Pathophysiology Exam 2

pathophysiology pain, behavioral disorders, pulmonary

simple reflex arc

immediate pain response without interpretation from the brain

the afferent neuron carries sensory impulses into the dorsal horn of the spinal cord; connects with interneuron that connects to efferent neuron that exits the ventral horn and enacts motor activity

protective, immediate action with need for time for brain to interpret

prostaglandins

enhance inflammation, pain, edema

leukotrienes

enhances inflammation, edema, bronchospasm particularly in asthma and allergy

bradykinins

enhances inflammation

glutamate

amplifies pain signal

acetylcholine

inhibitory action on pain in spinal cord

dopamine

inhibitory action on pain in spinal cord and brain

sensitization

repeated or excessive stimulation of C-fibers sensitizes the afferent neurons so even mild stimulation may be perceived as painful

exaggerates excitement of nerve fibers and impairs inhibitory interneuron influences

acute pain

results from new onset of tissue injury or inflammation; sudden, lasts hours to days, and resolves with healing of the disorder; facilitates tissue repair and healing by making injured area and surrounding tissue hypersensitive making individual avoid exposing the area to external stimuli and allowing an undisturbed healing process

chronic pain

persists beyond expected time for a given disease process or injury; duration greater than 6 months; may arise as a result of sustained noxious stimuli; debilitating; initially occurs due to a pathological condition but does not subside when the disorder goes away; pain itself usually becomes focus; difficult to treat, doesn’t respond to conventional analgesic treatments

neuropathic pain

caused by injury or malfunction of spinal cord and/or peripheral nerves; burning, tingling, shooting, stinging, or pins-and-needles sensation (paresthesia); possibly also stabbing, piercing, cutting, drilling pain; unique as it cannot be described as acute or chronic, can occur within days, weeks, or months of injury and tends to occur in waves of frequency and intensity; diffuse and occurs either at the level or level below injury (commonly in legs, back, feet, thighs, toes); very difficult to treat; often alternative therapies are needed to provide relief

myocardial infarction

squeezing, crushing chest pain (radiation to left arm, back, and possibly jaw; dyspnea, diaphoresis, pallor, hypotension, Levine’s sign [fist to chest])

peripheral arterial disease

intermittent claudication of lower extremity (cramping in leg that occurs with similar distance each time sensed; associated with pallor, paresthesia, cooler leg temperature; caused by lack of sufficient arterial flow)

pleuritis/pneumonia/pleurisy

chest pain with coughing or deep breathing (pleural friction rub heard on auscultation with stethoscope; squeaking or grating sounds of pleural linings rubbing together than can be described as the sound made by treading on fresh snow)

cholecystitis/cholelithiasis

(inflammation of gallbladder with gallstone): biliary colic; intense pain comes on in waves (nausea, vomiting, eructation [belching], full feeling of stomach, tenderness of RUQ with palpation [Murphy’s sign])

appendicitis

pain starts in umbilical area then gradually becomes localized to RLQ (McBurney’s point) (extreme tenderness of RLQ; signs of peritoneal inflammation include wanting to remain stationary, jumping/coughing hurts abdomen, psoas sign, rebound tenderness, guarding, Rovsing’s sign, rectal pain)

nephrolithiasis

(kidney stone): colicky pain from costovertebral region around body into groin (cannot find comfortable position; intense pain and hematuria)

uterine/ovarian/fallopian disorders

pelvic or abdominal pain radiates down leg to inner thigh obturator nerve (air can collect under diaphragm causing referred should pain)

stomach/duodenum peptic ulcer

gnawing, burning pain (pain occurs between meals; food soothes pain)

ruptured peptic ulcer/pancreatitis

pain in umbilical area straight to back (tachycardia, nausea, vomiting, anxiety)

aortic aneurysm/aortic dissection

tearing, mid thoracic pain (pallor, hypotension, anxiety)

firbomyalgia

Common syndrome in which people experience long-term, body-wide pain as well as pain in the joint, muscles, tendons, and other soft tissues; also experience fatigue, sleep problems, headaches, depression, anxiety, and other symptoms; most common among women aged 20-50; pain locations are called tender point; pain is described as deep-aching, radiating, gnawing, shooting, or burning and spreads out ranging from mild to severe

