exam 1 pathophysiology

mitochondria

generates ATP

endoplasmic reticulum

protein management

golgi apparatus

packaging

ribosomes

translate RNA to proteins

lysosomes

contains degradtative enzymes

cytoskeleton

provides structure and polarity to the cell

aerobic respiration

-requires oxygen

-has water and CO2 as a byproduct

anaerobic respiration

-no oxygen available; lack of perfusion/blood flow

-by product is lactic acid

which disorders might causes cells to switch from aerobic to anaerobic matabolism?

heart attack, stroke, severe blood loss; because of low blood flow/lack of perfusion

epigenetics

genetic code (genotype) is not altered, but expression of genes (phenotype) is changed

necrosis

an inflammatory, not programmed process that occurs once irreversible damage begins

apoptosis

programmed cell death that requires energy and is very organized

necrosis cell volume

increase in cell volume

apoptosis cell volume

cell shrinkage

necrosis plasma membrane

loss of plasma membrane integrity, leakage of cellular content

apoptosis plasma membrane

membrane remains intact but undergoes plasma blebbing ( irregularities as cytoskeleton breaks down)

atrophy

decrease in cell size

hypertrophy

increase in cell size

hyperplasia

increased number of cells

metaplasia

change in cell type

dysplasia

cells vary in shape/size, disorganized growth

neoplasia

"new growth", chronic inflammation and genetic damage, disorganized growth

endonucleases

recognize local distortions of the DNA and removes the distorted region

the problem with DNA repair

errors begin to accumulate and lead to malfunctions in proto-oncogene and tumor suppressor cells which can lead to cancer

what type of tumor has slow growth, is well defined, non-invasive, doesn't spread, has well differentiated cells, and a low mitotic index?

benign

what type of tumor has fast growth, not encapsulated, is invasive and infiltrative, spreads, is poorly differentiated, and has a high mitotic index?

malignant

cancer cell biology

the cell has unfixable DNA damage but continues to divide instead of going through apoptosis

normal cells and telomeres

normal cells divide a limited number of times and stop when telomeres become too short

cancer cells and telomeres

cancer cells maintain high levels of telomerase so telomeres don't shorten and cells keep dividing

stroma

tumor microenvironment

proto-oncogene

normal nonmutant genes that code for cell growth; only needs one allele mutated to become an oncogene

oncogenes

mutant genes that direct protein synthesis and cellular growth, promotes uncontrolled cell division

genetic events that form oncogenes

point mutations, chromosomal translocation, and gene amplification

examples of oncogenes

Ras, Her2-neu, MYC

tumor suppressor genes

genes that normally prevent uncontrolled cell growth; needs both copies of gene inactivated to lose function

examples of tumor suppressor cells

p53, BRCA1/2, Rb

how is chronic inflammation an important factor in the development of cancer

it stimulates a wound-healing response that includes proliferation and new blood vessel growth

examples of inflammation as a factor in cancer

ulcerative colitis and a chronic viral or bacterial infection

mass effect

displacement of normal tissues (from a tumor) interfering with normal functions

paraneoplastic syndromes

cancer cells in the body begin releasing hormones, neurotransmitters, proteins, or substances that the body interprets and then responds as if they were released from the correct gland or organ

cachexia

the most severe form of malnutrition

stage 1

confined to its organ of origin

stage 2

locally invasive

stage 3

advanced to regional structures

stage 4

has spread to distant sites

traditional cancer therapies

more side effects and lower post-treatment protections

immunotherapies

targets cancer cells, so fewer side effects and more effective protection post treatment

a patient with renal cell carcinoma has developed polycythemia (increased production of RBCs). this is most likely the result of...

paraneoplastic syndrome

a patient with colon cancer has been found to have metastasis to the liver. what fact would underlie this finding?

the portal system brings venous blood from the GI tract to the liver

anaplasia

cells lose their mature and specialized features

extracellular fluid

plasma (intravascular) and interstitial fluid (1/3)

intracellular fluid

inside cells (2/3)

body water content

depends on age, body mass, sex; adipose tissue is least hydrated and older adult females have more adipose tissue

