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Fall 2020 Advanced Patho > Cellular Basis Of Disease > Flashcards

Cellular Basis Of Disease Flashcards

1
Q

Part 1: The Language of Disease

A
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2
Q

What is Disease or Pathology?

  • Pathology =
  • Disease =
  • Diseases are d_______

How can you tell when someone is in a disease state?

A
  • the physical manifestation of a disease
  • defined as both the cause of the initial insult and also the pattern of a response that an organism has to that initial insult
  • Dynamic

Often the body’s response to the injury is actually more of a negative manifestation than the initial injury ie. HIV -> AIDS

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3
Q

Concept of “Normal”

  • Sources of Variation
    • G_______
    • A___
    • S___
    • Sit______
    • T_____
    • L_______ Conditions
A
  • Variation
    • Genetics
    • Age
    • Sex
    • Situational
    • Time
    • Laboratory Conditions
  • For many “normal” physiologic parameters = there is a range (ie BP) based on population sampling*
  • Situational ex) someone living at high altitude*
  • Time ex) assessing testosterone in men, highest in the morning (assessing hormone levels)*
  • Lab ex) diff labs have diff ranges*
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4
Q

The Language of Disease

  • Etiology =
  • Pathogenesis =
  • Clinical Manifestations =
A
  • “cause”
    • Idiopathic: cause of disease unknown
  • interaction btwn initial injury and body’s response to it to produce abnormal function - and the ultimate disease that emerges (more so from the body’s response)
  • the observable consequences of a diseae - S/S
    • ​Sign = objective, measurable (fever, rash, abnormal gait)
    • Symptom = subjective, felt by patient, must be reported by the patient
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5
Q

Causes of Cell Injury Categories

(3)

A

Unknown (Idiopathic)

Extrinsic (Physical agent vs. Infectious)

Intrinsic

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6
Q

Intrinsic Causes

  • In_____
  • Con______
  • M_____
  • Deg______
  • Neo_____
  • Imm______
  • N_______ Deficiency
  • Psy_____
A
  • Inherited
  • Congenital
  • Metabolic
  • Degenerative
  • Neoplastic
  • Immunologic
  • Nutritional Deficiency
  • Psychogenic

Caused by the body itself

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7
Q

Extrinsic-Physical Agent Induced Causes

  • Animation =
    • F_____
    • T________
    • H_______
    • R_______
    • El______
    • Ch______
    • Ia_______
A
  • Inanimate
    • Force
    • Temperature
    • Humidity
    • Radiation
    • Electricity
    • Chemicals
    • Iatrogenic - conditions inadvertently caused by medical care (ie. AKI from contrast)
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8
Q

Extrinsic: Infectious Causes

  • Animation =
    • Pathogenic O_______
    • V____/B_____/F_____
    • Pro_____
    • Pathogenic A_____
    • In_____/W______
A
  • Animate
    • Organism
    • Viruses/Bacteria/Fungi
    • Protozoa
    • Animals
    • Insects/Worms
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9
Q

Unknown Causes of Cell Injury

=

A

Idiopathic = uknown origin (ie essential HTN)

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10
Q

Factors of Pathogenesis

(4)

A
  • Time = how long exposure was to the injury
  • Quantity = how much exposure to injury
  • Location = which part of the body (ie DVT vs. PE)
  • Morphological Changes = morphological adaptations by cells and tissues in the body
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11
Q

Clinical Manifestations

  • Sign =
  • Symptoms =
  • Changes with time:
    • ​Latent period =
    • Prodromal period =
    • Acute Period
A
  • measurable, observable
  • subjective, felt/reported by patient
  • Changes with time
    • period of no S/S, period of quiet
    • first appearance of S/S
    • Severity of S/S reach its peak
      • ​after this either recovery or chronic period
  • Syndrome: sterotypical combination of signs and symptoms that presents for a disease/is expressed*
  • Ex) acute stage viral syndromes such as HIV*
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12
Q

Making a Diagnosis: Methods

  1. ______ Methods
    • S/S
  2. ______ Methods
    • U___alysis (f____ analysis)
    • _____ Analysis
      • Blood c____, ch_____, c_____, / S____
    • T____ Diagnosis
    • Electro_______
    • Ra_____

This all leads to you making what type of diagnosis?

