WCU PATHO FINAL PARK CH 1,2,4,7

Pathophysiology

The study of how the body functions in the disease state

Etiology

Study of causes or reasons for a particular disease or injury

Name two classifications of etiology

Idiopathic = cause is unknown

Iatrogenic = cause results from unintended or unwanted medical treatment

Pathogenesis

Development or evolution of disease

What are clinical manifestations

Signs = objective (measured)

Symptoms = subjective (feeling)

What are the stages and clinical courses

Latent period

Prodromal

Acute phase

Acute clinical course

Exacerbation

Remission

Convalescence

Describe latent period

Time between exposure of tissue to injurious agent and first appearance of S&S

Period during illness when S&S temporarily become mild, silent, disappears

Describe prodromal period

Time during which S&S fist appear

Onset of disease, first starting to feel bad

Describe acute period

Disease/illness reaches its full intensity

At your worse

Describe acute clinical course

Short lived; may have severe manifestations

Describe chronic clinical course

May last months to years, sometimes following an acute course

Describe exacerbation

A sudden increase in severity of disease or S&S

Describe remission

Decrease in severity, signs, or symptoms; maybe indicate disease is cured

Describe convalescence

Stage of recovery after a disease, injury, or surgical procedure

Treatment Implications

Understanding the etiology, pathogenesis, and clinical consequences of a particular disorder/disease/illness may determine which treatments could be helpful

What is the underlying cause

What are some individual factors that contribute to health and disease

Cultural - each culture defines health and illness in a manner that reflects their experience

Age - a normal value at one age may not be normal at another age

Gender - a normal value for men may not be normal for women or vise versa

Situational - determine whether a derivation from normal is abnormal or an adaption mechanism

Time - May impact how the body responds from day to night or at varying times

Epidemiology

Study of the patterns of disease involving populations; examining the occurrence, incidence, prevalence, transmission, and distribution of disease in large groups of populations/people

What are the types of epidemiology

Endemic

Epidemic

Pandemic

endemic disease

Native to a local region

epidemic disease

Spread to many people at the same time

pandemic disease

Spread to large geographic areas

What are the levels of prevention

Primary

Secondary

Tertiary

What is primary prevention

Altering susceptibility or reducing exposure for susceptible persons

Ex. Flu shot, vaccines

What is secondary prevention

Early detection, screening, and management of disease

Ex. Bone density, taking extra vitamins

What is tertiary prevention

Rehabilitation, supportive care, reducing disability, and restoring effective functioning

What is homeostasis?

A state in which all symptoms are in balance at an ideal "set point" despite alterations within the body

What type of parameters must be controlled in homeostasis

Osmolarity

Temperature

pH

Nutrients

Water

Sodium

Calcium

Oxygen

Hormones

What is allostasis

Ability to successfully adapt to challenges. A dynamic process that maintains or reestablishes homeostasis in light of environmental and lifestyle changes

Ex. Exercising which increases heart rate which is okay

What are stressors

Are agents or conditions that can endanger homeostasis

What turns on during stress

General adaptation syndrome (GAS)

What are the stages of GAS

Alarm

Resistance

Recovery

Exhaustion

What happens during alarm stage

Arousal of CNS begins, flight or fight response, sympathetic NS involved

Epinephrine, NE, and other hormones are released causing an increase in HR, contractility, oxygen intake (respiratory rate) and mental activity

What happens during the resistance stage

Activity of the nervous and endocrine systems in an attempt to return to homeostasis

What happens when successful during the resistance stage

Recovery

What happens during the exhaustion stage

Point where body can no longer return to homeostasis

Allostatic overload- "cost" of body's organs and tissues for an excessive or ineffectively regulates allostatic response

Organ damage begins (onset of disease)

What are some other responses of GAS

Corticotropin-releasing hormone (CRH) production

Antidiuretic hormone release

Sympathetic nervous system (SNS) activation and catecholamines (E and NE)

Renin-angiotensin-aldosterone pathway activation (increase BP, increase blood volume)

