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Goljan > 1. Cell Injury > Flashcards

1. Cell Injury Flashcards

1
Q

What do we use to measure oxygen in the body?

A

Hemoglobin, oxygen saturation (on the heme), partial pressure of arterial oxygen

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2
Q

What does it mean for oxygen saturation to be 100%?

A

All 4 spots on heme bound to oxygen

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3
Q

What is partial pressure of arterial oxygen?

A

Oxygen dissolved in PLASMA

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4
Q

What is the relationship between oxygen saturation and partial pressure of arterial oxygen?

A

Move in the SAME direction because oxygen saturation gets its oxygen from the oxygen dissolved in plasma

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5
Q

What is the most common cause of ischemia?

A

Thrombus in muscular artery

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6
Q

What is hypoxemia?

A

Decreased partial pressure of arterial oxygen

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7
Q

Whenever you have respiratory acidosis, what happens to partial pressure of O2?

A

Goes down - hypoxemia; there is always an inverse relationship between PCO2 and PO2

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8
Q

Patient with hypoxemia given 100% O2 and O2 doesn’t increase - what’s happening?

A

Shunt - perfusion but no ventilation (kids - hyaline membrane disease, adults - adult respiratory syndrome)

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9
Q

What happens when you give 100% O2 to someone with a perfusion defect?

A

O2 will increase because not every single alveoli is not perfused

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10
Q

Does anemia give you hypoxemia?

A

NO - it gives you decreased Hgb but PO2 and oxygen saturation are normal

You will have hypoxia (tissue lacks oxygen) but not hypoxemia (PO2 in the blood is normal)

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11
Q

Heater in the winter time, automobile exhaust, house fire - what should you think of?

A

CO poisoning

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12
Q

What else should you think of with house fire aside from CO poisoning?

A

Cyanide poisoning because of upholstery on furniture

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13
Q

What is the only lab value affected in CO poisoning?

A

Oxygen saturation is decreased because CO displaces O2 on the heme

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14
Q

How do we treat CO poisoning?

A

100% oxygen

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15
Q

What does cyanosis mean?

A

Decreased oxygen saturation

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16
Q

What is the first symptom of CO poisoning?

A

Headache

17
Q

Why do we not see signs of cyanosis with CO poisoning?

A

It produces a cherry red pigment that can mask the blue

18
Q

What is methemoglobin?

A

Hemoglobin with FE3+ instead of 2+ which makes it so that oxygen can’t bind - decreased oxygen saturation

19
Q

Dude coming out of the Rocky Mountains, cyanotic, give him 100% O2 and he’s still cyanotic - diagnosis?

A

Methemoglobinemia because of drinking water with nitrites/nitrates which are oxidative agents

20
Q

What is the main treatment for methemoglobinemia?

A

Methylene blue

21
Q

What are 2 things that sulfa and nitro drugs (oxidizing agents) do?

A
  1. Produce methemoglobin

2. Produce hemolytic anemia in G6PD deficiency

22
Q

Why do we see methemoglobinemia in HIV patients?

A

They are usually on TMP-SMX for treatment of PCP

23
Q

What shifts hemoglobin curve to the right?

A

CADET: CO2, acidosis, 23BPG, Elevation (causes increase in synthesis of 23BPG), Temperature

24
Q

What shifts hemoglobin curve to the left?

A

CO, HbF, alkalosis

25
Q

What inhibits cytochrome oxidase?

A

CO and cyanide (think 3 C’s)

26
Q

What does CO do?

A
  1. decreases O2 sat
  2. shifts hemoglobin curve to the left
  3. inhibits cytochrome oxidase

this is why CO is so bad

27
Q

What is one of the complications of salicylate poisoning?

A

Hyperthermia because salicylates are uncoupling agents

28
Q

Acute respiratory acidosis - what happens to Hgb, oxygen sat, PO2?

A

Hgb - nothing, Oxygen sat and PO2 - both decreased

29
Q

What can you give in addition to methylene blue for methemoglobinemia?

A

Ascorbic acid

30
Q

What are the biggest problems in tissue hypoxia?

A
  1. Decrease in ATP leading to anaerobic glycolysis and lactic acid build up
  2. ATPase pumps broken
    3.
31
Q

What does the build up of lactic acid do in a cell?

A

Denature proteins and enzymes –> coagulation necrosis (grossly: infarction)

32
Q

Why are cells swollen in tissue hypoxia?

A

Decreased ATP –> Na-K pump stops working –> Na stuck in cell –> cell swells

33
Q

What happens to calcium in tissue hypoxia?

A

Enters cell because Ca-ATPase pump stops working - once it’s in the cell calcium activates all kinds of enzymes (membrane damage, nuclear pyknosis)

34
Q

When you have free radical damage what kind of pigment do you see in cells?

A

Lipofuchsin - can’t break down lipids all the way

35
Q

What is the most common cancer that comes from radiation?

A

Leukemia

Goljan (21 decks)

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