NUR 318 (Week 4)

Pathos

Suffering

Logos

Discourse

Physio

Function of organisms

Pathophysiology

Systematic study of functional changes in cells, tissues, and organs altered by disease and/or injury.

Pathology

Study of structural alterations in cells, tissues, and organs that help identify the cause of a disease.

Pathogenesis

Pattern of tissue changes associated with the development of tissues

-genesis

Develop into being; origin

Etiology

Study of the cause(s) of disease and/or injury

Idiopathic

Diseases with no identifiable cause

Idio-

Greek: one’s own; personal; separate; distinct

Etio-

Greek/Latin: cause

Iatrogenic

Diseases and/or injury as a result of medical intervention

Iatro-

Medicine; healing

Physician

-genic

Producing; forming

Produced by; formed by

Clinical manifestations

Signs and symptoms (S&S; S/S)

Nosocomial

Diseases acquired from being in a hospital environment

noso-

Disease

Greek: Nosus

-comial

To take care of

Greek: Komeion

Diagnosis

Naming or identification of a disease

dia-

complete

-gnosis

knowledge

pro-

before

Prognosis

Expected outcome of a disease

Acute disease

Sudden appearance of S&S lasting a short time

Chronic disease

Slow development of S&S, lasting a long time or lifetime

Remissions

Periods when S&S disappear or diminish significantly

Exacerbatons

Periods when S&S become worse or more severe

Sequelae

Any abnormal condition following and a result of a (prior) disease, treatment, or injury

Example: Chronic constipation (obstipation) → Intestinal obstruction. Neck pain → Whiplash. PTSD → Childhood abuse

Sequel

Latin word for sequela/e

Atrophy

Decrease in cell size

-trophy

Nutrient material; food; nourishment

Hypertrophy

Increase in cell size

Hormonal Hyperplasia

Increases in cell number due to increased cellular division stimulated by hormones during pregnancy.

horman

Greek: to excite; to urge on

Pathological Hyperplasia

Increases in cell number due to increased cellular division stimulated by abnormal or precancerous changes.

Dysplasia

Abnormal change in size, shape and type of mature tissue cells

-plasia

Formation; growth; proliferation

Metaplasia

Reversible replacement of one mature cell type by another (sometimes less differentiated)

meta-

Greek: after; along with; among; behind; beyond

Caused by decreased workload, use, pressure, perfusion, nutrition, hormonal stimulation, or nervous stimulation

Atrophy

perfusion

blood supply

Can progress to maladaptive states

Caused by mechanical signals from increased workload OR trophic (chemical and hormonal) signals

Hypertrophy

Caused by an increased rate of cellular division in response to excessive hormone stimulation

Hyperplasia

Caused by underlying viral (HPV) infection, irritation from inflammatory, or infectious process

Dysplasia

Could be caused by tissue damage or regeneration

Metaplasia

Cause of Cellular Injury (I/H)

Ischemic and hypoxic injury

Ischemic and hypoxic injury

Lack of O2

Reduced O2 in air

Loss of Hemoglobin (HGB)

Decreased RBCs

Respiratory or cardiovascular diseases

Hypoxia can induce inflammation

Cause of Cellular Injury (R)

Reperfusion injury; ischemia-reperfusion injury; reoxygenation injury

Reperfusion injury

Blood supply returned to tissue after period of ischemia and lack of O2

Cause of Cellular Injury (FR)

Free radical injury

Cause of Cellular Injury (C)

Chemical injury

Cause of Cellular Injury (M)

Mechanical injury (unintentional and intentional)

Example(s):

Radicals causing membrane damage + mitochondrial Ca2+ overload

WBC damage: Neutrophil adhesion to the endothelium

Reperfusion injury

Free radical injury

ROS injuries generated from:

Reduction-oxidation reactions (redox reactions) in normal metabolic processes

Absorption of extreme energy sources

Enzymatic metabolism of exogenous chemicals, drugs, and pesticides

The process of transition metals (i.e., iron and copper) donating or accepting free electrons during intracellular reactions and activating the formation of free radicals

Nitric oxide (NO) acting as an important chemical mediator

Reactive oxygen species (ROS)

Chemically active molecules derived from molecular O2.

They naturally occur as oxidizing agents within cells, primarily produced during mitochondrial respiration and the process of generating energy.