A
  1. Clinical
  2. Laboratory
    • Urinalysis/Fecal
    • Blood
      • counts, chemistry, culture/ Serology
    • Tissue (biopsy)
    • Electrocardiogram
    • Radiography

Differential Diagnosis

Serology - looks at antibodies (ie. looking at if someone was exposed to Hep B - looking for IgF or IgM)

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13
Q

Part 2 Maintaining Cellular Function

A
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14
Q

The Cellular Basis of DIsease

  • Levels of organization
    • specialized ____ -> specialized _____ -> ______ -> organ ______ -> those organ systems help maintain normal _____ of the entire organism
  • Cellular Response to Injury
  • Interdependence of cells and systems =
  • Maintaining Cellular function?
    • Cells don’t have direct ____ to anything
    • What cells need to maintain normal function = by body’s system to maintain normalcy of ECF with ______, adequate v_____, p_____
    • ICF: we maintain ICF by maintaining the ____
A
  • Levels
    • cells -> tissues -> organs -> systems -> function
  • Cell response to injury
  • = Normal function of a cell allows for normal function of a system and vice versa
  • Maintaining cellular function
    • access
    • Oxygen, Volume, Pressure
    • ECF
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15
Q

The Interior and Exterior Cell Environment

ICF

ECF (2)

A

Intracellular Fluid

Extracellular Fluid

  • Interstitial Fluid (btwn cells and blood vessels)
  • Intravascular Fluid = plasma within blood vessels
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16
Q

Important Factors in Maintaining Cellular Homeostasis

(5)

A

Cell Volume (Water and Osmolyte Balance)

Electrolyte Balance

Maintaining pH

Cell Metabolism

Cell Transport

  • Cell Volume - too much or too little can cause death*
  • Electrolyte - especially Na, K, Ca- effects cell activity*
  • pH - V tightly controlled*! (as well as temp) - every enzyme that catalyzes reactions that our body relies - enzymes (proteins will denature if pH is imbalanced)*
  • Cell Metabolism - set of chemical reactions that allow cells to generate heat and ATP, conversion of energy (food) into energy in form of heat*
  • Cell Transport - normal movement of substances across the membrane*
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17
Q

Maintaining Cell Volume

  • By maintaining _____ and _____ balance
    • Water
      • _________ system
    • Osmolytes (Sodium and Potassium)
      • ________ system
      • ________ system
A
  • water, osmolyte
    • Water
      • ADH/Thirst System
    • Osmolytes
      • Renin-Angiotensin System (systemically)
      • Na+/K+ ATPase pumps (intracellulary)
  • Osmolyte balance = osmolarity of ICF = osmolarity of ECF (equal # of osmolytes on both sides)*
    • If unbalanced, water follows osmolytes (Na+, K+ are the main ones)*
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18
Q

Systemic Control of Water Balance

  • Body water is _____ from two primary sources
    1. water _____ alone or in food
    2. water liberated from ______ processes
  • Body water is primarily ____ through three routes
    1. water lost through _____
    2. water lost through _____
    3. water lost through _____
A
  • gained
    • consumed aka ADH system
    • metoblic
  • lost
    • urine obvs the most significant unless in a diarrheal state etc.
    • feces
    • sweat
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19
Q

ADH- Thirst System

  1. Water level drops below normal range
    • _____ detects higher concentration of solutes in blood
    • _____ creates feelings of ____ and ____ _____ releases more ____
    • The person _____ water and ____ stimulates kidneys to reabsorb more water
  2. Water level rises above normal range
    • ______ detects low solute concentration
    • ______ releases ___ ADH
    • Kidneys reabsorb ____ water
A
  1. Water loss
    • Hypothalamus
    • hypothalamus - thirst and posterior pituitary - more ADH
    • dirnks, ADH
  2. Water gain
    • hypothalamus
    • Pituitary, less ADH
    • less water reabsorbed
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20
Q

Renin-Angiotensin-Aldosterone System (Na+, K+)

