Patho exam 1

What are the three reactions cells have have to injury or stress over time?

1.) adaptive - compensatory, maintaining homeostasis

2.) maladaptive - derangements of structure and function

3.) necrosis - cell death

atrophy

cellular shrinkage, caused by low metabolic support, use, and stimuation, and old age

hypertrophy

cellular enlargement, caused by increase stress and resistance (intense exercise)

hyperplasia

increased number of cells, (keloids)

metaplasia

replacing one cell type with another cell type (In GERD, the esophogeal cells may be replaced with stomach cells after constand acid exposure)

dysplasia

deranged cellular growth

neoplasia

new growth (tumor)

TIPD

TIPD stands for things that drive cellular changes. “Injury TIPD the homeostasis scale out of balance.”

Toxic Injury (endogenous or exogenous)

Infectious/inflammatory

Physical injury

Deficit injury

Endogenous

within the body, genetic or hypersensitivity reactions

Exogenous

external from the body, alcohol, tobacco, chemical, etc.. lead, carbon monoxide, drugs that alter cellular function

Infectious/inflammatory injuries

may be viral, fungal, protozoal, or bacterial

Physical injuries

Thermal or mechanical

Deficit injury

not enough oxygen, water, nurtrients, temperature, or inadequate waste disposal

Apoptosis

programmed cell death, “neat & clean”

necrosis

messy and damaging cell death

Types of prenatal screening

chorionic villus sampling (CVS), ultrasound, amniocentesis, percutaneous umbilical cord blood sampling (PUBS)

congenital

present at birth

Sympathetic nervous system

AKA adrenergic system: fight, flight, or freeze. Stress triggers Norepinephrine and epinephrine release. Hormones increase heart rate, bp, respiratory rate, & pupil dilation while decreasing digestion and urine production. Norepinephrine and epinephrine released.

Parasympathetic nervous system

AKA cholinergic system: rest and digest. Acetylcholine released. Digestion increases, heart rate, bp, etc decrease.

Stages of stress (General Adaptation System, GAS)

1.) Alarm - Sympathetic nervous system stimulated

2.) Resistance - continued fighting, time limited. If stressor ends, parasympathetic nervous system engaged.

3.) Exhaustion - if stressor is prolonged, high levels of hormone secretion cannot be sustained then exhaustion ensues.

Immunosuppression

long term cortisol secretion = lowered immunity. Chronic stress can also atrophy the thymus gland. Both of these things will increase the risk for disease and infection over time.

Obesity

medical definitions: overweight (>20% ideal weight), obese (>30% ideal weight)

Adipose tissue function

insulation/warmth, cushioning/protection, energy storage, metabolic process

Impact of increased adipose cells

increased fatty acids, decreased insulin, increased risk for clot formation and high bp

risk factors for obesity

excess calorie intake vs output, sedentary behavior, poverty, age, female gender, smoking cessation, genetics, secondary disorder

Low weight red flag

BMI<17.5

what is the most common reason people seek medical help?

pain

Types of pain

1.) acute pain - sudden, hours-days, acts as a protective mechanism

2.) chronic pain - persistent, over six months, unpredictable

3.) neuropathic pain - injury/malfunction of the spinal cord, difficult to define and manage

hydrostatic pressure

movement of fluid from the vessels into the cells (fluid is pushed out)

osmotic pressure

movement of fluid from the cells into the vessels, force is created by albumin (fluid is drawn in)

osmolality

concentration of molecules per weight of water

• fluid excess lowers osmolality (it dilutes the concentration)

• fluid deficit increases osmolality

Isotonic solution

same concentration of solutes as blood

hypotonic solution

less concentrated than blood, less solute

hypertonic solution

more concentrated than blood, more solute

Causes of fluid excess/overload

excess intake, heart failure, renal failure, liver disfunction, pharmacological

clinical manifestations of fluid excess

1.) respiratory effects - pulmonary edema, shortness of breath, increases RR (tachypnea), crackles

2.) cardiovascular effects - jugular vein distension, bounding pulses, high bp, apprehension, edema/effusions

3.) diluted lab work

causes of fluid deficit (dehydration)

GI loss, increased urine output, intense bleeding or sweating, decreased fluid intake, pharmacological

Dehydration clinical manifestations

1.) neurological - anxiety/exhaustion

2.) integumentary - cold, clammy, poor turgor, dry mucus membranes

3.) renal - low urine output, concentrated urine

4.) weight change

5.) vital signs - tachycardia, high respiratory rate (tachypnea), high temp, low bp, orthostatic hypotension

6.) concentrated lab work - high sodium, serum osmolality, and hemoglobin/hematocrit