Chemical injury

Cause(s):

Diet, alcohol, drugs, and medications

Long-term exposure to air pollutants, insecticides, and herbicides

Some plants and fruits, often intended for health CARE, produce phytochemicals

Heavy metals like lead, mercury, arsenic, and cadmium

AIR POLLUTION

Mechanical injury

Cause(s):

Inflammation, Infection

MVAs (motor vehicle accidents)

Gunshots, stabbing, hanging, blunt force, choking, suffocating

Sports and recreation related injuries

Medical care

Apoptosis

Natural cell death - DOES NOT CAUSE INFLAMMATION

Regulated or programmed cell process by the “dropping off” of cellular fragments

Too much (degenerative disease) or too little (cancer) can lead to complications

Physiological process

Necrosis

Cell death due to disease, injury, or failure of the blood supply

Manifestations: Rapid loss of the plasma membrane structure, organelle swelling, mitochondrial dysfunction

Pathological outcome

Somatic death

The biological death of an entire organism

What signs does nurse look for in a patient of somatic death?

Absence of pulse and heart sounds

Absence of breathing

No pupillary response

Loss of consciousness

Pale, cyanotic, or yellow skin (no circulation or O2)

Rigor mortis (muscles stiffen hours after death)

Body temperature falls (algor mortis)

Dependent blood accumulation (livor mrotis)

Decomposition (putrefaction)

Autosomal Dominant

A disease caused by a single-parent (requires only one copy of a mutant gene of the 4 potential inherited)

50% or 1 CHILD IN 2 has the chance of being affected

Example:

Autosomal Recessive

1 copy of a disease-causing gene from each parent (requires two copies of a mutant gene of the 4 potential inherited)

25% or 1 CHILD IN 4 has the chance of being affected

Example(s):

Huntington's Disease: A neurodegenerative disorder characterized by motor skill problems, cognitive decline, and psychiatric issues.

Marfan Syndrome: A connective tissue disorder affecting the heart, eyes, blood vessels, and skeleton.

Polycystic Kidney Disease (PKD): A condition characterized by the growth of numerous cysts in the kidneys.

Autosomal Dominant

Example(s):

Cystic Fibrosis

A condition affecting the respiratory, digestive, and reproductive systems, characterized by the production of thick and sticky mucus. It results from mutations in the CFTR gene.

Sickle Cell Anemia

A blood disorder that affects hemoglobin within red blood cells, causing them to assume a rigid, sickle shape. This leads to various complications, including pain, infections, and anemia. It is caused by a mutation in the HBB gene.

Tay-Sachs Disease

A neurodegenerative disorder that results in the destruction of nerve cells in the brain and spinal cord. It is caused by a deficiency of the enzyme hexosaminidase A, due to mutations in the HEXA gene.

Phenylketonuria (PKU)

A metabolic disorder that increases the levels of phenylalanine in the blood, potentially leading to intellectual disabilities and other problems. It's caused by mutations in the PAH gene.

Autosomal Recessive

Example(s):

Cardiac hypertrophy can result from high blood pressure, requiring the heart muscles to work harder to pump blood, thereby increasing muscle mass.

Hypertrophy

Example(s):

Benign prostatic hyperplasia is an enlargement of the prostate gland due to an increase in the number of cells, common in older men.

Hyperplasia

Example(s):

A limb immobilized in a cast for a along time

Atrophy

Example(s):

In smokers, the normal ciliated columnar epithelial cells in the bronchi may be replaced by stratified squamous epithelial cells, which are more capable of withstanding smoke irritation.

Metaplasia

Example(s):
Cervical _, detected through Pap smears, can be a precursor to cervical cancer.

Dysplasia

Usually reversible if underlying stimulus is removed

Hypertrophy

Hyperplasia

Atrophy

Metaplasia

Not usually reversible and required medical intervention

Dysplasia

Changes in cell size

Hypertrophy
Atrophy

Changes in cell number

Hyperplasia

Changes in cell type

Metaplasia

Changes in cell arrangement and structure

Dysplasia

Usually physiological or pathological

Hypertrophy

Hyperplasia

Atrophy

Usually pathological

Metaplasia

Dysplasia

Incident rates

Occurrence of new disease/condition cases in a population over a specific period (trend)

Measurement: (# of new cases)/(# of individuals at risk at the initial specific period) in per 1000 or 10000 individuals

Use: Useful in studying causes and risk factors using new cases

Prevalence

Proportion of overall population affected by a disease at a specific time (snapshot), using new and old cases

Measurement: (# of new/old cases at particular time)/(total population at that time) in percentage, or per 1000 or 100000

Use: Useful in assessing disease burden on a population (level of a disease) and planning healthcare services

Relative risk

Compares the risk of an event (such as developing disease) occurring in one group with the same risk in another group. Most commonly found in exposed vs unexposed (control) group comparisons.

Calculation: (Incidence rate of disease in exposed group)/(Incident rate of disease in unexposed group)

Use: Helps understand strength of association between exposure and disease outcome; how more/less likely a disease occurs in an exposed group compared to unexposed group

Indicates the extent of a health problem at a point in time, useful for healthcare planning

Highlights the current burden of a disease or healthcare need

Influenced by both new cases and the duration of a disease

Prevalence

Valuable for understanding the risk of developing a disease and identifying causes

Identifies emerging health threats

Sensitive to time changes overtime

Incidence rate

Assesses the effect of exposure on disease risk, aiding in understanding causal relationships.

