

• Enzymatic digestion of cell parts

• Pathological

• Inflammation involved

Gangrene:

Tissue mass undergoing necrosis

Dry or wet

• Clostridium is wet

In 23 chromosomal pairs, how many autosomes are there?

44 and 2 sex chromosomes

46 chromosomes

Zygote

Genetic Disorders:

Single Gene:

1. Autosomal Dominant

2. Autosomal Recessive

3. X-linked D/R

Multifactorial

Chromosomal Disorders

Autosomal Dominant Inheritance:

Both male and females affected equally; 1 parent usually affected

• 1 Parent → 50%

• 2 Parents → 75%

• Marfan Syndrome

Marfan Syndrome:

Inherited disease of connective tissue; 1 in 20,000

• Causes: ocular skeletal, CV anomalies

• ADI

Problems with Marfan Syndrome:

Skeletal:

• Joint Hypermobility, spine deformed, long arms, thin body

Heart: Mitral valve prolapse

Vascular: Aortic valve disease & weak aorta

Myopia: Retinal detachment

Autosomal Recessive Inheritance

Both male & female affected equally

• Cystic Fibrosis & PKU & Tay-Sachs Disease

Outcome Probability of ARI:

1. Both Parents unaffected but carriers → 25% + 50% carriers

2. Both Parents affected → 100%

3. One Parent affected → 100% unaffected but carriers

4. One affected + One carrier → 50%

Cystic Fibrosis:

CFTR Gene mutation on chromosome 7; lower chloride transport

• Test: Sweat test checks for High Chloride

• Treatment: Preventative therapy & lung transplant

• ARI D

Organs Affected by Cystic Fibrosis:

1. Sinuses → Sinusitis

2. Lungs → Mucous Buildup

3. Skin → Salty sweat

4. Liver → Blocked biliart ducts

5. Pancreas → Blocked Ducts

6. Intestines → can’t absorb effectively

7. Sex Organs → Complications

Phenylketonuria (PKU):

Defect in amino acid metabolism → can’t convert phenylalanine to tyrosine (turns to melanin)

• Reduces IQ and causes fair skin/hair

• Eczema

• Treatment: Phenylamine restricted diet

• ARI D

Tay-Sachs Disease:

Glycolipids accumulation in brain neurons & retina; due to lysosome disfunction

• Destruction of brain, s.c., ANS neurons

• Lower IQ, Blindness, seizures, deaths ← 2-5 years

• Treatment: None but genetic screening

• Affects 1:30 Jews

• ARI D

Sex-Linked Inheritance:

Genes located on sex chromosomes

• Either X or Y Linked

• Sons of female carriers have 50%

X-linked Disease:

Males are more affected; causes color blindness

• Cannot transmit to sons but can with all daughters

Chromosomal Disorder Causes:

Two Types:

• Alterations in structure of 1+ chromosomes

  • Due to rearrangement/deletion chromosomal parts

• Abnormal chromosomes #

  • Splitting failure during oogenesis/spermatogenesis

  • Causes Down Syndrome/Trisomy 21

Down Syndrome Manifestations:

1. Protuding tongue

2. Flat nasal bridge

3. single palm crease

4. low IQ

5. Heart issues

Advice for pregnancy with Down Syndrome:

<35; triple screen, alpha fetoprotein

>35: Amniocentesis; chorionic villi

Turner Syndrome:

Missing X/Y; mostly X

• 45 chromosomes

• 1:2500 live births

• genetic testing diagnosed

Turner Syndrome Manifestations:

1. Short statue; webbing neck

2. Lack of sex characteristics and organs

3. Coaction of Aorta

4. Nonverbal problem solving

Functions of Body Fluids:

1. Transport gases, nutrients, & waste

2. Helps generate electrical activity to power body functions

3. Takes part in the transformation of food → energy

4. Environmental stresses and disease affects balance

How is Body Water distributed?

