PATHO exam 3 vocab

blood

a fluid connective tissue composed of plasma, formed elements, RBCs, WBCs, and platelets

hematopoietic stem cells

precursor cells in bone marrow and differentiate to form red cells, white cells, and platelets

hematopoiesis

formation and development of blood cells

(bone marrow replenishes the blood cells)

Vitamin B 12

necessary for DNA synthesis for cell division

ex. meat, liver and foods rich in animal protein

also needed for structural and functional integrity of nervous system

folic acid

necessary for DNA synthesis for cell division

ex. green leafy vegetables and animal protein foods

iron

necessary for hemoglobin synthesis

erythrocytes (red blood cells, or RBCs)

primarily concerned with transport of oxygen, most numerous cells, survive 4 months (120 days)

reticulocytes

immature RBCs become mature erythrocytes in the bloodstream

hemoglobin

oxygen-carrying protein formed by the developing red cell

red cell production

regulated by oxygen content of the arterial blood

erythropoietin (EPO)

hormone that stimulates erythropoiesis

released by the kidneys in response to hypoxia

hemoglobin (Hgb)

composed of 4 subunits, each one consisting of heme and globin

heme

contains an iron atom

anemia

reduction in red blood cells of subnormal level of hemoglobin

blood has abnormally low O2 carrying capacity

blood O2 levels cannot support normal metabolism

normocytic anemia

normal size and appearance

macrocytic (megaloblastic) anemia

cells larger than normal (folic acid and vitamin b12 deficiency)

microcytic anemia

cells smaller than normal

iron deficiency

normochromic anemia

normal hemoglobin content

hypochromic anemia

reduced hemoglobin content (iron deficiency)

hyper chromic anemia

increased hemoglobin content

hypochromic microcytic anemia

smaller than normal and reduced hemoglobin content (iron deficiency)

complete blood count (CBC)

to assess degree of anemia, leukopenia, and thrombocytopenia

blood smear

determine if normocytic, microcytic, or hypochromic microcytic

reticulocyte count

assess rate of production of new red cells

lab tests for anemia

determine iron, b12, folic acid

evaluation of blood loss from GI tract

stool examination, studies of GI tract

bone marrow study

study characteristic abnormalities in marrow cells, assess for infiltration by leukemic cells or metastatic tumor

iron-deficiency anemia

the most common type of anemia

hypochromic microcytic anemia

bone marrow replacement anemia

marrow infiltrated by tumor or replaced by fibrous tissue

anemia of chronic disease

mild suppression of bone marrow function

aplastic anemia

a condition resulting from an insult to the stem cells in the bone marrow resulting in destruction of inhibition of red bone marrow

RBC, WBC, and platelet production is reduced

sickle-cell anemia

defective gene codes for abnormal hemoglobin (HbS)

causes RBCs to become sickle shaped in low-oxygen situations

thalassemias

absent of fault globin chain synthesis

RBCs are thin, delicate, and deficient in hemoglobin

microcytic hypochromic anemia

acquired hemolytic anemia

normal red cells but unable to survive due to a “hostile environment”

polycythemia

condition of increased RBC concentration in the blood

result of increased blood viscosity

increased tendency to thromboses

pneumothorax

collection of air or gas in the pleural cavity that results in a collapsed or partially collapsed lung

air enters the pleural space from a lung or the atmosphere

manifestations of pneumothorax

chest pain, shortness of breath, reduced breath sounds on affected side. chest x-ray

spontaneous pneumothorax

no apparent cause

most cases in young healthy persons

rupture of small, air-filled bleb at apex of lung

traumatic pneumothorax

results from penetrating or crushing trauma to the chest

fractured rib, gunshot, and stab wound

hemothorax

accumulation of blood and other fluids in the pleural cavity

atelectasis

collapse of all of portion of the lung

symptoms of atelectasis

may lead to dyspnea and hypoxia

decreased breath sounds

pneumonia

inflammation of the lung due to infection

bacterial pneumonia

typically cause an acute inflammatory response that is characterized by exudate formation in the alveoli