  • _____ is an enzyme that converts _____ to ____, ACE turns ___ to ____
    • ​Renin is called the rate _____ enzyme in the production of ang 2 (indirectly)
    • Then ang II does all __ things
      • ​Adrenal cortex is located on top of the kidneys -> _______*** v important part
  • RAAS system controls (2) and ___
  • There is a normal amount of _____ and _____ in the body, so changes in ___ will cause changes in _____
  • Aldosterone stimulates: sodium _____ and potassium ______
A
  • Renin, antiotensinogen -> ang I, ang 1 t-> ang 2
    • ​limiting
    • 5
      • ​aldosterone
  • Na+, K+, BP
  • Renin, Ang II, BP -> Renin
  • retention, excretion
21
Q

RAAS System Chart

Factors that stimulate Renin secretion (3)

A
  • Decreased BP
  • Decreased Sodium
  • Increased sympathetic tone
22
Q

Cellular Control of Osmolyte Balance (Sodium and Potassium)

  • Na = high concentration in the ______ fluid
  • K = high concentration in the ______ fluid
  • The energy to drive the pump is released by ______ of ____
  • This sodium potassium pump is so important that 50% of our energy is directed towards them
A
  • Na = extracellular
  • K = intracellular
  • hydrolysis of ATP
23
Q

Part 3 Relationship between ECF and ICF

A
24
Q

Distribution of Fluids

  • Intracellular Fluid (ICF) = ~___% of body weight
  • Extracellular Fluid
    • Interstitial Fluid = ___% of body weight
    • Plasma = __% of body weight
  • TBW = ____+____
  • TBW usually ___% of body weight
  • Can vary by (2)
A
  • 40%
  • ECF
    • 15%
    • 5%
  • ECF + ICF
  • 60%
  • body fat %, age

Third space = membrane lined areas, synovial fluid sacs between joints

25
Q

Composition of Extracellular vs. Intracellular Fluid

  • Movement between compartments
    • ____ vs ____ & ____ vs. ____ fluid
A
  • ICF vs. ECF, Plasma vs. Interstitial
  • ​Homeostasis*
  • -Lots of Na, Cl , Ca outside*
    • Lots of K, Mg, proteins, amino acids*
  • Intracellular Ca is strongly controlled which is important*
26
Q

Disrupted Fluid Movement - Intravascular vs. Interstitial - Edema

  • Causes of Edema
    • ​Plasma Oncotic Pressure: ______
      • ​Causes =
    • Interstitial Oncotic Pressure: ______
      • ​Causes =
    • Capillary Blood Pressure: ____
      • ​Causes =
  • ​​_______** Obstruction
A
  • Edema = accumulation of fluid in the interstitial space
    • ​Decreased
      • Losses or diminished albumin
        • Kidneys usually regulate albumin well -> if AKI/injury -> nephrotic syndrome
        • Liver forms albumin (in impaired liver function/starvation -> albumin goes down)
    • Increased
      • increased capillary permeability (occurs with inflammation/injury) or vascular injury
    • Increased
      • HTN
      • Venous obstruction (blockage or volume overload)
27
Q

Capillary Bulk Flow

  • Pressures that determine direction of fluid flow:
    1. Capillary Blood Pressure (“____ pressure”): favors ______
    2. Capillary Oncotic Pressure (“______ pressure”) favors _______
    3. Interstitial Hydrostatic Pressure (“_____ pressure”) favors _______
    4. Interstitial Oncotic Pressure (“_____ pressure”) favors _______
A
  1. pushing, ultrafiltration
  2. pulling, reabsorption
  3. pushing, reabsorption
  4. pulling, ultrafiltration
28
Q

