2850 Pathophysiology Exam Two Flashcards
Tension headache pathophysiology
Stress induced, and often associated with muscle tension in neck, shoulders, and occipital area
Tension headache: clinical manifestations
Bifrontal or occipitofrontal pain with gradual onset
Pressure or band like pain
Vital signs and neuro exam normal
Tension headache: risk factor
Stress
Cluster headache: pathophysiology
Pathophysiology not entirely understood, but believed to be a neurovascular disorder
Cluster headaches: clinical manifestations
Severe, unilateral pain that is usually periorbital and radiates into the jaw, face, etc Eye tearing Eye redness Runny nose Pupil constriction Restlessness Eyelid edema
Cluster headache: risk factors
Alcohol Tobacco Stress Allergies Weather changes
Migraine headaches: pathophysiology
Pathophysiology not totally understood, but could be due to low serotonin levels in the brain leading to constriction and dilation of blood vessels
Migraine headache: clinical manifestations
Unilateral, vascular, throbbing pain that lasts for 4-72 hours May be preceded by aura Nausea and vomiting Light sensitivity Noise sensitivity
Migraine headache: risk factors
Low serotonin in brain Stress Hormones Smoking Weather Food additives Alcohol Caffeine Fatigue
Lupus: pathophysiology
Formation of autoantibodies that form immune complexes that are deposited in organs and tissues, which triggers an inflammation response that damages organ membranes and microvasculature
Which organs and tissues are most commonly affected by lupus?
Skin
Synovium
Glomeruli
Lungs
Lupus: clinical manifestations
Fatigue Fever Myalgias Arthralgias Butterfly rash Joint inflammation Musculoskeletal pain Splenic enlargement Pleurisy and pleural effusion Vasculitis Pericarditis Anemia Thrombocytopenia Headaches Leukopenia Nephrotic syndrome Raynaud’s phenomenon
Nephrotic syndrome
Hypertension plus hematuria
Ranaud’s phenomenon
Tricolor change in the fingers due to vasospasm of blood vessels
Lupus: risk factors
Genetic predisposition EBV antibodies Being a woman of childbearing age African American, Asian, or Hispanic descent Estrogen Certain prescription medications Environmental elements
Fibromyalgia: pathophysiology
Unknown
Fibromyalgia: clinical manifestations
Long-term, body wide pain affecting joints, muscles, tendons, and soft tissues
Fatigue
Headache
Sleep problems
Depression
Anxiety
Pain at at least 11 out of 18 specific tender points
Fibromyalgia: risk factors
Can affect anyone, but especially women between 20 and 50 years of age
What is the most important function of hemoglobin?
Combining with oxygen in the lungs and releasing it to peripheral tissues
What happens with PaO2 drops below 60 mmHg?
Hemoglobin drops off oxygen molecules too quickly, leading to tissue hypoxia
What is the role of erythropoietin in the stimulation of RBC production?
When bloodstream oxygen gets too low, the kidneys secrete erythropoietin, which stimulates the bone marrow to make red blood cells, increasing the oxygen carrying capacity of blood
What is the ventilation-perfusion ratio (V-Q ratio)?
Ratio of amount of air reaching the alveoli to the amount of blood reaching the alveoli
What is ideal in terms of the VQ ratio?
Equal amounts of air and blood reaching alveoli
What is the built in compensatory mechanism of the lungs to try to match blood flow and ventilation?
When there is little ventilation, pulmonary arterial vessels constrict, redistributing blood flow to better ventilated areas
What is the primary stimulus to control rate and depth of breathing?
Central chemoreceptors
How do central chemoreceptors work?
They sense changes in CO2 levels and blood pH and adjust rate and depth of breathing
Give an example of how breathing will be adjusted based on CO2 and pH
If CO2 levels are high/pH is low, respiration rate and depth will increase
Hypercapnia
High levels of CO2
What is the role of hypercapnia in breathing?
Stimulate breathing process
What is the secondary stimulus of breathing?