diabetic peripheral neuropathy

Affects both sensory and motor nerves in extremities; in uncontrolled diabetes; hyperglycemia causes increased intracellular glucose in nerves which impair axonal transport and causes abnormal action potential propagation; leads to lost sensation in feet and imbalance; ACE is also excessively produced because of excess glucose which causes endothelial injury and predisposes to arteriosclerosis; lack of neural sensation, decreased motor control, and diminishes circulation increases trauma and wound susceptibility; cannot perceive injuries so they become worse and infected and may lead to amputation

panic disorder

GABA and norepinephrine

major depression

serotonin (norepinephrine and dopamine)

schizophrenia

dopamine

Alzheimer’s dementia

progressive neurological degeneration of the brain; accumulation of neurofibrillary tangles and senile plaques; cerebrocortical atrophy and acetylcholine deficiency; risk factors include increasing age, family history

Lewy Body dementia

abnormal deposits of proteins called Lewy bodies; amnesia, language and personality changes, apraxia, agnosia, sundowning

vascular dementia

multiple small strokes; irreversible; vascular lesions; risk factors include hypertension, smoking, hypercholesterolemia, diabetes, CV disease, cerebrovascular disease

delirium

transient, usually reversible, cause of cerebral dysfunction (hyperactive or hypoactive state), sudden onset; decreases attention span, waxing and waning confusion, hallucinations, delusions, psychotic behavior

dementia

decline in reasoning, memory, judgment, and other cognitive functions; difficulties with ADL, not a normal part of aging

depression

sad most of day most days, decreased interest in pleasurable activities, weight loss/gain, insomnia/hypersomnia, psychomotor retardation or agitation, fatigue, worthlessness, guilt, decreased concentration and decisiveness, suicidal thoughts, and plan

delirium tremens

Begin 3 to 5 days after last drink; disorientation, fever, hallucinations, tremors; medical emergency requiring inpatient care; part of alcohol withdrawal

alcohol

CNS depressant; inhibits individual and may lead to out of character activities; irrational thinking, lack of judgement, absence of motor coordination; psycho-depressant

marijuana

impaired school or work function, giving up of previously enjoyed activities, and use in hazardous situations; psychoactive properties; psycho-depressant

opiates

diminished RR, constricted pupils, noncardiogenic pulmonary edema, respiratory failure; psycho-depressant/psychostimulant

amphetamines

SNS stimulation (tachycardia and hypertension, anorexia, insomnia, seizures); psychostimulant

agglutinogens

specific type of antigens on the surface of RBCs

alloimmune hemolysis

occurs when antibodies are formed against antigens on the RBC surface (can occur in transfusion reaction and HDN)

anemia

a condition where there is insufficient delivery of oxygen to the tissues caused by an inadequate number of mature, healthy RBCs in the blood

aplastic anemia

complete disruption of bone marrow function inhibits manufacture of all blood cells

cold agglutinin syndrome

hemolysis occurs at low temperatures because the antibody against the RBCs is of the IgM class

erythrocytosis

caused by a prolonged hypoxia as a compensatory effort by the body to improve oxygen delivery

erythropoeisis

specific series of steps in the bone marrow that leads to synthesis of mature RBCs

process of maturation of a pluripotent stem cell into mature erythrocytes in the bone marrow; under influence of EPO it develops into a nucleated erythroblast and then a normoblast which extrudes its nucleus to become a reticulocyte and then fully matures

hemoglobinopathy

inherited disorder of the structure of the Hgb molecule that can lead to destruction of the RBC (ex. SCA and thalassemia)

hemolysis

breakdown of RBCs

hyperbilirubinemia

bilirubin accumulates in the bloodstream (from conditions where there is a high amount of RBC breakdown)

intrinsic factor (IF)

an essential carrier protein of vitamin B12 in the stomach

melena

black tarry stools

oxyhemoglobin dissociation curve

represents relationship between PO2 and the affinity of Hgb to oxygen

pernicious anemia

decrease in RBCs that results from vitamin b12 deficiency

pica

craving for nonfood substances such as ice, clay, starch, chalk, dirt, and other materials

polycythemia

disorder characterized by over proliferation of all blood cells in the bone marrow