Informs about potential benefits or harms of specific exposures and interventions

Disregards temporal dynamics of a disease; only the study period

Relative risk

Modifiable risk factor

These are factors that can be changed or controlled by an individual, such as:

Lifestyle choices (e.g., smoking, physical activity, dietary habits)

Environment (e.g., exposure to toxins, living conditions)

Behaviors (e.g., alcohol consumption, drug use)

Non-modifiable risk factors

These are factors that cannot be altered by an individual, such as:

Age

Gender

Genetics

Family history

Example: The _____ of new HIV infections.

Description: This would refer to the number of new HIV infections that occur in a Riverside city during a Spring 2024. For instance, the Centers for Disease Control and Prevention (CDC) may report the annual ______ of HIV per 1000 people in the Riverside city.

Incidence Rate

Example: The _____ of diabetes.

Description: This measures the total number of individuals living with diabetes at a particular time, including both newly diagnosed and existing cases. It provides an overview of the disease burden within a population. For instance, the World Health Organization (WHO) might report that the global _____ of diabetes from 2020-2024 in adults over 18 years of age is around 8.5%.

Prevalence

Example: The _____ of lung cancer in smokers compared to non-smokers.

Description: This is the ratio of the probability of developing lung cancer among smokers to the probability among non-smokers. For instance, if smokers are 15 times more likely to develop lung cancer than non-smokers, they would have a _____ of 15 for lung cancer.

Relative risk

Prokaryotic cell

Properties:
Nucleoid

No membrane-bound organelles

Cell walls (peptidoglycan)

Single, circular chromosomes

Reproduce asexually (binary fission)

Ribosomes (small)

RNA Transcription/Translation simultaneous

No cytoskeleton

Simple flagella (flagellin)

Eukaryotic cell

Properties:

Nuclear envelope & nucleus

Multiple, linear chromosomes

Membrane-bound organelles

Ribosomes (large)

DNA Replication complex

RNA Transcription/Translation complex

Cell walls (cellulose in plants)

Can reproduce sexually via mitosis or meiosis (gametes)

Cytoskeleton

Complex flagella (9+2)

Mitochondria

A membrane-bound organelle in cytoplasm of eukaryotic cells

Energy Production (ATP): Site for tricarboxylic acid cycle (TCA or Krebs Cycle or Citric acid cycle) and phosphorylation

Regulates Metabolic Pathways: TCA cycle produces intermediates for metabolic pathways such as amino acid production. Site for beta-oxidation or fatty acid breakdown to produce acetyl-CoA for the TCA cycle.

Regulates sequester/release of CA2+

Regulates apoptosis pathway (releases cytochrome c)

ROS Production: During respiration, the production of ATP in electron chain transport produces these volatile molecules (damaging but signal the cells)

Metabolic Signaling: Senses energy status of cells and acts accordingly

Mitochondria

Modifies (Post RNA Translation), sorts, and packages proteins and lipids into vesicle transports

Cell Membrane Maintenance/Growth: Affects membrane composition and functionality through lipid transport and metabolism

Protein Quality Control: Sends misfolded proteins back to the endoplasmic reticulum or the lysosomes (degradation)

Immune Response: Helps present antigens for immune recognition

Complex Molecule Formation: Synthesizes polysaccharides used for extracellular matrix (protein meshwork in watery disaccharides) and cell signaling.

Golgi complex

Site of rRNa synthesis and transcription

Assembles ribosomes

Post-Translational ribosome modifier

Compartmentalizes genes (NOR) for rRNA (protein synthesis rate and metabolic activity)

Aids cell cycle and apoptosis

Helps assemble signal recognition proteins (SRPs) for targeting and inserting new proteins to the endoplasmic reticulum

Nucleolus

Diffusion

The movement of a solute molecule from an area of greater solute concentration to an area of lesser solute concentration

Hydrostatic

The mechanical force or pressure of water pushing against cellular membranes (partially balanced by osmotic pressures)

Example: 25-30 mmHg for blood reaching the capillary bed, across thin capillary membranes, into interstitial space

Osmosis

The movement of a water from an area of greater solute concentration to an area of lesser solute concentration.

Requires a membrane more permeable to water than solutes

Filtration

The movement of water and solutes through a membrane because of greater pushing pressure (force) one one side of the membrane than the other

Requires a membrane more permeable to water than solutes

Requires greater solute concentration on one side versus the other for water to pass more easily

Directly related to hydrostatic pressure and solute concentration (not particle size or weight)

Osmosis