Normal sodium levels

135-145 mEq/l

Normal potassium levels

3.5-5 mEg/l

Role of sodium

fluid balance (sodium is the most prevalent electrolyte in blood), nerve impulse, transmission, muscle contraction, acid base regulation

Hyponatremia

Sodium level < 135

1.) hypovolemic hyponatremia - water loss = sodium loss (excess loss of urine/stool, wounds/burns)

2.) hypervolemic hyponatremia - lots of water = sodium dilution

Hyponatremia clinical manifestations

confusion, seizures, headache, muscle cramps, twitching, nausea

Hypernatremia

Sodium level > 145

1.) hypovolemic hypernatremia - low water = high concentration of sodium (poor water intake, water loss)

2.) hypervolemic hypernatremia - excess sodium intake, renal dysfunction

Clinical manifestations of hypernatremia

irritation/restlessness, disorientation, seizures, dry/swollen tongue, sticky mucous membranes, thirst

Role of potassium

neuromuscular/cardiac function (depolarization/repolarization), cellular growth, glycogen storage, acid-base balance

hyperkalemia

potassium level > 5

causes: excess intake, cellular shift, & renal dysfunction.

clinical manifestations of hyperkalemia

Early: numbness, tingling, muscle cramps, nausea/diarrhea, apathy/confusion

Later: cardiovascular, irregular pulse, EKG changes

hypokalemia

potassium level < 3.5

causes: diuretics, burns, renal loss, GI loss, dietary deficiency

clinical manifestation of hypokalemia

nausea/vomiting, anorexia (loss of appetite), EKG changes, irregular pulse, postural/orthostatic hypotension, weakness, cramps, decreased reflexes, shallow

Role of calcium

cardiovascular function, bone/tooth formation, normal clotting, neuromuscular function

Relationship of calcium, potassium & magnesium

These three electrolytes tend to follow one another

Relationship of phosphate & sodium

have an inverse relationship

Normal pH levels in the blood

7.35-7.45

Regulatory systems of acid-base balance

1.) buffer systems - immediate

2.) respiratory system - minutes to hours

3.) renal system - hours to days

CO2, H+ role in pH

Decreases pH

HCO3 role in pH

Increases pH

Acute inflammation

rapid, enhances healing, short term

chronic inflammation

persistent, inhibits healing, causes damage, prolonged damage

Stages of acute inflammatory response

1.) vascular changes - initial constriction followed by dilation and permeability, fluids containing WBCs and platelets leak out of vessel

2.) cellular chemotaxis - chemical signal released to attract platelets and WBCs to injury, leukocytosis, release of inflammatory mediators

3.) inflammatory mediators - substances that promote or inhibit inflammatory reactions (cytokines, chemokines, acute phase proteins)

Signs of inflammation

heat, redness, swelling, pain, loss of function

what are inflammatory mediators and what do they do?

substances that promote or inhibit inflammatory reactions (cytokines, chemokines, acute phase proteins)

• Lab indicators: higher C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocytosis (high WBC count), and fibrinogen

White blood cell differential

measures the total number of WBCs, calculates the percentages of specific types of WBCs

Chronic inflammation shows an increase in what cells?

mainly macrophages, but also monocytes and lymphocytes

Causes of chronic inflammation

persistent infection, hypersensitivity disorders, prolonged exposure to toxins

clinical manifestations of chronic inflammation

body pain, chronic fatigue/insomnia, mood changes, gastrointestinal symptoms, weight change, & frequent infections

three levels of wound intention

1.) primary intention - clean lacerations, uncomplicated, no missing tissue, rapid healing

2.) extensive tissue loss, more complicated, increased risk for scarring/infection and longer healing time

3.) tertiary intention - large amount of deep tissue loss & contamination, requires decontamination as well as dressings or skin grafting, and takes a long time to heal

components in effective wound healing

nutrition, oxygenation, circulation, immune strength, contamination, mechanical factors, age

7 types of dysfunctional wound healing

• keloid - hyperplasia of scar tissue

• contractures - inflexible shrinkage of wound tissue

• dehiscence - opening of a wound’s suture line

• evisceration - opening of wound with extrusion of tissue and organs

• stricture - abnormal narrowing of a tubular body passage from the formation of scar tissue

• fistula - an abnormal connection between two epithelium-lined organs or vessels

• adhesions - internal scar tissue between tissues or organs

pressure injuries

localized injuries due to prolonged pressure, typically over bony prominences

• stage 1: persistent skin redness

• stage 2: partial thickness: epidermis & dermis involved

• stage 3: full thickness: dermis and subcutaneous tissue involved

• stage 4: full thickness through fascia, may involve muscle, bone, and tendon

• unstageable: slough or eschar obscuring depth

four main pathogens

bacteria, virus, parasites, prions

3 forms of infection transmission

airborne (aerosolized, evaporated), droplet, contact

stages of infection

• incubation: no symptoms (but contagious)