Capillary Bulk Flow Notes

  • Microcirculation: made up (3) is the only place that?
  • 4 passive forces - if you add up all those forces you get a ___ force
  • 2 spaces
    1. ​​Vascular Space
      1. ​Capillary Blood Pressure =
      2. Capillary Oncotic Pressure =
    2. Interstitial Space
      1. ​Interstitial Hydrostatic Pressure =
      2. Interstitial Oncotic Pressure =
  • The only pressure that constantly changes is?
  • Usually theres net _____ bc?
    • ​Bc our immune system lies in the lymphatic system, our ____ is constantly monitored by our immune system
    • All that fluid moving through the lymphatic system eventually drains to the?
A
  • capillaries, arterioles, venules - where fluid can cross
  • net
  • 2 spaces ​
    1. Vascular
      1. pushes against wall of capillary -> ultrafiltration
      2. albumin -> reabsorption
    2. Interstitial
      1. reabsorption
      2. Is normally 0 bc theres not suppose to be any plasma proteins (albumin) in that space unless - if not 0, it normally pulls fluid out -> edema
        1. vascular injury and it leaks out
        2. histamine release enlarges capillaries (intentional escape of albumin
  • Capillary Blood Pressure
  • Ultrafiltration bc our capillaries are always leaking fluid -> so why are we not always edematous? Bc our lymphatic system drains it
    • ECF
    • Vena cava - heart
29
Q

Disrupted Fluid Movement - Intravascular vs. Interstitial

Third Space Accumulation

  • “Third space” refers to the _______ compartment: body cavities lined with serous ______ ex) (3)
  • Third space fluid accumulations (or third spacing) are similar to pitting edema, occurs when there is an imbalance of starling forces (espeically in the case of _____ drainage blockade)
  • Examples of third spacing include (2)
A
  • transcellular, membranes (pericardial sac, peritoneal cavity, pleural cavity)
  • lymphatic
  • ascites, pleural effusions
30
Q

Third Space Accumulation Notes

  • Ascites happens when albumin gets really ____
    • These pts will usually be fluid volume _____ (edema) as well as ___ BP bc fluid is not staying in the vasculature
  • ____ produces albumin
  • Often seen with ____ failure and ____ bc of drop in albumin -> so you this plasma oncotic pressure that gets very low -> fluid leaks into interstitial space
  • Counter pressure from ascites then does what?
  • Ppl who have low albumin will have generalized ____ but bc of concentration of _______ in one space such as the belly -> there are concentrated areas
A
  • LOW
    • ​overloaded, low BP
  • Liver
  • Liver failure, starvation
  • helps the fluid stay in the mesenteric arteries that lines the GI tract = equilibrium
  • edema, capillaries
31
Q

Part 4 ECF Electrolyte Balance

A
32
Q

Alterations in the Movement of fluids between ICF and ECF

Altered _____, _____, and _____ Balance

Types of Alterations (3)

A

​​​Sodium, Chloride, Water

Isotonic, Hypertonic, Hypotonic

  • Sodum and Potassium imbalances most effect - “excitable tissues” aka nervous system and muscular system*
    • Hencesodium alterations effect things like LOC*
  • Potassium alterations effect cardiac function*
33
Q

Isotonic Alterations

  • Change in ___ accompanied by _____ changes in ____ and ____
    • Isotonic volume depletion (2)
    • Isotonic volume excesses (2)
A
  • TBW, proportional, electrolyte and water
    • Hemorrhage, Severe wound drainage
    • Excess IV fluids, Hypersection

Volume change, no change in osmolarity

34
Q

Hypertonic Alterations

  • Osmolarity of ECF is _____
    • Hypernatremia: ______ water intake, inappropriate administration of ______ saline, etc
    • Water deficit: ______ water intake, impaired _____ conservation of water
    • Hyperchloremia: accompanies any excess of _____ or deficit of _____, excess ammonium chloride _____, etc
A
  • elevated
    • inadequate, hypertonic
    • inadequate, renal
    • sodium, bicarbonate, diuretic

Common causes of hypertonicity -> hyperglycemia, hyerchloresterolemia

35
Q

Hypotonic Alterations

  • Osmolarity of ECF is ____ than normal
    • Hyponatremia: D_____, V_____, D_____, B____, Di_____, etc
    • Water excess: ______ urine formation, S _ _ _ _, etc
    • Hypochloremia: accompanies any deficit of ____ or excess of _____, v____ ( loss of HCL), etc
A
  • less
    • Diuretics, Vomiting, Diarrhea, Burns, Dilutional, etc
    • Decreased, SIADH
    • deficit sodium, excess bicarb, vomiting