Peripheral chemoreceptors
How do peripheral chemoreceptors work as a stimulus to breathing?
Receptors in the aortic arch and carotid artery respond to decreased arterial oxygen and stimulate respiration
Breathing stimulated by peripheral chemoreceptors is known as..
Hypoxic drive
What happens when central chemoreceptors are exposed to high levels of CO2 for long periods of time?
They become less responsive, and peripheral chemoreceptors take over as stimulus for respirations
At what level of SaO2 do peripheral chemoreceptors take over?
60 mmHg
Describe how mycobacterium tuberculosis is passed to other individuals
Inhalation of airborne droplets containing M. Tuberculosis bacilli, which settle in the bronchial tree and proliferate
What is the role of white blood cells in responding to infection with M. Tuberculi?
WBC’s wall off the infected area, forming a lesion called a tubercule (WBCs + bacilli+ fibrotic tissue) which scar tissue forms around, making the bacilli inactive
What happens when M. Tuberculi bacteria continue to multiply?
They break through the scar tissue tubercule and continue to proliferate and spread, becoming active again
What adverse effect happens in tuberculosis infection when macrophages degrade the bacteria?
Enzymes for killing the bacteria also damage the lung tissue, making lung tissue necrotic, and bacteria reinfect the bronchial tree (patient is contagious again)
What are presenting signs and symptoms of pulmonary TB?
Chronic cough with purulent sputum Hemoptysis Weight loss Anorexia Chest pain Fever with night sweats
What are some additional findings in patients with pulmonary TB?
Lung crackles
Enlarged lymph nodes
What populations are at high risk for acquiring TB?
Healthcare workers Urban residents Nursing home residents Prisoners Immunosuppressed patients Those born/living/traveling outside US
What other lifestyle factors increase the risk of acquiring TB?
Living in close quarters with other/infected people Alcoholism ESRD Diabetes Travel to areas where TB is common
What are the top causes/triggers of asthma?
Allergies Viral respiratory infections Exercise Inhaled chemicals Multiple episodes of asthma
What happens in the body (pertaining to asthma) when allergens trigger the immune system?
Bronchial constriction
Inflammation
Increase in size and number of goblet cells that secrete mucus
What is the role of T lymphocytes in the pathophysiology of asthma?
They assist B cells to turn into plasma cells that produce immunoglobin E, which triggers the release of histamines and leukotrienes
What is the role of leukotrienes during an asthma attack?
Responsible for development of bronchoconstriction, bronchial hyperreactivity, edema, and eosinophilia
What substance is stimulated during a viral respiratory infection that can trigger an asthma attack?
IgE directed towards viral antigens
What do viral and bacterial upper respiratory infections commonly cause in someone with asthma?
Bronchospasm and copious mucous production
How can exercise induce an asthma attack?
Provoking loss of heat and water from the tracheobronchial tree
What can exaggerate exercise-induced asthma?
Cold weather
How can inhaled chemicals induce bronchospasm?
They irritate receptors that stimulate a vagar reflex, which includes dizziness, sweating, nausea, fainting
What can multiple episodes of asthma cause in the airways?
Airway remodeling
Describe the process of airway remodeling
Proliferation of respiratory epithelium and hypertrophy of respiratory smooth muscle
What is the result of epithelial cell injury in patients with asthma?
It exposes airway to triggers for hyperreactivity, which can cause more frequent bronchospasm
What are clinical manifestations of asthma?
Wheezing Cough Dyspnea Chest tightness Prolonged exhalation
What is an early sign of airway obstruction?
Prolonged exhalation
What are signs of a severe asthma attack?
Use of accessory muscles
Distant/diminished breath sounds
Diaphoresis
List the signs that a patient is going into respiratory failure
Inaudible breath sounds
Repetitive, hacking cough
Cyanosis
What is the most common etiology of asthma?
Allergy
Which employment settings have the highest risk for exposure to chemical agents that can cause asthma?
