patho test 2 (no quizzes)

intracellular compartment (ICF)

fluid within cells, 2/3 of body water

site of ­ K+

intracellular compartment

moderate amounts of Mg 2+

intracellular compartment

extracellular compartment (ECF)

fluid within cells, 1/3 of body water

found in interstitial/tissue spaces, within blood cells

extracellular compartment

site of ­ Na⁺, Cl^-, moderate amounts of HCO₃^-

extracellular compartment (ECF)

third space =

when transcellular compartment contains large amounts of fluid

capillary filtration pressure

pushes water out of capillary to interstitium

capillary colloidal osmotic pressure

pulls water back into capillary

interstitial hydrostatic pressure

opposes outward water movement

tissue colloidal osmotic pressure

pulls water out of capillary

lymphatic system

accessory route to return interstitial fluid to the circulation

compulsive water drinking

psychogenic polydipsia

psychogenic polydipsia is seen in people with

psychiatric disorders

neurogenic DI (diabetes insipidus)

defect in synthesis/release of ADH

nephrogenic DI (diabetes insipidus)

kidneys don’t respond properly to ADH

syndrome of inappropriate secretion of ADH (SIADH)

ADH secreted despite normal OSM, decreases urine output, transient or chronic condition, dilution hypoatemia

hypertonic (translocational) hyponatremia

water shifts from ICF to ECF with hyperglycemia

hypotonic (dilutional) hyponatremia

caused by water retention, water intoxication

hypovolemic hypotonic hyponatremia

sweating in hot weather (lose water + salt)

euvolemic hypotonic hyponatremia

retain water with dilution of Na⁺ while maintaining ECF (e.g., SIADH)

hypervolemic hypotonic hyponatremia

seen with edema-associated disorders, e.g., heart failure, cirrhosis, renal disease

where is most fluid found?

intracellular compartment

primary source of water loss

urine

Na+ (sodium) regulates

extracellular fluid volume and osmolarity

Na+ (sodium) is regulated by

aldosterone and antidiuretic hormone (ADH)

Calcium, Ca2+ is regulated by

PTH

Regulate K+

insulin, epinephrine, aldosterone, and glucocorticoids

respiratory acidosis acute disorders of ventilation

problem with respiratory center of medulla, lung disease, respiratory muscle weakness, airway obstruction

respiratory acidosis choric disorders of ventilation

bronchitis, emphysema

respiratory acidosis increased CO2 production

exercise fever, sepsis

functions of the main electrolytes (ions)

transmit nerve signals, and contract muscles including the heart

causes of edema

increase in capillary filtration pressure, decrease in capillary colloidal osmotic pressure, increase capillary permeability, obstruction to lymph node

LDL

1° carrier of cholesterol

HDL

50% protein, little cholesterol

VLDL

higher amounts triglycerides, lower amounts of cholesterol

lipoproteins are made in the small intestine

chylomicrons

transport absorbed fats to skeletal muscle and adipose

chylomicrons

small, spherical dilation of vessel at bifurcation, eg circle of willis

berry aneurysm

involves entire circumference of vessel; gradual, progressive dilation of vessel

fusiform aneurysm

extends over part of circumfernce of vessel and appears sac like

saccular aneurysm

false aneurysm resulting from tear in intima layer of aorta the creates a blood filled cavity

aortic dissection

inflammatory injury and necrosis of blood vessel walls, may result in injury from direct injury to vessel

vasculitides

small vessel vasculitides

arterioles, venules, capillaries

small vessel vasculitides

mediated by type III immune complex hypersensitivity reaction, commonly involve the skin

medium sized vessel vasculitides

produce necrotizing damage to medium sized muscular arteries of major organ systems

large vessel vasculitides

involve large elastic arteries, involve infiltration of vessel wall with giant cells and mononuclear cells

Thromboangiitis obliterans (Buerger disease)

affects medium sized arteries, usually plantar and digital vessels

Buerger disease is common in

male smokers, 25-40 years, tobacco may trigger immune response

Buerger disease

pain associated with intermittent claudication, sensitivity to cold; area can become cyanotic