Diuretics block retention of sodium -> hyponatremia

36
Q

Potassium Balance

  • Maintained Systemically via =
  • Maintained Within the cell via =
  • Several other factors influence serum potassium levels by causing ICF/ECF shifts such as (3) ​​
A
  • Aldoserone mediated renal regulation
  • NA/K ATPase pumps
  • ECF/ICF pH
  • Insulin
  • Catecolamines
37
Q

Potassium Balance

ECF/ICF pH

  • Acidosis = K+ moves ___ the cell
  • Alkalosis = K+ moves ___ the cell
A
  • out
  • in
  • Acidosis = H+ ions into cell pushes K out -> hyperkalemia* (bc H+ is positively charged, it has to kick K+ out to balance net charge)
  • Acidotic states, potassium shifts out of the cell -> hyperkalemia*
  • Alkalotic = H+ ions pushed out of cell -> K+ moves in -> hypokalemia*
  • If you correct the acidosis or alkalosis you correct the hyper/hypokalemia*
  • All exhcnage between cell and blood stream happens at capillaries that allow free movement by diffiusion*
38
Q

Potassium Balance

Insulin

  • Increased insulin = K+ moves _____ cell
A
  • into
  • Potassium is required for glycogen synthesis,when insulin brings glucose into cell*
  • So when insulin binds to its receptor, it will cause the uptake of both potassium and glucose to facilitate glycogen syntehsis*
  • Mild hyperkalemia tx = kaexylate*
  • Severe hyperkalemia tx = insulin + glucose if person has normal sugar*
39
Q

Potassium Balance

Catecolamines

  • B2 adrenergics = K+ moves ____ the cell
  • a2 adrenergics = K+ moves ____ the cell
A
  • into
  • out

Catecolamines (epi, norepi) - they can bind to adrenergic receptors -> can cause potassium movement -> but isn’t strong enough to create serum level changes

40
Q

Factors controlling K metabolism

  • Factors that shift K+ into cells (4)
  • Factors that shift K+ out of cells (5)
A
41
Q

Part 5 ECF pH Balance and Cellular Metabolism

A
42
Q

Acid Base Balance

  • The pH of body fluids greatly affect the structure and function of _____, including ______ systems (pH of arterial blood is about ____-____)
  • The _____ and ______ are the primary regulators of acid-base balance
  • The pH of fluids are maintained through the use of _____ systems. Buffers are ____ acids and bases that can _____ excess ___ or ___ thereby preventing fluctuations in pH
A
  • proteins, enzyme, (7.38-7.42)
  • lungs, kidneys
  • Buffer, weak, absorb, H+ or OH-
  • pH of fluids and body temp change proteins in the body -> start to denature, enzymatic function is disrupted*
  • Buffers can absorb or donate H+ to balance pH of a solutiion - each buffer system has a different range of pH that they work best in - so they work together to handle a wider range of pH changes*
43
Q

Major Buffer Systems ​

(4)

A
  • **Bicarbonate (HCO3-/H2CO3)
  • Hemoglobin (Hb-/HHb)
  • Proteins (Pr/Hpr) (both intracelular and extracellular)
  • Phosphate (HPO4-/H2PO4-)
  • Most important buffer system is Bicarbonate (HCO3- weak base, H2CO3 weak acid), bicarbonate is derived from CO2 - our body takes CO2 (a waste product of metaboiism and puts it to work, which is why we hold onto quite a bit)*
  • Hemoglobin can bind to an extra hydrogen ion*
  • Proteins can be a negatively charged protein or neutral protein that is bound to a hydrogen ion*
  • Phosphate has ability to move back and forth into weak acid and base*
44
Q

Bicarbonate Buffer System

Regulated by ____ Regulated by _______

___ + ____ <—> ______ <—> _____ + _____

  • Respiratory ____ and _____ effects PCO2 and therefore CO2 available for _____ ____ production
    • _____ effect (___ to ____)
  • The kidneys regulate _____ levels of ___ and ___ by controlling HCO3- conservation (______) and H+ secretion (______)
    • _____ effect (___ to ___)
A