Farming Painting Construction Landscaping Janitorial work
What are common triggers of asthma in children?
Viral infections, like rhinovirus or RSV
Define COPD
A combination of chronic bronchitis, emphysema, and hyperactive airway disease. It is a poorly reversible airflow limitation
What are characteristic features of COPD?
Mucus hypersecretion
Hypoxia
Cyanosis
Persistent cough
What are some characteristics of emphysema?
Overdistended alveoli with trapped air
Hyperreactivity in the airways
What is the consequence of overdistended alveoli with trapped air?
Obstruction of expiratory airflow
Loss of alveolar elastic recoil
High residual volume of CO2
Summary: breathing in is okay but breathing out is hard
What happens with hyper reactive airways in emphysema?
Extremely reactive to irritants, leading to episodes of bronchoconstriction
What pathological changes lead to airflow limitation in COPD?
Narrowing
Excessive mucus and fibrosis in airways
Loss of alveolar elastic recoil
Smooth muscle hypertrophy
How are pulmonary structures remodeled in COPD?
Bronchioles are remodeled due to chronic inflammation, thickened bronchiole walls, and constricted lumen
What factors cause the damages to lung structures in COPD?
Leukotrienes
Interleukins
Tumor necrosis
What happens when increased levels of CO2 become chronic in COPD?
Respiratory drive stimulus changes from PCO2 accumulation to low levels of PO2 instead. Hypoxia stimulates breathing
Why must administration of oxygen to patients with COPD be carefully controlled?
Oxygen can depress patient’s independent drive to breathe, leading to respiratory arrest
What are characteristic s/s of COPD?
Dyspnea Cough Wheezing Hypoxia Cyanosis
What cardiac complication can be brought on by COPD?
Right sided heart failure
Why might individuals with COPD develop clubbing of the fingers?
Chronic hypoxia
What is a major cause of COPD?
Smoking
What are additional risk factors/causes of COPD?
Occupational or environmental exposure to chemicals or dust Secondhand smoke exposure Genetic predisposition Connective tissue diseases IV drug use
What is cystic fibrosis?
An inherited, autosomal recessive, multisystem disease
Describe the disruption of cells that leads to CF
Disruption of exocrine gland function and chloride secretion in epithelial cells of respiratory tract, pancreas, sweat glands, salivary glands, intestines, and reproductive system
What is the primary problem in CF?
Thick, viscous mucous secretions in multiple organ systems
What is the consequence of mucous secretions in CF for the lungs and bronchioles?
Impaired oxygen/CO2 exchange at alveoli
Promotion of bacterial growth
What are the consequences of CF mucous secretions on the GI tract?
Poor digestion due to increased mucous
What are consequences of the CF mucous secretions on the pancreatic ducts?
Obstructed ducts, leading to deficiency of pancreatic enzyme and deficient digestion of protein, carbs, and fats
What are respiratory signs and symptoms of CF?
Cough Excessive sputum Chronic infection Wheezing Air trapping Sinus disease Pallor
What are GI signs and symptoms of CF?
Failure to thrive Fat soluble vitamin deficiency Edema Pancreatitis Rectal prolapse Loose and fatty stools
Why are women of childbearing age at higher risk for iron deficient anemia?
Menstrual blood loss
Increased iron needs in pregnancy/delivery/breastfeeding
Why are infants and children at risk for iron deficient anemia?
Low iron in cows milk (after weaning from formula or breast milk)
Increased iron need during growth
Why are elderly adults at risk for iron deficient anemia?
Poor diet
Dental issues
Lack of stomach acid (which is needed for iron absorption)
What are some causes of GI bleeding?
Peptic ulcers
Esophageal varices
GI cancer
What is the first thing to do when a man presents with iron deficiency?
Check for GI bleeding
What is the RDA of iron intake for men and women?
Men: 8 mg/day
Women: 18 mg/day
What are signs and symptoms of anemia in general?
Fatigue
Weakness
Exercise intolerance
What are specific signs of iron deficiency?