viral pneumonia

draws inflammatory cells into the interstitium

clinical features of pneumonia

cough, fever, chills, sweating, dyspnea, purulent sputum, pain on respiration

treatment of pneumonia

antibiotics, analgesics for the chest pain, oxygen therapy, bed rest, increases fluids

tuberculosis

infection of the lungs by Mycobacterium tuberculosis

acquired by inhaling airborne droplets containing the bacteria or dead spores of the bacteria

infection begins with a primary lesion in the lower lung

diagnosis of tuberculosis

TB skin test, Mantoux, PPD

interferon-gamma release assay

chronic bronchitis

usually diagnosed on the basis of 2 consecutive years in which a productive cough is present for 3 or more months

dominant factor is smoking

symptoms of chronic bronchitis

productive cough, dyspnea, increases respiratory infections, use of accessory muscles of respiration is common

emphysema

characterized by destructive changes in alveolar walls and irreversible enlargement of alveolar air spaces

results in loss of gas exchange surface area

emphysema symptoms

onset of symptoms is insidious

dyspnea, tachypnea, use of accessory muscles of breathing, characteristic barrel chest, pursed lip breathing

cystic fibrosis

hereditary autosomal recessive trait that causes chronic dysfunction of the exocrine glands

results in thick mucus production that cases obstructions

is a systemic disease

lungs almost always affected , pancreas is also often affected

restrictive lung disease

problem is restricted expansion of the lungs

suffers exhibits reduced total lung capacity

extrinsic restriction

involves abnormalities external to the lungs that interfere with respiratory movements

intrinsic restriction (pulmonary fibrosis)

pulmonary interstitial becomes fibrotic and stiff

chronic bronchitis

usually diagnosed on the basis of 2 consecutive years in which a productive cough is present for 3 or more months

dominant factor is smoking

symptoms of chronic bronchitis

productive cough, dyspnea, increases respiratory infections, use of accessory muscles o respiration is common

emphysema

characterized by destructive changes in alveolar walls and irreversible enlargements of alveolar air spaces

results in loss of gas exchange surface area

pathogenesis of emphysema

neutrophils and macrophages responding to injury caused by infection or inhaled irritants release serine elastase

smoking affects this process by: causing damage that draws more phagocytes into the lungs, promoting excessive release of serine elastase, blocking the action of alpha1- antitrypsin

symptoms of emphysema

onset of symptoms is insidious, dyspnea, tachypnea, use of accessory muscles of breathing, characteristic barrel chest, pursed lip breathing

prognosis for COPD

long-term prognosis is poor

emphysema is the most common cause of death from a respiratory disease in the US

cystic fibrosis

hereditary autosomal recessive trait that causes chronic dysfunction of the exocrine glands

results in thick mucus production that causes obstructions

is a systemic disease

lungs almost always affected

pancreas is also often affected

treatment of cystic fibrosis

CFTR modulators, medications to thin mucus, chest physiotherapy, high-calorie diet, pancreatic enzyme supplements, sometimes lung transplantation is an option

prognosis of cystic fibrosis

considered a fatal disease

life expectancy has increased into the 30s

restrictive lung disease

problem is restricted expansion of the lungs (cannot fully inflate) , suffers exhibits reduced total lung capacity

extrinsic restriction

involved abnormalities external to the lungs that interfere with respiratory movements

intrinsic restriction (pulmonary fibrosis)

pulmonary interstitial becomes fibrotic and stiff

systemic lupus erythematosus (SLE)

sarcoidosis

radiation damage

pulmonary fibrosis

fibrous thickening of alveolar septa, makes lung rigid restricting normal respiratory excursions

diffusion of gases hampered due to increased alveolar thickness

causes progressive respiratory disability similar to emphysema

most causes derive from prolonged irritant exposure due to low-level occupational exposures (pneumoconiosis)

musculoskeletal causes of extrinsic restriction

chest abnormalities , scoliosis, large breasts/obesity

neuromuscular causes of extrinsic restriction

myasthenia graves, muscular dystrophy (weak muscular movements)