Lungs Kidneys

CO2 + H2O <–Ca–> H2CO3 <—> HCO3- + H+

  • rate, depth, carbonic acid
    • Rapid (min - hours)
  • plasma, HCO3- and H+, HCO3- reabsorption, H+ excretion
    • Slow (hours-days)
  • Again bicarbonate is the most important buffer system - and is the only one we activvely manipulate - respiratory and renal system*
  • How does CO2 become a weak acid and base?*
    • In presence of water and enzyme carbonic anhydrase produces carbonic acid (H2CO3)*
    • Carbonic acid then can go back and forth between carbonic acid and bicarbonate and free H+ ion*
  • So if you have alkalosis, the respiratory rate can raise CO2 levels by hypoventilation -> therefore making more H+ ions at the end of that formula*
45
Q

Respiratory vs. Metabolic Acidosis/Alkalosis

  • Causes of Metabolic Acidosis:
    • ​______ Noncarbonic Acids (3) etc
    • Bicarbonate ____ (3) etc
  • Causes of Metabolic Alkalosis
    • ​Excess ____ of Noncarbonic acids (4) etc
    • _____ Bicarbonate intake
A
  • Metabolic Acidosis
    • ​Increased: Ketoacidosis, Uremia (buildup of uric acid), Ingestion
    • Loss: Diarrhea, Renal Failure, Proximal tubule acidosis
  • Metabolic Alkalosis
    • ​Loss: prolonged vomiting, GI suctioning, hyperaldosteronism, diuretic therapy
    • Excess bicarb intake

Respiratory acidosis (hypoventilation), alkalosis (hyperventilation) -> any other cause is a metabolic cause

Resp and Metabolic systems compensate for each other when the other is causing acidosis/alkalosis

46
Q

Acid Base Balance Chart

A
47
Q

Cell Metabolism

  • Cell Metabolism =
    • ​Mono/Polysacharides = short/long chains of ______
  • 3 steps of Metabolism ​
    1. ______ = process by which ____ ( polysaccharides, fructose, lactose) that’s consumed and put through ______ to form ______then
    2. ______
    3. ______ -> oxidative phosphorlyation
  • Each of these steps in metabolism yields ____
A
  • process by which the cells in the body take in energy substrates (food-protein, carb, polysaccharides and fat) we metabolize these foods in order to synthesize ATP (how our body stores energy for future use)
    • ​sugars
  • 3 steps
    1. ​​Glycolysis = glucose -> glycolysis -> intermediates
    2. Krebs cycle
    3. Electron transport
  • ATP
48
Q

Cell Metabolism

  • By far the biggest yield of ATP is in the ____ step = which is the only use your body has for ____ and really only in this last step of metabolism that oxygen is used -> but enough energy to maintain systems to stay ____
  • About 75% of energy of that is yielded gets released in the form of ___
    • ​How our body maintains a _____ body temp (98.6), no matter the outside condition
  • And only 25% is actually harnessed to form ____
  • S the greatest product of metabolism is not ATP, its actually _____.
A
  • last, oxygen, alive
  • heat, stable body temp
  • ATP
  • heat
49
Q

Controll of Cell Transport

  1. ​Passive Transport (needs no energy) ​**​​​​
    • (3)
  2. Active Transport
    • ​​(2)
A
  1. Passive
    • Simple Diffusion
    • Osmosis
    • Facilitated Diffusion
  2. Active
    • Secondary Active Transport (uses movement of ions)
    • Primary Active Transport (used ATP)
  • Another important part of cell function is cell transport - controlling movement of substrates across plasma membrane*
  • Baseline permeability of plasma membraneis the most basic form of control*
    • Bc the primary structural component of the membrane is lipi -> anything lipid soluble is going to easily cross the membrane (anything lipid does not have a charge)*
    • On the other hand, anything that DOES have a charge/polarity cannot freely cross the membrane, needs assistance from a poor or more active mechanism*

Fall 2020 Advanced Patho (15 decks)

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