Har loss Cheilitis Nail changes Pica Cold intolerance Glossitis (tongue inflammation)
Normal BP parameters
Less than 120/80
Stage one hypertension parameters
140-159/90-99
Stage two hypertension parameters
Greater than 160/100
Primary hypertension
Also known as essential hypertension, it has no known cause
Secondary hypertension
Hypertension that is a side effect of a systemic disorder
What percentage of adults with HTN have primary HTN?
90-95%
What are risk factors for hypertension?
Age African American heritage Obesity Diabetes Inactivity Tobacco use High sodium diet Low potassium or vitamin D intake Excess alcohol Stress
Why are African Americans at higher risk for hypertension?
High sodium sensitivity
What are two major negative effects of HTN on the cardiovascular system?
High damaging forces against the endothelial lining
High resistance against the left ventricle
What are the effects of high aortic pressure?
Excessive workload in the left ventricle, which can lead to left ventricular failure
How does HTN predispose systemic arteries to injury?
It creates a high shearing force against artery walls, which causes endothelial weakening and injury, which can specifically cause blindness, kidney failure, stroke, and lower extremity vascular issues
What are signs and symptoms of target organ damage in HTN?
Chest pain Dsypnea on exertion Palpitations Headache Vision problems Dizziness Weakness Edema Leg pain
What symptoms may people with HTN complain of?
Often none
In extreme cases: headache, nosebleeds, blurred vision, palpitations
What change serves as the precursor to atherosclerosis?
Endothelial injury
What are common causes of endothelial injury?
Oxidizing free radicals
Shearing force of high BP
High blood glucose levels
Elevated LDL cholesterol
Non-modifiable risk factors for atherosclerosis
Age
Gender (males earlier)
Race (African American)
Family history
Modifiable risk factors for atherosclerosis
Diet Activity level Obesity Lifestyle HTN Diabetes
What is the age difference between men and women in the risk of developing atherosclerosis?
Men over 45 are at higher risk
Women over 55 or post-menopausal are at increased risk
Why are diabetic patients at higher risk for developing atherosclerosis?
Often have elevated triglyceride and LDL levels
Often have vascular changes
Why does smoking increase atherosclerosis risk?
Smoke contains free radicals that cause endothelial injury
Smoke decreases HDL levels
What lifestyle factors contribute to the development of atherosclerosis?
Tobacco use
Excess alcohol use
Stress
What is the bodily process of atherosclerosis development?
Endothelial injury brings WBCs and platelets to injury site
WBCs ingest LDL cholesterol
These cholesterol-laden WBCs become foundation for atherosclerotic plaque
What happens over time with atherosclerotic plaques?
It enlarges and becomes calcified and turns into a fibrous platelet cap (atheroma)
The expanding plaque stretches the vessel to its limit, and the vessel becomes stiff and hardened
What signs and symptoms may be present when atherosclerosis has caused organ dysfunction?
Chest pain SOB Palpitations Leg pain Dependent edema
What are signs and symptoms when atherosclerosis causes altered cardiac function?
Obesity SOB at rest Pallor Cyanosis Weak pulses in lower extremities Increased BP Rapid pulse S4 murmurs and bruits Chest pain Dyspnea upon exertion
Cardiac output
Amount of blood pumped out of left ventricle each minute
What is cardiac output based on
Heart rate times stroke volume
What controls the heart rate?
SNS and PNS
What influences stroke volume?
Preload
Afterload
Cardiac contractility
Preload
Volume of blood in the heart at the end of ventricular diastole
What does preload mean in the clinical setting?
Volume of blood that enters the right atrium from the venous system
Afterload
Amount of resistance ventricles must overcome to pump blood out of the heart
What creates high afterload for the right ventricle?
High pulmonary vascular resistance
Cardiac contractility
Myocardium’s ability to stretch and contract in response to the heart filling with blood
What conditions enhance contractility in a healthy heart?