Through:

1. Intracellular water

2. Extracellular/Plasma water

3. Interstitial water

Total Body Water (TBW):

60% of total human weight

1. Intracellular fluid: 2/3 of water

2. Extracellular fluid: 1/3

Extracellular fluid is divided into:

• Interstitial fluid: around cells; most of the bunch

• Intravascular: plasma & lymph fluid

• Transcellular fluid: low amount; synovial, intestinal, CSF, sweat, urine, pleural, peritoneal, intraocular fluids; joint spaces

  • Low # but important

TBW in Peds:

• 75-80% of body weight

• Susceptible to significant changes in body fluids; dehydration in newborns

Aging in TBW:

• v % of TBW

• v free fat mass & v muscle mass & renal decline

• Diminished thirst perception

Intracellular Compartment (ICF)

• Fluid contained within all of the cells in the body

• Higher concentration of K+

• Almost no Ca

• Moderate # of magnesium

• Small Na+

Extracellular Compartment (ECF):

• Contains all outside cell fluid; interstitial or tissue spaces & b.v.

• Higher concentration of Na+

• Moderate # of bicarbonate

• Small K+

Osmolarity:

• of the extracellular fluid almost entirely due to Na+

• of the intracellular fluid almost due to K+ as the primary electrolyte

measure of the total number of solute particles dissolved in a fluid

If ECF/ICF changes in concentration _______

fluid shifts from lesser → greater concentration

Kidneys’ involvement with fluid-electrolyte balance:

• Maintains & excretes body fluids

• Selectively retains substances needed & excretes unneeded ones (like electrolytes, metabolic waste & toxins)

• Regulates pH via excretion/maintaining hydrogen ions & bicarbonate

Lungs’ involvement with fluid-electrolyte balance:

• Rids 300mL of fluid/day out of body & plays role in Acid-Base Balance

• Regulates CO2 conc.

Heart’s involvement with fluid-electrolyte balance:

• pumps blood with sufficient force → perfuse the kidneys → kidneys work ^ effectively

Adrenal gland involvement with fluid-electrolyte balance:

• Secretes aldosterone: Na+ retention (water retention) & K+ excretion

Parathyroid’s involvement with fluid-electrolyte balance:

• Regulates Ca & P balance

• PTH: ^ Ca & v PO4 (phosphate)

Pituitary gland’s involvement with fluid-electrolyte balance:

• Secretes ADH (vasopressin) → ^ water reabsorption in kidneys

• posterior part

Tonicity:

Tension/effect that effective osmotic pressure of a solution w/impermeable solutes exerts on cell size due to water movement across cell membrane

• Isotonic: neither shrink/swell

• Hypotonic: Swell; high osmolarity inside

• Hypertonic: shrink; high osmolarity outside

Water movement between fluid compartments depend on:

• Osmolality: measure of the conc. of dissolved particles (solutes) in solution

• Osmotic forces: force driving water low → high conc.

• Aquaporins: protein that selectively transports water

• Starling forces: water leaving capillary site → lymph → venae cava

  • Net filtration = forces favoring filtration - forces opposing it

Hydrostatic pressure:

caused my water, more water → ^ hydrostatic psi

Colloidal osmotic/oncotic pressure:

Have more proteins → attract water

Filtration:

caused by capillary hydrostatic psi (35mm Hg) + blood colloidal psi (25mm Hg)

• Arterial end net filtration psi = +10 mmHg

No Net movement:

capillary hydrostatic psi (25mm Hg) = blood colloidal osmotic psi (25mm Hg)

• Mid Capillary net filtration psi = 0 mm Hg

Reabsorption:

Fluid re-enters capillary due to capillary hydrostatic psi (18 mmHg) < blood colloidal osmotic psi (25 mm Hg)

• Venous end net filtration psi = -7 mm Hg

Net Filtration:

• Forces favoring filtration:

  • Capillary hydrostatic psi (BP)

  • Interstitial oncotic psi (water pulling)

• Forces favoring reabsorption

  • Plasma (capillary) oncotic psi (water-pulling)

  • Interstitial hydrostatic psi

Edema:

Accumulation of fluid within interstitial spaces

• Causes:

  1. ^ in capillary hydrostatic psi

  2. v in plasma(capillary) oncotic psi

  3. ^ in capillary permeability

  4. Lymph obstruction

• Localized vs generalized:

• Pitting Edema

• Assessing via daily weight, visual assessment, measuring affected part, finger pressor for pitting edema

What are the causes of decreased capillary oncotic psi that would lead to Edema?

