patho exam 1

what are the goals of inflammation?

what are the goals of inflammation?

limit and control inflammatory process, prevent and limit infection/further damage, and initiate healing

IL-1 chemokine will do what to the inflammatory response

turn it on (pro-inflammatory)

antiinflammatory interleukins are

IL-10

what enhances inflammation

Tissue nuecrotic factor, leukocytes (b cells) or interferons

prostaglandins and bradykinins are cytokines associated with

pain

blocking prostaglandins to stop pain happens through

vasodialation

what are some cytokines that can limit inflammation

IL-10, TGF-Beta, histaminase,

what are some systemic effects regarding the inflammatory process

fever (IL-1, TNF, prostaglandins) leukocytosis. (any WBC involvement),

difference between a sign and a symptom?

a sign is an objective finding and a symptom is a subjective complaint by a patient

4 cardinal signs of inflammation are

redness, swelling, pain, heat

loss of function is a sign of

inflammation

you feel acute pain because the nerve fiber is damaged from the actual

damaged site

why is heat important in regards to inflammation

it will accelerate the chemical process and denature protiens

how is heat created

because vasodialation occurs allowing an increase in BF, creating friction, thus creating heat

swelling or edema happens because

of hydrostatic pressures (nutrients and water coming out of vessel)

order of inflammation is

watery exudate, fibrinous exudate, purulent exudate, hemorrahaic exudate

watery exudate indicates that there is

early inflammation

fibrinous exudate appears to be yellowish and clear. it indicates a more

advanced inflammation. can also be thick

purulent exudate (suppurative) means that there is pus. which usually indicates

bacterial infection

hemorragic exudate indicates

bleeding

A 45-year-old woman presents with a pleural effusion, and the fluid analysis shows the presence of blood mixed with inflammatory exudate. What type of exudate is this, and what are some possible causes of its appearance?

• The fluid is a hemorrhagic exudate, characterized by the presence of blood mixed with exudative fluid. This type of exudate can occur due to severe inflammation leading to damage of blood vessels, seen in conditions such as malignancy, tuberculosis, or trauma.

A 50-year-old man undergoes surgery for pericarditis, and the surgeon observes a thick, fibrin-rich exudate on the surface of the heart. What type of exudate is this, and how does it differ from other types of exudates in terms of composition and potential consequences?

The observed exudate is a fibrinous exudate, which is rich in fibrinogen that has polymerized into fibrin, forming a thick, sticky layer. It is often seen in severe inflammation, such as in pericarditis or pleuritis, and can lead to adhesions between tissues if not resolved.

: A 65-year-old woman presents with swelling in her knee after a recent fall. The aspirated joint fluid is clear and straw-colored with low protein content. What type of fluid is this, and what does it suggest about the underlying condition?

The fluid is likely a serous exudate, which is typically clear and has low protein content. It suggests a mild form of inflammation, such as that seen in early or non-infectious inflammatory processes like a mild injury or irritation

A 30-year-old man presents with a painful, swollen abscess on his leg. The abscess is drained, and the fluid is thick, yellow, and contains many neutrophils. What type of exudate is this, and what does it indicate about the nature of the infection?

• he fluid is a purulent exudate, which is thick, yellow, and rich in neutrophils, dead cells, and bacteria. It indicates a bacterial infection and the presence of pus, typically seen in abscesses, boils, or other pyogenic (pus-forming) infections.

acute inflammation is self limiting usually resolves on its own. what is a consequence of it?

chronic inflammation

inflammation that lasts 2+ weeks is chronic. what are some mechanisms regarding this?

there is pus formation, incomplete wound healing, microorganisms that can survice in macrophases, toxins, chemicals, particulate matter, or a physical irritant.

acute can become chronic. and chronic can become a ___ if not healed

granuloma

langhans giant cells are associated with

granulomas

regeneration leads to resolution to….

maintain function

regeneration can also lead to repair with

scar tissue

primary intention deals with tissue that can heal…

and usually has the best

minimally …best asthetic

secondary intention wounds will require more what and is….

healing time and it is an open wound

tertiary intention

wound is left open and then closed after

healing is what phase

proliferative phase 3

phase I of healing is called hemostasis where what occurs

coagulation

phase II deals w inflammation. what kind of cells are involved with this process

white blood cells like macrophases, neutrophils, lymphocytes

phase III is the process of actual….?

healing. scar tissue is replaced with normal or scar tissue.

dysfunctional wound healing causes dysfunction in the healing process. name a few examples

keloids (african american pop mostly)

dehiscence (wound opens back up and increases risk of infection)

contracture (tissue that is immobile or stuck)