pneumoconioses

asbestosis, anthracosis, silicosis

pneumoconiosis

chronic restrictive lung disease caused by inhalation of irritant dusts or droplets

inhalation gradually overwhelms airway clearance mechanism and results in particle accumulation in alveoli and interstitium

inflammatory and immune cell infiltration causes fibrosis

asbestosis

caused by exposure to asbestos fibers (building materials, tiles, insulation near pipes, break pads)

characterized by a slow and progressively diffuse fibrosis of the lungs

the most common type of pneumoconiosis

anthracosis

black lung or coal miner’s lung

caused by the accumulation of carbon deposits in the lungs resulting from inhaling smoke or coal dust

silicosis

develops as a result of inhaling silica (quartz) dust and causes a dense fibrosis with emphysema with respiratory impairment

affects stone Mansons, metal grinders, and those who work in quarries

symptoms of restrictive lung disease

asymptomatic for many years (poss. decades)

onset of symptoms is insidious, with dyspnea on exertion being the first symptom

tachypnea, dry cough, recurrent respiratory infections

treatment of restrictive lung disease

limited because of the irreversible nature of damage

stopping exposure

steroids to limit the damage caused by inflammatory cells

the liver

largest organ in body, right upper abdominal area, beneath the diaphragm, has a dual blood supply

main functions of the liver

metabolism ,synthesis, storage, detoxification and excretion

portal vein in liver

75% of blood, drains spleen and GI tract, rich in nutrients absorbed from intestines, low in oxygen

hepatic artery in liver

rest of blood, high in oxygen, low in nutrients

portal triad in liver

portal tracts travel together

hepatic artery branches, portal vein, bile ducts

bile

* when red blood cells break down, iron is reused and iron-free heme pigment forms bilirubin in and is excreted in the bile
* small quantities of bilirubin are continually present in blood
* when blood passes through liver, bilirubin is removed by conjugation (by combining bilirubin) with glucuronic acid
* aqueous solution with various dissolved substances

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cholelithiasis

formation of stones in the gallbladder

risk factors of cholelithiasis

* estrogen promotes increased excretion of cholesterol and decreases excretion of bile salts
* higher in women than men
* higher in women who have borne several children
* twice as high in women who use contraceptive pills
* higher in obese women (and men)
* obese people excrete more cholesterol in bile
* more common with increasing age

factors increasing solubility of cholesterol in bile

* cholesterol is insoluble in aqueous solution
* dissolved in micelles composed of bile salts and lecithin
* solubility of cholesterol depends on ratio of cholesterol to bile salts and lecithin

signs/symptoms of cholelithiasis

* asymptomatic if stones remain in gallbladder
* if stone is extruded into ducts
* biliary colic
* obstructive jaundice

biliary colic

* acute, colicky epigastric pain radiating to the right scapula
* pain is often worse following a high fat meal
* nausea and vomiting

* blockage of bile flow
* clay-colored stools

treatment of cholelithiasis

* laparoscopic cholecystectomy
* medications to try to dissolve stones

cholecystitis

* inflammation of gallbladder
* gallbladder becomes necrotic and infected
* gallstone gets stuc

etiology of cholecystitis

usually associated with impaction of a stone in new of gallbladder

symptoms of cholecystitis 

* fever
* as with cholelithiasis

treatment of cholecystitis 

antibiotics, analgesics, antiemetics, laparoscopic cholecystectomy when patient is stabilized

primary carcinoma

* HBV carriers have a high risk for develop liver disease and primary liver carcinoma
* uncommon in US and Canada but common in Asia and Africa due to high incidence HBV carriers
* In North America, most hepatic cancers develop in association with chronic hepatitis or cirrhosis

metastatic carcinoma

* vast majority of hepatic tumors in developed countries are metastatic
* spread from primary sites such as GI tract (via portal venous system)
* lung, breast, other sites
* via hepatic artery

symptoms of hepatic tumors

upper abdominal pain, weight loss, early satiety, palpable abdominal mass, ascites, hepatomegaly, splenomegaly, jaundice

treatment of hepatic tumors

surgical resection is the treatment of choice but many patients are not candidates