How is cortisol released

From the hypothalamus with the help of sympathetic will release CRH which stimulates anterior pituitary to release ACTH to stimulate the adrenal cortex to release cortisol which then suppressed inflammatory and immune responses or alters glucose, fat, and protein metabolism

What does ADH do

Also called vasopressin

Causes vasoconstriction (increase BP cause blood flow is slowed or blocked)

Makes kidneys reabsorb water from urine to blood (less urine is produced)

How does the SNS turn on

Starts with pain, fear, low BP which activated the hypothalamus which activates SNS to activate SNS neurons which release NE through adrenal medulla and E is released into blood which effects the heart and blood vessels which will increase HR and contractility, vasoconstrict skin, gut, and kidney which will all increase blood pressure

What does NE do

Causes vasoconstriction and raises BP

Reduces gastric secretions

Increases night and far vision

What does epinephrine do

Enhances myocardial contractility, HR and cardiac output

Causes bronchodilaton

Increases glucose release from the liver (glycogenolysis)

How does RAA work

Starts with kidneys release renin which will convert angiotensinogen (release by liver) into ANG I then with the help of ACE will get converted to ANG II which goes to adrenal cortex which will release aldosterone which causes the kidneys to secrete potassium and reabsorb sodium and water which will increase blood volume and BP

What are endorphins

Endogenous opioids (body's natural pain relievers)

Raises pain threshold

Produce sedation and euphoria

What is oxytocin

Produced during childbirth and lactation

Associated with bonding and social attachment

Thought to moderate stress response and produce a calming effect

How can stress affect the immune system

Decreases immune cell production (diverts energy away from other things your body thinks is nonessential)

Decreasing thymus activity

Overall, stress and cortisol suppresses the immune system

What are the four types of stress

Physiologic

Psychosocial

Acute

Chronic

What is physiologic stress

Stress induced changes in body functions

Detected by body's normal regulatory sensors

The body alters function to restore normal balance

When normal balance is restored negative feedback stops the reaction

What is psychosocial stress

Refers to events of psychological or social origin which challenge homeostasis

(Adverse environments or life experiences, position in a social hierarchy, isolation, discrimination)

Directly affects the CNS

Turns on stress response even when the body's internal sensors have not detected an imbalance (will not solve problem)

What is acute stres

Activates neural pathways that mediate: arousal, alertness, focused attention, aggression

For someone with limited coping abilities it can be detrimental

Some situations acute arousal can be life threatening, physically immobilizing a person when movement would avert catastrophe (moving out of the way of a speeding car)

What are some acute stress responses

Pounding headache, cold, moist skin, stiff neck

What is chronic stress

Long term stress: sympathetic activity and cortisol are elevated; complications result from the reduced immune response (body defense is lower)

What are some serious health problems that long term exposure to stress lead to

Raise BP

Suppresses the immune system

Increase the risk of heart attack and stroke

Contribute to infertility, speed up the aging process

Can require the brain, increasing vulnerability to anxiety and depression

What type of stress is PTSD

Chronic

What does PTSD do

Sympathetic system is activated

Cortisol levels stay the same. (Not elevated like how a stress response should be)

Due to experiencing a potentially life threatening event

Less than half of people exposed to traumatic experiences suffer from it

What are the three symptoms of PTSD

Intrusion

Avoidance

Hyperarousal

What is intrusion

Reexperiencing an event through flashbacks

What is avoidance

Emotional numbing, disrupt personal relationships, depressions

What is hyperarousal

Increases irritability, concentration difficulty, exaggerated startle reflex, increased vigilance and concern over safety

(Memory problem, sleep disturbances, excessive anxiety)

What is adaptation to stress determined by

Physiologic reserve

Time

Health status

Age

Genetic endowment

Hardiness

Psychosocial factors

Nutrition

Sleep-wake cycle

What is physiologic reserve

The ability of body system to increase their function given the need to adapt (HR)

Bigger PR better to deal with stress

How is time related to stress

Adaptation is more efficient when changes occur gradually

How is health status related to stress

Physical and mental health determines physiologic and psychological reserves and is a strong determinant of the ability to adapt

(If already sick wont adapt to stress well as someone who is healthy)