CH 4 altered cell and tissue bio

pathogenesis refers to the

steps in development of a disease

pathophysiology refers to the

functional changes that accompany a syndrome or a disease

Diagnosis is

a sum of all symptoms/signs

etiology refers to cause or origin of a disease as well as risk factors. describe the diff between cause/origin v risk factor

cause/origin refers to something that is genetic or present at birth. risk factor refers to something that is in a persons family history. it may or may not develop ex would be high blood pressure.

idiopathic means there is

no known cause

iatrogenic refers to the human..

errors during a medical procedure. leading to a disease.

predisposing factors refers to

tendencies that promote a disease. like diabetes pts can be predisposed to hypertension.

prophylaxis is designed to

promote or preserve health

acute is sudden and lasts…

less than 14 days

chronic is recurring or persisting and lasts about

more than 14 days

insidious is a

slow and gradual progression of a disease

subclinical means that the patient presents

no symptoms. also known as the incubation period.

signs are

objection findings ex: blood pressure, temp, blood orders

symptoms are

subjective complaints by the pt

manifestations are

evidence of disease

syndrome

signs and symptoms occurring together to a certain condition

homeostasis is the

bodys ability to maintain constant internal environment

when does disease tend to arrive?

when homeostasis is broken.

induction of stressors will cause a cell to ____ in order to achieve a new steady state in order to preserve ____

adapt, function

if a cell cannot adapt?

it will cause cellular injury or death.

an 18 year old presents in the ER complaining of acute pain in the LR quadrant. pain associated with acute inflammation of the appendix is predominatly result of the formation and release of which two cytokines?

prostaglandin and bradykinin

warm and redness related to the inflammatory process results from…

increased BF in the area

what mechanisms result in edema that occurs during the inflammatory process?

increased capillary permeability

edema results from vasodilation and increase in hydrostatic pressure. true or false

true

all the following are potential outcomes from acute inflammation except.

a unregulated cellular growth and differentiation.

b fibrosis (scarring)

c chronic inflammation

d tissue regeneration

a

which of the following events can lead to chronic inflammation

a autoimmune

b tuberculosis

c syphillus

d all of the above

all of above!!

reversible cell injurt usually refers to when

a cell can maintain its function and can recover

irreversible cell injury refers to when a cell

cannot recover and will results in necrosis or apoptosis

hypoxia means that the cell has suffered a ___ in where?

lack of O2 in the cell

ischemia results from

insufficient BF in the tissues

infarct refers to

cell death from ischemia

ischemia is the most common cause of ___ while hypoxia is the most common cause of ____

hypoxia, cellular injury

what are some of the mechanisms behind hypoxia?

lack of production of RBC, diseases of cardio/circulatory or respiratory systems

if there is reduction to blood flow to the tissue then ischemia will occur, hence resulting in hypoxia in the cell. if hypoxia is chronic then you will have

infarction (ex heart attack)

consequences of ischemia include lack of BF to tissue. which results in

lack of ATP production or an influx of Ca

why is there an influx of Ca in the ER during ischemia?

the Ca is not being recycled back fast enough, hence the influx of Ca

ischemia reperfussion injury can occur after strokes, heart attacks, or people who have sickle cell disease. what is produced because of this injury?

reactive oxygen species or ROS. the formation of free radicals

lipids, glycogen, protein are key signs of

intracellular accumulation or signs of injury.

mechanisms of intracellular accumulation are usually defects in protein….

name an example of this

protein folding, denaturation, or transport.

abnormal metabolism of alcohol in the liver will make it fatty (the lipids were not packed correctly and remained in the cytoplasm)

is fatty liver reversable

yes

cellular adaptions are a respone to pathological stressors. name them and which one isnt a true one

atrophy, hypertrophy, hyperplasia, metaplasia, and dysplasia is not a true adaption

atrophy refers to cells that decrease in size. its caused by two diff mechanisms, decreased nutrition and workload. describe them.

decreased workload happens because of decreased blood flow, like a person breaking a limb and not using the muscle makes the body take away it’s nutrients. this is considered reversible

decreased nutrition occurs because of endocrine related changes, like aging

hypertrophy refers to when cells increase in size not numbers. name the physiological and pathological differences

physiological hypertrophy can occur in the heart (increases during exercise) and uterus (myometrium during pregnancy) (hormone stimulation)

pathological hypertrophy occurs in the heart because of diseases like hypertension

hyperplasia is a reversible process that increases cell size and amount of cells. what are the physiologic and pathological examples. what about compensatory hyperplasia

the uteruses endometrium enlarging during the menstrual cycle or breast tissue enlarging during pregnancy is physiological.

pathological hyperplasia occurs when there is an abnormal stressor (growth factor hormone) over producing and enlarging an organ.

