patho exam 2

stages of GAS

• alarm

• resistance

• exhaustion

alarm stage

initial reaction, sympathetic NS

resistance stage

adaptation, limit the stressor

exhaustion stage

adaptation failing, coping methods utilized, disease develops

local adaptation syndrome

• localized version of GAS

• bodies attempt to minimize stress to a small location

first line of defense

• Innate Immunity

• nonspecific, distinguishes self from non-self

• does not distinguish between pathogens

• skin and mucous membranes

• immediate reaction

second line of defense

• Innate Immunity

• responds to antigens that penetrate first line

• inflammatory response

• pyrogens, interferons, complement proteins

histamine

triggers vasodilation

prostaglandins

stimulates pain receptors

manifestations of inflammatory response

erythema, edema, pain, warmth

pyrogens

• fever producing molecules

• released by bacteria after exposure to antigens

• travel to hypothalamus

interferons

• proteins released from virus of infected cells

• bind to uninfected cells and prevent viral replication

complement proteins

• blood plasma proteins that enhance antibodies action

• circulate in inactive state, activated by antigens

third line of defense

• adaptive (aquired)

• specific, develops over time

• uses memory system, able to recognize antigens

• distinguishes between self, nonself, and pathogens

T cells

cellular immunity

B cells

humoral immunity

cellular immunity description

• mediated by T cells on recognition of antigen

• T cells produced in bone marrow and mature in thymus

T helper vs T suppressor

notify B cells vs turn off antibody production

humoral immunity description

• mediated by B cells on encountering agent

B memory vs B immunoglobulin secreting

memory vs producing antibodies after initial reaction

IgG

• largest amount

• main defense

• passed through placenta or breastfeeding

IgE

• epipen

• allergic reactions

IgM

• my first antibody

• fights blood infections

• triggers more IgG

• first antibody made in fetus

IgD

• dispatch for B cells

• signal to activate for B cells

active acquired immunity

long lasting but takes a few days to be effective

active acquired immunity (natural)

have the disease and antibodies are formed naturally

active acquired immunity (artificial)

vaccines, no illness but antibodies are formed

passive acquired immunity

short lasting

passive acquired immunity (natural)

passed from mom to baby through placenta or breastfeeding

passive acquired immunity (artificial)

antibodies injected directly into the body to provide temporary protection until the body can form its own antibodies

hypersensitivity

inflated immune response to foreign substance

autoimmune

mistakes self for nonself

immunodeficiency

inadequate immune reaction

Type I Hypersensitivity: IgE mediated

• allergic reaction

• immediate response

• caused by repeated exposure to allergen

• T helpers stimulate B cells to produce more IgE

Type II Hypersensitivity: cytotoxic

• IgG or IgM antibodies bind to antigen on individual cells

• lysis occurs, immediate reaction

• recognition by macrophages triggers antibody production

Type III Hypersensitivity: immune complex mediated

• delayed

• circulating antigen/antibody complexes collect and enter tissue

• triggers complement system, causing inflammation

Type IV Hypersensitivity: Delayed

• 2 phases: sensitizing and effector

• cell mediated, causes severe tissue injury and fibrosis

• antigen presentation results in interferon release causing inflammation

periostem

• connective tissue that covers compact bone

• site for muscle attachment

red bone marrow

site for hematopoiesis

bone growth componenets

• calcitonin and PTH: regulate bone remodeling and mineralization

• estrogen: inhibits osteoclast formation in women

• testosterone: increases bone length and density in men

• vitamin D: controls absorption of calcium and phosphate

congenital diseases

kyphosis, lordosis, scoliosis

kyphosis

increase in curvature of the thoracic spine

lordosis

exaggerated concave of the lumbar spine

traumatic disorders

fracture, dislocations, sprains, strains, herniated disc

simple vs comminuted fracture

single break vs multiple fracture lines and multiple bone pieces

greenstick vs compression fracture

incomplete break in which bone is bent and outer curve broke vs bone is crushed or collapsed into small pieces

complete vs incomplete fracture

bone is broken in 2+ pieces vs only partially broken

impacted vs depressed fracture

one piece of bone is forced into adjacent bone vs broken piece of skull forced into brain

pathologic fracture

• results from weakness in bone structure

• osteoporosis or tumors

osteomyelitis vs osteonecrosis

infection of bone tissue vs death of bone tissue due to loss of blood supply

dislocation

separation of two bones at a joint

sprain

injury to ligament that involves stretching or tearing of ligament

strain

injury to muscle or tendon that involves stretching or tearing of tendon

herniated intervertebral disc

protrusion of nucleus pulposus through the annulus fibrosus

osteoporosis

• metabolic condition characterized by a loss of bone calcium that leaves bone brittle

• spongy bone becomes porous and compact bone becomes thing

osteoporosis manifestations

• asymptomatic in early stages

• osteopenia

• low back or neck pain

• height reduction over time

• kyphosis, fractures, bone pain

rickets

• soft weak bone in children due to extreme/prolonged vitamin d/phosphate/ calcium deficiency

osteomalacia

• adult version of rickets

• minerals shift out of bone

• if blood levels become too low it causes weak/soft bones

paget’s

• progressive metabolic condition characterized by excessive bone destruction and replacement of the bone with fibrous abnormal bone

• results in weak/fragile bones

inflammatory joint disorders

osteoarthritis, rheumatoid arthritis, pathogenesis, gout, ankylosing spondylitis

osteoarthritis

• degenerative joint disease characterized by local deterioration of articulating cartilage and its underlying bone