How is age related to stress

Capacity to adapt is decreased with extremes of age (infants and elderly)

What is genetic endowment

Genetic variability

How is hardiness related to stress

Individuals emotional reactions to stressful situations and their coping mechanism

How is psychosocial factors related to stress

Social support helps withstand stress

Ex. Support groups

How is nutrition related to stress

Deficiency or excess of essential nutrients

(Influences enzymes immune response wound healing obesity predisposes to atherosclerosis, hypertension)

What is sleep-wake cycle

Sleep restores function, tissue regeneration

Circadian rhythms affect function( hormone secretion, immune physical and psychological function)

What are some treatments to stress

Avoid coping behaviors that impose a health risk (alcohol, smoking etc)

Provide alternative strategies by consciously using higher brain centers to help control the sympathetic systems activity (relaxation response, imagery, music therapy, massage therapy, biofeedback)

What are the two reversible cell injury's

Hydroponic swelling

Intercellular accumulation

What is hydropic swelling

Cellular swelling due to accumulation of water

Why does hydropic swelling happen

Results from malfunction of sodium potassium pump accumulation of intracellular sodium

Any injury that results in loss of ATP will also result in swelling

What are the characteristics of hydropic swelling

Large pale cytoplasm

Dilated ER

Swollen mitochondria

Cells in organs increase in size and weight

What is intracellular accumulations

Excess accumulations if substances

Intracellular accumulation leads to cellular injury due to

Toxcity

Immune response

Taking up cellular space

What are the characteristics of intracellular accumulation

Excessive amounts of normal intracellular substance

Abnormal substances from faulty metabolism synthesis

Particles that the cell is unable to degrade

What is the most common site of accumulation

Liver

Name the adaptive cellular response

Atrophy

Hypertrophy

Hyperplasia

Metaplasia

Dysplasia

What is cellular atrophy

Cells shrink and reduce function

What are the causes of cellular atrophy

Decreased functional demand, disuse, denervation

Ischemia

Nutrient starvation

Interruption of endocrine signals

Persistent cell injury

What is cellular hypertrophy

Increase in cell mass and augmented functional capacity

What are the general causes of cellular hypertrophy

Increases cellular protein content

Increase functional demand

What is cellular hyperplasia

Increase in functional capacity related to an increase in cell number due to motorized division

What are the causes of cellular hyperplasia

Increases physiologic demand, hormonal stimulation, persistent cell injury, chronic irritation of epithelial cells

What is cellular metaplasia

Replacement of one differentiated cell type with another

What are the causes of cellular metaplasia

Adaptation to persistent injury, with replacement of a cell type that is better suited to tolerate injurious stimulation

Out of the cellular adaptions which one is fully reversible when injurious stimulation is removed

Metaplasia

What is cellular dysplasia

Disorganized appearance if cells because of abnormal variations in size, shape, and arrangement

What are the causes of cellular dysplasia

Adaptive effort to persistent injury gone astray

Out of the cellular adaption forms which one has a significant potential to transform into cancerous cells (preneoplastic lesions)

Dysplasia

Name irreversible cell injuries

Necrosis

Gangrene

Apoptosis

What is cell necrosis

Cell death, usually due to ischemia or toxic injury

Why does cellular necrosis occur

When the injury is too severe

What are the local and systemic indicators of cellular necrosis

Pain, elevated serum enzyme levels, inflammation ( fever, increased WBC, malaise (feeling of discomfort, unease)) loss of function

What are the four types of tissue necrosis

Coagulation

Liquefactive

Fat necrosis

Caseous necrosis

What is the most common tissue necrosis

Coagulative

What is coagulative necrosis

Process begins with ischemia, ends with degradation of plasma membrane (heart)

What is fat necrosis

Death of adipose tissue, appears as chalk white area, usually due to trauma or pancreatitis (pancreas)

What is liquefactive necrosis?

Liquification of lysosomal enzymes, formation of abscess or cyst from dissolved dead tissue (brain)

What is caseous necrosis?

Characteristics of lung damage secondary to tuberculosis (bacteria infection) resembles clumpy cheese (lung)