4 mechanisms of fluid regulation

-thirst mechanism

-sympathetic nervous system

-ADH

-aldosterone (RAAS)

RAAS

low blood volume sensed by kidneys causes the release of aldosterone to absorb sodium and water

addisons disease

lack of adrenal glands which will cause a decrease in fluid volume because the body cant retain sodium or water

cushings disease/ conns syndrome

excess production of adrenal hormones which will cause an increase in fluid volume because the body is retaining sodium and water

what effect can an increase in fluid volume have?

a high BP because there is more blood volume

the goal of RAAS

increases BP; activated by lack of perfusion

the role of ADH during RAAS

causes the kidneys to keep water

hydrostatic pressure

-greater on the arterial end of capillary bed and decreases as fluid moves to venous end

-wants to move fluid out

osmotic pressure

-remains constant

-favors keeping fluid in

edema

abnormal infiltration of fluid

what can lead to increased capillary pressure?

increased vascular volume, venous obstruction, liver disease with portal vein obstruction, and acute pulmonary edema

what can lead to decreased colloid osmotic pressure?

increased loss of plasma proteins and decreased production of plasma proteins like albumin

causes of increased capillary permeability

inflammation, allergic reactions, malignancy, and tissue injury and burns

what can cause an obstruction of lymphatic flow?

malignant obstruction of lymphatic structures and surgical removal of lymph nodes

third spacing

fluid trapped in transcellular spaces

common third spaces

pericardial sac, pleural space, and peritoneal cavity

a person develops a blood clot in the deep vein of their left leg. the clot is blocking most of the vein. what happens to capillary filtration?

capillary filtration increases because the increasing hydrostatic pressure pushes fluid out into the interstitial space

fluid volume deficit (FVD)

loss or insufficient intake of water and electrolytes

FVD signs and symptoms

quick weight loss, tissue turgor, dry mucous membranes, weak pulse, slow capillary refill

what is the body's compensatory response if blood volume/pressure is low?

increased heart rate

fluid volume excess (FVE)

excessive retention of water and sodium; can be caused due to overhydration, increased Na intake, kidney/liver disease, heart failure, and endocrine disorders

FVE signs and symptoms

rapid weight gain, strong pulse, increased BP, labored breathing, bulging neck veins, and edema

hypovolemia

depleted fluid in vessels

hypervolemia

excess fluid in blood fluid

hypovolemia signs

makes hematocrit more concentrated, flat neck veins, rapid weight loss, low BP, tachycardia

hypervolemia signs

dilutes hematocrit, neck veins distended, high BP, bradycardia, edema

hypovolemic shock

not enough fluid (blood) volume circulating

cardiogenic shock

compromise of myocardial performance, heart pump weakened/damaged

isotonic

equal amount of solute and solvent

hypotonic

concentration inside cell is higher than solution, cells swell and lyse; pushes water in

hypertonic

concentration outside cell is higher than outside the cell, cell shrinkage; pulls water out of cell

hypotonic fluids

less concentration of solutes in cell than in plasma; provides "free water" and treat cellular dehydration

hypotonic fluid example

0.9% NaCl (normal saline)

isotonic fluids

same concentration of solutes as plasma; used to restore vascular volume

isotonic fluid example

0.45% NaCl

hypertonic fluids

greater concentration of solutes in the cell than plasma, cells lose water

hypertonic fluid example

3% NaCl

when might we give free water via IV?

NEVER, you would want to use D5W

what condition could lead to cell lysis if not properly maintained?

hypotonicity

patient with severe hyponatremia would most likely be started on?

hypertonic fluid

a patient is severely dehydrated and hypovolemic. how could the body compensate for loss of volume?

increased vasoconstriction

possible causes of hypovolemia

profuse vomiting/diarrhea, diabetes insipidus, and burns on 50% of bodys surface area

Iatrogenic

adverse mental or physical condition induced in a patient through the effects of treatment

describe sodium and potassium levels in plasma and interstitial fluid

high sodium and low potassium

describe sodium and potassium levels in the intracellular space

low sodium and high potassium

where sodium goes....

water follows

effects of aldosterone

-increased sodium reabsorption

-increased potassium secretion

-secretion of hydrogen