Raynaud disease

vasospasm of arteries & arterioles in fingers (& toes), seen in healthy young women, begins with stress or cold

 venous thrombosis (thrombophlebitis)

presence of thrombus in vein with accompanying inflammatory response in vessel wall, more common in lower extremities, associated with blood stasis and vessel wall injury

a symptom of peripheral arterial disease

claudication (calf pain with walking)

stable angina

angina pectoris

angina pectoris

symptomatic paroxysmal chest pain/pressure associated with transient

prinzmental angina is caused by

spasms of coronary arteries; mechanism uncertain

silent myocardia ischemia

absence of anginal pain

silent myocardia ischemia is seen in patients that are otherwise

asymptomatic, with previous MI, with recurring angina episodes, or with

autonomic neuropathy (diabetics)

ST segment elevation

transmural injury

ECG changes

T wave inversion due to altered myocardial repolarization

ST segment elevation

transmural injury

Depression

subendocardial injury

abnormal Q wave

no depolarizing current conduction after injury

mitral valve prolapse

floppy mitral wave

mitral valve prolapse is

mucinous degradition of mitral valve leaflets to become floppy so that they balloon back into L-atrium during systole

mitral valve stenosis

incomplete opening, commonly the result of rheumatic fever

mitral valve stenosis results in

left atrium dilation and pulmonary congression

mitral valve regurgitation

incomplete closure, associated with rheumatic fever, rupture of chordae tendinae/papillary muslces

dialated cardiomyopathies

result in progressive cardiac hypertrophy and dialation with lower pumping ability of one or both ventricles, can result from infections, alcohol/toxic agents, neuromuscular or immunological disorders, genetic influences

hypertrophic cardiomyopathies

excessive ventricular growth/hypertrophy

restrictive cardiomyopathies

not common in western countries, ventricular filling is restricted because of rigidity of ventricular walls

peripiartum cardiomyopathy risk factors

maternal age, african-american, multifetal pregnancy, preeclampsia and gestational hypertension

peripartum cardiomyopathy is similar to

dialated cardiomyopathy

in most cases of peripartum cardiomyopathy

½ cases heart returns to normal within 6 mos; remainder of cases can result in maternal death with another pregnancy

kawaskai disease

mucocutaneous lymph node syndrome; acute febrile disease affecting skin, brain, eyes, joints, liver, lymph nodes & heart; results in vasculitis (inflammation of blood vessels)

coarctation of the aorta

narrowing of the aorta proximal of distal to the ductus arteriosus

coarctation of the aorta symptoms

disparity in pulsations and BP in arms bounding and legs (weak), surgically remediation between 2-4 years

transposition of the great vessels

aorta originates in right ventricle/pulmonary artery originates in left ventricles

transposition of the great vessels survival depends

on communication between R/L sides of heart via patent ductus arteriosus or septal defect

patent ductus arteriosus

persists after birth should close after 24-72 hours and become permanetely sealed by 2-3 weeks, treated surgically or with drugs that prevent prostaglandin synthesis

endocardial cushion defects

cushions form the AV canals, upper part of ventricular septum and lower part of atrial septum, common in Down’s syndrome children, may be partial or complete AV canal defects

Four asociated conggenital heart defects that are present in tetralogy of fallot

Ventricular septal defect, dextroposition or shifting to the right of aorta so that it overrides the right ventricle, narrowing of pulmoary outflow channel, hypertrophy of right ventricle

function of heart is supra-normal but inadequate because of high metabolic demands

high output

inadequate because of disordes that impair pumping abilty of heart

low out put

imparied ejection

systolic failure

imparied filling

diastolic failure

congestion in peripheral circulation

right side failure

congestion in pulmonary circulation

left side failure

AV node block

partial or complete interruption of impulse transmission from the atria to the ventricles

tachycardia

your heart is beating much faster than normal,

bradycardia

heart is beating slower than normal

heart flutter

heart palpitations

renin-angiotensin-aldosterone system

increases Na+ absorption and decreases GFR

myoglobin

released quickly, elevated within 1 hour of myocardial cell death, not cardiac specific

creatine kinase MB

isoenzyme specific for myocardial tissue, rises within 4-8 hours of injury, returns to normal within 2-3 days

troponin I & T

rise within 3 hrs of MI, remainc elevated for 7-10 days

cause of cardiac tamponda

increased fluid, blood or pus in pedicardial sac, due to tramua, surgrey, cancer, uremia, cardiac repture with MI

cardiac tamponade relief

echocardiogram can evaluate condition, to remove fluid from pericardial sac

stenosis

narrowing of a valvular orifice, failure of valve to open properly