reticulocyte

immature RBC

recticulocytosis

markedly higher percentage of reticulocytes in the bloodstream

sickle cell anemia (SCA)

disorder where RBCs contort into a sickle shape which die early and leave a shortage of healthy RBCs and can block blood flow causing pain

genetic mutation that causes synthesis of Hgb that is more fragile and inefficient at carrying oxygen; causes RBCs to be fragile and misshapen

fatigue, exercise intolerance, jaundice, gallstones, chest pain

complications: vaso-occlusive crisis (misshapen RBCs can lodge in capillaries causing tissue hypoxia and cause pain and chronic damage to liver, spleen, kidneys, and eyes), hand-foot syndrome, splenectomy; children are particularly susceptible to severe infections, growth retardation, osteomyelitis, and stroke (leading to paralysis); priapism; renal necrosis, retinal ischemia and hemorrhages can lead to partial blindness

subacute combined degeneration

degeneration of the dorsal columns and the lateral columns of the spinal cord due to demyelination

total iron binding capacity (TIBC)

measures the blood’s ability to attach itself to iron and transport it around the body

vaso-occlusive crisis

episodes of ischemia; occurs when sickled RBCs block blood flow to the point that tissues become deprived of oxygen

warm agglutinin syndrome

if the antibody causes destruction of the RBCs is of the IgG class the hemolysis will occur at any temperature

release of erythropoietin (EPO)

triggered by hypoxia (kidney releases EPO); low oxygen in arterial blood stimulates kidney to make EPO which stimulated bone marrow which synthesizes erythrocytes and increases oxygen carriage in the blood

jaundice

often a sign of a high amount of RBC breakdown but can also occur in liver disorders (bilirubin adheres to elastin which is a component of CT in the skin and sclera causing them to take on a yellow stain)

how bilirubin is created

porphyrin (part of a heme which is part of Hbg) is metabolized into protein biliverdin (green-colored compound that colors bile, feces, and ecchymoses) which is further broken down into bilirubin (yellow-colored compound that is a constituent of bile)

oxyhemoglobin saturation process

sole purpose of RBC is to transport oxygen from the pulmonary capillaries to cells and CO2 back to the lungs; at high levels of PO2 Hgb has a strong affinity and is fully saturated; however as PO2 diminishes Hgb site for oxygen go unfulfilled and become less attracted to oxygen; Hgb starts to drop its oxygen as PO2 falls below 60mmHg

some conditions increase or decrease Hgb oxygen affinity; acidosis, increase in blood CO2, and increased 2,3 DPG reduce Hgb oxygen binding affinity while alkalosis, decreased 2,3 DPG, and hypothermia cause an increase in binding affinity

CBC

includes Hgb, Hct, RBCs, MCV, MCH, and MCHC; different types of anemia produce different CBC results; measures all RBCs and RBC characteristics

Hgb lab

direct measure of the amount of hemoglobin in a given blood volume; a high number of RBCs can be indicative of secondary polycythemia or erythrocytosis (anemia has less than normal Hgb)

Hct (hematocrit)

percentage of blood that consists of RBCs (anemia has less than normal Hct)

MCV

volume of one RBC or corpuscle; reflects RBC size, classifies anemia as microcytic, megaloblastic (macrocytic), or normocytic

total RBC count

measure of number of RBCs in a given blood volume

Vitamin B12 deficiency

hematological: negatively affects hematopoiesis; needed for folic acid metabolism and RBC DNA, results in megaloblastic RBCs

neurological: CNS demyelination occurs, myelin defects and neural conduction mainly in dorsal horns and corticospinal tract of spinal cord; synthesis of serotonin, norepinephrine, and dopamine is affects; typical signs of anemia along with glossitis, numbness and tingling, unsteady gate

anemia of acute blood loss

caused by trauma, hemorrhage, clotting disorder; treat by establishing hemostasis and fluid volume

less than 15%: orthostatic hypotension and anxiety; 15-30%: SNS activity, increased HR, activation of RAAS, release of ADH, restlessness and change in consciousness; 30-40%: HR greater than 120bpm, hypotension, urine output 5 to 15 ml/hr; greater than 40%: severe hypotension, decreased consciousness, HR greater than 140bpm, no urine output