• tissue damage triggers enzyme release from local cells, accelerating cartilage disintegration

osteoarthritis manifestations

• gradual onset presenting after age of 40, develops slowly and worsens over time

• joint pain that worsens with movement, tenderness with light pressure

• limited ROM, crepitus, joint stiffness, joint swelling

rheumatoid arthritis

• systemic autoimmune condition involving multiple joints

• inflammatory process primarily affects synovial membranes

rheumatoid arthritis manifestations

• insidious onset, progressively worsens

• fatigue, anorexia, malaise, unsteady gait

• lymphadenopathy, bilateral joint pain, muscle spasms, joint deformity

RA: pathogenesis

synovitis, pannus formation, cartilage erosion, fibrosis, ankyloses

gout

inflammatory disease resulting from deposits of uric acid crystals in tissues and fluids

gout manifestations

• varies depending on phase

• intense pain at affected joint

• joint redness, warmth, swelling, and tenderness

• fever, joint deformities, limited joint mobility

ankylosing spondylitis

• progressive inflammatory disorder affecting sacroiliac joints, intervertebral spaces, and costovertebral joints

• new bone forms in attempt to remodel inflammatory damage

• results in joint fibrosis and calcification

ankylosing spondylitis manfiestations

• lower back pain, fatigue, weight loss, kyphosis

• pain and stiffness with inactivity, muscle spasms

chronic muscle disorders

muscular dystrophy, fibromyalgia, bone tumors

muscular dystrophy

• group of inherited, noninflammatory disorders characterized by degeneration of skeletal muscle (9 types)

• Duchenne MD is most common and most severe

muscular dystrophy manifestations

• mental retardation, muscle weakness leading to hypotonia

• por coordination, muscle spasms, delayed development of motor skills

• progressive loss of joint mobility, unilateral calf hypertrophy

fibromyalgia

• syndrome predominantly characterized by widespread muscular pains and fatigue

• affects muscles, tendons, and surrounding tissue

fibromyalgia manifestations

• vary depending on weather, stress/fatigue, physical activity, and time of day

• widespread muscular pain, depression, IBS, headaches, memory loss

bone tumors

• majority are malignant and occur secondary to other tumors

osteochondroma

tumor adjacent to growth plates, 10-20 years old

osteosarcoma

aggressive, begins in bone cells most commonly in femur, tibia, and fibula, children and young adults

ewing’s sarcoma

aggressive with unknown origin, children and young adults

bone tumor manifestations

• asymptomatic in early stages, pathologic fractures, bone pain, palpable mass

• fatigue, weight loss

congenital disorders integ

birthmarks and disorders of melanin

inflammatory disorders integ

contact/atopic dermatitis, urticaria, psoriasis

infectious disorder integ

bacterial, viral, parasitic

chronic disorders integ

acne vulgaris, rosacea

traumatic disorders integ

burns

albinism

• recessive condition that results in little or no melanin production

• problems with eye development and function

• eye changes: nystagmus, strabismus, photophobia, functional blindness

vitiligo

• rare, small patches of hypopigmentation

• occurs when cells that produce melanin die

contact dermatitis

• acute inflammatory reaction triggered by direct exposure to an allergen or irritant

• resolves in 2-4 wks

irritant contact dermatitis

• caused by chemicals, acids, soaps

• does not involve immune system but triggers inflammatory response

• manifestations: erythema, edema, pain, pruritus, vesicles

allergic contact dermatitis

• caused by chemicals, cosmetics, plants

• sensitization occurs on the first exposure and following exposure trigger Type IV cell mediated hypersensitivity rxn

• manifestations: erythema, edema, pain, pruritus, vesicles

atopic dermatitis (eczema)

• chronic inflammatory condition triggered by an allergen

• accompanied by asthma and allergic rhinitis

• manifestations: red/brownish gray colored skin patches, pruritus, vesicles, dry/cracked skin

urticaria

• raised erythematous skin lesions, result of Type I hypersensitivity rxn

• occurs when histamine release is initiated by substances/conditions

• manifestations: welts that blanch, pruritus

psoriasis

• common chronic inflammatory condition that affects the skin life cycle

• cell proliferation increases causing build up of skin cells and thickening of the dermis/epidermis

folliculitis

• involving hair follicles

• tender swollen areas that form surrounding the hair follicle

furuncles

• boils, begin in hair follicles and then spread into surrounding dermis

• most common in neck, axillae, groin, butt, and back

• starts as red painful nodule and forms into large red painful mass usually drains large amount of exudate

impetigo

• common and highly contagious (usually kids)

• begins as small vesicles that enlarge and rupture, forming honey-colored crust

• typically causes by staphylococci

cellulitis

• occurs deep in dermis and subcutaneous tissue

• results from direct invasion of pathogens through break in skin

• swollen, warm, tender area of redness

necrotizing fascitis

• rare/serious, aggresively destroys skin, fat, muscle, and other tissue

• GRAM POSITIVE GROUP A BETA HEMOLYTIC STREPTOCOCCUS

• bacteria releases harmful toxins that directly destroy tissues, disrupt blood flow, and break down tissue

herpes simplex 1

• begins in childhood, transmitted through saliva

• cold sore

herpes zoster

• caused by varicella-zoster virus

• lies dormant of cranial/spinal nerve, affects only this nerve

• red/silvery vesicular rash that forms in a line over innervated nerve

• shingles

verrucae

• caused by human papillomavirus

• transmitted through direct skin contact

• replication of skin cells causes thickening

• warts