Either

1. Loss of plasma protein to interstitial space from increased capillary permeability

2. Lower synthesis of plasma proteins from cirrhosis or malnutrition

3. Increased loss of plasma proteins from nephrotic syndrome

4. Increased plasma Na- and water retention from dilution of plasma proteins

What are the causes of increased capillary permeability that would lead to Edema?

Burns or inflammation

causes loss of plasma proteins to interstitial space

What are the causes of increased tissue oncotic pressure that would lead to edema?

1. Loss of plasma proteins to interstitial space

2. Lymph obstruction → v transport of capillary filtered protein

What are the causes of increased capillary hydrostatic psi that would lead to edema?

Venous obstruction, salt & water retention, and heart failure

Causes fluid movement to tissues

Lymph obstruction and its effects on edema:

1. Fluid movement to tissues

2. lower transport of capillary filtered proteins

Antidiuretic Hormone (ADH):

^ water reabsorption → plasma

• ^ plasma osmolarity → detected by receptors → either fluid intake (will lead to v osmolarity straight up) or hypothalamus detects it → PP pars nervosa → ADH → aquaporins ^ → renal water retention → v plasma osmolality

• v plasma volume → detected by receptors → hypothalamus detects it → PP pars nervosa → ADH → aquaporins ^ → renal water retention → ^ plasma volume

Atrial Natriuretic Peptide (ANP):

^ plasma volume → atrial stretching detected by endocrine cells → ANH release → (glomerulus starts to ^ Glomerular Filtration Rate → excrete more water) or (proximal tubule lowers Na+ reabsorption → excrete ^ Na)

• High amounts suggest heart failure

Renin Angiotensin Aldosterone System (RAAS):

either v extracellular fluid/arterial BP → kidneys sense low # of fluid → Juxtaglomerular cells secrete Renin → turn angiotensinogen to angiotensin 1 → converting enzymes in lungs turn 1 to Angiotensin 2 → (goes to adrenal cortex → induce aldosterone → ^ Na+ reabsorption of kidney thus water too → ^ Vascular volume & arterial BP) or/and (goes to arterioles → vasoconstriction of systematic arterioles → ^ arterial BP)

Osmolarity Alterations:

All occur in interstitial compartment; normal osmolarity is from 275-295 mm Hg

Can either be:

• Isotonic

• Hypertonic

• Hypotonic

Isotonic Alterations:

• TBW change w/proportional electrolyte & water change (no conc. change)

• Isotonic fluid loss/excess

Hypertonic alterations:

• Na gain & water loss → intracellular dehydration & hypernatremia

• ICF → ECF

Hypotonic alterations:

• v osmolality → cells expand & hyponatremia

• water moves into cells via osmosis

Fluid Volume Deficit:

in the Interstitial compartment

1. Isotonic Dehydration

2. Hypertonic Dehydration

3. Hypotonic Dehydration:

Isotonic Dehydration:

• Inadequate intake of fluids & solutes

• Excessive losses of isotonic body fluids

Hypertonic Dehydration

• Excessive perspiration, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, diabetes insipidus all lead to ^ fluid loss

Hypotonic Dehydration:

• Chronic illness, renal failure, chronic malnutrition

To assess body fluid losses measure:

• HR, BP, venous volume/filling, capillary refill rate

• Conditions that predispose Na + water loss, weight loss or body functions indicate v fluid volume

Fluid Volume Excess:

Interstitial compartment

• Isotonic Overhydration

• Hypertonic Overhydration:

• Hypotonic Overhydration:

Isotonic Overhydration

• Hypervolemia

  Excessive fluid in extracellular compartment

  fluid does not shift

  Causes circulatory overload & interstitial edema

Hypertonic Overhydration:

• Rare, excess Na intake

• fluid is drawn from ICF

Hypotonic Overhydration:

• Water intoxication

• Fluid moves into ICF → expansion

Proportionate changes in Na & H20 in Interstitial compartment

Loss of water & sodium → fluid loss in ECF

Gain of water & sodium → fluid excess in ECF