Increased preload/SV
What happens to contractility when afterload increases?
Contractility decreases, so less blood is ejected from the heart
What does RAAS stand for?
Renin-angiotensin-aldosterone system
Describe renin and its role in BP
Released from kidneys when renal perfusion decreases, triggering angiotensinogen to be released from the liver, which breaks down into angiotensin I, which triggers formation of angiotensin II when it encounters ACE in the lungs
What is the role of angiotensin II?
Arterial vasoconstrictor that raises BP, triggers ventricular remodeling, and stimulates adrenal release of aldosterone
Aldosterone and it’s mechanism of action
Acts at the nephron to increase sodium and water reabsorption from distal tubules to the bloodstream
What are the net effects of the RAAS?
Elevated BP and BV, which leads to increased workload for left ventricle
What problem does the RAAS create in left ventricular failure?
The increased BP and BV further weaken the heart muscles
Parasympathetic nervous system effects on the heart
Stimulates cholinergic receptors to slow HR and decrease contraction force
Sympathetic nervous system effect on the heart
Stimulates beta 1 adrenergic receptors to increase HR and contraction force
What role does the posterior pituitary play in blood pressure and blood volume control?
It releases ADH, which causes water reabsorption at the nephron for increased BV and BP
What does left ventricular diastolic dysfunction occur from?
Reduced relaxation or increased stiffness of ventricular muscle
What is the common cause for development of left ventricle changes?
Increased afterload caused by HTN
What does left ventricular systolic dysfunction occur from?
Reduced forward pumping strength of ventricle muscle, leading to decreased stroke volume and cardiac output
What are the two major types of consequence of left ventricle systolic dysfunction?
Backwards effect and forward effect
Backward effect of left ventricular dysfunction
Buildup of hydrostatic pressure in the left atrium and pulmonary vasculature, leading to fluid accumulation in pulmonary interstitial/intracellular spaces (pulmonary edema)
Forward effect of left ventricle systolic dysfunction
Inadequate ejection of blood into the aorta and decreased perfusion through the arterial circulatory system
What does left ventricle systolic dysfunction stimulate?
RAAS, ADH release, and SNS activation
What are the effects of angiotensin II on the systemic arterial system?
Widespread vasoconstriction
Increased peripheral arterial resistance
Aldosterone release
What are clinical manifestations of LVF?
Orthopnea
Paroxysmal nocturnal dyspnea (sudden SOB in middle of night)
Cerebral symptoms: headache, memory loss, insomnia, anxiety, disorientation
GI signs and symptoms
Right ventricular failure is also known as
Cor pulmonale
Backwards failure in right ventricular failure
Right ventricle is weak, leading to increased pressure in right atrium, which increases systemic venous pressure, leading to edema in the body
What is the result of increased pulmonary arterial blood flow?
Hypoxemia (tissue hypoxia)
What are clinical manifestations of right ventricular failure?
Jugular venous distension
Poor GI venous drainage
Peripheral edema
What conditions are associated with poor GI venous drainage?
Anorexia Nausea Early satiety Postprandial fullness Indigestion Impaired absorption
Stress incontinence: manifestations
Incontinence upon force, such as coughing, sneezing, or laughing
Stress incontinence: causes
Poor pelvic support or sphincter weakness due to pregnancy, age, or low estrogen levels
Urge incontinence: manifestations
Urgency and frequency of urination
Urge incontinence: cause
Overactive detrusor muscle, though the exact mechanism is unclear
Overflow incontinence: manifestations
Chronic overdistention and urinary retention
Overflow incontinence: most common cause
BPH
Neurogenic bladder: manifestation
Chronic bladder overdistention
Neurogenic bladder: causes
Spinal cord injury or disorder causing interruption of sensory nerve fibers or afferent nerve pathways between bladder and spinal cord
Mixed incontinence
Combination of stress and urge incontinence
Functional incontinence: manifestation
Incontinence due to not being able to get to the bathroom in time
Functional incontinence: causes
CNS damage, (stroke, dementia, immobility, cognitive impairment)
BPH: pathophysiology
Excessive cell growth of the prostate gland
BPH: etiology
Testosterone-sensitive cellular proliferation and lack of apoptosis in the prostate
BPH: clinical manifestations
Frequent urination but voiding only small amounts Incontinence Incomplete bladder emptying Dribbling Straining to urinate Weak urine stream Increased UTI/risk
By age 60, what percent of men have some degree of BPH?
