Pathophysiology Exam I

A set pathological process with well-defined signs and symptoms

Disease

Any indication of disease perceived by the patient, usually subjective

Symptom

Any objective evidence of disease or dysfunction. An observable physical phenomenon witnesses or interpreted by the clinician

Sign

The science and study of the causes of disease and their mode of operation

Etiology

The pathologic, physiologic, or biochemical mechanism resulting in the development of a disease or morbid process. All cellular events and reactions leading up to and occurring during the disease

Pathogenesis

The etiology of any disease begins with individual _____

Cell injury

Loss/lack of blood supply. Metabolic substrates build up in the tissues, injuring them faster

Ischemia

Act of taking up oxygen by tissues

Perfusion

Tissue death

Infarction

Deprived of oxygen loss of aerobic oxidative respiration

Hypoxia

An absence of oxygen supply to an organ or tissue

Anoxia

Every human cell evolves from the _______

fertilized egg

An undifferentiated (stem) cell capable of developing into any type of body cell is said to be ____

Totipotent

During _______ cells differentiate and therefore become specialized

mitosis

This cell type typically sits on a basement membrane

Connective tissue cell?

Epithelial cells

Mesenchymal cell

What are the two types of epithelial cells?

1. Lining Epithelial

2. Secretory Epithelial

____ epithelium means there is one layer of cells

Simple

_____ epithelium means there is more than one layer of cells

Stratified

Cells that are wider than they are tall (plate-like)

Squamous cells

Boxlike cells, approximately as tall as they are wide. Cube-shaped cells

Cuboidal cells

Cells that are taller than they are wide

Columnar cells

What kind of epithelium is found in the blood vessels?

Simple squamous epithelium

What kind of epithelium is found in the stomach?

Simple columnar, non-ciliated

What kind of epithelium is found in the larynx and respiratory tract?

Stratified squamous epithelium

What kind of epithelium is found in the urinary bladder?

Transitional epthelium

An organism with a complex cell or cells, in which the genetic material is organized into a membrane-bound nucleus or nuclei

Eukaryote

An organism that have DNA and are organisms such as bacteria that lack nuclei and other complex cell structures.

Prokaryotic

Non-living obligate intracellular parasites. Made only of a nucleic acid and a protein coat

Viruses

a small, spherical to rod-shaped, membrane-bounded cytoplasmic organelle, the principal sites of ATP synthesis (Krebs Cycle) found in eukaryotic cells only.

Mitochondrion

usually created aerobically (more efficient than anaerobically)

ATP

The cell's outer membrane made up of a two layers of phospholipids with embedded proteins. It separates the contents of the cell from its outside environment, and it regulates what enters and exits the cell. Internal receptors allow the cell to communicate with the external

environment

Plasma Membrane

Certain things can pass through the Plasma Membrane either ______ and or _____

actively and or passively

The process in which a cell takes in fluid together with its contents by forming narrow channels through its membrane that pinch off into vesicles, and fuse with lysosomes that hydrolyze or break down contents

Pinocytosis (cell drinking)

The process of ingestion and digestion by cells of solid substances, for example, other cells, bacteria, bits of necrotic tissue, foreign particles

Phagocytosis (cell eating)

What are the internal factors that cause cell injury?

1. Immunologic reaction - auto immune

2. Genetic derangements - cell line specific

3. Nutritional imbalance - non essential cells first

What are external factors that cause cell injury ?

1. Hypoxia

2. Physical agents - temperature, trauma, radiation

3. Chemical agents and drugs

4. Infectious agents

What is the difference between hypoxia and ischemia?

Hypoxia is a loss of O2 and ischemia is a loss of blood supply

Which are more dangerous/lethal, internal or external causes of cell injury/death?