compensatory hyperplasia occurs when an organ maintains its function, but enlarges. (liver regeneration or kidney)

metaplasia occurs because there is a replacement of one mature cell from another. why does this occur name an example

metaplasia occurs because there is a better adaption of cells, but it is mutated. GERD, lining of the esophagus changes from squamous to columnar. may predispose malignancy (because of mutation)

dysplasia is not a true cellular adaption because it is

a responce to cellular growth. usually low grade or high grade (carcinoma in situ)

high grade dysplasia indicates further….

pt tx

A 75-year-old woman has been bedridden for several months due to a hip fracture. Upon examination, you notice significant muscle wasting in her legs. What type of cellular adaptation is likely responsible for this observation, and what are the possible underlying mechanisms?

woman is likely experiencing atrophy of the muscles in her legs. This occurs due to disuse and the loss of muscle mass and function. The underlying mechanisms could include decreased protein synthesis, increased protein degradation, and reduced metabolic activity within the cells.

necrosis refers to irreversible changes in cells. it is ALWAYS pathological. name the types

1. coagulative

2. liquefactive

3. caseous

4. fat

5. gangrenous

coagulative necrosis is a type of cell death that occurs because of what characteristic

where does coagulative necrosis occur?

ischemia, usually firm or white

occurs in most organs except the brain, commonly associated with kidneys or heart or spleen

liquefactive necrosis is a type of cell death involved with the brain. what are some of its characteristics and causes of this

hydrolytic enzymes digest the tissue.

caused by bacterial/fungal infections or ischemic injury to the CNS

caseous necrosis is a combination of coagulative and liquefactive necrosis. its apperance is usually….

name an example

cheese like appearance and histologically related to granulomas (tuberculosis)

fat necrosis is a condition where fat cells die due to lack of oxygen. usually associated with the pancreas. a leakage of pancreatic lipase and calcium combined with create what kind of process to destroy the tissue

soapification. necrotic tissue will appear chalky white or opaque

gangrenous necrosis occurs because there is ____ or bacterial infection occurring (clostridium perfinges)

severe hypoxic injury

apoptosis can be both physiological or pathological. invoking NO ____

it is an active process, or programmed cell death. name examples

inflammatory responce.

physiological apoptosis could be embryogenesis (embryo’s webbed fingers leaving) or breast size after feeding. can also help with population control of cells.

pathological apoptosis occurs because of severe cell injury or an accumulation of miss folded proteins (endoplasmic reticulum stress)

autophagy occurs when a cell is induced by high levels of

nutrient starvation.

• A 30-year-old woman comes to the clinic with a history of frequent menstrual cycles. What kind of cellular adaption is occurring. Explain the pathophysiology behind this condition.

Hyperplasia is an increase in the number of cells within a tissue or organ. In this case, endometrial hyperplasia occurs due to an excessive proliferation of the endometrial lining, often driven by estrogen stimulation. Unlike hypertrophy, which involves an increase in cell size, hyperplasia involves an increase in the number of cells.

5-year-old man with a long history of smoking is found to have changes in the epithelial lining of his bronchi during a routine bronchoscopy. The normal ciliated columnar epithelium has been replaced by stratified squamous epithelium. What type of cellular adaptation has occurred, and what are the potential implications of this change?

The patient has experienced metaplasia, where one type of adult cell is replaced by another type that is better able to withstand the adverse environment. In this case, the columnar epithelium has been replaced by squamous epithelium, which is more resistant to the irritants in cigarette smoke. However, this adaptation can predispose the patient to a higher risk of developing dysplasia and eventually lung cancer.

• A 55-year-old woman undergoes a routine Pap smear, which reveals abnormal cells with variations in size, shape, and nuclear appearance. What type of cellular adaptation is indicated by these findings, and what is the clinical significance of this change?

• The findings are indicative of dysplasia, which is characterized by disordered growth and differentiation of cells, often seen as a precursor to cancer. In this case, cervical dysplasia could be a precursor to cervical cancer if not monitored and treated appropriately.

A 50-year-old man presents with high blood pressure and a long-standing history of untreated hypertension. His echocardiogram reveals an increased thickness of the left ventricular wall. Which type of cellular adaptation is most likely present in the myocardium, and what are the potential consequences if left untreated?

The patient likely has hypertrophy of the myocardial cells. This adaptation occurs as a response to the increased workload imposed by hypertension. If left untreated, it can lead to heart failure due to the reduced compliance and potential for arrhythmias.

A 60-year-old man is diagnosed with chronic kidney disease. Over time, his kidneys have decreased in size. What type of cellular adaptation is occurring in his kidneys, and what could be the possible causes?

• The patient is experiencing atrophy of the kidneys. This reduction in kidney size could be due to chronic ischemia, reduced blood flow, or the loss of nephrons. The kidneys are responding to decreased functional demand or reduced nutrient supply by reducing their size and function.