50%
Constipation: causes
Lack of fiber or fluid Lack of physical activity Ignoring urge to defecate Drugs (especially opiates) Diseases that slow GI tract
Constipation: manifestations
Hard stools Pain and discomfort Increased flatulence Increased rectal pressure Hemorrhoids Abdominal distinction and bloating
What is the most common GI disorder in the US?
GERD
GERD: pathophysiology
Lower esophageal sphincter is weak, allowing acid reflux into the esophagus, causing esophageal ulceration.
This causes metaplasia (esophageal epithelial cells turning into stomach-like columnar epithelium)
Delayed gastric emptying also contributes to discomfort and erosion
GERD: signs and symptoms
Dysphasia Heartburn Epigastric pain Regurgitation Respiratory complaints Bitter taste in mouth
Who is most affected by GERD?
Infants and those over 40
What is Barrett’s esophagus?
Changes in esophageal structure in GERD. Precancerous cellular changes
GERD: risk factors
Obesity Pregnancy Nicotine Alcohol use Chocolate Coffee Fatty foods Certain meds
Peptic ulcer disease: description
Inflammatory erosion of stomach or duodenal lining
Peptic ulcer disease: pathophysiology
Hypersection of hydrochloric acid, Ineffective GI mucous production, and poor cellular repair cause erosion of the mucous membranes in the stomach and duodenum. HCl leaks into the stomach wall and blood vessels, causing ulcers
What often damages the protective mechanisms of the stomach in PUD?
H. Pylori bacteria (secretes urease, which breaks down urea and neutralizes stomach acid)
What are some other causes of peptic ulcers?
Excessive NSAIDs
Alcohol abuse
Excess caffeine
Smoking
Why does chronic NSAID use cause peptic ulcers?
NSAIDs counteract prostaglandin E secretion, which stimulates gastric mucous production
Peptic ulcer disease: signs and symptoms
Epigastric or abdominal pain occurring 2-3 hours after eating Intense burning and gnawing pain Pain that wakes patient up at night Nausea and vomiting Blood in vomit or stool
Peptic ulcer disease: complications
Bleeding from the ulcer
Perforation
Scarring of stomach lining
Pyloric stenosis
Signs and symptoms of peptic ulcer perforation
Sudden, excruciating pain
Abdominal rigidity
Pallor
Cold sweats
Signs of gastric peptic ulcers
Pain relief immediately upon eating food, then pain gets worse after acid secretion starts
Signs of duodenal peptic ulcers
Pain that is not relieved by food, or food not relieving it until a while has passed after eating
Crohn’s disease: definition
Chronic, uncontrolled immune response of the bowel that leads to bowl destruction and sometimes obstruction
Crohn’s disease: pathophysiology
Mucosa of bowels is chronically inflamed with high levels of immunoglobins, T-cells, and macrophages. This causes inflammation and destruction of segments of the bowel
What are some characteristic features of the bowel of someone with crohn’s?
Granulomas (large masses of immune cells)
Cobblestone appearance due to sporadic areas of bowel destruction
Crohn’s disease: etiology
Unknown, but may be genetic or environmental
Higher SES or being female increase risk
Peak onset for Crohn’s disease
Between 15 and 30 years old, or between 60 and 80 years old
Crohn’s disease: signs and symptoms
Diarrhea Abdominal pain Remissions and exacerbations Blood in the stool Weight loss Abdominal pain Anorexia N/V/D Increased bowel sounds Arthritis Cheilitis