Internal are more dangerous (immunologic reactions, genetic derangements, nutritional imbalances). This is because external factors are easier to control

Ubiquitin is one of the most highly conserved __________. It is found in the ________, ___________ and __________

eukaryotic proteins

nucleus, cytoplasm, cell-surface membrane

What is the purpose of ubiquitin?

to protect itself from itself

Ubiquitin is a small _________ that is involved in ___________ and is a marker for __________ and __________

polypeptide

histone modification

intracellular proteins transport

breakdown

________ have been found to produce proteases that denature "bad proteins" when Identified by Molecular Chaperones.

Lysosomes

what do lysosomes denature?

What do they produce to do this?

bad proteins

proteases

Failure of the ubiquitin system has been linked to ____, ____, ____ and _____

Alzheimers, Parkinson's, ALS, cataracts

Hyperactive ubiquitin system has been linked to _____ and _____

Non-insulin dependent diabetes mellitus (NIDDM)

muscle wasting in aging

What are the adaptive responses of the cell?

Atrophy

Hypertrophy

Hyperplasia

Metaplasia

Dysplasia

Atrophy is reduced _____ or ______ of cells or organ in response to different situations

function or size

4 causes of atrophy

1. interruption of trophic signals

2. persistent cell injury

3. increased pressure

4. chronic disease

Atrophy due to persistent cell injury is MC caused by ____

Inflammation

Example: atrophy of gastric mucosa with chronic gastritis

What is an example of atrophy secondary to interruption of trophic signals?

Endometrium atrophies after menopause secondary to decreased estrogen production

Where is atrophy caused by increased pressure is most commonly located?

sacral decubitus

What are some chronic disease that can cause atrophy?

1. Cancer

2. AIDS

3. CHF

Increase in cell size and function, typically in response to increased demand or increased trophic signals

Hypertrophy

Increase in number of cells in an organ or tissue

Hyperplasia

This often happens together with hypertrophy but also can happen individually as well.

Hyperplasia

Give some examples of normal hyperplasia (3)

Hormone stimulation causing an increase in endometrial/uterine cells during puberty or early menstrual cycle

Increase in O2 demand at high altitudes, causing polycythemia

long standing inflammation

Chronic injury such as long standing inflammation or chronic physical or chemical. Ex: injury- tight shoes can lead to a corns/callous. This is any example of?

Hyperplasia

Why is it dangerous for a patient with sickle cell disease travel to Denver without slowly acclimating ?

Due to the high altitude, the patient will become hypoxic and start producing more Hb S polymers that can cause acute chest syndrome (basically their lungs fill up with blood)

Conversion of one differentiated cell to another

Metaplasia

Barrett's esophagus forms as a result of long-term exposure of gastric acid in the esophagus. Esophageal cells are differentiated to gastric cells. This is an example of ?

Metaplasia

A patient with chronic GERD who has Barrett's esophagus, their normal _______ epithelium is replaced with ______ metaplasia.

Stratified Squamous epithelium

Simple Columnar metaplasia

In the early stages of Barrett's esophagus, is it reversible?

YES! *

Disordered growth and maturation of the cellular components of a tissue. Occurs in response to a ________ and will usually regress

Dysplasia

persistent injurious influence

Dysplasia is the first step in __, ___ and __ cancers

Bladder, cervical and prostate cancer

Occurs when environmental changes exceed the cells capacity to maintain normal homeostasis. This is the "point of no return".

Cell injury

Inability to adapt to stress, a cell will suffer severe damage leading to death

NECROSIS

Failure of the Na+/K+ pump leads to _____, which is reversible

Cloudy swelling

Cloudy swelling leads to ____, which is also reversible

Hydropic degeneration (cellular swelling) (reversible if insult is removed in time)

Hydropic degeneration (cellular swelling) leads to ____, which is irreversible

Necrosis

This is usually due to decrease blood flow, ATP is produced anaerobically under these conditions and its usually reversible.