anemia of chronic blood loss

caused by GI bleed, menorrhagia, medications; patient may report no noticeable changes because blood loss is slow; often iron depleted, low MCV, low iron, low Hgb and Hct

pathophysiology of hemolysis/hemolytic anemia

occurs when erythrocyte destruction outpaces RBC synthesis by the bone marrow

such as in autoimmune disorder, transfusion reactions, HDN, certain medications

pathophysiology of polycythemia

opposite of anemia; overabundance of RBCs

primary: hyperproliferation of all blood cells

secondary: hyperproliferation of RBCs

risk factors for pulmonary embolus (PE)

age (heart failure risk increases with age), ethnicity (occurs more often in African Americans), family history and genetics, diabetes (increased risk of arteriosclerosis), obesity (associated with HTN and type 2 diabetes), lifestyle factors (smoking and sedentary lifestyle), medication (anabolic steroids, itraconazole, cancer drugs), sleep apnea (can cause hypoxia and increases risk of rhythm disturbances), congenital heart defects, viruses (can weaken heart muscles), kidney conditions (can cause excess blood volume, edema, HTN, and accumulation of nitrogenous waste)

developing a PE

embolus lodged in a pulmonary artery suddenly raises pressure within pulmonary artery which places overwhelming resistance against right ventricle that can rapidly and severely weaken the muscle and cause acute RVF; blood clot travels to the pulmonary circulation

pulmonary edema

edematous fluid builds within the pulmonary interstitial spaces and intracellular fluid compartments and hinders oxygen diffusion from the alveoli into the pulmonary capillaries; caused by too much fluid in the lungs; makes it difficult to breathe

how pulmonary edema develops in LVF

because the forward ventricle pump is weakened there is a buildup of high hydrostatic pressure backward up into the left atrium and pulmonary vasculature which causes fluid extravasation into the pulmonary interstitial and intracellular spaces leading to pulmonary edema

pulmonary hypertension

abnormally high pressure in the pulmonary arteries; measured with central venous line; congestion in the pulmonary vasculature causes increased resistance and workload of the right ventricle

how pulmonary hypertension develops in chronic lung disease

right ventricle is trying to pump into the pulmonary artery but its met with resistance; chronic lung disease can cause chronic hypoxia which stimulates vasoconstriction of the pulmonary artery leading to pulmonary hypertension

acidosis

decrease in pH; less than 7.35

alkalosis

a pH more than 7.45

atelectasis

collapse of a small number of alveoli resulting in reduced gas exchange

bradypnea

hypoventilation; respiratory rate less than 12 breaths per minute

bronchitis

inflammation of the bronchi and bronchioles caused by either bacterial or viral infection

community-acquired pneumonia (CAP)

most often caused by pneumococcus; pneumonia acquired in the community

diaphragm

muscle that separates the abdomen from the thoracic cavity; composed of skeletal and smooth muscle; controlled voluntarily and involuntarily

epiglottitis

infection and inflammation of the epiglottis

expectoration

process of coughing up sputum

expiration

accompanying air movement with lung deflation

group A beta hemolytic streptococcus (GABHS)

streptococcus pyogenes; cause of acute bacterial pharyngitis; can spread from pharynx to cause sinusitis and otitis media; can cause bacteremia, pneumonia, meningitis, necrotizing fasciitis, rheumatic fever, rheumatic heart disease, scarlet fever, toxic shock syndrome, and glomerulonephritis

hemoptysis

production of blood-containing sputum

hypercapnia

increase in CO2

hypoxemia

lack of sufficient oxygen in the arterial blood

hypoxia

when oxygen levels in the blood are sufficient to meet the needs of the tissue

inspiration

incoming air movement as the lungs expand

Mantoux tuberculin skin test

screening test for TB; can only indicate prior exposure and sensitization

mucociliary apparatus

specialized cellular mechanism of the bronchioles that consists of ciliated, pseudostratified columnar epithelial cells and goblet cells that secrete mucus; enables movement down to the throat and traps inhaled particles

oxyhemoglobin

oxygen combined with the heme portion of the hemoglobin

perfusion

movement of blood through the pulmonary circulation eventually providing oxygen to every part of the body