• prodromal: symptoms start

• acute: worst symptoms

• convalescent: symptom resolution

• resolution

Staphylococcus aureus

normal flora, community acquired infection more common in healthcare settings. It has the ability to genetically adapt to become antibiotic resistant

Group A beta hemolytic streptococcus (GABHS) (streptococcus pyrogenes)

known to trigger pandas (pediatric autoimmune neuropsychiatric disorder associated with streptococcus) which may cause OCD, tics, anxiety, irritability, emotional lability, motor difficulties, and joint pain

• strep throat

• tss

• rheumatic fever

• glomerulonephritis

• scarlet fever

• necrotizing fasciitis

streptococcus pneumoniae / pneumococcus

community acquired pneumonia (CAP), risk increases from smoking, allergies, bronchitis, viral infections, risk increases for those younger than two and those older than sixty. vaccine is available, though.

• respiratory symptoms: appear ill, anxious, short of breath, crackles heard at site of infection

mycoplasma pneumoniae

“walking pneumonia,” spread through droplets, risk increases when living/working in crowded areas

• fever, sore throat, chills, cough, unique: headache and earache

pseudomonas

widespread in nature, health care acquired infections. Complicated and life threatening. Risk increases after invasive procedures, burns, trauma, prematurity, and immunosuppression

E. coli

mostly harmless when inhabiting intestine, but some strains cause severe GI infections, renal failure, food poisoning, UTIs

c. diff

spore forming & toxin secreting, difficult to treat and not killed with alcohol. Increased risk from antibiotic use, which damages the good bacteria in the gut. Fecal/oral transmission. causes prolonged water frequent diarrhea, fever, and pain.

Influenza A, B, & C

capable of genetic mutation. Risk increases for very young and older adults, as well as those with chronic diseases. Risk also increases for pneumonia in older adults. There is a vaccine available.

SARS-CoV-2 (COVID-19)

Specific strain of coronavirus that may trigger a severe immune response. There is an increased risk for those with comorbidities and immunosuppression. Uniquely presents with a loss of smell and taste.

Herpes Simplex Virus (HSV 1 & 2)

Acute and latent infection. lesions on skin/mucus membranes can contain fluid filled with active viral particles, and experiences cycles of dormancy and reactivation.

• HSV-1: common cold sore

• HSV-2: genital/perineal area

TORCH infections

Maternal infection that is transmitted to child, acquired in utero or during birthing process

opportunistic infections

caused by pathogen that takes advantage of impaired immune defenses

active immunity

acquired via exposure to antigen. exposure to this disease or vaccination allows for the development of immunoglobulins

passive immunity

the transfer of premade/fully formed immunoglobulins or antibodies

3 types of immune disorders

1.) hypersensitivity disorders - overreactive

2.) immunodeficiency disorders - under reactive

3.) autoimmune disorders - self attacking

Hypersensitivity types and characteristics

• type 1 - immediate reaction, local or systemic (allergies and anaphylaxis)

• type 2 - cytotoxic hypersensitivity (transfusion reaction)

• type 3 - complex hypersensitivity, antigen + Ig = tissue damage, (lupus & rheumatoid arthritis)

• type 4 - delayed hypersensitivity

autoimmune disorders illicit what kind of response

the body is unable to differentiate between nonantigenic cells and antigen cells, organ specific or generalized

autoimmune disorders

body attacks its own tissues, for example: rheumatoid arthritis, synovial tissue is attacked.

immunodeficiency disorders

deficient innate or adaptive immunity, for example: severe combined immunodeficiency disease is comprised of 16 diseases, all genetic, with a low T-cell presence and severe risk of infection

relationship between sodium & potassium

sodium & potassium have an inverse relationship

HIV

human immunodeficiency virus, in which the virus attacks CD4 T-helper cells. As the virus replicates the cells are destroyed. low CD4 (under 200) indicated advanced progression of the virus, leading to AIDS.

Normal WBC count

4-10 cells per ?

anemia

low red blood cells

neutropenia

low WBCs

thrombocytopenia

low platelet count

iron deficiency anemia

inadequate dietary intake of iron or impaired iron absorption. Can also be caused by blood loss. Lack of low RBC production

Megaloblastic anemias

B12 and folic acid deficiency, chronic alcohol use, medications, increasing age, intestinal malabsorption. standard anemia symptoms and possible neurological symptoms (B12 plays a role in myelin sheath creation)