Ischemia

Injury to tissue that occurs after blood flow is restored

Ischemia/Reperfusion injury

Explain the pathophysiology being reperfusion injury

Decreased oxygen to an area leads to generation of free radicals. Reperfusion of the area brings oxygen to these free radicals to form reactive oxygen species (ROS)

Short term ischemia=

Longer=

Too long=

reversible

ROS could lead to death of cell

death of cell

Nectrosis is accidental, passive secondary to _________ which causes (4 things and) Leads to eventual cell death.

hostile environment

cell/organelle swelling, ATP depletion, increased plasma membrane permeability, release of macromolecules.

Fat necrosis can be seen in end stage _____

Pancreatitis

Liquefactive necrosis can be due to ____

Abscess

What is an example of caseous necrosis?

TB

Coagulative necrosis is the most common that involves the shrinkage of the nucleus caused by condensation of chromatin

Pyknosis

Pyknosis involves shrinkage of the ____ caused by condensation of ______

Nucleus

chromatin

Destructive fragmentation of the nucleus

followed by disintegration (_______)

Karyorrhexis

Karyolysis

List the steps in the swelling stage of the necrosis pathway

1. Decreased blood supply

2. Decreased delivery of O2 and glucose

3. Anaerobic glycolysis

4. Increased lactate

5. Decreased intracellular pH

6. Decreased ATP production

7. Distortion of the plasma membrane pumps skews the ionic balance of the cell

8. Calcium accumulates inside the cell

9. Cell swelling results (cloudy)

List the steps in the definitive necrosis pathway (irreversible)

1. Decreased blood supply

2. Decreased delivery of O2

3. Impairs mitochondria electron transport

4. Decrease in ATP production

5. Increased production of ROS

6. Release of Cyt C to cytosol

7. Initiate apoptotic cascades

8. Cell death

This pathway ensues if no intervention is made to stop it

Programmed cell death, a signaling mechanism by which cells commit suicide

Apoptosis

Inflammation is not seen in the vicinity of ____ cells, but is often seen in areas of ____

No inflammation with apoptotic cells

Inflammation present in areas of necrosis

Apoptosis triggered from activation of certain membrane receptors by their ligands

Extrinsic pathway of apoptosis

Apoptosis triggered by diverse intracellular stresses and is characterized by a central role for mitochondria

Intrinsic pathway of apoptosis

perforin/granzyme pathway of apoptosis: Caused by the _________ with their cellular target. This pathway is activated by the transfer of _______ from the _______ to its _______

interaction of cytotoxic T cells

granzyme B

killer cell

intended victim

Give two examples of initiation of apoptosis at the cell membrane

1. Binding of tumor necrosis factor-alpha to its receptor (TNFR) triggers apoptosis

2. Recognition of FasL by its receptor Fas

Apoptosis pathways are not rigid but most intermediate enzymes that transduce proapoptotic signals belong to a family of cysteine proteases called ______.

Capsids

What are two death receptors on the surface of cell membranes which are activated upon binding to their ligands and trigger a downstream series of events that end in apoptosis?

1. TNFR

2. Fas

This gene preserves the viability of an injured cell when DNA damage can be repaired, but propels it toward apoptosis in the presence of irreparable damage

P53

System of local reaction of tissues and microcirculation to a pathologic insult. Its a protective response to minimize the initial addicts of the injury.

Inflammation

What are the two types of inflammation?

1. Acute

2. Chronic

Inflammation that lasts minutes to days and is characterized by an accumulation of neutrophils

Acute inflammation

inflammation that lasts weeks to months or longer can be due to prolonged infections, exposures to toxic agents or autoimmune.

chronic inflammation

What are the 5 cardinal signs of inflammation?

Rubor (redness)

Tumor (swelling)

Dolor (pain)

Calor (heat)

Loss of function

What is the main blood cell line associated with acute inflammation?

Neutrophils

What are the main cells of chronic inflammation?

Macrophages and lymphocytes (B and T)

What is the role of fibroblasts in the inflammatory process?

Fibroblasts are important in wound healing (lead to fibrosis)

Cells that reside in the tissue and release chemicals important in the inflammatory response

Mast cells

(I think M and M , for Muscle (because thats a tissue) and Mast cell)